therapy

Mindfulness — Essential Bipolar Survival Skill?

→ July 13, 2016 - 17 Comments

Mindfulness — Essential Bipolar Survival Skill?

I wrote that Mindfulness Doesn’t Help My Bipolar Disorder. And I think mindfulness, at least how I was taught it, just doesn’t significantly, positive affect a serious, neurological illness. I find it works best in people who experience stress and anxiety. And many do agree with me on this.

That said, John McManamy does not. Here are his thoughts on mindfulness in bipolar disorder.

——————

Mindfulness is essentially the mind watching the mind. The practice has been around forever. It is a staple of Buddhist practice, and is also the basis of modern talking therapies such as cognitive behavioral therapy (CBT), even if its proponents fail to give it credit.

In all likelihood, if you have had success in managing your bipolar, you are employing mindfulness techniques, though you may be unaware of it.

Read more

Why Therapy Can’t Treat Uncontrolled, Serious Mental Illnesses

→ September 24, 2015 - 23 Comments

Why Therapy Can’t Treat Uncontrolled, Serious Mental Illnesses

I have been through lots of therapy and lots of therapists in my life and my contention is that therapy can’t be used to actually treat uncontrolled, serious mental illnesses. Now, don’t get me wrong, therapy can be supportive to a person with an uncontrolled, serious mental illness and therapy can be useful to a person with an uncontrolled, serious mental illness (such as in the case where the therapist tracks your bipolar symptoms and report changes to your doctor) but therapy cannot be used to actually treat a serious and uncontrolled mental illness.

Read more

How’s the Mindfulness Meditation Class Going? – Week 1

→ March 24, 2013 - 7 Comments

How’s the Mindfulness Meditation Class Going? – Week 1

As I said before, I’m taking a mindfulness meditation class and I can’t say as I particularly believe in mindfulness meditation. But, as I mentioned, I need to give treatments a chance if I want to get better, so, believe in it or not, I’m giving mindfulness meditation the ol’ college try.

The First Class of Mindfulness Meditation

In the first class we learned about deep breathing and the body scan (article to follow). These are really simple skills that anyone could do. But thinking about sitting still while “breathing” and “scanning my body” seemed kind of silly to me. I didn’t see how anything useful could result.

But I tried it anyway.

Read more

Mindfulness Meditation Skill #1 – Deep Breathing

→ March 22, 2013 - 5 Comments

Mindfulness Meditation Skill #1 – Deep Breathing

In my effort to document the mindfulness meditation class I’m taking, I introduce skill #1, something easy: Deep breathing.

I know, you think you know how to breathe. In fact, my guess is you’re probably doing it right now (at least I hope you are). Nevertheless, many people don’t know how to deep breathe and this is a problem during mindfulness meditation. Many people, especially women, shallow breathe and this isn’t the best way to nourish your body. Some people even go so far as to occasionally hold their breath, especially when anxious.

Shallow Breathing vs. Deep Breathing

Shallow breathing comes from the chest while deep breathing comes from the belly. (I know all about this because I was a trained signer when I was younger and you have to deep breathe in order to project and hold notes properly.) Women, often, don’t like to deep breathe because they’re scared that breathing from their belly will make them look fat. (Really.)

How to Know if You Deep Breathe or Shallow Breathe

Read more

Tips for Creating a Mindfulness Meditation Practice

→ March 20, 2013 - 2 Comments

(They call meditation “practice.” I suppose it’s to indicate that we’re all students and that we’re never done learning. It’s kind of a warm, fuzzy concept but I think it’s worth remembering.)

Tips on Mindfulness MeditationTips on Creating a Mindfulness Meditation Practice

These are simple, easy-to-remember tips on creating  a mindfulness meditation practice according to the course (and a little bit from me.)

Here are the tips provided when beginning a mindfulness meditation practice:

  1. Choose a sacred space and time – there is no perfect time for a practice but if you make it part of your routine, you’re more likely to do it. Make sure to minimize distractions. (And realize that your space might just be the corner of your living room. We don’t all have ashrams to retire to.) Many people find meditation earlier in the day easier.
  2. Sit in a comfortable and strong position – either in a chair or on the floor, sit with a straight back with your legs uncrossed. Let your face relax into a natural smile and let your hands rest on your lap or cupped in each other.
  3. Use a gentle-sounding alarm to time your practice – so you relieve the worry of time.
  4. Make your mantra, “meditate anyway…” – things will always seem “more important” than meditating and things will always stand in the way of your meditation practice – do the meditation anyway. Even if it is only 5-10 minutes, this is better than nothing and it’s daily practice that’s going to make this meditation useful (not to mention easier to continue in the future).
  5. Be gentle – let go of any preconceived notions of what a meditation “should” be and just be curious about whatever arises.
  6. Gently bring your mind back – when meditating, if your mind wanders, understand that this is normal and gently bring your mind back to the here and now.

I admit to not using all of these tips but I do think they are a good idea.

I’ll talk about how I put these mindfulness medication tips to work with some mindfulness meditation exercised next.

What is Mindfulness and Mindfulness Meditation?

→ March 20, 2013 - 9 Comments

What is Mindfulness and Mindfulness Meditation?

I’m going to be talking about an eight-week course I’m taking on mindfulness meditation, but before I start with my experience, I have to define a few terms so we’re all on the same page. I’m going to define mindfulness and mindfulness meditation so we all know what we’re talking about.

What is Mindfulness?

Well, that depends on who you ask. A very simple definition for mindfulness might be, “being right here, right now, and nowhere else.” Mindfulness has also been defined as “purposefully paying attention, in the present moment and without judgement.

Mindfulness MeditationAccording to Sheri Van Dijk, MSW, author of The Dialectical and Behavior Therapy Skills Workbook, mindfulness skills, “. . . help people to live more in the present moment, rather than getting stuck in the thoughts about the past or future, which can trigger painful emotions. These . . . help you get to know yourself better, because you’re focusing on the present moment, you’re more aware of your emotions, thoughts, and feelings.”

Multi-tasking is the antithesis of mindfulness. (Personally, I still don’t think multitasking is always bad and I don’t think mindfulness is right for all occasions. But that’s my personality and a function of my job.)

While mindfulness is a form of meditation practice, you don’t have to sit cross-legged on a yoga mat chanting in order to do it. Both formal practice and informal practice can take place.

Formal and Informal Mindfulness Practice

Read more

Trying Bipolar Therapy You Don’t Believe In – Mindfulness Meditation

→ March 18, 2013 - 21 Comments

Trying Bipolar Therapy You Don’t Believe In – Mindfulness Meditation

When people ask me about bipolar treatments or bipolar therapy here, I tell them about the research on the therapy or treatment and I tell them this, “different bipolar treatments and bipolar therapies work for different people so try it and see if it helps.”

And I consider this good advice. It’s absolutely true. Different bipolar treatments and bipolar therapies do work for different people – but that doesn’t mean that I, personally, believe in them.

And, to be clear, it’s not so much that I don’t believe in them entirely, it’s more that I don’t believe in them for me.

Enter mindfulness-cognitive therapy or mindfulness meditation.

Read more

Why People Refuse Therapy – Therapy Feels like an Insult

→ August 30, 2012 - 41 Comments

Why People Refuse Therapy – Therapy Feels like an Insult

Yesterday I was at my psychiatrist’s and I wasn’t doing terribly well. It seems I’m a little stressed. Turns out being a well-known mental health writer is a smidgen more challenging than one might think.

And so one of the recommendations my doctor made was to do some mindfulness training in a local program.

Instantly I felt myself rile against the idea. Internally I was feeling very resistant against yet more therapy.

And I realized why – therapy feels like an insult. The idea that I need more therapy seems to suggest that I’m not handling my disease in the best way possible. This seems to suggest that I don’t know everything already. More therapy feels like I’m doing something wrong and have to be fixed. The idea of more therapy suggests that someone else knows something that I don’t. And boy am I tired of bipolar treatments that don’t work.

Read more

Stopping Self-Harm Urges Using Dialectical Behavior Therapy (DBT)

→ February 1, 2012 - 25 Comments

Stopping Self-Harm Urges Using Dialectical Behavior Therapy (DBT)

If you feel you may harm yourself, get help now.

I talked about dialectical behavior therapy (DBT) in the last post. Dialectical behavior therapy is designed to work specifically with borderline personality disorder and part of this disorder is often self-harm so DBT uses specific techniques to try to stop self-harm urges and prevent self-harm.

What is Self-Harm?

Self-Injury and Cutting

Image provided by Wikipedia, author: Hendrike

Self-harm is a huge problem for many people. It is typically a sign of borderline personality disorder (BPD) but it can occur with any disorder (or no diagnosis at all). Self-harm, also known as self-mutilation or self-injury, can be any form of self-abuse including cutting, burning, hitting and statistics often include those with eating disorders as well. Millions of people in the US practice some form of self-harm.

Self-harm is often practiced by teens and is more common in women than in men, but make no mistake about it, many adults self-harm and men do as well. It is a behavior to be taken seriously. Here are some techniques to stop self-harm urges.

Dialectical Behavior Therapy (DBT) and Self-Harm

A lot of DBT techniques are built on scientific principles. The idea is to work to change your own neurochemistry or autonomic nervous system in a crisis. This sounds complicated, but really it isn’t; the techniques are quite simple.

Dialectical behavior therapy uses many acronyms to help people remember techniques and this one is T.I.P. – Temperature, Intense exercise, Progressive relaxation.

Self-Harm Avoidance Techniques

T – Change your body temperature to change your autonomic nervous system (the part of your body that handles unconscious functions like breathing and heart rate)

  • Take advantage of your dive reflex, seen when you dive into cold water. Hold your breath and submerge your face into ice water or hold cold packs up to your face. It’s important that you get the eye socket area and under the eye cold.
  • Warm your body to relax. Soak in a warm bath or put your feet in hot water.

IIntensely exercise to calm down a body revved up by stress and emotions.

  • Engage in intense exercise even if only for a short time
  • Expend your body’s pent up energy and strength by running, walking fast, walking up stairs, playing basketball, weightlifting, etc.

PProgressively relax your muscles. (There are many relaxation and meditation techniques that work to do this.)

  • Starting with your hands and moving to your forearms, upper arms, shoulders, neck, forehead, eyes, cheeks and lips, tongue and teeth, chest, upper back, stomach, buttocks, thighs, calves, ankles and feet – tense for 10 seconds the relax each muscle and move onto the next.

Putting Self-Harm Avoidance Techniques into Practice

Only you can stop your own self-harm. You have to trust that some of these techniques are going to work for you but you have to actually do them for them to work. You have to want to stop your self-harm. You have to reach out to others. You have to get help. You can stop self-harming, but you have to do the work to make it happen.

Note: TIP self-harm avoidance techniques provided by local DBT practitioners.

Dialectical Behavior Therapy for Borderline Personality Disorder

→ January 29, 2012 - 14 Comments

In spite of what some people intimate, I do endorse non-drug solutions and one of the best adjunct treatments to medications is psychotherapy. Many types of therapy can work for different people, but one current and research-backed therapy is dialectical behavior therapy (DBT).

Now, don’t let the big words scare you – this is not a scary therapy. This is simply a therapy that uses reason to integrate and synthesize opposite points of view. Meaning, the techniques taught are designed to find a balance in emotion, behavior and acceptance.

Borderline Personality Disorder Group TherapyDialectical Behavior Therapy and Borderline Personality Disorder

Dialectical behavior therapy was designed specifically to treat borderline personality disorder; however, it has shown usefulness in mood disorders and research is currently underway to see if DBT techniques are also useful in other disorders. This therapy represents a huge breakthrough as the first indicated treatment of borderline personality disorder.

What Does Dialectical Behavior Therapy (DBT) Teach?

Dialectical behavior therapy is more about teaching and doing than it is about talking. It is simply not talk-therapy.

Dialectical behavior therapy teaches:

  • Mindfullness – involves non-judgementally observing and describing the self and the environment. Involves being fully “present,” in the moment and participating in the activities and world around you.
  • Distress tolerance – involves accepting and minding meaning in distress rather than focussing on changing the stressful environment. Involves self-soothing techniques.
  • Emotion regulation – involves learning to maintain and regulate emotions; becoming less reactive to the situations around you.
  • Interpersonal effectiveness – involves learning how to effectively interact with others to obtain needs, say no and handle interpersonal conflict.

Other techniques such as self-management may also be added to the DBT teachings. It is often done in a group therapy setting.

What is Dialectical Behavior Therapy (DBT) Like?

Now, I admit, I have not had DBT, so I am not speaking from personal experience, but I have talked to local DBT experts who run a four-stage DBT program specifically for borderline personality disorder, and it looks like this:

Stage 1 of DBT

  • Decreasing or eliminating self-injurious behaviors
  • Decreasing or eliminating behaviors that interfere with therapy
  • Reducing or eliminating hospitalization as a way of dealing with distress
  • Decreasing behaviors that interfere with quality of life
  • Increasing behaviors that enable a person to have a life worth living
  • Increasing behavioral skills that help to build relationships, manage emotions and deal effectively with life problems

Stage 2 of DBT

  • Decreasing post-traumatic stress

Stage 3 of DBT

  • Increasing self-respect
  • Setting individual goals
  • Solving life problems

Stage 4 of DBT

  • Developing the capacity for freedom and joy

Does Dialectical Behavior Therapy (DBT) Work?

That depends on who you ask, but the research says yes, it works.

In randomized clinical trials, DBT was more effective than usual treatment in reducing suicidal and self-injurious behaviors, treatment dropout, hospitalizations, and self-reports of anger and anxious ruminations.Increased rates of global adjustment were observed after one year of treatment, and these gains were maintained over the subsequent year.

Dialectical Behavior Therapy (DBT) and Self-Harming Behaviors

Because many people with borderline personality disorder have self-injurious behaviors, dialectical behavior therapy has developed specific techniques for handling this behavior. I have been asked about these techniques repeatedly and will go into them next time.

Dialectical Behavior Therapy (DBT) Resources

You may not be able to find a therapist who specializes in DBT in your area. This is too bad considering how effective it is. Do not give up; however, as books, workbooks and online resources can walk you through DBT. Here are some DBT book resources:

DBT article resources:

DBT and borderline personality disorder website resources:

Note: resources provided by local DBT group and not personally endorsed.

No Evidence of the Effectiveness of Psychotherapy? – 3 New Things

→ September 15, 2011 - 20 Comments

This week I learned three new things about psychotherapy and depression.

I’m a fan of psychotherapy for everyone. In fact, if we could get the mid-East folks to sit down for some good counselling, I think it would be more effective in bringing peace than anything you can do with a gun.

With that said, there are limitations to therapy and sometimes therapy is not all it’s cracked up to be. So this week, a look at three perspectives on psychotherapy:

  • Psychotherapy is no better than placebo in treating depression?
  • Which type of psychotherapy is better for depression?
  • How does psychotherapy change the brain?

1. Is Psychotherapy Better Than a Placebo in Treating Depression?

When the study came out  a couple of years ago alleging that antidepressants were no better at treating mild-to-moderate depression than a placebo, the antipsychiatry world went crazy (if you will). All their dire claims, it seems, had been proven true.

Well, the sky hasn’t fallen yet, but interestingly the same kind of analysis, when applied to psychotherapy, can also allege that psychotherapy is no better than a placebo too.

Can Psychotherapy Treat Depression?Placebo for Therapy

Of course, there is no such thing as a placebo in therapy. There is no “inert” counselling session. Scientific literature attempts to compare cognitive behavioural therapy (CBT), interpersonal therapy (IP) and others against wait-listed participants and those who have received therapy not containing the specific therapeutic technique being tested. Basically, they tell a therapist not to therapy. Which is a pretty tough thing to ask a human to do. And naturally, humans aren’t going to do it well.

Does Psychotherapy Work to Treat Depression?

I would say yes, therapy, various types, including cognitive behavioural, interpersonal and supportive therapy, all help treat depression. However, some suggest the jury is still out on how effective therapy really is in treating depression.

2. What Therapy is Best for Depression?

[push]Psychologist Gary Greenberg states CBT is more of an ideology and a “method of indoctrination into the pieties of American optimism.”[/push]

When selecting a therapy for depression one has many choices but the prevailing one in the scientific community right now is cognitive behavioural therapy (CBT). Everybody loves it. It’s the golden child. CBT is a highly intellectual and analytical therapy that is short-term and action-oriented so it’s no wonder that people like it.

In the same article as the one talking about therapy effectiveness in the treatment of depression, they also discuss which therapy is best for depression, and it kind of seems like none of the therapies are best. (This could be because, statistically, some people respond better to one treatment while others respond to other treatments and when you lump them all together, a similar percentage responds to each.)

3. What Does Psychotherapy Do to the Brain?

As I have mentioned several times, depression decreases brain volumes over time – ie, depression shrinks your brain. It does this through decreasing neurogenesis (the creation of new neurons); however, electroconvulsive therapy (ECT) and antidepressants have both been shown to increase neurogenesis and brain volume.

Interestingly, so does psychotherapy.

More on brain changes as a result of psychotherapy here.

Until next week all. I’ll learn more and do better.

Page 1 of 212