Calming An Overactive Brain–My Day In Pacifica

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Today I am taking a seminar with William Sieber calling Calming an Overactive Brain. He’s an excellent presenter, with a good sense of humor, a down to earth speaker. He’s got a nice balance of enough confidence to be a an excellent speaker without being arrogant. This is quite rare in the seminar business. Even though there’s a lot of stuff I already know I’ve learned a number of  interesting things. The seminar is on the ocean in Pacifica, and outside the windows of the meeting hall I can see the waves crashing on the sand.

One funny thing happened at lunch. I had hurried out to the next door cafe so I could get a table before the crowds hit. Dr. Sieber showed up, looking for a table. I invited him to join me at my table. We started talking and discovered some remarkable commonalities! Both of us had attended Yale for training, me for undergrad, and he for graduate school. He had worked closely with Judith Rodin and Peter Salovey while there. Judy Rodin had been my first psychology professor, and probably the one that influenced me to go into psychology. Peter I had known while teaching at the Bridge, Stanford’s peer counseling center, many years before, and in whose book I have a chapter on Listening Skills. Eventually he went on to teach at Yale, and now is Yale’s president. More surprisingly, Dr. Sieber and I both interned at the Palo Alto Veterans Hospital, in different years! We had a fun lunch reminiscing.

About the seminar. He spoke at length about sleep and it’s impacts on health and wellness. For instance, one study showed that those who got less than 6 hours of sleep were 42% more likely to get diabetes. Or that those with the most disturbed sleep were 97% more likely to die in the next 20 years. Poor sleep makes you more prone to pre-diabetes, anxiety, upsetting emotions, not to mention lowering overall mood and vitality.

Less sleep also affects appetite and eating. Leptin is the hormone that lowers our appetite, and ghrelin is the hormone that increases appetite. With sleep deprivation our leptin goes down, and our ghrelin goes up, and on average we consume 250 calories more on days after a bad night’s sleep. This doesn’t sound like much, but it adds up to about 25 pounds of extra weight per year if you chronically sleep poorly.

I also learned how to assess sleep. The key metric is “sleep efficiency”. This means what percent of the time you are in  bed trying to sleep are you actually asleep. A good number is 90-95%. This is hard.  It means if I am in bed for 8 hours a night, I am asleep 95% of the time, or all except 24 minutes. What is your sleep efficiency? He went over how to use the sleep efficiency log to diagnose sleep problems and guide treatment.

One other interesting factoid for all of you pet lovers. Fifty-three percent of pet owners have disturbed sleep due to their pets.  Maybe we should all shut the door at night and train our pets to sleep somewhere else other than in bed with us.

He discussed how to fix common sleep problems. One such pattern is mine, the delayed sleep cycle. This is the night-owl pattern, going to bed late and getting up late. To fix it, he suggested a short term use of sleep aids to shift the cycle to earlier bedtimes, combined with bright light in the mornings, and no screen light for an hour before bedtime. Cutting back on caffeine use is also helpful.

Others suffer the early phase shift, those who fall asleep too early, and get up too early. To shift these people he recommended getting bright light exposure in the early evening so the melatonin production is suppressed until later in the evening.

In the afternoon we got into discussion of moods and control. Discussing anxiety, he explained the key role that perceived control over situations plays in creating or ameliorating anxiety. Exercise turns out to be a strong treatment for anxiety. Most people with anxiety disorders do not exercise more than once a week, and those who exercise 3 or more times a week rarely have anxiety disorders.

Then he turned to relaxation training for anxiety. He made a great point—that even if you train people to relax deeply, the probability of them continuing to practice even four weeks later is very low. So instead, he shared a 20 second relaxation. Take two deep and slow belly breaths, exhaling for longer than you inhale. While doing that go somewhere relaxing in your mind, and experience that place (ie the beach) in the sensory modality of your preference—seeing, hearing, smelling, or feeling. Make up a two word description of that sensory experience, i.e. “Warm sun”. Repeat that phrase as you take your 2 deep breaths, during the exhale.

He suggested pairing this relaxation practice with something you do multiple times a day. So for instance, pair it with hitting the Send button on your email. That way you will remember to practice a quick relaxation many times a day.

He also shared James Pennebaker’s work, which I often use with patients. Pennebaker found that writing about traumatic events for just 30 minutes a day for 4 days in a row had a fairly profound impact on future emotional and physical health. Interestingly, the initial impact was negative, more anxiety and upset, and more susceptibility to illness. But after three to six months, the pattern reversed, with people showing less upset and anxiety, and better health.

Finally, he shared some info about new findings about heart rate variability (HRV). HRV is the change in the rate of your heartbeat over each beat and each several seconds. It turns out that having MORE HRV is better for both mental and physical health. People with anxiety disorders have less HRV. And it turns out the the three factors that most predict low HRV are: sedentary lifestyle, a cynical and hostile view of life, and anxiety.

Can you retrain your heart rate variability? Yes, with both breathing retraining, and with biofeedback. And it turns out that when you learn to increase your HRV, your anxiety goes down. Very interesting and cool stuff.

The final part of the workshop was about mindfulness. I won’t even try to summarize this part of the seminar, as it was very detailed, and even profound. Perhaps I’ll blog about it later.

Overall, it was a good learning experience, with a wonderful view of the ocean the whole time!

Now I need to go to sleep early….

Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

SSRI Antidepressants Given in High Doses May More than Double the Risk of Suicide in Adolescents and Young Adults Under 25

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So you’ve got a teenage child who’s depressed. What do you do? A new study published in the Journal JAMA Internal Medicine suggests what NOT to do. In this study, conducted at Harvard, the authors looked at 162,625 people from ages of 10 to 64 years old who took selective serotonin reuptake inhibitors (SSRIs) for depression. (These are drugs like Paxil, Prozac, Celexa, Zoloft, Lexapro, and Luvox, and their generic equivalents.)

The researchers looked at the relationship between initial starting dose and the rate of deliberate self harm and suicidal behavior. What they found was shocking. They found that for people under the age of 25 starting SSRI medication at a higher than normal dose more than doubled the risk of self harm behavior! This translated into one additional occurrence of self harm behavior for every 136 patients who were treated with high-dose SSRIs. This is a lot of additional suicide attempts!

Interestingly enough, for adults 25 to 64 years old, there was only a very small increase in self harm behavior with high-dose SSRI treatment, and the overall risk of self harm behavior was much lower.

Delving more deeply into the data is interesting. In the under 25-year-old range, 142 patients attempted suicide within one year. The rate was 14.7 suicide events per 1000 person-years for those who started SSRIs at average doses, and 31.5 suicide events per 1000 person-years in those who started at high doses. For the older adults the rates were 2.8 per 1000 person-years for average doses, and 3.2 suicide events per 1000 person-years for those who started at high doses.  These numbers translated into seven more suicide events per 1000 for patients under 25 during the first 90 days of treatment with high dose SSRIs.

Also, disturbingly, the study found that 18% of all patients were started on high initial doses of antidepressants, despite clinical guidelines that specifically recommend starting at a low dose and titrating the dose upwards slowly.  The typical doses of common antidepressants are 20 mg for Prozac, 20 mg for Paxil, 20 mg for Celexa, 50 mg for Zoloft, and 10 mg for Lexapro. For unknown reasons, almost one in five patients were started at higher doses than these.

Why were almost one in five patients started at higher doses than these? I suspect I know the answer, although it wasn’t discussed in the study. Unfortunately, the vast majority of patients are given antidepressants by their internist or family physician or pediatrician. In contrast to psychiatrists, these practitioners do not have the time or bandwidth see patients every week. So they are more likely to start the patient at a higher dose.

Most psychiatrists will start patients at subclinical doses and gradually increase the dosage to avoid side effects. It certainly has been my clinical experience that some general medicine doctors do not do a very good job of administering antidepressants. That is why with most of my patients, especially if they can afford it or have good insurance coverage, I suggest that they seek the advice of a psychopharmacologist or psychiatrist for psychoactive drugs.

The authors of this paper point out that recent research suggests that antidepressant medication is at best only slightly effective in young people and that the dosage of antidepressants are typically unrelated to their effectiveness. Given these two research findings, it certainly does not make any sense to start antidepressant treatment at a higher than average dose.

But I would go one step further. I would argue more strongly that in most cases it does not make sense to use antidepressant medications in young people at all. Why expose a young person to the heightened risk of suicide for what is at best a relatively modest improvement in mood?

This is even more relevant when you consider that there is an alternative treatment that has no side effects and has been shown to be effective. That is cognitive behavioral therapy (CBT) for depression. And there is even a specific cognitive behavioral therapy for suicide prevention that has been developed. (CBT-SP). This is a 12 week focused CBT program that in one study demonstrated that it significantly lowered the probability of a suicide event in suicidal adolescents.

If medication is going to be used, one recommendation that follows from all of this research is that it is good idea for doctors to follow the guideline of “start low and slow” when prescribing antidepressant medications to people under 25. Start at lower than typical doses, and very slowly and gradually increase the doses. While this is happening the patient should be followed on a weekly basis.

If the prescribing doctor is not a psychiatrist who sees the young person weekly, it’s a good idea to pair this with weekly psychotherapy sessions. The weekly psychotherapy session, especially when conducted by someone skilled in cognitive behavioral therapy who evaluates mood and suicidal ideation at every session, can be an essential safety measure when prescribing antidepressants to young people. Or consider treating with CBT alone,  which may very well be just as effective.

Because this is so important, I am listing some references below.

No jokes today, as suicide is not a laughing matter…

References

http://www.clinicalpsychiatrynews.com/home/article/suicide-doubles-in-young-patients-starting-high-dose-ssris/3c57e41e724244599c16d5a565ac8ce3.html

https://archinte.jamanetwork.com/article.aspx?articleid=1863925

http://www.intechopen.com/books/mental-disorders-theoretical-and-empirical-perspectives/cognitive-behavioral-therapy-approach-for-suicidal-thinking-and-behaviors-in-depression

http://www.texassuicideprevention.org/wp-content/uploads/2013/06/AdolescentSuicideAttemptersLatestResearchPromisingInterventionsCharlotteHaleyJenniferHughes.pdf  (CBT-SP)

http://www.nimh.nih.gov/news/science-news/2009/new-approach-to-reducing-suicide-attempts-among-depressed-teens.shtml

http://www.clinicalpsychiatrynews.com/home/article/suicide-doubles-in-young-patients-starting-high-dose-ssris/3c57e41e724244599c16d5a565ac8ce3.html

Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

How to Forgive: A Cognitive Behavioral Model for Forgiveness and Letting Go of Anger and Frustration

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What is forgiveness?

Here’s what it is not. It is not for anyone else, only for you. It doesn’t imply reconciliation with the person who hurt you nor does it imply that you approve of their actions. It does not mean forgetting what happened.

What is forgiveness?

It is only for you, in order to help you feel better. As one well-known researcher said, “failing to forgive is like taking poison and waiting for the other person to die.”

Forgiveness means understanding what is causing your current distress. It is not what offended you or hurt you years ago or even a few minutes ago. The primary cause of your suffering is from your thoughts, feelings, and physical sensations in response to your thoughts about the event.

This is a subtle concept. Most of us believe the reason we are angry is because someone has done us wrong. And it’s true, that if we could erase the event, we would stop being angry. But none of us own a time machine so we can not erase the events.

What makes us suffer is each moment that we think about the offending person or event. And how we think about these events. It is as if you own a DVD collection of movies of different events in your life. If you were to choose to only watch the upsetting movies, your overall level of happiness would greatly diminish. Choosing to forgive is choosing the DVDs of your life that are positive and full of joy.

There is another component of how people think about grudges. We often have a magical belief that our anger at someone else causes them to suffer. We imagine them feeling guilty about their behavior and suffering even when we are not present. We think of ways to hurt them in return – the silent treatment, constant criticism, reminding them of their offenses. But the reality is that most people are very good at blocking out guilt and punishment. Whenever they’re not around us they tend to think about other things. And they develop good ways of avoiding our punishment. So really the one who suffers is the person who’s angry and who fails to forgive, not the offender. And if the person we take out our anger on is someone we are still in relationship with, it damages the relationship and makes it even less likely we will get what we want.

Another trigger for resentment and anger is holding onto what the anger and forgiveness researchers call “unenforceable rules”. These are what most cognitive behavioral therapists call “Shoulds”. They are the demands we make on the world and on people around us. You can’t force anyone to do something they don’t choose to do, and you can’t require people to give you things they choose not to.

For instance, you might want fidelity in your romantic partner. You certainly have every right to want that. But you can’t demand or enforce fidelity. If your partner chooses to go outside the relationship, you can’t really change it. The only options you have are how to react to this. You have choices to make about the relationship and about your future relationships.

The research on forgiveness is very interesting. It reduces blood pressure, stress, anger, depression and hurt while increasing optimism and hope. The primary researcher on forgiveness, Dr. Fred Luskin at Stanford, has even done forgiveness research with women in Northern Ireland whose husbands were murdered. Even with these extreme cases people have found the forgiveness model very helpful at easing the pain.

I’ve written about how to conquer anger using the S A P model. In this model you change your shoulds into preferences rather than demands, you place into perspective the events that have caused your anger, and you shift out of the blame model and depersonalize most events.

Forgiveness is about being happy. Living your life to its fullest is the best revenge you can take on someone who has offended you. Instead of focusing on the hurt or betrayal, focus your energy on getting what you want in your life in a different way other than through the person who has hurt or betrayed you. Take responsibility for your own happiness rather than placing it onto other people and then being disappointed when they don’t provide happiness.

Change your story. Too often we have what is called a grievance story. We tend to tell this story to many people. It always ends with us feeling stuck and angry. Change your story. Change the ending so that it ends with a powerful and strong choice to forgive.

 
So to summarize, here’s how to forgive:

1. Let yourself first feel the pain. Share the experience with a few close and trusted friends.

2. Recognize that your anger is a result of your choices about what thoughts to experience about an event. Decide to forgive so that you can move forward and feel better.

3. Recognize that you probably won’t be able to get rid of your hurt and anger by punishing the other person. All you will accomplish is to damage the relationship or make the other person suffer while you continue to suffer.

4. Recognize the role that your “unenforceable rules” or Shoulds plays in your continued hurt and anger. Change or eliminate these rules.

5. Figure out what you want in your life and how to succeed in achieving those goals even if the other person doesn’t provide the answers. Remember that happiness is the best revenge.

6. Use the S A P model to change your shoulds, eliminate exaggerated awfulizing thinking, and take away blame.

7. Rewrite your script. Tell the new story where you were hurt but recovered and forgave and moved forward. You are a hero!

 

Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

The Two Selves: Implications for Time Management and Productivity

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I’m on vacation. I’m sitting on the deck of a house overlooking Sunset Beach in Hawaii. It’s a windy day and the waves are blowing. Since I’ve been so lazy here I’ve been thinking about productivity. And the paradox of our two selves.

Here’s an interesting question. How is it that sometimes we tell ourselves “I’m going to do such and such task” and then don’t do it?

Who is the self who is giving the orders and who is the self who is not following them?

How is this even possible? Are we a collection of multiple personalities?

It’s such a common phenomenon that we take it for granted. We are never surprised when we say to ourselves “Gee I think I’ll skip that cake” and then we end up eating the cake. Or we say to ourselves “I think I’ll work on that project,” and then we surf the internet instead.

And yet there is something profoundly strange about all of these phenomena. It is as if there is one self who tells the other self what to do, and then that other self decides whether or not to do it. Who is driving this bus?!

How do these two selves work? There is a little bit of research about this. In his book Thinking Fast and Thinking Slow Daniel Kahneman discusses these concepts and notes that we always assume that our future self will be more disciplined and more self-controlled. However, this is almost never true. Our future self is merely an extension of our current self with all of its flaws. In fact, it is our belief in the future self being more sensible that allows our current self to overeat, smoke, drink, or procrastinate doing work.

We make the dangerous assumption that we can afford these bad behaviors in the present because our future self will clean up the problem. Unfortunately, our future self is just as much of a slacker and just as self-indulgent as our present self.

So how is it possible that we have these multiple selves and cannot control our own behavior? Who is driving the bus?

I’ve been doing a lot of thinking about this issue lately and I have to admit I am somewhat puzzled by these phenomenon.

First of all, we need some terminology. Let’s call the telling-yourself-to-do-things self the Commanding Self. And let’s call the self that actually does things The Behaving Self.

Perhaps the real self is the Behaving Self, and the Commanding Self is the illusory self. In this formulation the reason that we don’t follow through on things is that we don’t actually really want to. In this formulation we would elegantly use Occam’s razor to reduce ourselves to one self; the behaving self who is actually the real self. We would become reductionist behaviorists, and to determine what people want we would observe what they actually do.

But then why do we spend so much time and effort having this other self who tells us what to do? And sometimes we actually do listen to the commanding self. What is different about those times when we listen and those times when we resist?

For instance, most of us have the experience of doing exercise, at least occasionally. And in order to do this we must listen to our Commanding Self.

Perhaps some of the current research on willpower can help us to understand the circumstances when the Commanding Self is listened to, and when it is not.

Current research on willpower suggests that it is a precious and limited commodity. It diminishes rapidly when used, and perhaps has about a 15 to 30 minutes half-life before it is exhausted. Other research suggests it is powered by our glucose metabolism so ironically the best way to resist overeating is to have a little bit of a sugary drink to restore willpower. The other factors that diminish willpower include being tired, hungry, probably emotional, and any other state that diminished our being. The 12-Step people were on to something with their model of hungry, angry, lonely, and tired (HALT) which captures this concept perfectly.

So perhaps another way of conceptualizing this strange dichotomy of selves is that the Commanding Self and the Behaving Self have relatively different strengths depending on our state of being both physically and emotionally.

The Commanding Self has more relatively more strength when we are well-rested, emotionally balanced, and well fed. The Behaving Self takes over when we’re tired, emotionally upset, or hungry.

Perhaps we should label the Behaving Self the Misbehaving Self! After all, most of the time the Behaving Self actually does misbehave. And perhaps we should label the Commanding Self as the Demanding Self.

There are many other self splits that we can look at. For instance, there clearly is a split between our short-term self and our long-term self. Many of the discrepancies in our behavior are a result of this particular split.

For instance, dieting. The short-term self wants immediate food gratification regardless of the long-term consequences on our weight or health. The short-term self wants to spend money in contradiction to the long-term self’s goal of spending less money and saving more.

So how can we integrate these multiple selves? Is it possible to create cooperation between our Commanding Self and our Behaving Self?

Can we possibly learn to show up for ourselves and actually follow through on what we say we are going to do?

Here’s an interesting exercise. What if you means-tested each command by asking yourself “How likely is it that I will do this?” And only issuing the commands that your Behaving Self agreed with?

So if you sit down at your computer and say “I’m going to do some writing,” you would ask yourself, “Do I really want to do some writing, and will I actually follow through and do it?” If the answer was not a resounding yes, then you would not issue the command.

It would be a very interesting experiment to spend an entire day doing this. One could also experiment with lowering the expectations of the Commanding Self. For instance, rather than saying I’m going to lift weights for 30 minutes, I would say I will lift weights for 5 minutes and then decide if I feel like doing more. That way I have at least lived up to my own expectations.

Same with eating. Rather than say I’m only going to eat one chip , I would instead say I’m going to eat the entire bag. Then if I leave a little bit I have actually outperformed my expectations.

In a sense what I’m suggesting here is that we have an honest dialogue with ourselves. As we write down our to-do list each morning, we should pretend that we are a boss or a manager asking an employee if they are willing and able to do each task. “Are you willing to sit down today and write for an hour?” “I don’t really know. I’m feeling sort of tired and unmotivated today. I guess I can commit to writing for 30 minutes, but I am not sure about an hour.” “Okay, why don’t you write for 30 minutes?”

And with each item on the to-do list we would have this honest discussion. We might also have a meta-discussion about the entire to-do list. For instance, “I notice that there are a large number of items on this to-do list and you only have a few hours free today. Is it realistic to really accomplish all of these items or should you be moving several to another day?”

“Yes, I see what you mean. I probably can’t achieve all of these items. I guess I have to pick one or two items and focus on those.”

“Which items would you like to select? Which are your highest priorities?”

I recently did this experiment for several days and discovered that unless my ratings of wanting to do something were in the 80 to 100 range (hundred point scale), I didn’t usually do the task. This was very consistent. I also noticed that sometimes the rating of wanting to do something didn’t get up to this critical range until the task became urgent, which of course explains procrastination.

Using the Technique of Paradoxical Agenda Setting

The technique of paradoxical agenda setting involves taking a devil’s advocate approach. Rather than trying to motivate yourself to do things by telling yourself all the good reasons why you should do those tasks, you instead ask yourself about all the reasons not to do the task?

By focusing on all the reasons not to do something you can honestly assess your motivation and even address some of these resistances more honestly. Rather than just saying to yourself “Just do it!”, you look at your resistance and troubleshoot how to eliminate it.

Exercises

Exercise: Write down all the commands you give yourself for an entire day. That includes to do list items that you set yourself to do, informal commands such as “I won’t eat the entire pie,” as well as any agreements you make with other people to accomplish tasks.

Write down the tasks and the commands as you issue them, not later. Otherwise you won’t remember them. At the end of the day take an inventory. Determine how many of the commands you actually accomplished. You probably want to calculate a percentage accomplished.

Take a look at this percentage. If it is over 80 percent then your two selves are very well integrated and you probably should stop reading this article right now. If it’s between 50 and 80 percent you are doing better than most people but still have plenty of room for improvement. If it’s between 30 and 50 percent then you are struggling with a split between your Commanding Self and your Behaving Self. In fact, you might just want to call it your Misehaving Self. And if you are below 30 percent then you are probably suffering many consequences from your inability to integrate your multiple selves.

Exercise: Learning how to lower your own expectations. Write down a goal for today. Now cut it in half. Now cut it in half again. That’s the new goal. We always bite off more than we can chew.

Exercise: Ownership. Write down a goal for today. Ask yourself is this is really your goal or someone else’s goal? Is it something that you want to do or is it something that you think you should do based on someone else’s opinion.?

Exercise: Under-promise and over-deliver. For today, practice making very small promises to yourself and overachieving on each promise. You want to be authentic and sincere in these small goals. Don’t pretend that they are actually larger goals.

Exercise: Gradually increasing goals. If your exercise goal is to exercise 5 days a week for 30 minutes, but you only exercise once a week, then you must lower your goal first to one time a week. See if you can achieve that goal several weeks in a row. If you can, then you get to increase the goal to perhaps two times a week of exercising. Once you’ve achieved that goal you get to increase the goal to three times. But each time and each week you must reach that new goal otherwise you must go back to the previous week’s goal.

That means if you set a goal of exercising three times but you fail to meet that goal then you must roll back the goal to two times and achieve that goal that for at least two weeks in a row. This will train you to make reasonable and achievable goals and to follow through on those goals.
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“Everyone wants to go to heaven but no one wants to die” : The Paradox of Goal Versus Time Management.

One of the ways to explain the disparity between our multiple selves is the trade-off principal embodied by the heaven quote.

We all have many goals, but in order to achieve goals we need time. Goals are infinite, and we can add an unlimited amount of them to our to-do list. But time is the ultimate finite quantity. We can manufacture as many goals as we choose, but we can’t produce a single extra minute of time.

Hence lies one very simple explanation for the two selves paradox. The Commanding Self produces a list of goals or tasks to achieve. The other self, which we will call the Behaving Self, must perform the task of accomplishing these goals within limited time, and must balance the time to achieve one goal versus another goal. But because the Commanding Self doesn’t really consider time in it’s estimations, the Behaving Self is almost certain to fail. The problem is that the Commanding Self does not understand the trade-off principle. The Commanding assumes that time is infinite. Which of course is patently untrue.

So how to fix this paradox? Perhaps the Commanding Self should be required to first estimate how much time each task or goal will take. And then double or triple this time estimate. But that won’t be enough. Instead of a to-do list, perhaps the Commanding Self should only use a calendar and time schedule. If the Commanding Self wants to straighten up the house , then it should be required to put it on the time schedule. And if it doesn’t fit on a time schedule , then don’t put it on.

This gives power back to the Behaving Self. And it is the Behaving Self that actually performs tasks. So we need to take the power away from the Commanding Self, and give it back to the Behaving Self. This should resolve many of the paradoxes between the two selves.

In a sense, what I am suggesting here is for all of us to get rid of our to-do lists, and replace them with time schedules and calendars. If a task doesn’t fit in our schedule, then it doesn’t become an action item. Of course the challenge of this would be that we tend to greatly underestimate the time it takes to accomplish each task, so we would have to either leave extra time, or split tasks into numerous sessions of work spread out over several days.

I am reminded of Neil Fiore’s book The Now Habit. He talks about the Un-Schedule. What he suggests is that people put on their Un-Schedule all of the things they have to do every day. This includes basic tasks of daily life such as showering, eating, commuting, all meetings, etc. What is left is the actual time you have to accomplish tasks. And for most people this is a very small amount of time. He then suggests that you fill in half hour blocks of work, after you accomplish that 30 minutes of work.

It is very sobering to do this. Most people realize that at best they have an hour or two per day to actually accomplish new work. Many jobs include multiple meetings which are required, leaving relatively little time in the workday to actually accomplish anything. When I did this I realized that after I included all of my basic tasks of daily life, exercise, returning phone calls, processing emails, and seeing clients, most days I only had an hour or two to accomplish anything else. And this hour or two could easily be used up doing a few tasks. When I realized how little time I really had during the work week, I lowered my goals and was happy accomplishing one or two significant tasks each day.

So these are some rambling thoughts from the beach about the paradoxes which make up our lives. Now my Behaving Self is saying time to go for a swim!

Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

The Power of Nurturing: How Quality of Parenting Interacts with Nature to Determine Outcomes in Life, Even in Poverty

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National Public Radio (NPR) reported  recently on a very interesting study of babies. This research, performed by Elizabeth Conradt at Brown University, looked at a phenomena called baseline respiratory sinus arrhythmia. This in itself is a very interesting concept. What exactly is this? It is the difference between your heart rate when you inhale and when you exhale. It turns out that some people have a larger difference than others. Everyone has a different set point in terms of heart rate variability.

Babies that have a bigger difference tend to have greater abilities to focus on things in their environment. If you show them a new toy, they will really look at it and interact with it. Babies with low heart rate variability tend to lose interest more quickly.

So it’s better to have a baby with higher heart rate variability? It’s not that simple. Babies with a higher set point of heart rate variability are more irritable and fussy particularly when their environment is changing. On the other hand, babies with a lower set point tend to be less fussy.

Heart rate variability turns out to be a pretty good predictor of how sensitive babies are to their environment, both in good and bad ways.

Anyway, Conradt’s research looked at mothers and babies who were living in poverty. They were interested in predicting how the children would do as they aged.

So first, at five months of age, they measured heart rate variability while the babies were listening to soothing music and watching soothing video.

Roughly a year later, when the babies were around 17 months old, they came back to the lab. At this point they measured two things. First the researchers evaluated behavioral problems such as anxiety or aggression. Then they performed an interesting test that measures the quality of attachment between a mother and the baby. The researchers took the mother and child to a strange room, where the toddler played for a bit. Then, without any warning, the mother got up and left the room. In most cases this will trigger the baby being upset and crying. This is typical and normal. The baby thinks, “Where did my mom go?!”

What the researchers were really interested in was what happened three or four minutes later when the mother returned. Could the mother quickly soothe the upset child, or did the toddler pull away from the mother and continue to be upset?

The researchers made the assumption that if the mother could easily soothe the toddler then it was a marker of good attachment and a secure environment.

So here’s the very interesting part of this research. How did the initial heart rate variability set point correlate with behavioral problems? It turns out that if the baby had a high set point and insecure attachment to their mother, then they had the worst behavioral problems. But if they had a high set point and secure attachments to their mothers, then they had the lowest incidence of behavioral problems.

Children with low set points fell in the middle of the range of behavioral problems, and were not affected by the quality of their attachment with their mothers.

The amazing finding was that the children who had high set points and good quality parenting as reflected by secure attachments to their mothers tended to have less behavioral problems even than babies in middle-class and affluent families!

This is fascinating research. It shows the influence of both nature and nurture. And it shows how a biological trait such as heart rate variability can either lead to good or bad outcomes in life based on the quality of parenting. Mostly though, it demonstrates how crucial good parenting is to later outcomes in life. Good parenting can create successful, well-balanced children even in circumstances of poverty. In fact, the study showed that for the more sensitive children,  good parenting in poverty trumps bad or mediocre parenting in affluence!!!

 

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.