Sunday, July 20, 2014

My Experience Starting Meditation

I have recommended that my patients give meditation a try for a while now and decided that I should take some of my own medicine.  There is a lot of good empirical evidence supporting the efficacy of meditation and mindfulness practices in the treatment of depression and anxiety, among many conditions.  In addition there are really no side effects to balance against the benefits of meditation as there are with medications.

So with that in mind I decided to embark on my meditation journey.  First I did some reading.  I strongly recommend Jon Kabat-Zinn's work (especially Full Catastrophe Living), Mark Epstein's Thoughts Without a Thinker, and Rick Hanson's Buddha's Brain.  Each of these authors make a strong case for meditation and for accepting suffering as a given rather than something to waste effort avoiding.  Epstein and Hanson also make connections between meditation and neuroscience highlighting the scientific evidence for meditation's efficacy.

Once I had convinced myself that meditation had empirical support and was not just a new-age trend, I needed some help getting started.  Because I like technology I turned to smartphone apps that could guide me through some basic exercises.  I ended up using the headspace app and have been using it now for several months.  I really like the integrated approach used in this app. Each meditation builds on the last.  The first two series are shorter, ten and fifteen minutes respectively, and lead you to twenty minute meditations which is where the benefits really start to accrue. There is a subscription fee for the app after the first ten meditations but I have found it worthwhile.  Note, I have no connection or business arrangement with Headspace folks.

So what was it like to get started?  I found it difficult at first to make myself sit quietly for fifteen or twenty minutes (ten minutes was quite easy though).  There always seemed to be something else I thought I needed to do.  Weekends were especially difficult because my schedule was less predictable and I had trouble isolating myself from my family to meditate.  I suppose I felt a little self conscious, what I later discovered was ego imposing itself.  The key, I found, was not to let a few missed meditations scuttle the whole enterprise.  I got back to it when I could and gradually came to value the experience enough to prioritize it in my day.

Somewhere in the Take-20 series I had a powerful experience of relishing the time I was taking for myself.  I felt relaxed and joyful just to sit back and focus on my breath, doing nothing but settling the mind and being present in the moment; what a wonderful feeling!

At this point I miss a day here and there but for the most part I have established a pattern.  I highly recommend the practice, especially if you suffer from depression, anxiety or a sense that you cannot tolerate a feeling you have.

Wednesday, June 11, 2014

You Don't Have to be Sick to Talk to Psychologist

For some reason we have equated talking to a psychologist with a medical visit. We think that there has to be a problem for the doctor to fix to make it worthwhile to visit a psychologist. Where did this idea come from?  Why do we have to be in emotional pain or completely overwhelmed before we decide to talk to someone?  And when did all of this become a medical specialty?
Talking to a psychologist helps

There are lots of studies that document the effectiveness of psychotherapy for all sorts of issues including smoking cessation, anxiety, career burnout, depression, and many more.  I wrote about some of this evidence in my posting Does Therapy Really Work?  Furthermore, we know that talking to a psychologist can head off problems before they get too big to manage. For example businesses utilize psychologists to maximize efficiency and worker satisfaction. Sports teams consult with psychologists in making staffing decisions and helping players maintain peak performance. There are fascinating and useful studies on the prevention of stress and burnout in the workplace. Physicians and nurses have been helped in avoiding what is called "compassion fatigue" brought on by the demands of caring for the sick. 
Achieving our best
Psychologists can help you live more a productive and satisfying life. We don't need to be in pain in order to reach out for these services nor do we need a diagnosis in order to begin living our lives more fully. By talking in a safe and facilitating environment with a well-trained psychologist you can begin to explore all those areas that may be strengths and also some of the neglected corners.  By discovering more about yourself you can allow your natural capacity for adaptation to do its best.  Think of it as a tune up or an attitude check.  That's what top athletes and professionals do.  We can't always be at the top of our game and sometimes the ways in which we cope actually get in the way of our natural resilience.
Just Talking
My job as a therapist is to help you to talk.  It's not that hard really but sometimes knowing how to ask some of the right questions and listen for the blocks can really help you to explore your thoughts and feelings.  If you are interested in going a bit deeper we can try Therapeutic Assessment, a collaborative technique using psychological testing to answer questions you may have about yourself.  I wrote about that here.
So lets just agree that you don't have to wait to have a cold to start working on your immune system.  Give me a call if you are interested in learning about boosting your resilience or knowing more about yourself.

Wednesday, January 15, 2014

Does Therapy Really Work?

A lot has been written about what therapies work for what disorders in what patients.  A more central question is whether talk therapy in general has any evidence to support its efficacy in relieving human suffering.  It's a fair question but first let me say a little about the nature of the debate surrounding therapy effectiveness.

Many of the articles out there fall into a category that I refer to as "horse race studies."  These studies basically try to establish the superiority of therapy x over therapy y.  While interesting, they have more academic than practical relevance in most cases.  A broad literature establishes that non-specific factors, things like the alliance between the therapist and patient that exist across all therapies, are actually more related to outcome than specific techniques associated with say Cognitive Behavioral Therapy or Psychodynamic therapy. (For a review of research on non specific factors look here).

About a year ago I had the pleasure of attending a talk given by Jonathan Shedler in which he presented a summary of the research on psychotherapy effectiveness with an emphasis on longer term psychodynamic therapies.  Here is a brief summary of that excellent talk.

First, the current methodology for evaluating therapy effectiveness is the statistical technique called Meta Analysis.  Using this well-established technique, researchers can pool data from a number of studies and compare studies using a metric called Effect Size.  An Effect Size of 1 means that there was a change of 1 standard deviation on whatever is being measured.  Put another way it would mean that an individual was one standard deviation better on a measure of depression.  In the general population a 1SD change in height would mean that the average person would be six inches taller, or in terms of weight 70lbs lighter.  In other words this would be a big change.

In meta analysis an effect size of .20 is considered small, .50 medium and .80 and up large.

If you watch any TV at all you might think that medication treatments for depression were massively effective but are they?  According to meta analytic comparisons from FDA data Prozac and Zoloft have an effect size of .26, Lexapro .31 and Celexa .24.  These are all SMALL effect sizes.  What is even more disturbing is that there is evidence of bias in the reporting of this data in that about a third of studies never get published because they are not favorable.

OK, so medication is not the cure all we have been promised by advertising.  How does therapy stack up?

Smith, Glass and Miller (1980) looked at 475 studies and concluded that Psychotherapy produced an effect size of .85.  That would be a LARGE effect size and this finding has been replicated by others. In fact, one study including almost 1500 subjects found that psychodynamic therapy had an effect size of .97 immediately after treatment.  More importantly the positive effects INCREASED over time to an effect size of 1.51 nine months after treatment ended.  This may be because the therapy gave clients skills that they could apply to many aspects of their lives.

So psychotherapy is effective as established by rigorous science.