Stephanie Livingston–Psychologist

HABITS ARE HARD TO BREAK
Humans are creatures of habit. What we did yesterday is likely what we will do tomorrow. Most of us have some type of daily routine. Get up, shower, brush teeth, go to work or school, eat three meals, watch some TV, exercise, socialize and go to bed only to do it all over again the next day. Even if this is not your exact routine, you probably have some variation that you have stuck to for years. Of course you did not emerge from the womb with these habits, you learned them over time. And years later, these habits are second nature, you don’t even have to think about them. This can be a blessing and a curse. A blessing because you don’t have to spend your precious brain cells on consciously thinking about these necessary activities—you just do them. The curse is that changing habits which are no longer useful, is not always easy. We get comfortable in the way we do things and change seems to be like too much trouble. Unless someone or something pushes us out of our comfort zone, we end up repeating the same only patterns, similar to Bill Murray in the movie Groudhog Day-awakening every day to the same sequence of events.
Some examples of human laziness for change are: singles who identify their parents as beneficiaries for their bank accounts, rarely change their beneficiary after marriage.
This type of living reminds me of the anecdote about the daughter, mother, and grandmother who were preparing Thanksgiving dinner. The youngest daughter asked her mother why she cut off the ends of the ham before putting it in the baking pan, to which her mother replied, “I don’t know, that’s what my mother always did. The mother then asked her mother (the grandmother) why she cut off the ends of the ham, to which she replied, “Oh back in my mother’s time the pans were too small to fit the entire ham, so they cut off the ends.” The lesson here is that sometimes we just repeat what are parents or grandparents did, without ever questioning why. Today’s bakeware is probably more than big enough to hold an entire ham. But because the question was never asked, cutting off the ends of the ham became a useless tradition.
Change can be scary, time consuming, effortful and sometimes costly. But, without change we tend to remain stagnant. We might complain about our plight, but lack the motivation to make a change. Whether it is dissatisfaction with your job, your relationship, your body or your way of life change is a process. You first need to become aware that you want to make a change. Most smokers have tried to quite many times. Dieters have usually tried numerous fad diets to lose those extra pounds only to lose and regain even more weight, succumbing to yo-yo dieting.
What are some of the reasons our attempts to change unwanted habits get derailed?
*fear of change
*conditioning
*too much work
*feelings of loss (giving up something you enjoy like eating, gambling, smoking)
*physical addiction
*behavioral addiction
*peer pressure to stay the same

If you feel stuck in a dead end job, but you are afraid to interview elsewhere or go back to school to get more education, fear may be keeping stagnant. It seems so much easier just to stay put than to venture into the unknown and risk failure. But rest assured, if you do nothing, five or ten years now you will be that much older and still complaining. If you are 30 now and dissatisfied with your situation, do you want to be 40 in the same place. The older you get, the less likely you are to venture out to make a change.
Sometimes it just seems too hard to do things differently. You might have to actually invest time and energy into pursuing something new like dating your resume, brushing up on interviewing skills. If you are looking for love, you may have to step outside your comfort zone and do some new activities or write a dating profile. Or if you are trying to stop smoking, you may have to figure out what else you will do with your hands when you are having a drink or how will you relax, when smoking is your favorite form of winding down. Although, many smokers don’t realize that there is nothing about smoking that is relaxing because it increases blood pressure, heart rate, and respiration rate. The reason most people think it is relaxing is because they are doing relaxing activities while smoking (e.g., taking a break at work, sitting quietly after a meal). It’s the taking the break and sitting quietly that is relaxing and the smoker merely learns to associate smoking with relaxation because the two are happening together.
Conditioning is one of the biggest reasons we do the things we do. Skinner states we learn things through reinforcement and punishment. Rewards increase behavior and punishers decrease behavior. You are more likely to show up for work if you get a paycheck (reinforcer) and you are less likely to run a stop light if you get a $100 ticket (punisher). Pavlov posits that we learn through association, you pair to things together enough, when one thing happens you expect the other to happen also. If you are used to eating while watching TV, the TV may become a cue to eat, such that whenever you turn on the boob tube all of a sudden you want to eat, even if you are not hungry. And Bandura suggests that we learning things though simple modeling—observing someone doing something and imitating that behavior yourself. Girls model their mothers and boys model their fathers. How many habits do you have as a direct result of what one of your parents did?
Sometimes we don’t want to give up a behavior because we feel as though we are losing a part of ourselves. We then have to grieve the absence of that thing. You may enjoy going to the bar after work, gambling at the casino, or shopping for unnecessary things. Giving up those past times that have become addictions may leave a big hole in your life and you may not know how to fill it. Physical addictions can cause physical withdrawal when the behavior ceases. Similarly, behavioral addictions can have emotional consequences when it stops. That momentary high of buying yet another piece of jewelry on the shopping network or the excitement of taking a chance on winning a slot machine may leave you feeling empty if you give it up.
And sometimes it’s just pure peer pressure to maintain the status quo. Your friends may pressure you to have that extra dessert when you are dieting, go out drinking when you are on the wagon, or go to the mall, when they know you can’t control your spending. These are not your friends. Misery loves company. Your getting healthy may make them feel worse about themselves, but that is not your problem. Whenever you are confronted between having to choose between your so called friends and your values, think of the long term consequences of your decision. Be assertive, say no, and live with any guilt you may feel about not pleasing them.
If you are contemplating making a change, but don’t know where to begin start by:
*setting small weekly goals to ensure you have a successful experience. Cold turkey doesn’t work for everyone.
* reward yourself with something small (not food) when you accomplish your goal to keep yourself moving in a positive direction.
*replace the bad habit with a healthy habit. Otherwise, you are more likely to revert to your old ways if you don’t have a new coping mechanism;
*Say no, when you mean no and work on the guilt later.

FREEZE YOUR EGGS OR GO ON DATES

Have you give up on dating? Are you sick and tired of being sick and tired? I’m speaking to you, thirty- something, single females out there, because men don’t usually give up on finding someone with whom to cuddle no matter what the circumstances. Ladies, on the other hand, upon reaching the big 3-0, when dating has become a chore after more than a decade of finding Mr. Wrongs and no trip down the aisle, start thinking about alternatives. If you have traded in your stilettos and mini-skirts to dance the night away, for sweat pants, potato chips and a trot to the couch to watch the latest episode of Scandal—you just might be on the road to technological birth control. Dancing to the wee hours of the morning just seems like too much work with very little return. “After all, I probably won’t meet anybody anyway”, is a common refrain. You have a stressful job, working 60-80 hours per week and now your boss wants you to spend your leisure time with co-workers bonding in a game of laser tag or hanging out at a bar after work and sometimes on weekends! Has she lost her mind! It’s bad enough that I’m expected to answer e-mails in the middle of the night and eat lunch with my co-workers, that last thing I want is to spend “quality time” with the hired hands. So with all this time I’m spending with people I don’t mind working with, but with whom I don’t particularly care to socialize, I have no energy to develop my own personal life. It is unlikely I am going to meet my husband at work because most of the guys are dweebs, and even if I found a diamond in the rough I have a firm policy of not dating or even befriending co-workers. It rarely turns out well and then you still have to work together.
So you do the math. Let’s say that you spend 45% of your time doing work related stuff, 30% sleeping (yea right) and what’s left is me time–maybe 25% or six hours per day or 42 hours per week. That sounds like a lot of time but that includes, eating, hygiene, errands, church, volunteering, chores, and the list goes on. So you can see, if you don’t make a good faith effort to get out there in the dating game, you may be freezing your eggs sooner than you think.
Countless women have fallen for the ruse—women can have children into their forties and fifties these days. Modern technology has given us a taste of the fountain of youth. But no one really talks about the long term effects of various birth control methods, artificial inseminations, stimulating ovary hormones injections, or the psychological consequence of your test tube baby not knowing who their father is. Yes, it’s nice to have the option of freezing your eggs, but be careful not to see it as your first course of action. Some companies are even offering to pay for their female employees to have their eggs frozen. This may appear to be a real benefit on the front end, but may be detrimental on the back end. Companies are trying to make it alluring to commit most of your time to the office. Having beauty shops, food and cleaners on site makes it easy just to stay at the office. This is a trap. Freezing your eggs may just be an extension of dedicating your entire life to the office. If you don’t have to worry about having time to date because you are spending 80 hours a week working, you at least have the assurance that if you whittle away your childbearing years, modern technology is there to save the day.
The message is that there is nothing wrong with climbing the corporate latter or merely advancing your career by putting in the time, but keep in mind that time waits for no one, and if you’re thirty something, single without children and working 80 hours a week, you’re running out of time. Your default should be going the traditional route first—having balance in your life. If you are making time for yourself and engaging in social activities on a regular basis and actively looking for love you are more likely to find it versus hoping that prince charming will show up when you have reached the pinnacle of your career. Dating sites, meet up groups, introduction, being social, engaging in activities, blind dates, are all good ways to increase your chances of increasing your odds of finding companionship and maybe a daddy for your baby. If you aren’t doing any of these approaches, you are relying on luck to get you through. But remember that luck is merely preparedness when opportunity presents itself. So get your head out of the sand and off the couch and try to make something happen. And if you have been trying all these years and things just haven’t worked out re-examine yourself while you are in the process of putting those eggs on ice. Maybe you are getting in your own way. Maybe it’s you and not them who has issues. If so, fix it. Start by being aware of these pitfalls
Don’ts
1—be a workaholic—setting goals for your career but not your personal life
2—be afraid of intimacy
3—develop single-it is—getting used to being alone
4—date unavailable men (married, living with someone, commitment issues, gay,
5—–replace love with addictions (eating, gambling, shopping, drugs)
6—avoid socializing
7—hang out with the girls, married people, or family too much

Do’s
1—have good work/life balance and set goals for your personal life (be as diligent in your personal life as in your career)
2—figure out if you have a fear of intimacy (daddy issues, abuse)
3—do get comfortable with the idea of sharing your life and space being single (let him leave his toothbrush at your place, watch a football game even if you don’t know what the heck is going on)
4—date men who want the same things you want—commitment (if he says he doesn’t want to be tied down—believe him)
5—acknowledge that you are eating, drinking, gambling, shopping, or drugging because YOU ARE
LONELY!!!
6—get off the couch, put the ice cream back in the freezer and go mingle
7—spend more time with single friends who are also looking for love

If you see yourself way too much in the Don’ts list, you’ve got some work to do. Start today. Every day do one thing on the list. In just one week you will be well on your way to getting the love you want and keeping your eggs off ice.

DO YOU RELY ON THE RIGHT OR LEFT SIDE OF YOUR BRAIN?

Although we typically think of people who are logical, linear, methodical and verbal as being left siders. While the more creative, artsy, sensitive, and holistic ones are right siders. All the left siders in the house say “hey”. Now, all the right siders in the house say “hey.” If you are an accountant, engineer, or bank teller, you probably rely on the left side of doing things. However, if you are an interior designer, artist or entertainer, you tend to swing to the right more often. One side is not better than the other—just different. In fact we need both sides to function fully and to achieve the success and happiness we desire.
To give you a little neuroanatomy, the brain has two hemispheres connected by a small strip called the corpus callosumum. As mentioned earlier, the left side helps us to acquire and use verbal skills (e.g., language) and the right side more visual-spatial skills (e.g., driving a car). Another little tidbit is that the brain is contralateral to the body—meaning, if you had a stroke on the right side of your brain it would affect the left side of your body. But fortunately, if you have damage to one side of the brain, the other hemisphere helps to compensate for the loss. For instance, someone who loses their sight, might develop a keener sense of hearing. Our bodies are wonderful creations that have checks and balances to help us live full, productive lives. We have evolved to be survivors.
Our society so far has tended to lean more heavily on left side thinking. From hunter-gatherers, to farming, to industrialization, to technology—the southpaw brain has dominated. We tend to pay more respect and financially compensate more for logical linear thinking. How often have you heard, “when you go to college, major in the hard sciences (i.e., math, engineering, computer science), you’ll make more money. Or don’t become a “starving artist”. The message is– if you want to be “successful”, you should choose a path that will provide financial security. You can pursue your passion to become an actor or musician, but be prepared to live on a shoestring, until you make it big. Fortunately, that thinking is beginning to change. Schools of higher learning are beginning to realize that high scores on standardized tests are not the only predictor of success in life. Longitudinal studies have demonstrated that good grades are just as predictive of success in life as standardized test scores (e.g., ACT, SAT). Not to mention, it is becoming more and more important to be able to demonstrate that you are a well-rounded person versus just being a good test taker. I think the movie Internship is a good example of demonstrating the importance of balance. The nerdy, overachieving, highly educated, Millenial, Google interns were able to learn a great deal from the fast talking, fun-loving, unemployed salesmen—Vince Vaughn and Owen Wilson, and vice versa. Together, they made a winning team—left brain and right brain working together.
More and more, companies are recognizing that to move into the future, technology, combined with creativity is the winning strategy. Using both sides of the brain coupled with incorporating people from diverse backgrounds yields better results. Logic and creativity, will be necessary to compete in a global economy. So start padding your resume with activities outside the classroom. Are you volunteering or taking music, dancing, or acting lessons? Isn’t this a much fairer system than giving an unfair advantage to students who have the resources to take test preparation classes, or who have contacts to pave the way to enter college? Everyone has something to contribute, if given the chance. The graffiti artist from meager means may make a great graphic designer. Or the drug dealer, might possess the skills to run a legitimate business one day. You never know where the next Steve Jobs is coming from.
And lastly, let’s not forget your mental game. Performance of any kind is largely dependent upon your thinking habits. Whether you are primarily a left or right brain thinker, your emotions can either hurt or help how well you do. You may know a lot of facts, but when it comes to taking a test, your anxiety may make you fall on your face. Similarly, if music is your thing, and singing in your apartment or recording studio is great, but when you get on stage you freeze, you are not in control of your thoughts and emotions. Or if you are a writer, writer’s block can be a terrible demon to tackle. The strategies for managing performance anxiety are the same whether you rely on the left or right side of your brain to perform. Read my article on Test Anxiety for more information on this topic. Regardless of which side of the brain you rely on, try to develop the other. I learned in Martial Arts that whatever exercise we do on the dominant side of the body, we do twice as many on the non-dominant side. So if you are right handed and you did 10 moves with your right arm, you would do 20 with your left. In that way you are training your brain to use both hemispheres. Don’t neglect your non-dominant side—nourish it. It will pay you great dividends. Memory games, crossword puzzles, playing sports, can all help you to integrate both brain hemispheres. Don’t become too one-sided. Don’t be the nerd who doesn’t know how to have fun, or the laid back person who doesn’t have a plan. A little of both should do the trick.

BODY LANGUAGE–WHAT IS YOUR BODY REALLY SAYING?

Did you know that you communicate more with how you say things rather than what you say. Some researchers have revealed that approximately 55% of what we say is communicated non-verbally, 38% by tone of voice and only 7% is what we actually speak. Our body language is important in most aspects of life, including business, education, health, as well as sports and entertainment. Whenever you are trying convey a message, impress, influence, intimidate, control, or perform, your body language plays a huge role. How attentive would you be if you were in a lecture with a speaker who had a monotone voice and did not make eye contact with the audience? You might just fall asleep. Or if you wanted to show interest in a man with whom you are conversing, but your arms are crossed around your chest, you keep looking round the room and are facing away from the guy you hope to catch. What message are you really sending? What about the athlete who made a blunder on the field and walks around with his head down and pouting? This is not a message of confidence but defeat. Or you are a student sitting in class slumped in your chair while looking out the window? What impression do you think your teacher has of you? These are all situations where body language may be sabotaging your efforts. Our outward appearance affects how the outside world perceive us. However, these same behaviors can also influence our inside world.
You might be surprised to learn that putting a smile on your face when you are down, can actually make you feel happier. Or striking a confident pose, can make you feel more in charge. Researchers have actually studied the impact of body language on our emotions. One cosmetic surgeon noticed that his female patients who were depressed before getting Botox injections to remove frown lines, were less depressed after the injections. To test his observations, researchers studied the effects of Botox injections on two groups of women seeking treatment: those who wanted Botox for minimizing frown lines around the mouth and those seeking treatment for crow’s feet around the eyes. As expected, women who received Botox injections for frown lines were less depressed after treatment than women who received Botox for crow’s feet. These findings suggest that changing our outward appearance can alter our internal state.
It is not clear what the mechanism is that results in an internal emotional change from an outward physical change. One might speculate that the change happens because other’s perceive and react to us differently when our outward presentation is more pleasing. You in turn may feel better how they treat you. More importantly, it is likely that your mind and emotions subconsciously tend to want to align with your body. Your body is telling you how to feel. Studies show that when people are forced into a smile by holding a pencil between their teeth lengthwise report feeling happier than those who put the pencil in their mouths with their lips around the eraser, creating a frown.
once treated a woman who realized how her body language was affecting her dating life after an incident riding the bus. Carly happened to be sitting on the bus with an empty seat next to her. There was also an empty seat next to a woman across the aisle. A nice looking gentleman got on the bus and headed in both women’s direction. She noticed that the woman across the aisle made eye contact with the man and smiled. Carly on the other hand, had her arms crossed and looking away from him. Not surprisingly, he sat down next to Suzy Sunshine instead of Debbie Downer. Men, when given the opportunity, will take the path of least resistance. They don’t want to work too hard to get the girl. Carly immediately felt rejected, but looked in the overhead bus mirror and noticed her body language. It was then that she became aware of part that part of her difficulty in meeting men was by creating physical barriers. From that day forward she began to have more positive body language and she noticed she started to feel better on the inside, even if she didn’t get a smile from Prince Charming. So the next time you are feeling down, lacking confidence, or succumbing to anxiety pretend you are the person you want to be. Stand up straight, put that smile on your face and fake it til you make it! It will help you jump start the new you!

HOW BIOFEEDBACK CAN HELP YOU

Whenever you weigh yourself on a scale, you are using a biofeedback  instrument, the scale.  The biological piece that it is measuring is pounds and the feedback modality is the scale that provides that information . Something as simple as putting your hand over your heart and taking your heart rate can also be viewed as a form of biofeedback.  Your hand is the instrument and the feedback signal is the number of beats per minute.  What is the advantage of  having biological feedback information.   Well, the major advantage is that once you have the information, you can manipulate it.  Once you know how much you weigh, you can increase or decrease you weight and monitor your progress.  Likewise, once you become aware of your heart rate, you can make the beats go up or down or even skip beats if you so choose.  Some yogis are actually able to stop their hearts through intensive meditation practice.  Nowadays, biofeedback instruments are very sophisticated and oftentimes computerized.  There are instruments that measure muscle tension, blood flow, brain wave activity, blood pressure, respiration, heart rate, and heart rate variability (i.e., the activity between heartbeats).  It was thought that many of these bodily functions were automatic and that we had no control over them.  However, now we know that  once it is brought into our awareness we can in fact learn to control all of these systems in our bodies.

For instance, if you have a migraine headache, biofeedback can help you learn constrict and dilate your blood vessels at will, and thereby alleviating a vascular headache. This form of biofeedback is called temperature or thermal training.  This involves attaching a thermistor, which measures temperature; to your hands.  By learning to increase your hand temperature, you can essentially alleviate a migraine headache.  The same is true of electromyography to reduce muscle tension, EEG or neuro-feedback to stabilize brain wave patterns in seizure disorders, and respiration  rate.  Heart Rate Variability (HRV) is another form of feedback that helps an individual to control heart function.  It has been found that negative emotions such as anger, frustration, anxiety and stress can have a negative impact  on HRV.  The good news is that you can learn to control the impact of these negative emotions on your body.

Through the use of diaphragmatic breathing and imagery, a person can learn to  alter physiological functioning via biofeedback instruments.  Imagery often involves visualizing a relaxing picture in your mind, like lying on a beach or sitting by a lake.  Some studies show that images of feeling loved or appreciated are more effective when trying to learn heart rate variability.  In either case, our bodies tend to respond in a positive way to these images.  Our minds do not always distinguish between reality and fantasy.  If we visualize a stressful meeting with the boss, our bodies may respond with a stress response, (i.e., increased heart rate, blood pressure, muscle tension) at just the thought of the meeting.  Likewise, if you were to picture a relaxing scene, your body would respond with a relaxation response (decreased heart rate, blood pressure, muscle tension).    Biofeedback merely speeds up the learning process to control these different aspects of your body.  Through reward and punishment you can learn to change  bodily functioning at will.  An auditory and/or visual signal will let you know how you are doing and thereby shaping your behavior.  Sometimes games are part of the learning process to make things more interesting.  In each game, you get rewarded for changing your behavior in the desired direction and punished for the undesired direction.  Practicing just a few times per day can have a significant positive impact.  And this is all done without medication.

The practice of biofeedback is regulated by the  Biofeedback Certification International Alliance.  If you  are interested in biofeedback please call the BCIA office to locate a professional near you.

Should a man ever hit a woman?
I was listening to the radio on my way home from work and heard a controversial conversation on a relationship program. The topic of discussion was about violence between men and women and whether or not a man should ever hit a woman. This discussion came on the heels of the suspension of ESPN columnist Stephen Smith for allegedly making politically incorrect statements about the incident involving Ray Rice being caught on video physically abusing his then fiancé and now wife. Although Smith never condoned Rice’s actions, the fact that he brought up the issue of “provocation” in preventing violence, created a firestorm of criticism. It is a sad day when we can’t look at situations objectively. Just the act of questioning what precipitates a violent event, to some suggests condoning the misdeed. People are capable of just about anything under the right conditions. We know that there are often precipitating factors that can trigger violent actions including, environmental conditions such as crowding and heat; acting in self-defense; and mutual consent. It’s not surprising that crime rates increase in summer and overcrowded hot tenement housing is the breeding ground for aggression. And it is not all that uncommon for both men and women to engage in violent acts with each other. And there are times that people act against their values to inflict unnecessary violence when an authority tells them to do so.
Studies on violent behavior have demonstrated each of these conditions. When people read a list of aggressive words that tend to act in an aggressive manner. Children who watch violent video games tend to act more aggressively. And workers may displace their anger toward a demeaning boss by coming home and kicking the dog. Each of these situations can lead to violence.
The Milgram studies demonstrated how obedience is influenced by authority by shifting blame. In this study, subjects pretending to be prison guards were instructed to give increasing amounts of shock to pretend prisoners, for giving incorrect answers to questions. Prison guards administered large amounts of shock when told to do so, despite hearing the cries of the person receiving shock. This study was conducted by Stanley Milgram to investigate the atrocities of Nazism.
The point here is that asking the question of provocation before a violent act is important. It does not suggest that the violent act is right or deserved nor blaming the victim, but merely asking the question as to the circumstances preceding the act. After all the goal is violence prevention. If, as a society, we hold fast to the idea that a man should never hit a woman under any circumstances, we are being remiss in doing all we can to stop relationship violence. Even the gentlest man has his limits. Although most domestic violence disputes are those where men have been the perpetrator, women can also be abusive. Spitting, pushing, scratching, kicking, and punching are just a few of the methods women have used to inflict violence on their mates. Some men don’t retaliate as we saw in the video of Jay Z and Beyonce’s sister in the elevator. She was clearly the attacker without a physical response from him. We don’t know what instigated her attack, but he appeared to be merely defending himself. Did he have the right to hit her back, or should he refrain no matter what?
I have treated many couples who are in domestic violence situations where both men and women are the instigators. In one case, Ann grew up in a violent home, where her parents argued and physically fought each other regularly. She learned to equate violence with love. Her husband, Henry grew up in a quiet, orderly Southern, home, where his father was the king of the castle and his mother was submissive. Henry coped with conflict by shutting down and isolating himself, because he did not know how to deal with Ann’s rage. Ann’s reaction to Henry’s distancing, was to chase after him with name calling ad even hitting. They came to therapy after Henry warned Ann twice that if she ever hit him again, he would divorce her because he did not want to retaliate, go to jail, and possibly lose he job and reputation. After a few sessions of effective communication exercises and anger management, they both agreed to call a time out if things got heated. Henry was able to keep his end of the bargain, but Ann was not. Their last argument resulted in Ann chasing after Henry when he took a time out to de-escalate the situation, and hitting him in the back with her fist. He moved out the next day and filed for divorce.
Ann continued treatment during and after the divorce and came to realize the error of her ways. She had not learned to deal with her frustrations in a healthy way and paid a high price. She loved Henry and harbored many regrets about how things turned out. She knew that if she ever wanted to marry again and have a healthier relationship she needed to get her anger under control. One year after the divorce, she reconnected with an old friend, who she eventually dated. Charles was her prince charming, but she was concerned that her anger issues would re-emerge because he was even more conservative than Henry. He was Muslim and held very strict views about what men and women should and should not do. She re-entered therapy to make sure she didn’t mess things up again. After two years of dating Charles proposed and Ann accepted. Although they have had their moments of Ann asserting herself too strongly, so far she has not crossed the line of putting her hands on him—but on occasion feels tempted.
The issue of provocation is a real one, when it comes to violence. Ann appeared to be a gentle, quiet person, until her buttons were pushed. Old childhood wounds can be the catalyst for behavior unbecoming of “nice girls.” Just like Milgram’s studies, if the conditions are right we do things we might not ordinarily do. A responsible person will try to make themselves aware of those triggers that can incite drama and try to avoid them. If things get too heated, walk away. People don’t usually “ask for it.” That statement is merely a justification for poor decision making. The victim of abuse does not make the abuser hurt them. The spouse doesn’t drive the alcoholic to drink. And the cheater isn’t forced to have an affair because of an inattentive spouse. Yes, name calling, nagging, or frigidity might be the triggers for each of these actions, but you still have a choice.
If you find that you are repeatedly in violent relationships, it’s time to look in the mirror. Do you confuse violence with love? Do you incite violent behavior? If you answered yes to any of these questions it’s time to get help. Stop the violence!

TIPS:
*If your anger level is a 7 or above on a scale of 1-10 (1=low anger, 10=high anger) walk away because you are probably not communicating anyway.
*Try listening to your partner rather than thinking only about what you want to say and talking over him/her.
*Bite your tongue when it comes saying hurtful things. Once it is out of your mouth you can’t take it back.
*Show compassion. Try to put yourself in the other person’s place.
*Learn to forgive.
*If your anger is far beyond what the situation calls for, you are probably angry with someone from your past and bringing it into the present.
*When angry take a few deep breaths and imagine yourself in a quiet relaxing place. Keep your blood pressure under control. Exuding calm can be contagious.

Glass Half Empty or Half Full?
Do you see the glass as half empty or half full? Joan is a pessimist she sees the glass as half empty. If she is not dwelling on the past, she lives her life like “chicken little”—always feeling like the sky is falling, the sky is falling.” When she got a “did not meet expectations” on her performance review at work, she was sure that this meant that she was going to get fired, that her career was over, that she will probably perform poorly in other aspects of her life, and that it must be because she was stupid and undeserving. This is an example of the mindset of a pessimist. Once this type of thinking is set into motion, it can become a self-fulfilling prophecy and only reinforces what the pessimist thinks to begin with—that they are no good.
Learning to be pessimistic can start in childhood and become more engrained over time. Studies show that people who are pessimistic as children are much more likely to become depressed later in life. Pessimism is not just seeing life in a negative way, but also has to do with how you explain events in your life. If you attribute the good things in your life to luck or chance but the things you perceive as bad, to your own personal qualities (e.g., stupidity, unworthiness), you are likely a pessimist. Pessimism, like depression usually results from some type of loss such as divorce, death of a loved one, illness. When these events happen during childhood, the child may learn to become distraught, but not necessarily hopeless. He/she then carries this mindset throughout life. Although, a pessimist learned to see the glass as half full, it does not have to persist.
According to Martin Seligman, the expert on learned helplessness (i.e., a perception that you have no control over the things that happen to you) as it relates to depression, says that pessimism can also be a precursor to depression. Your attributional style (i.e. how you explain why good and bad things happen in your life) can determine whether you learn to become an optimist or a pessimistic. The three P’s, permanent, pervasive, and personal causes of bad events can determine in which category you might fall. This behavior has been shown empirically to be learned, usually from messages that the mother, transmits to her children, more so than the father and is not genetic. If you see the event as permanent, you probably cannot see any light at the end of the tunnel and fail to see the situation as temporary. If you see the event as pervasive, you may think that this one bad thing generalizes to all other aspects of your life. And finally, if the event is personal, you believe that there is something inherently wrong with you.
To illustrate Seligman’s approach as outlined in his book Learned Optimism, in contrast to Joan’s outlook, Susan also got a “did not meet expectations” performance review at the same company. However Susan’s outlook on life is very different from her friends’. Susan’s response to her review was that this is just one review and that she will work to do better in the next six months–Permanence. She decided to write a rebuttal to be put in her file for the things she disagreed with and set goals to accomplish the rest. She then wrote in her journal about the other accomplishments in her life, to remind herself of her other good qualities so that she did not let her disappointment about this review, spread to other aspects of her life–Pervasiveness. And finally, she did not beat herself up by making self-denigrating statements. Instead she said, “I am a capable person and am good at what I do, I just need to make some adjustments–Personal.
You can see how the thinking of a pessimist can go downhill pretty quickly. Since explanatory style, optimism or pessimism, can begin in childhood, by the time you become an adult, you have had years of looking at the world in a certain way. Though not always easy, learning to become an optimistic is within your reach and usually in your best interest. Although there are some advantages to pessimism, such as being more reality based and tempering idealism, in general you need a lot of optimism with a dash of pessimism. More often than not optimism has more benefits than pessimism. Studies have shown the following:
*Pessimism promotes depression
*Pessimism produces inertia rather than activity in the face of setbacks
*Pessimism is self-fulfilling. Pessimists don’t persist in the face of challenges, and therefore fail more frequently—even when success is attainable.
*Pessimism is associated with poor physical health.
*Pessimists are defeated when they try for high office
*Even when pessimists are right and things turn out badly, they still feel worse. Their explanatory style now converts the predicted setback into a disaster, a disaster into a catastrophe.
Taken from Learned Optimism: How to Change Your Mind and Your Life (Seligman, Martin, 2006)
Now that you know why becoming an optimistic is a good thing, you may ask the question, how does one go about changing such an ingrained thinking and behavior pattern? Fortunately, there are self-help books, like the one mentioned above as well as others that are based on Cognitive-Behavioral Therapy (CBT) that focuses on changing distorted or irrational thinking patterns. You might also seek treatment with a psychotherapist for the same. In the meantime, you can start today by asking yourself how you explain bad events in your life. Catch yourself, before you go down that pessimistic path and try to redirect yourself. Ask yourself the following questions, “Is this going to last forever–Permanence, Does it affect all other areas of my life–Pervasiveness, and Did it happen because I am inadequate or unworthy–Personal?” The answer is probably no in each case. But if you answered yes, you have some work to do. Find the silver lining in the bad event, learn from the situation, and move on. You will have many other opportunities to learn from your mistakes.

GET YOUR HEAD TOGETHER
Psychological approaches to male sexual dysfunction
Every night we are bombarded with commercials pushing drugs that claim to improve a man’s sex life. We see a middle aged couple sharing a moment together in a bathtub, on the beach, with running water everywhere. The good looking aging baby boomer, who has taken one of these sexual enhancing drugs, is comforted by the notion that when the moment arises, will be ready to perform in the bedroom. He is guaranteed an erection to meet his partners’ needs. But let us not forget the disclaimers (eg, you may have an erection for several hours, numerous side effects, contraindications). These commercials play on the fears of men who are growing older and fear not being able to have a satisfying sex life.
Are you taking one of these sexual enhancing drugs, used to address erectile failure, or are you considering taking one of these drugs? Before you make this decision, first discuss with your physician non-medication approaches to this problem. Erectile Dysfunction (ED) is defined as the inability of the penis to maintain and full and firm erection sufficient for penetration during intercourse. ED can include premature ejaculation and erectile failure. ED can be caused by a number of different things such as: the side effects of certain medications (eg, anti-hypertensives, narcotics), disease (high blood pressure, diabetes), depression or anxiety. Your doctor will help you to rule out any medical reasons for having this problem. If your doctor says that there do not appear to be any physical ailments that seem to be causing the problem, then you might consider psychological explanations. In fact sometimes ED can begin as the result of a medical issue, such as side effects from medication, but later be maintained because of psychological reasons, even after the medication has been stopped. For example, I once treated a 45 year old male in the Hypertension Clinic at The University of Chicago Hospitals for sexual dysfunction. He complained that the high blood pressure medication that he had been given was causing him to lose his erection. He had become very anxious about having sex, for fear that he would not be able to maintain an erection sufficient for intercourse with his wife. His wife was supportive and encouraged him to see his family doctor, but for many months he refused because he was too embarrassed. Finally, she made the phone call and he had a check up and told his doctor about the problem he was having with the medication. His doctor, changed his medication to a drug that had fewer sexual dysfunction side effects and sent him on his way. Unfortunately, this change in medication did not solve the problem, because by this time his performance anxiety was so high that he was afraid to try sex for fear of failure. The medication issue had resolved, but now it was the anticipatory anxiety that triggered the problem. At this point he agreed to try psychotherapy to address this problem.
He and his wife were evaluated, and it quickly became apparent that anxiety was playing the predominant role in his ED. After several sessions of treatment using cognitive-behavioral therapy, relaxation training, and biofeedback he was able to manage his anxiety and was able to perform sexually without difficulty. Those ED problems that are organic in nature (eg, prostate cancer, uncontrolled diabetes) will not likely be resolved with these psychological approaches alone. However, there are many options available to those with disease that has affected sexual functioning, including penile implants and sexual enhancing drugs, such as those previously mentioned. If you have discussed your problem with your doctor and he/she has recommended these approaches, then proceed. Otherwise, psychotherapy and marital therapy can be helpful in treating the patient and/or couple cope with diminished sexual functioning. There are also good self-help books that can step you through dealing with this problem.
With the prevalence of sexual enhancing drugs, that we see on television commercials almost every night, many men are falling into the belief that there sexual functioning should be enhanced even if they are not middle age or older. Some men in their thirties, who are healthy and have no disease processes are taking these drugs because they feel they need a boost. Chances are their issues could be resolved with psychotherapy. Oftentimes, these are men who have issues of self-confidence or they merely want to increase their sexual desire and performance, even if it is at a normal level. Those who seek out these drugs need to be aware that all drugs have side effects and the risks of taking such drugs should be discussed with your doctor. But more importantly, if there is another way to achieve sexual satisfaction without medication, why not give it a try. In the absence of disease, sexual desire and orgasm is 99.999999% psychological. Focus on getting your head together. That is, the one on your shoulders.
GET YOUR HEAD TOGETHER
Psychological approaches to male sexual dysfunction
Every night we are bombarded with commercials pushing drugs that claim to improve a man’s sex life. We see a middle aged couple sharing a moment together in a bathtub, on the beach, with running water everywhere. The good looking aging baby boomer, who has taken one of these sexual enhancing drugs, is comforted by the notion that when the moment arises, will be ready to perform in the bedroom. He is guaranteed an erection to meet his partners’ needs. But let us not forget the disclaimers (eg, you may have an erection for several hours, numerous side effects, contraindications). These commercials play on the fears of men who are growing older and fear not being able to have a satisfying sex life.
Are you taking one of these sexual enhancing drugs, used to address erectile failure, or are you considering taking one of these drugs? Before you make this decision, first discuss with your physician non-medication approaches to this problem. Erectile Dysfunction (ED) is defined as the inability of the penis to maintain and full and firm erection sufficient for penetration during intercourse. ED can include premature ejaculation and erectile failure. ED can be caused by a number of different things such as: the side effects of certain medications (eg, anti-hypertensives, narcotics), disease (high blood pressure, diabetes), depression or anxiety. Your doctor will help you to rule out any medical reasons for having this problem. If your doctor says that there do not appear to be any physical ailments that seem to be causing the problem, then you might consider psychological explanations. In fact sometimes ED can begin as the result of a medical issue, such as side effects from medication, but later be maintained because of psychological reasons, even after the medication has been stopped. For example, I once treated a 45 year old male in the Hypertension Clinic at The University of Chicago Hospitals for sexual dysfunction. He complained that the high blood pressure medication that he had been given was causing him to lose his erection. He had become very anxious about having sex, for fear that he would not be able to maintain an erection sufficient for intercourse with his wife. His wife was supportive and encouraged him to see his family doctor, but for many months he refused because he was too embarrassed. Finally, she made the phone call and he had a check up and told his doctor about the problem he was having with the medication. His doctor, changed his medication to a drug that had fewer sexual dysfunction side effects and sent him on his way. Unfortunately, this change in medication did not solve the problem, because by this time his performance anxiety was so high that he was afraid to try sex for fear of failure. The medication issue had resolved, but now it was the anticipatory anxiety that triggered the problem. At this point he agreed to try psychotherapy to address this problem.
He and his wife were evaluated, and it quickly became apparent that anxiety was playing the predominant role in his ED. After several sessions of treatment using cognitive-behavioral therapy, relaxation training, and biofeedback he was able to manage his anxiety and was able to perform sexually without difficulty. Those ED problems that are organic in nature (eg, prostate cancer, uncontrolled diabetes) will not likely be resolved with these psychological approaches alone. However, there are many options available to those with disease that has affected sexual functioning, including penile implants and sexual enhancing drugs, such as those previously mentioned. If you have discussed your problem with your doctor and he/she has recommended these approaches, then proceed. Otherwise, psychotherapy and marital therapy can be helpful in treating the patient and/or couple cope with diminished sexual functioning. There are also good self-help books that can step you through dealing with this problem.
With the prevalence of sexual enhancing drugs, that we see on television commercials almost every night, many men are falling into the belief that there sexual functioning should be enhanced even if they are not middle age or older. Some men in their thirties, who are healthy and have no disease processes are taking these drugs because they feel they need a boost. Chances are their issues could be resolved with psychotherapy. Oftentimes, these are men who have issues of self-confidence or they merely want to increase their sexual desire and performance, even if it is at a normal level. Those who seek out these drugs need to be aware that all drugs have side effects and the risks of taking such drugs should be discussed with your doctor. But more importantly, if there is another way to achieve sexual satisfaction without medication, why not give it a try. In the absence of disease, sexual desire and orgasm is 99.999999% psychological. Focus on getting your head together. That is, the one on your shoulders.

CONQUERING INSOMNIA—A Cognitive Behavioral Approach

Are you having problems sleeping? Insomnia is a health problem that will affect most Americans at some point in their lives. There are three major types of sleep disturbance. Onset and maintenance insomnia, and early morning awakening. Onset insomnia has to do with difficulty falling asleep; maintenance insomnia is related to staying asleep and EMA, means waking up earlier that one’s usual wake up time. Anxiety is usually related to onset insomnia. Have you ever found yourself lying awake at night, unable to sleep, because you cannot turn your mind off. You may be replaying the days’ events in your head or worrying about an important meeting tomorrow. EMA, on the other hand, is related to depression. If you find yourself awakening at three or four am, when your usual wake up time is six or seven you may have EMA. Many things can cause depression, but most often it is related to some type of loss—loss of a job, marriage, loved one, pet, or disability. These environmental events can lead to negative or distorted thinking patterns which in turn can lead to depression. Sleep disturbance is one of many symptoms of depression, be it hypersomnia (sleeping too much) or hyposomnia (sleeping too little). And then there are complications with sleep due to pain, disability, medication side effects, sleep apnea and environmental conditions such as temperature, and light.
Another group of people who may have sleep problems is shift work individuals. People who have been night owls all their lives, may have difficulty working during the day and sleeping at night. And conversely, people who are used to sleeping at night and working during the day, like most of us, may have trouble sleeping during the day and working at night. However, most people can adjust to a routine as long as it remains constant. Their body will likely eventually adjust to the new schedule. Unfortunately, those who are on rotating shifts, find It difficult to keep up with a constantly changing schedule. Their body never learns when It is supposed to sleep. It has been my experience that this group is the hardest to treat.
So you might ask, why is sleep so important. One of the most important reason is health. Studies have shown that when people are sleep deprived they tend to eat more, have higher blood pressure, and lowers immune functioning, which can lead to many illnesses. From a cognitive perspective, reaction time, attention and concentration, and memory are all affected by sleep deprivation. Slowed motor skills and mood changes are also side effects. Unlike, substance abuse, which can cause similar symptoms and the person is aware that the substance (ie, alcohol) may be causing their problem, most people are not aware of the impact of sleep deprivation on these different areas of their lives. Consequently, a person who is sleep deprived may have no problem getting behind the wheel of a car or operating potentially dangerous machinery. It takes only a moment of nodding off for a sleep deprived truck driver to cause a major accident. Most studies have shown that individuals need approximately eight hours of sleep per night, in order to feel rested and rejuvenated, irrespective of your age.
The good news is that there is effective treatment for insomnia that does not involve drugs. Cognitive Behavioral Therapy or CBT, involves changing thinking patterns and habits. The sleep hygiene rules listed below may help you get a handle on your sleep problems. A first course of action is to visit your primary care physician to rule out any medical reasons for having a sleep disturbance. Sometimes medications will be prescribed to help with sleep, especially in acute situations of severe stress or chronic illness. Over the counter medications can have mixed results. They often help initially, but if used for long periods of time, they may actually become ineffective and even interfere with your sleep.
Sleep hygiene rules
Regulate sleep wake cycle
Go to bed at the same time (within a 30 minute before and after bedtime window) and get up at same time every day. On weekends, do not sleep in more than one hour later than your normal wake up time.
Do not take naps. If you are severely sleep deprived, get up at your normal wake up time and if necessary take a short cat nap (15-30 min) and force yourself to stay awake until your bedtime.
Do not stay in bed for more than 15 minutes lying awake. Get up, go to another part of the house and do quiet things to make yourself sleep (TV, music, reading). Do not start cleaning the house, surfing the web, or doing work. And most of all to do not eat, because you may actually condition yourself to awaken during the night feeling hungry.
Avoid stimulants in evening
Do not smoke, drink caffeine, eat sweets, or exercise in the evening. However, if evening is the only time you have to exercise, it is better to exercise than not.
Relaxation techniques
Learning diaphragmatic breathing, imagery, or progressive muscle relaxation are ways of activating your parasympathetic nervous system (PNS) and facilitating asleep. Sleep is a passive activity, that requires you to let go. The sympathetic nervous system (SNS) is the alarm system, that kicks in when the body into fight or flight (increase blood pressure, respiration and heart rate). Think of the SNS as the accelerator and the PNS as the brake. When you are in an emergency situation you want to press the accelerator. But, if you are trying to go to sleep you want to put on the brake. Taking control and trying to force yourself to go to sleep rarely works. Tossing and turning and looking at the clock only makes the situation worse. Doing something that helps you slow down will help you to fall asleep.
Associate the bed with sleep not wakefulness
You should only sleep and have sex in bed. No TV, working, talking on the phone, or any other activity in bed. These behaviors require you to be awake and alert and contradict the calming down process for going to sleep. If you are doing activities that require you to be alert, you may begin to associate the bed with wakefulness not sleep.
Make your sleep environment conducive to sleep. Make sure you have a comfortable mattress, room temperature, and lighting.
Develop a pre-sleep routine
Signal to your body that it is time to go to bed by developing a routine just before bed. Activities such as showering, saying prayers/meditation, brushing teeth, or reading can all indicate to your body that sleep is imminent. Eventually, your body adapts to a schedule just like an infant whose parents maintain a rigorous feeding and sleeping schedule with them. After some training the infant will expect to eat and sleep at a certain time no matter where they are. The same can be true for adults. Good night and sweet dreams.

PAIN

IS IT ALL IN MY HEAD?

Stephanie L. Livingston, PhD

 

 

 

Pain is the most common presenting complaint by patients to their physicians and pain medications are the second most prescribed drug.  The direct and indirect costs for the treatment of pain is staggering.  These costs include surgeries, loss of job, absenteeism, pain treatment (medical and psychological), legal implications, and the impact on families.  Despite the costs and the fact that the concept of pain is better understood than a decade ago, the assessment and treatment of chronic pain is complex. One of the reasons for this complexity is the fact that pain is a subjective experience.  One can only make inferences about another’s experience of pain, by looking at “pain behaviors”.  Talking about the pain, walking with a limp, taking pain medication, being irritable, or grimacing are all examples of how one might demonstrate their experience of pain.  Consequently, a multidisciplinary approach to the treatment of chronic pain is needed and  includes the expertise of physicians, psychologists, physical therapists, and occupational therapists. Each healthcare professional offers a unique perspective in understanding chronic pain.

 

Many people do not realize that acute pain and chronic pain (six months or greater) are very different experiences.  Acute pain is typically thought of as a signal that something is wrong in the body and once the injury goes through a healing process, the pain disappears.  This is not the case with chronic pain.  Some people have had pain for many years, long after the original injury has resolved physically.  At this point, there are many factors which influence one’s experience of pain. From a Biopsychosocial perspective these factors include biological, psychological, and social/environmental  aspects.  Pain tolerance, genetic predisposition, and medication effects are examples of biological factors.  Depression, anxiety, stress, and anger are psychological factors.  Weather, exposure to toxins, work or family situations address social and environmental factors that influence chronic pain. 

 

Melzack and Wall, early pioneers in the area of the pain, introduced the idea of acute (ie, sensation) versus chronic (ie, perception) pain in their Gate Control Theory of Pain in 1965.  This theory attempts to explain the interaction of multiple factors in the production of the sensory and emotional experience of pain.  Some stimuli “open the gate” or increase one’s perception of pain and some stimuli “close the gate” or decrease one’s perception of pain.    The latter suggests subjectivity, meaning that how the person experiences the pain will depend upon whether or not the “gate” is open or closed. Examples of things that open the gate are sedentary lifestyle, negative mood states, low pain tolerance, and stress.  Examples of things that close the gate are medication, exercise, positive emotional states, relaxation, hypnosis, distraction and biofeedback, to name a few.  Therefore, many pain programs incorporate ways of closing the gate into their pain management strategies.  These treatment approaches might include, but are not limited to surgery, injections, medication, psychotherapy/psychoeducaction, physical therapy and occupational therapy.  In the case of surgeries for the management of pain, psychological assessment is a critical element in evaluating the prognosis for outcome after surgery (eg, compliance with treatment recommendations, making lifestyle changes).  Although psychological approaches are helpful in understanding pain, none can actually identify whether the pain is organic or psychogenic.

 

So, is the pain all in your head?  In many respects the answer is yes.  Not because the pain is not real, but because psychological factors, that originate in the mind can  play a role in one’s pain perception.  By learning to control psychological aspects of pain, the pain may be managed better.  If you have chronic pain and are having difficulty managing it, consider seeing a psychologist who specializes in pain management, in conjunction with your treating physician.

                                                  

Stephanie Livingston, PhD is a licensed psychologist practicing at the Woodland Pain Clinic. Call 312 907-3644 for an appointment.