The Big Screen

Therapists spend a lot of time in various trainings, and sometimes the speakers enthusiastically exhort us to try techniques for ourselves. This was one such day. “I can’t do this mindfulness thing,” my colleague said in an aside to me, “I can’t keep my mind empty.”

Unlike assertiveness, this was one area where I have something possibly useful to offer.

The point of mindfulness in mental health is not to be empty-minded. It’s to select, moment by moment, what will (versus what will not) be the center of our attention.

Imagine a giant movie screen. That’s your conscious awareness, overflowing with all sorts of activity. The thoughts that inspire strong negative emotions are, necessarily, quite compelling. We were designed that way. Otherwise, a lion would have devoured our ancestors, who failed to notice the threat as they contemplated a butterfly. This would have led to us, their progeny, not being here to discuss mindfulness or anything else.

Just so, we are prone to direct our attention to whatever thoughts pop up with negative emotions attached: fear, anxiety, anger, sorrow. They feel more urgent than happy thoughts, the way a lion feels more urgent than a butterfly.

Mindfulness practices simply coach us (over and over and over again) in the gentle practice of noticing the negatively charged thought, acknowledging it, and redirecting our attention to our preferred focus.

If you were watching a huge movie screen, for example, you might be tempted to watch the Antarctic explorer dangling in grave danger over a precipice…or, if that were too intense, you could redirect your gaze to the penguins frolicking in another corner of the screen. It’s your choice. It might have to be made over and over and over, but with practice people are able to do it relatively smoothly, having distracting or upsetting thoughts pop up at undesired times and merely refocusing on the matter at hand. If you are like most people, you are adept at doing this at least sometimes. You have merely to strengthen this skill, and learn to generalize it.

Of course, there is so much more to mindfulness than this: it is a science as well as an art, and grounded in psychology and other health sciences in more than two decades of research that includes brain imaging and not just subjective and scientifically flimsy self-reports. For a lot of people, though, it sounds impossible, implausible and suspiciously more like religion than science.

The best place to seek more information would be to look up the sizable work and research of Dr. Jon Kabat-Zinn, and from there the many practical applications and helpful resources.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2017

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Wrestling with OCD

If you have suffered with Obsessive Compulsive Disorder (OCD), or know someone who has, you are probably familiar with those distressing, intrusive thoughts that create so much anxiety. Traditional psychoanalysis used to focus on the content of those thoughts and seek to uncover the deep, buried wounds and wishes that led to these strange, seemingly alien notions. Thus the woman who was obsessed with the fear that her child would get hurt walking to school might be analyzed and advised that she seems to have a deep resentment against the child and all the responsibilities of motherhood and the worry is really an expression of an unconscious wish to be rid of the child. Talk about a guilt trip…!

Modern research and practice in treating OCD tends more towards the notion that everyone’s brain generates random and sometimes pretty crazy-sounding thoughts. Thus, the treatment is much less about wrestling with the particular content of the OCD thoughts and more about learning to compassionately notice that thought happening among all the other thoughts firing off like popcorn in the typical brain, use strategies to calm down the anxious physical reaction to the thought and refocus, gently and purposefully, on what one would rather think about at that moment in time. It stops becoming “Don’t think about X,” (try that: right now, I forbid you to think about pizza. Ha – how long did it take to imagine a pizza?). Instead, it becomes, “Yup, there’s that thought about X…and now I will take a deep breath and refocus on what I was doing/what’s going on right here and now.”

This is what mindfulness, stress management and cognitive-behavioral therapy can do, together, to help with OCD. The brain changes in response to choosing these behaviors, and the degree of physical distress decreases throughout the whole body.

If you are suffering with OCD, this kind of very well-researched approach may be what you need. Please contact a professional in your area if you think this might be helpful for you.

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Military Mental Health

It seems as if daily we are told how shamefully the military handles the problem of psychological distress and emotional pain for our men and women in uniform. In May, the USA Today newspaper empire asserted that the “Pentagon [is] perpetuating stigmas that hang over treatment, study finds.” (Zoroya, USA Today, May 6, 2016). The military is criticized because it takes mental health issues seriously enough to reconsider security clearances…unnecessarily “stigmatizing” those who have sought treatment.

This supposed stigmatization merits careful consideration. These include the depth and breadth of existing mental health services for active duty personnel and veterans; the conflicted American mindset on mental illness and emotional distress; and the logical outcome of this strange ambivalence.

A person not in the military or close to military personnel, may reasonably be under the carefully groomed media misimpression that the emotional well-being of our soldiers, sailors, airmen and marines is some sort of vague afterthought. Perhaps the general public is unaware that military mental health officers (people who are qualified to be licensed solo practitioners in the civilian world) are found in forward operating bases, combat outposts, and other deployment settings, providing critical incident debriefings, assessments, counseling, and referrals for more comprehensive care. When young men in harm’s way are despondent over a wife’s philandering, or are heartbroken over missing their child’s birth, the mental health officer is there. When there are incoming mortars, the mental health officer is there. When someone’s reaction to the weekly required malaria medication is extreme (malaria meds cause short-lived anxiety in about 1 in 10 people, and for some of that 10%, paranoia kicks in briefly, too), the mental health officer is the one who can figure out what’s going on and have the physician provide an alternative medication for the soldier – saving a military career from dissolving due to what looks like psychosis but is a transient medication side effect. In short, when crises occur, the “doc” or “shrink” or “combat stress lady” (quotes from military personnel) is there.

It is understandable that most civilians are unaware of mental health clinics on military bases, where military personnel and their families can receive counseling. Besides basic counseling services, mental health personnel provide services such as outreach before, during and after deployment, support while preparing for new babies, parent training, marriage counseling, couples’ retreat weekends, substance abuse education, and more. All these are part of the routine in military mental health clinics. Mental health officers are also able to veto a transfer if any member of the transferring family’s health or mental health needs cannot be adequately met at the new location. So…if Mom is being transferred to Base “A” and that area doesn’t have the specialized services that one child in the family needs, the transfer is nixed – possibly by a licensed clinical social worker at Lieutenant rank. The 2nd Lt. just overrode the entire command structure, in the military that is decried for not taking mental health needs seriously.

Then there are the VA system and the Vet Centers. Vet Centers are cousins of the VA. Unlike the VA, Vet Centers require only a DD 214 to provide free individual, couple or family therapy. It doesn’t have to be service-related…but if the problem seems to be service-related after all, the Vet Center personnel can help facilitate connection to the VA proper. These, too, are staffed by people licensed in their respective states as solo practitioners. There are no “not good enough to make it in private settings” amateurs serving in mental health positions.

Finally, there is the difference between benefits (think, Tricare, which is insurance for post-military service) versus service-connected health care (think, the VA system). A lot of veterans get that confused, and any of us who have tried to deal with health insurance and making sense of what is/is not covered, copays and coinsurance, and in and out of network…well, it’s understandable that almost anyone would find it confusing. Fortunately, the VA system and Tricare have professionals who do a lot of work (and get yelled at a lot) in trying to help people understand their benefits/insurance/service-connected health care, and connect them to the right services.

There are mental health services for military personnel and veterans. There could certainly be more, and the services available could be better marketed. In addition…there are stigmas.

Those stigmata comprise one more disgraceful example of too many Americans wanting to have their cake and eat it, too.

The regrettable medicalization of mental health has resulted in the mythology – happily embraced by many in the medical, pharmaceutical and professional-helper fields, as well as by many in the general public – that all mental disorder diagnoses are brain diseases. For example, many professionals will assure you that depression is strictly medical in nature; a brain disease, incurable but treatable by manipulating brain chemistry. Likewise, anxiety is (supposedly) purely a physical issue. People collect Social Security Disability, disability from their employers’ insurance, and other benefits, based upon having some sort of lifelong brain disease (according to psychiatry).

There are plenty of people eager to buy into this. We hear depression is epidemic (what else could we call something that apparently affects at least 20% of women and 10% of men each year, based on prescriptions for drugs?). Well, here is a recipe for depression:

  1. Maintain a sedentary lifestyle
  2. Eat a lot of junk food and assiduously avoid adequate portions of healthy foods
  3. Smoke cigarettes and/or abuse illegal or prescription drugs
  4. Drink more than one drink daily (females) or two drinks daily (males), or more than your physician recommends, given your particular health profile.
  5. Cultivate poor sleep habits. Watch television before bed; heck, watch television in bed, or use your smart phone, or tablet, etc. at bedtime. Drink caffeine less than six hours before bed. Wait until night time to argue with your spouse. Have a “nightcap,” which is a short word for “the alcoholic drink that will let you fall asleep more quickly and then wake up at 2 AM and have difficulty going back to sleep.” Eat salty foods before bed to activate your dopamine system and feel a little hyper.
  6. Avoid exposure to natural daylight.
  7. Watch lots and lots of television, or streaming video, or play video games, or surf the internet. The more the better. Strive for the national average of 6 hours or more daily (non-work related).
  8. Spend lots of time on social media. In particular, notice how much your life stinks compared to other people’s (supposed) lives.
  9. Shop for recreation. Spend money you don’t have on things you don’t need and then keep being surprised when, no matter how fancy the clothes or pricy the electronics, you are still, well, you.
  10. Be selfish.
  11. Don’t apologize, and don’t say thank you.
  12. Think a lot about how much other people are unkind, selfish, lazy, and how generally you are not getting your fair share.

Yes, I just described what an awful lot of people do, and yes, if you do enough of these things, you will probably feel depressed. Yet, as can be seen, every single one of these behaviors is optional for most people. Perhaps someone has physical challenges that prevent them from being active, but otherwise, these all represent choices made, choices which could be changed. If you were to do these things, and feel sluggish, unhappy, uninterested in life, helpless to make things better, etc., and reported this to your doctor, you could easily be diagnosed with depression.

The label depression, of course, is itself suspect. Within the mental health field, we are well aware of a dirty little secret. This secret is carefully hidden by pharmaceutical companies from the unsuspecting, suffering, and happiness-seeking public. That is, the criteria for almost every mental disorder diagnosis is a checklist. Committees review the research, argue about what should and should not be on the various checklists, have professional feuds, and publish the criteria. People are then diagnosed based off a checklist of symptoms or complaints. Those categories are fuzzy – a complaint I hear regularly from graduate students who, perhaps naively, expect pure, clear science. As soon as one set of criteria is published, the process starts all over again. This is how it came to be that, in the current diagnostic manual for the American Psychiatric Association, there is no such thing as bereavement. If you are still moping around after two weeks because someone you love has died, the American Psychiatric Association, in its infinite wisdom, has decided you meet criteria for Major Depressive Disorder. That’s the same Major Depressive Disorder diagnosis that many forces are pushing us to believe is simply a brain disease that requires lifelong treatment. I am not being sarcastic or flippant; it’s their decision, not mine. I was Hospice-trained and, even absent that, I am human and understand that bereavement is a long and painful process, even for the resilient among us.

The decision to eliminate the “bereavement exclusion” was supposedly made, in part, to allow people to use health insurance to pay for grief counseling. (At least, that’s the gossip I hear in mental health circles.) In other words, you are despondent. Someone has died. You go to a counselor. They diagnose you with depression, which is supposedly a brain disease, because you meet checklist criteria. You are now labelled with what many people assert is a lifelong condition due to your sick brain. You will now be able to have insurance cover your counseling (after your deductible has been met, of course). The diagnosis of a major mental disorder will last forever – long after you have forgotten whether you paid a copay or full fee for a handful of sessions, or went to a support group in a church conference room that a therapist facilitated as a volunteer.

Depression is worth discussing as one of the most common diagnoses. Psychiatrists and other physicians provide prescriptions for antidepressants, for example, to about 15% of the adult population annually – and many assert that depression is just a disease, like any other disease, and you have to face that you will be sick and need medication for the rest of your life. If that is the case, then why criticize the Pentagon for being concerned about someone whom psychiatrists assert has a lifelong brain disease having their finger on a trigger, or button, or sensitive data? Why should one person with a particular diagnosis be placed on perpetual disability and another maintain top secret clearance? Which do the people complaining about how the military stigmatizes mental health want?

To be clear, this is not unique to the military. People seek counseling, are unwittingly diagnosed, and discover later that they are deemed mentally ill and a high risk for suicide; perhaps their life insurance rates increase, or their health care premiums increase, and when the premium bills come in, they can’t remember having any mental problems except that time they saw a counselor after their grandparent passed away. The labelling can happen without any mental health treatment at all; if your physician lists a mental disorder as a possible diagnosis (fatigue, depressed mood, and poor sleep being symptoms of lots of problems, psychological and physical) while ordering blood tests (for what turns out to be something medical), that possible mental disorder diagnosis is in your health record, now part of your profile, even if you turned out to be anemic, not depressed.

Even if you are diagnosed with depression, the diagnostic categories don’t adequately describe what is happening, and they should. It is reasonable to expect that professionals, viewing the diagnosis on a chart, immediately discern the difference between these types of experiences:

I’m depressed and exhausted because I’m having hideous nightmares ever since my buddy was blown up and died in my arms” versus,

I’m depressed and exhausted because the 5 years I spent doing meth have caught up with me and my brain has been damaged,” or,

“I’m depressed and exhausted (and right now no one, including me, realizes it’s because I am among the one in 10 women who suffer depression as a side effect of chemical birth control).”

Right now, the label doesn’t differentiate. As you dig into the chart, yes, it’s there – but the most superficial record just shows the diagnosis code.

So, let us not pretend that the military is some big, horrid bully for treating serious mental disorder diagnoses as a possible risk factor for clearance. As long as those in power – throughout the medical, insurance, pharmaceutical and government arenas – are manipulating the definition of mental illness, one can hardly blame the military for being overly solicitous about the mental health of our men and women in uniform.

The conundrum of diagnoses and the risk of damage to one’s life explain why some military personnel are suspicious about seeking mental health treatment. We ought not to assume ignorance when they instead go to chaplains (who may be precisely who is needed) for wise and useful guidance. Similarly, they may choose to be self-paying for marriage counseling, stress management or other issues…off the record and off the base, their privacy is as sacred as mental health treatment ever was, before psychiatry yielded to intrusive insurance, and, as the big player in the mental health field, dragged most mental health professionals with it.

 

Dr. Lori Puterbaugh, LMHC, LMFT, NCC

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Way 12/Day 12: Make it a great year – work hard at something.

Yesterday the message was play – today’s the opposite.

Push yourself at something on an ongoing basis. Not crazy-hard – not without careful consideration of the process of change and development in that particular arena – but consistently. Consult experts for guidance on the particular area so you know how much effort is smart and how much is fruitless and/or dangerous.

Persistent effort changes the brain. Just like stewing over resentments makes one better at being bitter and resentful, persistent rehearsal of a new skill makes us better at it. However, there are limits. The brain develops in the way it develops. Until the brain has reached a certain level of development, for example, it’s not useful to try to pound algebraic concepts into elementary school students. They might memorize stuff to make grownups happy, but the ability to think abstractly that all those pesky “x” and “y” problems require is one related to neurological development, and that happens when it happens, not when competitive parents would like it to be.  That might be age 10 but for other kids, it might not be until age 12 or 14. That’s not a measure of intelligence, it’s just a pace of childhood development.

Staying young-at-brain requires exercising it. Find something interesting and push yourself.

Dr. Lori Puterbaugh

© 2016

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

31 Days/31 Ways: Make it a great year!

Day 6: No whining!

Practice makes perfect. If you practice complaining, focusing on the negative and wallowing in self-pity, you will become very, very good at being very, very unhappy – and pretty miserable to be around, too. The more you think a particular thought, the more energy your body put towards strengthening that particular set of connections in your brain. It’s hard to NOT complain, and there is a difference between whining and asking for something specific or relaying information. Try to catch yourself complaining and reframe it: make it a specific request, for example, or refocus on something positive.

A dear friend describes his approach to this: “Ron” died of a terrible disease very young. When something comes up I want to complain about now – years later – I stop and think, hmmm, how would Ron feel about being able to complain about that right now?

If that approach works for you, please borrow it!

Dr. Lori Puterbaugh

© 2016

The Change Challenge

Everyone wants to make changes. New Year’s Eve fast approaches, and with it, lots of resolving to make changes. Statistically, we hear that most resolutions are cast aside within days. What’s going on?

I find that people make three major mistakes when they prepare for change. See if one, or more of these, sounds familiar to you.

  1. You want change – instantly! Your short attention span means that investing in a process that takes time and sustained effort seems “stupid” or “pointless.” You are unwilling to accept that change takes time. You’ve heard stories about people having some sort of lightbulb moment and then they assert that “everything changed.” Yeah, well, that was the summary. Even if someone can indeed name their “pivot point” or the “a-ha!” moment when they realized change was necessary, or when they knew they’d “hit bottom,” or whatever term they’re using for realizing they need to make a change rather than ride along passively through life, letting change happen to them by default, it’s only the beginning. Actual change simply takes time, and as we all know, our culture is not big on the taking-a-long-time “thing.” We want change, now. Well, I have run many marathons and I never did figure out how to finish any of them in more than one step at a time. There did not seem to be an alternative route to getting the job done.

 

  1. You telescope – and then give up without trying. The flip side to the craving for instant change is a curious phenomenon that I call “telescoping.” You look ahead to a distant goal and see the end performance up close – as if it must happen imminently. Since you’re clearly unprepared to do what’s required at the end (yet), you give up on it. Well, the goal is distant for a reason. The process of getting closer to the goal prepares you for it. This is why freshmen write 2000 word papers and doctoral students write 300+ page dissertations, and it’s why little kids have training wheels and their parents have more gears than they have fingers to count them.

 

  1. You don’t understand that “change” means “change.” You don’t realize that making changes will change you in ways you cannot know for certain until you look back, later. For example, if someone decides to eat more healthily, s/he is simply not able to really understand the many subtle and not-so-subtle ways in which this decision will create change. The numbers on the scale are, frankly, the least of it. Addicted to salty snack foods (salt does indeed hit the brain’s dopamine/reward system quite effectively!) and packaged sweet baked goods, the new eating habit feels like punishment. At first, they resent the terrible restrictions placed on them (by choice) as deeply as a preschooler denied dessert over unfinished green beans. Every day, of every future year, will be, it seems, a torturous process in which they will be denied the cheesy poofs and sugar bombs they crave. They are unaware that eating better foods will change THEM, not just their weight. They cannot see that the person they will be in three months will not be the same person bitterly having almonds for a snack instead of a bag of salty, deep-fried crunchy things. In 3 or 6 months, they will sleep better. They will think more clearly because, finally getting the nutrients it craves, their brain can build new connections, repair old ones, and improve its efficiency. They will have more energy, and their taste buds will probably have recovered so that more nuances besides “salty” and “sweet” are available…but in their imagination, their future self somehow merely “looks better” but has undergone no interior change whatsoever. Their beautiful shell will be angrily chomping on a salad but look fabulous doing so.

Of course, some people do all of the above: they want change to be instant and are utterly terrified at what that change means as if they have to do it all now. They want to “be different,” on the one hand, right now, and seem unable to grasp that making changes will change them.

When you consider making a change, do you fear the initial process? The “sacrifice?” Do you worry the effort won’t be worth it, or do you telescope and, unprepared for the advanced part of the process, immediately discount your capacity to meet the challenge?

Whatever your change-challenge might be, it’s helpful to read the stories of people who made tremendous changes, and talk to people whose achievements you admire. Find out about the doubts, first steps, challenges, etc. See if they, too, wondered about being able to reach their goals, or felt awkward taking the steps towards a goal that seemed so far away and unachievable.

What are you going to change?

Dr. Lori Puterbaugh

© 2015

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.

Are you settling for 10%?

Why settle for 10%?

Sometimes 10% is just right.

God wants 10%. I can live with that.

The IRS wants WAY more than God, and we have to live with that…but it makes us sad.

When it comes to brain power, there’s that myth that “the average person only uses 10% of their brain!” Is that true? Scientists don’t think so, but it makes for good science fiction, when the occasional person is somehow altered to become a combination Einstein-Terminator. The subtle bias that being super-smart means being a freak isn’t lost on us, Hollywood.

It turns out, though, that perfectly normal people, in the absence of script-writers and special effects, can, via disciplined, deliberate effort, substantially – and I mean by up much more than 100 times – improve the speed and efficiency of their neural connections.  Here’s how that works (my apologies to neuroscientists for my gross oversimplification).

First, a little background on our nervous systems.

We have two major categories of nerve cells. Neurons are the ones everyone’s heard of: they’re usually referred to and people often don’t know that any other sort of nerve cell exists. Glial cells are the other kind. Most people haven’t heard of them but the people that have are super-enthusiastic about how much they contribute to our brains. In rock music terms, neurons are the Kurt Cobains: everyone knows who they are and everyone thinks they are great. Glial cells are Chris Cornell: the true nervous system fanatics know how great glial cells are and can’t believe everyone else can’t see past neurons/Kurt (no disrespect to Kurt Cobain intended!). Then we have myelin: it’s made out of fat, particularly those healthy fats such as DHA and EPA. The more you work your brain, the fatter it gets. That’s good – really good.

So…You decide to master a new skill. You focus – hard. The kind of hard thinking that makes your brain tired. It doesn’t matter what sort of skill it might be: kids learning their multiplication tables, a pitcher learning to throw a 90-mph perfect strike, a musician mastering Rachmaninov. Focusing, making efforts, tuning into all the aspects of the activity. Tossing a ball back and forth absentmindedly doesn’t make you a better pitcher. Focusing on the whole body experience – is this foot an anchor or is that leg a spring that, coiled tightly, releases energy at what specific point in the throw? What does it feel like in rib cage, shoulder, elbow, wrist? How is this attempt a little different from the one before? That studied, deliberate focus lights up the neural connections related to that activity, throughout the brain. Over time, as those neurons fire over and over, the glial cells pay attention. Whatever connections are working hardest get glial cell TLC – in the form of extra myelin. Glial cells wrap myelin, that white, fatty substance, around neurons, making the neurons more and more efficient. One hopes, at this point, that the person trying to develop expertise is eating a healthy diet with the right sorts of fats to support this brain development and getting enough sleep. (Consult your physician on this.) Over time, this intense process can improve the speed of the neural connections by up to 100 times! As the neural connection benefits from the support of the myelin, speeding up its efficiency, another change happens: the individual nerve cells themselves become faster by reducing their refractory period (that little, nano-second of rest/resetting between firings) by up to 30%. Factor that into the extra pace of the connections and, well…you do the math. You are upping your brain power by a tremendous amount in this area of interest.

What’s even more exciting is that our options for doing this are a wide-open window: you can go ahead and decide to devote the necessary focus and energy to many areas of interest over a life time, and, given overall health, a good diet and clean living, your brain will continue to dutifully respond to the demands you put on it.

Physical strength training benefits people in their 90s (yes, you read that right) and this sort of brain training – the kind people make naturally when they are interested and self-motivated – likewise can be a lifetime escapade of growth, challenge and fun.

Are you settling for 10%?

 

Dr. Lori Puterbaugh

© 2015

Posts are for information and entertainment purposes only and should not be construed to be therapeutic advice. If you are in need of mental health assistance, please contact a licensed professional in your area.