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Sport Psych

Martial Arts


Happy Habits: 50 Suggestions

The Secret of Happiness: Let It Find You (But Make the Effort)

Promoting Healthy Behavior Change

10 Common Errors in CBT

Why Are People Mean? Don't Take It Personally!

What to Do When Your Jealousy Threatens to Destroy Your Marriage

Rejection Sensitivity, Irrational Jealousy and Impact on Relationships

When You Have Been Betrayed

Crazy-Makers: Passive-Aggressive People

For Women Only: How to Have the Relationship of Your Dreams

What to Do When Your Partner's Jealousy Threatens to Destroy Your Relationship

Making Attributions for a Healthier Attitude

Happiness is An Attitude

Conflict in the Workplace

Motivation: Intrinsic vs. Extrinsic

Thinking Your Way to a Healthy Weight

Lies, Damned Lies, and Statistics

Guide to How to Set Achieveable Goals

Excellence vs. Perfection

Depression is Not Sadness

Feedback, Self-Efficacy and the Development of Motor skills

The Effectiveness of Cognitive-Behavioral Treatment for Anxiety Disorders

Performance Enhancement in the Martial Arts: A Review

Catastrophe? Or Inconvenience?

Kindle Books by Dr. Monica Frank

The Mindful Attitude: Understanding Mindfulness and the Steps to Developing Emotional Tolerance

Crazy-makers and Mean People: Handling Passive-Aggressive People

Stop Panic and Anxiety: 50 Tools

The Cognitive Diary Method to Changing Your Life

Happy Habits: 50 Suggestions


7 Rules and 8 Methods for Responding to Passive-aggressive Peoples

5 Common Microaggressions Against Those With Mental Illness

What to Expect from Mindfulness-based Cognitive-Behavioral Therapy (MCBT) When You Have Depression and Anxiety

Does Cognitive-Behavioral Therapy Lack Compassion? It Depends Upon the Therapist

When Needs Come Into Conflict

When Anger Hurts Those You Love

A Brief Primer On the Biology of Stress and How CBT Can Help

50 Tools for Panic and Anxiety

Coping With Change: Psychological Flexibility

Breaking Up is Hard to Do: Ending a Bad Relationship

I'm Depressed. I'm Overwhelmed. Where Do I Start?

Struggling to Forgive: An Inability to Grieve

Co-Dependency: An Issue of Control

The Pillars of the Self-Concept: Self-Esteem and Self-Efficacy


Mindfulness Training

Riding a Horse Across the Plains

Cityscape Mindfulness

Change Yourself--Don't Wait for the World to Change

The Great Desert Mindfulness

Tropical Garden Mindfulness

Thinking Your Way to a Healthy Weight

Lies You Were Told

Probability and OCD

Choosing Happiness

Magic Bubbles for Children

Lotus Flower Relaxation

Cloud Castles for Children

Hot Air Balloon Motivation

Day of Fishing Mindfulness

Audio Version of Article: Struggling to Forgive: An Inability to Grieve

Audio Version of Article: Crazy-Makers: Passive-Aggressive People

Audio Version of Article: Why Are People Mean? Don't Take It Personally!

Audio Version of Article: Happiness Is An Attitude

All Audio Articles


by Monica A. Frank, Ph.D.
Clinical and Sport Psychologist


July 1, 2015

Secure Attachment to Parents Improves College Adjustment

A teenager's ability to adjust to college may begin in early childhood and is moderately influenced by the relationship with the parent. An analysis of over 150 research studies shows that college students who have a secure attachment style with parents have a greater level of adjustment to being away at college (Mattanah, et al., 2011).

Secure attachment refers to the ability to trust that caregivers are available to them and they can depend upon them when needed. Keep in mind, however, that dependency of children is often confused with attachment. Dependency refers to an excessive need for parental involvement and is considered insecure attachment due to the unhealthy nature of the relationship.

college student Developmental theory indicates two points in life where children work on the issue of separation for the parents. The first point is around age two and the other is the late teens when children are leaving home for college. The success of separation during the college years is often dependent upon what children have learned previously in the earlier stage of development.

At age two children are beginning to explore the world. However, their success is based upon secure attachment to the parent. If the child has learned that the parent is emotionally and physically available, they use the parent as a home base. For example, if a child is placed in a room full of toys with the parent sitting in a corner of that room, the child with a secure attachment will explore the room but will keep an eye on the parent and occasionally return to the parent. A child with insecure attachment may instead fearfully cling to the parent.

Some of the causes of insecure attachment include physical or emotional neglect, inconsistency of primary caregivers (numerous babysitters), separation from primary caregiver, or traumatic experiences.

The college student with a secure attachment is able be independent while knowing the parent is available, if needed. Such a college student is less likely to be involved in destructive activities while away, is more likely to be engaged socially, and is able to maintain good study habits and grades.

Mattanah, J.F., Lopez, F.G., Govern, J.M. (2011). The Contributions of Parental Attachment Bonds to College Student Development and Adjustment: A Meta-Analytic Review. Journal of Counseling Psychology, 58, 565–596. DOI: 10.1037/a0024635

June 21, 2015

Is Your Boss Unfair? What You Can Do About It

Frequently, when employees learn to act assertively they are rewarded. I've had numerous clients who swore to me they would be fired if they approached their boss assertively. Instead, when I finally convinced them to act assertively and they learned the techniques of assertion, they were promoted or received other positive responses.

Research has found that the likelihood of a manager treating an employee fairly is based upon the expectation the manager has of how the employee will react. Generally, the more assertive the employee, the more likely the manager will treat the employee fairly (Korsgaard et al., 1998).

However, before confronting your boss be sure to learn the proper techniques of assertion. Assertive behavior is not merely stating your opinion or request directly. It is also about knowing your audience and learning to identify your goal, attend to tone of voice and nonverbal behavior such as eye contact and expressions, and choosing your words carefully. Practicing these techniques will make you more effective in getting your needs met in the workplace.

Korsgaard, M.A., Roberson, L. and Rymph, R.D. (1998). What Motivates Fairness? The Role of Subordinate Assertive Behavior. Journal of Applied Psychology, 83, 731-744.

June 18, 2015

Toxic Parents: Mean or Emotionally Distressed?

People are often confused by toxic parents who are also very loving and will do anything for their children. Such a duality is often due to emotional problems that are acted out in a toxic manner to the children. For example, a controlling OCD parent who is anxious about germs and spends hours a day cleaning may believe they are protecting their children. However, when the child breaks a rule such as coming into the house without showering the parent becomes angry and berates the child.

Sometimes the parents have self-esteem issues that cause them to want to be the perfect parent or social anxiety which causes them to be concerned about how they appear to others. Either of these is often reflected through attempts to have perfect children. The result, however, since children are not perfect is for these parents to be critical and demanding of the children. This can sometimes cause the opposite effect that they desire and the child may have behavioral problems or it may exacerbate the child's anxiety and cause the child to be more people-pleasing and passive.

In all these examples the parent might otherwise be loving and involved in healthy ways with the children. The confusion experienced by the children of such parents usually indicates the parent is not a mean person but that the behavior is due to these types of emotional problems. The parent feels the stress of the self-inflicted demands which is transferred to the children.

No matter the reason, however, it is still toxic behavior and can be quite disturbing for the child. Many of my clients with anxiety disorders recognize this and go to extreme lengths to not allow their anxiety to affect their children (or sometimes even be observed by the children). Usually the people who engage in these toxic behaviors aren't aware of their behavior and are unlikely to be receiving therapy.

The good thing about this type of toxic parent, at least for adult children, is they are often responsive to assertive limit setting. Because they don't want to be rejected which will cause them to appear to be bad parents to themselves and others, letting them know their behavior is unacceptable and that you might be forced to reject them sometimes changes the behavior. For example, “If you continue to criticize me, I will end the visit” said at the time of the behavior can make them more aware of their behavior and attempt to control it.

Therefore, before continuing to endure such behavior or ending all contact with a parent it may be beneficial to determine if the toxic behavior is due to these types of emotional problems. If so, it may be worthwhile to set limits with the parent. This does not mean saying something one time because most of us are not one-time learners especially when it comes to changing our behavior. Instead, it means saying something every time and following through on the consequence (such as ending the visit). After a few consequences, these types of parents are likely to realize you are serious and change their behavior. If they don't, there may be nothing you can do but protect yourself from the toxicity in anyway you can.

June 17, 2015

Cognitive Diary Training Example: Toxic Family and Holiday Visits

EVENT: Don't Want to Visit Family on Father's Day

EMOTIONS: anxious, discouraged, hopeless

DISTRESS RATING: 8--High level of distress

THOUGHTS: “My family is always mean to me. I can't stand going to family events. They put me down and ignore my children. They're probably right about me. I am a loser. My friend says I don't need to go and put up with such treatment. But if I don't go, it will make things even worse. They will talk about me and my parents will be angry with me. They are my family. I should love and respect them. I should go to keep the peace. It's only one day. I'll just take extra medication and I'll get through it.”

CAN YOU IDENTIFY THE IRRATIONAL THINKING IN THIS EXAMPLE? There are at least 4 irrational beliefs.

HOW CAN YOU CHANGE THE THINKING? What is another way of thinking about the situation that won't cause the feelings of anxiety, discouragement, and hopelessness?


June 13, 2015

“I'm Old, Not Stupid!” Patronizing Speech and the Elderly

In recent years my husband, a senior citizen who uses a cane, complains how restaurant staff talk to him. At first I thought he was being overly sensitive and would tell him that's just how they talk. However, one particular time it was noticeable even to me. The server used a high pitched patronizing voice when she talked to him and when she turned to me (I'm much younger than him) she used a normal tone. Then she turned to him and changed voices again. I could barely restrain myself from bursting out in laughter because it was so comically obvious.

Apparently, this is a significant problem for older adults (as well as those with mental illness) especially when hospitalized or in a nursing home. My husband, being a very assertive person, will ask the wait staff to speak to him in a normal tone, but usually, they don't even recognize what they are doing. As a result, he comes across as a cantankerous old man.

Patronizing speech includes high pitched tone of voice, slower and/or louder speech, simplified vocabulary and grammar, repetition, overly personal, praise for minor accomplishments, terms of endearment, and third person reference (“What do WE want?”). It has been found to be demoralizing and leads to withdrawal, lowered self-esteem, and feeling loss of control. Such speech has not been shown to have an effective purpose.

A research study by Ryan and colleagues (2000) examined the dynamic of patronizing speech by nursing home staff and predictably found that residents rated patronizing nurses more negatively although they had also come to expect and tolerate such treatment. However, this research further examined residents responses to patronizing speech and found residents who were more assertive were viewed as less competent. However, when they used humor as a response they were rated more favorably and still appeared assertive.

These results show that how an older adult responds to patronizing speech can impact the overall quality of the interactions with the staff. It is unfortunate, however, that those who are most vulnerable must alter their approach rather than the staff refraining from being patronizing.

Ryan, E.B., Kennaley, D.E., Pratt, M.W. and Shumovich, M.A. (2000). Evaluations by Staff, Residents, and Community Seniors of Patronizing Speech in the Nursing Home: Impact of Passive, Assertive, or Humorous Responses. Psychology and Aging, 15, 272-285. DOI: 10.1037//0882-7974.15.2.272

June 8, 2015

“Which Coping Strategy Should I Use?”

Sometimes when people visit Excel At Life's website they are overwhelmed with the variety of coping techniques and are unsure where to start. “Should I use an audio?” “Which audio is best for me?” “Or, should I use the cognitive diary?” “Which kind of cognitive diary should I use?” “Or, should I use a reward system?” “Should I take a tai chi class?” They want a step-by-step manual to tell them what to do.

Unfortunately, such a manual is impractical because different people may be responsive to different methods. And different situations may be handled best by different methods. My experience has been that clients will tend to find the methods that work best for them and rely on those. However, coping flexibility, the ability to use a variety of strategies, appears to be most related to psychological health when coping with stress.

Researchers Cheng and colleagues (2014) examined 90 studies looking at coping flexibility and found the most beneficial approach was fitting the coping strategy to the situation and engaging in an ongoing process to evaluate and adjust the strategies as necessary. What this means is that different situations may respond better to different coping strategies. And it depends upon the individual, their personality and skill level for the technique.

This approach is similar to what a cognitive-behavioral therapist does. When a client tells me “that didn't work” we evaluate the strategy, why it didn't work, and make adjustments or try a different strategy. What this means for you is to develop a wide variety of skills and experiment with using them for different types of stressful situations.

Tips for Using Coping Strategies

1) Learn many strategies. Those who cope well with stress have developed a wide variety of skills. Choose skills that appeal to you. Certain skills will be more effective depending upon the personality of the individual. For instance, I find that most people respond well to the relaxation imagery audios but some people need more active relaxation methods such as qi gong.

2) Try anything. If unsure which method to use, try anything. Be sure to make a reasonable effort with using the skill. If it doesn't work you can try something else.

3) Evaluate. If your first efforts aren't successful, evaluate the strategy. Were your skills strong enough? Do you need to practice more first? Would a different strategy be more effective with the situation?

4) Flexibility. As you evaluate skills over time, you will find particular methods that work for different purposes. You will also find that you are more skilled with certain techniques. However, even if you rely on certain strategies, continue to develop your abilities with other methods. Having multiple coping strategies and being flexible in choosing strategies will allow for greater success in coping with stress, anxiety, and depression.

Cheng, C., Lau, H.B., and Chen, M.S. (2014). Coping Flexibility and Psychological Adjustment to Stressful Life Changes: A Meta-Analytic Review. Psychological Bulletin,140, 1582–1607. DOI: 10.1037/a0037913

June 4, 2015

Listening to the Message of Anxiety

Recently, an acquaintance described feeling anxious and stated she needed to get some anxiety medication from her doctor. She said, "My family treats me so bad whenever I visit them that when I even think of visiting I get heart palpitations. My husband hates seeing them, too, and its affecting my marriage."

Mr. Zip This example illustrates not listening to anxiety. Normal anxiety has a purpose. The intention of anxiety is to inform us of a problem that needs to be resolved. However, sometimes people don't want to address a problem because it might be uncomfortable. In this situation, simply telling her family "It is unacceptable for you to talk to me this way and if you continue I will leave" places the responsibility for the problem on them. Sure, such a stance may be unpleasant initially especially when she has to follow through with the consequence and walk out. For this woman, she did not want to give her family reason to treat her worse. Even though it may be uncomfortable standing up to such people, by resolving the problem she doesn't have to take medication for the anxiety nor put her husband in a situation that creates problems in her marriage. Eventually, if she consistently gives her family this message they may begin to treat her better. And if they don't, she can give them another message: "I don't want to be around you because I don't like how you treat me."

However, when the problem isn't solved such situations can even be the beginning of developing an anxiety disorder. I have seen many clients over the years who have described their first panic attack as being related to a distressing situation they believed they couldn't control or resolve. Later, however, their anxiety became focused on the panic itself creating the panic cycle. In such situations I've always found it interesting that the panic attacks often solve the original problem in a roundabout manner: "I have a panic attack every time I try to drive long distances--I haven't been able to visit my family in years." In this way the panic is blamed rather than solving the problem in more direct ways: "I really want to come for a visit but I'm having uncontrollable panic attacks."

We may not always like the message anxiety is attempting to deliver. However, listening to the message and resolving the problem can prevent worsening of the anxiety. If the message is ignored, anxiety only becomes more insistent about delivering it. Once the message has been addressed, the anxiety has completed its job until another problem arises.

June 1, 2015

The Costs of “Get Over It”

Frequently, when distressed, people receive the message from others to just “get over it.” In other words, they are being told to ignore the distress, let go, and move on. Even though this message may be valid when considered in a long-term context, it can be harmful as a strategy for dealing with problems. People who are more emotionally sensitive will especially be harmed by this message by concluding that they need to suppress their emotions.

Many times people give advice from the advantageous perspective of the final outcome of their own experience. They tend to forget the process they went through to obtain that outcome. Therefore, advice to “let go” or “get over it” often ignores the messy process of feeling the distress, grieving, and the emotional expression/release prior to the outcome of resolving the distress.

Those who hear this advice as “ignore your emotions” are likely to experience negative consequences. Repression is a style of coping in which people ignore their emotions. However, even when reporting a lack of emotions, those who are repressing emotions show an even greater physiological reaction (heart rate, perspiration, etc.) than those who experience emotions. Thus, they are only suppressing awareness and expression of the emotion, not the physical sensation of the emotion itself.

Therefore, when the emotion is not fully expressed, negative health outcomes are more likely due to the stress on the body of trying to control the emotion. Researchers Mund and Mitte (2012) analyzed 22 studies examining repression and physical health. They found that those who repress emotion are more likely to have cardiovascular disease or hypertension.

Yet, even though it may be unhealthy to hold emotions in, this research should not be taken to mean that excessive emotional expression is healthy. As in most things, balance is important. We need to be able to release emotions appropriately, but not dwell on emotions excessively.

Mund, M. and Mitte, K. (2012). The Costs of Repression: A Meta-Analysis on the Relation Between Repressive Coping and Somatic Diseases. Health Psychology, 31, 640–649. DOI: 10.1037/a0026257

May 26, 2015

A Good Night's Sleep Doesn't Overcome the Stress of Controlling Parents

Studying how the quality of sleep affects the intellectual performance o f teenagers when stressed by harsh and/or controlling parents, researchers El-Sheikh and colleagues (2014) found that quality sleep did not overcome the stress of negative parenting styles. Not surprisingly, those adolescents who performed best were those with more positive parenting and better quality sleep.

When confronted with general daily stress, quality sleep can be an important coping tool that reduces the negative consequences of stress. Teenagers who have a poor quality sleep do not function as well intellectually even with positive parenting. However, when teenagers are confronted with the daily and extreme conditions of negative parenting, even a good night's sleep does not help their intellectual functioning.

Specifically, controlling parents who most likely want to improve successful outcomes in their children are achieving the opposite instead. The control reduces intellectual performance and increases the likelihood of academic failure.

Of course, this does not mean to be completely permissive and allow teenagers full reign. Generally, setting limits and consequences is a necessary and effective means of parenting. However, it should not be done in an aggressive or overly controlling manner. In other words, as children mature it is psychologically healthy for them to begin to make more decisions that directly affect their lives. Yet, the parents need to provide guidance.

El-Sheikh, M., Tu, K.M., Erath, S.A. and Buckhalt, J.A. (2014). Family Stress and Adolescents’ Cognitive Functioning: Sleep as a Protective Factor, 28, 887–896. DOI: 10.1037/fam0000031

May 20, 2015

Do We Really WANT to Educate Our Children?

An interesting video about changing the paradigm of our educational system caused me to think about whether we really want to educate our children. “Of course we do!” I can imagine everyone responding. And I certainly believe that people want their children to obtain a college degree so they can get a job, but do we, as a society, really want to EDUCATE our children? Why is it that some of the most successful people today are college drop-outs (Bill Gates, Steve Jobs, Mark Zuckerberg)?

Why is it that we know so much more about how people learn and yet we continue to teach children in archaic ways? Do we need to medicate our children so they fit this educational system or should we fit the system to the children? As the video indicates, why are children divided into classes according to age, for instance? Does that make sense? Shouldn't they be divided according to level of knowledge or ability in a particular subject? Why should they proceed at the same rate? Doesn't this lead to boredom both for those who are capable of learning more quickly as well as those who are confused and left behind? We wouldn't need enrichment programs or special needs programs if the system was designed to meet the needs of each child. Instead, our answer has been to medicate and single out children who don't fit the system.

education symbol We have the knowledge and the ability to educate children in more effective ways. For instance, I went to a high school that allowed us to proceed at our own pace. We received learning packets with our assignments and when we had completed them we took a test to indicate whether we were ready for the next packet. Our teachers were primarily engaged individually or in small groups with students. Everyone learned. And our education wasn't just in class but in the community. Graduating from my high school meant that a student had actually been educated to think and to be involved in the community.

When I ask if we want to educate our children, I mean that true education comes with risks. First, it requires more effort from the system, the teachers, the parents, and the students. The status quo is always easier than change. Second, true education requires evaluating the student, not the system, so that the student's needs can be met, not so the school gets funding. Finally, an educated society means one that thinks, one that evaluates. Being educated doesn't mean graduating from college, it means the ability to think and evaluate information effectively. An educated society does not easily accept what it is spoon-fed. Instead, it questions and evaluates the answers.

Some people might argue the cost of an educational system focused on the needs of each student would be prohibitive. However, the per student cost of a public high school education paid by the taxpayers in my state is actually more than the tuition currently charged by the high school I attended. The problem is not the cost of such an education but the shift in thinking required by everyone involved in the educational system (administrators, teachers, parents, students, taxpayers). A shift in thinking is change and people are uncomfortable with change.

May 14, 2015

Empathy Requires a Strong Sense of Self

Empathy is the ability to understand another person's emotional state and to feel for that person. When we empathize with another person (or with groups of people) we are more likely to be responsive to their need.

However, being responsive doesn't always mean taking care of their need—it means to respond in a way that is meant to be helpful. For instance, psychologists are very empathetic as a group. However, if we do our job correctly, we typically create discomfort in our clients. We may confront them about behavior they want to ignore. Or we may encourage them to do something they are afraid of and want to avoid. Or, we bring up subjects that cause them to cry. In fact, a maxim in our profession is “You will feel worse before you feel better.” Our empathy for other people and knowing that the way to emotional health is uncomfortable allows us to do what is best for our clients even though it may not feel good (for them or for us).

Many people believe empathy and selflessness go hand in hand. Yet, sometimes selflessness can be quite selfish. Often, when people tell me, “I don't want to confront (someone) because I don't want to hurt her (his) feelings” what they really mean is “I don't want to feel uncomfortable myself.” Although their statement about not wanting to hurt feelings appears to be empathetic, in reality, they are protecting themselves from discomfort which is why it may be selfish. In such a case, confronting someone about their behavior may be more selfless, empathetic, and ultimately helpful than staying quiet.

Even neuropsychologists studying the activity of the brain expected that empathy would be associated with selflessness shown by decreased right parietal lobe (RPL) activity of the brain. People who have damage to that area of the brain are less focused on the self and tend to be more selfless. However, these researchers found the opposite to be true which is that a stronger sense self shown by increased RPL was associated with empathy (Johnstone et al., 2014).

Such an outcome makes sense when considering that helping others may require doing things they may not like. Saying “no” to someone when you are empathetic to their need is harder and more uncomfortable than complying with their request. “No, I will not do this for you but I will show you how to do it.” “No, I will not pretend everything is okay when it is not.” “No, you cannot have everything you want.” Caring deeply for others and doing what is best for them especially when it may not be what they want requires a strong sense of self.

Johnstone, B., Cohen, D., Bryant, K. R., Glass, B., & Christ, S. E. (2014, November 17). Functional and Structural Indices of Empathy: Evidence for Self-Orientation as a Neuropsychological Foundation of Empathy. Neuropsychology. Advance online publication. DOI: 10.1037/neu0000155

May 10, 2015

Mom: Let Go of the Guilt

Many mothers feel guilty about working outside of the home and fear their children will be negatively impacted. The debate about the effect on children has raged for some time. However, the results are in and mothers employed outside the home need to let go of the guilt.

Analysis of more than four decades of research and nearly 70 studies examining the effects on children of mothers working outside of the home show very little effect (Goldberg, et al., 2008). Not only does a working mother not impact achievement overall in children, but some positive, yet small, effects appear for girls, 1-parent families, and some ethnic groups.

Although long believed by people that mothers employed outside of the home will negatively impact young children, no effect was shown for this age group. A small negative effect was shown for middle to high school age children possibly related to less supervision. Part-time employment appeared to effect achievement in children more positively than full-time employment but neither compared negatively to mothers in the home.

Goldberg, W. A., Prause, J. and Lucas-Thompson, R. (2008). Maternal Employment and Children’s Achievement in Context: A Meta-Analysis of Four Decades of Research. Psychological Bulletin, 134, 77–108. DOI: 10.1037/0033-2909.134.1.77

May 8, 2015

“I've Been There” Doesn't Always Mean “I Support You”

How often do you reach out for support during a difficult time only to find that people respond with criticism? Have you noticed that sometimes it is those who have successfully managed the same problem who are most critical of your struggle or failure?

If you have experienced this, it is not about you! Researchers Ruttan and colleagues (2015) have shown that when people have overcome a similar struggle they may be less compassionate for others' distress and failure. “You just have to pull yourself up by your bootstraps and do what I did.”

Perhaps this may be due to the tendency for people to not remember painful events as well as successful outcomes. If that is the case, reminding them of the struggle itself may trigger more compassion, “But what was it like when you were going through it? Were you overwhelmed and distressed at times? Did it seem insurmountable? Were you afraid you might fail?”

Ruttan, R.L., McDonnell, M. and Nordgren, L.F. (2015). Having “Been There” Doesn’t Mean I Care: When Prior Experience Reduces Compassion for Emotional Distress. Journal of Personality and Social Psychology, 108, 610–622. DOI:10.1037/pspi0000012

May 5, 2015

Antidepressants Do Little for Mild to Moderate Depression

Examining six studies used for Food and Drug Administration (FDA) approval, researcher Fournier and colleagues (2010) compared the efficacy of antidepressants based on the severity of the depression and found that little benefit over placebo occurred for those with mild to moderate symptoms. However, for those with severe depression the benefit was substantial. Unfortunately, to muddy the picture, when pharmaceutical companies obtain approval through the FDA they combine the data for mild to severe depression, and thus, it appears that antidepressants are helpful for any degree of depression.

Interesting. Major Depressive Disorder (the typical diagnosis for moderate to severe depression) affects less than 7% of the U.S. Population and only about 1/3 of those with severe depression are prescribed antidepressants. It is difficult to obtain actual statistics regarding how many people with mild to moderate depression take antidepressants. However, the director of the National Institute of Mental Health, Thomas Insel, M.D. states “The persistence of [such] high morbidity and mortality in the face of widespread use of antidepressants suggests either that the medications are ineffective, or they are not being used by those who need them the most. Indeed, there are data suggesting both underuse and overuse of psychiatric medications (http://www.nimh.nih.gov/about/director/2011/antidepressants-a-complicated-picture.shtml).” In addition, he indicates that over 80% of antidepressant prescriptions are written by primary care physicians and many without an associated psychiatric diagnosis.

Why should you be concerned? If you have mild to moderate depression, you need to consider that antidepressants come not only with significant potential side effects (weight gain, loss of sexual desire, fatigue, sleep disturbance, constipation) but also the development of a reliance upon the medication so that it becomes difficult to discontinue medication without a return of depressive symptoms as well as unpleasant withdrawal effects. Do you want to take such a medication when it has little benefit for you? Note: If you are already on antidepressants, do NOT discontinue the medication without your doctor's guidance (due to the serious withdrawal effects).

Why does it seem that many people with mild to moderate depression swear to the benefit they receive from antidepressants? Because they are experiencing a strong placebo effect. A placebo effect occurs due to the belief that medication is effective and that belief causes a reduction or elimination in symptoms even when a person is taking a sugar pill (placebo) thinking it is the actual medication. Interestingly, according to Dr. Insel, the placebo effect has become even stronger in the last two decades but they don't know why. I would posit that the reason the placebo effect has grown stronger is due to the marketing of the antidepressants by the pharmaceutical companies which has caused an associated increase in people's belief in the effectiveness of medication. Therefore, almost all of the effect that those with mild to moderate depression are attributing to antidepressants is actually a placebo effect (Fournier, et al., 2010).

What is the alternative? For people with mild to moderate depression, learning some skills and making lifestyle changes as taught by cognitive-behavioral therapy (CBT) can be much more effective than medication without the side effects.

Fournier, J.C., DeRubeis, R.J., Hollon, S.D., Dimidjian, S., Amsterdam, J.D., Shelton, R.C. and Fawcett, J. (2010). Antidepressant Drug Effects and Depression Severity: A Patient-level Meta-analysis. JAMA: Journal of the American Medical Association, 303, 47-53. DOI: 10.1001/jama.2009.1943

May 4, 2015

Mindfulness and Managing Chronic Pain

Mindfulness methods prove to be even more effective in managing chronic pain than cognitive therapy which has previously been shown to aid those with persistent pain. The mechanism of mindfulness that reduces the perception of pain appears to be the refocusing of attention away from the emotional thoughts related to the pain as well as developing a tolerance for discomfort (Davis, et al., 2015).

clouds For instance, mindfulness teaches the individual to focus away from thoughts such as “I can't handle this!” to the present situation or task at hand. Whereas cognitive therapy teaches a person to change the thought such as “I am learning skills to help me handle this.”

Although mindfulness may be a bit more effective than cognitive therapy, many mindfulness programs teach how to use mindfulness in combination with cognitive therapy. For instance, Excel At Life's audios (free to download) teach the steps to learn mindfulness which includes a step on incorporating cognitive reappraisal with the mindful refocusing.

Davis, M.C., Zautra, A.J., Wolf, L.D., Tennen, H., Yeung, E.W. (2015). Mindfulness and Cognitive–Behavioral Interventions for Chronic Pain: Differential Effects on Daily Pain Reactivity and Stress. Journal of Consulting and Clinical Psychology, 83, 24–35. DOI: 10.1037/a0038200

May 1, 2015

How We Might Stop Bullying: Kindness Curriculum for Preschoolers

When young children are specifically taught mindfulness and kindness, numerous benefits occur. A twelve-week mindfulness-based program with 24 lessons covering eight themes showed increased social competence and more sharing among preschoolers. Those with greater initial deficits had even more significant changes. Three months after the training, the children in the mindfulness group were rated higher in learning, social-emotional development, and overall health (Flook et al., 2015).

kindness Many of the incidents of school or workplace violence have been perpetrated by those who were bullied and marginalized early in life. If we are able to stop bullying and increase kindness in early childhood, we may be able to reduce violence later in life.

The following themes were taught to the pre-schoolers using mindfulness training:

Theme One: Mindful Bodies and Planting Seeds of Kindness

Theme Two: I Feel Emotions on the Inside

Theme Three: How I Feel on the Inside Shows on the Outside

Theme Four: Taking Care of Strong Emotions on the Inside and Outside

Theme Five: Calming and Working Out Problems

Theme Six: Gratitude

Theme Seven: All People Depend Upon Each Other and the Earth

Theme Eight: Gratitude and Caring for Our World and Wrap Up

Flook, L., Goldberg, S.B., Pinger, L. and Davidson, R.J. (2015). Promoting Prosocial Behavior and Self-Regulatory Skills in Preschool Children Through a Mindfulness-Based Kindness Curriculum. Developmental Psychology, 51, 44–51. DOI: 10.1037/a0038256

Excellence vs Perfection Some people may be curious as to why this website is dedicated to the "pursuit of excellence" when I am constantly warning about the dangers of perfectionism.  To address this question we must differentiate between the pursuit of excellence and the need to be perfect.  These concepts are not only different but can be considered antagonistic to one another. In fact these concepts are so opposed to one another that  excellence can best be attained by giving up the demands of perfection.

What is Perfectionism?  Perfectionism is the individual's belief that he or she must be perfect to be acceptable. Perfectionism is black and white with no gray area. Anything other than perfect is failure. Perfectionism is an attitude, not necessarily a behavior. In other words, two people can engage in the same behavior such as trying to win an Olympic gold medal but one can be pursuing excellence and the other is demanding perfection. The difference lies in the thought process about the goal or behavior, not in the goal or behavior itself.  READ MORE...

Catastrophe? Or Inconvenience? Listening to the weather forecast one frigid day, I realized how much we are influenced by the catastrophic thinking of the media.  The weatherman reported, "The weather has brought more misery to the St. Louis area."  Certainly, the weather was causing problems that day.  An ice storm caused car doors and locks to be frozen so that people had a great deal of trouble getting into their cars.  However, I thought, unless someone was in the middle of nowhere with no cell phone and they were unable to open their car door because of the ice, this was not "misery."  Instead, I would call it an "inconvenience."  Most of us walked out to our cars to find that we couldn't open the door, went back inside a warm house or office, and found some solution to our problem.  READ MORE...

Happiness is an Attitude For many years when my husband and I were first together I would ask him "When are things going to get better?"  We were dealing with the usual stressors that couples face: not enough time, not enough money, and the inevitable random events such as family conflict, deaths of loved ones, illnesses and injuries.  In addition, for most of our early years together I was in school and struggling with the balancing of demands of advanced education, part-time work, and a family.  But I had the belief that we were working towards this perfect life that one day would emerge shining a rainbow of happiness forever over us. My husband, inclined more toward the practical, just answered my question of "When are things going to get better?," with "Another six months."  That answer typically pacified me for awhile because I thought I could handle any amount of stress for six months.  However, a point would occur when I once again I asked my husband "When are things going to get better?"  Once again, he would answer "Another six months."  This scenario occurred fairly routinely for many years.

However, fortunately during this time I had experiences that began to teach me about my expectations of life.  In particular, when I was completing my internship at the Veterans Administration Medical Center I had the opportunity to work on the spinal cord injury unit.  That experience forever changed my thinking.  In particular, I was struck by the differences in attitude among the patients.  READ MORE...

Thinking Your Way to a Healthy Weight"I don't have any willpower."

"I'm weak."

"I'm lazy."

"I can't do it."

Do these statements sound familiar? Too often, our self-statements about weight management interfere with our efforts and lead to failure. By changing how we think about developing a healthy weight we are able to change the behaviors that can lead to success.

Not long ago I conducted a little experiment with my cardio-kickboxing class. After an intense class I told them to get the heaviest weights they could curl 8-10 times. I spent a minute telling them to focus on feeling tired, that they had just worked out hard and they couldn't do anymore. Then, they were to curl the weights to exhaustion. Once they finished, I spent another minute telling them to focus on having energy, feeling good, feeling refreshed, and knowing they could do more. Once again, they lifted the weights to exhaustion. The results were that out of nine people, only one did fewer lifts the second time! And typically, when someone lifts weights to exhaustion they should not be able to lift as much the second time when it is only a minute later. Although this was not a controlled scientific experiment, it was a demonstration to my class to show how powerful our thinking can be. What this exercise showed was how positive thinking overcame the natural exhaustion of the body and created a self-fulfilling prophecy of lifting more weight because the participants believed that they could. READ MORE...