Is Psychotherapy Dangerous?

"Everybody has a right to their opinion" is a statement we hear often and I usually agree with it. But I guess I'd like to qualify it - "everybody has a right to their informed opinion." There has been much discussion and writing about celebrities offering their opinions on...everything and the possible deleterious effects. What immediately comes to mind is Tom Cruise's Scientology-based tirade against psychiatry and psychotropic medications. I just read an angry letter to the editor in a fashion magazine in response to a profile of John Travolta in which he denounced psychotherapy.

Most intelligent people can take these celebrity pronouncements with a grain of salt and put them in the proper perspective - a non-expert who has the luxury of delivering his opinions to a huge, often-receptive audience. What concerns me more are how the articles in supposedly informed, respected publications like Newsweek are received by the reading public. An article by Sharon Begley (who writes about science and health) in a June issue of the magazine exemplifies my concern. In Get Shrunk at Your Own Risk, Begley cites several studies that report on the dangers of psychotherapy. I first became aware of this piece when a co-worker at my private practice clipped the article and posted it in our office early last summer. She was extremely upset by it, specifically by Begley's questioning of the efficacy of grief therapy. This woman had been helped through a terrible loss by a skilled grief therapist.

Just yesterday, I happened to pick up a (July 9, 2007) copy of Newsweek in a doctor's office waiting room. In it were letters to the editor in response to Begley's article. Three of the four letters rebutted the article. One writer, a licensed psychologist, stated an important point,

"Not all mental-health providers are equal - just as in every other profession
where there are good providers and questionable ones."

With almost twenty years in the field, I have seen plenty of evidence to support that statement - there are some incredibly bad practitioners out there. Some I've had to report to licensing boards for questionable conduct.

Begley's piece probably would have sparked less of a reaction from me had she cited all the specific studies to support her piece. She did quote two very credible sources, psychology professor Scott Lilienfeld of Emory University and psychologist John Norcross of Scranton University. (I mentioned Norcross's book Authoritative Guide to Self-Help Resources in a recent post - Bibliotherapy: Can Reading Alleviate Your Depression?) But Begley's unsupported statement, "but the number of people undergoing potentially risky therapies numbers in the tens of thousands," in my opinion, is irresponsible.

Although there is validity to warning the public about the potential dangers of any treatment, my fear is that people who might be helped by qualified, trained, licensed psychotherapists will be frightened away from seeking help after reading an article like this one.

Back to School Anxiety

I'm not just talking about the anxiety it causes in children, but the parents as well.

First, the children. Just think about all the worries swirling around their young minds as they prepare to enter another school year. They worry about their clothes and fitting in. They worry about the schoolwork in itself. Will it be much harder this year? Will I be able to handle the work? They worry about friends and new teachers. Imagine having to change jobs every year and all the anxiety that goes along with it. This is precisely what our children deal with every new school year.

Now let's think about the parents/guardians of these youngsters. As parents, worry is par for the course. We generally worry about everything involving our children. From the most mundane to the issues which truly merit worry. I, on one hand, look forward to my girls heading back to school. I work from home and having them underfoot all summer can be slightly distracting, if you know what I mean. ;) On the other hand, it upsets and worries me to no end. I know it's not right to worry about my children 'fitting in' with the others, but the truth is, it does matter immensely. I don't want my girls to be outcasts. It's not right nor is it fair, but it's the way the world is. I worry about their worries. I worry about their new teacher. I worry about the ever increasing amount of homework they'll have. And, I mostly worry about leaving them in the care of someone else all day long. I don't doubt our school district's teachers but it is difficult in this ever changing world to trust someone else with your most prized possessions.

So I practice breathing techniques regularly to help curb the anxiety. I've been both meditating and power walking daily in the hopes that it will help to calm me. As for my girls, I tell them they are beautiful and smart. They always get straight A's. I encourage them to be excited about this new adventure. Which is what it is, an adventure. And that should be fun and good, right? So why do I worry so much about this?

Happiness is an Illusion

What we think of as happiness is an illusion, at least according to Daniel Gilbert in his book, Stumbling on Happiness.

I read this tome thinking that a book with happiness in the title might provide some guidance on achieving happiness. In reality, this book is less about happiness than it is about how we think, how we perceive events and things, how we imagine our future and how we remember our past.

Stumbling on Happiness is a collection of interesting psychological facts and research with only a tenuous link to the science of happiness. The book offers some fascinating trivia about how we think, illustrated with witty anecdotes and scientific research on our metaphorical and physiological blind spots.

You will learn why being rich doesn’t make you happier and discover some of the elements of happiness.

When we have an experience – hearing a particular sonata, making love with a particular person, watching the sun set from a particular window or a particular room – on successive occasions, we quickly begin to adapt to it, and the experience yields less pleasure each time. Psychologists call this habituation, economists call it declining marginal utility, and the rest of us call it marriage.

Gilbert uses this principle of declining returns to explain why a lot of the things we expect to make us happy, don’t. People who have enough money to meet their basic needs for food, clothing and shelter, are only slightly less happy than multimillionaires.

However, most of the examples provided by Gilbert are only loosely related to happiness, and instead illustrate his point that our perceptions are often skewed. According to Gilbert, we have a poor grasp of reality, misremember the past and are frequently wrong in our predictions of the future. The bottom line? We are clueless when it comes to imagining what will make us happy, but we are happy about being deluded.

He comes up with some surprising statistics.

Despite what we read in the popular press, the only known symptom of “empty nest syndrome” is increased smiling.

Careful studies of how women feel as they go about their daily activities show that they are less happy when they’re taking care of their children than when eating, exercising, shopping, napping or watching television.

He believes that we convince ourselves that children bring happiness as a way of ensuring that we breed and stay around long enough to bring up the rug rats, rather than because the activity of childrearing is a source of joy.

The implication is that delusions and illusions are bad, and we should exist in reality. The counterargument to this is that if you believe you’re happy, then you are. After all, isn’t happiness a state of mind?

I don’t agree with all of Gilbert’s conclusions. For example, he suggests that people continue to choose romantic partners that are bad for them because they forget their negative characteristics and instead focus on the fond memories. I disagree. Forgetting the negative characteristics of past partners is only one possible explanation for seeking the same type of partner, over and over. It’s also possible that the individual has low self-esteem, is a poor judge of character, is attempting to avoid commitment or believes that they deserve exactly the partner they get.

Another flaw is that the book overlooks mental illness and emotional health issues. People with anxiety disorders and depression have negative cognitive distortions. Gilbert’s book focuses on positive cognitive distortions, ignoring an aspect of thinking that affects a large portion of the population at least some of the time.

Someone who has experienced a major trauma, may be haunted by this for the rest of their lives, experiencing nightmares, flashbacks and both physical and emotional signs of stress (PTSD). Gilbert glosses over this possibility, describing the resilience of humans and their ability to bounce back from tragedy, using examples such as Superman Chris Reeve. The reality is that some people are slow to recover, and a small number never recover from tragedy.


The solution
If we are lousy at imagining how we will feel in the future, how do we make decisions today that will make us happy tomorrow?

The only solution Gilbert puts forward is to find someone who is going through the exact situation we are anticipating and learn from their wisdom. Many of us learn from our parents, our teachers and other coaches who offer advice.

However, an equal number of us prefer the freedom to make our own choices and disregard perfectly good advice so we can find out for ourselves that the good looking man we met last month is a louse, that our sister will never change and that eating a jumbo pizza and an ice cream sundae always leaves us feeling bloated.


In the end the book raises more questions than it answers, but it is worth reading if you’re interested in psychology and want to learn more about the way we think.

Anxietycoach.com: Online help for anxiety disorders

I've come across this site a few times recently and have always kind of 'swept it under the rug'. But in light of my theory on always keeping the door open for new treatments, I figured this wasn't exactly fair and decided to check it out.

This site is "dedicated to helping people who have significant trouble with fears, phobias, and anxiety. We offer free self help information you can use to foster your own recovery; a workbook for people with panic attacks and phobias..."

I think the workbook idea is nice since you could use it as a journal to track the stress which lead to either a full blown panic attack or just anxiety. It also offers a guided program to help beat the anxiety and tricks to aid you. They also teach breathing exercises as well as lectures and workshops. Sounds plausible. It's always interesting to see and learn how others deal with their anxiety issues. I find it comforting, really. Like, I've said before, it's nice to know you're not alone in this.

This might a nice supplement to other forms of treatment. Maybe give it a shot and peruse the site a bit. You never know, it might lead you to an effective relief exercise or lesson.

Krista

RealAge - My Cat Got a Better Score than I Did!

Awhile ago, a friend forwarded me her RealAge score - 84 years of age. But here's the kicker - she's chronologically 55! I wasn't familiar with RealAge. It was first popularized on an Oprah Winfrey Show broadcast several years ago. RealAge is a book and Web site that uses information taken from your "lifestyle, genetics and medical history" to determine your biological age. Depending on the sum of these factors, you may be younger or older than your stated age.

Obvious factors are calculated in the RealAge Test , like do you smoke, exercise, etc. But less apparent factors also figure in - dog ownership, how social you are, for instance. My RealAge is 9.4 years older than I am. I did get positive credit for daily vitamin intake, eating breakfast, smoking cessation, good blood-pressure and owning a pet (although dog owners get a better score!). Points were subtracted for level of exercise, less than optimal diet, driving over the speed limit and having a smallish social network.

I'm glad to see that the RealAge founders/Web site hosts are medical doctors and that there is a disclaimer on the site cautioning readers that this content is not to be taken as "medical or other health advice." And although I think the test and individualized follow-up emails are very helpful and full of sound suggestions, I do have a few concerns. Your medical doctor or health practitioner always gets an extensive family medical history from you during a comprehensive exam. If your father died of heart disease, that information is vital and a possible indicator of future problems for you. When I do a mental status exam/initial evaluation, I obtain mental health and substance abuse family history and also thoroughly explore current and past stressors in the patient's life.

Oprah, by the way, scored almost 7 years younger than her chronological age. I imagine I would have too, if I had Oprah's vast wealth that provides financial security, a personal chef to cook me nutritious meals, a fitness trainer and other helpful support staff.

Shortly after receiving my test results via email, I was sent a test to determine my cat's RealAge. Fortunately for him, because of his conscientious owners, he scored 20 years younger (in cat/human years) than other cats his age and breed. Hmmm, I don't see him taking those expensive "mature" vitamins...

The invisible hand around my neck.

No matter how hard I try to pull it off, no matter how much I scratch at it, pull at it, the hand around my neck still tightens. No there's not really a hand around my neck nor is some whacky ghost trying to strangle me, but it certainly feels that way at times. That hand is actually a panic attack and boy are they getting bad. It's a feeling of suffocation or stangulation even though you are breathing. Many know and fear them. I am one of the many.

I had them under control not too long ago. With the help of therapy and medication, the anxiety calmed and I felt like I could breath again. That was only a few months ago, but it feels like another lifetime. With the school year approaching for my girls and all the stress that comes along with it, I find myself with that hand around my neck once more. Stress = anxiety = panic attacks. No matter how you try to switch that equation around, the end is always the same. Well, for me it is.

So, what am I doing to help this? Many things, actually. I hate to rely solely on medication to handle my attacks. I can, if I'm lucky, manage to focus on another task to keep my mind busy which helps to lead me out of an attack. (like being the nut standing in the kitchen at 5am baking bread) But, believe me, there are times that simply isn't possible. There are many times I simply can't focus on anything other than the anxiety which leads to more anxiety. It's a vicious cycle and those of you who suffer along side of me know exactly what I mean. I love to jump in my car and crank up the music to help ease the pain and that works alot of the time. I am very moved by music and can be drawn into a song in the same way I'm drawn into a book. I can actually mentally remove myself by doing this, but that's not always feasible. I'll often curl up with a good book praying it will lead me down another path and into someone else's life it only for a bit. Just long enough to get some relief. And in the end there are times I find myself turning to the medication out of sheer desperation. I don't find a thing wrong with that either. It works. It works every time. Every. Single. Time.

I've resigned myself to the fact that these darn attacks are a way of life for me. I pray my girls don't end up with them, but if they do I will help them find the treatment that works best for them. You see, to me it's all about keeping the door open. I won't say I'll try any treatment or medication, but I also won't shut to door to new ideas either. I'll listen to the pros and cons and weigh my options. Maybe give something new a shot. If it doesn't work for me that's fine. But I won't totally rule it out and I hope the rest of you won't either. You never know what might pop up and give you some relief.

So there ya go, that's my theory on treating anxiety attacks in a nutshell. This is my first post on this blog so I thought it a good way to introduce myself and my issues. :) I'm thrilled to be working with Talia and Nancy. Not only do I find blogging therapeutic, but maybe by listening to my thoughts someone might feel a bit better about what they're going through. It always helps me to know I'm not alone in this fight. To know there are tons of us dealing with this each and every day whether we like it or not. It's clear we don't really want this in our lives, but we have to learn to live with it and I look forward to sharing my feelings/thoughts. And maybe hearing back from others will lead me to a new treatment.

And to all of you in this crazy panic attack stricken world, just remember I'm here right with you. You're not alone.

Get free help for your depression

The Department of Neuroscience at Columbia University and The New York State Psychiatric Institute is looking for people to participant in mental health research relating to depression, bipolar and PTSD and more.

If you are based in New York you could be eligible to participate in research and receive free outpatient treatment. Check out the current studies on depression and bipolar for more details.

Is Second Life the Ultimate Cyber-Addiction?

Ten years ago when I got my first PC, the loaded software had the Sims game bundled into it. I played around with it a bit and thought it was just a grown-up version of playing with dolls - definitely not my thing. Although I like to think of myself as fairly cyber-savvy, I admit I didn't know much about Second Life, the online adult, virtual fantasy game until recently. After doing a bit of research, I might call it "the Sims on steroids!"

A recent Wall Street Journal article, "Is This Man Cheating on His Wife?" underscores the addictive quality of this game. It chronicles a 53 year old man who has become so enthralled with playing Second Life that his avatar (online persona/character) has married another avatar in the game. This is causing a great deal of stress in his primary relationship - his real marriage! He often spends six hours a night and up to fourteen hours straight on the weekends in his virtual world.

Oh, it gets even weirder - characters playing the game often buy property or businesses using lindens, the game's currency. The man's avatar above has a net worth of $1.5 million lindens. My first look at the Second Life Web site was like an anthropological expedition. Checking out the wares for sale in the retail section, I found they range from a squirrel you can purchase for your virtual yard, clothing and furniture, a private island and even cyber "contraband," like cocaine.

 

According to their Web site, 8,846,910 "residents" or players are enrolled on Second Life. That's a lot of time logged onto a virtual world. Much as the couple in the article are experiencing some very real marital problems, I'm concerned about the psychological and emotional effects of this level of game involvement. Although the AMA (American Medical Association) won't declare a definitive diagnosis for video game/Internet addiction, much research is indicating that there are significant negative, addictive behaviors associated with gaming and excessive Internet use. When does a harmless pastime become a threat to our psychological well-being?

Talia recently wrote about psychic phone-line addiction. Among the many concerns about this addictive behavior is the forming of relationships with people whom the callers have never met. Just as the man with the cyber-wife in Second Life, how can this not detract from the real relationships in our lives? The WSJ article quotes some very disturbing statistics:

Nearly 40% of men and 53% of women who play online games said their virtual friends were equal to or better than their real-life friends, according to a survey of 30,000 gamers conducted by Nick Yee, a recent Ph.D. graduate from Stanford University. More than a quarter of the gamers said the emotional highlight of the past week occurred in a computer world, according to the survey, which was published in 2006 by Massachusetts Institute of Technology Press's journal Presence.

Of course there is undeniable appeal to escaping our real lives, pressing deadlines, family conflicts, etc. by playing an online or video game. The idea of taking on a very different persona can be intriguing. I've logged more hours playing Tomb Raider than I'd like to admit. But when the fantasy life and/or character begins to have more value than the real one, that becomes problematic.

We will be seeing more and more research into this relatively new phenomenon - cyber addiction. There are behavioral treatment centers that are now specializing in this area. In my own therapy practice, I have worked with couples who present with communication-breakdown issues, but the core problem is sometimes one partner's unhealthy attachment to the Internet - porn, gaming, chat rooms, etc.

Nancy

The 4th Carnival of All Substances and Addictions

Check out the latest carnival of all substances at Everyone Needs Therapy: The 4th Carnival of All Substances for links to posts on addiction, codependency and recovery.

10 Life Lessons We Can Learn from Harry Potter

Very few things get the same response from teenagers and older adults. But when I mention to either population that I'm reading the last Harry Potter book, I often get the eye-roll. I suspect the teenagers are thinking, "how uncool" and the adults are thinking, "how quaint." But I'm undeterred; I'm a huge fan. No, I didn't stand in line to purchase my copy at 12:01 on July 21st, I pre-ordered mine from Amazon.

What I love about these books is that just about any age reader can enjoy them on some level. From an emotional/psychological-health standpoint, the books are full of important life lessons. Here are the ones that speak to me:

1. Family is important - In the Harry Potter books as in our lives, family isn't always the one to which we are born. Choosing people to be around who support and care for you is often a healthier choice than spending time with our dysfunctional birth-family members.
   
2. True friends stick by you - Hermione and Ron remain Harry's friends throughout the seven book series. And Harry isn't always the best friend to them. Your real friends put up with your nonsense, crankiness and your least attractive faults. They may tell you that you're being a jerk, but they stick with you anyway.
   
3. Not everything is as it seems - There are characters in the books who seem to be purely evil or purely good, but not everyone fits nicely into one particular category. As some characters evolve, our first impressions change. We shouldn't be so quick to judge from those first impressions we draw from people.
   
4. Not everything is black or white - Much like number 3, characters and situations in the Potter books rarely fall into nicely defined categories - there are varying shades of gray and nuances to be discovered. Picking up on these subtleties in life helps us form our belief systems and prevents us from being entrenched in our thinking.
   
5. Even small acts of bravery are noteworthy - Speaking up and defending yourself from unfair criticism is an act of bravery, especially if you have been conditioned to keep quiet. Changing careers in mid-life is brave. Choosing to leave a destructive and unhappy marriage can be an act of bravery.
   
6. We should apologize for bad behavior - There is a sizable portion of one of the Potter books that finds Harry to be fairly obnoxious, some of which seems to be a normal adolescent stage. He does make efforts to make amends to his friends for being a jerk. In a "victim-centered" society, we are not programmed to apologize for our behavior, rather we look for someone or something to blame. Saying, "I'm sorry" can be a very healing act.
   
7. Sometimes a dragon is just a dragon - Freud reportedly phrased it, "sometimes a cigar is just a cigar." We often try to read too much meaning into some situations - lately referred to as "over-thinking." K.I.S.S. (Keep It Simple, Stupid), although crude is a very effective strategy.
   
8. Positive reinforcement helps build healthy self-esteem - There are many authority (father types, mostly) figures in the Potter series - Dumbledore, Sirius Black, Hagrid, whose influence on Harry helps him become a confident, well-developed person.
   
9. Perseverance is important - In the beginning, Harry is repeatedly knocked off his broom in Quiddich matches. But he keeps on getting up, continuing to try and becomes an amazing player. Sometimes frustration and life circumstances beat us down and it's tempting to quit. But hanging in there has its rewards.
   
10. Magic is essential - We don't have wands or a repetoire of spells to cast, but there is magic around us everyday. Take the time and make the effort to find it.
    
    

Bibliotherapy: Can Reading Alleviate Your Depression?

An article in Tuesday's Wall Street Journal, Bibliotherapy: Reading Your Way to Mental Health made me chuckle. The article discussed something "surprising" therapists are suggesting to their patients - read a book and the recently-published science behind this approach. What amuses me was that it was presented as a new thing. We non-scientist types have been suggesting this to our patients for years! I was reminded of some studies that came out in the last year or so recommending exercise for depressed patients. Common sense tells us that physical exercise would be good for depression. But in the age of supermodels and celebrities writing books about lifestyle change, coping with stress, etc., it would seem we need some scientific review of those self-help books!

Years ago, one of the first books I had my patients read was psychiatrist David D. Burn's Feeling Good: The New Mood Therapy. What I like about this book is the lack of psychobabble terminology and self-help cliches. There are easy to read explanations of depression and other mood disorders and excellent examples of cognitive behavioral techniques (CBT) that can be practiced at home.

I'm a visual learner. You can tell me something, but if I read it, I will digest the information quicker and better. Many people tell me they also process new material better when they read it. It also gives them something to work on between therapy sessions. I've found that reading about psychiatric disorders also takes the patient out of the emotional/psychological mode and into the intellectual. It's often less threatening to read objective, factual information.

Medical and behavioral health journals divide these bibliotherapy books into two categories: those with proven clinical trials behind them and self-help books (that are often on the best-seller lists) that don't and that are often written by people without credentials in the mental health field. These trials are often conducted the way drug research is done, comparing the patients' depressive symptoms who read the books with patients who don't ("placebo") and haven't received any treatment in a "before treatment and after treatment" format.

The Journal article cites a helpful guide composed by John Norcross, a University of Scranton professor of psychology and researcher on the effectiveness of self-help books - The Authoritative Guide To Self-Help Resources in Mental Health. The book is based on five acclaimed national studies involving over 2,500 mental health professionals and it reviews and rates 600+ books.

Proponents of bibliotherapy suggest that it is effective on mild to moderate depressive and mood disorder symptoms and best done in conjunction with traditional visits to a credentialed therapist. It also shouldn't be considered as a substitute for medication if your health practitioner has prescribed that as part of your treatment.