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Sunday, October 31, 2010

To Lose Weight and Keep it Off, Try a Psychological Intervention

The epidemic of obesity in the US has recently been publicized in shows like “The Biggest Loser”  and “One Nation, Overweight.” In 2007-8, 34% of the US adult population was overweight and 34% was obese, according to figures from the Centers for Disease Control.  Among children and adolescents age 5 and older, the figures were 18 -20%. Being overweight, especially having excess abdominal fat and insulin resistance, the so called “metabolic syndrome,” conveys increased risk for Type II diabetes, high blood pressure, and heart attack or stroke.  There is also evidence from research studies that for many people, dieting alone doesn’t work for long-term weight loss. In one study, less than 20% of obese participants were able to lose 5% body weight and keep it off for 5 years. One reason for this regain seems to be our bodies’ natural tendencies to maintain body weight when food is scarce to prevent starvation.  Thus, dieting can slow metabolism, requiring further calorie restriction to lose weight.  Severe calorie restriction causes negative psychological effects, including depression, anxiety, irritability, obsessive thoughts about food,  binge-eating, and not feeling full even after a binge. 
As psychologists and counselors, we have much to contribute in the weight loss arena.  It is becoming increasingly clear from recent research that weight and eating are complex, incorporating biological vulnerability, activity level, diet, and behavioral and emotional factors. The most effective weight loss programs are those that combine diet, exercise, and psychological intervention. According to the Cochrane review, which synthesizes results of the most recent methodologically sound research, increasing the length or intensity of the psychological intervention significantly improves patient outcomes. In the future, we will see psychological interventions increasingly becoming the state of the art in weight loss treatment.


Cognitive Therapy for Weight Loss
Two innovative psychological interventions that have preliminary research support are Dr Judith Beck’s Cognitive Therapy for Weight Loss and Dr Jean Kristeller’s MB-EAT or Mindfulness-Based Eating Awareness Therapy. Cognitive Therapy is based on traditional Cognitive-Behavioral principles of planning what to eat, scheduling one’s day to include food shopping and mealtimes, arranging the environment to support weight loss and planning for “high-risk’ situations, such as a friend’s birthday party. The program also includes daily reading of written weight loss goal cards and countering counterproductive thoughts about food, such as “I deserve this piece of cake” or “I’ll never lose the weight.” In a Swedish study, the group randomized to receive Cognitive Therapy lost more weight and kept it off over the next 18 months, while those assigned to a waiting list gained weight over the same period.  

Mindfulness-Based Approach
MB-EAT  is based on the Mindfulness approach developed by Dr John Kabat-Zinn at Harvard and focuses on developing “innate wisdom” about food and appetite. Mindfulness exercises teach participants to tune into their own bodily cues of hunger and satiety as well as what specific taste or texture they are hungry for. There is also a behavioral exposure component in which participants expose themselves to increasingly tempting situations, including going to a buffet. The focus is on satisfying and pleasurable eating, rather than restriction.   A study of obese people and binge-eaters given MB-EAT showed that this intervention was more successful than a control condition at reducing emotional eating, and depression.  Dr Kristeller is currently conducting a study adding nutritional advice to MB-EAT to enhance the weight loss component.  
Biological Factors
It is also important to keep in mind that the factors maintaining excess weight are different for different people, which is why there can never be a “magic bullet” weight loss cure that works for everybody, despite advertiser’s claims.  A study conducted in Spain and published in the Journal of Clinical Endocrinology and Metabolism suggests that the hormonal biomarkers leptin and ghrelin were able to identify obese people more likely to regain weight after dieting. It is as if their brains were more resistant to hormonal signals of fullness.  Other studies have shown that people prone to emotional eating, that is eating in response to depression or anxiety, are also more likely to regain weight. There is a research base suggesting a link between abuse and attachment problems and obesity. Environmental factors such as poverty, lack of access to healthy food and exercise facilities, lack of time, and cultural practices also play a part in the weight loss and fitness picture.
Final Thoughts
As clinical psychologists and counselors working with overweight or obese patients, it is important to know about the research regarding weight loss and maintenance so we can individualize treatment to our clients’ lifestyles, biological makeup, and emotional and environmental factors, use approaches that have research support. We should also keep in mind the importance of working collaboratively with other professionals, such as exercise trainers, dieticians, and doctors, to most effectively help the patient. The rewards of this work are that you can teach people new healthy lifestyles that should help to prolong their lives.
Melanie Greenberg, Ph.D. is a Clinical and Health Psychologist in private practice in Mill Valley, CA. For more information about me, visit my goodtherapy.org profile, my website at www.melanieagreenbergphd.com or my blog at http://marinpsychologist.blogspot.com/.
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Tuesday, October 26, 2010

Emotional Storytelling after Stressful Experiences

This is an excerpt from my chapter entitled Emotional storyTelling After Stressful Experiences in the Handbook of Posiive Psychology edited by Snyder and Lopez, published by Oxford University Press, 2002. This work is protected by copyright. All rights reserved.

Dr. Elie Wiesel; a Heroic Emotional Storyteller
Elie Wiesel, an American Jewish writer and Holocaust survivor of Eastern European descent is an internationally recognized writer, teacher, and scholar, who dedicated his life to raising awareness about the Holocaust and about the importance of actively speaking up against human rights violations and genocide, wherever in the world these may occur. In 1986, he was awarded the Nobel Peace Prize for his contribution to human rights, and he has been an inspiration to other leading humanitarian figures, including Oprah Winfrey, whose moving visit with Dr. Wiesel to Auschwitz was broadcast on her program in 2006. Dr Wiesel’s novel Night, which was translated into English in 1960, is an autobiographical account of his deportation in 1944 as a young boy to the concentration camp, Auschwitz-Berkenau, along with his whole family. His mother and younger sister were taken away upon arrival and he never saw them again. He remained with his father until the latter, too, died in Berkenau several years later. 
Night has become the defining chronicle of the inhumanity and evil of the Holocaust. In the following excerpt, Dr. Wiesel describes his difficulty in finding words to describe such horrors and the motivation to bear witness that finally gave him the courage to write about his Holocaust experiences.
Convinced that this period in history would be judged one day, I knew that I must bear witness...Was there a way to describe the last journey in sealed cattle cars, the last voyage toward the unknown? Or the discovery of a demented and glacial universe where to be inhuman was human, where disciplined, educated men in uniform came to kill, and innocent children and weary old men came to die? Or the countless separations on a single fiery night, the tearing apart of entire families, entire communities?...
Only those who experienced Auschwitz know what it was. Others will never know… But would they at least understand?... having lived through this experience, one could not keep silent no matter how difficult, if not impossible, it was to speak…The witness has forced himself to testify. For the youth of today, for the children who will be born tomorrow. He does not want his past to become their future (From Preface to the New Translation of Night by Elie Wiesel, 1997).
Despite the difficulty in finding words to describe these unimaginable experiences, Dr.Wiesel felt a moral obligation to testify and bear witness on behalf of his own family members and other victims and survivors. He wrote to convey the horrors of Auschwitz to those who had not experienced it, and to motivate societies to actively oppose human rights violations; so that future generations could be protected from such a fate. It is not in the traumatic events themselves that Dr Wiesel finds meaning, but in the potential power of his words to evoke outrage and empathy, thereby motivating others to act to prevent a recurrence.
This, then, is one of the potential benefits of emotional storytelling after stressful experiences. It can transform one’s experience from a personal tragedy to a collective moral account. In their potential ability to touch the humanity and hearts of other people, to provoke moral indignation, instill compassion, and inspire action, words can provide the writer with a sense of purpose and potential control over future events that can counteract the helplessness and loss of meaning which characterize the experience of victimization. 

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Thursday, October 21, 2010

Where Did All the Time Go?

As Americans, we live in a society characterized by pleasure-seeking and overconsumption.  We are currently suffering many of the negative effects of overconsumption, including landfills and the obesity epidemic. In the midst of all this abundance, there is one thing most of us are starving for. More time!  More time to sleep, more time with our families, more time to get our errands done. More time to think about our lives and make the best decisions for ourselves, more time for self-care, more time for exercise.  As a nation, we are characterized by our work and productivity ethic. To slow down means to fall behind the competition or not to meet our goals for sales or income, or not to be able to pay our rent at the end of the month.  From High School onwards, most children and adults in this country don't get enough sleep, with damaging effects on learning, mood, weight and a host of other areas. The quality of life of US children is lower than in many European countries, according to current worldwide statistics. When asked what one thing they would like to have, most US children asked for more time with their parents.  Part of the problem with time in our big cities is that our society is so mobile, so we can't count on having family around to pitch in or help us out. Oftentimes, it's all up to us sandwich generation late baby boomers to look after our kids and try to figure out how to visit or care for aging parents living far away.  Marriages are also affected when there is no time for physical intimacy or to take time to negotiate conflict and reach a better understanding of our partner's needs.

As a Clinical Psychologist in private practice in Mill Valley, mindfulness techniques are an important part of my treatment.  Originally developed by Jon Kabat-Zinn at Harvard, mindfulness involves slowing down our minds for long enough to observe our breathing, our subjective experience, and our thoughts.  When we observe our own reactions with relaxed acceptance, we are able to withhold judgment and get closer to our own truths.  When we let go of our attachments to some particular outcome that boosts our self-esteem, we take some pressure off ourselves and can make more conscious and mindful choices about how we spend our time and what we allocate our efforts to.  Research shows that beyond the point at which our basic needs are met, more money doesn't lead to more happiness. Rather, it is the quality of our relationships that makes us happy.  Exercise, health, and fitness can also combat depression and improve sleep quality.   Seeing a psychologist to deal with an important life issue takes time and commitment, but by helping you make better choices about how to spend your energy and resources, it is an investment that can pay huge dividends by giving you more time, choice, and freedom.
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Monday, October 11, 2010

Psychological Effects of the Recession and Coping Tips

The worldwide recession has changed the way we do business here in California. We used to take for granted the fact that our education would buy us opportunities for advancement in our jobs and adequate healthcare. This is no longer true. With many high tech and sales jobs being outsourced, companies merging, cutting costs, laying off employees, and consolidating jobs, many of us are earning less than we were ten or fifteen years ago. There is no job security anymore. Everything is up for grabs.Many of us are paying $ 1,000+ for health benefits and every day there seems to be another vacancy sign as small businesses begin to close. Foreclosures and divorces are up. Many people are taking antidepressants, and stress is at an all time high. Many of us have long commutes and, regardless of whether both parents work, or one stays home and the other gets home after 7pm and travels, life seems to be a constant juggle. Some families are forced to relocate because of job considerations leading to feelings of dislocation and alienation.


As a clinical psychologist in private practice in Mill Valley, I see patients suffering from recession-related stress and associated relationship difficulties, insomnia, weight gain, or increased alcohol consumption.  People have lost their houses and jobs and have to start again or endure long periods of unemployment. For men, in particular, not being able to provide adequately for their families leads to feelings of personal failure, depression, and low self-esteem. Sometimes, this is masked by anger and irritability. This type of chronic, unrelenting stress is associated with inflammation and can and increase vulnerability to heart disease.


Here are some tips to deal with the recession without losing your health:


(1) Patience and Acceptance
These times represent a difficult period for our country and the world, yet they are just a few moments in the endless flow of time. Up and down economic  cycles are inevitable and if we just keep showing up, hang in there, and get through this period, we will get some relief at the next uptick.


(2) Revise Priorities
During the housing boom everybody was spending, spending, spending. We bought lots of stuff we don't need and that probably will end up in a landfill one day, such as excess clothing, toys, holiday decorations, shoes, gifts, home furnishings. Now, with people moving and downsizing, excess stuff just becomes a burden. It takes time to sort through it, costs money to store it, takes time to consign it for not much return. Nowadays, there's less trying to keep up with the neighbors because, most likely, they don't have money to spend either. Without money and possessions to obsess over and spend time accumulating, we can pay more attention to enjoying the beautiful nature around us, and our families.Play with your children instead of taking them to the mall and they'll be just as happy.


(3) Exercise
Exercise will get you out the house and into the fresh air and sunshine or into the gym with its associated social opportunities. Aerobic exercise also results in release of a chemical called endorphins, which are a natural opiate-like substance produced by our own bodies.  If you can't get off the couch, buy a dog, especially an active breed like an Aussie shepherd that will spend the day trying to herd you out the door.


(4) Give back to your community 
Volunteering for your local PTA, cr in the classroom not only keeps you connected and contributimg to your children's education, but offers new social opportunities and community connection. Focusing on doing something concrete to help your community distracts you from your own problems and gives you a sense of efficacy.


(5) Breathe!
Breathing engages the parasympathetic nervous system which puts the brakes on stress-related sympathetic arousal and gets your body moving back towards balance or homeostasis. Some forms of exercise, such as yoga or Pilates involve deep breathing combined with stretching. The air is free so grab as much of it as you want.


If your stress is ongoing, interfering with your mood, sleep, appetite, concetration, or relationships, you may want to consult a psychologist for a professional evaluaion.


Copyright reserved, October 11, 2010 by Melanie A. Greenberg, Ph.D.
My private practice is at 33 Millwood Street, Mill Valley, CA 94914
E-mail me at melaniegreenberg@comcast.net or check out my website at http://www.melanieagreenbergphd.com/ for more information.
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Thursday, October 7, 2010

Six Ways to Deal With Anxiety

We all know the uncomfortable feeling of anxiety. Our heart races, our fingers sweat, and our breathing gets shallow and labored. We experience racing thoughts about a perceived threat that we won't be able to handle.  That's because our "fight or flight" response has kicked in, resulting in sympathetic arousal and a narrowing of attention and focus on avoiding the threat. We seem to be locked in that state, unable to focus on our daily chores or longer-term goals. As a Cognitive-Behavior Therapist with more than 15 years of experience, I have found a variety of techniques that I can teach my patients with  anxiety disorders such as phobias, panic attacks, or chronic worry. Some are based on changing thoughts, others on changing behavior, and still others involve physiological responses. The more aspects of anxiety I can decrease, the lower the chance of relapse post-therapy. Below are six strategies that you can use to help your anxiety.:

(1) Reevaluating the probability of the threatening event actually happening 

 Anxiety makes us feel threat is imminent yet most of the time what we worry about never happens. By recording our worries and how many came true, we can notice how much we overestimate the prospect of negative events.

(2) Decatastrophizing

Even if a bad event happened, we may still be able to handle it by using our coping skills and problem-solving abilities or by enlisting others to help. Although not pleasant, we could still survive encountering a spider, having a panic attack, or losing money. It's important to realize that very few things are the end of the world.

(3)  Using deep breathing and relaxation to calm down

By deliberately relaxing our muscles we begin to calm down so we can think clearly. If you practice this without a threat present at first, it can start to become automic and will be easier to use in the moment  when we face a threat. Deep breathing engages the parasympathetic nervous system to put the breaks on arousal.

(4) Becoming mindful of our own physical and mental reactions

The skill of mindfulness involves calmly observing our own reactions, including fear, without panic or feeling compelled to act. It is soething that can be taught in therapy and improves with practice.

(5) Accepting the Fear and Committing to Living a Life based on core Values

Acceptance and Commitment Therapy (ACT) is an approach that encourages people to accept the inevitability of negative thoughts and feelings and not try to repress or control them. By directing attention away from the fear and back onto life tasks and valued goals, we can live a full life despite the fear.

(6) Exposure

Exposure is the most powerful technique for anxiety and it involves facing what we fear and staying in the situation long enough for the fear to habituate or go down, as it naturally does.  Fear makes us avoid or run away, so our minds and bodies never learn that much of what we fear is  not truly dangerous.


I use these techniques regularly in my clinical practice in Mill Valley, CA 94941. Please look at my website http://www.melanieagreenbergphd.com or look at my artiicle and profile on www.anxietyclinics.com for more detailed information.

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