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Friday, September 27, 2013

Four Things You Need to Know About Menopause

Although women often joke about menopause, most of us agree that it can be a challenging time.  You may experience moodiness, lack of sexual desire, hot flashes, sleep disturbance, or vaginal dryness, due to decreased hormone levels. As you enter your 50's, It takes more work to maintain a healthy weight, and your energy levels begin to decline, making it more difficult to get everything done. There is a silver lining, however. Things will get better before they get worse. Research on happiness shows many people report their 60's and even 70's to be the happiest years of their lives. With old roles changing and new challenges to face, these are the years to really focus on YOU and growing from the inside out.

Last year, I was a speaker at the Embrace the Change Menopause Health and Wellness Summit, along with other authors, physicians, and wellness coaches.

Below are four tips and pieces of information that will help you cope better during menopause:

(1) Menopause Does Not Equal Mental Illness

Researchers have surveyed thousands of women from all over the world and concluded that although there is some increase in depressed mood during peri-menopause/menopause, there is no increase in actual mental disorders such as Major Depression or Anxiety Disorders. Some women are more vulnerable to mental health problems than others - women with a history of depression or severe PMS, those experiencing  severe hot flashes and sleep disturbance, or women encountering other major life stresses at the same time may be more at risk. However, many women weather this transition with only minimal disruption. 

(2) Negative Mood During Menopause May Not Be Biological

Some of the mood & sexual desire change you experience during peri-menopause or menopause is due to hormones fluctuating and eventually decreasing. But some of it may not be caused by biology at all. Today, many women in their mid-40's and 50's are a "sandwich" generation, often facing the dual task of caring for kids and aging parents, leading to stress overload. Kids reaching adolescence may change family relationships. Financial stress of paying for college and retirement, and onset of chronic diseases, such as arthritis, heart disease, or diabetes or layoffs and age discrimination are just some of the challenges you may be dealing with. The good news is that if you're feeling down because of a situational stress, rather than messed up hormones, there's more opportunity to use your psychological coping strategies, such as taking mindful breaks, reaching out for support, or changing your thinking about the situation.

(3)  Mind Over Matter - If You Don't Mind, It Doesn't Matter

Your attitude towards menopause can make a big difference to the experience. Research by Professor Carol Dweck shows us that if we have a 'fixed mindset" and see our skills and abilities as unchangeable, we will have a worse outcome than if we adopt a "growth mindset," believing that we can adapt and grow our skills. A major life change, such as menopause challenges you to learn new new skills and adapt. You may need to learn new ways of communicating with your partner about sexuality and emotions. You may need to learn new skills to guide your kids through adolescence or communicate with aging parents. You may need to cope with unexpected losses or even divorce. You may also need to reach out more and find new friends who can support and understand you. It can be helpful to find new creative outlets to help you discover and express who you are at your core and what is most important to you.

(4)  Pay Attention to What Your Body is Telling You

Research shows that maintaining a healthy weight, having adequate nutrition, and staying active, during menopause can make symptoms and sleep disturbance less bothersome and can also decrease your risk of getting diabetes, cancer, or heart disease.  This may be the time to start a new exercise routine that works for you, as a woman in her 50's.  It is important to find an exercise, and way of eating  that you enjoy and can maintain over the long haul, rather than going for the "quick fix."  Prolonged stress can worsen menopause symptoms, so this may be the time to take up meditation or yoga, schedule more regular date nights, start a gratitude diary or vision board, or go hiking with a friend.

There is a lot of menopause information out there, but not all of it is research-based. Research supports the use of some treatment methods and supplements, but finds some to be ineffective.  Don't believe all the hype. Do your own research and form a partnership with an experienced and compassionate health professional who can advise you.  A psychologist with a specialty in health psychology can also help you address mood, mental health and cope with symptoms and changes related to menopause.

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Thursday, September 19, 2013

What is Acceptance & Commitment Therapy (ACT)?

Have you spent a lot of time and money on psychotherapy or self-help books, yet you still feel stuck in unhealthy habits? Knowing why you are depressed, anxious, or feeling pain  doesn't necessarily make you feel any better.  Understanding what is most meaningful to you in life (such as commitment to your health, family, or work) and committing to taking specific, manageable actions to achieve your goals in these areas can put you back in the driver's seat of your life. Acceptance and Commitment Therapy/Training (or ACT) is an intervention approach used in psychotherapy or workplace setting. 

ACT can help you in the following ways

  • break out of negative thought cycles, 
  • accept what you can't control
  • stop running away from pain
  •  tolerate risk, failure, and uncertainty to 
  • reap the rewards of living a meaningful, engaged life.

Some core principles of ACT are:

(1)  Experiencing the Present Moment

Similar to Mindfulness practitioners, ACT therapists use exercises to help clients remain present and focused on the breath or their moment-to-moment thoughts and feelings, rather than trying to avoid or judging internal experiences. Feelings themselves are momentary, changing experiences in your body and mind. However, because of childhood learning experiences, you may develop negative judgments about feelings and what it means to have them - like "You're depressed again - You're such a loser!"  When you pay attention to the feelings and describe them in language (e.g., my chest feels tight - seems like anxiety), they become less threatening. You realize that feelings will not make you die or fall apart, that you can tolerate them, and that they will pass. Watching feelings rise and fall in your body, gives you a sense of them as transient experiences, rather than part of who you are in essence.

(2) Being Willing to Be Where You Are

Acceptance is a term that is often confused with passivity. In ACT terms, acceptance means "being willing to experience the present moment, even if it's not what we would have chosen."  Acceptance means accepting your life for what it is, including trauma or suffering. ACT helps you realize that you can never completely obliterate or make up for negative experiences. At the same time, you have a choice about what to do with your life now. You do not have to let your views of ourself and your actions be determined by old automatic habits.

Changing habits takes time and effort. Therefore, you need to be willing to be uncomfortable You need to commit and persist even when your efforts aren't bringing any concrete rewards, you don't see major change, or you have a relapse. It takes time to change your brain pathways or to have other people notice you are different and behave differently towards you.

Being willing means you no longer avoid uncomfortable thoughts, feelings, or situations by zoning out, not showing up, turning to addictions, using anger to hide hurt feelings, or procrastinating. If you want to be healthier, you first need to be able to look at and experience how unhealthy you are right now. At the same time, you can commit to doing what you need to do in small daily actions that move you towards health. Lifting the veil of self-deception or avoidance can go a long way towards getting us on the right track.

(2)  Defining Your Core Values

Core values are the things in life that are most meaningful to you and that enrich your life. They include such things as "Being healthy," "Taking care of my family,"  "Being honest and accountable," or "Contributing to society."  When people come to therapy, they are often so overwhelmed with distress, anger, or struggles with pain or addiction, that they have lost touch with what really fulfills them. Even if they know "I want to be a good parent," their day-to-day behavior may not reflect this because they are preoccupied with seeking escape from daily stress or worrying about the future. ACT therapists use imagery and writing exercises to help clients define their individual core values and proactively seek out activities and people that enhance these values in their lives.

(3) Committing to Motivated Action

ACT therapists educate clients that, to live according to your values and live a meaningful lifs, you need to take reasonable risks, get out into the world, and tolerate uncertainty and anxiety. Exercises focus on setting manageable, attainable, meaningful goals - commitment to taking specific, small steps that help you live according to your values. The focus is on taking action, not expecting a particular result, since outcomes may be at least partially out of your control.  To be successful is not necessarily to always feel happy or pain-free, but to live a full life despite the anxiety or pain. By facing what you fear, the fear will eventually lessen, and, even if it doesn't you will know you have done the best we can. This takes you out of the cycle of self-doubt, regret,  and second-guessing.

(4) De-Fusing Your Self From Your Thoughts

A fundamental principle of ACT is that your thoughts, feelings, and sensations are not entirely who you are. ACT includes mindfulness, imagery, and language-based exercises to help you connect with your "observing ego" that can observe your thoughts and feelings, and can deliberately choose how much attention to pay them. Although your thoughts may  feel true, they are not necessarily the truth, because they are biased by your expectations from past experiences. A major ACT principle is that you do not need to let your thoughts and feelings determine your behavior. You can choose how to behave, based on your direct experience (what you see, hear, feel, observe - independent of thoughts or judgments) and your core values. You can evaluate a thought: "Is it kind? Is it truthful?,.." and so on. Based on the answer, you may take the thought seriously or let it pass on by. Rather than changing the content of your thoughts, you can choose to change how much to let them influence you. Thinking you are stupid or fat does not make you stupid or fat - it's just a thought, even if it feels like reality.

Issues and Populations Addressed

ACT Therapy  has been used with substance abusers, people suffering from chronic pain and illness, or patients with obsessive thoughts, anxiety, and depression. ACT works well with clients  who are tired of letting uncontrollable symptoms rule their lives and are willing to take a more active role.

According to SAMHSA's Registry of Effective Programs,

"ACT has been shown to increase effective action; reduce dysfunctional thoughts, feelings, and behaviors; and alleviate psychological distress for individuals with a broad range of mental health issues (including DSM-IV diagnoses, coping with chronic illness, and workplace stress)."

For more information about ACT, go to this link:

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Monday, September 9, 2013

Marin Health Psychologist Blog: How Mindfulness Can Help You Heal Your Emotions

Marin Health Psychologist Blog: How Mindfulness Can Help You Heal Your Emotions: What is Mindfulness? Dr Melanie :  “Developing an observing ego, becoming CEO of your own mind.” Why is Mindfulness so popular ...
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Why You Are Stressed at Work & How Therapy or Job Coaching Helps

National statistics show that American workers are working more hours, but are less satisfied with their jobs than ever before.  

According to the American Psychological Association: 

Jobs and careers are an important part of our lives. Along with providing a source of income, they help us fulfill our personal aims, build social networks, and serve our professions or communities. They are also a major source of emotional stress.

Stress at work can affect your mood, self-esteem, health, and relationships.  Coming home grumpy, zoning out with your partner or kids, drinking too much and being too tired to exercise can create a negative cycle in which your physical and mental health suffer. Job stress or burnout is a major problem that brings people to therapy. Feeling unfairly treated at work or facing a major disappointment can erode your self-esteem and make you question your own perceptions and abilities. 

Below are some of the most common reasons you may be stressed or dissatisfied at work.

1. Fear of losing your  job due to downsizing, mergers, or management changes

2. Not feeling appreciated or compensated sufficiently

3. Toxic office politics & poor leadership

4. Lack of meaning and monotonous work

5. Not feeling like you are growing or learning new skills

6. Age discrimination

7. Lack of opportunities for advancement

8. Too many or unclear demands

9. Lack of resources

10. Low employee morale

What You Can Do

A skilled therapist or career coach can help you understand negative patterns, such as self-sacrifice, perfectionism, reactivity to criticism, or avoidance, and how these may keep you stuck or interfere with your progress and satisfaction at work. Therapy can also help you set goals for a balanced life and prioritize healthy self-care that can keep you strong and motivated to withstand the uncontrollable ups and downs at work.  Therapy or coaching can help you decide whether you need to speak up, delegate more, or make a job change to be more satisfied and at peace.

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Mindfulness Can Improve Your Life - Here's Why

I have been interviewed many times about Mindfulness. Below are my answers to some key questions to help you understand why mindfulness is more than just meditation and can be such a key component of a happy, healthy, and successful life.

What is Mindfulness?

 Melanie  “Developing an observing ego, becoming CEO of your own mind.”

Why is Mindfulness so popular these days?

Melanie  “I think part of it is that the science has advanced and mindfulness has been supported by brain science. People like hard evidence. Furthermore Google, Aetna, General Mills, and other respected companies have become interested in Mindfulness and Google even has a Mindfulness Officer. When Google does something, businesses and people follow. And then a third reason is the times. We have experienced substantial changes in the work and financial environment since the global recession and  the wars in Iraq and Afghanistan… I think that people feel they have less control over their lives. Faced with uncontrollable events the usual problem-solving coping strategies do not work as well anymore. People are looking for different solutions.“

What are some benefits of practicing Mindfulness?

Melanie: “Improved relationships, less anxiety and better health – less stress, better life balance. Studies have shown mindfulness lowers blood pressure and improves chronic pain as well as creating beneficial brain changes related to empathy, focus, and emotion regulation."

How can I begin to practice Mindfulness?

Dr Melanie: "Mindfulness means deliberately and gently guiding your attention to whatever you are noticing, thinking, perceiving, or sensing right at this moment.  You can begin in the shower or while washing dishes. Notice the warmth of the water, the smell of the soap, the sight of the bubbles, the feeling of being clean or making something clean. Notice what you are thinking and feeling. Are you in the moment or is your mind already doing the next errand or planning your day? Can you begin to slow it down and gently bring it back?"

Why choose a therapist who integrates Mindfulness with psychotherapy?

Melanie: "Mindfulness is kinder and more objective way of relating to your own thoughts and feelings, It can help you feel more comfortable with them, deepen your emotional experience, while at the same time making it more peaceful and less frightening. When psychotherapy leads to recollection of painful memories, Mindfulness is a powerful tool to keep you grounded and stop your brain's fear centers from taking over. With repeated practice, it can have an uplifting effect, making you more resilient and positive and less emotionally reactive. This helps you make faster progress in therapy as you with less pain and distress. You will have a powerful new tool to deal with feelings and calm your brain down."

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