The Psychology Lounge (tm) » Psychology

New Study Suggests You Can Reprogram Your Brain in Less Than Five Days!

Andrew Gottlieb, Ph.D. — Sat, 24 Apr 2010 23:16:45 +0000

Many previous studies have shown through the use of neuroimaging that meditation can change the brain. But most of those studies have looked at medium to long-term meditators. Some looked at monks who had meditated for decades, and some looked at new meditators who had meditated daily for 6 to 8 weeks. At least this much meditation practice was thought to be necessary to create measurable changes in the brain.

But a new study at the University of North Carolina at Charlotte suggests that brain changes may happen much more quickly, in as few as four days!

Student volunteers were randomly assigned to either practice mindfulness meditation or listen to the reading of JRR Tolkien’s The Hobbit, for 20 minutes a day, for four days. The groups were tested using behavioral tests of mood, memory, visual attention, attention processing, and vigilance. The meditative practice was a simple mindfulness technique. Participants were told to focus on their breath, and that when thoughts distracted them to notice the thought, and then refocus on the breathing.

What were the results? Both groups improved in mood, but only the meditation group improved in cognitive measures. In one challenging mental task, the meditation group did 10 times better than the reading group. It appeared that meditation improved the ability to sustain attention and vigilance.

This is an exciting study which hopefully will be replicated and expanded with their neuroimaging to see if there are functional or structural brain changes after brief meditation practice.

To summarize, it appears that a brief four-day practice of mindfulness meditation can significantly improve cognitive functioning that is related to attention and vigilance.

How lasting is this effect? Does it wear off in hours, days, etc.? What is the dose response ratio of meditation to cognitive functioning improvement? For instance, would eight days of meditation practice create even more cognitive improvement?

In any case, it’s worth practicing meditation at least briefly to see its effects on your mind and your emotions. Commit to 20 minutes a day for one week, and see what happens for you.

Now I’m off to meditate…

Does Money Buy Happiness? No, And The Answer Of What Does Buy Happiness May Surprise You

Andrew Gottlieb, Ph.D. — Thu, 03 Dec 2009 03:03:12 +0000

It is often said that money can buy happiness, and as I’ve blogged in earlier articles, this is true, but only up to a basic middle class economic status. Above that, money doesn’t seem to add much happiness. (See my posts here and here.)

So what does buy happiness? We have a surprising answer from our friends across the pond, at the University of Warwick in England. A new study published online Nov. 18 in the journal Health Economics, Policy and Law surveyed thousands of people on their levels of happiness and correlated it with external factors such as a pay raise or winning a lottery prize, and compared this to receiving psychotherapy. Astonishingly, even to me, a psychologist, the increase in happiness from a $1329 course of therapy was so large that to equal it people had to get a pay raise of more than $41,542! That’s a ratio of 32 times! That means a dollar spent on therapy boosts happiness 32 times more than the same dollar received in a pay raise or lottery prize.

As the study author Chris Boyce, of the University of Warwick, summarized: “Often the importance of money for improving our well-being and bringing greater happiness is vastly over-valued in our societies. The benefits of having good mental health, on the other hand, are often not fully appreciated and people do not realize the powerful effect that psychological therapy, such as non-directive counseling, can have on improving our well-being.”

Bravo,Chris! Now when patients ask me whether therapy is worth the money, I can confidently say that research suggests it might be one of the best investments you can make in yourself and your own happiness. (And it’s okay to get a raise, as long as you spend it on therapy!)

The only problem I can see with this article being published is that it may lower MY happiness, as I might get busier, perhaps earning more money, but not having time to see my own therapist!

So to answer the original question, does money buy happiness? Money doesn’t buy happiness; it buys psychotherapy, which yields 32 times more happiness than money!

Link to study: http://www.nlm.nih.gov/medlineplus/news/fullstory_92421.html

Why do Most Psychologists Ignore Science Based Therapy? Evidence Based Psychotherapy and the Failure of Practicioners

Andrew Gottlieb, Ph.D. — Sat, 10 Oct 2009 00:16:41 +0000

A new article in Newsweek magazine titled Ignoring the Evidence documents how most psychologists ignore scientific evidence about treatments such as cognitive behavioral therapy which have been proven to be effective.

A two-year study which is going to be published in November in Psychological Science in the Public Interest, found that most psychologists “give more weight to their personal experiences then to science.”

The Newsweek article has a wonderful quote,

“Thanks to clinical trials as rigorous as those for, say, cardiology, we now know that cognitive and cognitive-behavior therapy (teaching patients to think about their thoughts in new, healthier ways and to act on those new ways of thinking) are effective against depression, panic disorder, bulimia nervosa, obsessive-compulsive disorder, and -posttraumatic-stress disorder, with multiple trials showing that these treatments-the tools of psychology-bring more durable benefits with lower relapse rates than drugs, which non-M.D. psychologists cannot prescribe. Studies have also shown that behavioral couples therapy helps alcoholics stay on the wagon, and that family therapy can help schizophrenics function. “

The article documents how most psychologists fail to provide empirically proven treatment approaches and instead use methods which are often ineffective. The truth is there is very little evidence for most of the types of therapy commonly performed in private practices by psychologists and by Masters level therapists. If you are shopping for the most effective types of therapy you need to find a practitioner who is skilled at cognitive behavioral therapy (CBT) which is one of the few psychotherapy approaches that has been proven to work on a variety of problems.

Another interesting article in Newsweek about evidence-based treatment discussed bulimia. Here’s the summary:

“On bulimia (which affects about 1 percent of women) and binge eating disorders (2 to 5 percent), the verdict is more optimistic: psychological treatment can help a lot, and cognitive behavioral therapy (CBT) is the most effective talk therapy. That’s based on 48 studies with 3,054 participants. CBT (typically, 15 to 20 sessions over five months) helps patients understand their patterns of binge eating and purging, recognize and anticipate the triggers for it, and summon the strength to resist them; it stops bingeing in just over one third of patients. Interpersonal therapy produced comparable results, but took months longer; other therapies helped no more than 22 percent of patients. If you or someone you love seeks treatment for bulimia, and is offered something other than CBT first, it’s not unreasonable to ask why. Cynthia Bulik, director of the University of North Carolina Eating Disorders Program, summarized it this way: “Bulimia nervosa is treatable; some treatment is better than no treatment; CBT is associated with the best outcome.”

So the bottom line is this:

1. Most psychologists who don’t practice Cognitive Behavioral Therapy (CBT) are just winging it, using treatments that haven’t been shown to work by scientific studies. It’s as if you went to a regular physician and got treatment with leaches!

2. Many psychologists claim to use CBT but haven’t really trained in the use of CBT, or have taken a weekend workshop. Unless they prescribe weekly homework that involves writing down thoughts, and learning skills to analyze and change your thoughts, then they aren’t really doing CBT, and I recommend you find someone else.

3. If you have an anxiety disorder, depression, bulimia, or obsessive compulsive disorder, and haven’t been offered CBT, then you are not receiving state of the art treatment.

How to Deal with Teenage Depression: A New Study of Adolescent Depression and its Treatment

Andrew Gottlieb, Ph.D. — Tue, 17 Feb 2009 01:09:37 +0000

A new study reported in the Journal of the American Academy of Child and Adolescent Psychiatry found some interesting results of a study of teenage depression and its treatment.

This study of 439 teenage children with major depression, done at the University of Texas Southwestern Medical Center at Dallas tested anti-depressant medication (fluoxetine or Prozac), cognitive behavioral therapy (CBT), and a combination of both (COMB). They found that only 23% of the patients had their depression cured by 12 weeks of therapy. But 9 months of therapy was much more effective, with 60 percent going into remission.

The bad news though is that this means that almost half of the teenagers (40%) were still depressed after 9 months of therapy.

The good news is in terms of relapse. Of those who responded quickly to treatment, two-thirds retained the benefits of treatment over 9 months. The same was true of those who took longer to respond.

Which treatment was better? That is an interesting picture.

It depends at which time point you are looking at. At 12 weeks, the results for percentage fully remitted (cured) of depression were: combined drug and CBT therapy (37%), drug therapy only (23%), and CBT therapy only (16%). The combined therapy was significantly better than the other therapies. But note that overall, only 23% of the teenagers had recovered at 12 weeks, which means that 77% were still suffering!

But at nine months the outcomes look quite different. The combination therapy is still the best, but by less of a margin. The results for remission at at 9 months were: combination, 60%; drug, 55%; cognitive-behavioral therapy, 64%; and overall, 60%. By 24 weeks all the treatments were working well. But a full 40% of the teenagers were still depressed.

So the right answer to the question of which treatment works better is neither. Both drugs and cognitive behavioral therapy were equally effective, over the long term. But the combination of both was worked more quickly. As the researchers said, “choosing just one therapy might delay many teenagers’ recovery by 2 or 3 months.” As the saying goes, candy is dandy, but liquor is quicker, and we might conclude that drugs or CBT are dandy, but combined therapy is quicker.

So what does this mean to parents of depressed teenagers? Here are my takeaway messages:

Don’t expect treatment for depression to work quickly. It may take more than 9 months of weekly treatment before your teenager responds to therapy. This means at least 40 sessions of therapy.
Be patient, and set reasonable expectations for both yourself and for your child. Tell them that therapy will help, but it may take a while. Let support networks such as school counselors or trusted teachers know to be patient.
Although medications and cognitive behavioral therapy were equally effective in the long run, the combination of both tended to work much more quickly. So if you can afford it, and have access to good practitioners who do cognitive behavioral therapy, use both.
Be aware that in other studies, the relapse rate for medication treatment of depression was significantly higher than for cognitive behavioral therapy, once the medications are discontinued. So choosing medications only may increase the risk that your teenager will relapse into depression.
Be aware that much teenage depression can be a reaction to social environments. This includes the family, the school, and peers. Be sure that your teen’s therapist is attuned to family, school, and peer issues. They should meet with the whole family at least several times.
Take teenage depression seriously. It’s not just a phase. Teenage depression, when serious, can greatly increase the risk of suicide. All suspected depression should be evaluated by a professional and treated if present.

SOURCE: Journal of the American Academy of Child and Adolescent Psychiatry, February 2009 . And December 2006 issue too .

The Magic of Behavior Therapy: True Stories

Andrew Gottlieb, Ph.D. — Wed, 29 Oct 2008 19:05:27 +0000

Although I’ve been practicing behaviorally oriented therapy for more than 20 years, I’m still amazed and delighted by its power and effectiveness. Here are four tales of behavior therapy, from both inside and outside my office, with children, adults, and even animals!

Playing with Spiders

I recently had a very satisfying experience in the clinical practice. A client of mine asked me if she could bring her grandchildren to a session, in order to work on their spider phobia. I told her that if they were willing, I’d be happy to work with them. We would be able to make some progress by having the children look at pictures of spiders on my computer. The kids were 10 and 13, let’s call them David and Janet.

She surprised them (and me) by announcing at the beginning of the session that she had actually brought two live spiders in jars. This changed my plans for the session. I told the kids that we would only work with the live spiders if they were comfortable doing so. (It’s not a good idea to spring surprises during desensitization sessions.)

So we started doing what is called desensitization. This is a process where step-by-step, in a gradated way, the client is exposed to the fearful object. We started off by looking at pictures of spiders on the web (pun not intended). I picked less scary pictures at first, and I asked the children to rate their anxiety. Then I asked them to see if they could lower their anxiety numbers. We used a hundred point scale, and when they were able to lower their anxiety from 70 or 80 to 30 or below, we moved on to the next picture.

Eventually they were looking at pictures which were quite scary looking, even for me, and I like spiders!

Next we went on to work with the actual spiders. There were two spiders. One of them was a small daddy long-legs spider, and the other was a relatively small but scary looking spider. I decided to work with the daddy long-legs spider, as it was slower moving, and less scary looking.

First I had them look at the spider in the jar. Next I had them hold the jar. They were able to do this fairly rapidly. The next step was to open the jar, and look into the jar with the spider walking around inside the jar. David and Janet were able to do this without very much anxiety at all.

The next step was harder. It was to allow the spider to walk around on my office floor, and to have them touch the spider. I made this a little bit easier by having them put on surgical gloves. First I modeled the behavior for them. I touched the spider, and then I allowed the spider to walk over my hand.

Now it was their turn. First one, then the other, tentatively touched the spider. At first their anxiety rating was quite high, 70 or 80. Then I had them do this repeatedly, until they were able to do it with relatively low anxiety ratings of about 40.

One of the advantages of working with both of them simultaneously was that they were a bit competitive. Janet was initially a little braver, but David quickly responded to this challenge, and matched her touch for touch.

Once they were comfortable touching the spider with gloves on, it was time to take the gloves off. Once again I modeled for them touching the spider comfortably. In a few minutes, they were able to allow the spider to walk over the back of their hand. After a few minutes more, they were able to have the spider walk up their arm.

By the end of the session they were very comfortable playing with this small spider. They were actually having fun playing with Mr. Daddy Long-Legs. And this was only a 60 minute session!

Once again, I was amazed at the power of simple behavioral tools. Modeling — where the therapist demonstrates a behavior. Gradated exposure — gradually exposing the person to increasingly fearful stimuli. Reinforcement — where the therapist complements and praises the client for successful exposures. Shaping — where the client is reinforced for behaviors that gradually approximate the target behavior.

In less than 60 minutes I was able to take these two brave children from being terrified of spiders to relative comfort with spiders. Given that most people are not comfortable having a spider crawl up their arm, by the end of the session they had actually exceeded the comfort level of the average person.

(I recently got a follow-up report on the kids. According to grandma, David now can pick up dead spiders with his fingers, without using paper, which he could not do before. While his family was recently eating dinner, they noticed a large fly buzzing around. During their meal, the fly got caught in a spider web in the corner of nearby window. After the family had eaten dinner, they inspected the web and found the spider wrapping the fly. They left the web in place, deciding that it was beneficial, and David was comfortable with the arrangement. Janet reported that was able to put her hand on a picture of a big, multi-colored ugly black tarantula in her science textbook, with her mom watching. )

Bridging the Gap

Another opportunity for using the science of behavior therapy arose on a vacation. My partner and I were visiting Vancouver Canada, and one of the attractions there is the Capilano Suspension bridge (www.capbridge.com ). The bridge is a 6 foot wide suspension bridge which is 439 feet long, and 230 feet above a river gorge. It’s like the bridge in Indiana Jones and the Temple of Doom, swaying as you walk across it.

There was only one catch, my partner is very afraid of heights. She hates any situation involving them, and doesn’t even like walking across the Golden Gate Bridge.

But I thought that this might be an opportunity for her to overcome this fear, and offered to do in vivo desensitization with her if she was willing.

So we did. First I had her approach the edge of the bridge, and once again, I had her rate her anxiety using a 100 point scale. Ninety, she said. I then asked her to use breathing and relaxation to lower the anxiety. Before long she was able to stand at the very end of the bridge.

Next I had her advance out a few feet onto the bridge, stay there as long as she needed, and then retreat to solid land. She repeated this several times, until it was more comfortable.

Then I modeled walking partly across the bridge. I went slowly and hesitantly, modeling caution and slowness rather than speed and bravado. A coping model that shows the person overcoming fear is more effective than a perfectly confident model, I have found.

She then walked 10 or so feet across the bridge, and stood on the swaying bridge. Fear spiked and then subsided.

All along, I was giving her a lot of praise and encouragement. Next she managed 15 feet, and then retreated. Then she advanced 20 feet, then 30, then 40, and so on, until she was able to walk all the way across the bridge. Once she had accomplished that success, I had her repeat the process until her comfort level increased. I even invited her to jump up and down on the bridge, to demonstrate her lowered fear levels.

By the end of our visit there, not only was she able to traverse the bridge (which I admit was scary, even for me), but she was also able to traverse another attraction, a catwalk that was built between a number of Douglas Fir trees, which at points is 100 feet off the forest floor. This required more desensitization, but was successful in the end.

By the end of the day my brave partner had successfully overcome a lifelong fear of heights, and experienced some tourist attractions that she never would have enjoyed previously. When I showed her the video of her walking across the bridge, she was amazed at what she had been able to do.

Which is what I truly love about behavioral therapy; the ability to quickly and without lengthy therapy to overcome lifelong fears and expand one’s personal horizons!

Shaping Sandy to Swim

Another technique of behavior therapy is called shaping. What is shaping? Shaping is a technique where you reinforce gradual approximations of that behavior until you achieve the full behavior.

I had an opportunity to utilize shaping last summer when we spent some time at Lake Tahoe. We were renting a house on the beach, and our next-door neighbors had an adorable golden retriever named Sandy. Sandy loved to play on the beach, and her favorite game was fetch. But she wouldn’t go in the water past her ankles, and was afraid to swim. The owner said that she had never been willing to swim, even though they came up to Lake Tahoe regularly. The dog was about three years old.

I was challenged. Could I use behavior therapy to help Sandy overcome her fear of water and start swimming? I knew one thing; that dogs instinctively know how to swim, so it wasn’t a question of skill.

I decided to utilize the technique of shaping. First I made friends with Sandy by playing fetch on the beach. Pretty soon whenever I came out to the beach Sandy would run over with a stick to play.

Next I trained Sandy to follow me with the stick. She would follow me anywhere on the beach. Then I went into the water and encouraged her to follow me a few feet in order to grab the stick. She was willing to come into the water a little bit. I would praise her, and I would play some more with her on the beach.

Next I made it a little bit more difficult. In order to grab the stick she had to follow me into the water a few feet more.

I kept repeating this, each time requiring her to follow me further out into the water. Pretty soon she was following me five or 10 feet out into the water, but she still wasn’t swimming. Her feet were still on the bottom.

Next I used a slightly different technique. This time I had her come out into the water and grab the stick with her mouth. Instead of releasing it, I held on and moved out deeper into the water. Pretty soon her feet were off the bottom and she was swimming. I would then let go and she would swim back to shore, shake off, and play with me some more. The first time I did this she seemed a little perturbed, but quickly got into the game.

Over a couple of training sessions during the same day I continued this process. She got more and more confident, and was willing to swim out to grab the stick.

Finally I had her owner call to her while swimming in the deeper part of the beach. I threw a tennis ball out to the owner, and Sandy much to everyone’s surprise, swam out to the owner, grabbed the tennis ball, and swam back to the beach!

After that, Sandy seemed comfortable swimming in order to fetch a stick or a ball, even when it required her to swim in deeper water. Shaping had allowed her to learn gradually to overcome her fear and be able to swim with comfort.

The owners were amazed, as many times they had tried to coax her into the water. All I did was apply systematic methods of behavior therapy in order to allow Sandy to succeed. I shaped Sandy to swim, and she followed her destiny as a waterdog retriever.

Finding the Right Reinforcer

I want to tell one more story about behavior therapy, this time with dogs.

Although I’m a human therapist, I am very fond of dogs, and if I had an alternate career it would be as a dog trainer.

My friends Marli and Stu have two adorable dogs. They are Papillons, which are small cute toy dogs, who look a little bit like the gremlin "Gizmo" in the movie Gremlins . They have the same floppy ears and big eyes. (But they don’t turn into monsters if you feed them after midnight!)
In an effort to make their lives a bit more convenient, my friends had installed a dog door into their bedroom so that the dogs could go outside without needing help.

The problem was that neither Vinnie, the older dog, nor Bowie, the younger dog, was willing to use the dog door. They were both afraid of it. After weeks and weeks of hoping the dogs would figure out how to use the door, they still had not. Stu and Marli kept putting the dogs through the door, but the dogs never figured out how to use the door on their own.

Enter the confident behavior therapist, who offered to solve this problem. I was very confident that I could use food treats to entice the dogs through the door. Once having learned how to go through the dog door, I felt that they would continue to use it without treats.

I asked my friends not to feed the dogs the day I came over so that the dogs would be hungry and more motivated by food.

To make a long story short, I failed miserably. I was able to coax the dogs through the dog door by physically picking them up and pushing them through the door, but no amount of food treats would entice them to go through the door. They seemed uninterested in food treats. After several hours of trying everything I could think of, I gave up.

This bothered me greatly. Had I lost my behavior therapist powers? Had the technology failed? That night, as I tried to fall asleep, I found myself obsessing a lot about the problem. Just as I was about to fall asleep I realized the solution.

Can you guess what the solution was? I will give you a hint that it had to do with what type of reinforcements I had selected. Let me give you one more hint. Both of these dogs are very attached to my friend Marli. They like Stu, but they are crazy about Marli! They follow her everywhere. When she comes home from work they go nuts wanting to play with her.

The solution was to change the reinforcement. Instead of putting food on the other side of the dog door, I needed to put Love! What I did was to have a Marli call her husband Stu right before she came home. Then he would put the dogs outside. She would come inside the house, and call to the dogs through the dog door. The first time she did this both dogs dove through the dog door as if it wasn’t even there!

The next time she came home she came through the yard, and called to the dogs from the outside. Once again, motivated by love, they were very willing to use the dog door to get outside.

After a few days, they no longer had to use this procedure, as the dogs were happily using the dog door on their own. Behavior therapy had triumphed once again, but it required a more careful behavioral analysis of what these particular dogs found reinforcing. They were more motivated by love than by food.

And that’s a key secret…sometimes the best motivators are subtle, and never forget the power of love to motivate! If reinforcement isn’t working, it’s probably because you are not using the right reinforcement.

Should the Golden Gate Bridge Have a Suicide Barrier? (Is Suicide an Act of Impulse or an Act of Premeditation?)

Andrew Gottlieb, Ph.D. — Mon, 04 Aug 2008 06:39:40 +0000

One of the consistent and most fascinating facts that arises out of any serious study of psychology research is how much we are influenced by external factors. So much of our behavior is influenced by seemingly small external factors. We eat more when served bigger portions. We spend more when sales are in effect. Red cars are more likely to get speeding tickets. We are more likely to marry someone who lives or works nearby.

But what about the truly profound and serious decisions of life? What about something as serious as suicide? Can it be that even such a grave decision is affected by seemingly small external factors?

The New York Times Magazine recently published a fascinating article “The Urge to End It All“, which addressed this very issue. I highly recommend you read the entire article.

First, some numbers. (I love numbers). The current suicide rate is 11 victims per 100,000 people, the same as it was in 1965. In 2005, about 32,000 Americans committed suicide, which is two times the numbers who were killed by homicide.

For many years the traditional view of suicide was that it reflects mental illness — depression, bipolar illness, psychosis, schizophrenia, or other mental illnesses. This view assumed that the method of suicide was not important; it was the underlying mental illness that mattered.

But something happened in Britain in the 1960s and 1970s that set this model on its head. It’s called the “British Coal Gas Story” and it goes like this:

For many years people in Britain heated their homes and stoves with coal gas. This was very cheap, but the unburned gas had very high levels of carbon monoxide, and a leak or an opened valve could kill people in just a few minutes in a closed space. This made it a popular method of suicide — “sticking one’s head in the oven” killed 2500 Britons a year by the late 1950s — half of all suicides in Britain!

Then the government phased out the use of coal gas, replacing it with natural gas, so that by the early 1970s almost no coal gas was used. During this time Britain’s suicide rate dropped by a third, and has remained at that level since.

How can we understand this? If suicide is the act of an ill mind, why didn’t those who could no longer use coal gas find another means? Why did the suicide rate in Britain drop by a third when the option of coal gas was no longer available?
The answer turns conventional wisdom about suicide on its head. Conventional wisdom is that people plan out suicides carefully, and so convenience of method shouldn’t matter. But actually it appears that often suicide is an impulsive act, and when you make it less convenient, people are less likely to complete the act.

Another example of this is found in the Golden Gate Bridge. For years this gorgeous bridge has been a popular suicide point, where nearly 2000 people have ended their lives. There have been many debates about erecting suicide barriers on the bridge, but most opponents say “they will just find another way.”

But Richard Seiden, professor at University of California Berkeley, collected data that addresses this issue. What he did was to get a list of all potential jumpers who were stopped from committing suicide between 1937 in 1971, 515 people in all. He then pulled their death certificate records to see how many had gone on to kill themselves later. What would you guess was the percentage of these people who tried to jump off the Golden Gate Bridge and who later killed themselves? 50%? 75%? 25%?

Actually it was only 6%! Even allowing that some accidents might have been suicides, the number only went up to 10%. Although higher than the general population, it still means that for 90% of these would-be jumpers, they got past whatever was bothering them, and went on to live full lives.

Richard Seiden got some great stories out of this study. One of the things he found was that would-be suicides tend to get very fixated on a particular method. They tend to only have a Plan A, with no Plan B. As he says, “At the risk of stating the obvious,” Seiden said, “people who attempt suicide aren’t thinking clearly. They might have a Plan A, but there’s no Plan B. They get fixated. They don’t say, ‘Well, I can’t jump, so now I’m going to go shoot myself.”

One example he cites was a man who was grabbed on the east side of the bridge after pedestrians noticed him looking upset. The problem was that he had picked out a spot on the west side of the bridge that he wanted to jump from, but there were six lanes of traffic between the two sides, and he was afraid of getting hit by a car on his way over!

As Seiden said, “Crazy, huh? But he recognized it. When he told me the story, we both laughed about it.”

Another great example is from two bridges in Northwest Washington. The Ellington Bridge and the Taft Bridge both span Rock Creek, and both have about a 125 foot drop into the gorge below. For some reason the Ellington has always been famous as Washington’s “suicide bridge”. About four people on average jumped from the Ellington Bridge each year as compared to slightly less than two people from the Taft.

In 1985, after a rash of suicides from the Ellington, a suicide barrier was erected on the Ellington Bridge, but not the Taft Bridge. Opponents countered with the same argument, that if stopped from jumping from the Ellington, people would simply jump from the Taft.

But they were wrong. Five years after the Ellington suicide barrier went up a study showed that while all suicides were eliminated from the Ellington, the rate at the Taft barely changed, inching up from 1.7 to 2.0 deaths per year. What’s even more interesting is that the total number of jumping suicides in Washington dropped by 50%, or the exact percentage the Ellington had previously accounted for. So people stopped from jumping from the Ellington did not jump from other locations.

Coming back to our model that small external factors can have large influences on behavior, you might wonder why the Ellington was the suicide bridge instead of the Taft. It turns out that the height of the railing was what made the difference. The concrete railing on the Taft was chest high, while the concrete railing on the Ellington (before the barrier) was just above the belt line. One required a bit more effort and a bit more time to get over and this tended to reduce the impulsive action of jumping.

Which brings us to guns. Although guns account for less than 1% of all American suicide attempts, because they are so lethal, they account for 54% of successful suicides. In 2005 that meant 17,000 deaths. It turns out there when you compare states with high rates of gun ownership to states with low rates of gun ownership; you find that there is a direct correlation between the rate of gun ownership and the rate of gun suicide. This is not surprising.

What is more surprising is that in the states with low gun ownership, the rates of non-gun suicide are the same as those states with high gun ownership. So the lack of availability of guns does not encourage people to find other means of harming themselves. Studies show that the total suicide rate in high gun ownership states is double that of in low gun ownership states. So the Supreme Court, in their recent ruling regarding Washington, D.C.’s ban on handguns, may have missed the more important data when they focused on homicide rates. From these studies scientists conclude that a 10% reduction in firearm ownership would result in a 2.5% reduction in the overall suicide rate.

I am not anti-gun. I like shooting, and if I were a hunter, would probably own a rifle. But this is why I don’t own a gun, and this is why I don’t recommend that most people own a gun. All of us are potentially subject to dark moments of the soul, and the research detailed in this New York Times article suggests that the more barriers and impediments there are to impulsively harming ourselves, the less likely we are to try. If you do own guns, at least try to create barriers and delays such as keeping the guns locked up in a gun safe, keeping ammunition separate from the guns, or even not keeping ammunition in the home where guns reside. Not only does this protect you from those dark moments of the soul but it may also protect someone you love, your spouse, or your child.

Again, I highly recommend a careful reading of the original article, as it has much other information that is useful and interesting.

In answering the question of the title, I have to say that reading this article convinced me that we should build a suicide barrier for the Golden Gate Bridge. Yes, it would lower the beauty of this gorgeous bridge, at least for pedestrians, but I have to believe that saving another 2000 lives trumps a pretty walk across the Bay.

Is “Married Sex” an Oxymoron? (and Other Myths of Sexuality)

Andrew Gottlieb, Ph.D. — Fri, 06 Jun 2008 05:08:27 +0000

Recently I’ve been thinking a lot about sex. (That sounds bad, doesn’t it?)

It’s not what you think. My own life in that respect is just fine, thank you! But in the couples counseling work I do, sex is a big deal. Most of the couples I work with are married, and most of them are not having much sex. Some are not having any sex. Is “married sex” an oxymoron? And why?

It is remarkable how easy it is for couples to get out of the habit of having sex. As part of my general screening/evaluation interview with new couples, I always ask, “When was the last time you two had sex?” I’m often stunned when they can’t remember, not because they are suffering memory impairment, but rather because it has been that long. It’s not uncommon that it has been more than a year, or even more than several years.

What’s surprising is that most of the couples I see are not coming to therapy for help with sexual issues. You could argue that I don’t see a representative sample of couples, and I would agree. But even amongst my friends who are married, sex is a relatively rare phenomenon.

Recently the New York Times had an interesting article called “Yes Dear. Tonight. Again” about two couples who faced a similar sexual drought in their marriages, and who had an unusual response. One couple, the Muller’s, decided to have sex 365 days in a row. The other couple, the Brown’s, went for the more reasonable 101 days (or nights). The Muller’s book is called “365 Nights”, and the Brown’s book title borrows from the famous Nike line; “Just Do It.”

I haven’t read either book. What I found interesting was that both couples reported that their overall relationship improved by having more sex. It turns out that there is a high correlation between marital satisfaction and the frequency of sex. No one really knows if more sex makes people happier, or happier couples have more sex, or both. But the couples who wrote these books add a data point to the notion that more sex makes people happier.

How often do married people have sex anyway? From the Times article: “According to a 2004 study, “American Sexual Behavior,” by the National Opinion Research Center at the University of Chicago, married couples have intercourse about 66 times a year. But that number is skewed by young marrieds, as young as 18, who couple, on average, 109 times a year.” So the youngest of couples are having sex about twice a week. And older couples are having sex quite a bit less, perhaps less than once a week. And some couples are having much less sex, such that they could count the number of times per year on two hands, without using toes!

So let’s assume that the causal relationship works in both directions—happy couples want to have more sex, and more sex makes couples happier. What can we do about this? Helping couples to be happier is outside the scope of this article, and is something that often takes couples therapy. But what about the other side of the equation, that of having more sex?

First of all, we need to consider some myths of sexuality. The first myth is that sex shouldn’t be planned and scheduled. I don’t know where people get this idea, because we plan and schedule everything else good in our life. We buy concert tickets months in advance, we make reservations at good restaurants, we plan to attend our children’s school play. We plan to go to work each day.

Imagine if we applied the same model to daily life as we use with sex: “You know, honey, I just don’t feel like driving the kids to school today. I ate too much as breakfast, and I kinda feel fat, and getting behind the wheel will make me feel bad.” “Yeah, I don’t really feel like going to work today. I’m a little tired. I think I’ll just stay home in bed and sleep all day.”

This is what I call the Myth of Spontaneity. We wait for the sun and the stars and the moon to line up for both people in the couple, and then and only then can we consider sex. If anything else then gets in the way like kids or telephone or dogs, forget it. Waiting for everything to be ideal for two people greatly lowers the odds of having sex at all.

Instead, I suggest that couples make sex dates. (Or call them pleasure dates.) Sit down and talk about how much sex you would like to be having. What’s the optimal frequency for each of you? Compromise if you have different answers. Then pull out your calendars, and figure out times when you can plan to have sex. Consider other distractions like children, pets, jobs, etc. Every couple should be able to find at least one time a week where they have some time and some privacy to get intimate.

Then make it happen. As the Browns would say, Just Do it! No excuses. If you find there is always something getting in the way, consider what the issues are. Are there other resentments that are being expressed sexually? Are there sexual issues that need to be talked about and worked on? Are there issues of appearance or hygiene that can be addressed? Sit down and talk about what’s getting in the way, and if you can’t do it alone, then see a therapist to help talk it out.

Another myth is what I call One Size Fits All. This means that couples often think of having sex in terms of a standard sexual script; a little foreplay, maybe a little oral sex, a few minutes of intercourse, and off to sleep afterwards. It is a full course meal or nothing at all. The antidote for this myth is to have a varied repertoire of sexual activities you both enjoy. Perhaps sometimes it is okay to have a quick snack, instead of the full meal, so to speak. If one person is tired, and one is feeling more amorous, maybe the tired person can be pleasured by the amorous one. Again, it helps to talk over these options. What do each of you like to do when you are not that sexually energetic? And sexy cuddling is okay too. Maybe you fool around a little, skin to skin, and no one orgasms, and that’s fine too.

Still another myth is what I call Not Tonight Dear. This is the idea that it’s fine to turn down sex whenever you don’t really feel like it, since after all, you wouldn’t want to have sex if you don’t feel like it. The problems with this belief are multiple. First of all, most people are very sensitive about being rejected sexually. A “not tonight dear” crushes them. And then they are less likely to initiate the next time. Second, if both people say “no” often, it dramatically lowers the chances that the couple will ever have sex. And both people will decrease how often they initiate, further lowering the probability of successful sexual connecting.

What is the antidote? First of all, try to limit saying “no” to the extreme examples. If you are having a massive migraine headache, food poisoning, or something similar, I think it is fine to say no. The “no” response should be rare, less than once in ten times. In the Brown’s book “Just Do It” there is a story of one time that the husband was having a vertigo episode, but they still had sex!

Second, it is okay to say yes in a limited way. For instance, let’s imagine you don’t feel very turned on. I think it is okay to say something like, “You know, I’m not feeling very sexual right now, but I’m willing to play a little and see if that changes. Is that okay with you?”

Finally if you really do need to say no, then offer a specific alternative time and place. For example, “I’m really tired tonight, honey, and I’d really rather make love tomorrow morning, is that okay?” And be affectionate and loving when you say it.

So let’s review. If you want to make sure that “married sex” is not an oxymoron in your life, then follow these guidelines:

1. Plan to have sex. Make dates to have sex, and keep the dates. Decide on your sexual goals, and then figure out the best times to schedule your “pleasure dates”.

2. Be flexible about the kinds of sexual encounters you can have. Sample from a varied menu of sexual options, and don’t be all or nothing about sex. Even sexy cuddling can be a type of sex, and is better than nothing. Not all sex needs to result in orgasm for both or even one partner.

3. Avoid turning down sex more than infrequently. To paraphrase the Brown couple, Just Say Yes. This lowers the probability of hurt in the bedroom, and keeps both partners willing to initiate because they know that rejection is infrequent.

4. Talk about your sex life, what works, and what doesn’t work. This is the only way you can improve things. And if you are too shy or inhibited to talk about it on your own, see a good couples or sex therapist, who can facilitate this dialogue.

And having said all that, now I have to go, as I have a scheduled date with my sweetie!

(Fade to black…)

The Mystery of the Obesity Epidemic: Solved? (Hint: It’s simpler than you think)

Andrew Gottlieb, Ph.D. — Sun, 30 Mar 2008 18:15:36 +0000

Was Grandma Right?

It’s been too long since I last wrote, but I’ve been catching up on my sleep. Why will become relevant after you read this article.

Sleep is something we mostly take for granted as part of our daily lives, much like eating and showering. But why do we sleep? What does sleep do for our minds and our bodies? What happens if we don’t sleep, or if we don’t sleep enough?

For those of you who are interested in these questions, I’d highly recommend that you read the transcript of The Science of Sleep, an excellent piece by 60 Minutes that aired on March 16, 2008. Not only did I learn many interesting facts about sleep, I learned about my own health and how sleep affects it. More on that later.

Why do we sleep? After all, from a survival point of view, sleep is not really a good thing, in the sense that we are unconscious and helpless during sleep. So for sleep to have evolved, then it must serve some vital functions. (I should point out though, that sleep might have survival advantages, since if early humans slept in caves and other sheltered places, sleep would have kept them out of the reaches of nocturnal predators. The folks who didn’t sleep much, and who wandered around all night, probably got eaten!)

One clue of how important sleep is in studies done in the 1980’s with rats. When rats were prevented from sleeping (did they use disco music to keep them awake?) they died after 5 days! Sleep seems to be as important to rats as food.

Let me present a quick primer on sleep. When we sleep, we actually go through multiple cycles of different stages of sleep. These stages are stages 1-4 of non REM (NREM) sleep, and stage 5 which is REM (rapid eye movement) sleep. The key stages are Stage 4, or Delta Sleep, and Stage 5, REM sleep. Stage 4 Delta sleep is the deep restorative sleep where our bodies get rebuilt and restored. Stage 5 REM sleep is when we dream, and it appears that our minds get restored during REM sleep. Typically the whole cycle takes about 100 minutes, and we have 3 or 4 of them each night.

Sleep may play an important role in enhancing memory. One study found that when people learned a new skill in the afternoon, and then were tested after a night of sleep, they did 20-30 percent better than those who were tested after twelve hours, but with no sleep in between the learning and testing. This is fascinating, and jibes with a trick I learned in graduate school. When I would study statistics, I’d always review my notes right before going to sleep. The next morning, the memories of those notes were imprinted magically in my mind.

Sleep also plays a critical role in stabilizing mood. One experiment tested people who were sleep deprived by showing them disturbing images within an fMRI scanner, to look at their brain activation. They found the sleep deprived subjects had a disconnect between the brain’s emotional center (the amygdala) and the part of the brain that controls rational thought (the frontal lobe). So they couldn’t control their emotional reactions. They looked more like psychiatric patients. Of course we all know that sleep deprivation makes us cranky and short-tempered, this explains why.

Another important function of sleep is physical rejuvenation. It appears that Stage 4 sleep is essential here. In the 60 Minutes piece they show an experiment where a young man named Jonathan is deprived of only Stage 4 sleep. Each time his brain waves show Stage 4 sleep, loud sounds are played to bring him out of deep sleep. He gets a normal amount of sleep, but a reduced amount of Stage 4 sleep. After 4 nights of this regimen, this 19 year old is starting to look physically like a 70 year old. His body becomes no longer able to metabolize sugar effectively, putting him temporarily at increased risk for Type 2 diabetes.

Other studies confirm this. After just a few nights of partial sleep deprivation, young healthy people show a metabolic change that is similar to what happens as people develop Type 2 diabetes. They no longer metabolize sugar effectively. They deposit more fat. The hormone leptin, which controls appetite, seems to drop, and they want to eat more.

This is truly astonishing. If relatively short term sleep deprivation can cause such a profound shift in the body’s sugar metabolism, then this may be the key to unlock one of the great medical mysteries of the 20^th century: Why obesity has increased so rapidly since 1980? Could it be that the obesity epidemic is really a sleep deprivation epidemic? Could it be so simple? Not junk food, television, lack of exercise, and all of those things that people talk about? Could grandma have been right?

Here’s the clue.

In 1960 a survey of a million Americans showed an average of 8.0 hours of sleep per night. Today similar studies show we are only getting 6.7 hours a night. That’s a drop of 16.25% in less than a generation. And teenagers are the most sleep deprived of all, since they require 9-10 hours of sleep, and most get less than 7 hours of sleep, thanks to ridiculously early school start times. Teenagers may be lacking between 22 percent and 30 percent of their needed sleep.

So we have a plausible explanation for why everyone, even children and teenagers, is getting fatter. Sleep deprivation causes shifts in metabolism, creating a pre-diabetic state, and lowering level of the satiety hormone leptin, which causes us to eat more, and store more fat. Add sugary or high carbohydrate foods, and we get even fatter. Add inactivity, and we get even fatter. The damage begins early, perhaps in early teenage years.

So if we want to lose weight, then the old saw of a healthy diet and plenty of exercise may be wrong. The proper advice is probably lots of sleep, a reasonably healthy diet, and a little exercise. Or since exercise improves sleep quality, sleep, exercise, and diet. Without adequate sleep, diet and exercise are doomed to failure, since even young people may unintentionally be turning their bodies pre-diabetic, which makes it very hard not to gain fat.

So that’s why I haven’t written. After a lifetime of staying up late, and cheating sleep, I’m starting to try to get a solid 8 hours of sleep a night. Already I’ve lost a few pounds, even though I haven’t been exercising much. The other advantage of going to bed earlier is that when you are sleeping you are not eating.

So try it. Get 8 or 8 1/2 hours of sleep a night. And make sure your teenagers get 9 or 10 hours a night. No more websurfing or TV late at night. And write me and let me know if your weight drops as a result.

Now I’ve got to stop writing and go to sleep…

The Neuropsychology of Long Lasting Love: Can Brain Scans Tell Us Something Useful About Staying in Love?

Andrew Gottlieb, Ph.D. — Fri, 08 Feb 2008 19:56:02 +0000

The Wall Street Journal today has an article called Keeping Love Alive, which documents some fascinating research looking at why a small minority of long term couples seem to maintain intense passionate loving connections.

First the grim background to these findings. Keeping love alive is no mean feat, as the research on long term relationships suggests that for most couples love is a fading affair.

From the article:

“Each year, according to surveys, the average couple loses a little spark. One sociological study of marital satisfaction at the University of Nebraska-Lincoln and Penn State University kept track of more than 2,000 married people over 17 years. Average marital happiness fell sharply in the first 10 years, then entered a slow decline.”

This is not such good news for all of us in long term relationships. What do we have to look forward to? A sharp decline in happiness for the first ten years, and then a slow erosion of whatever remaining happiness is left, until either we run out of love or time, whichever comes first? Ugggh!

But then to the rescue comes Arthur Aron, who is a social psychologist at Stony Brook University. He’s looked at those unusual couples who claim that their love is just an intense years later. It’s a strategy of research which is called examining the outliers, those people who fall outside the averages.

Aron and his students are studying these couples in an interesting way. They are taking pictures of their brain function, using magnetic resonance imaging (MRI). They have a person lie inside an MRI machine, and look at pictures of their spouse, while measuring the activity in their brain.

What have they found? It turns out that when these passionate couples look at or think about their spouses, a part of their brain called the ventral tegnmental area lights up. This is a section of the brain that is rich in the neurotransmitter dopamine, which is connected to our ability to feel pleasure and joy. The results have been duplicated in China, suggesting this is not just a western cultural phenomenon.

So what does this all mean? It’s not of much help in the challenges that I face as a marriage therapist, in helping couples repair damaged love. One of the interesting details reported in the article was that these passionate long term “in love” couples show one behavior in common. They are constantly affectionate, kissing, hugging, and holding hands. They display many PDA’s (public displays of affection).

Now that there is a brain measure of this intense love, what is more important is to study how people get there. Are these couples just more intensely in love to begin with? Perhaps it is like cognitive function, where those who start off smarter and more educated deteriorate more slowly in old age. Maybe these passionate couples simply start with more love, and show erosion, but they have such an excess that it doesn’t matter.

We might be able to answer some of these questions with a long term longitudinal study of new couples that followed them over 10 years or longer.

Is it a selection process, where better mate selection leads to better long term outcomes? Or are there behavioral differences, a set of behaviors and attitudes that preserves love? These are the key issues in answering the question of how do we go about Keeping Love Alive.

What I find deeply fascinating is that in spite of the fact that most people value love as one of the most important things in their lives, we actually know very little about what predicts success, and even less about how to help people love better. Brain scans may tell us more about the process of love and attraction, but unless we develop a “love beam” that changes the activity of the key brain regions, it won’t help us fall in love and stay in love.

…Excuse me, I’ve got to go kiss my sweetie!

Secrets of How to Get Moving (Especially When You Are Stuck)

Andrew Gottlieb, Ph.D. — Sat, 19 Jan 2008 19:09:53 +0000

In a previous article I wrote at length and I admit, rather philosophically, about getting things done. In this article I am going to do something a little different. Clients often ask me for specific tips to help them get moving. We’ve all had the experience of being completely blocked, seemingly unable to get anything done, and struggling to get moving. Some of this is mood and energy based. When we are tired, sleep deprived, or blue, it’s hard to motivate to do anything, especially tasks that are not fun or interesting. But life demands that we function even under these circumstances, so here are 5 tips for how to get moving when you are blocked.

1. Priming the Getting Things Done Pump

The first secret is to prime your “getting things done” pump by getting something done, anything. Pick a small task that you’ve avoided or failed to do for a long time. It can be anything. It should take no more than 5 or 10 minutes to complete. The key here is that you are going to complete something, and it’s something you’ve been avoiding for a long time.

I picked a Microsoft Class Action legal settlement form that entitled me to $125 in rebates on computer products. I had sent it in a long time ago, but it had been rejected and returned on a technicality. I pulled it out, found an appropriate receipt to attach it to, and put it in an envelope, and mailed it. Time? About 8 minutes. Not only did I get something done, but I made $125 in 8 minutes, that’s $937 per hour!

The principle is to get something done, which flexes your “getting things done” muscles. By picking something you’ve avoided for a while, you get an even bigger kick.

2. The Smallest Piece Technique

You can use a related technique even for a huge and complicated tasks that we all tend to avoid starting, and thus never finish. If you have a huge task, break it down into component pieces. Then pick a very small piece, a piece that will take 5 to 10 minutes, and do it.

This breaks the ice, and gets you moving on the big task. Often once you’ve done the first small piece you can then do more pieces. Often it is best to use a pump priming strategy here. Pick the smallest piece there is, and get it done. For instance, if you want to do your taxes, you might simply set the task of pulling out your tax folders, and putting them on your desk. That’s it, you are done. (But now you want to do more, don’t you!)

This also works well for getting started with exercise. Rather than saying to yourself, “I’m going to take a 1 hour walk”, and then doing nothing, decide to take a 5 minute walk. Once you are outside and walking, you probably will find yourself walking for more than 5 minutes. The key is to set the task of walking 5 minutes every day, and then you break down your resistance.

3. The Dice Man (or Woman) Technique

The next technique is a good one if you find yourself frozen with indecision. You have a many important tasks to do, and you can’t decide which one to do first. You are like an octopus that is pulled in many different directions by each of its tentacles, and hence is frozen in place completely.

In this case, use the Diceman strategy. The The Dice Man is the title of a comedic novel published in 1971 by George Cockcroft under the pen name Luke Rhinehart, in which a psychiatrist begins to make all his life decisions using a set of dice. (It’s a wild novel, and pretty interesting.)

To use this strategy, make a short list of the some of your main tasks. Number them 1-6 or 1-12. Then throw one or two dice, and do the one that the dice indicates. Or you can throw darts at the list, or even just toss a penny onto the list, and do the task the penny falls upon.

What this does it to short-circuit the part of your brain that is trying to prioritize many equally important tasks, and gets you moving and finishing a task. Often, once you do this, it is much easier to continue picking tasks and doing them.

4. The Entertainment Strategy

What about those tasks that are just plain boring? For instance, like filing, or unloading or loading the dishwasher. The best way to do these tasks is to pair them with some other activity that is fun.

For loading or unloading the dishwasher, you could use a phone with a hands-free headset, and talk to someone you like while you take care of the dishes. The same technique is useful for straightening up the house.

For filing, this is also a good technique. Another approach is to do the boring task while watching or listening to some entertainment. I find baseball and football games on television perfect for tasks like filing. Both have many slow points, which allows me to get a lot done without missing key points. Listening to a good show on the radio also works.

5. When All Else Fails, Bribe Yourself!

Another way of getting unpleasant boring tasks done is to pair them with specific rewards. For instance, let’s say you have a big task to do like doing your taxes. This is a task that takes a couple of days. Before you start, set yourself a specific reward once you have finished. It could be that you get to buy something for yourself. Or go do an activity that you like. The key is to make sure that the reward is big enough to motivate the task. Telling yourself you get to eat a piece of pie after spending two days doing taxes won’t work. It probably will take something bigger, and not pie! I call this strategy “paying yourself to get things done.”

So there you have it. Five quick ways to explode your resistance and get something done! Good luck!

I have to go now, and pay one bill.