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 …

Men Get Mad Not Sad

There are hundreds of papers written about why it is that women have a much higher rate of depression than men. A new article published in the journal JAMA Psychiatry (August 28, 2013) suggests that some if not all of that difference may have to do with the fact that men express and experience depression differently.   The authors of the …

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 …

Depressed Mothers and Oxytocin

Oxytocin is often brought up in conversations about childbirth. After childbirth, new mothers normally experience surges of oxytocin that increase feelings of maternal bonding, trust, and empathy. In addition to facilitating pair bonding, recent studies have shown oxytocin  plays a greater role in mental health than originally thought. Low levels of oxytocin may be a phenomenon linked to depression. Maternal …

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 …

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 …

Coming Home

Where does the mind go when it is not occupied by the worries, frustration, and anxiety? Does it go to a happy place, or are people naturally angry? According to Rick Hanson, PhD, the mind constantly fluctuates between a reactive and responsive state. When in the responsive state, the body is able to relax and reenergize. It is a time …

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 …

DSM5

In the next few days the American Psychiatric Association is meeting in San Francisco and will announce the latest version of its diagnostic and statistical manual: DSM5. Tom Insel, the Chief of the National Institute for Mental Health, created quite a stir last week by seeming to announce that the new diagnostic manual was an emperor with no clothes. The …