Psych Scamp

Quote of the Day

2012-01-25T18:14:00.000-08:00

My head is bursting
with the joy of the unknown.
My heart is expanding a thousand fold.
Every cell,
taking wings,
flies about the world.
All seek separately
the many faces of my love.

- Rumi

Quote of the Day

2012-01-06T10:00:00.000-08:00

Love is the passionate search for a truth other than your own; and once you feel it, honestly and completely, love is forever. Every act of love, every moment of the heart reaching out, is a part of the universal good: it's a part of God, or what we call God, and it can never die.

- Gregory David Roberts (from Shantaram)

A New Year

2012-01-01T11:33:00.000-08:00

The new year can be a time of emotional turmoil as the energy of the holidays winds down and expectations for change rise up. Below are three articles from Yoga Journal that discuss the differences between goals and intentions, how to make healthy resolutions, and how to positively effect change in your life. The articles are written with a lot of yoga language, but the messages can be applied to anyone.

The Heart's Intention

Resolve to Evolve

Nurture the New You

Old Holiday Posts

2011-12-24T09:57:00.001-08:00

I should have re-posted these earlier, but here are some old posts about the holidays:

Gratitude
Gifts for Someone who is Depressed
Holiday Survival Guide
Is it ok for a therapist to accept/give gifts?

Quote of the Day

2011-12-24T09:49:00.000-08:00

Love hinders death. Love is life. All, everything that I understand, I understand only because I love. Everything is, everything exists, only because I love. Everything is united by it alone.

- Tolstoy (War and Peace)

Gratitude

2011-12-16T18:38:00.000-08:00

The holidays can be a stressful time and it’s easy to find things to complain about. But this is also a wonderful time to practice gratitude. Rather than getting upset when dealing with people who aggravate us, we can use this opportunity to look for the good qualities in people (and tell them). If someone gives us a gift we don’t like, we can remember that giving is about the gesture and be thankful someone took the time to consider us.

Here is a study showing that expressing gratitude increased one’s perception of communal strength in a relationship as compared to just generating positive thoughts.

This series of studies found that demonstrating gratitude was related to fewer depressive symptoms.

This study showed that “positive emotions experienced in the wake of the attacks--gratitude, interest, love, and so forth--fully accounted for the relations between (a) precrisis resilience and later development of depressive symptoms and (b) precrisis resilience and postcrisis growth in psychological resources.”

How to practice gratitude:

Set aside a few minutes each day, maybe first thing in the morning and/or just before bed, to reflect on any positive events that occurred during the day. It doesn’t matter if it’s a small event or a big one, the point is to look for all the good things that happen every day (even on a bad day). Not only does this help us be more gracious, warm people, but it also reminds us that when everything seems to be going wrong, we can still find things that we were grateful for.

Similar to above, keep a gratitude journal. At the end of the day, write down at least three things you were grateful for. (If you're a geek, use the digits of pi as a guideline for how many things to record, e.g. since pi=3.14, on the first day record three positive things, on the second day 1 thing, on the third day four things, and so on).

Say thank you when someone does something nice for you. And mean it. Similarly, you can also write thank you notes or letters to people who have done something you have appreciated in the past.

Find joy in the small things.

Keep a physical object that helps you remember gratitude.

Check out this site to see what other people are grateful for (and maybe post your own thanks).

Challenge yourself to go a week (or two or three) without complaining or criticising yourself or others.

Look for the good in the seemingly bad. Here is a gratitude poem that may help:

Be Thankful

Be thankful that you don’t already have everything you desire,
If you did, what would there be to look forward to?

Be thankful when you don’t know something
For it gives you the opportunity to learn.

Be thankful for the difficult times.
During those times you grow.

Be thankful for your limitations
Because they give you opportunities for improvement.

Be thankful for each new challenge
Because it will build your strength and character.

Be thankful for your mistakes
They will teach you valuable lessons.

Be thankful when you’re tired and weary
Because it means you’ve made a difference.

It is easy to be thankful for the good things.
A life of rich fulfillment comes to those who are
also thankful for the setbacks.

GRATITUDE can turn a negative into a positive.
Find a way to be thankful for your troubles
and they can become your blessings.

MDMA Therapy

2011-12-04T21:29:00.000-08:00

MDMA is illegal and I am not endorsing its use, nor am I qualified to. The following is a review of techniques, etc. in documented literature.

It’s been a long time since I’ve written anything controversial. Given the subject of this post, I feel it is necessary to make a couple of important statements. First of all, I do not condone the use of drugs for recreational purposes and it is not my intention to influence people to do so. Also, a reminder that I am not a doctor; I have no clinical or personal experience with this therapy. The information provided here is based on opinions I have heard from professionals and research studies.

That being said, I think there are some benefits to this therapy. Taking a small dose of a drug once is likely safer than taking multiple doses of antidepressants, etc. for years (provided it is obtained from a reliable source. There are testing kits you can buy, but these appear to have quite a few limits, see here for a detailed description. You can also check PillReports.com to compare what you have with their database). People with treatment resistant depression or PTSD who suffer from severe loneliness may find that the reported effect of MDMA of feeling connected can help them to understand what not-loneliness feels like so that they can cultivate this feeling more efficiently in the future without the aid of medications (or MDMA).

MDMA use in Psychiatry:

MDMA is being tested for PTSD, anxiety, depression (a recent study with rats showed a dose dependent response that peaked at a certain dose. The study also demonstrated no antidepressant effects of methamphetamine), pain management, and cancer (both for helping patients deal with their cancer situation and possible as an anti-cancer drug).

Other potential uses, particularly because of the feelings of connectedness that are induced, include couples therapy, family therapy, and group therapy.

There has been a lot of research into the therapeutic effects of MDMA. Recently a group published a paper examining long-term effects:

“In long-term follow-up, averaging 3.5 years after the initial treatment, most of the people remained free of PTSD — of the 16 patients who participated in the follow-up study, 13 still did not meet the criteria for PTSD. Mithoefer [the author] notes, however, that the people who have not yet elected to participate in the long term follow-up may have done so because they had not fared well.”

"MAPS and Mithoefer's major breakthrough showed that over 80 percent of the subjects in the MDMA group no longer qualified for a diagnosis of PTSD, as compared to 25 percent in the placebo group," he told AlterNet. ‘An even more important breakthrough, which we are currently working to write up in a scientific paper, is from the results of our long-term follow-up evaluations of the subjects, administered at an average of 41 months post-treatment. We found that, on average, the subjects have actually gotten a bit better over time, demonstrating that MDMA-assisted psychotherapy has lasting benefits.’”

http://www.alternet.org/drugs/151263/ecstasy_as_treatment_for_ptsd_from_sexual_trauma_and_war_new_research_shows_very_promising_results/?page=entire

Info about MDMA:

This paper (note the author disclosure) posits three explanations as to why MDMA may be beneficial to therapy:

1) MDMA increases oxytocin levels, which may strengthen the therapeutic alliance; 2) MDMA increases ventromedial prefrontal activity and decreases amygdala activity, which may improve emotional regulation and decrease avoidance and 3) MDMA increases norepinephrine release and circulating cortisol levels, which may facilitate emotional engagement and enhance extinction of learned fear associations.

While the terms MDMA and ecstasy are often used synonymously, these days they are not the same thing. MDMA used to be the principle component in ecstasy, but now ecstasy can contain a bunch of other things including meth, cocaine, speed, caffeine, etc. and may not even contain any MDMA at all.

Remember, MDMA is illegal. But if you have it and want to get more information on its identity go to PillReports.com which is a global database of "Ecstasy" pills based on both subjective user reports and scientific analysis.

Participating in MDMA therapy:

MAPS (Multidisciplinary Association for Psychedelic Studies) has ongoing clinical trials that you might qualify for if you happen to live near one of their offices.

Talk to your therapist about their opinions. Legally, they can not endorse MDMA use in therapy. However, you may be able to broach the subject as a hypothetical situation as a means of discussing what their response would be if you came to session with MDMA in your system. I do not recommend ever showing up to therapy having taking MDMA without first discussing it with your therapist. It would be very disrespectful to put your therapist in such a compromising situation. Furthermore, one of the points of using MDMA in therapy is to generate a feeling of connectedness in a safe environment; keeping secrets is contradictory to this intention and may have negative impacts on the therapeutic relationship later. If you do decide on MDMA therapy, do let your therapist know at the beginning of the session that you have taken the drug so that they can watch for adverse side effects and properly understand any changes in your behaviour.

All of the above is assuming you have a progressive therapist. It is very unlikely that your therapist will want to be involved in a session with a patient under the influence of an illegal drug. If this is the case, but you still feel strongly that this is the right therapy for you, find a friend whom you feel secure with and are comfortable talking to. Let them know what you are doing and why and ask if they would be okay with supervising and listening during the experience.

Have a plan:

Know yourself. If you think you may be in a vulnerable place where MDMA use could become habitual, take the time to carefully plan out a course of action (if you decide action is even appropriate for you). Make sure you view this as a one time event (do whatever you have to do to make the experience sacred for yourself) and not as an excuse to begin using drugs recreationally.

You may want to find an area near your therapist’s office that feels calm and safe. Since your therapist will probably not give you longer than the usual 1 hour session, arrive at this place well before your session so that you can time when the MDMA begins working with the start of your session. The reason I recommend this is because I think it could be quite distressing being on the bus for a long time with a drug you may have never experienced in your system (and you definitely should not be driving under the influence of any drug).

It is important you feel safe in your setting and that you feel knowledgeable and confident about the experiences you might have.

Do not take an excessive dose. Research studies report experimental doses of 75 - 150mg. Check this site for a dose that might be appropriate for you.

Some research studies have people wear eye masks and listen to relaxing music on headphones. I think this is a good way to relax and prepare yourself for the session ahead. Make yourself a playlist of soothing music that will last the 30 -60 minutes it takes for the drug to take effect.

Have a friend accompany you (maybe not to the session itself, but to be there before and after in case you need emotional support). This should be a person whom you trust, feel safe with, and who is preferably sober.

Bring water and wear comfortable layers. Hyperthermia can be a side effect so you want to ensure you are well hydrated and cool.

Bring comforting objects. Whether during or after your session, you may experience intense emotions. Have some things handy that you can use to soothe yourself (teddy bear, a particular scent, a soft fabric, iced herbal tea, pictures that make you laugh or remind you of good times, art supplies…). If you have a depression emergency kit, you can use that. If you don’t, now is a good time to make one.

Bring a digital recorder. I have never used MDMA and I don’t know how it affects a person’s memory, but for patients with depression (or anyone for that matter), remembering everything that was discussed in therapy can be a challenge. Talk to your therapist/friend about how they feel about recording the session.

Have a place you can go after session while the drug leaves your system. Have ideas of where you can go if you need to feel safe. Also keep in mind places you may like to go if you are feeling well. It may take a few hours for the drug to leave your system so you want to be in an environment that best suits your emotional needs. Since MDMA is supposed to have sensory effects maybe you would like to go for a walk on a sandy beach or have a meal at a restaurant serving foods with interesting flavours and textures.

Potential harmful effects:

Side effects include anxiety and depression when coming off the drug, hyperthermia, visual distortions, nausea, vomiting, jaw-clenching, eye-twitching, and dizziness, as well as depression and fatigue in following days. After frequent or heavy use, some users report bouts of dizziness or vertigo which gradually subside after cessation of use. There have been problems with MDMA users experiencing dehydration, hyperthermia, hyponatremia, exhaustion, blackouts, and a few cases of death generally while using MDMA at clubs or raves.

MDMA has been shown in many studies to be neurotoxic, particularly causing harm to the cells in the brain which produce serotonin. There is evidence that MDMA can cause permanent harm or cell death. These studies have been done using rodents, monkeys, and using laboratory cell cultures. The neurotoxicity seems to be associated with, or magnified by, the increase in body temperature caused by ecstasy ingestion. Here are a few of the many references about this:
http://www.ncbi.nlm.nih.gov/pubmed/1379014
http://www.ncbi.nlm.nih.gov/pubmed/18991870
http://www.ncbi.nlm.nih.gov/pubmed/16884865
http://www.ncbi.nlm.nih.gov/pubmed/12464456
(source)

The following information comes from http://www.erowid.org/chemicals/mdma/mdma_basics.shtml which is a great site full of detailed and thorough information about MDMA (usually I just link to the website, but because this information is important I am reporting in full here).

Contraindications:
• Do not take MDMA if you are currently taking an MAOI. MAOIs are most commonly found in the prescription anti-depressants Nardil (phenelzine), Parnate (tranylcypromine), Marplan (isocarboxazid), Eldepryl (l-deprenyl), and Aurorex or Manerix (moclobemide). Ayahuasca also contains MAOIs (harmine and harmaline). MDMA and MAOIs are a potentially dangerous combination. Check with your doctor if you are not sure whether your prescription medication is an MAOI.
• Avoid taking MDMA if you are currently using the protease inhibitor Ritonavir. This may be a life-threatening combination.
• Individuals with a history of heart ailments, high blood pressure, aneurysm or stroke, glaucoma, hepatic (liver) or renal (kidney) disorders, or hypoglycemia may be at higher risk.
• Avoid strong stimulants in combination with MDMA.
• Avoid high doses and frequent use. Recent studies suggest that the heavier and more frequent the use, the more concerning the long term after-effects may be.
• A small percentage (1-10% depending on race & family history) are "slow metabolizers", who have low levels of a liver enzyme (P450 2D6) which metabolizes many drugs, including MDMA (as well as Prozac, DXM, and many other pharmaceuticals). These people may be more sensitive to MDMA, might require lower doses, and should be cautious.

Onset:

Depending on how much and how recently one has eaten food, MDMA generally takes 30-60 minutes (although sometimes as long as 2 hours) to take effect. Unlike with many other psychoactives, the onset of MDMA is very quick. Often at the point one realizes that perhaps they are starting to notice effects, they are already 'launching' quickly towards the peak. This quick and extremely sharp 'launch' can be unnerving, feeling a bit like it's too quick and hard to know when it's going to end, but the feeling generally only lasts a few minutes until the full effects are reached.

Duration:

The primary effects of MDMA last approximately 3-4 hours when taken orally. For many people there is an additional period of time (2-6 hrs) where it is difficult to go to sleep and there is definitely a noticeable difference from everyday reality, but which is not strong enough to be considered 'tripping'. Many people also experience a noticeable shift in mood for several days after use; for some this is a period of depression while others experience lifted mood.

The Crash:

Some users of MDMA experience a dramatic worsening of mood as the peak effects wear off, often called the "crash". This is often the result of coming down from a wonderful experience, not wanting the feelings to go away, and being sad, scared, or annoyed afterwards. Crashes do not happen after every experience and some users never experience them. One of the primary problems associated with crashing is that some users find themselves redosing in order to stave it off.

Hangover:

Many users report feeling extremely drained the day after MDMA use. This 'day after' effect means for many MDMA users that they need to plan 2 days for the experience: one for the peak experience and one recovery day, with very little planned. Many users also experience some level of post-MDMA depression, often starting on the second day after the experience and lasting for up to 5 days. A small percentage of users report depressive symptoms for weeks afterwards. Alternately, some users report feeling better than normal for a week or so after taking MDMA. The negative after-effects of taking MDMA appear to be worse with higher frequencies of use, higher dosages, and perhaps total lifetime usage.

Further Reading:
http://www.mdma.net/therapy/method.html
http://www.maps.org/research/mdma/
http://www.macalester.edu/academics/psychology/whathap/ubnrp/mdma/table.html
*** http://www.erowid.org/chemicals/mdma/mdma_basics.shtml
http://garthkroeker.blogspot.com/2009/05/mdma-ecstasy-risks-and-benefits.html

Again, MDMA is illegal and I am not endorsing its use, nor am I qualified to. The above is a review of techniques, etc. in documented literature.

Quote of the Day

2011-12-02T16:00:00.000-08:00

A rush of bliss
flows suddenly through all my senses!
I feel a glow, a holy joy of life
which sets my veins and flesh afire.

- Goethe (from Faust)

A Funny Web Comic

2011-12-01T08:35:00.000-08:00

This is one of my favourite comics and the artist just did a strip about depression which I thought I would share. The line that makes me laugh the most? "Did you know some people have pets that are dead?"

http://hyperboleandahalf.blogspot.com/2011/10/adventures-in-depression.html

Mindfulness-Based Cognitive Therapy for Bipolar Disorder: Effects on Cognitive Functioning

2011-11-24T13:44:00.000-08:00

Here is a new study providing more evidence for the benefits of mindfulness based approach to therapy (specifically, MBCT):

"The study described here evaluated changes in cognitive functioning associated with MBCT in individuals with bipolar disorder who had residual mood symptoms. Prior to treatment, our sample of participants with bipolar disorder reported substantial impairment in levels of cognitive functioning. Our results indicate that patients with bipolar disorder who participated in MBCT showed improvement in executive functioning and memory to levels comparable with normative samples. Improvements were seen at post-treatment compared to before treatment, as indicated by large effect sizes on many sub-scales, but the effects of the treatment appeared to be attenuated over time. Nevertheless, improvements in many areas of cognitive functioning, particularly memory and task monitoring, were maintained at the follow-up evaluation 3 months after treatment, as indicated by small to medium effect sizes…Of note, improvements in executive functioning in the current study were maintained at especially high levels several months after completing MBCT…

It is important to note that these improvements were not accounted for by decreases in symptoms of depression, although there was evidence of some improvements in cognitive functioning associated with decreases in manic symptoms…It may be that improving the ability to observe thoughts and feelings while disengaging from interpreting their meaning frees up cognitive resources otherwise tied to focusing on one’s thoughts, resources that are useful in allowing one to plan, organize, and perform other executive functions. Similarly, awareness of one’s bodily sensations may make people cognizant of their mood and their body’s needs, making these needs less likely to go unmet and thus to interfere with their cognitive functioning…

Mindfulness appears to have positive effects on cognition, particularly through increasing the ability to maintain focus over longer periods of time. Indeed, previous research has shown that mindfulness is associated with increases in attentional control. Mindfulness meditation has also been linked to activation and increases in white matter in the anterior cingulate cortex, a region implicated in executive attention and that is impaired in individuals with bipolar disorder…

Several limitations of the present study should be noted. Appropriate caution is warranted when interpreting the results of open trials, which lack a valid comparison group. It is unclear whether MBCT would improve cognitive functioning to a greater extent than would other adjunctive, manualized treatments for bipolar disorder…The frequency of practice of the mindfulness techniques learned in MBCT was also not systematically evaluated in this study…This study was also limited by a small sample size…In addition, findings were reported from participants who completed the cognitive functioning measures, all of whom also completed the treatment trial. Therefore, the findings must be interpreted cautiously… It is also important to note that the cyclical nature of bipolar disorder may have contributed to some extent to the cognitive and mood changes observed in this study…
In addition, this study used only self-report measures of cognitive functioning…The present study also utilized a sample of bipolar patients with residual mood symptoms, rather than a sample of individuals in a current mood episode."

Quote of the Day

2011-11-23T10:56:00.000-08:00

Accept the changes you initiate, try to make peace with the past, and find renewal and real joy in your new apprenticeship. Even if you're left with something of a hurt heart, and even if you struggle with thoughts about the past and about what might have been, you can still find great satisfaction in your new life, as you learn its ropes and as you begin to experience some successes in it.

- Eric Maisel (from Creativity for Life)

Quote of the Day

2011-11-14T17:53:00.000-08:00

I believe that love that is true and real creates a respite from death. All cowardice comes from not loving or not loving well, which is the same thing and when the man that is brave and true looks death squarely in the face...it is because they love with sufficient passion to push death out of their minds, until it returns, as it does, to all men and then you must make really good love again.

- Midnight in Paris (Woody Allen)

Quote of the Day

2011-11-11T20:25:00.001-08:00

“Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma – which is living with the results of other people’s thinking. Don’t let the noise of other’s opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.”

- Steve Jobs

Quote of the Day

2011-11-08T08:29:00.001-08:00

Don't be put off by people who know what is not possible. Do what needs to be done, and check to see if it was impossible only after you are done.

- Paul Hawken

Quote of the Day

2011-11-03T20:42:00.000-07:00

“We make a living by what we get, but we make a life by what we give.”

Winston Churchill

Quote of the Day

2011-10-30T20:52:00.000-07:00

Never regret something that once made you smile.

- Amber Deckers

Quote of the Day

2011-10-29T20:21:00.001-07:00

“I believe in pink. I believe that laughing is the best calorie burner. I believe in kissing, kissing a lot. I believe in being strong when everything seems to be going wrong. I believe that happy girls are the prettiest girls. I believe that tomorrow is another day and I believe in miracles.”

― Audrey Hepburn

Self Help Apps

2011-10-26T16:01:00.000-07:00

These reviews include only free apps. The selection was chosen based on screenshots that looked promishing and a few that were recommended from other sites.

Moody Me: This app is essentially useless. You can choose a mood label from a list of about a dozen different moods and that’s about it.

Best Self-Help Quotes: Has a bunch of quotes you may or may not find inspirational.

Transform Your Life – An Awareness Package: Has daily quotes along with contemplative assignments (which I think gives this app a slight advantage over the quote only ones). It looks interesting enough that I might keep it around for a while.

TracknShare: This is a good mood diary that allows you to track mood, sleep, diet (by food group and includes a category for ‘sweets’), weather, and stress (and quite a few other things). It also lets you record notes and track acts of kindness and gratitude and puts it all into a graph. Unfortunately, the free version becomes limited after about a week, but the app does provide good ideas of what to include should you want to make your own mood tracker.

MoodTracker: Has medication reminders/trackers as well as mood, drugs, menstruation, sleep, and functionality. Graphs results. I prefer TracknShare.

My Instant Coach: This app gives general advice to life’s most common questions. I expected to really dislike this app, but it does a fair job of giving you some ideas and strategies of how to begin tackling your problems. It’s not complete by any means, but it is just an app and might give you some ideas or new perspectives you hadn’t thought of. It has me intrigued enough that I will keep it around for a while.

iZen Lite 2: This is a digital version of a zen sand garden which you can rake and decorate with a few different rocks. You can also share/save your garden. It’s nothing fancy, but I think I will enjoy it more than playing Angry Birds. And maybe it will make being on a crowded bus a little more relaxing.

My Thoughts: This is a collection of affirmations (e.g. “Today is the beginning of my new life”). I think it’s better to generate your own affirmations, but that can be very difficult some days. At the very least, it’s something positive to look at and think about during your day.

ZaZen Lite: I had high hopes for this one, but it’s really just a timer. Though it does have a nice bell sound.

MindfulnessAttitude: Again, a disappointment. It is intended to give descriptions of the different aspects of mindfulness, but the descriptions were very brief ahttp://www.blogger.com/img/blank.gifnd far from explanatory.

There are also a lot of free meditation apps, but I think finding the right guided meditation is a personal thing, so I won’t review any of them here.

Remember, these apps aren’t intended to replace therapy. I wouldn’t even really call them an adjunct to therapy, but they can be useful reminder tools.

If you don’t have an apple product, but like the idea of tracking your moods check out some of my mood diaries (under the label Mood diary). Or create your own personalised version in excel.

Quote of the Day

2011-10-16T09:49:00.000-07:00

However, as human beings we are gifted with this wonderful human intelligence. Besides that, all human beings have the capacity to be very determined and to direct that strong sense of determination in whatever direction they like. So long as we remember that we have this marvellous gift of human intelligence and a capacity to develop determination and use it in positive ways, we will preserve our underlying mental health. Realizing we have this great human potential gives us a fundamental strength. This recognition can act as a mechanism that enables us to deal with any difficulty, no matter what situation we are facing, without losing hope or sinking into feelings of low self-esteem.

- Dalai Lama

Caprica Metaphor

2011-10-15T09:30:00.000-07:00

For those of you who don’t know, Caprica is a spin-off of the Battlestar Galactica series which takes place before the Cylon war and concerns, among other things, the development of Cylons. In the series, Cylons are a combination of robotics and avatars based on real people. One of the central characters, Zoe, who developed the avatar program ( with the original version being a copy of herself) dies leaving her avatar to live on in a virtual world (and sometimes in a robot). There is also one other ‘dead’ girl who lives in the virtual world.

The world these girls live in is a violent, immoral game world. They hate it, but of course they can’t leave. So they decide to change it, fighting against the attitudes that prevail there and even building a beautiful sanctuary with playful pink trees.

Those living with depression often feel like they are trapped in a dark, chaotic world with no one to turn to. But this isn’t true. We all have the ability to transform our world, and ourselves. It’s difficult work that requires help, but all we have to do is have a clear intention of what we want and head in that direction. This is not to imply that a person can completely manipulate the outside world or alter their past, but that how we perceive and interact with that world (by choosing optimism, healthy relationships…) is something within our control and we can shape our future.. One can even create an ideal, ‘happy place’ that can be used with meditations and relaxation techniques.

For those of you familiar with the show, this is only meant to be a limited metaphor…

Quote of the Day

2011-10-09T09:22:00.000-07:00

Since patience or tolerance comes from an ability to remain steadfast, to avoid being overwhelmed by adverse situations or conditions, we should not see patience as a sign of weakness or giving in, but rather as a sign of strength. Responding to a trying situation with patience and tolerance rather than reacting with anger and hatred involves active restraint, which arises from a strong, self-disciplined mind.

- Dalai Lama

Forest Bathing

2011-10-05T21:21:00.000-07:00

Shinrin-yoku, or forest bathing, is a Japanese term for spending time in the forest with the purpose of decreasing stress and other negative feelings. While there are quite a few studies showing walking in the woods is beneficial, it is difficult to find evidence as to what specifically, or holistically, is the acting agent(s). It is hypothesised that phytoncides, volatile substances given off by plants , may be the primary agent working as a sort of aromatherapy. Another hypothesis is that our technological and social evolution has developed faster than our biological evolution and that humans still feel more at home, and therefore more at ease, in the forest.

While I wouldn’t label these studies as particularly rigorous, anyone who has walked in the woods can certainly attest to its positive effects on well-being. Whether forests are good for us or cities are detrimental, taking a walk in nature is an easy way to decrease stress levels. The exercise alone will bring positive results. Additionally, taking time for some mindfulness exercises will also increase well-being. And the thrill of a new adventure is always stimulating.

That being said, there are certain precautions to be taken when embarking on any outdoor trip:
• Let someone know where you will be and when you expect to return
• Know the layout of the trails or have a map
• Check weather conditions
• Pack adequate food, clothing, water…
• Carry a first aid kit
• Travel with a companion or group
• Carry bear spray

Furthermore, those suffering from specific fears of the woods should consider working through an exposure hierarchy and ensure they have an exit strategy if the situation becomes too stressful.

A 2011 study demonstrating decreased cortisol levels and increased parasympathetic activity.
http://www.ncbi.nlm.nih.gov/pubmed/21288543

A 2007 study showing similar results.
http://www.ncbi.nlm.nih.gov/pubmed/17435356

A 2008 study/review that admirably tried to control for forest-like settings. Not surprisingly, the results were inconclusive, but one wouldn’t really expect to get the same physiological response from sitting in a wood room as from walking in a forest. This paper also reviews some other forest bathing studies.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793347/?tool=pubmed

A 2010 review of 24 studies.
http://www.ncbi.nlm.nih.gov/pubmed/19568835

A 2010 study concluding that time in the forest increases expression of anti-cancer proteins.
http://www.ncbi.nlm.nih.gov/pubmed/18336737

Quote of the Day

2011-10-03T11:44:00.000-07:00

"...perhaps the most pure and exalted kind of love, is an utter, absolute, and unqualified wish for the happiness of another individual."

- Dalai Lama

Disadvantages and Advantages of being on Disability

2011-10-01T15:15:00.000-07:00

This paper (Disability and the Duty to Accommodate in the Canadian Workplace) takes a very thorough look at the legalities of Canadian employees with disabilities and the responsibilities of employers in such circumstances with many real-life case examples. It’s quite long, but worth looking through, especially if you have specific concerns. Mental health disabilities are discussed beginning on page 54 and contains some interesting cases. (I didn’t see a publication date, but I expect it is quite a few years out of date).

This site offers a more brief description of legalities.

Advantages (you don't neccesarily have to be on disability to access these resources):
-social programs to help with returning to work which may include some financing of education
-cost of living slightly offset by bus pass ($45/yr) or driving program as well as subsidised medication costs (also talk to your psychiatrist about Plan G which covers some psychiatric drugs)
-check with your city to see if they offer a free pass to community cenres (Vancouver does. It is called the LAC - Leisure Access Card and gives you access to pools, gyms, ice rinks and sometimes discounts on classes).
-time to heal
-fewer daily stresses
-may allow for a career change
-time to get to know and discover new and interesting things about yourself and develop new skills
-develop new social circles
-time to give back to the community by volunteering
-understand and have greater empathy for people in similar situations
-programs such as free cooking classes offered by Community Mental Health Teams

Disadvantages:
-increases social isolation
-loss of purpose/incentive (I’m using the term generally here. Even if you don’t particularly like your job, having an established routine can be beneficial. It’s important to find new, healthy ways to fill your time).
-decreased income which may affect other areas of health such as nutrition and environmental living conditions if you must move somewhere with cheaper rent
-may be some stigma or gossip upon returning to work
-may be negative judgments from others regarding your disability
-stressful dealings with the government regarding the validity of your illness
-difficulty transitioning back into a working lifestyle which may cause symptoms to recur (it’s important to have support for this transition)

It is important to have a good working relationship with your psychiatrist. Without their support, and filling out pages of forms, you will not be eligible for disability benefits. And, of course, a discourse on your current health status and abilities, especially if you think it has affected your ability to work, is very important.

Remember, the application process takes time. If you are concerned about your condition and think you might require disability assistance, start talking to your doctor sooner rather than later so you don’t end up worsening your condition in a job you can’t do or in a financially stressful situation if you have to leave work before the paperwork goes through.

This site has information on eligibility and application requirements. Remember, you can (and should) appeal if your application is denied the first time around.

Quote of the Day

2011-09-30T20:00:00.000-07:00

The most profound benefit of yoga and meditation for me has been a natural relaxing into my life. Obstacles are not so scary. I am more fluid, more curious, and at the same time more patient. I have more options for happiness because I don’t require specific conditions. It is a relief to discover that I can be happy even if the world doesn’t revolve around me or my agenda.

- Cyndi Lee

Vitamin H – Biotin

2011-09-29T21:34:00.000-07:00

Vitamin H, more commonly known as biotin (the H represents "Haar und Haut”, German words for “hair and skin”) or vitamin B7, is part of the B complex group of vitamins. Biotin is necessary for cell growth, the production of fatty acids, and the metabolism of fats and amino acids. It also plays a role in the citric acid cycle. Biotin can improve blood sugar control and help lower fasting blood glucose levels in persons with diabetes.

Biotin deficiency is rare because, in general, bacteria in the large intestine produce biotin in excess of the body's daily requirements. Deficiency can be caused by the consumption of raw egg whites (eating two or more uncooked egg whites daily for several months).
Symptoms of overt biotin deficiency include:
• Hair loss
• Pink eye
• Dermatitis in the form of a scaly red rash around the eyes, nose, mouth, and
genital area.
• Neurological symptoms in adults such as depression, lethargy, hallucination, and numbness and tingling of the extremities.

Dietary Sources:
Biotin can be found in brewer's yeast; cooked eggs, especially egg yolk; sardines; nuts (almonds, peanuts, pecans, walnuts) and nut butters; soybeans; other legumes (beans, blackeye peas); whole grains; cauliflower; bananas; and mushrooms.

Raw egg whites contain a protein called Avidin that interferes with the body's absorption of biotin.

Quote of the Day

2011-09-27T19:27:00.000-07:00

What the water wants is hurricanes,
and sailboats to ride on its back.
What the water wants is sun kiss,
and land to run into and back.

- Sufjan Stevens

Reconstructing Visual Experiences from Brain Activity Evoked by Natural Movies

2011-09-26T17:18:00.000-07:00

This story is all over the news today. Apparently, a group of researchers were able, more or less, to reconstruct images that subjects had viewed by analysing fMRI data. The subject set was very small, 3 people, and as much as I love that we are beginning to live in the future, I don't feel I possess adequate knowledge to really critique this article. This site, however, offers a bit of a critique.

Dance and Dementia

2011-09-24T17:47:00.000-07:00

A large (469 subjects) , long term (21yrs) study published in 2003 compared the effects of several leisure activities, cognitive and physical, on the outcome of dementia. Despite what much of the internet says, this study does not conclude that dancing reduces the incidence of dementia. In fact, they make no claims that any physical activity reduces risk and further conclude that cognitive activities need further examination to determine whether their role is causal or consequential in relation to the development of dementia.

‘Among cognitive activities, reading, playing board games, and playing musical instruments were associated with a lower risk of dementia. Dancing was the only physical activity associated with a lower risk of dementia. Fewer than 10 subjects played golf or tennis, so the relation between these activities and dementia was not assessed.’ (Other physical activities examined included doing housework, climbing stairs, bicycling, swimming, playing team games, babysitting, and participating in group exercise).

‘A one-point increment in the cognitive-activity score, which corresponds to participation in an activity for one day per week, was associated with a reduction of 7 percent in the risk of dementia.’

‘Perhaps reduced participation in leisure activities is an early marker of dementia that precedes the declines on cognitive tests. Alternatively, participation in leisure activities may be a marker of behavior that promotes health. But the specificity of our findings for cognitive activities and not physical activities argues against this hypothesis… despite the magnitude and consistency of the associations, our findings do not establish a causal relation between participation in leisure activities and dementia, and controlled trials are therefore needed.’

‘If there is a causal role, participation in leisure activities may increase cognitive reserve, delaying the clinical or pathological onset of dementia. Alternatively, participation in cognitive activities might slow the pathological processes of disease during the preclinical phase of dementia. Our findings do not imply that subjects who were less active cognitively increased their risk of dementia.’

‘There was no association between physical activity and the risk of dementia. Exercise is said to have beneficial effects on the brain by promoting plasticity, increasing the levels of neurotrophic factors in the brain, and enhancing resistance to insults. Cognitive and physical activities overlap, and therefore it is not surprising that previous studies have disagreed on the role of physical activities. Although physical activities are clearly important in promoting overall health, their protective effect against dementia remains uncertain.’

This doesn’t mean that physical activity, and dance, is not beneficial to persons with dementia (or anything else for that matter). A 2009 study showed decreased agitation in participants with dementia who engaged in a four week Wu Tau dance therapy intervention.

Racist Psychology Today Article

2011-09-22T17:33:00.000-07:00

This is a bit old, but I'm a bit slow. There are many sites discussing everything that is wrong with this article, but I'm only linking to one here.

Quote of the Day

2011-09-14T17:41:00.000-07:00

We need only courageously expand our concept of intimacy to include all the other forms that surround us on a daily basis. By broadening our definition of intimacy, we open ourselves to discovering many new and equally satisfying ways of connecting with others.

- from The Art of Happiness

Quote of the Day

2011-09-06T10:13:00.000-07:00

May I be happy.

May I be peaceful.

May I be safe from harm.

May I enjoy happiness and the root of happiness.

May I experience ease and well-being in body, mind, and spirit.

May I hold myself with softness and care.

May I be free from suffering and  the root of suffering.

May I be free from the suffering caused by greed (or anger, fear, confusion, and so on)

May I experience ease of body, ;mind, and spirit.

May I respond to suffering with compassion.

Quote of the Day

2011-09-05T09:44:00.000-07:00

“The way that we see things today does not have to be the way we saw them yesterday. That is because the situations, our relationships to them, and we ourselves have changed in the interim. This notion of constant change suggests that we do not have to be discouraged.”

-T.K.V. Desikachar

Quote of the Day

2011-09-04T10:09:00.000-07:00

Do not brood over your past mistakes and failures as this will only fill your mind with grief, regret and depression. Do not repeat them in the future.

- Swami Sivananda

Eros the Bittersweet - Review

2011-08-15T16:09:00.000-07:00

Eros the Bittersweet (Anne Carson)

This is an interesting book that examines the dichotomy of love (Eros type) primarly through association with Greek literature and language (with a focus on poetry). It is ironically romantic in all the right places as well as informative and insightful. Besides being entertaining, I think this book could provide grounding for those who feel dominated by their love feelings.

“Eros is an issue of boundaries. He exists because certain boundaries do. In the interval between reach and grasp, between glance and counterglance, between ‘I love you’ and ‘I love you too,’ the absent presence of desire comes alive. But the boundaries of time and glance and Ilove you are only aftershocks of the main, inevitable boundary that creates Eros: the boundary of flesh and self between you and me. And it is only, suddenly, at the moment when I would dissolve that boundary, I realize I never can.”

“Our souls once lived on wings among the gods, he [Plato] says, nourished as gods are by the infinite elation of looking at reality all the time. Now we are exiled from that place and quality of life, yet we remember it from time to time, for example, when we look upon beauty and fall in love.”

Quote of the Day

2011-07-24T20:36:00.000-07:00

Love is there if you want it to be. You just have to see that it's wrapped in beauty and hidden away between the seconds of your life.

- from Cashback

Fear, Stem Cells, and Emotional Memory

2011-07-19T13:17:00.000-07:00

This summary is from Science Daily which also has the link to the actual article.

Fear Boosts Activation of Immature Brain Cells: Adult Neural Stem Cells Play Role in Creating Emotional Context of Memory

Scientists have long known that fear and other highly emotional experiences lead to incredibly strong memories. In a study appearing online in advance of publication in the journal Molecular Psychiatry, UC Berkeley's Daniela Kaufer and colleagues report a new way for emotions to affect memory: The brain's emotional center, the amygdala, induces the hippocampus, a relay hub for memory, to generate new neurons.

In a fearful situation, these newborn neurons get activated by the amygdala and may provide a "blank slate" to strongly imprint the new fearful memory, she said. In evolutionary terms, it means new neurons are likely helping you to remember the lion that nearly killed you.

"We remember emotional events much more strongly than daily experiences, and for a long time we have known that connections between the amygdala and hippocampus help to encode this emotional information," said Kaufer, an assistant professor of integrative biology and a member of UC Berkeley's Wills Neuroscience Institute. "Our research shows that amygdala input actually pushes the hippocampus to make new neurons from a unique population of neural stem cells. This provides completely new cells that get activated in response to emotional input."

The finding has implications for post traumatic stress disorder (PTSD) and other problems caused by faulty regulation of emotional memory.

"Many affective disorders involve disordered emotional memories like PTSD, depression and anxiety. We think that newborn neurons may play a role in creating these emotional memories," she said.

The finding comes a year after brain researcher Fred Gage at the Salk Institute for Biological Studies in La Jolla, Calif., showed that the formation of new memories is associated with increased activation of two-week-old newborn nerve cells in the hippocampus that are derived from adult neural stem cells. Adult stem cells appear to differentiate continually into new nerve cells -- nearly 100 each day -- yet half of those newborn neurons are slated for death within four weeks after their birth. If they are highly activated, however -- such as in learning new complex information -- many more of them will survive and presumably help in establishing new memories in the brain.

Kaufer, who conducts research on the effects of stress on the brain, knew that many types of positive and negative experiences, such as exercise and stress, affect the rate of neurogenesis in the hippocampus. Along with graduate students Elizabeth Kirby, the lead author of the study, and Aaron Friedman, she was intrigued by the idea that emotions might affect neurogenesis in the hippocampus, since the brain's clearinghouse for emotions, the amygdala, is connected to the hippocampus via multiple neural circuits. To test this, Kirby focused on the basolateral amygdala, the region of the almond-shaped structure that handles negative emotions, including stress, anxiety and fear.

Using rats, Kirby surgically destroyed the basolateral amygdala and discovered that the production of new nerve cells in the hippocampus decreased. To make sure that the cell damage created when the amygdala was surgically destroyed was not affecting the experiment, the researchers borrowed a gene therapy technique from Robert Sapolsky's lab at Stanford University to genetically introduce potassium channels into the amygdala, which shut down the activity of the nerve cells without causing injury. This also decreased neurogenesis in the hippocampus.

They next tested Gage's theory that new neurons are especially sensitive to input two weeks after they form. Kirby and Kaufer labeled hippocampal cells created over a three-day period in a group of rats, and then conditioned a fear response in these rats two weeks later. They then confronted the rats with the same fearful situation or a neutral yet novel context the next day. When they examined the brains, they found that the newborn neurons had been specifically activated by the fearful situation. However, when they destroyed the basolateral amygdala, new neurons were no longer activated in response to the fearful memory.

"The research suggests that newborn neurons play a role not only in the formation of memory, but also in helping to create the emotional context of memory," Kirby said. It also suggests that the basolateral amygdala drives the ability of new neurons to be part of an emotional memory.

The team now plans to see whether other negative stimuli, such as stress and anxiety, similarly cooperate with amygdala activity to alter neurogenesis in the hippocampus.

Quote of the Day

2011-07-19T12:01:00.000-07:00

They open, you know, as roses do, pine cones,
from being tightly wrapped in themselves
to being how we all might become
this very moment, pointy, sinewy,
and ready for the fire of someone else's presence.

- Coleman Barks (from Lightning Bugs and the Pleiades)

Quote of the Day

2011-07-14T11:58:00.000-07:00

Grace means more than gifts. In grace something is transcended, once and for all overcome. Grace happens in spite of something; it happens in spite of separateness and alienation. Grace means that life is once again united with life, self is reconciled with self. Grace means accepting the abandoned one. Grace transforms fate into a meaningful vocation. It transforms guilt to trust and courage. The word grace has something triumphant in it.

- Yrjo Kallinen

Self Worth

2011-07-07T14:01:00.000-07:00

We can all think of many objective ways of measuring worth (income, titles…) and it may be we hear these terms so often associated with the word worth that it can become difficult to define our own meaning of worth. And yet, self worth is a subjective measure. While external validation is important, worth is something a person should feel, not a thing they are told they possess. Every person has their own individual qualities that defines their unique worthiness. I encourage readers to come up with their own ideas of what makes them feel worthy (this may take some time, especially for those with mental illnesses. And remember, worthiness is not something you have to work on, it is something you already are and you only need recognise it. You will likely find that once you begin to feel worthy whatever other self improvement projects you may be working on (self-esteem, kindness…) will come much more easily.

Quote of the Day

2011-06-26T12:45:00.000-07:00

"There is no path to Happiness. Happiness is the path. There is no path to Love. Love is the path. There is no path to Peace. Peace is the path."
— Dan Millman

Warm Temperatures Improve Feelings of Social Isolation

2011-06-24T15:09:00.000-07:00

See also Heat Therapy.

A 2008 study demonstrated that “Experiencing Physical Warmth Promotes Interpersonal Warmth.” The idea is based on the fact that both physical and psychological 'warmth' (friendliness, helpfulness, trustworthiness, empathy, ) can be visualised in the insula. In the first part of the study in which participants were asked to hold a hot or cold beverage and then rate personality traits as either warm or cold. While the findings of this experiment were significant they were not great and the experiment wasn't double-blind. The authors also reported significant findings for the second part of the study (which was double-blind). However, in this experiment participants, after holding a hot or cold pack, were asked to choose between a fruit drink or a gift certificate for coffee. The authors state that this choice was phrased to the participants as a 'gift for yourself' or a 'gift for a friend,' but I don't believe that is an accurate way of measuring altruistic behaviour as the participants could still easily choose the gift certificate for themselves, despite the phrasing of the experimenters (a better way would be to offer them the option of donating a dollar to charity or taking a dollar for themselves).

A 2009 study consisting of three parts confirmed that physical warmth influences psychological warmth. In the first part “participants were handed either a warm or cold beverage and were then asked to rate perceived social proximity to another person.” In the second part participants were placed in a warm or cool room and then asked to describe a short film (the theory being that “If an increase in ambient
temperature would induce social proximity relative to when ambient temperature is low then
we would expect language use to mediate this relationship such that the description of social
events is relatively more concrete in warmer conditions.”) and also to rate perceived social proximity to the experimenter. The third part was the same as Experiment 2 (based on a different language theory) and included a perceptual focus task.

A 2011 study done in four parts also confirms the relationship between physical and psychological warmth. “In Study 1, higher scores on a measure of chronic loneliness (social coldness) were associated with an increased tendency to take warm baths or showers. In Study 2, a physical coldness manipulation significantly increased feelings of loneliness. In Study 3, needs for social affiliation and for emotion regulation, triggered by recall of a past rejection experience, were subsequently eliminated by an interpolatedhttp://www.blogger.com/img/blank.gif physical warmth experience. Study 4 provided evidence that people are not explicitly aware of the relation between physical and social warmth (coldness), as they do not consider a target person who often bathes to be any lonelier than one who does not, all else being equal.”

These studies indicate that the therapeutic process might benefit from the therapist keeping the office temperature on the warmer side. As well, one may be able to improve their general mood and social relationships by keeping warm or holding warm objects. When I write an article later on how to be nicer to people, I will cite this information.

Quote of the Day

2011-06-23T23:28:00.000-07:00

All states of being are determined by mind.
It is mind that leads the way.
As surely as our shadow never leaves us,
So well-being will follow
When we speak or act
With a pure state of mind.

- from 'A Dhammapada for Contemplation"

Quote of the Day

2011-06-09T10:16:00.000-07:00

"It's beautiful. It's beautiful because it's complicated. Because there's not one thing. There's not one thing that makes sense of everything."

- Joe Meno (from The Great Perhaps)

Chocolate is Good For You?

2011-05-27T13:21:00.000-07:00

Eating small amounts of dark chocolate can be beneficial to your health.

It may reduce blood pressure and other cardiovascular risks:
http://www.ncbi.nlm.nih.gov/pubmed/18716168
http://www.ncbi.nlm.nih.gov/pubmed/18827977
http://www.ncbi.nlm.nih.gov/pubmed/17609490

It may help prevent strokes:
http://www.nature.com/jcbfm/journal/v30/n12/full/jcbfm201053a.html

It may improve visual and cognitive function:
http://www.ncbi.nlm.nih.gov/pubmed/21324330

It may improve mood (did we really need science to tell us that?):
http://www.ncbi.nlm.nih.gov/pubmed/19942640

This study showed an association between increased depression ratings with chocolate consumption (note the author's study limitations):
http://archinte.ama-assn.org/cgi/content/full/170/8/699

Here is a recent article examining the how cocoa polyphenols are used by the body and questions the health benefits:

“There is recent epidemiological evidence that chocolate consumption may improve vascular health. .. However, human bioavailability studies suggest that the plasma concentrations of cocoa polyphenols are manifold lower than those concentrations used in cultured cells in vitro. The experimental evidence for beneficial vascular effects of chocolate in human interventions studies is yet not fully convincing. Some human intervention studies on chocolate and its polyphenols lack a stringent study design. They are sometimes underpowered and not always placebo controlled. Dietary chocolate intake in many of these human studies was up to 100 g per day. Since chocolate is a rich source of sugar and saturated fat, it is questionable whether chocolate could be recommended as part of a nutrition strategy to promote vascular health.”
http://www.ncbi.nlm.nih.gov/pubmed/21437025

A German study showed positive health benefits with 6g of dark chocolate (dark typically implies a chocolate bar with at least 70% cocoa) a day.
http://eurheartj.oxfordjournals.org/content/31/13/1616.long

However:
- beneficial flavanoids (polyphenols) can also be found in healthier foods such as fruits and vegetables (apples, beans, onions, grape juice...).

- you can't know the flavanoid content in chocolate :
“According to scientists from the University of California, Berkeley, the percentage of cocoa listed on a label is not a dependable indicator of flavonoid content. A bar that is, for example, 65 per cent cocoa may not be better than one that is 55 per cent.
This is because a lot depends on the type of cocoa beans used and how they have been processed. The higher the temperature at which the beans are roasted and the longer they are fermented, the fewer heart-healthy flavonoids survive, and this is not mentioned on the pack. Even if flavonoid content is given, scientists claim that results can vary from lab to lab.
That said, the bottom line is that you are likely to get more flavonoids in a dark chocolate that lists cocoa beans, cacao, chocolate liquor or cocoa mass on its ingredient list. Milk chocolate tends to have very few flavonoids and white chocolate none. “
http://women.timesonline.co.uk/tol/life_and_style/women/diet_and_fitness/article5008739.ece

- choose dark chocolate to avoid excess sugar (the darker the chocolate the less sugar)
- beware of chocolates labelled 'dark' that do not have the cocoa content printed on the label as these are likely to be 'dark flavoured' chocolates that are treated with alkali.
try to find cocoa that has been the least processed (maybe some organic cocoa powders?)

In summary, a small amount of flavanoid-rich dark chocolate should not cause any detrimental health effects and may be beneficial to psychological and physical health.

Quote of the Day

2011-05-23T10:45:00.000-07:00

Everything was beautiful, and nothing hurt.

- Kurt Vonnegut

Quote of the Day

2011-05-14T17:02:00.000-07:00

The breeze at dawn has secrets to tell you.
Don't go back to sleep.
You must ask for what you really want.
Don't go back to sleep.

- Rumi

Quote of the Day

2011-05-11T21:21:00.000-07:00

"But you don't become great by trying to be great. You become great by wanting to do something, and then doing it so hard that you become great in the process."

-xkcd

Quote of the Day

2011-05-06T09:44:00.000-07:00

"The key was to not lose heart. In all things probably. Even for gorgons. And so I was determined not to."

- Lorrie Moore (from A Gate at the Stairs)

Mental Health Awareness

2011-04-29T09:47:00.000-07:00

Some time ago I wrote an article advocating for more public awareness/fund raising for mental health issues.

Today I read an article that discusses the same issue and also advertises for an upcoming mental health awareness event called 'Ride Don't Hide' which is a spinning relay that takes place on May 7. (For details see the RideDontHide site or the CMHA site). From the Ride Don't Hide site: "On August 1, 2010, Michael Schratter left on a one year global journey, cycling 40,000 km, crossing 6 continents and 30 countries, in an effort to bring awareness to mental illness and help shatter the stigmas that surround it. This endeavor is more than cycling trip; it is an international movement for personal rights. Raising awareness, expectations, and funds, Michael Schratter will help shatter the stigma, one pedal at a time. "

The article can be found here. "Then there is local entrepreneurial legend Joe Seagull, who recently donated $12 million to VGH for a new psychiatric facility. He said, “It is not sexy to fund, but mental illness crosses all boundaries.” Well said, Joe!"

Assisted Suicide

2011-04-28T18:31:00.000-07:00

I'm not going to get into a lengthy opinion article on the subject, but it was in local news recently so I thought I would share that. You can read the story at the CTV site (among other places).

Swearing Lessens Pain

2011-04-25T09:17:00.000-07:00

Here is an interesting artictle,*$%#@! Cursing Can Soothe Pain, Research Shows, that looks at two studies which show swearing eases pain. The exception is for people who swear frequently, for whom this pain alleviating response does not seem to work.

Also be sure to check out the link to the LA Times article which looks at alternatives to swearing and mentions the research where looking at an affected body part reduces pain (this last method is also discussed nicely on Garth Kroeker's blog).

Quote of the Day

2011-04-22T13:20:00.000-07:00

Gene Therapy for Depression

2011-04-16T17:38:00.000-07:00

This recent article looks at a novel way of treating depression through gene therapy. The study was done on mice and the investigators were able to both cause and treat depression like symptoms (motivation).

“Because retroviral vectors are thought to insert themselves at random positions in the host genome, insertional mutagenesis as a potential risk of retroviral gene therapy has been debated for some years…The manipulations needed to create genetic therapy add enormous complexity to considerations of safety and preclinical toxicity testing.”
http://www.nejm.org/doi/pdf/10.1056/NEJMp020184

According to this recent opinion article, there have been recent attempts to find safer viral vectors, but that has yet to be discovered.

Risks associated with gene therapy include negative immune response, viral spread, viral reversion to causing disease instead of treating it, and tumor induction.
http://www.mayoclinic.com/health/gene-therapy/MY00105/DSECTION=risks

Here is a very thorough article discussing the risks of and potentially safer ways of using gene therapy.
“The ability of retroviruses to integrate into the host cell chromosome also raises the possibility of insertional mutagenesis and oncogene activation… A considered review of retroviral induced pathogenesis suggests these events were qualitatively, if not quantitatively, predictable. In addition, it is clear that the probability of such events can be greatly reduced by relatively simple vector modifications, such as the use of self-inactivating vectors and vectors derived from non-oncogenic retroviruses. However, these approaches remain to be fully developed and validated.”

Quote of the Day

2011-04-15T13:53:00.000-07:00

"...you have more than all of this requires."

http://www.intent.com/node/247088

Quote of the Day

2011-04-14T19:09:00.000-07:00

Such beauty that for a minute
death and ambition, even love,
doesn't enter into this.

- Raymond Carver

How We Decide - Review

2011-04-14T17:45:00.000-07:00

How We Decide (Jonah Lehrer)

This was actually a quite decently written book. Like all popular psychology books, it can drone on at times and the citations aren't always thorough, but it certainly had it's fair share of life or death examples of decision making to keep things exciting (I sense a bit of irony here...). The author did seem to portray the stock market as a can't lose situation. I don't think this was his intention, but I don't recall any stories about people losing money. If nothing else, it has made me more conscious (or as conscious as the author alludes to a person being able to be) of my general purchasing habits.

Anger

2011-03-17T19:32:00.000-07:00

Anger can be an overwhelming and destructive emotion which can easily grow if not checked.

Regard anger as a warning signal – recognize it, let it go, and search for the root of the anger so as to identify and be able to work on the solution to the trigger event.

Imagine what a reconciliation would look like and how you would feel. If reconciliation is not an option, imagine what it would be like to be ok with letting go of a difficult situation in order to make room for a better one.

When you are no longer feeling intense anger, you can then decide which of the above options would suit you better and begin working towards that goal. This may be as simple as agreeing to disagree or it may be more difficult requiring comprise or ending an abusive relationship.

Get outside perspective by talking to friends or family. They may be able to provide you with an outlook that isn’t confused by such a powerful feeling.

Be willing to admit you overreacted. This is not to say that the reason for your anger should be ignored, but that a violent reaction, emotional or physical, is not helpful in reaching a solution.

Try to understand the other person’s point of view. It may be possible they didn’t intend to hurt you.

Talk to the other person, when you’re less angry. By communicating you can help them understand your perspective as well as learn theirs so that missteps don’t occur in the future.

Understand how being angry can negatively affect your health, such as increased risk of coronary heart disease, and the people around you.

Find things to counteract your anger such as watching a funny movie.

Be willing to apologise and just as important, be willing to accept an apology.

Take a deep breathe and relax your muscles.

Have a few quotes or mantras written down to remind yourself of the negativity of anger and the benefits of letting it go.
“For every minute you are angry you lose sixty seconds of happiness.” (Ralph Waldo Emerson)
“In a controversy, the instant we feel anger, we have already ceased striving for truth and have begun striving for ourselves” (Abraham J. Heschel )
“To forgive is the highest, most beautiful form of love. In return, you will receive untold peace and happiness.” (Robert Muller)

There is increasing evidence that venting anger does not help alleviate the emotion and may actually increase it. From a cognitive perspective, venting can be viewed as practicing. It can also harm the people around you.

Questions to Help Angry People Think More Logically
• Why am I angry?
• What else contributed to this state of mind?
• What other feelings do I have?
o Am I feeling rejected?
o Hurt?
o Shocked?
o Threatened?
o Am I afraid of change or of losing something?
o Am I feeling vulnerable?
o Bewildered?
o Guilty?
o Insulted?
o Harassed?
o Manipulated?
• What did I expect in the situation?
• Did I check to see if my impressions are correct?
o What is the proof?
o How else could I interpret this?
o And how else?
• Am I overreacting or blowing things out of proportion?
• Who am I angry at?
• Am I venting my anger at someone other than the source of my frustration?
• Am I overlooking the good aspects of my relationship with this person?
• Is the event really less important than I first thought?
• Am I blaming someone for the anger I responded with?
• Did the person I am angry at intentionally hurt me?
• Could a difference in lifestyles, values, opinions, or upbringing play a part in this conflict?
• How do the other people involved in this situation probably feel?
o In what other ways could they possibly feel?
• Am I being selfish and forgetting the needs and desires of other people?
• How can I best bring about the changes I need?
• Do I need to learn to accept a situation that won't change?
• What would I say to a friend in this situation if I were trying to help?
• What would a counselor, teacher, or minister trying to help say?
http://www.sensiblepsychology.com/improving_anger.htm

Additional links:
http://www.apa.org/topics/anger/control.aspx

Outliers: The Story of Success

2011-02-01T11:35:00.000-08:00

(by Malcolm Gladwell)

Outliers examines what it is that determines a person’s success, particularly for those people who excel in their discipline and finds that a combination of talent, skill, determination, hard-work, luck, timing, and politics is more important than any ‘innate’ proclivity.

“Success is the result of what sociologists like to call ‘accumulative advantage.’ The [person] starts out a little bit better than his peers. And that little difference leads to an opportunity that makes that difference a bit bigger, and that edge in turn leads to another opportunity, which makes the initially small difference bigger still – and on and on until the [person] is a genuine outlier.”

The ‘little bit better’ referred to here has to do with when a person was born. As many activities such as school and sports recruit only once per year, that means there could be a year’s age difference between people admitted at the same time, and the older child will have physical and cognitive benefits over his younger peers.

The book also talks about the 10,000 hour rule which is what is estimated as the time needed to become an expert at a skill. It includes other narratives, some interesting and some long-winded, about success (and failure) stories.

“We pretend that success is exclusively a matter of individual merit. But there’s nothing in any of the histories we’ve looked at so far to suggest things are that simple. These are stories, instead, about people who were given a special opportunity to work really hard and seized it, and who happened to come of age at a time when that extraordinary effort was rewarded by the rest of society. Their success was not just of their own making. It was a product of the world in which they grew up.”

One of my favourite stories compared the genius Chris Langan who was denied a scholarship because of incomplete paperwork to Openheimer who tried to kill his tutor and was only put on probation and required to see a psychiatrist.

While not a literary masterpiece, Outliers is certainly interesting and quick read.

You Don’t Know Jack

2011-01-31T21:11:00.000-08:00

This is a very thought-provoking and emotional movie about Dr. Jack Kevorkian. I am not familiar with Dr. Kevorkian, other than the obvious, so I can not comment on the accuracy of the representation, but it is nonetheless a well produced, directed and acted film with extraordinary performances by Al Pacino and John Goodman.

The movie tells the story of Dr. Kevorkian from when he first decides to undertake assisted suicides, as well as his friends, supporters, and protesters. It also does a good job of showing Jack Kevorkian’s sometimes quirky personality and creative talents in poetry, art and music. As would be expected, it is a complicated story.

The Art of Happiness

2011-01-29T17:16:00.000-08:00

(By His Holiness the Dalai Lama and Howard C. Cutler, M.D.)

This is a refreshing book that happily doesn’t read like a self-help book, but is helpful. Because the Dalai Lama talks about feelings rather than diagnoses, there is something for everyone in this book.

Though the Dalai Lama is Buddhist and obviously draws on that experience, the book is non-dogmatic but does devote a chapter to the positive and negative influences of religion, in general.

I had one strong disagreement with the Dalai Lama’s point of view. For a meditation exercise, readers are asked to visualise a ‘…self-centred person…” on one side and a ‘group of people who are in desperate need of help’ on the other. He goes on to say, ‘the well-being of a group…is more important than that of a single individual.” It seemed cruel to me to label the self-centred person as not as needy of help. Certainly we should look for ways to help all of those in need. And while helping a group may mean helping more people directly, it is also important to remember that by helping the individual, we are also helping all the people that individual comes into contact with. The author of the book also had a problem with this, but never brought it up with the Dalai Lama.

I think it is good to read a little bit of this book everyday to encourage regular positive thinking (not unlike doing a daily gratitude list).

Bee Hive Metaphor

2011-01-26T18:12:00.000-08:00

Each of us is composed of many different aspects of personality, as the division of labour is divided amongst a society of bees. Some of these roles may appear more dominant than others, as we all tend to have dominant traits. But in order to function optimally, each role needs to be recognised, developed, and receive an equal amount of credit for its contribution to the survival of the hive.

Members of the hive:

The queen is the sexually mature member of the hive. She is well taken care of by the other members of the hive who see that she is well fed and kept clean. The queen is an example of our need to be nurtured and our physical requirements in order for our entire being, or hive, to survive.

Worker bees have a variety of specialised roles -

Cleaner bees are responsible for the tidiness of the hive. If the cells of the hive are not sufficiently clean, the queen will not use them. This is a reflection of how important our physical environment is to our well-being and growth. (See environmental psychology). Not only does our environment affect our mental health, but cleanliness is also important for our physical health (even small things like dusting can improve our allergies and immune system). Similarly, other bees work are responsible for propolising the hive which aids in keeping the hive clear of bacteria and fungi and provides ventilation.

Nurse bees tend to the larvae. This can be seen as the need to nurture our childish side ensuring play, creativity, and ambition.

Wax bees produce the materials needed for hive construction and are responsible for the building and upkeep of hive cells. These bees may represent the need for constant maintenance, both emotionally and physically, and also serve to remind us of certain material necessities, emotional and physical. Builders also aid the construction of the hive. This could represent cooperation between our different aspects.

Some bees are responsible for storing honey and pollen, a reminder to plan for future contingencies and to ensure nutrients are available.

Other bees are responsible for feeding; it is not enough to simply have healthy food around, it must also be delivered, or eaten.

The queen’s attendants clean and feed the queen – hygiene, and again nutrition, are vitally important. Also, not only is it important to be tended to, but it is also important to assume the role of attendee and know how to care for the self and others.

Mortuary bees remove the dead from the hive by carrying them a distance from the hive. I think this not only represents the honour we should show the deceased who were important to us, but it also serves as a metaphor for how we should treat past events that we need to let go of – with care, grace, and respect.

Fanning bees control the temperature and air flow in the hive. Ambient temperature can affect sleep and mood. (See also Heat Therapy).

Guard bees protect the hive and its members. Although too much caution or violence can be a bad thing, it is important to ensure the safety of your physical and mental self by either avoiding dangerous situations or, when necessary, but standing your ground (in extreme cases, one may have to physically defend themselves, but we also need to protect ourselves from negative attitudes – both our own and from others).

Foragers gather food and material. They are also responsible for communicating to other foragers where supplies may be located. This may represent our practical self which needs to tend to day-to-day activities such as paying bills, ensuring food and toiletries are in stock, making appointments, running errands…

Here is an interesting article on how the division of labour is determined in bees.

Eye movement desensitization and reprocessing (EMDR)

2011-01-19T19:49:00.001-08:00

EMDR was discovered by Francine Shapiro in 1987 when she noticed a decrease in her anxiety when her eyes were moving. Since then, there has been much research into the efficacy of this therapy in the treatment of all types of psychiatric disorders, most commonly PTSD, though the neurological mechanism of action has yet to be discovered.

In EMDR, the patient is asked to concentrate on a troubling thought while the therapist directs their eye movement back and forth (auditory or tactile stimuli may also be used). The therapy also uses relaxation and positive imagery techniques. This combination of relaxation, cognitive methods, and distraction is probably what makes EMDR effective.

Evidence does suggest that EMDR is beneficial. Some studies claim it is superior to other therapies, while others suggest there is no significant difference. As with all therapies, I suggest a person be open minded to anything that might work and to work through the different types until they find what style, or combination of styles and medications, works best for them. (EMDR requires less work from the patient outside of sessions and arguments could be made on both sides why this may or may not be beneficial).

References:

http://www.ncbi.nlm.nih.gov/pubmed/20709492
Findings indicate that the eye movement component in EMDR is beneficial, and is coupled with distinct psychophysiological changes that may aid in processing negative memories.

http://www.ncbi.nlm.nih.gov/pubmed/11037095
In most cases EMDR was shown to be effective at reducing symptoms up to 3 months after treatment. In one case benefit was maintained up to 9 months and in another (uncontrolled) follow-up treatment effect was present at 15 months. Two studies suggest that EMDR is as effective as exposure therapies, three claim greater effectiveness in comparison to relaxation training, and three claim superiority over delayed treatment groups. Of the studies examining specific treatment components, two found that treatment with eyes moving was more effective than eyes fixed, while three studies found the two procedures to be of equal effectiveness.

http://www.ncbi.nlm.nih.gov/pubmed/16740177?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Our results suggest that in the treatment of PTSD, both therapy methods tend to be equally efficacious. We suggest that future research should not restrict its focus to the efficacy, effectiveness and efficiency of these therapy methods but should also attempt to establish which trauma patients are more likely to benefit from one method or the other. What remains unclear is the contribution of the eye movement component in EMDR to treatment outcome.

http://www.ncbi.nlm.nih.gov/pubmed/17636720?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedreviews&logdbfrom=pubmed
There was some evidence that individual TFCBT and EMDR are superior to stress management in the treatment of PTSD at between 2 and 5 months following treatment, and also that TFCBT, EMDR and stress management were more effective than other therapies.

A Year of Healthy Living

2010-12-23T22:24:00.001-08:00

As this may be my last post for a while, I thought I would make it a big one. What follows is a list of ways to change thoughts, behaviours, and attitudes. It also nicely coincides with the new year.

Suggestions and explanations:

• The idea behind this list is to provide a variety of ways of changing your state of being in simple ways. Some things are specific, while some are more general and open to interpretation and contemplation. Even though you may already do many of this things, it is also beneficial to do them on purpose and with awareness.
• Print out the list and choose an activity at random each day, being fully committed to completing it. If the activity is weather or seasonally dependent, complete it at the earliest opportunity.
• There are two big things on this list. The first is yoga, which I included because of it’s many benefits. A good yoga instructor can be a great therapist providing positive comments as while as guiding you through relaxation, meditation, and exercise. If you aren’t comfortable going to a gym, get yourself a dvd or find tutorials online. If you don’t have a lot of money, many studios offer karma classes where you can pay by donation and Lululemon offers free classes at their stores. Don’t be concerned about your fitness level; I’ve gone to yoga classes where all I’ve been able to do is sit through half of it. The other big thing is to create a new, healthy habit which takes a bit of time.
• Whenever your senses are involved in an activity, be especially mindful about what you are feeling.
• Whenever repetitions or time suggestions are given, feel free to do more.
• You may want to keep a journal to record how you responded to each activity. Notice the things you find helpful and try to do them more often.
• Some things on this list may seem silly and trite, but not only does doing something outside your comfort zone and regular behaviour help change emotions, it can also give you an excuse to have fun. It’s ok, nobody’s watching.
• If you like, print the list onto pretty paper and put the items in a decorated jar.

1. Say something nice about someone you don’t like (bonus if you say it to them).
2. Give up your seat on the bus or let someone in if you drive.
3. Pay attention to objects in your favourite colour.
4. Do one thing that you’ve been putting off.
5. Call someone just to say ‘hi.’
6. Say something nice about yourself (even if you don’t think you believe it).
7. Give change/food to a homeless person (and say ‘hello’ to them).
8. Back up your important data.
9. Make a playlist of music that makes you happy.
10. Eat something delicious.
11. Watch a funny video on you-tube.
12. Tell someone who is important to you that they are important.
13. Create something (art, craft, food…).
14. Wear your favourite outfit (even if the weather is bad and even if you’re not going out).
15. Pet an animal.
16. Find or make a card and mail it to yourself.
17. Find or make a card and mail it to someone else.
18. Look at the stars.
19. Look at the moon.
20. Eat something green.
21. Eat a vegetable.
22. Start reading a book (bonus if you finish it).

23. Don’t assume the worst.
24. Smile often. Remember to create a half-smile as often as possible.
25. For 1min, examine an object nearby in detail.
26. Smell a flower.
27. Feed some birds.
28. Put up a new picture on your fridge or wall.
29. Eat some nuts.
30. Look at art (online is ok).
31. Wear nice underwear.
32. Read a comic.
33. Watch something funny.
34. Throw a rock.
35. Wear something in your favourite colour.
36. Light a candle.
37. Tell someone a joke.
38. Give a stranger a compliment.
39. Eat blueberries.
40. Sit in your favourite spot for 5 min.
41. Walk barefoot over 3 different surfaces (and compare how they feel).
42. Learn a new word.
43. Wash the dishes.
44. Play with bubbles (the bubbles in your dishes sink count).
45. Water or plant a plant.
46. Warm a towel before bathing so it is warm when you dry yourself.
47. Go for a 10min walk (take notice of your surroundings).
48. See how many different leaves you can find.
49. Take photos of at least 5 things that catch your eye.
50. Make a list of all the species (try to get to 100) in your backyard.
51. Write a positive message on a piece of paper and leave it somewhere public for someone else to find.
52. Sing.
53. Laugh often.
54. Notice people’s umbrellas (or bags, jewellery…).
55. Notice the different types of dogs/cats you see.
56. Be grateful.
57. Plan a meal (and make it).
58. Plan an activity for this week (and do it).
59. Stretch often.
60. For 1min, pay attention to your breath without changing it. Notice how deep the breath is, whether you breathe into your stomach or chest, the rate of your breaths…
61. Eat something red.
62. Buy a flower for your house.
63. Give yourself a foot massage.
64. Dance.
65. Do as many sit-ups as you can.
66. Do as many push-ups as you can.
67. Do as many jumping-jacks as you can.
68. Do your hair differently.
69. Give someone on the internet a positive comment on their blog/video.
70. Watch a cute animal video.

71. Next time you buy groceries, buy something you wouldn’t normally get.
72. Draw a picture (and maybe give it to someone).
73. Look at old photographs.
74. For 1min, work on slowing down the rate of your breath.
75. Take a deep breath and sigh out loud.
76. Rub your palms together quickly until they are warm and then gently massage your eye sockets (with your eyes closed) with the heels of your hands.
77. Clear your plans for 1 day and then fill the day with improvised activities.
78. Every time you have a negative thought, also think of something positive (even something as simple as ‘kittens are cute’).
79. Every time you think something negative about another person, also find something positive to say about them.
80. Dedicate all of your positive experiences to a person who might need some extra help/energy.
81. Say something nice about your body.
82. Practice simplicity. Cut out superfluous activities doing only what is necessary.
83. Choose an activity from an art therapy website (and do it).
84. Write down all the positive events/feelings that occurred during the day (find at least three).
85. Notice moments of quiet.
86. Whenever you feel overwhelmed, stop what you are doing and take 3 deep breaths.
87. Order free samples of stuff from the internet (smartcanucks.com).
88. Find 3 scents you enjoy.
89. Write (anything you want).
90. Change your physical state (posture, facial expression…)
91. Don’t panic.
92. Spend 1 day away from the internet.
93. Look at pictures of space.
94. Learn something new.
95. Think of 5 people you have enjoyed spending time with.
96. Make plans to spend time with someone (and do it).
97. Get up to watch the sunrise (you can go back to bed afterwards).
98. Keep the beat to a song (snap your fingers, tap your foot…).
99. Jump up and down a few times.
100. Stick your tongue out.
101. Do yoga.
102. Throughout the day, check your body for areas of tension and then relax them.
103. Trust in something.
104. Eat something yellow.
105. Touch a tree.
106. Notice how your body temperature changes throughout the day and how the temperature varies in different areas of your body.
107. Eat a healthy breakfast.
108. Eat a healthy dinner.
109. Draw/write something with your opposite hand.
110. When bathing, notice what it feels like to be wet.
111. Take a chance.
112. Hug something, someone, or yourself.
113. Touch 5 different things.
114. Look up volunteer opportunities (bonus if you start volunteering).
115. Avoid drama.
116. De-clutter your home or office.
117. Forgive (yourself and others).
118. Drink a hot beverage.
119. Smile at strangers.
120. Skip.
121. Make a paper airplane or origami.
122. Be brave.
123. Participate (in conversations, the work you are doing, in your community…).
124. Whistle.
125. Learn to say ‘hello’ in 5 languages.
126. Watch the sunset.
127. See something good in every person you encounter.
128. Be patient.
129. Have 1 day without any tv.
130. Take the stairs instead of the elevator/escalator.
131. Make your bed.
132. Read a children’s book.
133. Be curious.
134. Google your name to see who else is out there.
135. Look at the clouds.
136. Take vitamins (vitamin B and omega-3 are especially good for depression).
137. Listen to the birds.
138. Do something difficult.
139. Floss.
140. Daydream.
141. Take a different route to work.
142. Take a bath with low or no lights.
143. Go through your closet and donate what you don’t need anymore.
144. Set a nice table for dinner (even if you’re only eating KD).
145. Say ‘I love you’ to someone (or yourself).
146. Remember a moment of joy and bring that feeling into whatever you do.
147. Look out the window.
148. Clean out your junk drawer.
149. Do 10min of exercise.
150. Clean your fridge.
151. Change the desktop background on your computer/phone.
152. Do a puzzle or solve a riddle.
153. Play a game.
154. Pretend your coffee/water is a magic potion and choose a superpower and pretend you have it for the rest of the day.
155. See how long you can hold your breath.
156. Make a list of the bigger goals you want to accomplish (a set an intention to complete them).
157. Write a poem/haiku.
158. Start a piggy-bank or savings account.
159. Clean out your inbox.
160. Pick a person and make a list of all the things you like about them (and give it to them).
161. Search for an interesting rock to keep.
162. Write a note by cutting words out of a magazine.
163. Memorise a poem.
164. Try not to think about dancing unicorns.
165. Send a thank-you note to someone.
166. Try to catch food in your mouth by tossing it in the air.
167. Follow a bug for 5min to see what it does.
168. Paint with your fingers/toes.
169. Find free activities to do in your city.
170. Grow an herb.

171. Explore lolcats.
172. Make yourself a survival kit. Include things that make you feel better: a soft, scented scarf, an old letter from a friend, a picture that always makes you smile...Bring out your kit when you're feeling down.
173. Pick a letter of the alphabet and notice things that begin with that letter.
174. Build a fort.
175. Be the person you want to be.
176. Give advice to yourself in the past.
177. Notice people who are holding hands.
178. Take an old book and leave it somewhere for someone to find (maybe leave your email in it to see if anyone contacts you).
179. Send a postcard to a stranger and get one back (postcrossing.com).
180. Go to bed on time.
181. Indulge in a guilty pleasure (as long as it doesn’t harm anyone).
182. Share a one sentence story at onesentence.org.
183. Drop a dollar on the ground and see if it’s returned or just leave it for someone to find.
184. Make an animal sound.
185. Sit in 5 different positions.
186. Hold an ice cube in your hand.
187. Balance something on your nose/head.
188. Sit in a different chair/area than you usually do.
189. List as many words beginning with D as you can in 3 min.
190. Listen to music while lying on the floor in the dark.
191. Plan a holiday (even if you can’t go).
192. Think about the best sex you’ve had.
193. Look up your name at urbandictionary.com
194. Drink everything through a straw.
195. Bring cookies (or something) to work.
196. Lie in the sun.
197. Change your ring tone.
198. Believe that everything is always getting better.
199. Be accepting.
200. Really taste your food.
201. Drink your coffee or tea without sugar if you normally have sugar, or with sugar if you normally drink it without.
202. Notice 5 things you can see.
203. Notice 5 things you can hear.
204. Notice 5 things you can smell.
205. Notice 5 things you can feel.
206. Count to 10 without being interrupted by other thoughts. When you are interrupted, start the count over.
207. Measure your breath by counting how many footsteps you take per breath.
208. Notice how your arms swing when you’re walking.
209. Make a list of your favourite movies.
210. Try not to say the word ‘is.’
211. Ask someone to recommend a book (and read it).
212. Ask someone to recommend a movie (and watch it).
213. Wear nice jewellery.
214. Don’t complain.
215. Appreciate what you have.
216. Choose happiness.
217. Try to feel your heart beating in your chest.
218. Don’t procrastinate.
219. Avoid alcohol/drugs.
220. Walk backwards.
221. Blink your eyes rapidly and the close them and watch the lights.
222. Jump on the bed/couch.
223. See how many times you can use the word ‘definitely.’
224. Think about your favourite building (and visit it).
225. Do a cartwheel, headstand, or handstand.
226. Create a Venn diagram.
227. Go for a bike ride.
228. Spin in circles and then try to walk straight.
229. Let go.
230. Ask why.
231. Shake your head back and forth quickly.
232. Blubber your lips like a horse.

233. Find beauty in ordinary things.
234. Clean out your purse/wallet.
235. Eat something crunchy.
236. Eat something soft.
237. Take something out of storage.
238. Leave work at work.
239. Keep your favourite xmas ornament out all year.
240. Notice people’s xmas trees through their living room windows.
241. Brush your teeth with the opposite hand.
242. Give up a bad habit.
243. Think about all the compliments you’ve been given and believe them.
244. Put your feelings into words and recognise them as something separate from your identity.
245. Do the opposite of what you want to do when you’re feeling unwell.
246. Leave a cheerful message on someone’s voicemail (or your own).
247. Clean your floors.
248. Clean your toilet.
249. Decide, right now, to be happy.
250. Make birthday cards and plan to mail them.
251. Clean unused files and programs from your computer.
252. Hold the door open for someone.
253. Dust.
254. Sign up to get free stuff on your birthday (register Starbuck’s card, Vera’s Burger Shack, PaJo’s Fish & Chips, Marble Slab, Sephora, Orange Julius…).
255. Eat something yellow.
256. Let someone go in front of you in a line.
257. Put change in an expired meter.
258. Tip generously.
259. Make a donation to a charity (even just $1).
260. Make a kind wish for someone.
261. Give money to a street musician.
262. Pick up trash in your neighbourhood.
263. Fix something that is broken or needs mending.
264. Leave change in a vending machine.
265. Ask someone to recommend a recipe.
266. Offer to make or buy someone coffee (this can be the stranger behind you in line).
267. Look people in the eye.
268. Listen sincerely to people (maybe ask someone to tell you a story).
269. Share your umbrella with a stranger.
270. Have flowers delivered to a friend (or yourself).
271. Buy yourself a treat.
272. Put up a funny `lost` poster and see who responds.
273. Offer to do a someone a favour.
274. Embrace your mistakes.
275. Clean your bedroom.
276. Eat a healthy snack.
277. Measure your carbon footprint (and make plans to reduce it).
http://www.carbonfootprint.com/calculator.aspx
278. Be especially good to your body.
279. Choose to be an affirming person.
280. Give the benefit of the doubt.
281. Make kindness a priority.
282. Ask someone to recommend some music you`ve never heard.
283. Try to create no waste.
284. Give yourself a hand massage.
285. Eat (a small piece) of dark chocolate.
286. Stand and sit tall.
287. Bounce a ball.
288. Feel the rain on your face/skin.
289. Look up a famous philosopher and get a quote.
290. Do some math (long division or whatever your level is).
291. View problems as challenges to be overcome.
292. Listen to a podcast.
293. Masturbate or have sex.
294. Take a nap.
295. Learn binary.
296. Learn a card trick (and show it to someone).
297. Write a letter to your future children/grandchildren.
298. Read the newspaper (the whole thing).
299. Play on a swing.
300. Remember a time when you felt accomplished.
301. Contemplate which era you would visit if you had a time machine.
302. At the end of your work day, write down 3 positive work related things.
303. Write a letter to your future self.
304. Give yourself a head massage.
305. Know you’re loved.
306. Lie down and relax for 5min.
307. Clean your bathroom.
308. Think before you speak.
309. Eat a fruit.
310. Eat a vegetable.
311. Put clean sheets on your bed.
312. Go on an adventure (visit a new neighbourhood, shop at a different grocery store…).
313. Feel the wind.
314. Laugh at something that isn’t funny.
315. Look at nature photos.
316. Clean behind the fridge/stove.
317. Touch your toes (you can bend your knees if needed).
318. Do as many squats/lunges as you can.
319. Scrunch up your face.
320. Stand without moving for 1min.
321. Do alternate nostril breathing (close your left nostril with your forefinger and breathe in through your right. Then, close your right nostril with your thumb and breathe out through your left. Inhale through your left, close the left nostril and release the right, and breathe out through the right. Repeat a few times.).
322. Inhale in 1 breath and exhale in 3 separate breaths.
323. Hum.
324. Breathe in and out rapidly through your nose (aim for 3 breaths/sec).
325. Breathe in as much as you can and fully exhale to get all the air out (it helps if you pull in your stomach at the end of your exhale).
326. Give yourself a shoulder massage.
327. Find reasons to agree.
328. Find reasons to love yourself and your life.
329. Spend an extra second with every thing you do.
330. Allow yourself to not like something that isn’t healthy for you.
331. Get rid of 1 thing.
332. Create a new habit by doing something everyday (this can take 15 -60 days).
333. Be disciplined.
334. Recall the most severe weather you have experienced.
335. Don’t worry.
336. Make a list of new things you learned this week.
337. Set 3 goals for the day and do them.
338. Think of something you have to look forward to.
339. Tell yourself, ‘I’m awesome,’ frequently (even if/especially you make a mistake).
340. Learn to stop. Set a time limit for a task (choose a time that is shorter than the task would require to be completed) and let yourself stop. You can finish your task at a later time.
341. Scream.
342. Instead of thinking ‘what if’ think ‘next time.’
343. Let go of negative relationships.
344. Read out loud.
345. Shake someone’s hand.
346. Balance on one leg and then the other (if you want to make this more difficult, you can try lifting one leg into the air and closing your eyes).
347. Do something silly.
348. Recognise the work you’ve done, the progress you’ve made and celebrate your successes.
349. Don’t make excuses.
350. Be courteous.
351. Focus your imagination and efforts on becoming a positive person.
352. Don’t curse.
353. Create a visualisation of a happy place (if you already have one, go there).
354. Choose 11 activities to add to this list.

Gifts for Someone Who is Depressed

2010-12-03T20:06:00.000-08:00

Another re-post from last year.

This could be for the holidays or a special occasion or just because. The best gift is your support, but presents are nice too. The following list is compiled from ideas I found on the interweb and my own ideas. There are of course many wonderful gifts you could give to any person, but I tried to make this more specific for depressed people by choosing gifts that are not only presents, but will enhance their life in a healthy and positive way.

* Ask them to do something healthy for you -bake a cake, make a cd, play a song if they play an instrument. Some people might be more willing to engage in activity if they’re not concerned about the cost/benefit to themselves. Eventually, an individual has to choose to things by and for themselves, but a little help getting started can go a long way.

* Make them some homemade food. Self-care can be difficult when depressed and appetite particularly can fluctuate. Having nutritious, wholesome, and comforting food at hand can make the difference between a person eating or not.

* Pretty paper or a nice journal. There can be a lot of CBT homework and scheduling; having some brightly coloured paper might encourage someone to fill out their 3 positive events for that day, for example.

* A day out. Ask them to go for a walk with you. Take them to a movie or concert. Bear in mind, they might not be in their best mood. So don’t necessarily expect the outing to be overly joyous, but do know that even if it seems you are only helping a small amount, that amount can be greater to your guest. In short, don’t put expectations on them to respond in a particular way.

* A plant or pet. Things like pets you need to be careful with; they might not have the energy to train a puppy. Something like a Siamese fighting fish might be more appropriate. Sometimes when a person is depressed they can be resistant to caring for another person/thing. If the gift dies, don’t be angry. Offer whatever emotional support they need to take care of this new thing; it might seem a simple skill, but even the easy stuff gets difficult in difficult times.

* Something comforting such as a blanket, stuffed animal, new socks, or hot chocolate packages.

* A picture (or pictures) of them by themselves or with someone else doing something memorable. It’s easy to forget that you were ever happy when you’re depressed.

* Money, gift cards, or offer to pay bills. That alone can alleviate a lot of stress.

* Adopt a child or endangered animal in their name. Encourage them to write letters to the child or stay updated with conservation through the newsletters that are mailed to sponsors.

* Enroll them in a class. Exercise is extremely good and an activity like yoga could help with mindfulness while they exercise. But any class (cooking, academic) that encourages social activity and skill building is good.

* A book. But a positive book, not one with a sad story and a sad ending. Self-help books are also an option, but these can be personal. Give them the opportunity to tell you it’s not quite the right book, but they would like something similar.
Garth Kroeker has a good reading list.

* Music. This can be given either as a cd/mp3 or an instrument. I recommend Glenn Gould’s 1955 recording of the Goldberg Variations.

* A light box. Very helpful for seasonal as well as chronic depression.

* A comedic dvd or cd.

It might sound cynical, but when giving a gift that involves the receiver and another person, be sure they like that other person. The thought always counts, and they will most likely appreciate the gesture, but it’s also nice to have something tangible. I don’t mean this to sound materialistic, most of the above suggestions can be done at little cost, only that concrete reminders of healthy times/relationships can last longer than thoughts which can become easily distorted or forgotten by the depression. The other option is to let them choose their companion (for example, give them two movie tickets, but don’t suggest they have to take you. Do encourage them however, to take someone. Adding a social activity to a pleasurable one can make it that much better.).

*** Avoid things like alcohol

* This site has some humourous gifts, but exercise caution when practicing irony.

Holiday Survival Guide

2010-12-03T20:03:00.000-08:00

This is a re-post from last year.

The holidays can be a particularly lonely time for people. Even for those who look forward to the holidays, they can still be overwhelming. The following is a list of some things that may be helpful.

* Create/buy an especially thoughtful gift for someone who has supported or helped you.

* Do the above for someone random- a person on the street, pick an address from the phone book, or a needy family.

* Donate to charity. Clean out your closet and give what you don’t need to a local shelter.

* Volunteer. Help out in soup kitchens or with the red cross. Spend time with the elderly who might not have family visiting.

* Breathe. Holidays are chaotic and you may be forced to spend time in the company of people you dislike. Take time for yourself. Leave the party to go for a quiet walk. Find an empty room where you can read a book for a while. Sit in your car and listen to music for a few minutes.

* Be nice to people you don’t like.

* Host a dinner for a few people you are close to. Cooking for other people can be very therapeutic (in my case, this oftentimes leads to food poisoning, but the activity of cooking and sharing is still a positive event).

* Take a trip. I don’t encourage people to avoid difficulties, but sometimes you need a break so why not take that trip to Paris during the holidays?

* Exercise. This is something I always recommend, but the holidays can be especially lethargic times so it is important to maintain your exercise regime. Going for a run can also get you of a crowded, or empty, house.

* Make sure you have enough medication if your doctor will be taking time off.

* Remember, you don’t have to listen to Christmas music. At times this may be unavoidable, but in your home you can listen to whatever you like, even on Christmas morning. Some people may weary of the holiday music that is played in stores as early as November 1, so listen to your ipod while shopping.

* Do not feel obligated to anyone to do anything.

* Avoid alcohol.

* Eat nutritious foods as well as the delicious ones. And eat in moderation.

* If people start bickering, say something nice about them or someone they are talking about.

* Accept gifts graciously.

* Keep an emergency plan in place. Know where the hospital is if you’re out of town. Keep a list of friend’s numbers or call lines.

* Don’t abandon your regular activities. Keep doing all the things you normally do to stay healthy.

Eating in Montreal

2010-11-11T14:50:00.000-08:00

Good food is good for the soul and one of the pleasures of life.

I will continue to update this over the next couple of weeks.

St. Viateur Bagels – Sooooo delicious. Warm, soft, and sweet. 5/5

Cheskies – They didn’t have challah when I was there, but their rugala was very good and their chocolate croissant was ok. The walnut-fruit croissant didn’t do anything for me. I found the pastry to be flaky, but too dry. 3/5

Suite 88 – Delicious and reasonably priced chocolates (about $2 per piece or $3.50 for a chocolate bar). I had an apple martini chocolate shooter, a dark chocolate cup with warm white chocolate in it, two chocolate bars (caramel and orange, both milk chocolate), a caramel truffle, a maple dark hot chocolate, and a pumpkin milk hot chocolate. The hot chocolates are so thick it’s like drinking a melted chocolate bar…wonderful.
4/5

Formagerie Hamel (Atwater Market) – The baklava was good, but unremarkable, could have been sweeter. The cupcake was a little dry and I wouldn’t buy one there again.
2.5/5

Des Caraibes - The food was nicely flavoured and the portions were large. A decent place for a $10 meal. 4/5

Patati Patata – Very good poutine with red wine gravy. The fries could have been slightly crispier and it was a bit scanty on the curds. 4.5/5

AA – My first poutine, so I remember it as good, but the creepy old guy who stared at me the whole time has marred my experience. The chicken burger was an over mayonaised diner classic. Andre, one of the owners, was noticeably more hospitable than the surly waitress. 4.5/5 (poutine) 2/5 (burger)

La Banquise – A poutine place with 20+ varieties. Had one with sausage, hot peppers, and tobasco sauce (Kamikaze), one with turkey, bacon and onions in peppercorn sauce (Danse), one with ham and cheese (Hawaii 5.0), and one with guacamole, sour cream and tomatoes. Both were very good, but the fries could have been crispier. 4/5

The Main (Like Schwartz’s but without the line-up) – Bought a pound of smoked meat. I guess it was good but it didn’t do anything for me. I’ve been told this is one of the best places for smoked meat in the city. 5/5

Divine Chocolates – I had a dark chocolate, sea salt caramel which was delicious, but their stuff was pricey (the individual chocolates are comparable to other shops at about $2 a piece, but the chocolate bars are about $8). 4.5/5

Marius and Fanny – I had an orange caramel chocolate; the chocolate wasn’t great, but the filling was very good. I also had a passion fruit macaroon which was delicious.
3/5

Thai Phon – A bit pricey for thai food ($10 per plate) and the pad thai was almost all noodles, but the spices were very good. 3.5/5

Patisserie Chez de Gaulle(231 St. Viateur) – The ‘religieuse,’ a large, chocolate mouse filled pastry glazed with chocolate and topped with a smaller, caramel coated caramel mouse filled puff, was beyond heavenly and well worth the $4. The chocolatine ($2.50) was very good; the pastry was light and moist with the sweetness that is butter. I also had a St. Honore which was a custard filled pastry with jam in the middle topped with whipped cream, fruit, chocolate, and cream puffs which themselves were topped with burnt sugar.
5/5

Poutine Lafleur – This place had a few varieties of poutine. I had the regular poutine and the all-dressed poutine (steak, ham, onions, green peppers, and mushrooms). Both were delicious. The gravy had a unique and flavourful combination of spices. Just up the street is a small coffee shop, Café Boutique, which sells fancy condiments (cranberry-maple-balsamic salad dressing, cranberry-blueberry-green tea salad dressing, onion confit…)
4/5

Parentheses – This is a small, cozy coffee shop well suited to the antique neighbourhood in which it resides. The chocolatine was slightly overcooked. They also had a small selection of chocolate truffles which I didn’t try.
3/5

Boulangerie Banette – The chocolatine was way overcooked. 1/5

Boulangerie Laura – The chocolatines and croissants looked overcooked, so I didn’t bother with them, but I did have a chocolate puff which was made of nice, flaky pastry and nicely sugary. The baklava was sticky and sweet (though I always prefer my greek desserts saturated in honey). 3.5/5

Les Chocolats Briimstone – This was a small little store jam filled with delicious looking treats including a large selection of imported chocolate bars (one had bacon in it), homemade chocolates, homemade fudge, and other treats. I had a blueberry port chocolate, a love potion (strawberry and spice) chocolate, and a raspberry, white-chocolate bar. One of my favourites was the white-chocolate lemon truffle - tart and sweet! Also, the owner is super friendly. 5/5

Souvlaki George – This was one of the worst meals I’ve ever eaten. It was so bad, I couldn’t even force myself to finish. The gyro had a decent enough pita and tzatziki, but the meat was unidentifiable and was flavoured with a mishmash of indistinguasible spices that left a horrible taste in my mouth for hours. The fries, for the poutine or as a side, tasted dry and previously frozen. The gravy for the poutine was completely bland but, all considered, it doesn’t do anything to save the dish. 1/5

Pizza St. Henri – The pizza is like any other cheap pizza and the poutine is flavourless and made with frozen fries. 1/5

Rotisserie Italienne – This is a small restaurant with delicious, homemade Italian food. The pizzas are traditional thin crust. I had the 4 Season Pizza which came with ham, clam, mushrooms, and red peppers (a different slice for each). I also had the Plat Mix Pasta which is a sample of 3 different pastas and sauces for 2 people. The red wine was watery, but actually gained flavour with the food and complimented the food nicely. Almost all of the dishes are under $10 (for a full plate of pasta). They also do delivery.
5/5

Les Chocolats de Chloe - These were very fine chocolates. I had the banana and the passion fruit. Both had distinct flavours without being overpowering and the banana didn't taste at all artificial. 5/5

Bitoque - A BYO restaurant with wonderful decor, food and service. The food isn't cheap, but is comparable to other restaurants in this category (table d'hote costs $30 - $40) and there is more than enough food to fill you up. 4.5/5

Bacon & Egg Poutine – This was invented by my friend and entails frying cut-up bacon (3+ pieces) in butter, add in poutine (without disposing of any of the grease in the pan), add in 1-2 eggs. A heart attack to end all heart attacks. 5/5

Poutine Review Site:
http://www.montrealpoutine.com/reviews.html

http://poutinepundit.wordpress.com/reviews/

Restaurant Review Site:
http://www.cim.mcgill.ca/~jer/visit/rest.html

This is Your Brain on Music – A Review

2010-10-30T11:12:00.001-07:00

This is Your Brain on Music (Daniel J. Levitin) is one of the best popular science books I’ve read. I find the subject matter personally appealing and the author does a good job a discussing scientific ideas in a manner accessible by the general public.

The problems I did have with the book were not a fault of the author’s, but of my own tendency to not enjoy such books. He insulted physics at least twice (in fairness, his aim was to make an endearing joke poking fun at a discipline the majority of the population does find annoying) and I found his use a musical references to be superfluous. Even if I was familiar to the music he was using as examples, the usage of these examples still went overboard at times.

The last third of the book, as with the first few chapters, was more science based with fewer personal tangents. The chapter What Makes a Musician? was appealing to me both as an amateur musician and for the psychological parallels between learning new musical skills and learning new behavioural and cognitive skills. In this chapter he references a study in which the results indicated that a predisposition toward talent can be overridden by practice. He also emphasises the importance of caring about what you are doing, “…caring leads to attention, and together they lead to measurable neurochemical changes. Dopamine, the neurotransmitter associated with emotional regulation, alertness, and mood, is released, and the dopaminergic system aids in the encoding of memory traces.”

Another quote: “Although music certainly uses brain structures and neural circuits that other activities don’t, the process of becoming a musical expert…requires many of the same personality traits as becoming an expert in other domains, especially diligence, patience, motivation, and plain old-fashioned stick-to-it-iveness.” The importance of these qualities to overcoming any psychological illness is obvious.

Final Rating: For people without a background in music or neuroscience, this is a wonderful book. For those with a background, it is still entertaining and one can easily skim through sections they find trivial.

Photo Therapy

2010-10-05T14:22:00.000-07:00

This is really just a subdivision of art therapy with the medium being photography. It can be used on its own as an exercise to do a sort of ‘inventory’ of the self. Or, it can be used as an adjunct to other therapies and CBT exercises.

One exercise is to use the following subjects (or your own ideas) to compose a autobiographical photo essay of about 6-12pictures. Another idea is to examine each subject individually, particularly in how you relate to it (what I mean is to not use the camera or the work as a way of separating yourself from your thoughts/feelings, but instead to use it as a way to add a new and different perspective. In other words, regard this as an exercise in mindfulness).

Subjects:
- A beautiful/memorable place
- Favourite colour, activity, texture, food…anything of which you have a favourite
- Life chart (home grew up in, schools attended…)
- Feelings (play, anger, depression, joy, sorrow, laughter, loss, hardness, softness, trust, sharing…)
- Future self (perceptions of growing old, how you would like to see yourself, aspirations)
- Your world (your view and interactions – your regular bus, the type of coffee you drink, the drawer at work where you hide all your candy)
- How the landscape effects you
- Portraits of people whom you admire
- Light, time, patterns
- Pictures of you doing pleasurable activities. This is especially beneficial if you include another person in the activity to take the photographs of you.

A twist on the project is that for photographs representing negative feelings or beliefs, use a program such as photoshop to create a positive image. As an added bonus, you will be learning a new skill (photo editing) or refining skills you already possess. This is something I believe is important in all therapies which, in my opinion, spend too much time focusing on the negative and too little time focusing on the positive and on change.

Therapeutic Pets

2010-07-23T16:01:00.000-07:00

In 1857 British novelist George Eliot wrote, “Animals are such agreeable friends. They ask no questions and they pass no criticism.”

I agree that they may be agreeable most of the time, but they most definitely ask questions (Can I eat that? Can we go now? Now? Now?), and pass criticism (If I can’t eat that, now, I will bite you).

One book on animal assisted therapy says, “And cats do have some behavioural problems.”

The therapeutic value of animals can be increased by combing it with volunteering. Some programs ask volunteers to bring their own animals in to patients and there are also programs where volunteers take working dogs out public to aid in training them.

Below are some of the positives and negatives of pet ownership.

Benefits –
* Increases exercise. Going out for walks, riding horses, or chasing kittens.
http://rileyjennifer.blogspot.com/2009/06/exercise.html
* Source of companionship. Even just the presence of something alive can be vitally invigorating.
* Helps build relationship skills. You might notice some things about how you treat yourself or others when you pay attention to how you treat your pet and learn what is and is not effective.
* Allows for meeting new people. Dog walking, clubs, going to the pet store.
* Increases responsibility and pride. It is one thing to be responsible for yourself when ill, but a great deal of worthiness can come from taking care of something else, sick or not.
* Adds structure and routine. A pet will ensure you get you out of bed in the morning to feed or walk it (and if you have a cat, very likely it will get you out of bed several times throughout the night as well). Also, especially with dogs, feeding and exercise will also be more scheduled
* Cute and furry (possibly).
* Commitment. It can be a healthy process to make a weighted decision and committing to it long-term.

Costs –
* Too much time with only your pet may cause you to lose the ability to verbally engage with other humans.
* Responsibility. Undertaking ownership of a pet that is too demanding, or having too many pets, may increase stress.
* Claws, teeth, fur, and bodily fluids.
* Abusing your pet. When you are manic or depressed or anxious and don’t want to be touch and something touches you, you may strike out. Generally speaking, it is also very easy to abuse animals verbally and physically. Though this may be on a smaller scale, it is not healthy for either animal or owner.
* Limits social outings. There might be places you can’t go because you can’t bring your pet or leave it behind for some time. Some people may be allergic and can’t come to your home.
* Commitment. Maybe not so much with fish, though they can live up to 10 years. But other animals need to be fed and cleaned. They also need a home, so moving internationally would be more difficult, though not impossible, with a pet.
* Cost. Food, litter, accessories, vet bills can add up (however, you can choose the type of pet you want based on your budget).

The scientific therapeutic value of pets is not compelling, but this may be due to flaws in study designs. Scientific American Mind has a very good article looking at anecdotal versus scientific evidence.
http://www.scientificamerican.com/article.cfm?id=is-animal-assisted-therapy

Dogs, horses, and dolphins are probably the most famous animal assisted therapy animals. Rabbits, other rodents, and birds are also used. Cats are used as well, but I am curious as to the frequency of this (there is a reason cats are not generally supposed to be out of bags).

Horses and dolphins have a particular character to them which can increase bond. I waver on the issue of swimming with dolphins, but I am not against it. More easily accessible though are stables offering trail rides which can be a casual way of engaging with a larger animal.

I have said a lot of negative things about cats here, but they are undeniably unique and wonderfully engaging animals.

MEG

2010-07-15T15:25:00.000-07:00

Magnetoencephalography (MEG) is an imaging technique sharing components of EEG and fMRI. It uses the fluctuating electrical activity in the brain which induces a magnetic field in the active region which can then be measured using magnetometers. The magnetometers are commonly referred to as SQUIDs (Superconducting Quantum Interference Devices). There are different orientations of the magnetometers – single, axial gradiometer, planar gradiometer – which are positioned above the head.

As with all superconductors, a very cold environment must be provided. SQUIDs are typically cooled with liquid helium which is maintained at its boiling temperature of 4K (for a reference point, liquid nitrogen freezes in liquid helium) and stored in a giant thermos called a dewar.

SQUIDs are sensitive to very small magnetic fields on the order of 5×10−18 T.
The magnetic fields generated in the brain are on the order of 10-15T. The Earth’s magnetic field is about 5.0 × 10-5T. So in order to obtain a signal clean of any ambient noise, the process must take place in a highly shielded room, including a very thick door with a strong vacuum seal (the room is similar to a vault). The walls of the room are composed of layers of aluminium and a ferromagnetic material.

In comparison to the MEG, an EEG measures electrical activity directly and requires electrodes to be applied directly to the head. Also, direct measures of electrical activity can become distorted as the signal passes through ions and the skull, whereas such distortion is not obtained with MEG.

There are fewer safety concerns with an MEG than an MRI since there is no large magnetic field involved. The images obtained can be combined with images obtained in fMRI studies by measuring specific points on the head after the MEG and then overlaying the two images.

Here is a paper that discusses in more detail MEG and EEG.
http://www.bem.fi/bem/research/eegmeg/index.htm

Exercise Prohibition in Eating Disorders Programs

2010-07-08T14:40:00.000-07:00

Earlier this year it had been brought to my attention that there exists eating disorder (ED) programs which prohibit exercise. Presumably, this is to encourage weight gain and discourage over-exercising. However, the idea is absurd and archaic in my opinion. Regular monitoring puts stress on patients and staff, and diverts energy from healing.

As with food, exercise can not be avoided in daily life and a complete ED program would integrate healthy exercise as it does healthy eating.

Additionally, exercise has been proven to improve mood and can also give patients a sense of responsibility and independence. http://rileyjennifer.blogspot.com/2009/06/exercise.html

Certain precautions when dealing with patients who may be physically compromised such as with low blood pressure need to be considered. However, in an ED program all exercise is monitored by a medical staff member trained to handle emergencies.

Depending on the physical status of the patient, varying degrees of intensity of exercise could be tolerated. Because of the specific nature of eating disorders, mindful engagement with the body should be encouraged in all exercise routines. This is easily accomplished with a moderate activity such as yoga (St. Paul’s Hospital in Vancouver incorporates yoga into their ED program).

References: 1, 2, 3, 4

Clapping Therapy

2010-06-29T13:13:00.001-07:00

I absolutely love clapping in music (though other supposed music lovers I know detest it). As it turns out, there is a ‘clapping therapy’ also know as interactive metronome training.

Interactive Metronome® was developed in 1994 by Jim Cassily, a recording engineer … who taught piano lessons on the side, discovered that I.M. helped his autistic students. Not only did they get the timing down, it also helped them with attention, concentration, coordination, language processing, reading skills and control of aggression.
http://docs.google.com/gview?a=v&q=cache:kXTu8yB799YJ:www.interactivemetronome.com/IMPublic/Media/Happy%2520clapping%2520therapy%2520-%2520Greater%2520Baton%2520Rouge%2520Business%2520Report.pdf+clapping+therapy&hl=en&gl=ca&sig=AFQjCNE02twrkA3grUwrSsNbNuxcFG3R9w

One study on children with attention and coordination disorders found, “...Interactive Metronome training may address deficits in visuomotor control and speed, but appears to have little effect on sustained attention or motor inhibition.”
http://www.ncbi.nlm.nih.gov/pubmed/19202457?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

A case study: “This child's participation in a new intervention for improving timing and coordination was associated with changes in timing accuracy, gross and fine motor abilities, and parent reported behaviors.”
http://www.ncbi.nlm.nih.gov/pubmed/16396435?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

A study on children with ADHD: “The Interactive Metronome training appears to facilitate a number of capacities, including attention, motor control, and selected academic skills, in boys with ADHD.”
http://www.ncbi.nlm.nih.gov/pubmed/11761130?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

A Parkinson’s study: “These results suggest that computer-based motor training
regimens might be useful for improving or retaining motor function in Parkinson’s disease.”
http://www.interactivemetronome.com/IMpublic/Research/Parkinsons%20Neurology%20Journal.pdf

Another Parkinson’s study: “This study provides evidence for the potential of cueing to improve gait in PD-CI. Only individuals with mild CI were included, and the effect with increased CI and different types of dementia requires further evaluation.”
http://www.ncbi.nlm.nih.gov/pubmed/19199354?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

A Parkinson’s study which examines an alternative to the audio metronome: “Rhythmic somatosensory cueing may be a viable alternative for auditory cueing and is robust to changes in walking speed and visual distractors.”
http://www.ncbi.nlm.nih.gov/pubmed/16780887?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

A study in schizophrenic patients found that, “…patients with marked negative symptoms performed best when their actions were more stimulus-driven [marked by metronome] than willed [consciously attempting to perform well] strengthens the case that negative schizophrenic symptoms reflect a disorder of willed action.”
http://www.ncbi.nlm.nih.gov/pubmed/17292482?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

A paper published by the Institute for Applied Psychometrics looks at four different timing therapies and has a long list of references for further reading.
http://www.iapsych.com/im/iaprr9.pdf

According to a site which sells the IM, “The device can strengthen motor skills, including mobility and gross motor function, and improve many fundamental cognitive capacities such as planning, organizing and language.”
http://www.healthsouth.com/what_we_do/inpatient_rehabilitation/rehabilitation_technology/interactive_metronome.asp

Clapping itself is used in conjunction with music therapy in the treatment of autism, dementia, and Alzheimer’s.
http://www.articlesbase.com/mental-health-articles/autism-music-therapy-how-music-truly-helps-autistic-people-739429.html

http://www.myoptumhealth.com/portal/Information/item/Music+and+Art+Therapy+for+People+With+D?archiveChannel=Home%2FArticle&clicked=true

http://www.selfgrowth.com/articles/7_Tips_for_Alzheimer_s_Music_Therapy.html

As far as I can tell, there has been no clinical research investigating the specific effects of clapping on mood. But it is exercise, so I imagine a heavy regime of clapping could boost mood.

A song about clapping that refuses to let you dwell in a bad mood:
http://www.youtube.com/watch?v=OiTd_xHMEnI

Lithium and Suicide

2010-06-17T14:19:00.000-07:00

An article in the British Journal of Psychiatry examined the relationship between lithium levels in drinking water and risk of suicide. The analysis was done by a team in Japan.

“We found that lithium levels were significantly and negatively associated with SMR [standardised mortality ratio] averages for 2002–2006. These findings suggest that even very low levels of lithium in drinking water may play a role in reducing suicide risk within the general population.”
And UBC’s very own Dr. Allan Young had some words to say on the matter, particularly on the possible future debate of whether or not lithium should be added to drinking water:
http://bjp.rcpsych.org/cgi/content/full/194/5/466
“It would be most unfortunate if these findings became little more than a factual curiosity, of the sort that bright students sometimes use to highlight the limitations of a professor’s wisdom… It would be surprising if lithium in drinking water were not to raise a…panoply of questions… Following up on these findings will not be straightforward or inexpensive, but the eventual benefits for community mental health may be considerable.”

The following studies provide support for decreased suicidality with lithium treatment. However, all of these studies are done by the same group of authors, more or less. As well, there are some conflicts of interest between the authors and companies producing pharmaceuticals, including lithium.

2003
The findings indicate major reductions of suicidal risks (attempts > suicides) with lithium maintenance therapy in unipolar >/= bipolar II >/= bipolar I disorder, to overall levels close to general population rates. These major benefits in syndromes mainly involving depression encourage evaluation of other treatments aimed at reducing mortality in the depressive and mixed phases of bipolar disorder and in unipolar major depression.
http://www.ncbi.nlm.nih.gov/pubmed/12720484?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedreviews&logdbfrom=pubmed

2001
Results from 33 studies (1970-2000) yielded 13-fold lower rates of suicide and reported attempts during long-term lithium treatment than without it or after it was discontinued. Although greatly reduced, these rates remain above those estimated for the general population. Evidence for substantial, if incomplete, protection against suicide with lithium is supported by more compelling evidence than that for any other treatment provided for patients with mood disorders. Studies of commonly used, but incompletely evaluated, alternative treatments are required, and further protection against premature mortality can be anticipated with better protection against bipolar depression.
http://www.ncbi.nlm.nih.gov/pubmed/11411189?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_TitleSearch&linkpos=3&log$=pmtitlesearch4

2001
There is no definitive evidence from this review as to whether or not lithium has an anti-suicidal effect.
http://www.ncbi.nlm.nih.gov/pubmed/11687035?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedreviews&logdbfrom=pubmed

2000
Protection against suicide with lithium is incomplete, but rates of suicides plus attempts during lithium treatment may approach general population base rates.
http://www.ncbi.nlm.nih.gov/pubmed/10826667?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedreviews&logdbfrom=pubmed

2003
The findings indicate major reductions of suicidal risks (attempts > suicides) with lithium maintenance therapy in unipolar >/= bipolar II >/= bipolar I disorder, to overall levels close to general population rates.
http://www.ncbi.nlm.nih.gov/pubmed/12720484?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedreviews&logdbfrom=pubmed

2006
Risks of completed and attempted suicide were consistently lower, by approximately 80%, during treatment of bipolar and other major affective disorder patients with lithium for an average of 18 months. These benefits were sustained in randomized as well as open clinical trials.
http://www.ncbi.nlm.nih.gov/pubmed/17042835?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

2006
The findings support growing evidence of lower risk of suicidal acts during closely monitored and highly adherent, long-term treatment with lithium and indicate that treatment adherence is a potentially modifiable factor contributing to antisuicidal benefits.
http://www.ncbi.nlm.nih.gov/pubmed/17042834?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=4&log$=relatedarticles&logdbfrom=pubmed

Studies done by some different people:

1995
In view of the fact that a placebo-controlled mortality study under long-term conditions is neither ethically nor practically feasable, our findings cannot prove definitively that long-term lithium treatment counteracts factors responsible for the excess suicide and cardiovascular mortality of affective disorders. However, our observations are compatible with such a notion.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T2X-3YMWF86-K&_user=1022551&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1040649680&_rerunOrigin=scholar.google&_acct=C000050484&_version=1&_urlVersion=0&_userid=1022551&md5=bac5a02c883fd9a0fa77156c63c7e3e5

1999
The findings suggest that ongoing lithium treatment is associated with a lower suicide risk. Whether this is due to lithium's mood-stabilizing properties, to lower suicide risk per se in the patients who remain in treatment, or to a specific antisuicidal effect of the lithium ion cannot be determined since patients were not randomized to discontinue treatment. This methodological shortcoming is shared with every study in the field. All results regarding the influence of lithium on suicide rates must therefore be interpreted with extreme caution.
http://cat.inist.fr/?aModele=afficheN&cpsidt=1816513

2001
The reduction in suicide attempts, in both responders and non-responders, indicates that lithium possesses a specific anti-suicidal effect besides its mood-stabilising property.
http://cat.inist.fr/?aModele=afficheN&cpsidt=1069492

Cooking Therapy

2010-05-07T12:08:00.001-07:00

Many people claim that cooking is a de-stressing activity. It is certainly a great activity for mindfulness with all of the sensory information (kneading dough, smell of cinnamon, steam and heat, colours…)

And cooking does have many therapeutic values.

Physically, it requires motor coordination, range of movement, and muscle strength in the arms, hands, and everywhere else (from standing). The physical sensory information during cooking is also important (for safety, testing doneness…)

Cooking is often viewed as an art form as much as a science. The cognitive processes of problem solving (what can I substitute for milk?) and puzzle solving (following steps) can aid with memory and attention. Furthermore, the process of cooking involves structured planning (buying groceries) and time management skills. When mistakes are made, improvisation and flexibility of the mind are brought into play. The complexity of a recipe and individual experimentation can further enhance these skills, as well as add new spices to the cupboard.

As to why people regard cooking as de-stressing, cooking can increase self-esteem, competence, pride, and perceptions of abilities. A sense of humour and light-heartedness about one’s own limitations may occur when a mistake is made or things just don’t quite turn out to be edible.

Cooking can provide the opportunity increase social relationships. One can join a cooking class or a community cooking group. In both, or even if cooking solo, the product can be shared with others at dinner parties, potlucks, bake sales, and gifts further expanding the network.

On an intimate note cooking can provide comfort (especially in the winter when a warm oven is running). It can add a romantic quality to relationships that one desires to be romantic. A particular recipe can get one in touch with their domestic roots. It can also be a time of reminiscence, perhaps an old recipe your grandmother used to make or her handwriting on a recipe card.

A daily routine connect you to your home, life, family, and vitality by allowing you to nurture yourself and others.

Cooking can raise awareness about nutrition and this information can be used when ordering in restaurants.

Without going too much into eating disorders, cooking provides a necessary framework and indeed most hospitals have a cooking group as part of treatment.

A person with an eating disorder may already be adept at cooking as it is not unusual for such people to collect recipes and cook frequently, though without eating the product themselves.

Cooking groups in treating eating disorders offer the same benefits as above, but in addition they can decrease anxieties associated with food. Cooking in treatment programs is still social, but it also redefines and explores relationships and their context with food. There may be special activities such as mother/daughter cooking classes or role playing in the kitchen.

An interesting study done this year examining the effect of cooking shows on students eating habits:

“A television show on nutrition and cooking may be influential in changing students' knowledge, but it seems to have little impact on dietary behaviors. With a recent increase in popularity of cooking shows, future research should investigate the impact an extended cooking and nutrition show series might have on young adult viewers.”

Oh, and also cooking can be fun; that’s just what I’ve heard.

References (because I needed them): 1

Full Moon, Strange Behaviours, and Medical Emergencies

2010-04-07T16:22:00.000-07:00

I was going to write an article on this, but I found an excellent review with many interesting highlights in the Canadian Medical Association Journal:

Past beliefs regarding the association of full moon and human behaviour may have been due to the extra light at night, “Even partial sleep deprivation over the course of a single night can induce mania…”

“At the Bethlehem (or Bedlam) Hospital in London, inmates were chained and flogged at certain phases of the moon "to prevent violence."”

“Why, then, is the belief in a "lunar effect" still so strong? Explanations include: a lack of understanding of physics, psychological biases (e.g., selective recall or selective perception), sensationalism, and the entertainment value of a belief in lunar influence.”

According to wiki, research has indicated there is an effect of light on menstruation (which often has an effect on mood and behaviour, but no direct correlation with the full moon.

Here is another article demonstrating no significant effect of lunar cycle on hospital activity.

Some popular culture trivia - according to Joss Whedon, the affective period of a full moon on werewolf activity is actually 3 nights (astronomically there are 8 phases of the moon each lasting 3.69 days).

Vitamin G (B2)

2010-03-26T18:10:00.000-07:00

Vitamin G is what they used to call Riboflavin/B2 in the old days (I’m guessing because the discoverer’s name was Gyorgi). More on B vitamins here.

It functions in body growth and red blood cell production and helps in releasing metabolic energy (from fats, ketone bodies, carbohydrates, and proteins).

Indications of riboflavin deficiency include cracked lips; inflammation of the mouth and tongue; mouth sores; sore throat; oily, scaly skin rashes on the scrotum, vulva, or area between the nose and lips; red, itchy eyes that are sensitive to light; and iron-deficiency anemia. The nervous symptoms of riboflavin deficiency include numbness of the hands and decreased sensitivity to touch, temperature, and vibration.

Sources include lean meats, eggs, legumes, nuts, green leafy vegetables, dairy products, and milk provide riboflavin in the diet. Breads and cereals are often fortified with riboflavin.

Because riboflavin is destroyed by exposure to light, foods with riboflavin should not be stored in glass containers that are exposed to light.

The RDA for adults is about 1.1 – 1.3mg.

Toxicity is extremely unlikely, except in cases of injections. Riboflavin is water soluble and any excess is excreted through the urine.

Climbing

2010-03-19T19:27:00.000-07:00

The relation rock climbing = dangerous = possible psychiatric disorder does get mention in the DSM-IV (masochism is one diagnosis). But this is a pretty tenuous relationship even within the DSM.

Climbing, indoor or outdoor, isn’t nearly as dangerous as it is scary, and it’s not terribly frightening either.

But where it is either of those things, there is a wonderful opportunity to develop self-confidence, risk-taking (the good kind – where fear would otherwise hold you back from achieving a goal), trust (in the person belaying you), and to overcome anxieties such as may be associated with heights (after you fall a couple of times you realise it’s perfectly safe. You can then train yourself to take bigger falls).

Besides the above, climbing has many other advantages in aiding with mental health.

• It is a very supportive social outlet. Climbers, sometimes even ones who don’t like each other, tend to support and encourage each other.
• It’s exercise - with all of the associated mental health goodness.
• It can help with problem solving skills as you need to assess the route both before and during climbing in order to choose your next move.
• It brings greater awareness to the body and what it, and you, are capable of. You might need to train to do a specific move or you might just try something and be amazed at the efficiency and pliability of the human body.

There isn’t much climbing specific research in relation to psychiatry, but this article found that climbers, regardless of their skill level, had “internal motivational orientation and positive physical self-perception.”

This is an article with some interesting details in its study design (participants had to pay in order to participate), but it supports my opinion, so I’m going to cite it. The study (which included five days of rock climbing) found an “increase in formal and informal social interactions, motivation to learn, and optimism to learn, and [a] decrease in symptoms…”

Is it ok for a therapist to accept/give gifts?

2010-03-12T14:27:00.000-08:00

Is it ok for a therapist to accept gifts?
This is something that varies between therapists, with some drawing an absolute boundary at ‘no, not ever.’ While certain gifts such as those of large monetary value, of cash itself, should be gently and graciously turned away, small trinkets of acknowledgment and gratitude can be accepted. The hurt that could be caused by such a rejection may not justify rigid boundaries. The intent of gift should be examined in any case and if gift giving becomes overly compulsive, acceptance of the gifts would need to stop.

Is it ok for a therapist to give gifts?
Yes. Because presents are shiny and they make people happy. Seriously though, at certain times gift giving may be appropriate and alleviate loneliness. Again, the gift should have little or no monetary value. Something like a card during the holiday season or on a birthday would be acceptable.

Managing Your Time During Session

2010-03-10T12:38:00.000-08:00

Fifty minutes goes by quickly, and a lot happens in a week, so it can be frustrating when session has ended and you haven’t discussed all of the issues important to you. Of course, there is never going to be enough time to discuss everything, but it is important that what is most relevant to you is covered.

Here are some suggestions that may help you optimise your time with your therapist:

* Keep track of important events and feelings that occur throughout the week. Make some brief notes if you have trouble remembering details later, but do not put any lengthy descriptions on your list. Give yourself some time before session to review your important topics and prioritise which events you most want to discuss.

* Make notes during session. A lot of different thoughts will occur and a lot of conversation will be exchanged. If your memory is poor, which is common during emotional states, you may have trouble later recalling advice you had intended to remember or thoughts that came up but didn’t fit into the conversation at the time.

* Make a list after session of things you would like to discuss the following week. Review and edit this list before your next visit.

* Allow for developments. Don’t be too strict in how you want the session to go. Let conversations, relationship dynamics, and topics develop naturally and work on what comes up.

* Keep an eye on the clock. You may have to postpone one discussion in order to ensure another is given air.

* Recognise avoidance behaviours which waste time and alter ambivalence in order to get more work done.

* Don’t worry if you feel like you’re wasting your time talking about ‘trivial’ topics; a lot of therapy is in the how you address any topic. Use your time in session to practice healthy behaviours and challenge new thinking models.

Rabbit Syndrome

2010-03-01T10:04:00.000-08:00

Rabbit syndrome (RS) is a rare extrapyramidal condition in which a person has involuntary, fine, rhythmic movements along the vertical axis of the mouth at a frequency of approximately 5 Hz. The syndrome is associated with long-term use of older antipsychotics and may appear either during treatment or after discontinuation (3). The absence of involvement of the tongue and persistence in Stage 1 non-REM sleep (2) distinguishes RS from tardive dyskinesia (TD).

Similar to TD, however, RS may be triggered or intensified in physically or cognitively stressful situations.

RS also shares some similarities with Parkinson’s disease in that it may be associated with drug-induced parkinsonism and symptoms persist during stage 1 non-REM sleep.

Populations of the middle-aged to elderly, women, schizophrenics, and those with previous brain damage are more at risk for RS (1).

Of the older neuroleptics, haloperidol is most commonly associated with RS followed by
piperazinic phenotiazines (Fluphenazine, Perphenazine, Trifluoperazine). (1)

Of the atypicals, risperidone has the highest incidence of extrapyramidal symptoms.
Others include clozapine, olanzapine and aripiprazole (4). I have also seen a case report of quetiapine induced RS in a bipolar patient (5). Conversely, there was also a case study of RS being treated with quetiapine in a schizophrenic patient (6).

RS can be treated with anticholinergic agents such as benztropine, biperiden, procyclidine and trihexyphenidyl typically disappearing in a few days. However, there is the possibility that RS will reappear after stopping anticholinergic medications. A drawback to this treatment though is that the same agents may lead to the development of TD. (1)

A case report of olanzapine treated RS (7).

References: 1, 2, 3, 4, 5, 6, 7, 8

Choir Singing

2010-02-19T18:38:00.000-08:00

Benefits of singing in a choir:

* Breathing exercises.
* Balance awareness - standing on both feet.
* Cognitive aspect of reading music.
* Facial movements involved in singing mimic those of positive mood states and can increase mood.
* Reading lyrics without singing as a rhythm exercise.
* Singing in a group increases social activity and it can be fun to sing live harmonies on a large scale. Most likely, the group will be a supportive and encouraging crowd.
* Challenging – musical range, length of breath…
* Rewarding when the music all comes together and you can listen to, and be a contributing part of, the harmony.
* Performance adds a new dimension to the interaction with the music and the additional pleasure of sharing the music with others.

Overall, singing in a choir increases awareness of self, others, and the relationship between the two.

This study showed that singing in a choir can improve mood and reduce stress hormone levels.

Another study examined the difference between singing and listening to music and found that active singing was required in order to see beneficial results.

If you are not an expert singer, churches will usually accept singers, regardless of faith. Other non-audition choirs can be found with a little searching of community centres.

A quote from ‘The Elegance of the Hedgehog’ regarding choirs:
“Every time, it’s a miracle. Here are all these people, full of heartache or hatred or desire, and we all have our troubles and the school year is filled with vulgarity and triviality and consequence, and there are all these teachers and kids of every shape and size, and there’s this life we’re struggling through full of shouting and tears and laughter and fights and break-ups and dashed hopes and unexpected luck-it all disappears, just like that, when the choir begins to sing. Everyday life vanishes into song, you are suddenly overcome with a feeling of brotherhood, of deep solidarity, even love, and it diffuses the ugliness of everyday life into a spirit of perfect communion.”

Other fun, group singing exercises include getting a few friends together to sing along to the Buffy musical or Dr. Horrible’s Sing-Along Blog.

When You Can’t Take Care of Yourself

2010-02-05T19:42:00.000-08:00

Illnesses can be debilitating and everyday life duties (eating, bathing, paying bills, cleaning…) can become overwhelming. If you find yourself in a position where you can no longer keep up with it all, you may need to turn to someone else for support. Hospitalisation is one option, but if you are unable to get admitted or you don’t want to stay in a hospital, staying with a friend or family member is another option.

But it can be difficult to be away from home; Your routine is influenced by your home environment and there is a certain amount of comfort in routine, and all of your stuff is there.

Here are a few ways you can make your stay away from home more familiar:

• Bring some of your favourite objects with you: your favourite coffee mug, pictures, a comforting blanket, your own pillow, a plant, a food you like to eat for breakfast…
• Bring some activities with you: yoga mat, computer, word games, crafts…
• If you have any prior scheduled activities, keep them.
• Do what you can at your host’s house: help with the dishes, make a thank-you card, set the table, make coffee in the morning…any small task that will help you regain independence.
• Go home for short periods of time: spend your afternoons at your house in increasing amounts of time to regrow accustomed to living in that place on your own again. This can help reduce anxiety and also keep your place in order while your gone (e.g. bringing the mail in, feeding pets, watering plants…).

Most importantly, remember that it is ok to allow yourself to be taken care of and it is not a sign of weakness or laziness but is rather a sign of mature awareness of what you have to do to ensure you receive the best care (from yourself or others) possible.

MAOIs

2010-02-01T11:42:00.000-08:00

The old class of antidepressants known as monoamine oxidase inhibitors are used in the treatment of smoking cessation as well as atypical and treatment resistant depression. They are also used for treating social anxiety, agoraphobia, panic disorder and borderline personality disorder.

The neurotransmitters serotonin, norepinephrine and dopamine are monoamines. In the gap between nerve cells - the synapse - used neurotransmitters are destroyed by an The enzyme called monoamine oxidase (MAO) degrades these neurotransmitters. And depression is associated with low levels of the neurotransmitters. MAOIs block the activity of this enzyme, increasing the availability of the neurotransmitters, and possibly relieving depressive symptoms.

There are two isoforms of monoamine oxidase, MAO-A (generally related to serotonin, melatonin, epinephrine and norepinephrine) and MAO-B (deaminates phenylethylamine and trace amines). Dopamine is equally degraded by both types
and different types of MAOIs act on either or both of these.
Early MAOIs are irreversible in that they permanently deactivate the MAO and the enzyme is not functional for about two weeks, when it has been replaced.
A few newer MAOIs, notably moclobemide, are reversible, meaning that they are able to detach from the enzyme to allow for regular processing.

MAOIs are also selective to the type of the MAO receptor. Some MAOIs inhibit both MAO-A and MAO-B equally, other MAOIs work on one group specifically.
Common MAOIs include Phenelzine (Nardil), Tranylcypromine (Parnate), Isocarboxazid (Marplan), Moclobemide (Aurorix, Manerix, Moclodura), Selegiline (Selegiline, Eldepryl, Emsam), Nialamide, Iproniazid (Marsilid, Iporzid, Ipronid, Rivivol, Propilniazida), Iproclozide, and Toloxatone.

The most common side effect when taking an MAOI is insomnia. Other common adverse reactions include dry mouth, dizziness, feelings of lightheadedness, an excessive drop in blood pressure when standing, constipation, and weakness. Men taking MAOIs may experience sexual side effects with such symptoms as erectile dysfunction, delayed or painful ejaculation, loss of sexual sensation and anorgasmia (inability to reach orgasm). Some women have reported sexual side effects such as decreased libido and vaginal dryness.

Less common side effects reported include rash, nausea, vomiting, stiff neck, flushing, feelings of fear, chest pain, and headaches.

Symptoms of MAOI overdose include severe anxiety, confusion, seizures or convulsions, severe drowsiness or dizziness, cold clammy skin, rapid and irregular pulse, fever, hallucinations, severe headache, coma, tremors/spasms, excessively high or low blood pressure, muscle stiffness, difficulty breathing, extreme sleep difficulties, or abnormal irritability.

Tyramine, a compound found in many foods, beverages and other substances, has an effect on blood pressure. It is regulated by the MAO, so when taking an MAOI, tyramine can reach dangerous levels, resulting in critically high, and possibly fatal, blood pressure. Therefore, careful dietary restrictions need to be implemented while on a course of MAOIs.

Treatment with moclobemide does not have the same dietary restrictions as with other MAOIs, though caution should still be taken with foods high in tyramine.

A new study looked to re-examine the effects of MAOIs in treating bipolar disorder and found that they had positive treatment outcomes.

MAOIs have many negative drug interactions and combinations need to be monitored closely. Combinations of MAOI/TCA (tricylcic antidepressants) are risky, but possible.
“Overall, it appears from the literature that the combination of MAOIs and TCAs can be relatively safe and effective in the treatment of patients whose depression is treatment-resistant. On the other hand, the risks associated with MAOI and TCA treatment have made this strategy relatively unpopular since the introduction of the newer agents.”

A 3 year follow up study confirms the safety of MAOI/TCA combos.

“The combination of amitriptyline and trimipramine with MAOIs appears to be safe, but imipramine and clomipramine should definitely be avoided because of the risk of fatal serotonin toxicity. It is usually thought best to start the MAOI and TCA treatment simultaneously at low dose or cautiously to add MAOI treatment to established TCA medication.”

Some old (1988) clinical evidence for MAOI/lithium combos:
“Lithium combined with phenelzine alleviated the symptoms of four severely depressed patients. Previously, all four patients had failed to respond to tricyclic antidepressants, and three had not responded to monoamine oxidase inhibitors.”

Two other studies indicate an MAOI/Li combo is beneficial. Both of these studies had their limitations, but really, what study doesn’t?

The following dietary precautions came from here.

Foods to Avoid

This list consists of foods with sufficient tyramine (in small or usual serving sizes) to create a dangerous elevation in blood pressure and which therefore should be avoided (McCabe, 1986).

• Alcoholic beverages - avoid Chianti wine and vermouth. Consumption of red, white, and port wine in quantities less than 120 mL present little risk (Anon, 1989; Da Prada et al, 1988; McCabe, 1986). Beer and ale should also be avoided (McCabe, 1986), however other investigators feel major domestic (US) brands of beer is safe in small quantities (1/2 cup or less than 120 mL) (Anon, 1989; Da Prada, 1988), but imported beer should not be consumed unless a specific brand is known to be safe. Whiskey and liqueurs such as Drambuie(R) and Chartreuse(R) have caused reactions. Nonalcoholic beverages (alcohol- free beer and wines) may contain tyramine and should be avoided (Anon, 1989; Stockley, 1993).
• Banana peels - a single case report implicates a banana as the causative agent, which involved the consumption of whole stewed green banana, including the peel. Ripe banana pulp contains 7 mcg/gram of tyramine compared to a peel which contains 65 mcg/gram and 700 mcg of tyramine and dopamine, respectively (McCabe, 1986).
• Bean curd - fermented bean curd, fermented soya bean, soya bean pastes contain a significant amount of tyramine (Anon, 1989).
• Broad (fava) bean pods - these beans contain dopa, not tyramine, which is metabolized to dopamine and may cause a pressor reaction and therefore should not be eaten particularly if overripe (McCabe, 1986; Anon, 1989; Brown & Bryant, 1988).
• Cheese - tyramine content cannot be predicted based on appearance, flavor, or variety and therefore should be avoided. Cream cheese and cottage cheese have no detectable level of tyramine (McCabe, 1986; Anon, 1989, Brown & Bryant, 1988).
• Fish - fresh fish (Anon, 1989; McCabe, 1986) and vacuum- packed pickled fish or caviar contain only small amounts of tyramine and are safe if consumed promptly or refrigerated for short periods; longer storage may be dangerous (Anon, 1989). Smoked, fermented, pickled (Herring) and otherwise aged fish, meat, or any spoiled food may contain high levels of tyramine and should be avoided (Anon, 1989; Brown & Bryant, 1988).
• Ginseng - some preparations have resulted in a headache, tremulousness, and manic-like symptoms (Anon, 1989).
• Protein extracts - three brands of meat extract contained 95, 206, and 304 mcg/gram of tyramine and therefore meat extracts should be avoided (McCabe, 1986). Avoid liquid and powdered protein dietary supplements (Anon, 1989).
• Meat, nonfresh or liver - no detectable levels identified in fresh chicken livers; high tyramine content found in spoiled or unfresh livers (McCabe, 1986). Fresh meat is safe, caution suggested in restaurants (Anon, 1989; Da Prada et al, 1988).
• Sausage, bologna, pepperoni and salami contain large amounts of tyramine (Anon, 1989; Da Prada et al, 1988; McCabe, 1986). No detectable tyramine levels were identified in country cured ham (McCabe, 1986).
• Sauerkraut - tyramine content has varied from 20 to 95 mcg/gram and should be avoided (McCabe, 1986).
• Shrimp paste - contain a large amount of tyramine (Anon, 1989).
• Soups - should be avoided as protein extracts may be present; miso soup is prepared from fermented bean curd and contain tyramine in large amounts and should not be consumed (Anon, 1989).
• Yeast, Brewer's or extracts - yeast extracts (Marmite) which are spread on bread or mixed with water, Brewer's yeast, or yeast vitamin supplements should not be consumed. Yeast used in baking is safe (Anon, 1989; Da Prada et al, 1988; McCabe, 1986).

Foods to Use with Caution
This list categorizes foods that have been reported to cause a hypertensive crisis if foods were consumed in large quantities or stored for prolonged periods, or if contamination occurred. Small servings (1/2 cup, or less than 120 mL) of the following foods are not expected to pose a risk for patients on MAOI therapy (McCabe, 1986).
• Alcoholic beverages - see under foods to avoid.
• Avocados - contain tyramine, particularly overripe (Anon, 1989) but may be used in small amounts if not overripened (McCabe, 1986).
• Caffeine - contains a weak pressor agent, large amounts may cause a reaction (Anon, 1989).
• Chocolate - is safe to ingest for most patients, unless consumed in large amounts (Anon, 1989; McCabe, 1986).
• Dairy products - Cream, sour cream, cottage cheese, cream cheese, yogurt, or milk should pose little risk unless prolonged storage or lack of sanitation standards exists (Anon, 1989; McCabe, 1986). Products should not be used if close to the expiration date (McCabe, 1986).
• Nuts - large quantities of peanuts were implicated in a hypertensive reaction and headache. Coconuts and brazil nuts have also been implicated, however no analysis of the tyramine content was performed (McCabe, 1986).
• Raspberries - contain tyramine and small amounts are expected to be safe (McCabe, 1986).
• Soy sauce - has been reported to contain large amounts of tyramine and reactions have been reported with teriyaki (Anon, 1989), however analysis of soy sauce reveals a tyramine level of 1.76 mcg/mL and fermented meat may have contributed to the previously reported reactions (McCabe, 1986).
• Spinach, New Zealand prickly or hot weather - large amounts have resulted in a reaction (Anon, 1989; McCabe, 1986).

Bibliotherapy II – Other Types of Books

2010-01-21T16:14:00.000-08:00

What I want to talk about here is how bibliotherapy can be used by examining personal identification with a book or character, in a similar fashion as art therapy looks at a picture.

Looking at why a particular book or character is a favourite may aid in understanding the self more clearly. In novels where a character encounters a similar problem as the reader, there is opportunity to examine how each person dealt with the issue and what other possible solutions might be. Novels can be prescribed for such learning, examining how a character in a similar situation responds differently.

Reading itself can help with cognitive and memory problems; when you encounter a word you are not absolutely sure of, look it up in a dictionary; memorise a poem (preferably a positive one or one you can recite and work through in therapy). Also, of course, you are learning stuff along the way.

Books can widen your frame of mind and increase your empathy and creativity by showing you different cultures and ideas.

The more you learn from reading, the more your self-confidence will increase.

Reading can also be used in conjunction with CBT exercises such as pleasure and mastery skills and in distress tolerance.

Reading can be used to develop your social network, and cognition, through book clubs. It can help you develop social skills by going to a bookstore and asking for help. Libraries have regular literary events where you can meet new people. It can also be used as a way to bond with your child or partner.

I also review regular books here as well, so I’m not going to provide a list of recommended reading. What I do recommend though is to keep a variety of books on hand so if you find yourself in the mood for clinical literature instead of fiction, you have it there. You may find you enjoy reading different types of books at different times of the day. And don’t be afraid to read more than one book at a time.

Bibliotherapy I – Self-Help Books

2010-01-13T16:42:00.000-08:00

Bibliotherapy is when a person is either prescribed a self-help book from a therapist or decides to work through one on their own. The amount of therapist involvement can vary greatly, though generally I advise people to have some supervision. Bibliotherapy may prove helpful in most psychiatric disorders, although it is less effective for thought disorders or psychoses.

In one study, bibliotherapy was one of 4 self-help treatments all of which showed a decrease in alcohol consumption, even at 1 year follow up.

A meta-analytic study, looking at self-help books, concluded, “…bibliotherapy may be moderately effective…” but had inadequate information on whom the therapy might work best for.

Another study found bibliotherapy to be effective in depressed older adults.

A 1994 study demonstrating the effectiveness of bibliotherapy in panic disorder to be similar to group therapy.

Another meta-analytic study found “…that bibliotherapy is an effective treatment for unipolar depression. Bibliotherapy is as effective as individual or group therapy.”

This is a newer study, meta-analysis again, which I am citing because it highlights an important point. The authors concluded there was insufficient evidence for the efficacy of bibliotherapy in a group aged 14 – 18 years. However, only one self-help book was used and there could be large variation in how an individual responds to a particular book. There is also the issue of how relevant the content of a book is to a particular age group (and this could be extended to groups of people with different types of disorders).

This is an interesting paper looking at the definitions of bibliotherapy and how to use it more effectively (it is targeted towards librarians working with children, but can easily be generalised).

There are many more studies in this area.

I have reviewed a couple of self-help books and will continue to do more. David Burns' The Feeling Good Handbook is very popular. I, however, found the content to be a little bit threatening. I suppose since it is so popular, I should review it in more detail…

Choosing a self-help book can be a very personal thing. You may find working with more than one to be helpful.

I have begun some revisions on typical CBT and DBT homework since I find most of the exercises dwell too much on the negative (search under label – “worksheets”).

Resources

2010-01-08T12:34:00.000-08:00

...In the Lower Mainland.

Covenant House: 575 Drake Street, Vancouver , BC. 604-685-7474 or toll free at 1-877-685-7474. covenanthouse.org.

“Covenant House has developed three core services (Community Support Services, CSS, which provides street outreach and a daily, non-residential, drop-in program; a 54 bed-, 24-hour crisis shelter; and Rights of Passage, ROP, a 6- 24 months transitional living program). These core services are supported by several in-house programs (drug and alcohol and mental health counselling, life-skills training etc.) designed to provide each young person with a "one-stop shop" approach to leaving the streets and achieving independence.”

Mood Disorders Association of BC: 202-2250 Commercial Drive,
Vancouver, BC. info@mdabc.net. mdabc.net. 604-873-0103.
The MDA website has a list of support groups all over BC as well as other educational events.

Heretohelp.bc.ca has oodles of brochures.

British Columbia Schizophrenia Society:
BCSS has quite a few different programs. 604-270-784. 1-888-888-0029. bcss.prov@telus.net. bcss.org

Early Psychosis Intervention Program: psychosissucks.ca

The Force Society for Kids Mental Health: bckidsmentalhealth.org

Other sites:

vch.ca/mood/
vch.ca/psychiatry/adc.htm
vch.ca/community/mental_health.htm
vch.ca/psychiatry/opp.htm
anxietybc.com/
facetheissue.com
mindyourmind.ca
youthinbc.com
reachout.com.au
heretohelp.bc.ca
realitycheck.net.au
griponlife.ca
youthsuicide.ca
epitrainingbc.org

The Mindfulness and Acceptance Workbook for Depression

2009-12-27T12:17:00.000-08:00

I began reading this book with the cynical expectation of being brainwashed by ACT (acceptance and commitment therapy). I relaxed some when in the middle of the book I read, “The type of acceptance we encourage you to practice is best thought of as a voluntary, intentional stance of nonjudgmental awareness of thoughts, feelings, memories, and sensations in the context of a triggering event.” By the end of the review, I absolutely loved the book. But I am quite certain I wasn’t brainwashed. Instead, I think it was the large focus on mindfulness with lots of engaging exercises that won me over.

The authors use a comprehensive definition of health that includes physical, psychological, and social aspects. The text itself is interesting in that it contains elements of ignorance, intelligence, poetry, insightfulness, creativity, superiority, and flaky triviality.

In the foreword the authors claim that, “Depression is not just a feeling. Depression is an action.” I would argue that depression is much more than either or both of those things. However, depression does affect action and action can likewise affect depression so both need to be ‘treated’ (by treating actions I mean learning healthy new behaviours and coping strategies).

There is a lot of talk of avoidance (presumably in order to contrast acceptance) of issues as being a root problem for depression. It is not uncommon for people with depression to avoid certain problems, but it is also common for depressed persons to be actively seeking solutions, only their illness clouds effectiveness. People with depression do try.

The ideas, at least in the first half of the book, are quite dichotomous. The book only has two options for thinking processes – wise mind and reactive mind – whereas I am more familiar with the three option approach – emotional mind, reasonable mind, and wise mind, which is a combination of the former two. There was actually a sentence at the end of a chapter implying that if the reader wasn’t ready to commit to change, they shouldn’t read any further until they are. I encourage readers to continue regardless as there are some beneficial exercises.

Many of the exercises in the book were insightful. I particularly liked the one where you get to write your own epitaph – “I should have separated the whites.” This type of individual engagement with understanding problems and solutions is likely to be more effective than simple fill-in-the-chart exercises.

It’s refreshing to see CBT ideas translated with a different vocabulary. An example of this is the ‘phishing’ metaphor used to help the reader identify problematic thinking. In CBT these same thinking types are recognised as ‘mind reading,’ ‘all or nothing thinking,’ etc. Plus, bonus points for using a computer metaphor leaning on the geeky side.

Final Rating: Very good.

Heat Therapy

2009-12-13T22:24:00.000-08:00

Heat is often used to treat pain associated with muscles and bones, but there doesn’t seem to be much research as to the psychological effects of thermal treatments. Undoubtedly though, warmth engenders anxiolytic effects. (An interesting note, heat therapy is commonly advertised as a treatment for anxiety, among other things, in dogs.)

One study directly related to the measure of psychiatric symptoms, found that people with mild depression who were exposed to thermal treatment (sauna and warm blanket in a warm room) had a greater reduction in psychological and physical symptoms (including appetite) than a control group.

In a 2008 study, researchers found that, based on the hypothesis that the insula is involved in processing both physical and psychical warmth, exposure to warm objects increased interpersonal warmness (generous, caring). The study design itself is quite amusing.

Other studies (1, 2) have found warm baths before bedtime reduced insomia and improved sleep in older adults and the elderly, respectively.

Suggestions on ways to warm up: sauna, bath, pocket packs, trip to the tropics, electric or regular fireplace, electric blanket, warm drink.

Things to be cautious of: burns, overheating/hyperthermia, dehydration.

It would be curious to see if a combination of heat and light therapy, such as in a tanning booth (you can wear sunscreen) had some adjunctive effect.

Gifts for Someone Who is Depressed

2009-12-10T15:45:00.000-08:00

This could be for the holidays or a special occasion or just because. The best gift is your support, but presents are nice too. The following list is compiled from ideas I found on the interweb and my own ideas. There are of course many wonderful gifts you could give to any person, but I tried to make this more specific for depressed people by choosing gifts that are not only presents, but will enhance their life in a healthy and positive way.

* Ask them to do something healthy for you -bake a cake, make a cd, play a song if they play an instrument. Some people might be more willing to engage in activity if they’re not concerned about the cost/benefit to themselves. Eventually, an individual has to choose to things by and for themselves, but a little help getting started can go a long way.

* Make them some homemade food. Self-care can be difficult when depressed and appetite particularly can fluctuate. Having nutritious, wholesome, and comforting food at hand can make the difference between a person eating or not.

* Pretty paper or a nice journal. There can be a lot of CBT homework and scheduling; having some brightly coloured paper might encourage someone to fill out their 3 positive events for that day, for example.

* A day out. Ask them to go for a walk with you. Take them to a movie or concert. Bear in mind, they might not be in their best mood. So don’t necessarily expect the outing to be overly joyous, but do know that even if it seems you are only helping a small amount, that amount can be greater to your guest. In short, don’t put expectations on them to respond in a particular way.

* A plant or pet. Things like pets you need to be careful with; they might not have the energy to train a puppy. Something like a Siamese fighting fish might be more appropriate. Sometimes when a person is depressed they can be resistant to caring for another person/thing. If the gift dies, don’t be angry. Offer whatever emotional support they need to take care of this new thing; it might seem a simple skill, but even the easy stuff gets difficult in difficult times.

* Something comforting such as a blanket, stuffed animal, new socks, or hot chocolate packages.

* A picture (or pictures) of them by themselves or with someone else doing something memorable. It’s easy to forget that you were ever happy when you’re depressed.

* Money, gift cards, or offer to pay bills. That alone can alleviate a lot of stress.

* Adopt a child or endangered animal in their name. Encourage them to write letters to the child or stay updated with conservation through the newsletters that are mailed to sponsors.

* Enroll them in a class. Exercise is extremely good and an activity like yoga could help with mindfulness while they exercise. But any class (cooking, academic) that encourages social activity and skill building is good.

* A book. But a positive book, not one with a sad story and a sad ending. Self-help books are also an option, but these can be personal. Give them the opportunity to tell you it’s not quite the right book, but they would like something similar.
Garth Kroeker has a good reading list.

* Music. This can be given either as a cd/mp3 or an instrument. I recommend Glenn Gould’s 1955 recording of the Goldberg Variations.

* A light box. Very helpful for seasonal as well as chronic depression.

* A comedic dvd or cd.

It might sound cynical, but when giving a gift that involves the receiver and another person, be sure they like that other person. The thought always counts, and they will most likely appreciate the gesture, but it’s also nice to have something tangible. I don’t mean this to sound materialistic, most of the above suggestions can be done at little cost, only that concrete reminders of healthy times/relationships can last longer than thoughts which can become easily distorted or forgotten by the depression. The other option is to let them choose their companion (for example, give them two movie tickets, but don’t suggest they have to take you. Do encourage them however, to take someone. Adding a social activity to a pleasurable one can make it that much better.).

*** Avoid things like alcohol

* This site has some humourous gifts, but exercise caution when practicing irony.

Psychiatry Blog Novels

2009-12-04T10:40:00.000-08:00

I’ve been trying to put together a collection of blog novels directly related to psychiatry. Unfortunately, my ability to use a search engine is embarrassing and so far I’ve only found two such books. But I know there must be more, so if anyone has any suggestions, please feel free to comment.

1. ‘The Goose That Laid the Golden Egg’ a Twitter novel about a psychiatrist who takes on a multibillion dollar drug co and finds his mother along the way.

2. ‘In the Absence of White Rabbits’ examines in great detail one woman's relationship with her psychosis, psychiatrist, and imaginary friends.

Cat Ownership Metaphor

2009-11-23T22:22:00.000-08:00

Like emotions, when a cat’s needs aren’t being met, they will let you know. This desperate attempt at communicating may be quite unpleasant, as cats (emotions) have a limited capacity for communicating with their owners. You may be clawed at, jumped on, or left with copious amounts of bodily fluids on your living room floor.

The important thing to remember is that your cat is not doing these things simply to aggravate you. They are just trying to let you know something isn’t working for them. Also like emotions, cats can not be ignored (one person, literally, suggested the option of putting a cat down if they had become a nuisance, which I vehemently disagreed with, literally and metaphorically). You have to live with them.

You might be able to take a brief reprieve by putting the cat outside or in another room for awhile (this could refer to any distress tolerance techniques), but eventually they will scratch at the door demanding to be let back into your company.

On the positive side of this metaphor, cats can be very tender, loving, warm, and playful companions.

However, in order for felines to function in full capacity, one needs to figure out the specific favour being requested. In the literal sense, this might be accomplished through any type of therapy or personal introspection.

If the issue has been left for too long before being attended to, the work in remedying the situation (cleaning up the copious amounts of bodily fluids) can be unpleasant. And one can easily become disgruntled if after cleaning up a mess, the cat repeats the same unwanted behaviour (this might mean one has tried a particular coping strategy, and found it successful, only to have their original issue resurface). But all this means is that more work needs to be done in identifying the problem. It could also mean that the problem has been identified, but the remedy is a process rather than a one time fix (such as if the cat had a bladder infection and required medicine for a few weeks).

If ‘owned’ in a healthy manner, cats will function in a likewise manner. This is not to say they will always behave perfectly, as feline temperaments are subject to situational changes (literally this might be any non-constant stressor such as getting a flat tire during rush hour, etc.), but that they will behave appropriately in stressful situations (instead of urinating on your laundry, they may meow outside of their litter box to let you know it’s time to clean it. A person who has a flat tire may call BCAA instead of getting angry).

And sometimes a cat just needs to be, gently but sternly, taught what the rules are (setting boundaries on your emotions and behaviours).

All in all, when properly tended to, living with cats is an extremely enjoyable experience.

Vitamin Water Update

2009-11-22T18:34:00.001-08:00

Original Post Here.

I have received quite a bit of varying information with these drinks. Of course, when dealing with percent daily values there is going to be some fluctuation in recorded measurements. There is also likely to be some variation between flavours.

For this chart, I have physically looked at the labels for Jones 24C, Aqaufina +, and Glaceau and calculated the percent values myself (Jones 24C is a new addition to the chart).

	Life Water	Dasani Plus	Aquafina Alive	Aquafina +	Glacéau	Jones 24C	Coke
	Life Water	Dasani Plus	Aquafina Alive		Glacéau		Coke
Calories	100	0	0	120	120	**	110
Fat	0	0	0		0		0
Sodium	87.5	62.5	162.5		0		30
Total Carbs	25	2.5	0		32.5		30
Sugar	25	0	0		30		0*
Fiber	0	2.5	0		0
Vitamin A					50	300
Vitamin C	100		100	250	150	400
Vitamin E	20	10	10	80	50	75
Vitamin B3	10	10	50	25	30	70
Vitamin B5				85	40	40
Vitamin B6	10	10	50	35	25	250
Vitamin B12	10	10		40	25	500

Personally, I think Jones has gone a bit overboard; there are risks to consuming too much Vitamin B. And I am quite certain I recorded those numbers correctly, but I feel that something must be off somewhere.

I maintain my previous belief that vitamins come best without sugar, are cheaper as supplements, and tastier as food.

Sexy MRIs

2009-11-19T16:04:00.000-08:00

Call me a physics geek, but when I learned I was going to be introduced to an MRI machine, I was already giddy. When I finally did meet the object of my amorous affection, it tried to undress me (big magnet plus metal clasps on bra and shirt equals considerable excitement). I thought my love for this massive magnetic force had been consummated the day I went inside of it (it even required me to remove my birth control), but it turns out there are people luckier than me out there.

A 1999 study done by a group of researchers in Holland (Pek van Andel won the Nobel Prize for this work), aimed to examine the anatomy of genitals during intercourse. The second objective, and the one most deserving of funding, was simple curiosity, “To find out whether taking images of the male and female genitals during coitus is feasible…”

The study design was quite interesting. There is an interesting figure in the paper – a sketch drawn by Leonardo da Vinci depicting the anatomy and coital details of intercourse. There are also of course, actual images obtained from the experiment.

There is also a video available.

Holiday Survival Guide

2009-11-14T13:04:00.001-08:00

The holidays can be a particularly lonely time for people. Even for those who look forward to the holidays, they can still be overwhelming. The following is a list of some things that may be helpful.

* Create/buy an especially thoughtful gift for someone who has supported or helped you.

* Do the above for someone random- a person on the street, pick an address from the phone book, or a needy family.

* Donate to charity. Clean out your closet and give what you don’t need to a local shelter.

* Volunteer. Help out in soup kitchens or with the red cross. Spend time with the elderly who might not have family visiting.

* Breathe. Holidays are chaotic and you may be forced to spend time in the company of people you dislike. Take time for yourself. Leave the party to go for a quiet walk. Find an empty room where you can read a book for a while. Sit in your car and listen to music for a few minutes.

* Be nice to people you don’t like.

* Host a dinner for a few people you are close to. Cooking for other people can be very therapeutic (in my case, this oftentimes leads to food poisoning, but the activity of cooking and sharing is still a positive event).

* Take a trip. I don’t encourage people to avoid difficulties, but sometimes you need a break so why not take that trip to Paris during the holidays?

* Exercise. This is something I always recommend, but the holidays can be especially lethargic times so it is important to maintain your exercise regime. Going for a run can also get you of a crowded, or empty, house.

* Make sure you have enough medication if your doctor will be taking time off.

* Remember, you don’t have to listen to Christmas music. At times this may be unavoidable, but in your home you can listen to whatever you like, even on Christmas morning. Some people may weary of the holiday music that is played in stores as early as November 1, so listen to your ipod while shopping.

* Do not feel obligated to anyone to do anything.

* Avoid alcohol.

* Eat nutritious foods as well as the delicious ones. And eat in moderation.

* If people start bickering, say something nice about them or someone they are talking about.

* Accept gifts graciously.

* Keep an emergency plan in place. Know where the hospital is if you’re out of town. Keep a list of friend’s numbers or call lines.

* Don’t abandon your regular activities. Keep doing all the things you normally do to stay healthy.

Emotion Regulation Homework Sheet 1 : Observing and Describing Emotions - Revised

2009-11-08T12:07:00.000-08:00

The revised worksheet can be downloaded here.

What follows is an adaptation of an exercise taken from the Skills Training Manual for Treating Borderline Personality Disorder by Marsha Linehan. The skills in this book, as well as any other CBT or DBT book, are not limited to BPD nor are they limited to people suffering from any disorder, but are useful to all people.

My problem with most of this type of homework is that it tends to focus on negative emotions. It is of course important to understand these, but it as at least as important to recognise the positive ones. Even in a deep depression, there will be moments when things aren’t as bad, even if it only lasts a moment. But depression makes it difficult to remember these moments, which is why I think it is important to reinforce them by documenting them (just saying happy words can alleviate some symptoms, even if you don’t believe in them).

So I am beginning a series of revisions to common homework worksheets that encourage the recognition of positive emotions and events as well as challenging the negative ones. There is nothing really new in terms of techniques in these adaptations, but rather they incorporate different exercises into a more complete, and I think beneficial, exercise.

It is best to complete this form when the emotion was recent so that you can record in more detail.

Also, very importantly, for every negative emotion that you complete one of these sheets for, do at least one other for a positive emotion. This will not only reinforce healthy thinking, but will also help you when planning for future negative emotions (for example, you may fill out a sheet for feeling worthless and another day have an experience of feeling worthwhile. You can then use your physical, emotional, and behavioural reactions to the positive situation to revise how you might change these things when experience worthlessness again. E.g. when feeling worthless your shoulders were slumped, but when feeling worthwhile you were standing straight. You can then go back and make sure that changing your posture to sitting up when feeling worthless is on your list of physical changes to make).

Related to the above parenthesis, you may find these sheets useful for compiling a list of warning signs and coping strategies.

Mindfulness in Elementary Schools

2009-11-06T19:42:00.000-08:00

Not to be too cynical, but with all the programs that have been and are being cut, I sometimes wonder if there is any reason to send a child to school anymore.

But, on the bright side, people are beginning to understand that character development mostly happens during the developmental years and if we would like to prevent future mental illness, this is period of time to act.

Mindfulness isn’t prevalent in the school curriculum, but it is growing. This paper discusses the mindfulness program at a school in Los Angeles.

“There was less conflict on the playground, less test anxiety—just the way the kids walked into the classroom was different. Our state test scores also went up that year, which I’d like to attribute to my teaching but I think had more to do with the breathing
they did right before they took the test.”

“…many schools are adopting mindfulness trainings because the techniques are easy to learn and can help children become ‘more responsive and less reactive, more focused and less distracted, [and] more calm and less stressed.’ While mindfulness can produce internal benefits to kids, the Garrison report also found that it can create a more positive learning environment, where kids are primed to pay attention.”

Locally, psychologist Kimberly Schonert-Reichl recently finished a pilot project on
mindfulness in six Vancouver schools with positive results (which is also discussed in the same publication).

“…results also showed that these children were less aggressive, less oppositional toward teachers, and more attentive in class. Those who received the mindfulness training also reported feeling more positive emotion and optimism, and seemed more introspective than children who were on a waitlist for the training.”

The project site for this research can be found here.

Musicophilia – A Review

2009-11-04T21:59:00.000-08:00

No one can say that Oliver Sacks doesn’t have an extensive collection of strange stories. As interesting as these stories can be though, I find his narrative to be redundant. While the anecdotes may drone on, there is interesting information in his tangents and footnotes.

The book discusses the effects and involvement of music in many psychiatric and neurological cases. A chapter is devoted to music therapy for speech and movement, especially with autism, and the importance of a connection between the musical therapist and the patient.

Sacks at one point cites Nietzsche and his philosophy on physiological and psychological effects of music (other notable people discussed include Darwin and Freud).

There is mention of an interesting use of botulinum toxin in the treatment of musical dystonia, a condition which appears to affect a particular body part, most often the fingers, only when an instrument is being played. The effects of the treatment are limited though:

“Such injections-though not always effective-have enabled some musicians to resume playing their instruments, [but] it may be unwise…to attempt a return to performance.”

The book discusses both the loss of music, in either functionality or appreciation, and the gain of music, as in the composition of large works while dreaming.

Final Rating: A good afternoon book of which you don’t necessarily have to read every page and which is a good source for further research into the areas of music and neurology.

Graduate Studies

2009-10-31T13:56:00.000-07:00

There was a very interesting article, The Ph.D. Problem, in Harvard Magazine detailing many of the problems in the pursuit of higher academic education. The content of the essay is disheartening, though not unrealistic.

While I remain cynical where politics of academia are concerned, research is an absolute necessity. This article focuses on the area of humanities, but general complaints (length of degree, job security, overspecialisation, exclusivity) about the process of graduate education could be applied to other departments.

“…if doctoral education in English were a cartoon character, then about 30 years ago, it zoomed straight off a cliff, went into a terrifying fall, grabbed a branch on the way down, and has been clinging to that branch ever since…the result of this is a kind of normalization of what in any other context would seem to be a plainly inefficient and intolerable process.”

(I actually think this is a metaphor that can be applied to chronic mental illnesses where unhealthy living is accepted because the normality of the distribution of life events has been shifted due to stagnation.)

“An estimate of the total elapsed time from college graduation to tenure [in humanities] would be somewhere between 15 and 20 years. It is a lengthy apprenticeship.”

“Job satisfaction is actually higher among Ph.D.s with non-academic careers than it is among academics, partly because spousal problems—commuting marriages—are not as great outside academia.”

“…there is a huge social inefficiency in taking people of high intelligence and devoting resources to training them in programs that half will never complete and for jobs that most will not get.”

External Validation

2009-10-28T08:51:00.000-07:00

"Self-esteem is the greatest sickness known to man or woman because it's conditional."--Albert Ellis, Ph.D.

If you google external validation, you come up with a lot of hits asserting it’s a bad thing. Or at the very least, it’s not as good as ‘self-esteem’.

Nathaniel Branden, a psychotherapist who received his Ph.D in the 70’s, called external validation "pseudo self-esteem." He made the common argument of "true self-esteem" being derived from internal sources, such as self-responsibility and self-sufficiency. He defined true self-esteem as "...the experience of being competent to cope with the basic challenges of life and being worthy of happiness". (1)

Yet external validation is something children need. Adults with mental health problems (most famously, borderline personality disorder) may not have been nurtured in that area when they were children, or even as adults, and so might need such validation in their adult years.

External validation may be necessary in the development of self-esteem; Encouragement and approval most definitely do aid in building self-esteem traits.
Linehan, the famous validator, proposed six levels of validation: listening nonjudgmentally, accurate reflection, mind-reading, or articulating unspoken thoughts and feelings, understanding the historical background of a behaviour, confirming thoughts, behaviours and feelings based on current circumstances and radical genuineness, which requires the therapist to speak authentically to the patient and his/her family (2, 3).

Indeed, Linehan is such a proponent of validation for treatment, she developed DBT (dialectical behaviour therapy) which is grounded in two core concepts - validation and problem solving.

External validation is not bad. Nor is it dysfunctional or overrated. It is simply a necessary component in the development of self-worth and independence. I am not indicating one should constantly and pathologically seek out validation, but it is a process many individuals need to go through and those who are need not view their behaviour as something to be rid of, but to be open to the validation they are receiving.

The above is true of anyone; we all need to know we’ve done a good job or look nice in that new shirt. Compliments, which are a form of external validation, improve productivity and mood, generally making the world a better place.

References:

1. Branden, N. (1969). The psychology of self-esteem. New York: Bantam.
2. Linehan, MM (1997). Validation and psychotherapy. In A Bohart & C. Greenberg (Eds.) Empathy reconsidered: New Directions. Washington DC: APA
3. Woodberry, KA, Miller, AL, Glinski, J, Indik, J, & Mitchell, AG (2002). Family therapy and dialectical behavior therapy with adolescents: Part II: A theoretical review, American Journal of Psychotherapy, 56, 585-602.