License, No License?

I don't usually quote P. T. Barnum, but today I must. Not "have to," mind you, but must because I've, once again, run into a situation that warrants it for the public good.

On my recent trip, I met many people from all over the world and many of them are in or are entering the mental health field on an advanced-degree level. This is where good old P. T. of circus fame comes in. Remember he said, "There's a sucker born every minute?" He had another one, too, and it was, "Every crowd has a silver lining." Well, some people are taking that to the bank, or plan to and it will be at the expense of those who don't carefully screen service providers as well as the local laws that permit such actions.

While seated at breakfast, I listened as one person bubbled about how, not being able to get licensed as a psychologist in a particular state, this individual, nevertheless, would practice because hypnosis was a fertile field just waiting for the unlicensed. I don't know what the laws are in every state regarding hypnosis and who may be qualified to practice it, but this person seemed to know this particular state would let anyone have carte blanche. Yes, no national exam, no necessary licensing, no supervision, no required continuing educations credits, nothing. All they needed was office space and a sign out front and there they were, in practice.

It was a way to get around something that is the thorny problem of calling yourself a "psychotherapist" or claiming to do "therapy" because this person would just offer hypnosis and "it will just go wherever it goes." I suspect that means that it may just enter the area of therapy, but it wasn't the hypnotist's problem, was it? No, it was the client or consumer or whatever you called this "mark" as they do in the crime world.

Am I using that term "crime" too freely? I don't think so because, as I see it, this is a direct attempt to commit fraud in terms of services. Insurance companies don't allow themselves to become "marks" and they avoid anything that isn't qualified for payment. Shouldn't you do the same?

Related Topics: What Hypnosis Does to the Brain, How to Find A Therapist


Technorati Tags: therapist, screening, license

Anxiety and Stress in Postpartum Women

The problem of postpartum depression has, deservedly, received renewed research and public interest thanks to many high-profile women talking openly about the problem and several, unfortunately, high-profile murder cases. Researchers, however, may have focused their attention on only one postpartum problem to the exclusion of another, anxiety and stress resulting from childbirth.

Now, a research article in the British medical journal Psychiatry (2006, 6:12) has brought this problem to the fore. The authors indicate that a measure which is widely used, the Edinburgh Postnatal Depression Scale, was minimizing or overlooking anxiety in the absence of depression. Therefore, women with postpartum-related anxiety and stress symptoms failed to appear as a group which should be considered for treatment. They set out to rectify this error and to "assess the prevalence of postnatal distress using this scale and another, the Depression Anxiety Stress Scale (DASS-21)."

A sample of 325 women ages 18-44, with a mean age of 32, were evaluated in health centers in Australia. The result was that a total of 41 women of the sample not only had depression, but symptoms of anxiety and depression.

The implications are that women need to be evaluated not only for postpartum depression, but the symptoms of stress and anxiety which may be hidden if current methods of evaluation are continued. Healthcare workers, therefore, need to be mindful of these additional treatment issues and look for more sensitive instruments for evaluation.



Related Topics: Babyproof Your Sanity: Six Tips for New Parents, New Moms Need Time to Heal

Technorati Tags: postpartumanxiety, postpartumstress, postpartumdepression, postnataldistress

Sick Building Syndrome Study

Millions of people get up each morning feeling tired, but pretty much okay and it may remain that way until they actually get to the office. Once the building looms large in front of them, it begins. They feel sick then, or they begin to feel sick just after they wake up in the morning. What is it?

Over the past few decades, a new word came into our vocabulary: sick building syndrome. Some buildings, true, have architectural design problems that have led to improper venting, poor air circulation or the growth of mold. All of these can make you sick and one very famous building, which shall remain nameless for now, is said to have major problems with their environmental air quality.

But an article published in Occupational and Environmental Medicine (March 2006) details a study of 4,052 Londoners and their relationship to the building in which they work. The researchers included 44 different locations in the London area and what did they find? It's not the building, it's the job and the employees' ability to have some control over their actual workstations. When they did, the symptoms they were experiencing decreased in number. Interestingly, younger workers and women had more symptoms.

Although buildings may have inherent problems that can contribute to illness, the stress of the job appears to play an even greater role in employee health and the researchers believe that has been missed in the attention being paid to the building rather than the workers.

One thing we should also remember is the contagion factor in employee illness. I'm not referring to bacteria or viruses, but to emotional factors. When a worker begins to become sick, they pass it on to other workers, even when it's a stress-related illness. If you listen to conversations in workplaces, you will begin to notice that there may be a common threat in many of them and it's often centered around management and its demands on employees. Once employees feel undervalued or overworked, a different kind of environment is set up and it's not one conducive to health of either the physical or emotional type.

Related Topics: Top 9 Jobs Where Bacteria Thrive, WebMD Health Poll: How Stressful is Your Job?

Organized But Still Stressed

Good organizational skills don't seem sufficient to protect women from the anxiety that comes from being so over-scheduled, according to an article in the Journal of Marriage and Family.  Organization may have led to more free time, but even that wasn't enough to ease the sense of feeling rushed and anxious.

Women, unfortunately, appear to feel more rushed than men, but perhaps that's because of societal pressure on women.  The research actually was an analysis of two prior studies done in the 1975-1976 and 1998-1999 ranges, so it may not account for other factors that would seem to ease this stress, such as computers, but actually don't.  I'm reminded of the new gadget that was recently introduced by Microsoft for the so-called "soccer moms" that advertisers seem to be falling over themselves to get to buy new gadgets.  

The device, which is supposed to make mom's life easier, actually is another tether to keep her ever-connected and to eliminate that much-needed downtime that mental health professionals know is necessary.  So, instead of whiling away her time watching little Johnny or Mary on the soccer field, mom can now catch up with her e-mail, do some shopping, write notes to herself or check her schedule.  Now isn't that a wonderful thing?  The next thing they'll come out with is a device that cardiac patients can use in the CCU to keep up with their office duties.  Obviously, I'm being facetious here.  The nurses, bless them, would never permit it.

Related Topics: High-Tech Weight Loss, Exercise, Stress Management Curb Heart Disease

Technorati Tags: stressinwomen, stressmanagement, cellphones, PDA

The Integrated Approach to Life

One of the truisms of life, to my way of thinking anyway, is that life's not really very simple and there are no quick-and-easy ways to handle the unexpected roadblocks you may face. Another thing I know, too, is that you can learn to navigate life's course, become adept at creating solutions that fit into your life and leave you happier and healthier.

So, following along with this theme of life and how to best handle its challenges, we need to look at a more integrated approach to life. How do all the pieces fit in and what do we need to do to make it work best for us? There are no really one-step fixes that will do it just like there's no "miracle" diet to lose weight such as the "diet of the week." If those diets worked so well, how come we always need a new one each month? Simple. They just don't work. This is where planning and creativity come in.

You don't have to be an Einstein to handle your life and, as I've always said to my patients, you don't have to re-invent the wheel. It's there and you just need to figure out how to put it on your wagon.

Research and common sense have led me and most of the professional community to believe that a holistic approach is the sane approach. So, it's not just medication or just therapy or just diet or just exercise. It's all of these elements and that's why I'm happy to see that the folks here at WebMD have created just what we needed; a site called Integrative Medicine. See if you don't agree with me on this one. I know it's going to be very helpful for everyone who dips a toe into this particular pool and soon you'll see you will want to swim, not just dip that toe in.

Related Topics: Chronic Stress: The Body Connection, WebMD Video: Success Over Stress

Technorati Tags: integrative medicine, medical treatments, acupuncture, biofeedback, hypnosis, meditation

Respect Thy Patients

Have you ever gone to your doctor's office and not felt any anxiety whatsoever?

I think few people can confidently answer 'Yes' to that question. If it's not our concern that our physician may discover some illness or problem, it's our wish not to know what something is when we find a lump or get dizzy or feel sluggish. We'd rather not know, we tell ourselves, because it might mean we have a dreadful illness. The fear not only keeps us from getting medical check-ups and regular dental care, it keeps us in a state of constant apprehension, waiting for the other shoe to drop.

What might contribute to this fear of going to our doctor's office? It might be a bad experience with a healthcare professional, painful treatments, or something bordering on disrespect. But all of this is going to be the old medical model. Patients have been letting healthcare professionals know that they are no longer patients they're 'customers', and they want different treatment. In fact, I saw an article devoted to just that subject in a major New York City newspaper.

While I've heard some professionals reminisce about the 'good old days,' I also know that medical schools and residency programs have done some major retooling. I had an opportunity to teach second-year med students how to interview patients in a hospital. The first thing I told them was that you have to introduce yourself and ask how the patient would like to be addressed.

I find it rude and unacceptable when an elderly woman or man is treated like a department store mannequin and addressed by their first name. I wasn't raised that way, and it's not something I've ever done. I know that I am here, safe and secure in my home, because the elderly of this world worked long hours in dreadful conditions just so I could reap the benefits. I will never forget them for their contributions to the world in which we live.

One of my fondest memories is of an elderly man I met one day while consulting at a nursing home. He was at the end of the hall in the last room, and he was all alone. The nurses thought he could use someone to talk to and I obliged.

I only got to meet him twice because he was gravely ill, and he was a delight. I sat listening as he told me how he had been a coachman and how they heated the coach with a pan filled with hot coals in the winter. I would have loved to have heard more.

Other residents would tell me of their memories of childhood in Europe or the streets of New York or the film sets of New Jersey. Each of them gave me something and for that, also, I am grateful. Too often it is the illness and not the person that has been treated, and we need to get back to remembering that whether 'patients' or 'customers,' each person is an individual who deserves our caring and our respect.

Related Topics: Seniors: Longer Lives, Better Health, 7 Key Traits of the Ideal Doctor

Technorati Tags: patientrespect, medicalcheckups, doctorsofficeanxiety

The Case for Therapy

Ideas are powerful and so are words. Putting the two together is, essentially, what is done in psychotherapy. I'm always interested in articles that tell me why or how something works, and so it was when I began reading a professional article on our brain's lifelong ability to reorganize itself simply by new experience. If experience is the best teacher, this article has certainly made another case for that distinction.

Remember what you've heard about the brain and how we were always being told that it had all the cells it ever would have and that there was little hope for building a better brain for ourselves? I can recall nothing but negative comments in terms of hope for the brain in this increasingly stressful world of ours. It seemed that what was there when we were born would be all we'd get, and we'd just have to learn to tend that garden lovingly and hope to keep it producing year after year. I learned a few years ago that the brain actually has a hidden reserve of cells deep within it that could, if scientists are correct, make it possible to grow entire sections of whatever brain cells we needed. I found that extremely hopeful.

The authors of the paper not only indicated that brain growth and strengthening of connections through experience (therapy), aided by medication, could foster greater growth (neurogenesis) in adults. The results of their investigation also provided a key to the role that stress plays in defeating this brain growth by decreasing the availability of something called BDNF (brain-derived neurotrophic factor). It is this factor which is responsible for much of the brain's ability to grow and adapt. The technical term for it is neuronal plasticity, meaning those little cells are able to serve us if we only train them.

So, decreasing stress levels is not only good for your physical and mental health, it's beneficial to your brain and your ability to adapt to whatever comes your way.


Related Topics: Antidepressants May Boost Brain Growth,Stressed Out!

Technorati Tags: psychotherapy, braingrowth, stressmanagement

Carbs and Anxiety

When anxiety or panic attacks return after successful treatment with medication, there may be many causes, but few among us would suspect diet. A case of a woman who had received just such successful treatment and who, once she began a high-protein, low-carbohydrate diet, began to have attacks was described in Psychosomatics' April 2006 issue.

The woman, who began The Atkins Diet, which is centered around high protein and low carbohydrate intake, began to experience increasing intensity of panic with all the classic symptoms. Attacks were sudden and lasted an average of 30-45 minutes. Suspecting that it may have been her diet, she returned to eating carbohydrates and all symptoms ceased shortly thereafter.

The authors of the case presentation indicated that such diets have been shown to be linked to mood change, fatigue, dizziness, headache, confusion, and sleep problems and all of this is documented in the professional literature. They suggest there may be a link between ketosis (fat metabolis)) and levels of serotonin in the brain. Carbohydrates have also been shown to play a role in serotonin levels by way of tryptophan, and this may explain the mood changes shown.

The thing that readers should take from this article is that diet can play a dramatic role in anxiety and, especially, mood disorders.

Related Topics: Build Your New Food Pyramid, The Whole Truth About Whole Grains

Technorati Tags: low-carbdiet, high-proteindiet, anxietydisorders, panicattack

Your Turn Now

As I engage in that seemingly endless struggle to work on another book, the thought occurred to me that I should ask readers what they'd like to see. So, here it is.

What would you like to see my next book tackle? What are the topics that interest you and which you'd like to see covered in my blogs? Is there something that is of particular concern or presents a difficulty that you'd like to see a psychologist write about and offer ways to handle it?

I can't promise that I'll get to all of them, but it will provide me with some valuable direction for this blog.

I'd like to hear from you. No idea is too obvious or unworthy of consideration. I remember I used to tell my college students that they couldn't ask a stupid question because, if it was something they didn't know and wanted clarified, it certainly wasn't stupid.

Bring on the suggestions. Thanks.

Cardiac Patients and Stress

Stress is a problem which, when unchecked, can cause a host of problems and this has been confirmed in a study which appeared in the Journal of the American College of Cardiology. The study, which looked at the cardiac consequences of performance anxiety, an argument with a loved one or doing math calculations and its related stress, found that "what goes on in their heads could have consequences for their hearts as well."

The results of the study indicate that certain heart disease patients are more vulnerable to the physical effects of this psychological stress. Anxiety, depression and anger were seen as contributing to heart-related problems. Investigators found that one-third of their patients had temporary changes in heart rhythm or restricted blood flow, even when they were placed in artificial situations where they role played the aforementioned problems with anxiety and stress.

One of the professors indicated that "we believe the phenomenon of mental stress-induced reductions in blood flow to the heart is much more common than has been previously recognized." Psychological stress was seen as playing a potentially lethal role in arrhythmias, blood clotting, and spikes in blood pressure. The stress may bring on, it's theorized, spasms in the small blood vessels of the heart and reduce blood flow.

In order to help cardiac patients in a complete treatment plan, the researchers suggest, it's necessary to come up with real-life solutions patients can use every day to avoid this dangerous predisposition to stress.

Related Topics: Learn & Live Quiz from the American Heart Association, Why Men and Women Handle Stress Differently


Technorati Tags: heart disease, stress, high blood pressure

Weight Control and Your Nervous System

Weight continues to be a major concern for many people and in their efforts to either lose weight or maintain their weight some products may be chosen that could result in problems with anxiety.

In 2003, a ban was issued on ephedra as a non-prescription weight-control product. The FDA considered there was reason for concern a potential health problems could result from its use. Appeals were launched, however, and it may be back on the market.

What is the problem? Anything that can cause your metabolism to ramp up and body heat product to increase may signal problems. The FDA noted over 16,000 adverse events and other groups indicated their were actual deaths resulting from its use.

I recently had a conversation with a psychologist who talked about a patient who is in the military and this man was enthusiastic about ephedra and wanted his wife to stockpile it. Why? It seems that there are strict weight guidelines that military personnel must maintain and, if they don't, their career may be adversely affected.

My concern is the fact that any stimulant that may cause excess heat production or, possibly, excess urination may also affect the delicate balance in the nervous system. Sodium and potassium are vital for normal nervous system functioning. A change can result in high anxiety, insomnia, irritability and even suicidal thinking, so please do your homework if you intend to go on any diet or diet supplement. It's your body and you only have one of it.

Related Topics: Federal Court Weakens FDA's Ephedra Ban, Report Urges Tougher Dietary Supplement Law

Technorati Tags: ephedra, anxiety, weightlosssupplements

Stress and Abortion

South Dakota's governor signed an abortion ban into law today. I can only wonder what this will mean for women in that state who find themselves pregnant and who would have found such a procedure necessary. I'm not trying to be political, but I am trying to look at the facts as they may play out.

Recently, I read Freakonomics in which the economist Steven Levitt takes what he knows is an unpopular stand regarding abortion. He analyzes the data and finds that there is a direct relationship between unavailability of abortion, as in Roumania a decade or so ago, and the rise of crime. How do these two facts correlate?

Levitt says it may be that these mothers who did not abort were teenagers unable to raise children, too poor or unavailable emotionally and their children ended up in lives of crime as a result. All of this may be true, but what else do we know about unwanted pregnancies?

Unwanted pregnancies are stressful pregnancies. We can only imagine how this stress affects the fetus as it develops and how the emotional climate after this child's birth will continue to affect it in negative ways. Children born to stressed mothers, according to a 1999 study from the University of California School of Medicine, are more likely to have low birth weight and to be born prematurely. Mothers in these situations are more likely to decrease their attention to nutrition, smoke, drink or use drugs. Alcohol abuse in response to stress in a pregnant woman can lead to children with Fetal Alcohol Syndrome, a life-long problem of lower intelligence and behavioral outbursts. Then there is the problem of insomnia brought on by the stress, irritability, increasing anxiety and increasing levels of stress hormones.

I can remember my mother telling me many years ago about how poor women in the neighborhood, who had no access to birth control, went to back-alley abortionists. In some instances, it meant a large family without a mother after she died as a result of this.

Related Topics: Less Stress for Healthier Mom and Baby, Abortion Impact: Long-Term Stress?

Technorati Tags: abortion, teenagepregnancy, abortionlaw

Stress: The Mind and Knowing

"What the mind does not know, the eye does not see," reads an Asian Indian expression. I was told that many years ago as I sat with a physician looking over a research proposal at a hospital. We'd read it over several times and still it didn't seem right; we were missing something.

Have you ever read and read something and felt that you either didn't really "get" what it meant or had problems seeing how it applied? It doesn't help if someone comes along, reads it over and says something like, "It's as plain as the hair on your head." You wonder; were they being sincere or making fun of me?

Stress has an ability to decrease your ability to "see" in all its aspects. You don't see the intent of a memo, the real focus of a piece of research or the holes in it and you suddenly realize that your mind is clouded by something.

We had read and re-read that research proposal over and over and it just kept feeling like we were walking in mud. Years before, I had used a very famous psychology experiment, The Stanford Prison Experiment, in my undergraduate classes to show students how even experienced researchers sometimes miss the problems in their research. Now, I was the one on the receiving end of not knowing what was wrong here.

The physician and I decided to call it a day, take the proposal home and get back together later in the week and when we did, we saw it through fresh eyes. I had put mine on top of a bookcase and just let it sit. I knew that too many re-readings wouldn't help. I needed some distance from it.

When we met again, the problems in the proposal shouted out to us and we had one of those "voila!" moments. There it was and it was sitting there all along for us to see, but we didn't because of the stress we were under.


Related Topics: Women More Sensitive to Stress Than Men?, Marital Support Eases Job's Blood Pressure Toll

Technorati Tags: stress, perception, comprehension

Elderly "Criminals?"

Who is a criminal? Is it the person who walks into a bank and robs it or the man who, with a sick wife and no money for her medicine, takes the medicine from the pharmacist's store without payment? Technically, both are criminals, but we have to remember that there are differences in the intent and, perhaps, that needs to be taken into consideration.

In psychology, we look at morality and how it is developed, but there have been some problems in this theory of moral development and now the question has to be asked if a moral person can commit a crime. Obviously, the answer is yes.

I read about an elderly 87-year-old woman riddled with pulmonary problems and needing constant oxygen and I was, again, brought back to the plight of those in need and who step over that moral boundary.

The woman in question must have felt intense stress, anxiety and fear as she did what she knew was wrong; sold her pain medication to drug addicts. Living on $500 a month must have forced the decision that pain would be her companion for the remainder of her life. I can believe she felt if she could endure more pain, perhaps she could afford something else she needed like fuel or food or her oxygen perhaps.

One man I heard about recently had to spend $2,000 a month on one medication and he couldn't afford it, so he just didn't take it. How could he have taken it? A physician I know has to spend over $1,000 on one medication she needs and it is not an easy task for her. Both have autoimmune disorders that are debilitating and strain the quality of their lives. The stress of paying for these vital medications, too, adds to the intensity of the symptoms they feel and their exacerbations of their illnesses.

The sheriff in this particular case finds himself and his deputies in a very stressful situation, he admits, because now they have criminals who need doctors, daily medical care and medications. It's job stress unlike anything he could have imagined. There's a ripple effect here.

The medical professionals, too, are feeling increased stress because they have to give the elderly drug screens to make sure they're taking their pain medications. Staffers have to call patients perhaps more often just to check up on them. Who would have thought that drug dealers would get such treatment? I'm not intending to be funny here, but it does seem a peculiar situation that the only way to receive more attentive help is to be thought guilty of committing a crime.

Not everyone feels the elderly involved are good people gone somewhat "bad." One man said they were just doing what their families always did, steal. He called it a "family tradition." So, we can malign them, jail them and mistrust them because they must be criminals. Not a happy thought.

Related Topics: Supplementing Medicare?, Medicare Benefits

Technorati Tags: seniorcriminals, seniors, stress, medicalcosts

Stress Study

Stress-related studies cause my ears to perk up and my eyes to widen, so it was that I began to read the results of a recent survey conducted by The American Psychological Association in conjunction with iVillage.com and the National Women's Health Resource Center. The results certainly looked interesting enough.

The survey found that Americans smoke too much, eat too much and are too inactive in response to stress. None of that is very earthshaking to me or, I suspect, to you. You know that carbohydrates seem to provide comfort and fight depression and you also know that cigarettes contain a mild anxiolytic (nicotine) and you know that when people are stressed the first thing that comes to mind is to try to sit down and relax, not get up and exercise. They don't have images of jumping jacks running through their heads as they make the journey home to their safe retreat.

Yes, survey participants also worry about money, elderly parents, the nightly news, their kids and spousal health. All things we'd expect. I guess I would have liked to have Steve Levitt, the maverick economist and author of "Freakonomics," sitting beside me to help sort this all out. Levitt has an uncanny way of explaining so many things that I would value his input.

What was bothering me about this very impressive study? Well, for one thing, it didn't address where the survey may not have provided information we didn't already know. It was a "random-digit-dial telephone survey" and it reached 2,152 adults age 18 and over. Impressive. But, it was conducted during the winter months and what do we know about that? Well, people exercise less, eat more (especially comfort food) and they might stay indoors and socialize there where smoking helps with social anxiety.

Okay, I'm being picky. I do think that stress is serious, has a negative impact on your mental and physical health and it deserves more attention. I also think that we should be doing something each day to give ourselves a stress break. Let me hear your tips to fight stress. Yes, I do want to hear them.

Related Topics: Beating Winter's Woes, Sleep Loss in America

Technorati Tags: stress, depression, stressstudy