Happy Holidays

Happy Holidays and Merry Christmas to All!

Holiday Joy!

One of the major causes of stress for most people is a sense of uncertainty. Uncertainty can be rather exciting at the onset and most people actually begin a relationship or set about making new plans with this sense of excitement and possibility.   However, after a short while, for many, the uncertainty about a close relationship, finances and our future can lead to worry and anxiety.   Eventually, this feeling of anxiety may become chronic and can lead to clinical depression, anxiety, anger responses and over-sensitivity.

For many, the Holiday season brings on a heightened sense of uncertainty, especially around relationships. This is a normal response and can lead to worry, anxiety or feeling especially sensitive to others comments and actions.

This Holiday Season, acknowledge your uncertainty and accept that it might lead to some feelings of anxiety.  Instead of allowing the worry to overtake you and rob you of feeling any of the joy and pleasure of the season, do something about it!   Find ways to stay in the moment.  And do not set your expectations so high that no one can fulfill them! Instead, identify ways that you can enjoy the season without setting up high expectations of others.  Find even small ways to feel good.  Give an anonymous gift. Write a note to someone you have neglected.  Find a sense of humor! Volunteer.  And let go of your worry and anxiety by de-stressing – get exercise, take time for your own peace of mind.  And remember – as much as you are able - surround yourself with others who are positive.

Your Guide to finding Happiness during the Holidays and Beyond

Are you hoping to experience and feel at least some level of happiness during the holidays?   You are certainly not alone in this pursuit! Many people look to the holidays to help them to feel better, more hopeful and happy.  And one of the reasons the post holiday blues take hold for some, is that the happiness is fleeting.  The word happiness in actually an abstract concept. If you asked three different people to define happiness, you would no doubt end up with three different definitions.  Seligman and colleagues have invested years of research on the concept of happiness.  They suggest  that a better way to view ‘happiness’ is to examine three distinct routes to happiness:  1) positive emotion and pleasure, 2) engagement and 3) meaning.  Their research suggests that people differ in how and what they pursue in life and that satisfied and happier people are those who orient their life pursuits based on all three of these routes, but hold engagement and meaning as more important that positive emotion/pleasure.

It is important to also know that studies on happiness show that people pursuing happiness benefit more than from just feeling good.  Research shows that happy people are healthier, more successful, and more socially engaged, and the cause and effect of happiness actually runs both ways! For example, if you are happy, this will have a positive effect on your social relationships; those relationships in turn give you more happiness.

How can this help you then, as you consider ways to find your own (not so fleeting)  happiness?
Review the list below and try out the exercises.  Be sure to commit to doing at least one of the exercises for at least one week. Commit to trying them all out over the next few weeks. Continue with the ones that resonate most.


Gratitude Visit: Take one week to write and then deliver a letter of gratitude in person to someone who has been especially kind to you and whom you have never properly thanked.

Three good things in life: For one week - write down three things that go well each day; describe a causal explanation for each thing every night for one week.


You at your best:  Write about a time when you were at your best and then
reflect on your personal strengths displayed in the story. Review the story once every day for a
week to reflect on the strengths you have identified.


Identify and Use your signature strengths in a new way:
Take the inventory of character strengths (Brief strengths) online at www.authentichappiness.org and receive individualized feedback about your top five (“signature”)
strengths (Peterson et al., 2005a). Use one of these top strengths in a new and
different way every day for at least one week.

Finally – remember this. For most people, happiness does not just happen! It is a purposeful way of reflecting and doing your life, finding ways to create your own world of meaningfulness, gratitude and positive emotion.
To learn more, visit the website:
http://www.authentichappiness.sas.upenn.edu

Holiday Happiness?

Even though the holidays may bring on feelings of joy and happiness and celebration, for many, the holidays are the most difficult time of the year. Even if you tend toward optimism and love to celebrate at this time of year, you may secretly struggle with feelings of loss or stress, perhaps based on memories and experiences of years past.  Take time out this year to reflect on your relationships, past holiday experiences and your strengths.  Remind yourself of your strengths and be open to learning from your experiences.  Read through the strengths identified below, based on Seligman’s work on Positive Psychology.

Seligman’s work (Peterson and Seligman, 2004) proposes virtues and character strengths as a foundation for understanding the positive human experience.  Read through the virtues and strengths and identify the ones that are the closest match to your experience and self-knowledge.  Contemplate your strengths, how they support you and how they contribute to a more positive emotional experience.   Next week, I will discuss more on virtues, strengths and effective interventions for self growth and support.  For more information, go to the Happiness and Positive Psychology website:
http://www.ppc.sas.upenn.edu/


Classification of Virtues and  Character Strengths (Peterson & Seligman, 2004)

1. Wisdom and knowledge
You resort to your cognitive strengths and like to learn and use knowledge.  There are times you think in a novel and creative way and turn this into productive outcomes.  You are curious and interested in ongoing experiences, are open minded by looking at things from all sides, like to master new skills, topics or areas of knowledge and you provide wise counsel to others.

2. Courage
You muster up emotional strengths that involve the exercise of will to accomplish your goals even in the face of opposition. You strive to be authentic, speak the truth and present yourself in a genuine way.  You don’t shrink from a challenge or threat, difficulty or pain and you are persistent and finish what you start.  You typically have a quality of excitement and energy in your life circumstances.

3. Humanity
You have strong interpersonal strengths that involve “tending and befriending” others. You enjoy being kind and doing favors and good deeds for others; you love and appreciate close relationships with others and you tend to be aware of the motives and feelings of self and others.

4. Justice
You feel strongly about precepts that underlie healthy community life and firmly believe in
treating all people the same according to notions of fairness and justice.  You use your leadership skills to organize group activities and see them to fruition.   You are a great team player.

5. Temperance
Your have strong  ability to protect yourself against excess; you forgive those who have wronged you, incorporate modesty into your experience by allowing your accomplishments to speak for you, you choose carefully by not saying or doing regretful things, you self-regulate your feelings and actions.

6. Transcendence
You rely on your inner experience that allows for forging connections to the larger universe and the meaning of human experience. You notice, and appreciate, beauty, nature, excellence, skill, art, performance in all areas of life.  You tap into gratitude and appreciation, expect the best and work at achieving it, like to laugh and bring smiles to others.   You have religious, spiritual beliefs about the higher purpose and meaning of life.

May today be the beginning of a Happier Holiday!

http://www.ppc.sas.upenn.edu/

The Mind-Body Connection and You

There is now both reliable and valid scientific evidence from the fields of behavioral medicine, neuroendocrinology, neuroimmunology, neurobiology, and nutrition science to support the conclusions that our autonomic, endocrine and immune systems are not autonomous, but instead work in concert with each other.  These systems engage in interactive dialog with each other, and communicate with our limbic emotional system and perception/sensation systems to maintain health and also fight disease.

Research over the past 30 years has seen considerable advances into the scientific understanding of the immune system.  Science has now established the knowledge that the mind (psychology), the brain (neurology) and the body’s natural defenses (immunology) communicate with each other in a bidirectional flow of hormones, neuropeptides and cytokines.  This growing field of research is called psychoneuroimmunology (PNI).     Consider this: there is now irrefutable evidence that all of the body’s defense systems are under the control of the central nervous system (CNS).   In other words, every idea, thought and belief has a neurochemical consequence.  Neuropeptides flow from the CNS, impinging on specific receptions on the leukocytes, thus regulating their function.  What researchers know then, is that the CNS has the potential to critically inhibit or enhance immunity through two major neuroimmunomodulatory pathways:  the neuroendocrine and the autonomic nervous systems.

What can you do as a patient, whether you are struggling with a chronic illness, newly diagnosed with a threatening disease or health and working toward goals to improve your overall health and well-being?

Begin by examining your stress levels. How do you manage?  Do you feel good about how you cope or do you know that you are frequently stressed beyond your ability to cope? Ask for help.   Examine your health beliefs and ask questions of your health care providers.  Ask for psychological support for stress management, or help with depression, anxiety or other diagnosis.  Read and learn all you can about the biopsychosocial aspects of your condition.  Rely on scientific evidence, scientific based websites and reputable publications.  Question and learn about complimentary and adjunct support and discuss with your health care providers, including your medical doctor and your psychologist.
For an excellent academic overview on this topic:  Mind-Body Medicine: A Clinician's Guide to Psychoneuroimmunology; edited by Dr. Alan Watkins ISBN:  0 443 05526 2

Related articles

• Some depression might have roots in immune-generated inflammation (scientificamerican.com)

Do women respond differently to stress than men?

Shelly C. Taylor, a recognized psychologist and researcher at UCLA, investigated  women’responses to stress and how those responses may be different from the accepted “fight or flight” theory I discussed in an earlier article.  The results from Taylor’s study demonstrated that the neuropeptide called oxytocin, (which also plays a roll in sexual arousal, monogamous bonding, childbirth, maternal bonding to the newborn, among other primarily female responses) also plays a role in the stress response.  Taylor provides support for identifying oxytocin as a ‘social thermostat.’  As a social thermostat, oxytocin informs the brain on whether social resources are adequate to deal with stressful events.  Based on the study, Taylor suggests that oxytocin then, may be a biological marker, with higher levels of oxytocin indicating inadequate or depleted social connection and support.  If you want to read and learn more about your own stress style and how to uniquely and proactively manage your stress response, I highly recommend the book “So Stressed,” by Stephanie McClellan, M.D. and Beth Hamilton, M.D. (ISBN #9781416593584)  They present an excellent guide to stress, how stress uniquely effects women, four types of stress profiles, and what women can do to uniquely and proactively  counter stress and become psychologically and physiologically healthier. So then, do women respond differently to stress than men?  Yes, there are definite differences, one of them, based on Taylor’s work is to tend and befriend, reaching out to others and seeking support when it is needed.

Are you a Victim?

When you experience a health crisis – whether it’s being newly diagnosed with a disease, experiencing overwhelming stress from dealing with a chronic disability or recovering from an injury, feeling angry may be a normal response.  However, ongoing anger is not a healthy response to the stressor and may keep you from healthy management and feeling better in the long run.   Chronic anger may add to your stress levels, increase the cortisol in your system, which in turn contributes to more inflammation and poorer health. The key is to learn and then act on the knowledge that there are normal and healthy anger responses and there are also unhealthy anger responses.

In addition to denial, what is another common and unhealthy anger response? In addition to denial, which I discussed last week, is a type of anger response that involves seeing yourself as victim of your circumstances, your disease, and even your overall health status. Taking on a role as 'victim' may not seem like an anger response, but it is in essence, blaming externals for your course of illness and treatment and denial of your own agency in the process. This passive denial approach to disease and illness management was in many ways, considered appropriate and a normal adjustment as few as 25 years ago. The older medical model of ‘compliance,’ inferring that the healing professional knows everything and the patient (victim of the disease or accident) must only listen and follow directions in order to heal and become whole again, was a largely accepted viewpoint in medicine for many, many years.  We now know that for most patients, the best approach to disease management involves ‘adherence’ to the treatment plan. 

Adherence involves the patient actively learning, discussing and contributing to decision making with his/her health professional.   As a result, research shows that for most, this leads to higher motivation and better success in managing their disease.   For example, if diabetes management is your issue, then together with the health care professional, you establish your goals, how you’re going to achieve them and how long you will take to meet each objective.  Having this kind of agency and ownership of your treatment plan will help you overcome feelings of anger and be successful in the long run. So then, what is one of the best ways to overcome feeling victimized?   Become an active patient, willing to learn new things, ask questions, speak up about your denial, fears and your hopes and work together with your health care professional to improve your health and your wellbeing.

Are you in Denial?

                                 

Whether your are newly diagnosed with diabetes or another serious illness,  or you have been told by your doctor that you have high cholesterol and high blood pressure and your well-being is at risk,  when you were first confronted with the diagnoses, you may have responded with feelings of anger.  And actually, feeling angry is a normal response to hearing and learning of a serious diagnosis.  However, ongoing anger is not a healthy response to this new stressor and may keep you from a healthy acceptance of the diagnosis.   The chronic anger may add to your stress levels and keep you from healthy behaviors and self-management.  Finding ways to control your anger is important, then. Begin, by realizing that there are normal and healthy anger responses and there are also unhealthy anger responses.

What is a common and unhealthy anger response and the alternate healthier way of managing your anger?  One of the most common anger responses to having been diagnosed with a serious disease such as diabetes is one of denial.  The denial may be over the actual diagnosis of the disease or the long term and potentially life long aspects of the disease.  One of the unhealthy ways to express the denial is through blame – blaming others, including family members, blaming scientific progress for not finding a cure, blaming the environment, for making your life more difficult.   You may end up lashing out at those who are there to help you the most, including your family and friends.  What is a healthier denial response then?  How can you work through the denial in a way that de-escalates your stress levels,  keeps your anger managed in a healthy manner and includes your loved ones in a supportive role?

First and foremost, admit your denial. Admit to your loved ones and your health care providers and ask for help.  You can rest assured that your feelings are not unique. Denial is one of the biggest hurdles to overcome.  The next step in working through the denial, once you admit to yourself and others, is to work at expressing your thoughts and feelings without denial and blame.  Practice this often and try it out on others.  Eliminate blaming others from your vocabulary.  Work at owning your diagnosis by verbalizing your diagnosis and letting others know of your progress.  You may be surprised to find that by re-framing your language into thoughts and phrases that are free of denial and blame, you will emotionally and psychologically reach a point of healthier anger management and healthy acceptance of your diagnosis.

Where do you want to go?

Have you ever taken time out to really consider why you want to lose weight or get healthier overall, or let go of a substance abuse problem or even change your attitude?   You may experience ongoing demands and stress at work, stress at home, relationship struggles, illness, or financial crisis and rarely or never take time out to contemplate and really pay attention to who you are,what you are experiencing and why you have certain goals, hopes and dreams.  Practicing mindfulness is one way to accomplish a greater sense of self and others and gain a deeper understanding of what really matters to you.  What is mindfulness?  It is an awareness of the here and now, the real-time experiences in your day to day life. It is acceptance and fully attending to whatever happens in your daily life.  It is living each moment and each event as fully as possible, embracing the hope and the despair, the joy and the discouragement, the risks and the fear and as fully as possible.  This is counter to the manner is which most of us have learned to experience our lives.  We live in a society where almost everywhere we look,  the focus is on how to be more, accomplish more, be more successful, be more beautiful, and then be viewed by more as worthy. We cannot easily escape media's over-emphasis of the perceived and highly regarded rewards that accompany looking your best, losing weight, having cosmetic surgery, or undergoing that much "needed" makeover.  Consider this though. The real makeover needs to start from the inside.  Jon Kabat-Zinn, author of the book entitled “Coming to our Senses” reminds us of this: “There is no time other than now.  We are not, contrary to what we may think, “going” anywhere. Even though we may imagine some other future moment as more fulfilling, more pleasant, more rewarding, we can’t really know this."  Instead of living in a dream reality, wake up! Today is your reality.  Embrace who and what you are.  Does this mean you can't hope, dream, want, wish, work toward, strive, commit? Of course not.  You can do all of these things but remain mindful of the fullness and beauty and richness of your current experience.  How to accomplish this?  Practice mindfulness. Practice being in the moment. Practice letting go and accepting and moving on and letting go again and moving on again. Practice mindfulness and remaining in the here and now and experience a more peaceful and less turbulent journey as you pursue your dreams and goals.

The mind-body connection

Current research fully supports the notion that  psychological treatments of people who seek help in a medical setting can make a significant difference in their overall health.  In the 1980's, estimates were that approximately 25% of visits to a primary health care practitioner are for psychological and mental disorders, masked by physical symptoms. This estimate has increased to 30-50% today. And estimates today suggest that more than 60% of emergency room visits involve a psychological component.  We also know that up to 80% of medical patients overall, struggle with various levels of psychological distress. What does this all mean?  Most importantly, statistics now clearly demonstrate that illness is not only physiological and that the psychological component is an important contributor to health, well-being and therefore illness.  The biological, psychological and social are intertwined in a complex and powerful manner.  What can be done?  Physicians and physician's groups need to continue to increase efforts to include psychologists in their treatment plans and willingly refer when the patient might benefit from psychological intervention.  And patients need to increase their awareness of the mind-body connection, examine their own psychological struggles, talk to their health care providers about their physical and psychological status and ask for help and psychological support when they need it.

Why Exercise?

What are some of the psychological benefits of regular exercise?  Results of studies on men, women, children, youth, mid-life and the elderly point to the benefits of overall improved sense of well-being.  Specific studies on the effects of exercise on clinical depression have shown that it is a viable treatment option for some people.  A sense of self-efficacy and confidence is another benefit for the far majority of people who keep up an exercise regimen and get physically healthier as a result. These are just a few of the psychological benefits of regular exercise.

What is it then, that keeps people from exercising? Why not just go out and do it?  The benefits are numerous, from physiological benefits of managing and preventing diseases like diabetes and high blood pressure and cardiac illness to greater quality of life to extending ones' longevity to improving your overall mood, and keeping depression under control.

If you ask most sedentary people why they don't exercise, they may tell you that regular exercise is too hard and they really don't like it!   If you fit in this category, consider re-thinking your attitude.  First of all, replace your idea of 'exercise' with 'activity.'  What activities do you like or did you like before you became sedentary?  Going dancing, playing on a softball team, playing with your children or grandchildren, walking hiking, swimming and gardening  - are all an improvement over a sedentary lifestyle.  Remember that as few as 30 minutes a day of moderate activity - brisk walking for example can not only help you become physically healthier but also  psychologically healthier.

How to start? Identify an activity that you consider to be enjoyable. You are much more likely to keep up the activity if you enjoy doing it in the first place!  Find another person or a group who like the same activity.  Other like-minded friends can help you feel and stay motivated and supported as you work toward your goal of increasing enjoyable activities (and exercise) into your lifestyle. 

How do you cope?

For a person who is struggling with dealing with self-management of their diabetes regimen, trying to lose weight or manage other health related issues, the demands create an ongoing challenge and the need to cope with the stress.  There are numerous researchers who have explored types and theories of coping, with the purpose of wanting to understand how people become 'good copers' versus those who are not able to cope with such demands.  One of these theories or concepts of coping is called the problem focused model (Lazarus). This type of coping involves how the person attempts to change the environment in order to adapt, deal with or change the stressor. Research is this area suggests that for many individuals who tend to cope using a problem focused approach, their sense of psychological well-being is better than those who focus on their emotions.  Additional research has added further understanding to this model of problem focused coping, acknowledging that individuals consciously select and engage in particular coping behaviors, and that individuals also differ in their coping strategies, depending on the stressor.  What kind of 'coper' are you? Do you focus on how you feel, and base your coping strategies on your feelings?  Or - are you a problem focused 'coper' - seeking how you can change your environment so that you feel better?  Whatever approach works for you  - is the most important concept of all.

Adherence leads to success!

Research continues to point patients and health care providers to the awareness that adherence to a weight loss (and if diabetic, better glucose control) program is somewhat complicated.
What actually is adherence?  In simple terms, it’s the patient’s purposeful attitude and behaviors that result in success over time in following the self-management regimen, whether it’s weight loss or glucose control or lowering your blood pressure.  Adherence is a different concept that the older ‘compliance’ model.  Compliance infers an obedience and behavior based on another person's demands. We know now, that if you only follow your doctor’s orders, because he or she said you must, you are more likely to fail in successful self-management of your health challenges.  If you take on some of the responsibility, learn as much as you can about your diagnosis or health problem, ask questions of your health care professionals and make your own personal commitment to health improvements, you will be much more successful in the outcome!  What do you think?  Reply to my blog and let me know if any of this resonates with what you are experiencing!

Biopsychosocial explanations for disease and health

Research into explanations for illness and disease and research of successful interventions are increasingly acknowledging the need to address the illness through a biopsychosocial lens.

The biological component is the focus on the physiology and physical features of the individual.  The biological includes family history, current illnesses, past illnesses, exercise and activity levels, nutrition, hormones, age, sleep hygiene, cholesterol levels, blood glucose levels and other biometric assessments as warranted.  Typically, the biological component of the biopsychosocial model is what most of us experience when we visit our physician due to illness.  However, research has demonstrated over and over again that the medical (biological) model, as a sole answer to our health issues and diseases, is not enough.  For example, we know now that stressors – stress events as well as chronic stress contribute to the disease process through the inflammatory pathways.

The psychological portion of the biopsychsocial model helps in part to explain both the disease process and poor health versus good health in many individuals.  For example, having the diagnosis of depression can wreak havoc on our immune system.  Taking psychotropic medications lend themselves to problems with libido, blood pressure and weight gain, to name a few.  Stress, as highlighted earlier, is a large contributor to the inflammatory processes in progression of disease.  Positive cognitions and positive perceptions - including feeling hopeful, encouraged and inspired, help to counter the inherent negative feelings of fear and anxiety when diagnosed with a disease.  The current research on mindfulness is showing promising results in demonstrating how the relaxation and meditative processes lend themselves to improved health status.  The psychological theories addressing motivation – called ‘readiness to change’ theories, are demonstrating that individuals can be much more successful in making positive health regimen changes when in the action stage.  The understanding of one’s own health beliefs and core assumptions can contribute to understanding the fears and assumptions one may have about disease. The list goes on and on regarding research that demonstrates the psychological component as being key to explanations for disease processes and health and wellness.

The third component of the biopsychosocial model is definitely not the least of the three, but instead, offers a more complete understanding of disease, health and wellness processes.  Some of the newest research in community identifies social contagion as a factor in happiness, group health behavior change and obesity.  Research on social support has taught us that we may report having a supportive family, but in truth, family may also contribute to our failures in self management of our disease.  Group belonging, meaning and recreation helps to counter the feelings of anxiety and the fear of illness in death in cancer patients.  These few points are just a sampling of the varied research and interventions applied to enhance our understanding of health and wellness and offset the stress and difficulties that accompany disease within a family member.

Remember the importance of viewing your own health, wellness and disease issues through the biopsychosocial lens.  Such an approach will give you an improved understanding of what you can and cannot do to change what can be changed and accept what cannot.  Many people find that increasing their knowledge and understanding of the disease and health and wellness processes gives them more confidence and increases their sense of hope and motivation.

Core Assumptions About Illness

When a person is diagnosed or is struggling with an ongoing illness, how the family adapts, manages and copes with that family member and the illness, arises from core beliefs based on generational perceptions, values and explanations for illness.  Within the family culture, any illness and healing process represents two sets of core beliefs: 1) beliefs of the family members; 2) beliefs of the ill patient.

Most people have rather firm convictions and beliefs as to why disease occurs as well as why one person is afflicted and another is not.  Even though science may provide the intellectual explanation of the disease process, core beliefs including values and spiritual matters typically arise to provide another level of explanation, justification or rationale regarding the disease.

Within the family, explanations for the illness may include spiritual beliefs such as judgment (God is punishing), hope (prayers for healing) and acceptance (it’s God’s will, meditation and mindfulness).  In some families, there is a core belief that illness is shameful. For the ill family member, this may results in feelings of guilt, resentment and despair.  Another approach in some families is that of denial, in which members of the family willingly deny (frequently out of fear) the diagnosed member expression of his experience, his fears or procedures undertaken.   Family beliefs may also be based on scientific studies and understanding (he should have taken better care of himself) or psychological reasoning (she gets so stressed out it’s no wonder she got the disease).

In addition to one’s family influenced beliefs, individual core beliefs also come to the fore when illness enters a family member’s life. Individual core beliefs may be based on ethnic and cultural belief systems as well as familial systems.  We tend to turn to personal core beliefs in times of crisis, struggle, difficulty, uncertainty. For example, an adult daughter may think:  “My father is very ill;” “good daughters care for their ill parents”

Researchers have found that core beliefs about the meaning of one’s own diagnosis of illness vary a great deal across diseases and even within one disease.  For example, the person diagnosed with diabetes may think that it is simply a disease that is caused by too much sugar in one’s diet and as an opportunity to make some positive changes; another person, diagnosed with diabetes, may immediately catastrophize and think of the worst possible outcome (I’m going to die; God is punishing me). Researchers are beginning to realize that these individual core beliefs about one’s illness may more accurately predict adherence and long term self care surrounding the diagnosis.

Newest research on Stress

At the American Psychological Association National Convention, August, 2010, Dr. Janice K. Kieolt-Glaser presented some of the newest behavioral medicine research on stress entitled "How stress kills: Assessing the damage and various remedies."
(Janice K. Kiecolt-Glaser, PhD, Jean-Philippe Gouin, MA, Nan-Ping Weng, MD, PhD, William B. Malarkey, MD, David Q. Beversdorf, MD, Ronald Glaser, PhD; Institute for Behavioral Medicine Research, Ohio State University College of Medicine).

The study investigated the effects of stress on individuals who reported having experienced childhood adversity in a sample of adults who are caretakers of a parent or spouse diagnosed with  Alzheimer’s disease. Conclusions based on this research suggest that childhood adversity worsens effects of stress, adding to current hardships. In other words, children who experience trauma  - be it physical abuse, sexual abuse or neglect, may be more prone to entering a cycle of negative emotion, i.e., depression and anxiety that may lead to problems in later life and possibly precipitate early death.

For example, children who experiences highly stressful events – such as death of a parent, witnessing severe marital problems or experienced abuse, may be more vulnerable to stressors as adults.
The research suggests that childhood adversity may for some,  have a long term, negative affect on health.  These childhood stressors may also contribute to inflammation and cell aging much earlier than for those who did not experience the stressful events in childhood.

The average age of the men and women who participated in the study was 70 years.  The participants were a community sample of 58 caregivers for a spouse or parent with Alzheimer’s disease or another progressive dementia.  The participants depression levels,  report of childhood trauma and biochemical markers of stress were analyzed and compared to a control group.


The researchers measured several blood inflammatory markers: cytokines interleukin (IL-6), tumor necrosis factor-alpha (TNF-a) and telomere length. (Telomeres are the ends of strands of DNA. Shorter telomeres have been linked with aging, age-related diseases and death. IL-6 and TNF-a have also been linked to a number of cardiovascular, including diabetes, autoimmune and infectious diseases).

Conclusions from the study found that " childhood adversity was associated with shorter telomeres and increased levels of inflammation even after controlling for age, caregiving status, gender, body mass index, exercise and sleep," said Kiecolt-Glaser.
"Inflammation over time can lead to cardiovascular disease, osteoporosis, arthritis, Type 2 diabetes and certain cancers.“  Childhood abuse and caring for an ill spouse or parent was also associated with higher levels of depression, she said.


Clearly, results of this study suggest the importance of early intervention to prevent the stress effects as well as undertaking immediate  interventions in those affected - for the  reduction of symptoms and increased ability to cope.  These interventions should include psychological treatment for depression and anxiety as well as the building of coping skills, encouraging regular exercise and instruction and practice in mindfulness.

How Self-Efficacy can help

When a person is challenged with trying to adhere to a weight loss program, wellness program or a diabetes management regimen, researchers have identified factors called individual differences that may contribute to success. One of these individual differences factors  is self-efficacy.

Researchers have found that a high sense of  self-efficacy has been shown to be related to better self management, and better outcomes for many individuals.   Even if other psychosocial supports are not all favorable, a strong sense of self-efficacy can offset these difficulties.

The concept of self-efficacy was proposed by Bandura (1977) and was developed within the framework of social learning theory.  The self-efficacy model identifies the individual’s perception of his or her ability to carry out a given behavior or group of behaviors.  This perception or sense of self efficacy has an effect on the person’s emotions, cognitions, and motivation in difficult or threatening situations such as facing life-long self management of diabetes.   In other words, if a person faced with the demands of self-management believes that she can be successful, her mood, her thoughts and her motivation to continue to try will be enhanced.    This most often results in better self-management and better results!

Depression and what you can do about it.

Almost everyone gets the blues. Who hasn't felt sad at one time or another? But what if the blues hang on and on, affecting you day after day? What if a persistent sadness permeates all aspects of your life: your ability to perform, how you eat, how you sleep, and how you deal with friends and family? It could be that depression may have you in its grip.  Many times, with help from a psychologist- especially one who works from a cognitive behavioral perspective - you can work through your depression, get relief from your symptoms and find proactive ways to prevent re-occurrence.   Sometimes, medication plus cognitive behavioral therapy is the most helpful treatment. Here are some markers and symptoms that may be a sign of clinical depression:

•    You feel sad or cry a lot, and it doesn’t go away.
•    You feel guilty for no real reason; you feel like you’re no good; you’ve lost your confidence.
•    Life seems to have no meaning. You feel like nothing good is ever going to happen again.
      You feel  pessimistic or it seems like you have no feeling at all.
•    You don’t feel like doing a lot of the things you used to enjoy like listening to music,
      playing sports, being with friends, going out and you want to be left alone most of the time.
•    It’s hard to make up your mind. You forget lots of things, and its hard to concentrate.
•    You get upset easily. Little things make you lose your temper; you overreact.
•    Your sleep pattern changes; you start sleeping a lot more, or you have trouble falling asleep
      at night. Or you wake up really early most mornings and can’t get back to sleep.
•    Your eating pattern changes; you lose your appetite, or you eat a lot more.
•    You feel restless and tired most of the time.
•    You may be starting to feel so badly that you start to wonder if life is worth living, you think
      about death, or may even have thoughts about committing suicide.

If you experience symptoms of depression for more than two weeks, it's wise to talk to your doctor or a mental-health professional even if you think the symptoms are caused by something else. Most importantly, don't be afraid to ask for help.

STEP OUT to STOP DIABETES!

Join me for the American Diabetes Association STEP OUT to STOP DIABETES Event at Knott's Berry Farm, Oct. 9, 2010.  There is no fee to enter the event. You can donate your money, your energy, your time or all three!  Let me know if you want to join me!

Together we can help to STOP DIABETES!  Read below (from the  ADA website ) and remember that the American Diabetes Association is a great resource for weight loss management, diabetes management and preventing diabetes!

For more helpful information, check out the STOP Diabetes link today:
http://stopdiabetes.diabetes.org
Why Stop Diabetes?
Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors appear to play roles. There are 23.6 million Americans living with diabetes, a disease that is outpacing heart disease, cancer and AIDS. Diabetes is a disease that has deadly serious consequences, and there is no cure.

Did you Know?  When you walk, you help Stop Diabetes.

Walking is one of the easiest, most relaxing forms of exercise for many people, but especially for those living with diabetes. Walking helps control blood glucose levels in people with diabetes and improves overall quality of life. It is also an activity that can help prevent or delay the onset of type 2 diabetes in people at risk.

You can walk almost anywhere at any time. And walking can give you more energy and help relieve stress. It?s a simple, positive way to improve your health. You don?t need expensive equipment ? just a good pair of walking shoes!

And walking for the cause helps raise funds for the mission of the American Diabetes Association: to prevent and cure diabetes and to improve the lives of all people affected by diabetes.

Join me! Email me! Don't hesitate to contact me if you have questions:  drjburkhardtpino@gmail.com.

Stress and Coping to Feel Better

Did you know that stress is the most common cause of ill health in our society? Some statistics suggest that up to 70% of all visits to your family doctor may be stress induced. 

The causes of stress are quite complex but typically they can be grouped in two ways:  external stress and internal stress.

External stressors may include loved ones getting sick or dying, losing your job or dealing with difficult people at work.

Most stress though, is generated internally! Since we create the majority of our emotional upheavals and upsets, we cause most of our own stress! The good news is that you can do something about it.

Having a sense of control over your interpretation and emotional response to any given situation, gives you a sense of choice and power that you can do something about the stressor.

And what is of key importance for you to know is that there is one very important concept regarding stress: To take control of the stress you are experiencing, you must decide to make some changes. You have to figure out what you are doing that is contributing to your problem and change it.

Here are some change strategies to help you to take control of your stress: 

Change stressful situations.
Do better at managing your time and your money. Get help if you need it.  Work on being assertive.  Find ways to solve your problem instead of stewing about it.  Consider leaving the job, responsibility or relationship.

Change your thinking.
Work at reframing your negative thinking into more positive thoughts.  Practice refuting negative thoughts that try to invade your sense of well-being.

Get Some Aerobic Exercise
As a way of draining off stress energy, nothing beats aerobic exercise.

Learn how to do relaxation exercises and/or meditate
Practice putting your body into a state of deep relaxation. Dr. Herbert Benson of Harvard University has named this "the relaxation response."

Get a consistent good night’s sleep
Reduce your stress by getting a good night’s sleep. Studies show that a good night’s sleep helps with memory, weight loss and reduction of stress.

Even Small Weight Loss can Make a Difference!

Did you know that if you are overweight, you are a member of the majority in this country? Studies suggest that up to 64% of American adults are either overweight or obese. These statistics represent a sharp increase over the 55% in 1994. This is about double the rate of obesity since 1980.The World Health Organization has labeled obesity a global epidemic. Recent statistics estimate that 1 billion people in the world are overweight; 300 million are obese.  And consider this: if you are overweight or obese, you are at greater risk for Type 2 diabetes, as they commonly co-occur.

There is a positive side to this news!  Although statistics are rather alarming, researchers have found that even small weight losses might have important health benefits.  Whether or not you are diagnosed with diabetes and are overweight or obese, even a small weight loss is associated with improved glycemic control and reduced blood pressure.

The Diabetes Prevention Program (DPP) research involved more than 3200 overweight individuals with impaired glucose tolerance. These people participated in a lifestyle intervention study. The lifestyle intervention group committed to increasing physical activity for more than 150 minutes per week. The placebo group (no increase in activity) and the Metformin (Glucophage, 850 mg per day) and no increased activity group, followed the intervention for up to 4 years. Results showed that there was a positive and preventive effect for members in the lifestyle intervention group. This held true for both sexes and all racial and ethnic groups. The group that showed the most promising results, the lifestyle intervention group, showed an average weight loss of 15 pounds at the six month mark.  Even after 4 years, the weight loss in this group still averaged 8 pounds.

Be encouraged! If you are struggling with your weight, take heart! Check with your doctor first and then take those walks, ride your bike, increase your activity, working up to 150 minutes a week. Even losing a few pounds can make a difference; even small successes will benefit your health.

Summary and commentary by Dr. Burkhardt Pino from the article "Treatment of Obesity" by Fabricatore and Wadden, Clinical Diabetes (2003).

How to overcome anxiety

Help with Anxiety!

Are you struggling with anxiety or panic attacks? Do you worry excessively about your work, your family, your relationships or your health?  Do you think that when you feel bad and experience symptoms of anxiety, then your feelings “make” you think negative and sad or angry thoughts? 

Actually, what psychologists know is that often, people who are experiencing depression or anxiety have the negative thoughts FIRST and that these fearful thoughts are not really based in reality. These distorted, negative, pessimistic thoughts then begin to produce the ‘bad’ feelings; the feelings in turn produce more distorted thinking, making the symptoms even more difficult to overcome.  

The important thing to note here is that the distorted thoughts are usually ‘automatic’ in nature. This means that the person is probably not even aware of his or her automatic, distorted thoughts, but that these thoughts automatically enter the thinking patterns in a continual manner and across different situations in life.

Put more simply, your automatic thoughts and interpretations of a situation or circumstance can have a very big - and negative impact on how you feel.

Cognitive-behavioral psychologists have identified several negative thinking patterns - distorted thoughts - that are common to people who struggle with feelings of anxiety and depression.

How to begin to understand your own distorted thinking?  Review these 3 common types of distorted thinking that frequently lead to anxiety or depression.  Now list at least three examples of your own thoughts that lead you to feeling depressed and anxious. First, describe the event that prompted you to feel anxious or depressed - and then de­scribe the thoughts that promoted the bad feelings. Once you identify your negative thoughts - your automatic thoughts - you have made the first step to overcoming your anxiety or depression. 

Type	Definition	Example
Mind reading	You make negative assumptions about other people’s thoughts and motives.	Sheila asked her friend Mary to join her for lunch.  When her invitation was refused, she thought “Mary never wants to go to lunch with me. I know she doesn’t really like me.”
Forecasting	You predict that an event will not turn out well.	Gina finished her audition for the play. She immediately pre­dicted that she would not get the part. “I’ll never get a good part. My audition was really bad news.”
Feelings are facts	Whenever you feel a certain way, you decide that the feeling is your reality.	Jim was not invited to join any of is friends after work on Friday. He felt left out, inferior and lonely. . He thought, “No one likes me. I am such a loser.”

 

Weight loss strategies that work!

Review these helpful strategies and ask for help when you need it!

Find Good Role Models:  Did you know that a person will more likely follow suggestions and adhere to necessary weight loss lifestyle changes if the health care provider they work with is knowledgeable and also follows a healthy lifestyle?  Healthcare providers who are physically active, eat healthy and can discuss their own emotional eating triggers, develop better rapport with their patients as well as provide inspiration and support.

Teamwork: If you have been unable to achieve an ideal body weight after 5 or more years of effort, you might have more success working with a team trained to help you.  The team most likely will include your mental health professional (psychologist, therapist), a nutritionist, a physical trainer and your physician.  You most likely will gain added benefit from the variety of support you get from each of these professionals.

Psychology:  Did you know that many patients' severe weight problems arise from emotional problems, attitudes, or beliefs that truly need to be addressed in psychotherapy? You may continue to struggle with both losing the weight and keeping it off, if the psychological and emotional problems and issues are not resolved.

Readiness: Understanding your readiness to lose weight is the first step!  Are you contemplating losing the weight or have you begun to take action? Have you had success, but are now having trouble maintaining the weight loss?  Once you get professional help in identifying your own readiness level, you must also address the behavioral and emotional readiness factors.  These may include the costs and benefits of keeping the weight versus the costs and benefits of losing those pounds.

How to BEGIN to Think SMART and Feel BETTER

Many people think that when we feel bad and experience symptoms of depression or anxiety, then our feelings “make” us think negative and sad or angry thoughts. Actually, what we now know is that often, people who are experiencing depression or anxiety have the negative thoughts FIRST. These distorted, negative, pessimistic thoughts then begin to produce the ‘bad’ feelings; the feelings in turn produce more distorted thinking, making the symptoms even more difficult to overcome. The important thing to note here is that the distorted thoughts are usually ‘automatic’ in nature. This means that the person is probably not even aware of his or her automatic, distorted thoughts, but that these thoughts automatically enter the thinking patterns in a continual manner and across different situations in life.

Put more simply, your automatic thoughts and interpretations of a situation or circumstance can have a very big impact on how you feel. Psychologists have identified several negative thinking patterns that are common to people who struggle with feelings of anxiety and depression.

Three common types of negative thinking patterns are identified and described below. Review these and begin to identify which ones may be impacting how you feel.

1. Catastrophizing: When something happens, you blow it completely out of proportion and think of the worst possible outcome.

The boss told Jenny that the budget is tight and there would no longer be funds for hiring an intern. Mary thought, “This is awful. She probably wants to fire me and this is her way of prepping me for the bad news.”

2. Black or White Thinking: You view people or situations, or even yourself as entirely bad or entirely good—nothing in -between.

When Mark presented his proposal to his dissertation committee, they interrupted so many times with questions, he went over his allotted hour for the presentation. Mark immediately thought, “They didn’t like my ideas; I barely got to finish the presentation.”

3. Judging:  You are overly critical of your self or others; your use of should have, ought to, must, have to, and should not have is very frequent.

Jan made a sales presentation to a client. The client was very attentive and made comments about being impressed with the product. Jan thought, “I spent too much time trying to explain myself. I should have been more prepared.”

Remember to review these and begin to identify which ones may be impacting how you feel. Knowing how and why you feel bad is a first step to feeling better!

Top Ten Better Ways to Communicate

Here are ten ways for you to develop healthier communication patterns with your friends and family. Try them out!

1. You state how you feel without BLAMING others.

2. You can disagree without turning it into an ARGUMENT.

3. You handle your anger without getting aggressive.

4. You handle OTHERS getting angry without your getting aggressive.

5. You act respectful at all times.

6. You expect others to be respectful of YOU at all times.

7. You can say you dislike someone's behavior WITHOUT saying you
dislike the PERSON.

8. Mistakes are viewed as OPPORTUNITIES to LEARN.

9. When there are disagreements, the atmosphere focuses on remaining RELAXED.

10.You take RESPONSIBILITY for your OWN behavior (no blame).