Stephanie Livingston–Psychologist

COVID-19: Mental Health Survival Kit

Since March 2020, humans have been confronted with an issue that has turned our lives around. The rise of the coronavirus pandemic has changed the way we do business in most aspects of our lives. Our health, jobs, homes, worship, how we shop, and the way we interact with each other has taken a sudden turn. Change, good or bad, requires us to adapt to a new situation which can at times be stressful. If we have good physical (e.g., exercise, healthy eating, good sleep hygiene), mental (e.g., meditation/spirituality, optimism, relaxation), and social (e.g., family/friends, meaningful work/purpose, play) coping skills, getting through this pandemic will be much easier.  Since the Spring 2020, when we had to shelter in, mental health disorders have escalated in number and severity.  We are suffering from higher rates of anxiety depression and suicide. Turmoil has become the sign of the times, with rising  divorce rates and domestic violence. We can likely attribute much of our suffering to job loss or potential loss concerns; illness and/or death of loved ones; loss of meaningful activities, social isolation and loneliness. The good news is that we do have some control over these situations we view as unpredictable and therefore stressful.

My own experience with the onset of the shelter-in policy related to COVID-19 was eye opening. I had the benefit, that many people do not, of working remotely but had to change my private practice model from in-person sessions to 100% virtual (i.e., using technology) rather than in-person therapy. It was a blessing to have the flexibility of avoiding commuting to the office, thereby saving on time and money.  However, I immediately fell into some bad habits that got me completely off track from my normal routines. I found that my eating, sleeping, and TV watching habits changed dramatically. I no longer felt a need to go to bed at a certain time and awaken at a certain time. I started binge watching TV series and constantly checking out what was in the fridge to eat. Why not? It was there! It wasn’t long before I gained a few pounds, overdosed on the varies series on the boob tube, and found I was exhausted during the day. I noticed that many of my patients were experiencing the same things. It was after a few weeks that I had to treat myself as a patient and decided to practice what I preach—“Doctor heal thyself.”

My adaption to this dramatic change in our society was to start with the basics as I mentioned earlier—eating, sleeping, and exercise.  I started by reverting back to my previous sleep/wake habits by going to bed at 9pm and up at 5am, ensuring my much needed eight hours of snooze time. Similarly, I figured that it was my best bet to keep my eating habits the same as when I went to the office. No more donuts or Cheetos for breakfast and M&Ms for a late afternoon pick me up snack. I decided to eat like I did before, juice and fruit upon awakening; oatmeal or yogurt a couple of hours later; salad for lunch; tea in the afternoon, and dinner as usual. Fortunately, my exercise habits improved during shelter-in because I had more time to work out, especially running outside to get out of the house. Yay! The isolation piece wasn’t as bad as for someone living alone. Having a spouse helped to mitigate feelings of loneliness that many people who live alone have been experiencing. In addition, I participated in various virtual activities to stay connected with family and friends. As businesses began to reopen, occasional social-distancing outings .  (e.g., outdoor dining, apple picking) were a plus. I immediately started to feel better within a week or two just keeping to my normal routine.

As far as enjoyable activities, I spent more time in my garden during the day whenever I had a free moment and certainly on weekends. I have always found interacting with nature to be calming. I dusted off my piano and started playing again, practicing yoga in the evening, and did more reading for pleasure.  When forced to slow down and smell the roses, you would be surprised at the impact on your mental and physical well-being. More recently, I have decided to use my writing skills to work doing articles for my website and starting a podcast—this is my first.

My way isn’t the only way to finding ways to cope with this pandemic and disruption in our live, but find a path that is best for you. We are resilient people who have adapted to changes in our lives at many levels (e.g., environmental, economic, political). Sometimes change is a good thing. Remember that time you got fired but went on to get a better job, started a business, or went back to school. Or, remember the partner you thought was the love of your life who dumped you, but you went on to find someone better? Keep in mind there is always a silver lining in every cloud, you just have to look for it. What is your silver lining in this pandemic?

For those of you who have spiraled into severe anxiety or depression and can’t seem to rebound remember that there is effective treatment. Virtual therapy, hotlines, self-help books and medication are options. Cognitive-Behavioral Therapy (CBT) has been shown to be very effective with both anxiety and depression; as well as regular exercise. In fact, for many people who experience mood disorders, CBT alone can be just as effective as antidepressant and antianxiety drugs. The important thing is to do something. Make a plan and execute. It’s okay to feel anxious but what are you going to do about it? Figure out the source of the problem and eliminate it if you can and if you can’t learn new coping skills to counteract the effects of potential stress factors. People tend to feel better when they feel they have some control over the controllables. If you are lonely, make finding a mate a priority, even though it may be difficult in these uncertain times. If you are single and feeling lonely it has probably never been as pronounced as now. Loneliness is a health risk factor comparable to smoking cigarettes. Be aware that social media can be a positive means of staying connected during this pandemic, but for some it is detrimental. Many young people, who use social media to compare themselves to others, often feel as though they don’t measure up—forgetting that what they are viewing is not always reality. Studies show that there is a correlation between social media and depression, so be wary. If you find that you feel worse after checking out what’s happening on Facebook or Instagram—get off for a couple of weeks and see how you feel. Spend more time making your life different rather than wishing it were.  Develop healthy eating and sleeping habits, exercise, stay connected to family and friends, find a hobby, relax, and practice your spiritual beliefs. Taking one small step will eventually get you to the finish line of positive mental and physical health. Act now!

HIGH BLOOD PRESSURE
ARE YOU WORKING YOURSELF TO DEATH?

Hypertension is a chronic medical condition that is characterized by an elevation in arterial blood pressure. Blood pressure is measured by systolic (top number) when the heart muscle is contracting or diastolic (bottom number) when the heart muscle is relaxed between heart beats. A reading of 120/80 is typically thought of as normal blood pressure, but can range between 100-140mmHg systolic, over 60-90mmHg diastolic. If a person’s reading is consistently at or greater than 140/90 hypertension exists. Most people have primary or also known as essential hypertension, with no underlying medical cause. Less than 10% of the population have secondary hypertension, which is caused by some other medical condition. Essential hypertension, can be the result of many factors such as age, weight, eating and exercise habits, genetic predisposition, and stress. Stress can influence blood pressure because the chemicals that are released during the stress/fight or flight response results in a constriction of the blood vessels, which raises blood pressure. Over time, the daily hassles of life can add up and cause prolonged elevations in blood pressure, which can result in hypertension and many other associated medical problems, such as stroke and kidney failure.
My dissertation research at The University of Chicago Hospitals revealed some interesting things with respect to hypertension and psychosocial factors in black women. Specifically I looked at a concept proposed by Sherman James called, John Henryism, an active coping mechanism used to deal with exposure to prolonged stressors, such as social discrimination. As the legend goes, John Henry was a slave, who could reportedly out- perform the mechanical steam drill, but at the expense of dying from over exertion. James, an epidemiologist, during his data collection for his research, interviewed a man named John Henry Martin, who had characteristics similar to the legendary John Henry. John Henry Martin was a black man who freed himself from the sharecropper system to successfully farm 75 acres of his own land through hard work and determination by age 40, but at the cost of serious health problems by age 50, including hypertension, arthritis, and peptic ulcer. James developed the John Henryism Scale to measure the degree to which a person relies on hard work and determination to achieve their goals. My research findings using female subjects were consistent with James’ research with males, which revealed that those women who scored high on John Henryism tended to have higher blood pressures than those who scored lower.
I have learned over the years as a psychologist that sometimes trying too hard can be detrimental in the long run. For instance, relaxation techniques, which are meant to calm the body and mind and counteract the effects of stress, require a person to give up control. Trying too hard to relax, like trying too hard to go to sleep just doesn’t work. It is not until the person gives up control that sleep comes. Pushing too hard can elicit a stress response which counteracts the relaxation response. There are times when taking control in an active way is beneficial, like when trying to complete a task or playing a sport. It is important to know the difference when you need to take control or give up control.
Many studies have shown the benefits of relaxation techniques (e.g., biofeedback, meditation, diaphragmatic breathing, imagery) in reducing blood pressure. I have used a self-regulation strategy called heart rate variability (HRV), which involves using computer software that is able to measure a person’s heart rate (HR) and HRV—what happens between heart beats. This activity occurring between heartbeats can be affected by negative emotions such as anxiety, stress, anger, and frustration. A clip is attached to the individual’s ear lobe, where the HR and HRV are transmitted through a wire into the computer and the software transforms this information into a graphic that gives feedback as to the level of these physical activities. The trainee uses breathing and imagery techniques to learn to control their HR and HRV. Oftentimes imagery techniques involve thinking of something relaxing and your body responds by becoming more relaxed. In the case of HRV training, the trainee is taught to think of images of love and appreciation, because studies show that it tends to have a more positive effect. My patients who have used these techniques have been very encouraged in learning to control their blood pressure.
At our clinic, BioSynergy, this process involves taking the blood pressure first to get a baseline. Next, the trainee goes through a round of HRV, and then takes their blood pressure again. A training session of HRV involves playing games on the computer where the trainee is able to achieve a goal, like having images on the screen do certain things like having a rainbow go into a pot and fill up with coins or keeping a balloon afloat, as a result of making the HRV go up or down. The goal is to obtain coherence, meaning a smooth HRV pattern. High coherence guarantees success in playing the games. As mentioned previously negative emotions can have an adverse impact on coherence, making the HRV patterns more erratic. Low coherence can result in a stress response being elicited and all the things that go along with this response, such as release of stress hormones, which can in turn increase HR, HRV and a host of other physiological responses.
Most people are not aware that the heart has a brain of its own that sends signals to the rest of the body, just like the brain in your head sends messages down to the body. Therefore, by controlling the heart, one can learn to control other systems in the body voluntarily. You can try this for yourself at home, by taking your pulse or blood pressure, try thinking of something relaxing or a situation where you felt loved or appreciated for ten minutes, and take your measurements again and see if there is a difference. Keep in mind that you are doing this without the benefit of technology. Imagine what you could do, if you had a little help. The mind is a powerful tool, the body is a highly efficient machine, and computers are intelligent devices. Learning to control the interaction of these three entities, create a dynamic force that can take your mind and body to new levels.
These techniques are not meant to be used in replacement of medication or other medical advice. Consult your doctor before considering using these strategies to manage your blood pressure. DO NOT STOP TAKING YOUR MEDICATION WITHOUT YOUR DOCTORS CONSENT. Contact us today for an appointment. We have offices in Illinois and Indiana and take most insurances.

Stereotype Threat—does being a minority affect your performance

Have you ever been the only girl in a math class of all boys and felt intimidated; or a black student in a predominately white college or university, or a white male competing in a basketball camp of mostly black males? If you have felt intimidated in any of these situations, you may have been a victim of “stereotype threat”, A concept developed by Claude Steele, a social psychologist at Stanford University. He found that stereotype threat, feeling pressure to perform in a given situation because you feel that you have been type cast, negatively affects performance. The girl in a math class of mostly boys may have learned to believe over the years that boys are better than girls in math. Or the black student may have internalized the belief that whites are smarter or are at least preoccupied with the idea that white students may view them in that way. And the white basketball player, like the movie title “White Men Can’t Jump” may feel intimidated by black basketball players who tend to dominate in this sport. In Steele’s ongoing research, he found that the individual who may be a victim of stereotype threat may not even be consciously aware that they are experiencing it. The problem with stereotyping in this case, is that it tends to have a negative effect on performance. The part of the brain needed to perform the task at hand, whether it is doing well on a math test or shooting a basketball gets drained by the focus on the effects of the stereotype; thereby hindering performance. You can imagine how stereotype threat can be manifested in everyday life in most areas such as business, education, sports and entertainment, and health.
What is the solution to stereotype threat, you might ask. Something as simple as writing a narrative about one’s values and why one hold’s these values prior to going into the stereotype situation, like taking a test, can improve performance significantly. Or, reminding yourself of your accomplishments or credentials prior to your performance, can also be helpful. Steele found that black students who had to check the race box prior to taking a test was enough to trigger stereotype threat. However, when students were allowed to do the narrative exercise before the test, they were able to counteract the effects of stereotype threat.
At our clinic, we help people counteract the effects of stereotype threat by: evaluating the individual to determine if they are experiencing stereotype threat and the type of stereotype threat. Different types of threat require different approaches. We will also rule out any mental disorders that may play a role (e.g., stress, anxiety disorders, depression) in underperformance. Subjective and objective measures, (eg, clinical interview, testing, stereotype threat scales, physiological measures) both pre and post treatment will be used. The goal is to Devise an individualized program to address the specific needs of each client.
Treatment protocols include a combination of (behavioral skills training, relaxation techniques, mental skills techniques, cognitive-behavioral therapy, biofeedback). The goal is to generalize these strategies to improve performance by applying these strategies to real world settings.
Contact us today for an appointment, if you want to improve your performance in work, school, health, business, sports, or entertainment. We have locations in Illinois and Indiana.
Taken from, Whistling Vivaldi, (Steele, PhD, Claude, 2010, W.W. Norton & Co, Inc.)

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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.