Crazy Talk

The Relationship Formula

In my work as a therapist, I've noticed that the relationship problems that my clients come in with often boil down to problems in communication.  Well, this is not an amazing revelation, but what I noticed is that people don't know what to do to fix the communication breakdown. 

I've developed a very simple formula for my clients to use and I've been amazed at how universal and how successful it is.  When consistently applied, it never fails.  And I'm going to share it with you.

Step 1 - Figure out what you feel

Step 2 - Figure out what you need from the other person

Step 3 - Communicate both of these things as clearly as you possibly can

Step 4 - Observe the other person's reaction and listen to what they say

Step 5 - Repeat

(note: the results of Steps 1 and 2 may be different when repeated as a result of a properly executed Step 4, which is why repeating for a few cycles is so important)

It may sound overly simple but that's part of what makes it useful.  When things get emotional, as they often do in our important relationships, and you feel stuck, you can refer to this simple easy-to-remember formula.  Like I said, it always works.

Vet the advisor BEFORE taking the advice

I'm not thrilled with the title but since it's been a while since I've posted I thought I'd get to the point instead of stressing over it.

In this age of information overload, time management is essential and I have been encountering a huge waste of time in my practice and in my life in general.  It has to do with coming across some piece of new information and springing into action only to find that the information was misleading or just plain wrong.  Sometimes looking back, I realize that the original source of the information may not have been the most reliable.  This can be a frequent occurrence when dealing with the internet.

But whether online or on TV (or in a blog), we have to get into the habit of considering the source before considering the information.  By actively seeking out trusted sources or at least having a basic method to evaluate sources, we can save an enormous amount of time otherwise wasted chasing "false leads". 

Advertisers want to sell you a product and they're getting more and more sneaky.  Product placements and "news" items that are actually promoting a specific product or service are everywhere. I'm not saying that anything that is advertised is of no use, but you have consider the source before you use the information to make a purchasing or consumption decision.

Don't be Arbitrary - Dosing

I've had a surge of this in my practice to decided to post about it.  What is "this"?  The "this" is patients arbitrarily deciding what dose of medication is their maximum.  Of course we want to use the minimum effective dose and of course side effects need to be addressed, but I'm talking about arbitrarily deciding not to go above a certain number.  If a recipe called for you to put something in the oven for 30 minutes at 400 degrees, you wouldn't just declare that 15 minutes was plenty and that you wouldn't go above 250 degrees.  You wouldn't do this because you know that the outcome of the dish wouldn't be the same.  It just wouldn't cook properly and would lead to a bad outcome.  The same is true with medication doses.  You can't cut the dose in half without likely reducing its effectiveness.  If you are worried about side effects, talk this over with your doctor.  Sometimes the side effects are independent of dose and sometimes they can be minimized by going slowly. 

It's a difficult decision to consider going on medications for any condition but once you've made that difficult leap, don't deprive yourself of relief by sabotaging the treatment by not taking the full dose.

Some Quick Tips (Sleep)

Here are some quick sleep tips (tune in next time for exercise):

Sleep
1)    Quantity, quality, and consistency.  These are the aspects of sleep to pay attention to if you feel like you aren't sleeping "enough".  The first one is obvious, you need a certain amount of sleep and if you are deprived, you'll feel tired.  The second points to the fact that it's not just spending time in bed that's important but getting good quality sleep.  Paying attention to the sleep environment (comfort, noise level, temperature) can help ensure good quality sleep.  Consistency means having a relatively stable bedtime and wake-up time.  Our brains are used to habits and we get thrown off when we don't have a stable routine (think jet lag).

2)    Don't ignore things the effects of things that can interfere with sleep.  Again, this one is pretty simple but people manage to overlook it.  I'm talking about things like caffeine, food, alcohol, and other substances that can make you groggy or too peppy to sleep.  Most people know that caffeine makes you stay awake but will often overlook their post-dinner espresso as a possible reason they can't sleep.

3)      Sleep helps consolidate memory.  There is a good reason to read before bedtime.  There is data that shows that memories can consolidate while we're sleeping.  We might assume that it is better to study early in the morning while we are fresh but in terms of retaining information, it is often better to study new material at night and then sleep on it.  (Remember, this doesn't justify the all-nighter because then you're not actually getting the sleep)

Do you need treatment?

Every once in a while a curious friend will ask me about the patients that I treat in my practice wanting to know why they need to come see me.  The question always stumps me because the concept of "need" is not as black and white as we would like to believe.  Who needs to see a psychiatrist?  The extreme cases are pretty easy to categorize.  Individuals with severe symptoms of depression, psychosis, anxiety, insomnia, whatever, can probably described as needing to see a psychiatrist.  Of course, you then have to define "severe" but let's say that without treatment, these individuals would frequently end up in the hospital and when outside be unable to function.  On the other end are individuals with no mood, anxiety, sleep, or relationship issues...do you know anyone like that? 

In the end, unless we fall in the extreme category, we each need to decide for ourselves, but I wouldn't make the question about whether we need treatment but whether the cost in time and money of treatment makes sense.  With this shift, the stigma of being in treatment would diminish and more of the people who could really use some help would be freer to get it.

Who's physically healthier, the person who gets his annual physical or the person who hasn't seen a doctor in years?  Who has better teeth, the person who sees their dentist or the one who doesn't?  Who's healthier, the person who makes the decision to see a mental health professional or the person who decides that they don't need to?

The Science of Positive Thinking

As the economy suffers and my patients follow suit, I find myself talking more and more about the role of positive thinking in helping my patients feel better.  And I find that I am encountering a lot of skepticism and resistance.  The resistance comes down to a general belief that the positive thinking doesn't work; that it's not scientific.

Not scientific?  Ever hear of the placebo effect?  This phenomenon is so widely accepted that it is taken for granted.  Every new treatment has to prove itself better than placebo to be approved.  But what is the placebo effect if not positive thinking?  The idea behind placebo controlled trials is to determine whether a medication works because it is making some physiological change or just because the patient (and doctor) think it's going to work.  The placebo effect can be as high as 30 or 40% if not higher.  That's an effect based on positive thinking.

In these difficult times, maybe we should pay attention to what science has long accepted.  Believing that positive change is possible can make all the difference.

The Stealth Winter

The first official day of spring is just a few days away and the weatherman described tomorrow's weather as a return of winter.  It's not going to snow but may dip down into the upper 30s.  Certainly not what we want the temperature to be as we gear up for spring, but not exactly the worst the NY winter sends our way.

My focus today is on the importance of our expectations on how we react to certain situations.  Looking back at data on the average temperature historically on March 19 in Central Park in NY shows that the average high is about 46F and the average low about 33F.  These are averages.  The temperature right now at about 1:30 in the afternoon is 43F, toward the upper part of the range so on the warmer side for what is usual this time of year.  Yet for some reason, we expect it to be warmer, maybe related to an association with the official first day of spring.  This is a set up for disappointment.  It's usually colder than it is this year this week and the forecaster still describes the weather as a return of winter.

If we didn't expect it to be spring-like, the weather wouldn't bother us so much.  Maybe what we need to do is move the first day of spring into April.  That's not going to happen but hopefully we can apply this lesson to other expectations we have to avoid setting ourselves up for disappointment.  There is nothing wrong with being optimistic and in fact I've advocated that general attitude in previous posts.  The distinction is holding unrealistic expectations in the face of evidence to the contrary.  It's good to be open to the possibility of how we'd like things to be but better to prepare for what seems most likely given the information we have available.

Freedom of information more than just interesting reading

I read an article today related to New York City's new law that requires restaurants to list nutrition information, including calories, on their menus. The article indicated that the posting of the calorie information has impacted the way that New Yorkers are ordering. It suggested that people are making healthier choices simply by being presented the calorie information.

This observation supports my idea that people often allow themselves to deny some pretty obvious facts, whether related to calories, or health, or most things.

Another area that this could be relevant is pricing for prescription drugs. For many years, pharmaceutical companies have successfully defeated legislation that would require drug prices to be listed on medication bottles. They have invested heavily in lobbying Congress each time the issue has come up. The reason for this is that they know that people would be less apt to be wasteful and irresponsible with their medications if they knew how much they cost. I think this is true even if they are not necessarily the ones paying the full cost. People have a sense of what is a fair price; this is why the market is a useful way to balance cost through supply and demand.

I commend NY legislators for applying their understanding of human nature to give New Yorkers more information about the food they eat and I hope that the Federal government will fulfill their responsibility to the American people by ignoring the drug companies' lobbyists and making the simple requirement that drug costs be transparent.

Staying Sharp by...babysitting?

I just read an interesting tidbit and since, as usual, I'm overdue for a post, I thought I'd share it. Recent research has demonstrated that one important factor in maintaining a healthy brain as we age is socialization. Specifically, it seems that caretaking in particular is linked to longevity and avoiding cognitive decline.

Most people know that human females have a longer life expectancy than males. Related to the observation that caretaking extends lifespan and helps maintain cognition was the observation that in species in which the males take the primary roles as caregivers, it is the males that have longer lifespans!

One take away message is that for people deciding what to do to try to maintain clear thinking as they get older, it makes sense to opt for time with other people, especially in a caregiving role rather than say, doing crossword puzzles alone.

The power of caregiving is also buttressed by the observation that pet owners tend to have lower rates of depression and suicide.

There is no fat gene

Sorry about the microscopic font but Typepad apparently tried to "improve" the functionality of the posting process and for some reason I'm stuck in Arial 13 point.

I saw an article in the NY Times today about red wine being associated with longevity and it highlighted for me what a disservice the media is doing in reporting and subtly influencing scientific research. The article actually goes on to describe some interesting insights about reservatrol, a compound in red wine that is being investigated. However, the title, to me, just gives people an excuse to drink more.

This brings me to today's post. It seems to me that there is a lot of effort that goes into justifying current maladaptive behavior rather than encouraging different behavior that is healthier but requires some effort.

We need to recognize that data can be interpreted in different ways. I imagine that researchers have identified specific compounds that are related to fat storage in humans and that these compounds exist in different amounts in different people. This does not mean that they are a fat gene that explains why so many people are obese.

Evolutionarily, everyone is hardwired to consume more calories than are absolutely necessary because the human organism was designed to function in an environment in which access to calories was not certain. Because meals were not always guaranteed (there was a drought, or the traps were empty this week, or the fish weren't biting) it made sense to have an appetite that ensured a little extra. Well, now we live in a society in which not only are calories guaranteed, they are thrown at us at every turn. Advertisers work to convince us that we need more and more. So it's not surprise that our natural set point is to overeat.

If we want to control our weight and be healthier, we have to use this knowledge to make better choices and not simply rely on instinct.