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50 Great Myths of Popular Psychology: Shattering Widespread Misconceptions about Human Behaviorby Scott Lilienfeld, Steven Lynn, John Ruscio, and Barry Beyerstein.

Do most people in their 40’s to early 50’s experience a midlife crisis? Do psychiatric admissions go up during a full moon? Can playing Mozart to infants boost their intelligence? Do most people only use 10% of their brain power? Is low self-esteem a major cause of psychological problems?

From Oprah and Dr. Oz to the nightly news, we are constantly exposed to psychological concepts on a daily basis.  While some of this information is factual and can be useful, a great deal of what we believe to be true is actually myth and misconception.  Professors Lilienfeld, Lynn, and Ruscio have taken on the task of “Mythbusting” in the field of Psychomythology.  This is a refreshing and fun look at many of the concepts that have been accepted as fact by our popular culture.  It is refreshing to find a scientific, evidence-based approach to psychological ideas in a time that has become so dominated by subjective experience.  This books reviews 50 of the most popular psychological myths and explores both the facts and misconceptions  surrounding each of these topics.  This book is sure to spur interesting conversations at your next cocktail party or social gathering.  Prepare to join the ranks of the Mythbusters as you will soon be equipped to set the record straight.

The Kitchen Shrink: A Psychiatrist’s Reflections on Healing in a Changing World by Dora Calott Wang, M.D.

Have you ever wondered what it is like to be a psychiatrist? To know the intimate thoughts and struggles that go on in the minds of those who are charged with the restoration of health and well-being? The Kitchen Shrink might be the book for you.

The Kitchen Shrink is a beautifully written memoir by Dr. Dora Wang detailing her life as a psychiatrist, wife, and mother and her experience of the shift that has occurred in medicine over the past twenty years.  Dr. Wang is an incredibly gifted writer and storyteller.  Unfortunately, the story she has to share is not as beautiful: there has been a paradigm shift away from patient-centered, “cradle-to-grave” medicine to a more business-centered, insurance driven model that focuses, not on quality, but rather on efficiencies–where the patient has been removed from the center of attention and remade as a “cog” in the health care machine.  I found myself wanting to share my patient-care stories with Dr. Wang as I read her poignant and all-too-familiar accounts.  While I know that her story is both emotionally-wrenching and true, I am left to wonder who, outside of physicians and those interested in health care reform, will find and read this book. While Dr. Wang does not suggest any specific health care reform options, she does a wonderful job of illuminating many of the problems with our current state of health care while reminding us of medicine’s noble history as the healing art.  Through the intimacy shared in her writing, Dr. Wang feels like a kindred-spirit in the quest for balance, happiness, and contentment.  I look forward to reading more from her in the future.

I love mnemonics and acronyms; they make it easy to remember useful information.  We tend to use them frequently in medicine (ie, RICE: rest, ice, compression, elevation) and in mental health (ie, screening for alcohol dependence, CAGE: cut down, annoyed, guilty, eye opener).  I was reminded of a particularly useful one this week: HALT.  While HALT is primarily used for individuals in recovery for substance abuse issues, I find it useful to apply to any automatic, problematic behaviors in which people engage (including emotional eating).

HALT refers to the possible responses to the question “Why am I doing this? How am I really feeling? Am I really…?”

  • H- Hungry
  • A- Angry
  • L- Lonely
  • T- Tired

By asking oneself these questions, it enables the individual to be more mindful of the situation and more accurately meet his or her needs at that moment instead of engaging in emotion-led, automatic behaviors.  So the next time you find yourself grabbing for a cookie or glass of wine, try asking yourself if you need to HALT and be certain of your motivations at that moment.

Lost in Time

Review: Time Management from the Inside Out by Julie Morgenstern

One of my favorite lectures from residency was on “Unchangeables.” This list of core characteristics, thought to be unalterable, included such things as empathy, sense of aesthetics, sense of direction, being a “reader”, organizational ability, and sense of time.  With the permission afforded me by this list, I have spend many years indulging in “tardiness.”  I would tell myself, “I can’t help being late, I have an imperfect sense of time.”   I routinely get lost in activities and lose track of time, or miscalculate how much time a particular activity will take, and I am always late.  This defect in my “sense of time” has caused a great deal of consternation in our family as I am married to a man with a perfect sense of both time and organization. Needless-to-say, he doesn’t buy into my excuse nor does he care about “timeliness” being an unchangeable.  So in an attempt to maintain peace and harmony in our home, I went in search for the seemingly impossible: a way to become aware of time.

What I found was a book: Time Management from the Inside Out by Julie Morgenstern. Ms. Morgenstern promises a “foolproof system for taking control of your schedule and your life.”  What she delivers is a system of time organization that takes into account the individual’s quirks and shortcomings.  She begins by having the individual do a “three level diagnostic” looking for particular obstacles, then teaches several pneumonic driven “take-charge” programs (WADE: write it down, Add it Up, Decide, Execute your plan; the 4 D’s: Delete, Delay, Diminish, Delegate).  Ms. Morgenstern’s strength lies in her organizational expertise and she applies her strategies adeptly to “time.”  While I will likely always struggle with accurately predicting how long it will take me to do a particular thing, it’s encouraging to learn and implement some strategies to prevent my particular time management challenges from derailing my entire day.  If you find yourself frustrated at the end of the day, asking where the time went, this may be the book to help you “Analyze, Strategize, & Attack” your way into better time management.

Are you always searching for “something more?”  Do you identify with any of the following drives or characteristics:

  • Extreme Confidence
  • Constant Need for New Challenges
  • Need for Recognition based on Performance, not gender
  • Greatest pleasures come from work place achievements
  • Learn best from Experience

Have you been frustrated by managers or situations that don’t challenge you to grow, provide opportunities for connecting, or sufficient validation?  This may be the book for you.

Always searching for tools, tricks, and tips to share with my girlfriends and patients, I was thrilled when presented with the opportunity to review Marcia Reynolds’Wander Woman. (obligatory disclosure: I received a review copy of the book at no cost with no obligation to provide a positive review) Going beyond the traditional call for finding “balance”, Wander Woman presents as a self-help book for “high-achieving women who are confident, ambitious, driven yet anxious, discontented, and above all, restless.”  This book succeeds in this endeavor and is a fascinating character study as well.

Dr. Reynolds begins by defining what constitutes a “Wander Woman” and explores the conditions that have contributed to the formation of such persons.  She then describes the process of “intentional transformation” and does a beautiful job of elucidating the many archetypes that characterize the various aspects of one’s personality: the Victim, the Saboteur, the Rebel, and so on…  Dr. Reynolds utilizes her masterful coaching expertise to provide specific exercises to aid in the discovery and development of these aspects of personality, provides instruction on correcting distortions of thoughts (“debunking your assumptions”), as well as gives specific directions on how to gain useful insight through the technique of “Appreciative Dialogue.”

Although I initially was interested in this book as it would apply to others, I quickly found myself relating to this Wander Woman phenomenon…with one exception: I no longer feel the need to “wander.”  I was fortunate enough to find and create the conditions I needed for contentment and fulfillment in my personal and professional life by becoming self-employed.  This solution, while appropriate in my situation, is not an option for many.  Fortunately, this book guides women through the process of self-discovery and provides specific resources for developing a “conscious strategy to find your direction and plan for your future.”

I recommend this book to any woman interested in introspection, not just those who set out to become “high-achievers.”  Wander Woman is full of great insights and is a wonderful exercise in personal development and transformation for any woman who wants “to know what they can accomplish in this lifetime without feeling exhausted and lonely in the end.”

(from the publisher)

Dr. Marcia Reynolds is fascinated by the brain, especially the nuances of the female brain. She is a master certified coach with a doctorate in organizational psychology, focusing on the needs and challenges of smart, strong women in the workplace. She travels around the world speaking at conferences and teaching classes in leadership, emotional intelligence and organizational change. Her book Wander Woman: How High Achieving Women Find Contentment and Direction was released this summer.

You can read more about the book at wanderwomanbook.com and follow the author on Facebookand Twitter.

“I forgot to take my medication for a few days and I thought I was going crazy…I thought I had the flu- given the headaches, diarrhea, nausea, vomiting, chills, dizziness and fatigue.  I have had insomnia, agitation, difficulty concentrating, vivid dreams, feeling like I just not myself, irritability and even suicidal thoughts. What the heck is going on?!?”

SSRI discontinuation Syndrome (or SSRI Withdrawal syndrome) is a condition that can occur following the interruption, dose reduction, or discontinuation of Selective Serotonin Re-uptake Inhibitors (SSRIs) or Serotonin-Norepinephrine (SNRIs) antidepressant medications. The symptoms often begin between 24 hours to 10 days after reduction in dosage or complete discontinuation, depending on the elimination half-life of the drug and the patient’s metabolism. While some of the prescribing labels of some SSRIs note the possibility of “intolerable” discontinuation reactions they are not commonly discussed and are sometimes mistaken by patients and physicians as worsening of psychiatric symptoms, or worse, dismissed as being imagined.  Unfortunately, some patients have extreme difficulty discontinuing use of SSRI drugs.  Discontinuation Syndrome tends to occur more frequently with antidepressants having a shorter half-life (Luvox, Paxil, Effexor, Cymbalta) than with longer-acting (Prozac).  The exact mechanism of SSRI Discontinuation Syndrome is unknown and is likely due to a variety of factors.

Symptoms that can occur in this discontinuation syndrome can include:

  • Dizziness
  • Vertigo
  • Lightheadedness
  • Difficulty walking
  • Nausea/vomiting
  • Fatigue
  • Headaches
  • Insomnia
  • Shock-like sensations “Brain Zaps”
  • Paraesthesia (skin crawling, burning or prickling)
  • Visual disturbances
  • Diarrhea
  • Muscle pain
  • Chills
  • Agitation
  • Irritability
  • Impaired concentration
  • Vivid dreams
  • Depersonalization – sense of unreality and loss of self
  • Suicidal thoughts

These symptoms last anywhere from one to seven weeks and vary in intensity from mild-moderate to extremely distressing for some individuals.  Studies now indicate that 35-78% of individuals who are on SSRIs or SNRIs for five weeks or longer, who then abruptly stop these medications or decrease their dose too dramatically, will develop one of more of these discontinuation symptoms.

To avoid these symptoms: Do not stop your antidepressant abruptly.  Take your medication regularly: in some of the shorter half-life medications, symptoms may occur in sensitive individuals who are a few hours late in taking their medications.  Talk with your provider about what to do if you miss one or more dose of your medication.  If you are experiencing any of these symptoms, discuss them with your provider as soon as possible.  SSRIs and SNRIs can be useful tools in the treatment of depression and anxiety; however, they must be adjusted and titrated with care and caution.  These discontinuation symptoms can frequently be minimized or avoided with proper planning and judicious titration and should not be taken as an absolute reason not to try such medications if deemed appropriate.

It’s Summer! It’s that time of year when temperatures rise, clothing covers less, and thoughts turn to having the perfect “swimsuit” body and that favorite of four-letter-words: DIET.  While there are a multitude of books available promoting weight loss; most are based on unhealthy fads that do not translate into long-term weight loss.  Most of these tomes tell what magical mixture of foods, or lack thereof, will cause the pounds to melt away.  The only problem is that, once you return to your normal pattern of eating, the pounds find their way back home and bring their friends.  A few years ago, I was faced with a diagnosis of diabetes and the reality of needing to lose 35 pounds on a permanent basis.  I set out to find a way to change not only my eating habits but, most importantly, how I thought about food.  Fortunately, I discovered Dr. Judith Beck’s “The Beck Diet Solution.”

Dr. Beck’s book seems unique in the weight loss genre: it doesn’t suggest any particular diet or exercise program.  It promises to work with ANY healthy diet and exercise plan.  This book uses techniques from Cognitive Behavioral Therapy (a mental health technique created by her father, Dr. Aaron Beck, to treat depression) to identify the distorted thoughts that keep one from being motivated, disciplined, and successful.  Dr. Beck’s book goes beyond “eat less and move more” and teaches how to do so when you don’t want to or when it’s not easy.  People who struggle with their weight, says Beck, all have one thing in common: They don’t know how to think like a thin person – their behavior, mindset, lifestyle, and habits all sabotage their best intentions. For example, she writes, people often have thoughts such as “I know I shouldn’t eat this, but I don’t care,” or “It’s okay if I eat [this food] just this one time.” Permanent weight control requires a life long change in thoughts and attitudes while dealing with such sabotaging habits and behaviors.  Three years later, I’ve maintained the weight loss I achieved using her techniques.  So before you sign up for hormone weight-loss shots or some other fad diet de jour, consider checking out “The Beck Diet Solution” and see if there are some “sabotaging thoughts” that are derailing your best intents and efforts.  While you won’t drop “7 pounds in 7 days”, it certainly is more palatable than Dolly Parton soup and grapefruit for every meal.

While many pharmacological treatments for depression and anxiety “work” by raising Serotonin level, too much Serotonin can be a potentially “bad thing.”  Serotonin syndrome can be a rare potential side-effect of taking SSRI’s/SNRI’s/MAOI’s antidepressants. Serotonin Syndrome is a potentially life-threatening drug reaction that can occur when levels of the neurotransmitter Serotonin become too high in the brain and body. This condition generally occurs when individuals are taking multiple drugs at the same time that act independently to raise Serotonin levels.  While some of these drugs are obvious (antidepressants), many are not, such as certain medications for migraines or pain.

Symptoms can occur within minutes to hours, and may include:

  • Agitation or restlessness
  • Diarrhea
  • Fast heart beat
  • Hallucinations
  • Increased body temperature
  • Loss of coordination
  • Nausea
  • Overactive reflexes
  • Rapid changes in blood pressure
  • Vomiting

Serotonin syndrome is more likely to occur when you first start or increase the medicine.  For example, you can develop this syndrome if you take migraine medicines called triptans together with antidepressants called selective serotonin reuptake inhibitors (SSRIs) and selective serotonin/norepinephrine reuptake inhibitors (SSNRIs), or even Herbal/OTC treatments. Popular SSRI’s include Celexa, Zoloft, Prozac, Zoloft, Paxil, and Lexapro. SNRI’s include Cymbalta, Pristiq, and Effexor. Herbal treatments for depression: St. John’s Wort (Hypericum), 5-HT, and SAMe.  Brand names of triptans include Imitrex, Zomig, Frova, Maxalt, Axert, Amerge, and Relpax.  Ultram has also been thought to interact and potentially cause this reaction as well. Older antidepressants called monoamine oxidase inhibitors (MAOIs) can also cause serotonin syndrome with the medicines describe above, as well as meperidine (Demerol, a painkiller) or dextromethorphan (cough medicine). Drugs of abuse, such as ecstasy and LSD have also been associated with serotonin syndrome.

What to do if you suspect you may be experiencing symptoms of Serotonin Syndrome?   Call your doctor.  Do not stop your medications abruptly unless directed to do so by your physician.  Although not a common occurrence, it can be dangerous and is considered a medical emergency.  Always let all of your health care providers know all of your medications so they can monitor for potential interactions.

I am excited to be a part of a wonderful group of women who will be  contributing regularly to the Book End Babes website.  I will be writing about “Wellness” every 1st and 3rd Wednesday.  My first post appeared today:  Play to Your Strengths: which takes a look at the problems that many women face when trying to be “balanced” and “have it all”.  I would love to hear your thoughts; please feel free to leave comments on either website.  Also, please let me know if there are any other topics you would like me to cover or books that I should check out.

Mindfulness meditation is a term that is used to describe the cultivation of “non-judgemental, moment-to-moment awareness” of events in our daily life.  Through the purposeful exercise of bringing our awareness to the present moment, we can learn to be “more present” in our day to day lives and less distracted by ruminations of the past or anxieties about the future.  Such a practice can lead to a greater richness and fullness in relationships with spouses & children, help with problems with over-eating, as well as help coping with chronic stress, pain, or illness.  While it is based in Buddhist mediative discipline, Mindfulness Mediation is not a religious meditation; although, being “mindful” and “present” is emphasized by most religious and spiritual traditions.  Mindfulness meditation is not for the purpose of relaxation, although you may feel more relaxed, but rather an exercise in bringing our awareness to the present moment, “the only moment in which we are really alive”.  Most any activity can be done “mindfully” by experiencing the activity with all of our senses.

Mindful breathing is foundational to many mindfulness exercises and is a great place from which to begin a mindful meditation practice.  Mindful breathing does not require a large commitment of time, any special equipment, or location.  Our “breath” intersects both the voluntary and involuntary nervous systems.  Because of this, mindful breathing offers a wonderful opportunity to experience mind-body connectedness.  You may have noticed that when you are very upset or agitated, your breath becomes shallow and rapid.  This shallow breathing further exacerbates feelings of anxiety and creates a negative feedback loop.  Conversely, when we focus our attention on the breath and allow it to “be” without forcing it to be any particular way, our breathing calms down and with it, our mind calms down as well.  Our mind receives the message, “Everything is okay, no need to worry”, which helps us to feel at ease.

Here is a brief, introductory mindful breathing exercise:

Assume a comfortable position, either seated or lying down.  Allow your awareness to center on one area of the breath: such as the flow of air at the nostrils or rise and fall of the abdomen, but away from the mind and “thinking”.  Allow your body to breathe in and out exactly as it wants to.  You may notice the flow of the air in and out, the onset of the breath, the inflection point just before you begin to exhale, and the length of the pause before your next breath begins. Be aware that with every breath you are nourishing every cell in your body. Continue to follow the breath in and out of our body.  When your thinking pulls you away, as it will certainly do, notice the thoughts without judgement and gently bring your focus back to your breath.  Continue your practice for a comfortable period of time; perhaps starting with five to ten minutes.

Guided mindful mediations are a great way to experience Mindfulness Meditation and are readily available from various sources.  I have enjoyed the CD “Mindfulness for Beginners” by Jon Kabat-Zinn (available on iTunes or through Amazon.com).  I also highly recommend “A Mindfulness-Based Stress Reduction Workbook” by Bob Stahl, PhD and Elisha Goldstein, PhD. for more complete instruction in the art of mindfulness meditation.