The Psychology Lounge ™The Psychology Lounge ™ http://www.PsychologyLounge.com by Dr. Andrew Gottlieb (650) 324-2666 Sun, 07 Dec 2014 01:28:35 +0000 en-US hourly 1 Copyright © The Psychology Lounge ™ 2014 LoungeWizard@PsychologyLounge.com (The Psychology Lounge ™) LoungeWizard@PsychologyLounge.com (The Psychology Lounge ™) http://www.PsychologyLounge.com/wp-content/plugins/podpress/images/powered_by_podpress.jpg The Psychology Lounge ™ http://www.PsychologyLounge.com 144 144 by Dr. Andrew Gottlieb (650) 324-2666 The Psychology Lounge ™ The Psychology Lounge ™ LoungeWizard@PsychologyLounge.com no no Calming An Overactive Brain–My Day In Pacifica http://www.PsychologyLounge.com/2014/05/12/calming-overactive-brain-day-pacifica/ http://www.PsychologyLounge.com/2014/05/12/calming-overactive-brain-day-pacifica/#comments Mon, 12 May 2014 19:49:36 +0000 http://www.PsychologyLounge.com/?p=436 Send to Kindle

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 …

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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.

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SSRI Antidepressants Given in High Doses May More than Double the Risk of Suicide in Adolescents and Young Adults Under 25 http://www.PsychologyLounge.com/2014/05/12/ssri-antidepressants-given-high-doses-may-double-risk-suicide-adolescents-young-adults-25/ http://www.PsychologyLounge.com/2014/05/12/ssri-antidepressants-given-high-doses-may-double-risk-suicide-adolescents-young-adults-25/#comments Mon, 12 May 2014 19:24:39 +0000 http://www.PsychologyLounge.com/?p=431 Send to Kindle

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. Wh…

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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.

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How to Forgive: A Cognitive Behavioral Model for Forgiveness and Letting Go of Anger and Frustration http://www.PsychologyLounge.com/2014/01/21/how-to-forgive-a-cognitive-behavioral-model/ http://www.PsychologyLounge.com/2014/01/21/how-to-forgive-a-cognitive-behavioral-model/#comments Wed, 22 Jan 2014 00:07:03 +0000 http://www.PsychologyLounge.com/?p=425 Send to Kindle

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 …

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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.

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New Hope for Procrastination: Procrastinators are Trying to Repair Their Negative Moods by Avoiding Work According to the Wall Street Journal http://www.PsychologyLounge.com/2014/01/08/new-hope-procrastination-procrastinators-trying-repair-negative-moods-avoiding-work-according-wall-street-journal/ http://www.PsychologyLounge.com/2014/01/08/new-hope-procrastination-procrastinators-trying-repair-negative-moods-avoiding-work-according-wall-street-journal/#comments Wed, 08 Jan 2014 23:11:18 +0000 http://www.PsychologyLounge.com/?p=422 Send to Kindle

The Wall Street Journal has an intriguing article To Stop Procrastinating, Look to Science of Mood Repair. In the article, they discuss new research that suggests that many of the avoidant behaviors procrastinators use are actually attempts to repair low moods. Procrastinators often feel anxious or worried about the task they are attempting to accomplish, so that go to Facebook, the refrigerator, or to sleep to avoid those feelings. Learning new ways of dealing with negative feelings, and using some acceptance methods so that they can better tolerate the negative emotions …

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The Wall Street Journal has an intriguing article To Stop Procrastinating, Look to Science of Mood Repair. In the article, they discuss new research that suggests that many of the avoidant behaviors procrastinators use are actually attempts to repair low moods. Procrastinators often feel anxious or worried about the task they are attempting to accomplish, so that go to Facebook, the refrigerator, or to sleep to avoid those feelings. Learning new ways of dealing with negative feelings, and using some acceptance methods so that they can better tolerate the negative emotions are both helpful strategies for overcoming procrastination.

Highly recommended article, check it out! I’d write more, but I’m trying to get to work and stop avoiding by writing about avoidance!

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.

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The Treatment of Tinnitus using Cognitive Behavioral Therapy http://www.PsychologyLounge.com/2013/12/03/treatment-of-tinnitus-using-cognitive-behavioral-therapy/ http://www.PsychologyLounge.com/2013/12/03/treatment-of-tinnitus-using-cognitive-behavioral-therapy/#comments Tue, 03 Dec 2013 21:53:31 +0000 http://www.PsychologyLounge.com/?p=418 Send to Kindle

Tinnitus is condition where the person hears a ringing in their ears or other sounds when none of these sounds are present. It is a very common problem, especially as people age. According to studies, up to 20% of people over the age of 55 report symptoms.

What causes tinnitus? There can be many causes. The most common cause is noise-induced hearing loss. Other causes include medication side effects, as well as withdrawal from benzodiazepines. In many cases no apparent cause can be found.

For many, tinnitus is a relatively minor problem that they tend to ignore. Almost everyone ha…

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Tinnitus is condition where the person hears a ringing in their ears or other sounds when none of these sounds are present. It is a very common problem, especially as people age. According to studies, up to 20% of people over the age of 55 report symptoms.

What causes tinnitus? There can be many causes. The most common cause is noise-induced hearing loss. Other causes include medication side effects, as well as withdrawal from benzodiazepines. In many cases no apparent cause can be found.

For many, tinnitus is a relatively minor problem that they tend to ignore. Almost everyone has momentary tinnitus symptoms. But for other people tinnitus creates a tremendous amount of psychological distress. This includes anxiety and depression. The person fears the loss of their hearing, and tends to focus intensely on their symptoms. They begin to avoid situations where their symptoms are more noticeable. This typically means avoiding quiet locations where there is no sound to mask the tinnitus sounds. Or it may involve avoiding situations where there are loud noises such as movie theaters due to the fear of further hearing loss.

Similar to some forms of obsessive compulsive disorder (OCD), the person may begin to engage in frequent checking behavior. This means that they consciously check the presence and volume of the ringing in their ears. They may also frequently check their hearing.

The person also suffers from constant thinking about causes of the tinnitus. They often blame themselves for exposure to loud noises in earlier life. They think about the music concerts they attended where they didn’t wear earplugs, or even recreational listening to music. They have strong feelings of regret that can blend into depressive symptoms.

Unfortunately there are no terribly effective physical treatments for tinnitus. This leaves psychological treatment as the primary modality for successful reduction of distress.

Cognitive behavioral therapy (CBT) conceptualizes tinnitus much like it conceptualizes the experience of chronic pain. Chronic pain consists of two components. The first component is the physical sensations. The second component is the bother or suffering caused by these physical sensations.

Tinnitus can be conceptualized in the same way. The subjective experience of sounds in the ears is the physical sensation. The interpretations of these sensations lead to the emotional reactions; suffering and bother.

Although CBT cannot directly change the physical sensations of tinnitus, it can change the reactions to these sensations. And changing the reactions can actually lead to a subjective experience of diminishing symptoms.

What are the components of the CBT treatment for tinnitus?

1. Psychoeducation. The first step is to educate the client about how tinnitus works. The model used is that the loss of certain frequencies in the hearing range leads the brain to fill in those frequencies with sounds. It is very much like phantom limb pain, where an amputee may experience pain in the removed extremity.

The nature of hearing loss is explained, and psychoeducation regarding tinnitus and the risk of further hearing loss is discussed. If needed, results of hearing tests can be discussed relative to the actual severity of hearing loss. Although in some cases of tinnitus hearing loss is quite significant and may actually impair functioning, in many cases the hearing loss is relatively minor and does not impair functioning in any way.

2. Cognitive therapy. Here the therapist helps the patient to identify the negative thoughts that are leading to anxiety and/or depression. Typical thoughts for anxiety are: “I can’t live my life anymore with this condition. I will lose my hearing entirely. The sounds will drive me crazy. I’m out of control. If I go into _____ situation I will be troubled by these sounds so I must avoid it. I need to constantly check my hearing to make sure it’s not diminishing. I need to constantly check the tinnitus sounds to make sure they are not getting worse. They are getting worse! They will get worse and worse until they drive me crazy.”

Typical thoughts for depression are: “Life has no meaning if I have these sounds in my ears. I can’t enjoy my life anymore. It’s hopeless. There’s nothing I can do about it. Doctors can’t help me. It will get worse and worse and slowly drive me crazy. I won’t be able to function.”

Once these thoughts are identified then the skills of challenging them and changing them are taught to the client. The client learns how to alter these thoughts to more healthy thoughts. This produces a large reduction in anxiety and depression.

3. Attentional strategies. Because much of the subjective perceived loudness of tinnitus is based on attention, with higher levels of attention leading to higher levels of perceived loudness, developing different attentional strategies will help very much. In this part of the treatment mindfulness training and attentional training is used to help the client learn how to shift their attention away from the tinnitus sounds onto other sounds or other sensations. Often a paradoxical strategy is first used, where the patient is asked to intensely focus only on their tinnitus sensations. This teaches them that attention to tinnitus symptoms increases the perceived severity, and helps motivate them to learn attentional strategies.

Another aspect of attentional retraining is to stop the constant checking of symptoms and hearing. Helpful techniques include thought stopping where the client may snap a rubber band against their wrist each time they notice themselves checking.

4. Behavioral strategies. Tinnitus sufferers typically develop an elaborate pattern of avoidance in their lives. They avoid situations where they perceive tinnitus sounds more loudly. This can include avoiding many quiet situations, including being in quiet natural places such as the woods, or even avoiding going to quiet classical music concerts. They also tend to avoid situations where they might be exposed to any loud noise. This includes movie theaters, concerts, and even noisy office situations.

The behavioral component of CBT encourages an exposure-based treatment whereby the client begins to deliberately go back into all of the avoided situations. In situations where there is actual loud noise exposure at a level potentially damaging to hearing, they are encouraged to use protective earplugs.

The purpose of the behavioral component is to help the person return to their normal life.

5. Emotional strategies. Sometimes it is necessary to help the client go through a short period of grieving for their normal hearing. This allows them to move forward and to accept the fact that they have hearing loss and tinnitus. Acceptance is a key factor in recovering psychologically. This often also includes forgiving themselves for any prior excessive loudness exposures.

Changing the thoughts about the tinnitus symptoms also produces emotional change and a reduction in anxiety and depression.

In summary, cognitive behavioral therapy of tinnitus seeks to reduce the psychological suffering caused by the sensations of tinnitus. Cognitive, emotional, behavioral, and attentional strategies are taught to the client to empower them to no longer suffer psychologically from their tinnitus symptoms. Successful treatment not only reduces the psychological suffering, but because it also changes the attentional focus and lowers the checking of symptoms, people who complete CBT for tinnitus often report that their perceived symptoms have reduced significantly.

Tips:

1. Traditional psychotherapy is typically NOT helpful for tinnitus.

2. Find a practitioner, typically a psychologist, with extensive training in Cognitive Behavioral Therapy. If they have experience treating tinnitus that is even better.

3. Give treatment a little time. You will have to work hard to learn new ways of thinking and reacting, and this won’t happen overnight. You should be doing therapy homework between sessions.

4. Medication treatment such as anti-anxiety or antidepressant medication is typically not very helpful, and in the case of anti-anxiety medications can actually worsen tinnitus especially during withdrawal. First line treatment should be CBT.

5. Get help. Although the actual symptoms of tinnitus have no easy fix, the suffering can be treated and alleviated. Especially if you are experiencing depression symptoms, is is important to seek therapy with a CBT expert.

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.

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The Two Selves: Implications for Time Management and Productivity http://www.PsychologyLounge.com/2013/08/29/the-two-selves-implications-for-time-management-and-productivity/ http://www.PsychologyLounge.com/2013/08/29/the-two-selves-implications-for-time-management-and-productivity/#comments Thu, 29 Aug 2013 21:48:29 +0000 http://www.PsychologyLounge.com/?p=410 Send to Kindle

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 personalit…

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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.

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12 Techniques for Giving Criticism and Feedback so that People Can Hear It without Getting Defensive http://www.PsychologyLounge.com/2013/05/13/12-techniques-for-giving-criticism-and-feedback-so-that-people-can-hear-it-without-getting-defensive/ http://www.PsychologyLounge.com/2013/05/13/12-techniques-for-giving-criticism-and-feedback-so-that-people-can-hear-it-without-getting-defensive/#comments Tue, 14 May 2013 02:20:51 +0000 http://www.PsychologyLounge.com/?p=399 Send to Kindle

I was recently asked a very interesting question by one of my clients. He asked, “What percentage of people can listen to feedback and criticism without getting defensive?” I responded, not really in jest, “Only the people that have taken my non-defensiveness training!”

The reality is that most people instantly get defensive when criticized or even given mildly negative feedback. Regular readers will recall that I’ve written extensively about how to respond non-defensively: see “Radical Non-Defensiveness: The Most Important C

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I was recently asked a very interesting question by one of my clients. He asked, “What percentage of people can listen to feedback and criticism without getting defensive?” I responded, not really in jest, “Only the people that have taken my non-defensiveness training!”

The reality is that most people instantly get defensive when criticized or even given mildly negative feedback. Regular readers will recall that I’ve written extensively about how to respond non-defensively: see “Radical Non-Defensiveness: The Most Important Communication Skill.”

But I also wanted to write about the other side of the equation – some techniques for giving feedback and criticism that lower the probability of the other person feeling hurt or getting defensive.

Here are 12 great concepts in giving feedback and criticism.

1. Focus on behavior and not on the person. Never label the person with a pejorative label. Avoid words like “inconsiderate”, “jerk”, “slob”, “lazy”, and all other negative label words especially four letter words.

2. Be specific and concrete when you focus on behavior. Use the journalistic technique of who, what, when, where, and if appropriate, why when you describe a behavior. For instance, consider this feedback from a wife to her husband: “An hour ago, when we were talking to Herb and Lucille, in their garden, you told them about my getting fired from my job. This upset me because I have a lot of shame right now about getting fired.” Notice that this feedback includes all of the specific descriptors.

3. Whenever possible, tell the person what you want instead of what you don’t want. So instead of criticizing your partner for sitting on the couch while you clean the kitchen, instead ask them to help you clean the kitchen. If there is a specific behavior that you would like the person to stop, it’s okay to ask them to stop but usually better to also specify something else that you would prefer. Example: “I’d really like it if you wouldn’t scream at the children. Could you instead talk firmly to them? I’d really appreciate that.”

4. Recognize what people can change and cannot change, and how difficult a specific behavior will be for them to change. This is a difficult lesson, and one that most of us resist. But it’s terribly important.

I’m reminded of the famous parable of the frog and the scorpion. In the story, a scorpion and a frog meet on the bank of a stream and the scorpion asks the frog to carry him across on its back. The frog asks, “How do I know you won’t sting me?” The scorpion says, “Because if I do, I’ll drown, and I will die too.” The frog is satisfied, and they set out, but in midstream, the scorpion stings the frog. The frog feels the sting, knows he is dying, and has just enough time to gasp “Why did you sting me, now we both will die?” Replies the scorpion: “Because I am a scorpion, it’s my nature…”

Another similar saying is, “Never try to teach a pig to sing, it will frustrate you and annoy the pig.”

Some things people can change and others are more linked to their basic character and nature, and are extremely difficult if not impossible to change. There is also the issue of what people are willing to invest energy in changing.

Here are some criteria for determining whether a particular criticism even make sense.

  • Has the person had a specific behavior for most of their life? If so, what makes you think it will suddenly change?
  • Is the person genuinely interested in making the desired change? Is it within their value system to change? People can change the things that they strongly wish to change, but if they’re only changing because you asked them to, they will most likely fail.
  • How much energy would it take for the person to change the behavior? Something that takes very little energy is more likely to happen than a request which will take herculean amounts of energy.
  • Is changing this particular behavior the most important thing for you or might there be a different behavior that would yield more satisfaction for you?
  • Does the person have shame attached to the behavior you are criticizing? If so, you should carefully consider whether the criticism is worth the pain you will most likely cause.

The idea here is to avoid asking the scorpion not to sting. If someone’s been messy and disorganized for their whole life, it’s probably not reasonable to ask them to become neat and organized. That doesn’t mean you couldn’t make any requests, but a more reasonable request might be to ask the messy person to keep their mess within a specific room or rooms, and then close the door.

Always evaluate if it’s even worth giving criticism. Remember, criticism is fairly toxic to relationships. Women sometimes criticize men in the hopes that the men will change. Nobody really changes. If you feel a need to criticize your partner constantly than the problem is probably with you and your lack of tolerance and acceptance. Or maybe you need to re-evaluate whether the relationship makes sense to continue.

5. Avoid giving feedback or criticism when you are particularly angry. Very few of us have the skills to give gentle and reasonable criticism when we are really frustrated and angry. If you give criticism when you are pissed off, you will blow it. You won’t be able to follow any of the rules in this article. Your primary goal will be to hurt the other person, which never works out well.

6. Pick your time and place carefully. This should include assessing your partner’s state of mind. If they are hungry, angry, stressed out, or tired then defer your criticism for later. It will never go well if you’re not attentive to time and place and state of mind. And remember, sometimes the right time and place is never and nowhere.

7. Ask for change, don’t demand change. Most of us get really stubborn when someone demands that we change. Besides, who made you the boss?

8. Avoid spending any significant time discussing the past. Mistakes made in the past are over and done with unless you own a time machine. Giving multiple examples of past mistakes will only overwhelm the person and make them defensive. Give only one example at most. Better yet, use an example from the current time. Assume your partner isn’t stupid and can understand the specific behavior you’re asking them to change.

9. Once you’ve asked for a change don’t micromanage that change. Let the person figure out how to do it, and don’t stand over them or constantly monitor them.

10. Be very specific about your feedback and the desired outcome. Your requested outcome should be so clear to the other person that anyone would be able to determine whether the outcome had occurred or not. Use the journalistic model of who, what, when, where, and why. Use accurate language, and avoid extremes of “never” or “always”. Don’t ask your partner to never again throw their clothing on the floor. Instead, specify that you would like it to happen less frequently.

11. Use a soft start up. Give a compliment first and be gentle in the feedback you give. Point out (if true) how the criticized behavior is a departure from the person’s usual terrific behavior. This is a way of giving a compliment while giving criticism. Example: “You are usually so helpful in the kitchen. But last night you left all of the dirty dishes. I’d really appreciate if you’d clean them up this morning.”

12. Never threaten your partner or deliver ultimatums. Even if you are at the end of your rope never threaten the termination of the relationship. When people hear an ultimatum they shut off. Also it triggers resistance since none of us like to be blackmailed into action.

Also, you can only make an ultimatum once. If you make it more than once you lose all credibility. So just avoid them entirely. (Notice this applies to parenting children as well.)

So there you have 12 great techniques for giving feedback and criticism in a healthy way. Remember that it’s essential to balance criticism with lots and lots of compliments and showing appreciation. Good relationships typically have at least a 5 to 1 ratio of positive feedback to negative feedback. If your relationship has a lower ratio than this then it’s time to change. Catch your partner doing things that you like and appreciate, and let them know in a warm and genuine way. This is perhaps the most important secret of giving criticism – let it be in the context of lots of praise.

Now I have to go tell my sweetie that she is awesome!

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.

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The Power of Nurturing: How Quality of Parenting Interacts with Nature to Determine Outcomes in Life, Even in Poverty http://www.PsychologyLounge.com/2013/03/08/the-power-of-nurturing-how-quality-of-parenting-interacts-with-nature-to-determine-outcomes-in-life-even-in-poverty/ http://www.PsychologyLounge.com/2013/03/08/the-power-of-nurturing-how-quality-of-parenting-interacts-with-nature-to-determine-outcomes-in-life-even-in-poverty/#comments Fri, 08 Mar 2013 20:37:41 +0000 http://www.PsychologyLounge.com/?p=389 Send to Kindle

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 …

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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.

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Guns Are Weapons of Mass Destruction: Lessons of the Newtown School Shooting http://www.PsychologyLounge.com/2012/12/14/guns-are-weapons-of-mass-destruction-lessons-of-the-newtown-school-shooting/ http://www.PsychologyLounge.com/2012/12/14/guns-are-weapons-of-mass-destruction-lessons-of-the-newtown-school-shooting/#comments Fri, 14 Dec 2012 23:32:57 +0000 http://www.PsychologyLounge.com/?p=384 Send to Kindle

I normally don’t blog about political issues, but today is an exception. Friday’s horrific school shooting in Newtown, Connecticut shows that guns are weapons of mass destruction. It’s time for this country to get serious about regulating them.

Other types of weapons of mass destruction are banned or tightly controlled in this country. You can’t buy a rocket propelled grenade launcher. Nor can the average citizen acquire C-4 explosive. Or nerve gas. Or suitcase nukes. Why do we allow virtually anyone to acquire the weapons of mass destruction tha…

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I normally don’t blog about political issues, but today is an exception. Friday’s horrific school shooting in Newtown, Connecticut shows that guns are weapons of mass destruction. It’s time for this country to get serious about regulating them.

Other types of weapons of mass destruction are banned or tightly controlled in this country. You can’t buy a rocket propelled grenade launcher. Nor can the average citizen acquire C-4 explosive. Or nerve gas. Or suitcase nukes. Why do we allow virtually anyone to acquire the weapons of mass destruction that we call guns?

The Second Amendment reads, “a well-regulated militia being necessary to the security of a free state, the right of the people to keep and bear arms shall not be infringed.” This was written hundreds of years ago, at a time in our history when we had just recently won our freedom from Britain after a bloody war. There was a genuine risk that England could attempt to reconquer our country, and thus maintaining an armed populace made good sense.

But today nobody is trying to invade the United States, and if they did they would be met with extreme force from our military. Our biggest danger now comes from inside, from disturbed individuals who acquire weapons of mass destruction, i.e. guns, and who kill innocent children and adults.

Imagine if instead of using guns, these school shooters built themselves suicide bomb vests. Would we not ban or tightly control any components that were necessary to build these vests? Of course we would. After the Oklahoma City bombing the government imposed controls and tagging on fertilizer components in order to reduce the possibility of future fertilizer bombs.

How many more children must be gunned down until the National Rifle Association and the Republican Party are willing to consider genuine and effective controls on guns? Do we need a school shooting every week in order to for our society to decide to make changes? Or every day? I hope not.

The Second Amendment in no way prevents strict regulation of guns, ammunition, and cartridges. Notice the emphasis on, “a well-regulated militia.” This would allow for any regulation necessary to lower the risk to innocent people. We already regulate gun ownership—screening, waiting periods, no fully-automatic machine guns, strict controls on silencers, etc.

So what are some reasonable regulations or interventions that might lower risk of mass shootings?

The first one is to re-institute the assault weapons ban. No hunter or civilian needs a semi-automatic rifle that can fire more than five or 10 bullets. Another option is to ban ammunition magazines that hold more than 10 bullets. This should apply to semi-automatic handguns as well. Again, there is no legitimate use for a civilian where they would need to fire more than 10 bullets.

There are several ways to impose these changes. One would be an outright ban, but politically this might be difficult. Another option would be regulation using taxation. Just as we have significant taxes on alcohol and cigarettes in order to lessen their use, we could have very large taxes on ammunition magazines larger than 10 bullets, and on semi-automatic rifles. If these cartridges each had a tax of $100 attached to it, and each semi-automatic rifle a tax of $1000, the sales would plummet. Manufacturers abandon production of these products.

California has already instituted many of these regulation, and the federal government should consider enacting similar rules.

Stricter legislation might be even better. If we truly are serious about eliminating these weapons of mass destruction, then we should ban not only the sale, but also the possession of large magazines. There would be an interim period during which civilians could turn in these cartridges to local law enforcement, but after that time, the possession of such large magazines would  become a felony.  Companies that manufacture these magazines could offer a trade-in program where citizens could trade in a large magazine for a legal sized magazine. This would be an incentive for both manufacturers and owners to make the swap.

Those who argue in favor of better screening for gun ownership are fooling themselves. All that our current screening procedures do is identify people who have a prior history of documented illegal behavior or disturbed behavior. There is no screening method that could identify those who will commit mass murder in the future, if they have no prior records of disturbed or illegal behavior. So tighter screening methods will not work.

And those who argue for arming schoolteachers are equally foolish. In theory it sounds great, every schoolteacher carrying a weapon and being well-trained to take out the next school shooter. In practice, it won’t work because as horrific as they are, the probability in any one classroom of a school shooter is exceedingly low. This will lead to schoolteachers leaving their guns in their desks, unloaded, and being completely unready to take on the well-prepared school shooter who will be heavily armed, wearing a bulletproof vest, and all too ready for action. Even the average police officer, armed with only a handgun, rarely takes on heavily armed perpetrators, instead leaving that task to SWAT teams who carry much more potent weaponry. And I don’t think we want to arm schoolteachers with machine guns!

In conclusion, guns are weapons of mass destruction and we should regulate them as such. As a society we should ask ourselves how many more innocent children need to die before we get serious about such regulation. We can regulate guns without banning them, and hunters, target shooters, and even people using guns for home defense will not be unduly affected. But Congress needs to hear from people, and I strongly encourage everyone who cares about the safety of children to reach out to their Congressman and their Senator and let them know that it’s time to change gun regulations to stop the mass destruction.

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.

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New Rapid Home Testing Kit for H.I.V. Goes on Sale, Should You Use It? (P.S., Dr. House Was Right, Everyone Lies About Sex http://www.PsychologyLounge.com/2012/10/05/new-rapid-home-testing-kit-for-h-i-v-goes-on-sale-should-you-use-it/ http://www.PsychologyLounge.com/2012/10/05/new-rapid-home-testing-kit-for-h-i-v-goes-on-sale-should-you-use-it/#comments Sat, 06 Oct 2012 01:07:35 +0000 http://www.PsychologyLounge.com/?p=377 Send to Kindle

The New York Times reported today that there is a new rapid home testing kit for HIV that went on sale today, October 5, 2012. The kit is called OraQuick, costs $40 and takes 20 minutes to provide results. This is a major breakthrough, as it allows people to quickly determine their HIV status in the privacy of their own homes. It also opens up the potential for sexual partners to test each other before having sexual contact. I’m sure the company that makes the OraQuick test, OraSure Technologies, would love it if many people use this test before having sex. But is this a good idea?…

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The New York Times reported today that there is a new rapid home testing kit for HIV that went on sale today, October 5, 2012. The kit is called OraQuick, costs $40 and takes 20 minutes to provide results. This is a major breakthrough, as it allows people to quickly determine their HIV status in the privacy of their own homes. It also opens up the potential for sexual partners to test each other before having sexual contact. I’m sure the company that makes the OraQuick test, OraSure Technologies, would love it if many people use this test before having sex. But is this a good idea?

The kit is not perfect. It is almost 100% accurate when it indicates that someone is not infected with HIV, and, in reality is not. But it is only 93% accurate when it says someone is not infected and the person actually does have the virus. This is most likely because there is a period of time after infection before the body is producing antibodies that the test detects.

Should you use this test when considering becoming sexual with a new partner? Consider some very disturbing facts based on two sexual surveys reported in this article. In the first survey, nearly 20% of infected homosexual men reported having unprotected sex with at least one partner without revealing their HIV status.

In the second study, they found that 9% of HIV-positive heterosexual men and women, and 14% of HIV-positive gay or bisexual men reported having recent unprotected sex with someone who they either knew was uninfected, without revealing their own infection! Putting this in real numbers, the authors of this survey estimated that over a year, 34,000 infected gay men and 10,000 infected heterosexual men and women had sex without telling the truth.

This really speaks to the issue of not trusting what people say about sexuality. Too often I hear experts giving the advice to ask your potential partner about their sexual history and their HIV status. Given the results of these two surveys, that seems naïve, foolish and dangerous. People lie about sex. If you are a gay male, it’s reasonable to expect that one in five infected potential partners will lie to you about their HIV status. If you’re a heterosexual, the number drops to a little below 10%. Are those the odds you want to take with your life?

What this really speaks to is the importance both of testing and of safe sex. Since the OraQuick test is only 93% accurate when the person taking it is infected, that means 7% of the time, with an infected person, the test will falsely tell you that they are not infected. So those odds aren’t very good either. So let’s calculate the probability that your new potential sexual partner might be HIV-positive, lying about it, and the OraQuick test would falsely tell you they were HIV negative.

If you are a gay man, then the probability is 20% times 7%, which equals 1.4%. If you are heterosexual the probability is 9% times 7%, which equals 0.69%. So the odds that your deceitful HIV-positive partner would not be identified by the OraQuick test are 1.4% if you are a gay male, and 0.69% if you are a heterosexual man or woman.

So even by using the OraQuick test, you can’t eliminate all risk. That’s why practicing safe sex makes so much sense. At least do so when having casual sexual contact, before you get to know the person well and can figure out whether they are trustworthy or not.

So to summarize, the new OraQuick test allows for quick at home testing of HIV status. Given the facts about how many HIV-positive gay and straight people are not honest about their HIV status, it makes sense to consider using this test. But there is still a risk, since the test is least accurate when used on HIV-positive people. The OraQuick test can improve your odds, but for ultimate safety, practice safe sex!

No joke to end this post, because this is such a serious matter.

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.

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Understanding and Overcoming Social Anxiety: Part Two http://www.PsychologyLounge.com/2012/09/16/understanding-and-overcoming-social-anxiety-2/ http://www.PsychologyLounge.com/2012/09/16/understanding-and-overcoming-social-anxiety-2/#comments Sun, 16 Sep 2012 18:54:51 +0000 http://www.PsychologyLounge.com/?p=360 Send to Kindle

In Part One of Understanding and Overcoming Social Anxiety, I discussed the basic core beliefs of people who suffer from social anxiety. To review, the core beliefs are:

1. Everyone is noticing me

2. Everyone is judging me, harshly

3. As a result of these judgments, I will be humiliated and rejected.

4. If people judge me negatively, I must suffer terribly.

I wrote about a simple behavioral experiment that challenged the first belief, that everyone is paying attention to you. How do we challenge the rest of these beliefs?

Let me digress for a moment into a bit of theory about change. …

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In Part One of Understanding and Overcoming Social Anxiety, I discussed the basic core beliefs of people who suffer from social anxiety. To review, the core beliefs are:

1. Everyone is noticing me

2. Everyone is judging me, harshly

3. As a result of these judgments, I will be humiliated and rejected.

4. If people judge me negatively, I must suffer terribly.

I wrote about a simple behavioral experiment that challenged the first belief, that everyone is paying attention to you. How do we challenge the rest of these beliefs?

Let me digress for a moment into a bit of theory about change. In my opinion, there are two types of change, first-order change, and second order change. First-order change is change that occurs within a given mental system, without changing the system itself. Second order change is transformative, in that it changes the basic framework of the system.

A good example of this is the concept of a nightmare. Within the nightmare a person can do many things such as running away, fighting, screaming, etc. but they are still within a nightmare. Second order change means waking up from the nightmare.

In the case of social anxiety, first-order change would entail questioning the beliefs that people are judging you harshly. It might entail gathering evidence whether your beliefs about people judging you are accurate or not.

Although this approach would be useful, it’s not really transformative. Second-order change would be to change the belief that other people’s judgments matter. Not caring even if people are judging you negatively would be the ultimate second order change.

Now let’s come back to earth! How would we apply each of these types of change to social anxiety? To do first-order change you could check out your mind-reading perceptions. For instance, if you are worried that your boss was judging you negatively, you could sit down with your boss and ask for feedback. You could first start by asking for general feedback, such as “How do you think I’m doing?” Then you could narrow it down to your specific concerns. For instance, imagine that you are worried that you are not working fast enough. You could ask your boss, “Do you think I’m keeping up with the pace?”

With a friend or loved one you could use a similar strategy. You could tie nonverbal cues to your questioning. For instance, let’s imagine that your spouse furrows their brow at you. You imagine they are judging you negatively. You would then ask, “I noticed that you furrowed your brow at me just then, what were you thinking?”

This strategy would result in first-order change; that is, you would correct your beliefs that everyone is judging you negatively. But it wouldn’t change the power of those imagined or real judgments to upset you.

A second order change strategy for social anxiety would be to do some behavioral exposure tests that would help you overcome the fear of judgment. I do these with my patients frequently. For instance, we might walk around my office neighborhood wearing masks. Or we might put on two brightly colored socks that don’t match, roll up our pants so that the socks are fully visible, and walk around. Other tasks might include singing loudly (and off key) as we walk down the street. Another task might be on an elevator, announcing the floors as each passes.

The key concept behind all of these types of tasks is to overcome the fear of people noticing you and judging you. Clients quickly realize that the judgments of strangers really don’t matter.

There are literally hundreds of these types of anti-embarrassment tasks. (I’ve listed some good ones below.) One can create a laddered hierarchy of tasks ranging from relatively easy tasks to very scary tasks. Then the client can work their way up the hierarchy so that they get more and more comfortable being judged.

Another approach is to deliberately work on incurring some mildly negative judgments from people you are close to. For instance, I might ask a client to wear a shirt that their spouse disapproves of or doesn’t like. Or one could deliberately espouse an opinion that a friend would disagree with. The idea of this is to get comfortable with mildly negative judgments even from people you are close to.

A key concept regarding judgment that I try to teach clients is that if one has a clear sense of one’s self, including strengths and weaknesses, then it’s possible to be relatively independent of the judgments of others. You get to determine your own judgments of yourself, and when the judgments of others correlate with your own judgments, and then you can respond non-defensively. But when the judgments don’t correlate with your own judgments of yourself, you can gracefully ignore or dispute them. The key concept is that everyone has different opinions about almost everything, and you get to determine your own opinion about yourself.

In fact, one might view social anxiety through the lens of the sense of self. Those who suffer social anxiety usually have either a negative view of themselves which they project onto the judgments of others, or have an unstable view of themselves which depends on the judgments of others. In either case the core problem is the sense of self.

To walk around with a profoundly negative view of oneself would be even more painful if one was fully aware of the source of this negative view – one’s own thoughts. Because this is so painful, people with a negative self-concept will typically project this negative self-concept onto the world, and experience everyone around them as judging them negatively. The first step to overcoming this tendency to project and to mind-read is to make the assumption that virtually all of your beliefs about others judging you are actually a reflection of you judging yourself.  Then you can deal with the real problem – your own thoughts.

If you have an unstable view of yourself, and depend on the judgments of others to figure out who you are, then changing this is more challenging. I often give clients a variety of written tasks so that they can explore their beliefs about themselves. The challenge is to figure out who you really are, including both your strengths and weaknesses. And then accept both. Once you are okay with who you are, then the judgments of others don’t really matter very much.

Now I want to clarify an important point. Some judgments do matter. For instance, if you work in a company and your boss determines your bonuses and raises, then your boss’s judgment of you matters, at least in terms of your economic health. Other judgments that typically matter might include a graduate school thesis advisor, who can determine whether you can progress in your program or not. And in general the judgments of the people closest to you do matter, at least over the long run. If your wife or husband begins to have a generally negative judgment of you that persists, this may end up in divorce. But note that even in these close relationships, a momentary negative judgment doesn’t really matter. If my hair gets too long, and starts to look funny for a week or two until I get it cut, my sweetheart won’t reject me. (Of course, she may drop subtle hints about haircuts!)

So, to summarize:

1. Social anxiety is at its core a disorder of the self. People with a strong and confident sense of self don’t suffer social anxiety. One might conceptualize social anxiety as a frantic attempt to accurately determine one’s self by polling others.

2. There is first-order and second-order change regarding social anxiety. First-order change involves making more accurate determinations of the judgments of others towards you. First-order change involves challenging mind reading beliefs and testing whether others are even paying attention to your behavior.

Second-order change is more profound and more radical. It involves learning not to care, even when others judge you negatively. It also involves bringing back your attention from the outside world and the judgments of others to the inside world and your own judgments of yourself.

3. Almost everyone can benefit from tuning into their inside judgments of themselves. As Oscar Wilde once said, “To love oneself is the beginning of a life-long romance.” We are stuck with ourselves, flaws and all, and learning to love and truly accept ourselves is really the beginning and the end of internal comfort in life.

 

 

 

Appendix: Some Examples of Anti-Embarrassment Tasks

In an elevator, open your briefcase or handbag, and look inside, and ask “Got enough air in there?”

Say “Ding” at every floor.

On a bus or subway, stand up and announce each stop.

On the street, ask for directions to a store you are standing right in front of.

 

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.

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Understanding and Overcoming Social Anxiety: Part One http://www.PsychologyLounge.com/2012/08/29/understanding-and-overcoming-social-anxiety-part-one/ http://www.PsychologyLounge.com/2012/08/29/understanding-and-overcoming-social-anxiety-part-one/#comments Wed, 29 Aug 2012 22:32:45 +0000 http://www.PsychologyLounge.com/?p=352 Send to Kindle

Social anxiety is a common psychological disorder, affecting about 5 percent of the population in a strong way and up to 13 percent of the population in a weaker way.

Social anxiety is not just shyness, but a much more profound problem. People with social anxiety disorder often become intensely anxious in social and performance settings, sometimes to the point of having a full blown panic attack.

As Jerry Seinfeld once said, “According to most studies, people’s number one fear is public speaking. Number two is death. Death is number two. Does that sound right? This …

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Social anxiety is a common psychological disorder, affecting about 5 percent of the population in a strong way and up to 13 percent of the population in a weaker way.

Social anxiety is not just shyness, but a much more profound problem. People with social anxiety disorder often become intensely anxious in social and performance settings, sometimes to the point of having a full blown panic attack.

As Jerry Seinfeld once said, “According to most studies, people’s number one fear is public speaking. Number two is death. Death is number two. Does that sound right? This means to the average person, if you go to a funeral, you’re better off in the casket than doing the eulogy.”

There are several core beliefs that drive social anxiety.

The first of these beliefs is that everyone is paying a lot of attention to you and your behavior. People are noticing.

The second belief is that when people notice you, they will then judge you harshly. (Since most socially anxious people are very judgmental of other people, they assume that everyone is equally judgmental.)

The third of these beliefs is that as a result of these harsh judgments, people will reject and/or humiliate you.

And the fourth belief is that as a result of these judgments you must feel very badly, full of shame and worthless feelings.

All of these beliefs are what we in Cognitive Therapy call ANTS, or automatic negative thoughts. Let’s go through them one by one and analyze how accurate or distorted they are. Then we can talk about some behavioral experiments you can do to dispute these beliefs.

The first belief: that everyone is paying a lot of attention to you and your behavior, is simply not true. Most of the time, most people are fairly oblivious, mostly thinking about things of concern to themselves. You’re not in the spotlight unless you are a genuine celebrity.

The second belief depends on the first belief. If people don’t even notice you, then they certainly aren’t judging you harshly. The other distortion in the second belief is that people will judge you harshly. Even when people do make judgments they are typically not particularly harsh.

The third belief, that as a result of judgments people will reject or humiliate you, most likely stems from grade-school teasing and bullying. In adult life, most judgments are never acted on, and they are never expressed. After all, the modern workplace has very little tolerance for negative teasing or humiliation. People may think some judgmental thoughts about you, but unless you imagine them thinking those thoughts, they will never have any impact on you.

The final belief that you must feel badly if someone else judges you negatively is also quite distorted. It’s quite possible to know that someone is judging you negatively, and feel fine about yourself. After all, all judgments are simply another person’s opinion, not truth. If another person thinks your haircut looks funny, that’s just their opinion. You have the right to have a different opinion.

An important concept in all social anxiety is the idea of mind-reading. Most socially anxious people practice this form of cognitive distortion constantly. They assume that they can read minds, and will read into every subtle expression a negative judgment. This is of course a major cognitive distortion. Nobody can read minds. A furrowed brow can mean many different things, and can even mean the person has a mild headache, or needs a new eyeglass prescription.

Most of the time, when the socially anxious person is mind reading, they are actually projecting their own insecurities about themselves onto other people’s judgments. Let’s imagine that I am particularly self-conscious about my thinning hair. As a result of this insecurity I may imagine whenever someone looks at my head that they are actually looking at my hairline, and thinking negative thoughts about my impending baldness. This is called projection.

In almost all cases of imagined judgment, what is actually happening is projection. You can quickly figure this out by asking yourself, “Is the imagined judgment coming from the other person actually something I feel quite insecure about?” If the answer is yes, then most likely you are mind-reading and projecting.

It would be nice if just a rational discussion of these distorted beliefs created change, but in my experience as a cognitive behavioral therapist, simple discussion rarely changes beliefs completely. But there are some behavioral experiments that are very powerful in challenging these beliefs.

The first belief, that everyone is paying a lot of attention to you, can be challenged using the following behavioral experiment. Do this with a friend or a therapist. Have the friend or therapist wear something quite odd, like a mask or something equally outrageous in terms of dress. Have them walk down a busy street. Walk about 10 feet behind them so that you can observe carefully people’s reactions. Before you start, write down your prediction as to what percentage of people will notice and react to your friend or therapist looking very odd.

Walk around, and keep a running count of everyone who seems to notice, and everyone who seems oblivious. When you have collected a fair amount of data, calculate the percentage of people who even noticed your friend or therapist wearing a mask. You can also track the type of response that you notice. Do people smile or laugh, or do they frown and seem judgmental in a negative way? Compare your actual data to your predictions.

I think you will be surprised at the results of this experiment. Once you have done this experiment I recommend putting a mask on yourself and walking around and noticing people’s responses.

In Part Two of this article I will discuss some other behavioral experiments that can help you overcome social anxiety, as well as discussing some issues of deep change.

Now I’m off to give my eulogy, which is scary but better than the alternative!

 

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.

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Jet Blue and Orchard Supply Hardware Customer Service: Epic Fail for JetBlue, Epic Success for Orchard Supply Hardware! (Followup: Blogging Matters, Sometimes) http://www.PsychologyLounge.com/2012/08/07/jet-blue-and-orchard-supply-hardware-customer-service-epic-fail-followup-blogging-matters-sometimes/ http://www.PsychologyLounge.com/2012/08/07/jet-blue-and-orchard-supply-hardware-customer-service-epic-fail-followup-blogging-matters-sometimes/#comments Tue, 07 Aug 2012 20:51:14 +0000 http://www.PsychologyLounge.com/?p=331 Send to Kindle

In a previous post I wrote about my experience with JetBlue and Orchard Supply Hardware customer service.

Here’s a followup which shows one Epic Success, and one Even More Epic Fail!

An executive vice president from Orchard Supply Hardware called me up to discuss the situation. He was apologetic, friendly, and agreed with me that the right policy would have been to honor the coupon. We had a nice chat about customer service, and at the end of it he offered me a gift card to compensate for any inconvenience. I was impressed that a) someone at Orchard Supply Hardware cared enoug…

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In a previous post I wrote about my experience with JetBlue and Orchard Supply Hardware customer service.

Here’s a followup which shows one Epic Success, and one Even More Epic Fail!

An executive vice president from Orchard Supply Hardware called me up to discuss the situation. He was apologetic, friendly, and agreed with me that the right policy would have been to honor the coupon. We had a nice chat about customer service, and at the end of it he offered me a gift card to compensate for any inconvenience. I was impressed that a) someone at Orchard Supply Hardware cared enough to call, and b) that he appreciated my feedback. Kudos to Orchard Supply Hardware!

JetBlue on the other hand, managed to make things even worse. When I asked them to fix the miles problem, their unilateral response was to take away my JetBlue miles, and then tell me to contact American to get the miles there. At the end of all of this effort, basically what they did was to take away my JetBlue points permanently, and give me American Airline’s phone number to see if I could get miles from them! Thanks JetBlue for absolutely nothing!!!!

JetBlue turned an Epic Fail into an Even More Epic Fail. That’s a good trick.

 

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.

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Gallup Survey Shows Stay-At-Home Moms Are More Depressed http://www.PsychologyLounge.com/2012/05/23/gallup-survey-shows-stay-at-home-moms-are-more-depressed/ http://www.PsychologyLounge.com/2012/05/23/gallup-survey-shows-stay-at-home-moms-are-more-depressed/#comments Wed, 23 May 2012 19:05:28 +0000 http://www.PsychologyLounge.com/?p=344 Send to Kindle

Are stay-at-home moms more depressed than working mothers? In a Gallup poll released last week, stay-at-home moms showed a 28% depression rate compared to 17% of working mothers and 17% of working women without children.

Stay-at-home mothers reported more anger, stress, sadness, and worry. They were more likely to report themselves as struggling and suffering!

This is very important data. According to Gallup, stay-at-home moms make up 37% of mothers with kids living at home.

So who are these stay-at-home moms? Contrary to the mythical model of the rich stay-at-home mom who …

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Are stay-at-home moms more depressed than working mothers? In a Gallup poll released last week, stay-at-home moms showed a 28% depression rate compared to 17% of working mothers and 17% of working women without children.

Stay-at-home mothers reported more anger, stress, sadness, and worry. They were more likely to report themselves as struggling and suffering!

This is very important data. According to Gallup, stay-at-home moms make up 37% of mothers with kids living at home.

So who are these stay-at-home moms? Contrary to the mythical model of the rich stay-at-home mom who bounces between yoga class, tennis, pilates, and home to the nanny, the reality of stay-at-home moms is much grimmer. They tend to be poorer on average, younger, Latina, less likely to have graduated from high school or college, and more likely to have been foreign-born.

Here’s some more data directly from the Gallup report, which explored the well-being of 60,000 U.S. women in 2012.

In terms of worry 41% of stay-at-home moms reported worry, compared to 34% of employed moms and 31% of employed women without children.

In terms of sadness 26% of the stay-at-home moms reported it, compared to 16% of employed moms and 16% of employed women without children.

In terms of depression, almost a third of the stay-at-home moms (28%) reported depression, while only 17% of employed moms and 17% of employed women without children reported depression.

The only negative emotion that didn’t vary very much was stress. 50% of stay-at-home moms reported stress, but 48% of employed moms and 45% of employed women without children also reported stress. So apparently stress is pretty much the same across the board for women.

In terms of anger, 19% of stay-at-home moms reported it, while 14% of employed moms and only 12% of employed women without children reported anger.

What about positive emotions? Even though Gallup makes much of the lower ratings of positive emotions for stay-at-home moms, the numbers don’t reflect very large differences. 42% of stay-at-home moms reported themselves as struggling, while 36% of employed moms and 38% of employed women without children reported themselves as struggling. Not a very large difference and probably not statistically significant. What’s interesting about this data is that so many women, regardless of their parenting status, report themselves as struggling. This is quite troubling. I’d be very curious to see comparative data on men.

This is interesting research and completely consistent with some other research that was conducted by Daniel Kahneman and associates on women’s experienced happiness performing various activities. He looked at the percentage of time that women spent in unhappy mood states. Parenting activities showed a 24% on happiness ratio as compared to 18% for housework, 12% for socializing, 12% for TV watching, and 5% for sex! Even though children are delightful, parenting is hard work, and there are many negative emotions associated with it. Working outside the home has negative emotions also, with a 27% unhappy emotion ratio, but it also has rewards and recognition that the lonely job of parenting does not have.

So what should we make of all this research? What wasn’t investigated by Gallup is the relative advantages versus disadvantages for the children of stay-at-home moms versus working moms. So we don’t know if there are significant benefits to the children, which might compensate for the higher levels of suffering reported by stay-at-home moms. I may come back to this issue in a future blog post.

In any case, it suggests that stay-at-home moms need much better support systems from our society, and that we also need to develop better ways for women split time at home and work. Currently there are few options for women who wish to work part-time at satisfying jobs. Because child care in the United States is so expensive, it is difficult for poorer women to stay in the workforce. This may lead to higher levels of depression and suffering in women.

From a clinical perspective, psychotherapists need to be alerted to be extra careful to screen stay-at-home moms for depression and anxiety disorders. I have a quick depression screening test on my website which stay-at-home moms can use to identify if they are suffering depression. If so, call someone for help. Don’t suffer in silence.

 

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.

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Jet Blue and Orchard Supply Hardware Customer Service: Epic Fail! (updated) http://www.PsychologyLounge.com/2012/05/01/jet-blue-and-orchard-supply-hardware-customer-service-epic-fail/ http://www.PsychologyLounge.com/2012/05/01/jet-blue-and-orchard-supply-hardware-customer-service-epic-fail/#comments Tue, 01 May 2012 19:34:40 +0000 http://www.PsychologyLounge.com/?p=327 Send to Kindle

As a psychologist, I am always amazed at how foolish companies can be in terms of customer service. I recently had two experiences which demonstrate this.

The first one was with Orchard Supply Hardware (OSH). They had published a 20% off coupon for this past weekend. It was a two-day coupon, and I didn’t look at it terribly carefully, assuming that it was good for Saturday and Sunday as most weekend coupons are. On Sunday I went over to Orchard Supply Hardware with my significant other. We were shopping for a new backyard umbrella and stand. A very nice sales clerk,  Pilar, s…

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As a psychologist, I am always amazed at how foolish companies can be in terms of customer service. I recently had two experiences which demonstrate this.

The first one was with Orchard Supply Hardware (OSH). They had published a 20% off coupon for this past weekend. It was a two-day coupon, and I didn’t look at it terribly carefully, assuming that it was good for Saturday and Sunday as most weekend coupons are. On Sunday I went over to Orchard Supply Hardware with my significant other. We were shopping for a new backyard umbrella and stand. A very nice sales clerk,  Pilar, showed us the options. We then asked her if we could apply the 20% off coupon. That’s when we found out, according to her, that the coupon was actually only for Friday and Saturday. We asked her if it was possible to have the manager override it so that we could still get the discount. We told her that we would buy an umbrella and a stand if we could get the discount. She told me it was impossible, that the computer would not allow it.

As we checked out, buying a few small items that we needed, but not an umbrella and not the stand, we saw almost everybody presenting the same coupon and being told the same thing. In several cases the person shrugged and then said well I don’t want to buy this, walking out of the store in disgust.

So here’s an example of terrible customer service. You have a large group of people who bring in a coupon one day past its unusual expiration date, asking for the coupon to be honored. All of these customers want to give you money! Rather than give your managers the ability to do this, you have a rigid computer system, and you lose sales. Anyone who has come into use that coupon on a large item most likely walks out without buying that item. Epic fail!

Another example was my  interaction today by phone with JetBlue Airlines. I recently flew round-trip from San Francisco to Boston. JetBlue has a tie-in with American Airlines such that you can choose to receive American miles rather than JetBlue miles. At the airport I had specifically given my American frequent flyer number, and requested that I receive American miles rather than JetBlue miles. When I checked my statement I discovered that I had been incorrectly credited JetBlue miles and had received no American miles.

So I called JetBlue and spoke with Monica in their True Blue frequent flyer department. I should add that first I spoke to a regular customer service person who kept me on hold for 5 min. and then transferred me to Monica. When I explained to Monica that I would like her to switch the miles over to American, she curtly told me that once the miles were credited it was not possible. Even worse, she gave me a ridiculous explanation telling me that since I had bought my ticket after logging into my True Blue account, the ticket would automatically accrue True Blue miles even if I had my American frequent flyer number in the account. Since there’s no way to buy a ticket without logging in, that was pretty ridiculous.

I then asked to speak with her supervisor, which resulted in another long hold, at which point I decided to give up since it was clear that JetBlue had no interest in fixing this problem.

Once again, epic fail. I had been really impressed with the actual flight, the comfort of the seats, the friendliness of the staff. This had been my first JetBlue flight. But I have to admit that given my poor customer service experience regarding the frequent flyer miles, it leaves a sour taste in my mouth regarding JetBlue.

The key point in the JetBlue customer service failure and the Orchard Supply Hardware Customer service failure was the inability of the front line sales person to have the authority and the power to fix the problem instantly. So many companies seem to believe that empowering front-line people to fix problems is somehow a huge mistake. This is wrong!

In summary, there are a few key points.

1. Customer loyalty and satisfaction is difficult to gain, but incredibly easy to lose. Once you betray a customer’s trust, it’s almost impossible to regain it.

2. Customers repeat bad experiences much more than good experiences. From a marketing perspective, when a customer has a bad experience it potentially drives away many other customers as that customer tells their experience to other potential customers.

3. The goal of all customer service should be to leave the customer feeling good about the interaction. The best outcome is to give the customer what they want. In this case, for Orchard Supply Hardware, it would have meant honoring the 20% coupon. In the case of JetBlue, it would’ve meant transferring the miles over to American Airlines.

4. If you can’t give the customer exactly what they want, offer something else good. For instance, Orchard Supply Hardware could have offered another type of discount, or a coupon good for future use. JetBlue could have offered me some bonus miles under their own program.

5. If, for some inexplicable reason, you cannot offer the customer something good, at least be very apologetic. Neither the clerk at Orchard Supply Hardware nor the customer service rep Monica at JetBlue said the magic words. “I really wish that I could do something more for you, but I can’t. I really apologize.”

The failure to even apologize leaves me as a customer just amazed. Epic fail! Shame on both Orchard Supply Hardware and on JetBlue Airlines!

(See my update to this story here, where JetBlue compounds their failure, and Orchard Supply Hardware makes it right, with amazing customer service.)

 

 

 

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.

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