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Friday, December 23, 2005

The Problem with New Years Resolutions

This is the time of year that people often decide upon New Years resolutions. While there is nothing wrong with making a resolution, my clients often tell me that they often don't follow through with them. What are some things that you can do to make changes in your behavior and make them stick?

First of all, while New Years Day may be a convenient time to decide to make behavior changes, realize that there is nothing magical about it. Treating New Years Day as some kind of magical point in time could make you discouraged and wanting to quit altogether if you relapse. If your behavior change relapses to your old behaviors on January 26, then January 27 is just as good to begin all over again. There is nothing magical about January 1.

Similarly, don't let setbacks ruin your determination. Setbacks are normal. Relapses happen. It's only human. Sometimes a relapse makes people feel hopeless and helpless. While some people can stop drinking or smoking or some other bad habit all at once and forever, that is not the most typical pattern of change.

Thirdly, make a list of all the reasons why you really want to change. What are all the advantages of changing and all the disadvantages of not changing?

Fourth, if there are circumstances which act as trigger events for you negative behavior, remove them. For example, if you are trying to diet, and you are snacking too much, remove the snacks from view. In fact, remove them from the house altogether. If you are trying to stop smoking, remove not only cigarettes, but also the lighters, ashtrays and anything which would remind you of smoking.

Fifth, create a setting which encourages healthy behavior. Again, using the dieting example, tempt yourself with healthy foods. If you are reaching for healthy foods, then you are not reaching for unhealthy foods. If you are satisfied with healthy foods, then you will not crave unhealthy foods as much.

Sixth, reinforce yourself for behavior change. Treat yourself to something positive in a healthy way as a reward for positive behavior change.

Seventh, watch out for negative thinking and don't allow negative thoughts to undermine your behavior change. Some typical sabotaging thoughts might be, "I can't do this," "I don't deserve to have things go well in my life," and "one relapse means that I have failed altogether."

Eighth, take it one step at a time. Work from one success to another. Don't make it into an all or nothing proposition ("Either I lose a hundred pounds or I haven't lost anything.")

Ninth, focus on the process of healthy behavior and not simply eliminating negative behavior. For example, instead of thinking that one will NOT eat, focus on eating in a healthy manner. Every meal that you eat that is healthy is a success. This is a different way of thinking from focusing on what you are not going to do. Eat healthy three meals a day, and you are having three successes a day. One failure is only one failure among many successes. Life itself is a process. The process can be healthy or not. It can be positive or not. Don't just focus on the end goal. Also focus on daily process of living your life in a healthy way.

Tenth, realize that when you decrease a negative behavior, you are essentially creating a type of vacuum. There is a saying that "Nature abhors a vacuum." That is, a vacuum tends to suck things into it. If a person has been smoking, they have been lighting up, smoking cigarettes, emptying ashtrays, going to the store for more cigarettes, and so on. These are behaviors that fill time. If they give up smoking, there is now extra time, and there is a vacuum of sorts. They need to fill the time with something positive and constructive or the extra time on their hands will "suck" the old behaviors right back. If a child is writing on a wall with crayon, you can punish them and they will stop. But if you don't give them constructive alternatives, they may go right back to doing it. On the other hand, if you go to the toy store and bring back a white board with markers or a large paper tablet with markers and encourage them to mark on it, then they are much less likely to go back to drawing on the wall. This is because you have filled the vacuum. So if you give up on one behavior, look for positive behaviors which will give you something to do with your hands, or your mouth, or your time.

Wednesday, November 30, 2005

Investing in Your Life

What would you do if you were given $100,000? Well, you might have some special circumstances that would determine it for you--kids needing to go to college, a family member with high medical bills, and so on. But imagine that you didn't need the money--what would you do with it?

I would hope that you might do several things with it, such as enjoying some if it, investing some of it, and sharing some of it. For example, you might want to buy a new car. Then you might take some of the money and put in a bank account. Some more of it might go into long term savings, and some might be shared with those you love or those in need.

Emotionally, all of us go through times when we have enough or more than enough emotional energy, and other times when we are pretty much running on empty. During the times when we are full of energy, it can be like we have just been given a lot of money. It's like we have been given a "present." If we don't pay attention to what we are doing with our energy and positive feelings, we may "spend" it all on the moment, preventing it from having any long lasting consequences. Even when we are depressed, we will often have brief periods of feeling better. At those times, extra energy can feel like an unexpected gift.

Here are some suggestions to consider the next time that you have the present of extra energy.

Spend some of it. That's not so hard is it? Although for some of my clients, it actually is. They have a hard time having fun. For others, however, that is the easy part. Spending it can mean simply doing whatever strikes you as enjoyable--something you want to do or accomplish.

Secondly, invest some of that energy. Invest it in building a social support network for yourself. That will pay dividends for you the next time you are down. Research has shown that high quality social support is the best thing since sliced bread. It helps buffer us against stress and strengthens our immune systems against physical infection. A short term investment (one that will yield relatively quick rewards) is to reach out to friends that we have neglected recently. We can reestablish friendships that we have not let slip away totally. That doesn't take as much energy as forming new relationships. (For a good online article on developing social support and relationships, see the Mayo Clinic web site-- ).

A long term investment of the extra energy might go into starting brand new relationships. They take longer to form. But they too yield rewards in the long run in the form of emotional support. A long term investment might also be starting up a new sport or starting to play an instrument.

And then there is the issue of giving some of it away. Research has shown that altruism has positive effects. Volunteer and use some of that energy to help others. It will have a positive effect on you in return.

So, remember the next time that you have some extra energy--enjoy it!! But also invest some of it in your future. And give some of it away, too.

Tuesday, November 08, 2005

The Problem with Anger

First of all, I want to make it clear that anger is a normal feeling. There's nothing unhealthy about feeling angry now and then. In fact, it would be abnormal and unhealthy not to feel angry now and then. The problem with anger comes when it loses its rightful proportion in our life.

First of all, let's take a relatively common situation. You are driving in traffic, and another driver cuts you off. He is driving recklessly, perhaps speeding. The typical response of most persons is anger, and that would be normal and natural. The anger comes--it peaks--and it goes away. We forget about it.

However, for some people, the anger comes, and then it gets stronger and stronger. The reasons for this are not fully understood. But one reason it can happen is that persons are using negative self talk to build up their anger. "That stupid person. How dare he do that? Somebody ought to teach him a lesson!." This type of thinking increases the anger.

Another approach to the same situation would be to acknowledge one's anger and then steer a wide berth around such a person. That is, to let the anger come--and then to go, without the negative self talk strengthening the anger.

Some persons are chronically angry. They keep resentments alive on, and on, and on. This is not the same as anger. It is very unhealthy psychologically and physically. It has negative effects in every area of one's life.

I have been asked by some patients, and indeed I have asked myself at times, if this approach to anger isn't really just suppressing it. And suppression and repression can have negative consequences, too. The answer is no. First of all, I am recommending that you be fully aware of your anger at first. There is no suppression here. Secondly, I am recommending that you don't rehearse negative thoughts. In other words, there is a difference between smothering a fire and not putting more wood on a fire. Thirdly, I am recommending that after having an awareness of the feelings and thoughts, that you simply let go. You therefore maintain an awareness of all the thoughts and feelings that you did have, but you are choosing to let go. The choosing is an important part of the process. When you choose to do something, it is conscious and deliberate. This has no negative psychological effects as far as I know. In fact, it has positive effects because it frees you up to go on with your day in a positive constructive way. It also frees you from some of the negative physical effects of chronic anger. Some of these are explained in my handout on coping with anger at .

Saturday, October 29, 2005

Stress and Anger as Psychological "Luxuries" We Can't Afford

Most people think of stress and anger as simply part of life. We have to put up with them because they come with the territory of living. However, research increasingly indicates that both of these take a negative toll on our minds, bodies, and relationships.

Certainly, they are not totally avoidable. Some degree of stress is healthy for the body and mind. It actually strengthens us. But the old saying of Nietzche is not true--"Whatever does not kill me makes me stronger." In fact, what does not kill us may kill off brain cells and add fat to our waist. Excessive stress has been shown to harm cells in the hippocampus, which is a part of the brain central to storing memories. It has also been shown to lower the immune system's ability to fight off infection. Depression and anxiety can be triggered by stress in some individuals. For others, stress may lead to unhealthy use of alcohol and other substances.

The goal of the healthy individual need not be to eliminate stress altogether but to avoid very high, unusual levels of stress if possible. How can this be done? Many people believe that the stress they experience is totally beyond their control. But it is not. Here are some things which can be done to diminish stress.

First, live a healthy lifestyle. Do the obvious. That is, don't take excessive risks financially. Nurture and nourish relationships. Build for the future in both finances and social support.

Secondly, work on any excessive negative thinking. My web site has several handouts on how to do this ( Very often 50% or more of the stress we experience is of our own making from excessive negative thinking.

Deal with problems slowly, methodically, one at a time. Don't avoid problems. They will just pile up. And don't try to take on all problems at once. That will just overwhelm you.
Most of my clients have one of two different problems: either excessive negative thinking or avoiding problems. Working these two areas can do wonders for a person's stress level.

Next week: the "luxury" of anger.

Wednesday, October 19, 2005

Is There a Type D Personality and Does it Matter?

In the past, it was thought that the hard driving, time pressed Type A personality led to more heart attacks than the easy going Type B personality. Unfortunately, that research lead did not prove to be true. But wait, now there is research on a Type D personality, and it remains to be seen whether the Type D personality predicts heart problems any better than the old theories. However, some research suggests that it does.

Johan Denollet, a psychologist in the Netherlands at Tilburg University found a personality type likely to build up chronic stress. They have both negative emotions and an inability to talk with others about those emotions. They tend to overreact to situations with negative emotions but then can't express these emotions and get them out of their systems, so to speak.

Persons high in Type D characteristics tend to have more heart disease, hypertension. They also tend to respond less well to treatment, have a poorer quality of life and to die prematurely. Among heart patients, they are four times as likely of getting another heart attack or dying too soon.

If you are interested in looking at the Type D questionnaire, you can go to

Tuesday, October 18, 2005

Sometimes the Closet Overflows

One of the analogies I use with my clients is that of the stuffed closet.

Imagine that as a child, a person learns to clean up the items in their room by throwing them in their closet. And then, as they grow older, everytime they need to clean their room, they simply open the door and throw more things in. This works for years, say, and then there is just too much in the closet. Nothing else can be thrown in. And so the person doesn't know how to deal with the odds and ends they have lying around. If they open the closet, everything comes tumbling out. And if they don't open the closet, they don't know what else to do with their problems.

This is just the problem that many of my clients face. As a child, they learned to deal with problem feelings and thoughts by stuffing them deep down, out of awareness. This worked, more or less, for years and years. But finally, there is just too much stuffed down. In psychology, we call this repression.

Eventually, it starts to come out as depression, anxiety, anger, flashbacks, physical symptoms, etc. Now they have a dilemma. Their only mode of coping is to stuff things. But there simply is no more room for things to be repressed. And if they try to sort through the things in the closet, they feel overwhelmed.

This is where the therapist comes in. At this point, there really is no choice but to start sorting through the years of accumulated issues which were not dealt with. Perhaps not every one of them has to be looked at, but the big ones at least. The therapist can help guide the client through this sometimes rather arduous process. But in the end, the closet is cleaned out. The symptoms are reduced. And the client is no longer hiding from their own thoughts and feelings.

Thursday, October 13, 2005

Therapy As a Rapid Process

Perhaps this will sound confusing after my last post, but therapy can sometimes be a rapid process. How can that be after pointing out just how long it can take to get to the bottom of things in my last post?

The fact is that not everyone comes to therapy with the same expectation. Some people are coming for an overhaul and others for a tune up. And others are coming to get their engines jump started. In fact some psychotherapy theorists have argued that all we should really be doing as therapists is helping people to get "unstuck." The idea here is that people are generally coming up against one problem after another, and that is a normal situation. However, sometimes they come up against situations which they can't solve. They are not thinking creatively or "outside the box." With help, however, they can solve their dilemma and continue to go on with their lives.

Another way of looking at therapy as a rapid process is to consider mild to moderate depression. The client comes in in a demoralized state. They have started thinking negatively. They have quit being assertive. They have pulled away from friends. They have quit eating and sleeping in their normal patterns. All of these problems tend to pile on top of each other and compound each other. Very often, as the therapist helps the client to improve one area, there is a positive spreading of effect so that the other areas start to improve. Instead of a negative chain reaction, there is a positive chain reaction.

Many therapists today teach cognitive therapy, which is a set of skills designed to overcome irrational negative thoughts. This therapy was originally designed to be administered in 20 sessions. However, even that is a long time for many patients. The average number of sessions for a client to stay in therapy is 6 to 8 sessions.

There is no "right" length of time to stay in therapy. It is up to each patient/client to decide how much change they want to accomplish. It is also up to them to decide how much of their personal lives they want to disclose in order to accomplish that. The important thing is for the client to be up front with their therapist, explaining what they want to accomplish and how much time they are willing to invest in that. The therapist can then tell them if their expectations are realistic or not.

Tuesday, October 11, 2005

Therapy As a Slow Process

I will be writing another column on Therapy As A Rapid Process. Today, I want to address the opposite side of the issue. Sometimes it is a slow process. There are several reasons that it can be slow. One is that it takes time to trust the therapist. I used to think that it would be possible to derive a full treatment plan from an initial, thorough intake. Wrong. The fact is that sometimes the client does not trust the therapist enough to tell them what is bothering them until perhaps the tenth, twentieth, or thirtieth session.

Secondly, sometimes the client themselves does not know what is bothering them. Or perhaps they have a vague idea of the problem, but they have a hard time focusing in on it or articulating it.

Other times, therapy takes quite some time because there are years of habits. The habits can include negative thinking, fear, avoidance, and so on. These do not change overnight.

Fortunately for some patients, they have adequate insurance to allow them to stay in treatment and do the work they need to do. Unfortunately, others do not, and they are only able to take advantage of the "front end" of therapy. But that is much better than nothing.

Next time, how therapy can be a rapid process...

The Two Kinds of Problems

Most of my clients have one or both of two kinds of problems: they are either troubled with negative thoughts which make them feel angry, depressed, anxious, etc., or they avoid dealing with issues and problems.

Negative thinking is something I deal with a lot on my website ( However, I don't deal that much with avoidance on the web site. There are two ways that people avoid--externally and internally. Externally, people may avoid dealing with problems. As a result, the problems just keep getting bigger and bigger, causing more and more difficulties in the person's life.

The other type of avoidance is not facing their own internal thoughts and feelings. They try to stuff these internal issues into the closet so to speak. However, after a lifetime of closet stuffing, they often end up with a problem. They only way they know to deal with things is to throw them out of site in the closet. But every time they open the closet, there is so much in there, that it all starts to tumble out. In other words, a person can only repress and avoid thoughts and feelings so much before there is no way to stuff any more. The thoughts and feelings which they thought they had successfully managed to avoid are now coming out as symptoms and interpersonal problems. That is where a therapist can be helpful. Because when everything starts to tumble out, a therapist can help to sort it all out so that it is not overwhelming.

More on Unwanted Thoughts

Some unwanted thoughts are what we call "obsessive thoughts." These thoughts are generally of a violent, sexual, or religious nature and are just the opposite of what we truly believe and/or want. These thoughts can be in words or in pictures. Because they are the opposite of what we truly feel or think, they are very distressing. The technical name for this is "ego dystonic," i.e., they feel bad to our ego.

The way to deal with these thoughts is not to fight them but to see them for what they are. They are coming from some part of our brain but they are not really us. As such, there is no reason to fight them. They simply need to be set aside. Fighting them seems to energize them. Usually, the best course of action is to simply set them aside with as little mental energy as possible and go on to distract ourselves with something else.

Monday, October 10, 2005

Do I Have to Feel Guilty For Having Certain Thoughts?

One of the problems I encounter with my patients is that they have thoughts that make them feel guilty. Sometimes these are thoughts that are evaluating others. Sometimes, they are thoughts which are sexual in nature. Sometimes, they are simply unacceptable in other ways.

This is a very complicated subject, but let me begin by saying that one sure way to create psychological problems in ourselves is to try to reign in our thoughts too closely. This can sometimes lead to repression (thoughts being kept out of awareness through an unconscious process) or denial (when we emphatically deny at a conscious level what we are actually thinking or feeling).

The brain has a variety of structures within it, and they are not all equally under our control. The limbic system can generate emotions, impulses, and thoughts of a sexual, fearful, or hostile nature. It may take a few seconds before we realize what is happening and have a chance to begin to process these rationally. This is normal.

Another issue is the issue of evaluating others. Many people feel guilty because they believe they are judging others. This is partly a problem of words. Judging can be evaluating others (I don't think he looks good with orange hair), or condemning others (Only a worthless bum would have orange hair). Many religions warn against condemning others. However, a person would have to be brain dead in order not to evaluate situations. We evaluate because that's what our brain is built to do and trained to do. There is no sense in feeling guilty about that.

However, in judging people by condemning them in our minds as worthless, inferior, and so on, we are indeed putting ourselves in a very precarious position psychologically (and spiritually). Each person is who they are as a result of their genetics and personal experience as well as decisions they have made. When we judge others, we are in essence saying, "If I had had their genes and their family upbringing, I would be doing better than they." In fact, there is no way of knowing that. Perhaps we would be doing worse!

Judging as condemning can lead to excessive angry feelings. We can evaluate without it necessarily strengthening our anger. But to condemn is to be self righteous and almost always strengthens angry feelings.