Nothing can seem more urgent, important, and real than the sense that there is not enough for us. Not enough love. Not enough food. The sense of scarcity may not even connect to any clear sense of what is missing. But that doesn’t take away its power. Regular readers of this blog know that we appreciate the insights of Rick …
Treatment as Punishment
I have spent the last two days mulling over an interaction with a patient and with his therapist. The patient is a brilliant, young man who has somehow entered into a conflictual relationship with me. The nature of that relationship was encapsulated for me in a comment by his therapist. She called to let me know that he was escalating …
Acceptance versus Avoidance
Acceptance and Commitment Therapy (ACT) is based on the belief that five fundamental errors are responsible for much of human distress. One of these errors is the tendency to want to avoid painful feelings at all costs. Our addiction to our cell phones can serve as a distraction from the distress of loneliness. Or drinking. Or smoking. A colleague suggested …
Take Action… Why Do I Have to Pick Up My Room?
Sometimes wrestling with depression can seem an awful lot like having to deal with a truculent eight year old. It is 7:00 in the morning, and the alarm goes off. When you aren’t feeling depressed, that means that you get up without thinking about it too much, and take a shower or make some coffee to start the morning. But when you …
Dual Treatment: Medications and Therapy Work Together to Treat Depression
A review in the prestigious journal JAMA Psychiatry suggests that there may be a clear biological explanation of how medications and psychotherapy work together to treat depression. The authors note that recent, unexpected, research findings suggest that antidepressant medications reactivate the brain’s ability to relearn old lessons. The medications allow the brain to modify old neuron connections in a way …
Cluelessness: Getting Stupid
Late on a Friday afternoon, I found myself with two patients (back to back) who were yawning and seemingly drifting off during the course of our conversation. Now, that could have meant that I was being particularly boring. But, in this case, it was the manifestation in the office of something that had been going on at home and causing …
Pay Attention
We need to be noticed and attended to. It is one of the most important psychological needs we have. For several years, I have been lecturing residents in psychiatry at UCSF on the management of people in crisis. One of the topics, is how to work with people who are potentially violent. On an inpatient psychiatric unit there are, from …
Emotion Regulation and Bipolar
Researchers from the University of Mannheim investigated brain activity in people at increased risk of bipolar disorder to see if there was something about how these people handled negative emotions that might them be at increased risk of mood cycles. They used a powerful brain imaging technique called functional magnetic resonance imaging that allows researchers to see which parts of the …
Proactivity
Proactive behavior refers to actions taken that are forward thinking, that anticipate future problems, and are aimed at avoiding those problems. They are focused on changing the environment for the better. Proactivity contrasts with reactivity as an approach to challenges. Reactive behavior is about dealing with the crisis that is present right now. Reactivity also often is associated with a wish …
Coming Home
In a different post, we talked about the frustrating problem of getting sick at the beginning of vacations. We said that this has to do with the difficultly that our bodies have switching from high stress to relaxation, and something called cortisol withdraw. A version of this same phenomenon may be happening in your home almost every evening. This week …
Selective Attention
One morning, while I was riding a bike, I got to thinking about how mood affects attention and how that, in turn, creates a different reality for us depending on what mood we’re in. To think all these thoughts were sparked by my reaction to the image of a dead squirrel… Several weeks ago, it had been an especially dark …
Just Be Quiet
I just met with a smart, funny, attractive graduate student who had a severely traumatic childhood. She came in looking obviously frazzled and announced that she had been crying continuously since she got a terrible haircut the previous day. I wouldn’t be human if I didn’t feel the urge to reassure her. Especially because, in addition to all her …
Leaving War Behind
I spent many sessions working with a successful entrepreneur to try to help him cope better with stress and depression. His problems seem to be neatly encapsulated in Joseph Campbell’s notion of the Hero. Like all of the heroes in the past, he set out as a young man to make fame and fortune and to change the world for …
Know Your Body
Geneen Roth talks about how infatuated she was with her imperfections while growing up. She was constantly thinking of how much better looking she would be if she didn’t have certain features. If only she could cut out all the flaws, so just her best features would remain she could be happy. Roth tried to reach self improvement through shaming …
The No Motivation Blues
Today, I met with a couple of women whose central concern was the fact that they felt a complete loss of motivation. One of these women is finishing graduate school. Only a few weeks away from graduating, she has found that she is not completing the assignments that she needs to in order to graduate. She knows that she can do …
Gambling: Sucked into the Slots
Dr. Howard Forman interviewed Dr. David Forest about the reasons behind the great appeal of slot machines. Gambling is a phenomenon that has been sweeping the nation. People are simply captivated by the machines. Dr. Forest attributes the allure of the slots to both players and professionals to the bio-psycho-social attractiveness of the machines. The machines attract so many players …
Defuse Dangerous Thoughts
We want to spend a little bit of time talking about one powerful technique for dealing with dangerous thoughts. Dangerous thoughts are thoughts that make themselves true in powerful and self-destructive ways. One example of a dangerous thought is from a very attractive young woman who had a terrible childhood of neglect. She has a powerful, dangerous thought that pops …
Stress, Resilience and the Neurobiology of Depression
Dr. Eric Nestler, M.D. believes that when it comes to treating depression, we should be doing better. Less than half of those with depression get better after receiving maximum treatment. Dr. Nestler describes depression as a broad syndrome hat involves many different diseases. Because the specific causes of depression cannot be identified, this disorder is difficult to treat. In order …
Cling Less and Love More
Right in the midst of working with a young woman who has been struggling with how to accept the possibility that a new relationship might have to end (her boyfriend is still caught up in thoughts and feeling evoked by his ex, who sounds like the kind of intense woman who can easily trap a young man in a prolonged …
Check Your Wallet
Recently, we were writing about the bias that practitioners have that the technique that they they have mastered is the most effective treatment for any condition. We were reminded of this issue very vividly this morning when we met up with one of our favorite people, an older man who has been seeing us for a couple of years. He …