Exposing The Top 5 Self-Help Myths

In the spirit of pioneers, we’re concocting our own remedies and salving our own wounds. But is it good medicine? Once the preserve of charlatans and psychobabblers, self-help has undergone its own reinvention, emerging as a source of useful information presented by acknowledged authorities. Often, the messages of self-help books tend to be vast oversimplifications, misrepresenting a part of the truth for the whole, as the following list of popular misconceptions and distortions demonstrates.

Psychology Today list the top 5 myths as:

1. Vent your anger
2. Think yourself happy by focusing on the positive
3. Visualize your goal, and you’ll help make it come true
4. Self-affirmations will help you raise low self-esteem
5. “Active listening” can help you communicate better with your partner

Read the rest of this article on self-help myths at Psychology Today.

Antidepressant warnings

In light of a review on drug safety and the risk of suicide, Johns Hopkins asks whether antidepressants are safe.

Call it the pill paradox: Some 20 years ago, selective serotonin reuptake inhibitors (SSRIs) burst onto the scene, lauded for their ability to treat depression. Today, however, some studies have linked SSRIs to an increased incidence of suicidal thoughts and behavior. This has led to what’s being called a “crisis of confidence” in antidepressants, with many people wondering whether antidepressants, especially SSRIs, are safe to take. Read more on antidepressant warnings.

Vanessa Vega Interview on Anorexia and Self-Harm

After reading Vanessa Vega's memoir Comes the Darkness, Comes the Light: A Memoir of Cutting, Healing and Hope I had the opportunity to interview Vanessa about her challenges with anorexia and self-injury. Vanessa hopes that sharing her story will help others battling similar issues and shine some light on self-injury, which she says affects millions of people.

Are you grateful for the adversity you have experienced? Some people talk about the positive aspects of mental health or dealing with adversity? Do you feel it has made you stronger, or would you rather have skipped the experiences?

At the time, I struggled to find a greater purpose for the adversity in my life. But in retrospect, I can see a clear correlation between my past obstacles and my present life. I am the person I am because of the obstacles I have worked through. My drive, dedication and desire to help others stems directly from some of the darkest times in my life.


What was your reason for sharing your story?

There are a couple of critical reasons why I shared my story. One, I have spent most of my life longing for reassurance that I wasn’t the only person in the world who thought some of my thoughts or engaged in self-injury behaviors. None of the therapists I worked with had much experience with self-injury and I could never find any books or stories of other self-injurers to reassure me that I wasn’t hurting in isolation.

This led me to believe that my behaviour was somehow genetic, that perhaps there was something wrong with me that couldn’t be fixed. I believed if the contrary were true, information would be more readily available. And yet, it was because of the work I did in therapy that I started to realize that my behaviors were rooted in deep-seated issues from my pas and that I wasn’t alone! If this were true, then that meant that I could control how I dealt with emotionally intense situations.

Once I reached a level of understanding within myself, I saw an opportunity to reach out to others who might also be struggling but weren’t at a place yet where they could openly talk about their pain.

This fact leads me to the second reason I chose to tell my story. There are millions of people in the world who self-injure, yet few medical, health care professionals, parents or educators know anything about it. Part of my struggles were exacerbated by the fact that I couldn’t find anyone who dealt exclusively with self-injury and could best help me to understand myself. I was able to find someone trained in eating disorder recovery and because self-injury and eating disorders are “sister” disorders, I was able to apply my treatment for one problem to the other, but I shouldn’t have had to do that. I want to bring this disorder into the forefront. I want someone who is struggling with self-injury to be reassured, as I never was, that they are not alone and that there is help available!


How have you coped with getting published? It’s a process that can involve rejection and bad reviews. Has this been an issue for you?

To date, all of my reviews to date have been incredibly positive and supportive. I knew when I was writing the book that I had to do the best job possible so that I would be 100% satisfied and proud of what I had created. I am. I wrote the book with the intention of helping as many people as I could and knowing that my book is doing so means more than anything to me. Ultimately, this is my story. I do not claim to have all the latest research statistics or to offer readers any easy answers. Instead, what I hope my book offers readers is hope.


Who do you speak to and what is the message you deliver?

I have spoken to parents, educators, medical and health professionals about self-injury. There is an incredible interest in this topic, but because so few people are willing to talk about it, many never get their questions answered. I embrace every opportunity that comes my way to help educate individuals about self-injury.


Do you foresee a point where you never deliberately harm yourself?

As with all persons in recovery, that is my ultimate goal. As of today, I have made it almost two complete years without purposefully injuring myself. Because this is a disorder rooted in emotional issues, the urge to self-injure remains. This is something I deal with on a daily basis. I believe as I continue in my recovery, even the urges to self-injure will fade.


What coping strategies do you use/have you used to reduce the compulsion to self-harm?

I have literally had to learn a new set of behaviors in order to reach this point in my recovery. I have sought out a couple of close friends whom I could trust with this issue and my needs and created a support system for myself. When I am times of emotional crisis, I can call on these individuals, night or day, for support.

In addition, like an alcoholic forced to clean out their liquor cabinet, I too have had to clean out my life…I have had to remove my previous tools of self-injury from my home in an effort to make getting them next to impossible. (I couldn’t throw them away initially, so a friend has kept them for me. Even though I haven’t used them in almost two years, they have been a security blanket for me so long that I’m not yet to a place where I can completely get rid of them. I expect that time to be coming soon and then I believe a new level of healing will have taken place!)

And finally, I have learned how to verbalize my feelings instead of internalizing them. This has been the hardest adjustment of all. But by getting to a place where I say, “I am feeling really overwhelmed right now”, it allows others to know how I am and to offer their support. I no longer feel like I am struggling in isolation and that has helped me to create new trusting relationships with the people in my life and to strengthen my ability to clearly identify my feelings rather than just “hurt” and cut to feel better.


I see from your blog you are still in recovery from anorexia. What triggers this?

I wish I could say this too was no longer an issue, but it is. I am an incredibly sensitive person and so in times of emotional intensity, my appetite is the first thing to go. In many ways, I feel like things in my life have to be going along perfectly in order for me to “deserve” food. The reality is that is rarely the case and that’s why I continue to struggle.


What strategies do you have for prevention of anorexia relapse?

Because this is something that has gone on for so long, most of the people in my life know about it. If I’m not eating, limiting my food intake or exercising too much, people will ask me about it.

As a teacher, I stand in front of nearly 140 students each day and I want to be as positive a role model to them as I can. I use this as a motivator to help stay on track as much as possible.

What’s the best advice anyone has ever given you for dealing with challenges/adversity?

Obstacles are a part of life. These are some of the most difficult times in our life, but critical to our development. I am who I am as a direct result of the obstacles in my life. They have helped to shape my drive and character.

No one likes to struggle, but if we aren’t struggling, we aren’t growing. It is during these times that we learn new things and realize how strong we really are.

In your book it appears you forgive your father, however in your blog, you say you can never forgive him. Which is it and what is your advice to others who feel they have been wronged?

I do forgive my father for many of the things that he has done. I believe he did the best he could at the time with what he had. However, there are other things I find difficult to accept. I have worked hard to move on from those things, but there are still some residual feelings of frustration that remain.


What was the response from other members of your family to going public with the story?

Incredibly positive. I allowed each person in my family an opportunity to read the book before my agent sold it. That way, if there were any discrepancies or questions, we could resolve them beforehand. There were not. My family has been very supportive of this effort and realize how important my story is to others who may be hurting.


What has been the single biggest help in your recovery?

A desire to get well. Period. Without a desire to move on in my life, I would have never had the courage to reach out and get the help I needed. I think each person has to reach “their bottoming out point” and I reached mine. I knew if I did not seek help, I would inadvertently kill myself and I could not allow that to happen.


What is your next book project?

Writing for me is a process. I have currently started two new non-fiction projects and am waiting to see which one fully manifests itself first. They are both completely different books, and so I cannot say quite yet what my next book will be about. I’ll let you know!


To check out a review of Vanessa's book click here.

You can also visit Vanessa's website and blog where she updates her progress.

John Kirwan talks about Depression

In this video ex All Black John Kirwan talks about his personal battle with depression and his role fronting a New Zealand depression awareness campaign. His openness has directly contributed to a higher awareness of depression, breaking down stereotypes about depression, particularly among men.

John Kirwan’s contribution to the depression campaign has been significant, and initial feedback from pre-testing results are confirmed by a national survey showing 78% of those surveyed recalled the advertisements, and of these 98% were positive about them. Both the survey and 0800 helpline callers have identified his personal honesty and openness as a key factor in the success of the campaign.



John Kirwan has since been appointed an Officer of the New Zealand Order of Merit for his services to mental health awareness.

Learn to love your body

According to National Organization for Women (NOW) Foundation, 80% of U.S. women are dissatisfied with their appearance. Gok Wan quotes a similar statistic for UK woman in the BBC show How to Look Good Naked which started screening in New Zealand a few weeks ago.

How to Look Good Naked has some wonderful lessons for any woman who doesn't like the way she looks. One of the most interesting findings of the show, is that most of the woman think they are bigger than they are. In the four episodes I have watched the women had to pick out the woman closest to their size from a line up of six women. So far they have had to pick their breast size, waist measurement and their muffin top (that's the tummy roll that sticks out over the top of your jeans). Consistently the women overestimate the size of their own bodies by 4-6 inches (10--15cm) when comparing themselves to other women, and are pleasantly surprised to find out they are not as big as they imagined.

By the end of the episode they are comfortable with their bodies, and willing to model lingerie in front of a crowd of more than 2,000 people! Check out a review of the first episode of How to Look Good Naked.

At BlogHer Suzanne Reisman reminds us that we are all perfect in our own way, and writes a post campaigning for people to show real untouched images (remember our post a while back on the airbrushed Faith Hill cover image?). She is encouraging everyone to post a photo of themselves in their swimsuit. Are you brave enough to join her?

Shorter Fall Days = SAD Symptoms Kick In

It doesn't take many days of sunsets at 7:50 p.m. for my own mild SAD to kick in. Even though the daytime temperatures are still hitting the 80s, I'm pulling out the wool throws and thinking about making a vat of mac and cheese. This is a common response as we head into Fall. Most of us occasionally suffer from the "Winter Blues," but SAD or Seasonal Affective Disorder is more than that.

According to Mental Health America (formerly National Mental Health Association) , a diagnosis of Seasonal Affective Disorder can be made after 3 consecutive winters of the following symptoms if they are followed by complete remission of those symptoms in the spring and summer months:

• Depression
• Anxiety
• Mood changes: extremes of mood and in some, periods of mania in spring and summer
• Sleep problems: desire to oversleep and difficulty staying awake or disturbed sleep and early morning awakening
• Lethargy
• Overeating: craving for starchy and sweet foods resulting in weight gain
• Social problems: irritability and desire to avoid social contact
• Sexual problems: decreased libido and decreased interest in physical contact

Causes

SAD may be a result of seasonal light variation. As seasons change, there is
a shift in our "biological internal clock" or circadian rhythm due partly to
these changes in sunlight patterns. This can cause our biological clock to
be out of step with our daily schedules.

There has also been research linking the sleep-related hormone, melatonin to SAD. Results of some of these findings can be found on NIMH's (National Institute of Mental Health) site.

Treatment

An excellent resource, for both health professionals and lay people is Winter Blues: Seasonal Affective Disorder: What Is It and How to Overcome It by Norman E. Rosenthal, MD. Dr. Rosenthal explores several treatment options, including the most popular, light therapy, but also herbal, vitamin and antidepressant options. Light therapy is usually recommended, utilizing a 10,000 lux light box, which contains fluorescent light tubes covered with a plastic screen blocking ultraviolet rays. The Cleveland Clinic offers a more extensive exploration of light therapy for SAD. This article also has a list of sources for light boxes. The model shown below is from goLITE.

Most cases of SAD are mild to moderate. But with any possible diagnoses, if you believe you are experiencing symptoms of SAD, you should see your doctor or a mental health professional. Many of the symptoms of SAD can also be indicators of a more severe depression or other disorder.

Easy Goal Setting

Setting goals is simple. All you have to do is write a list of everything you’ve said you would do “one day” or thought you might like to do, but put on the backburner.

Dig up all those buried hopes and dreams and put them on paper. Write down everything that comes to mind no matter how outrageous or improbable it may seem. If the activity is legal and you want to do it, then write it on the list.

Here’s a sample list of goals to help you get started. I would like to...

• learn to play the piano, speak Russian, wallpaper, sail, sing in tune
• walk my dog every day
• paint the spare room
• declutter my desk
  
• backpack in Tibet
• buy a new house
• dine at the best restaurant in town
• write a novel

Now have fun creating your own goals. Get out a blank piece of paper and write down everything that comes to mind, no matter how trivial. Use the headings below as a guide to make sure that you haven’t missed out anything.

1. Physical (diet, exercise, fitness, sports, weight loss, etc.)
2. Career (education, training, job skills, change of job, etc.)
3. Money (savings, income, debt reduction, reduce spending, etc.)
4. Social (friends, outings, clubs, etc.)
5. Education (study, learn new skills, etc.)
6. Family (time together, outings, improve relationships, etc.)
7. Spiritual and personal growth (attend church, read, take time out, etc.)
8. Community (charities, volunteer work, etc.)
9. Indulgence (have a massage, dine at good restaurants, etc.)
10. Other (projects around the home, travel, hobbies, etc.)

Look at each of your goals and decide which goals would make the most positive impact on your life. Next, choose up to three goals for each of the ten categories and write them down on the blank lines.

From there you can take each goal and chunk it down into smaller subgoals, set time limits and a series of action items for completion. I always recommend picking one goal and taking immediate action within 24 hours to get you motivated. Planning is easy, taking action makes things happen!

Another way to motivate yourself is to start seeing yourself as successful, happy, relaxed and confident. You can do this by cutting out pictures of your dream lifestyle or daily visualisation or you could take a more tangible step such as taking your dram car for a test drive. I also recommend talking with other people that have achieved an aspect of your dream life and finding out how they achieved their goals.

Related posts:
The 10 Biggest Mistakes People Make with New Year's Resolutions

Top 10 Bipolar Blogs

John at PsychCentral has created a list of the top 10 blogs on bipolar disorder including bloggers that post on their personal experiences, and those that discuss issues with medications, the latest research and treatments.

Recovery from self injury is a slow process

Over the last couple of weeks I have been reading Vanessa Vega’s memoir Comes the Darkness, Comes the Light: A Memoir of Cutting, Healing and Hope which is one of the best memoirs I have read. My all time favourite memoir is Elizabeth Wurtzel’s Prozac Nation, but this comes a close second.

Normally I whip through books very quickly, but this book makes you take a step back and think. It is at times horrifying to read. I had several ‘Oh my Gawd’ moments when I read about the injuries Vanessa inflicted on herself, and I shed a few tears along the way. While self-harm isn’t uncommon, the secretive nature of self-harmers and the social taboos around it mean that it is a topic that few people are willing to talk openly about and Vanessa’s book is a very open account of some truly horrifying moments.

In Vanessa’s story I found some parallels with other stories I have read about self-harm, in particular her comorbid eating disorder (anorexia) and the escalation of injury over time. However Vanessa’s story is also different in many ways. Vanessa’s self-harm started at an early age and continued for much longer than other stories I have read. Growing up in a household with an autocratic father and a people-pleasing mother Vanessa was actively discouraged from expressing any negative emotions. Sadness, anger and frustration were all banned and Vanessa was sent to her room to reflect on her thoughts.

It is clear from reading this book that Vanessa is someone who spends a lot of time in rumination. She is very sensitive and longed for validation and affirmation from her parents, her teachers and the world at large. For some children being sent to their room may have been an appropriate punishment but Vanessa revelled in the chance to be alone with her thoughts and while there she obsessed over the treatment she received and the injustice of not being permitted to express anger, when her father had a habit of doing that. It was as she later told her therapist convenient, that the rules applied to the children and not to the parents.

While in her room Vanessa would bang her head against the headboard of her bed with such ferocity that at times she felt she might pass out. She also developed the habit of using a cupboard in her room as a safe place where she could hide from trouble, and continued this habit into her adult life.

Her anorexia started at an early age. There is one particularly memorable time when she lay naked and shivering in her room with the window open because she had read that the cold would cause her to burn more calories.

Reading this review of the book you might think Vanessa is being self-indulgent or a bit of a cry baby, but as you read her story you never sense any self-pity. Instead her account of her childhood is so rich in description that you find yourself empathising with her, and understanding why she acted the way she did – including a cunning plan to get her brother into trouble that backfired in spectacular fashion.

Throughout the book it becomes clear that Vanessa’s father has had a profound impact on her life. From the high standards he demanded to his critical behaviour and deadly wit, a picture builds of a child who is psychologically abused. Some of the incidents that Vanessa describes in her book include:

• Upon hearing that Vanessa’s doctor thought she had anorexic tendencies, her father remarked that she was a third world wannabe
• He said she was so retarded the special Olympics wouldn’t take her
• His punishment regime took torture to a new high. Many kids will remember being beaten with a belt but Vanessa’s Dad took it one step further. The child was taken into his room and given a selection of his belts to choose for the punishment. The anticipation of what was coming and being forced to choose the method of punishment only added to the anguish
• Vanessa showed an early talent for writing winning writing contests while still at school. After feeling that nothing was ever good enough for her parents she at last felt that she had her moment to shine. After winning she was asked to rewrite the story in her best cursive so it could be housed in a university collection. In her third year of winning the contest she decided to invite her father to a writing conference.

I wanted my father to be there with me to share in something I had created. But to him, it wasn’t good enough.
“Let’s rework this, Vanessa.”
The story was already accepted. That’s the one I have to turn in.
“No one is going to know. I really think we can work together and make this stronger, okay? You want this to be the best, right?”
Silently, I died a little inside.
I already thought I was the best. I mean isn’t that what first place meant?

Who couldn't empathise with Vanessa's distress? What a soul-destroying experience to have your precious work undermined this way. Unfortunately, things didn’t improve as Vanessa grew older or after she left home. The self-harm escalated. She was peeling the nails off her toes to experience pain, she cut herself ritualistically on a daily basis and towards the end of the story she was resorting to beating her arms with hammers and other implements. I had several ‘Oh my Gawd’ moments reading the book and that was one of them. Another is when Vanessa finally decided to stop taking laxatives in her quest to be slim. After relying on laxatives for so long, her body was unable to process food. Her system was so backed up that she lost 20 pounds in a day!

This is a well written book that provides an insight into the mind of someone battling an eating disorder and self-injury. I was impressed with Vanessa’s willingness to bare her soul and describe her life and her journey to recovery. The book includes accounts of events in her childhood interspersed with stories from her individual and group therapy sessions. The book culminates with Vanessa confronting her father. After many years without contact Vanessa writes a letter to her father and finally meets him as an adult, a process that she described as healing.

My only disappointment is that I felt Comes the Darkness, Comes the Light: A Memoir of Cutting, Healing and Hope ended too soon and left unanswered questions. There was so much more I wanted to know. In the book Vanessa says that she found it hard to get the eating disorder under control at the same time as the self-harm. At the end we find out that she has gone from cutting four or more times a day, to once a twice a year – a tremendous achievement – however it’s not clear whether Vanessa has conquered her eating disorder.

I would also have liked follow up on her relationship with her mother and her brothers as it is evident from the story that much of what happened was a family issue. There is an oblique reference at the end to the effect that her father’s behaviour had on her brothers, and of course, that aroused my curiosity! I wanted to know if they were as deeply affected as she was, and I was interested to know what coping mechanisms they employed. I will be interviewing Vanessa in the next few days so I will put my questions to her and find out more about her recovery.

Watch The Secret for Free

For those of you who haven't yet watched The Secret, check out this link to the first 20 minutes of The Secret Video. This is an official link provided by the makers of the DVD.

Disaster Needn't Dampen Spirits

We all experience unexpected events in our lives - how we cope with them makes all the difference. For some an unexpected disaster such as floods or storms, can cause unending misery, flashbacks and possibly post traumatic stress disorder (PTSD). Others find ways to learn from setbacks and move forward with their lives. Some people experience amazing gratitude and new-found resilience after disasters.

I want to preface the following with an important point. While my friend's experience was intense, it doesn't compare to the loss of lives and indescribable damage suffered recently in many areas from hurricanes, tornadoes, flooding and fires. My intention is not to minimize or trivialize those events.

Late August, my oldest friend's affluent Chicago suburb was hit by a devastating storm. Much like an ice storm we experienced a couple years ago at Christmas, there were unexpected outcomes. I asked her to share her experience.

Did you have any warning before the storm?
That Thursday, the Chicago-area weatherman did not predict severe storms or tornadoes - only more of the rain and possible pop-up storms that had been predicted for the past ten days. The first notice of pending trouble came with a neighbor saying that school was letting out early due to strong storms and a tornado warning. The only other warning was the sudden power outage.

What was your experience when it hit?
"As I went about gathering candles, flashlights and closing windows, the wind picked up and the rain started to pound. When it got really, really loud, I went into an interior room with a brick wall, knowing that was the safest place. But I just HAD to watch so I emerged just far enough to watch through my patio doors. As the noise got even stronger, I saw the top half of my healthy maple tree twist in the wind, snap off and slam into the property beyond, taking the fence with it. In that same gust of wind, a huge trunk fell from right to left across my yard and I could see was a chaotic mass of branches and leaves. Ten minutes later, the howling subsided."

What about the aftermath?
When it stopped, my friend went door to door asking if anyone was hurt or if their homes were damaged. There were no injuries. "This was one of the first 'Aha' moments and we realized how lucky we were." Soon neighbors emerged from their homes and into the street to assess the damage and begin clean-up. And for the next four days while the power was still out and most services unavailable, neighbors collaborated to help each other. They had impromptu shared meals and barbeques on gas stoves and grills as the food in fridges and thawing in freezers was at risk for spoiling. They pooled tools to saw branches, car cellphone chargers and other items to make storm aftermath and cleanup more manageable. Young moms tried to entertain kids without TVs or microwaves. By the second day, as flood waters began to back up into basements, some as much as 18 inches, the collaboration continued. "We gathered for the simple comforts of food and camaraderie."

What did you learn from this experience?
After power was restored, dangling electrical wires fixed and threatening tree limbs removed, there was time for reflection.

"It put things in perspective. During this week of natural disaster and recovery, I learned that bad things are often paired with good things. This was a very, very bad storm, but we were very, very lucky that for the most part, life and limb were spared. Remarkably few people focused on the negative, even those who had to move out of their homes until repairs were done.

It's a humbling experience, one that reminds us life is fragile and can change in an instant. We all came away with a renewed sense of community and appreciation of the power of people working together. In times of crisis, people are amazingly strong, generous and supportive. This fact often gets lost in the drone of daily life and I'm grateful that I got a glimpse of how decent humankind can be. When the next disaster strikes, I'll know that help is only as far away as the next person."

Relapse from antidepressant medication may be lack of response to medication

Have the depression meds stopped working? Or did they never work in the first place? This question is now being raised by researchers who suggest that patients who have an initial response to antidepressants, and then relapse, may have been experiencing the placebo effect.



This is a different issue to "Prozac Poop-Out", a term coined to describe the problem long-term users of SSRI anti-depressants have when they suddenly stop being effective. When this happens the problem can usually be remedied by changing anti-depressants, increasing the dose of the existing anti-depressant or stopping and restarting the anti-depressant.

A new study by Rhode Island Hospital researchers indicates that a relapse during antidepressant continuation treatment may be due to a relapse in patients who were not true drug responders. The loss of drug response may be due to loss of placebo response (a positive medical response to taking a placebo as if it were an active medication.). The study was published in the August issue of the Journal of Clinical Psychiatry.

Historically, the treatment of depression is divided into three phases – initial/acute, continuation and maintenance. During the initial phase, the goal is to reduce symptoms and psychosocial impairment. During the continuation phase, usually six months to one year after initial treatment response, the goal is to maintain the gains and prevent a relapse. In the maintenance phase, which occurs after a sustained period of improvement, the goal is to further maintain the gains and prevent recurrence of the disorder.

Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital and associate professor of psychiatry and human behavior at the Warren Alpert School of Medicine at Brown University, is the paper’s lead author. Zimmerman, along with his colleague Tavi Thongy, MD, also of Rhode Island Hospital and Brown University, conducted a meta-analysis of continuation studies of new generation antidepressants that began as placebo-controlled acute phase studies. Treatment studies of depression have found that approximately 50 to 65 percent of patients respond to medication and that approximately 25 to 35 percent respond to placebo.

Past studies have indicated that a number of patients who respond to treatment in the initial phase experience a relapse or recurrence despite ongoing pharmacotherapy during the two latter phases of treatment. This return of symptoms is often interpreted as a loss of efficacy of antidepressant activity, and is referred to as tachyphylaxis or the “poop-out” effect.

Zimmerman says, “When a patient improves after being prescribed an antidepressant medication you do not know if they got better because of the medication or because they had a placebo response.”

The researchers used formulas developed by Quitkin and colleagues more than a decade ago to calculate the relapse rate attributable to relapse in presumptive placebo responders. “Our study suggests that the return of symptoms despite ongoing treatment during the continuation and maintenance phases of treatment may not represent a loss of drug effect because the patient may not have experienced a true drug response in the first place.”

Zimmerman also notes, “While our conclusion is limited to the continuation phase of treatment, our results suggest that these findings probably also apply to the maintenance phase of treatment.”

Urge Surfing to beat addictions and cravings

A technique known as "urge surfing" which harnesses mindfulness can be helpful for people who are experiencing cravings. Originally developed as a tool to help people struggling to battle alcohol and drug addiction, urge surfing is now being used to help people with overeating, gambling, compulsive shopping, smoking and other compulsive urges.


The idea behind urge surfing is that cravings come in cycles, like waves. They grow in intensity, before crashing and losing their power. By delaying gratification, and taking time to identify your thoughts, feelings and physical sensations at the time, coupled with learning to sit comfortably with your urges you can learn to let them go, and not act on them.

I often find that people confuse urge surfing with simply sitting on their hands and waiting for the cravings to pass. While delaying action can help some people, urge surfing is a more proactive approach that involves listening to your mind, heart and body. For example, where do you notice the craving on a physical level? Are you feeling tension in your shoulders or a gnawing feeling in your stomach? How does your mouth feel? What thoughts are you experiencing? Notice those thoughts and observe them calmly. Keep breathing calmly and steadily and let the thoughts pass through your mind like a video or audio reel.

Instead of battling the urge (or wave) ride it out and wait for it to crash and for cravings to disappear. When you give in to the urge, and give yourself the "fix" you crave, it only increases future cravings. By learning to ride the wave and let it go, over time you will notice cravings are less frequent.

This is a technique that takes time and patience, but if you're prepared to invest the time, it can pay big dividends. The catch is that most people find that the urge to smoke, drink, eat or gamble is so strong, that they forget that this tool is available to them. One good way to get in the habit of using mindfulness to combat cravings is to practise meditation or mindfulness daily, even if only for 30 seconds.

Any time I mention meditation or mindfulness in my workshops, the majority of the students get a glazed look in their eyes, and start fidgeting and complaining that they can't sit still for that long, let alone keep their thoughts focused on candles, mantras or clearing obsessive thoughts. My solution is to start with small achievable goals.

Most practitioners recommend spending 20 minutes a day in meditation. However, for the purposes of beating cravings 30 seconds may be all you need to stop your thought process and reorient your thinking into a more healthy pursuit. Urge surfing can also be adapted to help people with panic attacks or any form of obsessive thoughts. When you have compulsions or cravings, you need a way to interrupt your thoughts before you take action. Mindfulness, or urge surfing, can achieve exactly that.

Recommended Books
Stress Management, Mindfulness and Relaxation

Can you be addicted to food or eating?

Today's Washington Post raises some interesting questions on the issue of eating. There has long been argument over the question of compulsive eating. Is the compulsion to overeat a bad habit, an addiction, emotional or comfort eating, or a response to biological factors such as hormones?

At Brookhaven National Laboratory, psychiatrist Nora D. Volkow and her colleagues map receptors on brain cells for dopamine. This powerful neurotransmitter plays a key role in addiction. Dopamine systems in the brain are disrupted by addictive drugs, from alcohol to methamphetamine, which hijack the control of volition and the brain's quest for rewards.

It turns out that food also affects the brain's dopamine systems. When Volkow, who is also director of the National Institute on Drug Abuse, and her colleagues compared brain images of methamphetamine users with obese people, they found both groups had significantly fewer dopamine receptors than healthy people. Even more interesting: The higher the body mass index, the fewer the dopamine receptors -- a finding that may open the door to a better understanding of why it is so difficult for some people to lose weight and keep it off.

What role dopamine may play in obesity -- and how eating affects it -- is still to be determined. No one knows when the obese people in the study lost their dopamine receptors in the brain or if that loss could be reversed with weight loss. Are some people more susceptible to the effects of eating sugary, high-fat fare because they start out with lower levels of dopamine receptors in the brain? Or could eating those foods decrease dopamine receptors?

The article also refers to the challenges that individuals who feel "addicted" to food face compared with other addictions, such as smoking, drugs and alcohol, which can be eliminated from the diet. Abstinence from addictive substances is a philosophy espoused by Overeaters' Anonymous, which recommends eliminating all sugar and white flour from the diet, to reduce food cravings. In my discussions with people who have been abstinent from sugar and white flour, most have found that this successfully curbs their food cravings, with the proviso, that a life without sugar and flour isn't always practical or desirable.

7 Simple Stress-Reduction Strategies

Like most people who work in the corporate world, my spouse has been experiencing a high level of job stress lately. He works more hours, takes very little time off and often stresses about work even when away from the office. The light at the end of the tunnel, or at least a brief respite, will come in a few weeks when we go to the beach for a week. A week in a beach house is a no-brainer stress reduction strategy. There are countless books, audio tapes and Web sites with similar stress management advice. But here are some simple, everyday things we can do to reduce stress:

1. Take a break from your "real" life

Sure vacations are great; the anticipation, the total change in venue, etc. Unfortunately, not everyone can afford the money or time. But most of us can take an afternoon, a day or two or a long weekend and escape our everyday routines and pressures. Go to a B&B for the weekend. If strapped for cash, visit an old friend out of town. It doesn't have to cost anything other than maybe gas money - take a day and go to a local state park, spend the day in an art museum (especially when they have free admission!).

2. Spend time with friends

With our hectic lives and schedules, time with good friends becomes a luxury. Maintaining friendships shouldn't be such hard work. I often have to schedule a lunch date with my best friend weeks in advance. But considering the benefits of time with someone with whom you can "let your hair down" and be yourself - isn't it worth the extra effort? And I'm not talking about friends who are constantly in crisis or are always seeking your support and advice. When you are feeling stressed is not the time to take on the role of lay therapist! This should be a mutually beneficial relationship.

3. Breathe!

How often have we heard that breathing correctly can reduce stress. It's a physiological response. Most of us breathe too shallowly. Try really filling up your lungs and slowly exhaling, taking 5 or 6 deep breaths. It's a proven antidote for anxiety. One of my favorite books about stress management and relaxation is The Relaxation and Stress Reduction Workbook, by Martha Davis, Matthew McKay and Elizabeth Robbins Eshelman. First published in 1980, it has step-by-step instructions for learning to breathe correctly, progressive relaxation, meditation, visualization and many other stress-reducing techniques. For years I have referred patients to this book in my practice.

4. Use the "right" side of your brain

Much research has been done on the use of the left and right sides of our brains. Simplistically stated, the left side is said to control logical, rational and analytical thinking; the right side - the intuitive, creative and "holistic" thinking. For instance, a math professor would probably be left-brain dominant, an artist, right-brain dominant. I often hear people who are typically left-brained say, "I'm not that creative. I'm a logical thinker." Opening up and exploring that right-brain connection can be a stress-buster. A good example is a friend who is a litigation attorney. Since I've known him he has explored creative pursuits by learning to bake artisan breads and taking a watercolor painting class. Here's a fun, short test to see if you are right- or left-brained: Are You Right or Left Brained? (FYI - I scored 35% left brain and 65% right brain.)

5. Hang out with animals.

There have been studies confirming that having a pet reduces blood-pressure and has many other positive health benefits. My neighbor has a menagerie of animals, both indoor pets and livestock (most of whom are also pets). Sometimes when stressed, I find myself going over for a "horse fix." In their presence, I can feel that stress leaving me. Throw a Frisbee for your dog or build a fort for your cat with bed pillows. Go to the zoo and sit near a rhino or polar bear.

6. Sure, we all know this one - physical exercise reduces stress

But sometimes walking or running on a treadmill doesn't do it. Go smack a tennis or racket ball. Bounce a ball off a brick wall. When I lifted weights, I found pulling down a heavy, overhead lat bar did it for me.

7. Have more fun

Most of us work too hard, sleep too little, make poor diet choices and/or have too much stress in our lives. When was the last time you did something silly and fun? Laughed until you teared up? Rent a truly goofy movie. Call that friend who makes you laugh.

Emotional Eating Carnival September 2007

Welcome to this edition of the Emotional Eating Carnival.

JoLynn Braley presents Overeating - Is It Emotional or Physical? posted at The Fit Shack, saying, "I've experienced a great reduction in the desire to eat over emotions when I've eliminated processed, sugared, foods from my diet. This leads to the question of whether emotional eating is purely emotional, or fueled by physical cravings (food addiction)."

The Career Counselor presents A Weighty Question posted at ask the CareerCounselor, which discusses how people perceive overweight job applicants.

Karen Halls presents Weight Loss Without Cravings And No Diet posted at Addiction Recovery Blog, saying, "This article discusses something most people never heard of - Emotional Freedom Techniques."

The post doesn't tell you how to use EFT for weight loss or emotional eating. If you're looking for information on EFT for comfort or stress eating, I recommend Paul McKenna's book I Can Make You Thin. McKenna uses EFT together with self-hypnosis, visualisation and neurolinguistic programming (NLP). The book comes with a CD and instructions to practise the EFT technique at home.

Chad Sutton presents How to keep a food diary posted at TalkPsych. Sadly the article doesn't provide detailed information on keeping a food diary but it does give you some helpful ideas about keeping a note of your mood at the time of eating.

I love New York! But...

I hate the memories of 9/11. It plays on my depression and my GAD. I knew some of the firefighters that were killed that awful day. I have friends who lost loved ones there as well. It's awful to head into Lower Manhattan and see a large crater where thousands used to work. It's truly heartbreaking to see what once was a gorgeous skyline forever lost.


And yet, we're heading to New York City tomorrow to celebrate our youngest's birthday. This is a tradition for our family for quite a few years now. My daughter's love the American Girl dolls so that's where we head. To Midtown Manhattan, two blocks from Times Square, to what my girls consider heaven....the almighty American Girls Place. We go into NYC at least once a month so you'd think I'd be ok with it by now. But, I'm not.

I panic when I see the Holland Tunnel because enclosed spaces and I do not get along well. Then I start thinking about how much of a target that tunnel is for terrorists. Then I start thinking about how nearly everything in this city is a target for terrorists or some other tragedy. There's the Empire State Building, Rockefeller Center, many bridges, and OH YES, the very famous Times Square. I could easily just skip going to the city for those reasons and many more I don't want to bore you with. But then I think about my girls and how much they love going. My husband would be extremely disappointed too. He sees Ground Zero as a place to pay our respects to the lost. I see it as pain, sadness, and broken hearts. Which makes my depression start to spin an evil web.

I actually sit with a pillow covering my eyes and holding my breath as we enter the Holland Tunnel. Is this therapeutic and medically endorsed? Probably not, but it works for me at that particular time. I do lean on my anxiety medication to help me through the rest of the day. Usually one will do it. Calming me enough so I can not be the person standing in the middle of Times Square having a full on panic attack and yelling about possible terrorism. LOL No I've never done that, but I've come close a few times. :)


I look forward to heading off tomorrow. I can't wait to see my daughter's faces light up when they see the Statue of Liberty. Which is just before I catch site of the dreaded tunnel. It's their joy and happiness that gets me through along with a little help from my old friend Mr. Xanax.

Have a great weekend everyone! I'll be back to post about how the trip went for me on Tuesday.