June 14, 2013
LISTENING TO YOUR HEART HELPS MORAL DECISION-MAKING: BUT IS IT GOOD FOR FEAR AVOIDANCE DECISIONS?
Most of us understand that a polygraph test measures a person's physiological response to determine whether the person is lying or telling the truth. For instance, when someone is lying, the heart rate increases. However, what you may not know is that our physiological responses guide our behavior. What this means is that when most people perceive a fast heart beat they are more
likely to act morally.
When researchers provided false heart rate information to participants indicating a fast heart rate, they found that when heart rate was perceived as faster people were more likely to volunteer for a good cause and were less likely to lie for personal gain. However, people were not as influenced by their heart rate when they more mindfully focused on their decision. This indicates that the physiological response may be an important factor with increasing moral behavior (Zhong and Page-Gould, 2013).
Although trusting this process with moral decision-making may be useful, trusting it completely can lead to problems. For instance, I see the same process occur in my clients with anxiety disorders. They make avoidance decisions based on their physiological
response rather than thinking through the situation. In cognitive therapy, we refer to this irrational thinking style as "emotional
reasoning". For example, the person thinks "My heart is pounding, I feel scared, this must be a dangerous situation so I must avoid
it." Now, for many people those thoughts aren't as obvious as what I just described so it seems like a much more automatic
Much of cognitive therapy when people engage in emotional reasoning is to help them think through the situation:
Client: "I'm afraid of flying."
Therapist: "What are you concerned about when flying?"
Client: "I'm afraid the plane will crash and I will die."
Therapist: "What is the evidence for that?"
Client: "I know that flying is the safest form of travel but I still FEEL scared."
Therapist: "Is that feeling reality or is it just a learned response?"
Client: "I guess it is a learned response."
Therapist: "So what can you do about it?"
Client: "I can tell myself that flying is safe and that my heart pounding doesn't mean anything."
Obviously, actual sessions aren't this simple but it gives you an idea of the process of learning to think through a situation so as to use the brain to determine whether the physiological response is accurate or not. Notice that I said "determine whether the
physiological response is accurate or not." What I mean by this is that we need to listen to our emotions because sometimes they
are accurate indicating something actually is dangerous. However, we need to evaluate the emotions before making decisions. For more info, read : Use Your Head! And Your Heart!
Zhong, C. and Page-Gould, E. (2013). Listen to Your Heart: When False Somatic Feedback Shapes Moral Behavior. Journal of Experimental Psychology: General, 142, 307-312.
June 12, 2013
Passive-Aggressive Example: SISTER'S LACK OF SUPPORT
Question: I've had to work at different locations due to personal conflict with my boss. At the beginning of this saga, I stated to my sister who works for the same company "I'll never work for that boss again." Well, after a year of drama, it looks like I will be going back to that location. I feel like my sister is trying to rub my nose in it. She left a long-winded message on the phone about me returning and told my mother about it. I feel irritated by it. What should I do?
Obviously, we aren't privy to the tone of the sister's comments, but according to the writer's description we can assume the tone is either sarcastic or somewhat gleeful such as "I guess you're going back after all." In that case, this would be an example of back-stabbing passive-aggressive behavior (PA) because when the writer needs her support, the sister uses sensitive information against her.
June 11, 2013
ANOTHER NATURAL CONSEQUENCE EXAMPLE
Many parents are experiencing difficulties with adult children living at home. Although I imagine most adult children are respectful and appreciative of their parents' assistance, some parents report frustration regarding their children not helping around the house. Yet, because they are adults, there are few consequences available short of kicking them out of the house.
In one such case, the parent stated "I just want her to pick up her dishes and put them in the sink." This parent had made the request repeatedly, but to no avail. So we decided on the following strategy.
Again, as in the previous post, the Mother quit saying anything about the dishes. Instead, she calmly gathered them up and put them outside her daughter's bedroom door. Now obviously, this requires more effort on the Mother's part than just doing the dishes herself. However, after a few days, the daughter started taking care of her dishes.
This example is actually what we call a logical consequence rather than a natural consequence as it requires a more creative solution instead of just allowing whatever happens. For example, a natural consequence is allowing the adult child to oversleep and be late for work rather than taking on the responsibility of trying to wake him or her. The natural consequence is whatever occurs for being late to work. The parent is removed from the process.
(My apologies to any adult children living at home who suddenly find dishes in front of their door.)
June 7, 2013
Discusses the difficulty many people with depression experience when trying to engage in cognitive-behavioral therapy (CBT). The effort required seems overwhelming. This article provides some simple suggestions to help get started with CBT.
June 5, 2013
HOW EFFECTIVE IS CBT FOR CHILDREN WITH ANXIETY DISORDERS?
A review of studies conducted in clinics throughout the world showed that children treated for anxiety with cognitive-behavioral therapy (CBT) not only benefited from therapy, but 50% of those who completed therapy were symptom-free. In additon, for those who were not symptom-free at the conclusion of therapy, studies with follow-up data showed that symptoms continued to improve after the completion of treatment. Finally, for the 20% who did not complete therapy, it is not clear whether they quit due to improvement or due to dissatisfaction with treatment (Lee et.al, 2013).
For parents who are concerned about medicating their children, such studies are encouraging. Most children can reduce anxiety symptoms significantly and safely by learning the CBT methods. Parents need to be aware of this information because although cBT has been recommended as the first-line of treatment, most children with anxiety disorders are not referred for CBT. In fact, although CBT is the treatment of choice, most children suffering from anxiety do not receive CBT even when meeting with a therapist claiming to provide CBT (Seligman and Ollendick, 2011)!
How can a parent know if CBT is being provided? CBT teaches skills. It is NOT just talking to a therapist. The therapist should be training the child how to manage different situations by thinking about them differently or by using anxiety reduction methods. Discuss with the therapist the specifics of how the child will be taught to manage anxiety.
Lee, C.M., Horvath, C. and Husley, J. (2013). Does It Work in the Real World? The Effectiveness of Treatments for
Psychological Problems in Children and Adolescents. Professional Psychology: Research and Practice, 44, 81–88.
Seligman, L.D. and Ollendick, T.H. (2011). Cognitive Behavioral Therapy for Anxiety Disorders in Youth.
Child and Adolescent Psychiatric Clinics of North America, 20, 217–238.
June 3, 2013
PROBLEM WITH DEPRESSION AND CBT: IT CAN BE OVERWHELMING
One of the reasons more people don't benefit from cognitive-behavioral therapy (CBT) is that it involves determination and work—two things that can be overwhelming for depressed individuals. A examination of over 30 studies of CBT and depression shows that CBT is effective but in real-world outpatient settings there is a 25% drop-out rate (Gutenberg & Hiller, 2013).
If the drop-out rate is that high with personal encouragement from a therapist, it is likely much higher when someone is attempting to use self-help materials such as the apps by Excel At Life. Such work can be difficult for someone who is seriously depressed and doesn't feel like doing anything including basic self-care activities.
Certainly, it can be overwhelming for even a non-depressed person to make major changes in his/her life. That is why the Android app Depression CBT Self-Help Guide
encourages the users to take small steps. The app contains many different strategies but not for the purpose of doing all of them. By providing many suggestions, the hope is that the depressed individual may find one that can be a starting point.
So, if you are depressed and using the app, don't focus on making too many changes. Instead, focus on something that seems doable. For instance, listen to an audio even if you can't give it full attention. Or, read the positive affirmations even if you don't create one yourself. Eventually you are likely to find that you will be able to do more and obtain more benefit.
Gutenberg, J. and Hiller, W. (2013). Effectiveness of and Dropout From Outpatient Cognitive Behavioral Therapy for Adult Unipolar Depression: A Meta-Analysis of
Nonrandomized Effectiveness Studies Journal of Consulting and Clinical Psychology, 81, 75–88.
June 2, 2013
This audio discusses the concept of probability to help those with Obsessive-Compulsive Disorder (OCD) challenge certain types of obsessions.
Many people with OCD have problems with probability because they want 100% certainty which is an impossible goal to attain.
When you first listen to this audio it may be uncomfortable because it challenges irrational beliefs. However, if it seems relevant to the obsessions you have, it is best to listen to it repeatedly to help change the thinking.
June 1, 2013
DRUG COMPANIES TO PROFIT FROM GRIEF? AN OPINION
A controversial change to psychiatry's new diagnostic manual (DSM-V) now makes grief that lasts beyond 2 weeks a mental illness which allows physicians to label millions more people as mentally ill and prescribe medications to treat grief. Interestingly, almost 70% of the panel developing the diagnostic criteria have ties to the pharmaceutical companies (Cosgrove and Krimsky, 2012) which indicates possible bias.
Why is this a problem? My observations in my clinical practice has been that when the symptoms of grief are medicated, the individual is not able to properly engage in the normal healing process. As a result, the grief is repressed only to return when the medication is discontinued.
Not only that, but the serious side effects of most anti-depressants can reduce quality of life especially when used for a normal condition. Although the pharmaceutical companies may report lower levels of side-effects when using self-report measures which are notoriously inaccurate, when valid and reliable measurements are used the side-effect statistics are often much higher. For instance, the sexual side-effects of the SSRIs are closer to 55% rather than the 2-7% reported in the drug inserts. In addition, the average
weight gain is 15-24 pounds and increased sleep disturbance is common (Ferguson, 2001).
Who does it benefit to label grief as a mental illness? In my opinion, it does not benefit the general public who may be prescribed these powerful drugs that can have serious unwanted side-effects. This is especially true when there are other more effective methods to help people experiencing grief. In addition, with the current move to electronic health records many more people will forever be labeled, and unfortunately, there is still a stigma attached to mental illness.
Cosgrove, L. and Krimsky, S. (2012). A Comparison of DSM-IV and DSM-5 Panel Members' Financial Associations with Industry: A Pernicious Problem Persists. PLoS Med 9(3): e1001190. doi:10.1371/journal.pmed.1001190
Ferguson, J.M. (2001). SSRI Antidepressant Medications: Adverse Effects and Tolerability.The Primary Care Companion to the Journal of Clinical Psychiatry, 3, 22-27.
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?
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
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.
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.
Not a day goes by when I don't throw down the
morning newspaper complaining about the use of
statistics in an article. In our world the media
liberally sprinkles statistics throughout articles
and television programs to support a point of view.
The problem, however, is that statistics are
frequently misleading if not outright inaccurate.
Without a clear understanding of the nature of
statistics and the definitions of statistical terms,
the public believe the statistic-supported
statements as if they are fact. In addition,
without understanding the agenda of the journalist
or analyst using the statistics, the public accepts
these "facts" uncritically.
Frequently, I am asked how to handle irrational
jealous feelings. Usually, the individual
recognizes that her feelings are unreasonable with
no valid evidence but feels incapable of controlling
the jealousy. In addition, the person usually
recognizes the destructive nature of indulging in
the feelings and the resulting behavior. Such
behavior typically involves excessive questioning of
her spouse, suspiciousness, and accusations. Many
spouses become extremely frustrated with this
behavior because they have no way of proving their
faithfulness. This leads to an escalating cycle of
anger which is used as further evidence by the
jealous spouse that her suspicions are correct.The jealous spouse often desperately wants to stop
the behavior but finds that he can't control the
thoughts which makes him feel miserable. He
believes that if he can just prove his suspicions
one way or another, he will feel better. The
unfortunate fallacy in this thinking, is that trust
can never be proven; it can only be disproved. The
definition of trust is the belief
something is true. Therefore, without evidence to
the contrary, if we want a satisfying relationship,
we have to choose
to trust the person we
don't have any willpower."
"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
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.