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Whether you played an April Fools’ joke on someone or you were the target of a prank, you benefited from April Fools’ Day in more ways than you realize if you had a good belly laugh as a result.

Laughing provides many physical and emotional benefits. According to Humor and Health Journal, laughing lowers blood pressure, reduces stress hormones, increases immune function, releases endorphins, and produces a general sense of well-being. Laughing also provides a workout for the diaphragm and increases oxygen flow providing a cleansing effect similar to deep breathing. By finding the humor in situations, we are guarding against interpreting these situations as threatening or challenging, which will only serve to increase the distress we feel. By making light out of a situation, we may feel more in control and less overwhelmed. Not bad considering laughing is free and has no unpleasant side effects!

Need more humor in your life? Start your day off on a healthy and happy note by listening to comedy on your way to work (and guard against stress from traffic too!). Watch a sit-com. Have a tickle-fest with your children. Look for the silly in things. Set aside time to allow yourself to laugh if you need to (there are actual “laughing clubs” in India that meet just for this purpose!). Take note of the unexpected or humorous things around you and share it with a friend.  Try subscribing to a free online joke-of-the-day website. Share these jokes with your family at dinnertime so the whole family can benefit from laughter.

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So You Want a Healthier Lifestyle: Are You Ready to Make a Change?

by Rhonda Karg, Ph.D

Nearly everyone has at least one health behavior they would like to change: getting regular exercise, eating a healthier diet, losing weight, drinking less alcohol, and quitting smoking, to name a few. So why do most people struggle with taking action and improving their health behaviors? People struggle with taking action to change because they think that the desire to change equals readiness or motivation to change. However, making the decision to change an unhealthy behavior almost always involves ambivalence, and on an internal level, considering the pros and cons of changing versus staying the same. That ratio of pros to cons is what tells us if a person’s desire equals readiness and motivation. If a person’s readiness/motivation to change the behavior is low, the cause could be that the pros of staying the same outweigh the cons of changing. For example, in the case of health behaviors, the immediate rewards of the unhealthy lifestyles (e.g., getting fast food) often outweigh the costs of implementing healthier choices (e.g., preparing a healthy meal). If readiness and motivation are low, you will need to get support and work on changing your perception of pros and cons, and/or doing more exploration of pros and cons to move into action!

Do you have a behavior you want to change? How ready are you to make this change? Answer the following questions in terms of a problem behavior to find out!

PROS AND CONS OF CHANGING

Rate each item as to its importance in deciding to take action. Rate each item as accurately as you can. Fill in the number that most closely reflects the importance of each item:

Your health is extremely important. Make your self-care and your health a high priority! As a single parent myself, I know how difficult it can be to take time out of your busy schedule to engage in self-care. But if you have desire to make the changes, you can shift that into readiness and motivation, and reach your self-care goals!

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A conversation with Haleh Moddasser of Stearns Financial Services Group

In a nutshell, what are people doing right and what are people doing wrong when it comes to their financial health?

Interestingly, the answer is the same to both questions – and that is “worrying”. People worry about money. They worry about paying for college, upsizing, downsizing, retiring, and a myriad of other unknown financial events such as a job loss or a leaky roof. This type of worry is a good thing when it causes people to take positive actions such as carefully planning their expenditures, saving for retirement and investing wisely. It is bad, however, when it causes otherwise healthy people to lose sleep at night. There is a fine line between enjoying today and saving for tomorrow – most people have a hard time finding that line.

Depression has long been referred to as the ‘common cold’ of mental health, i.e., a lot of people will experience this at some point in their lives. What is the equivalent analogy in financial health? What has historically been thought of by financial experts as the ‘common cold’ of financial health?

The most prevalent “illness” we see are people becoming overly influenced by the daily barrage of negative media, something we often refer to as “newsfluenza”. Unfortunately, our 24/7 media continually feeds us “newsworthy” bites of information that impact the markets in the short term, but have little relevance in the long term. This type of media hype can often lead to emotional decision making that can destroy a long history of prudent saving and investing. Often, investors will sell investments at the bottom of the market, or buy at the top, simply because they become either fearful or greedy. This type of irrational decision making, often referred to in the industry as “behavioral finance”, accounts for at least 60% of the losses most people incur in their investment portfolios.

What steps can people take to prevent that; and which steps can they do themselves versus which are best done with help from a professional?

The key is to adopt an investment approach that includes a diversified, well balanced portfolio of high quality securities, and to stick to it. This can be accomplished in many company retirement plans or by independently using a good mix of mutual funds. For busy professionals, or those who would rather not spend their time continually monitoring their investments, it is often best to use a professional. As an objective third party, a professional can more easily avoid “behavioral finance” mistakes. Additionally, because professional investment advisors are focused on the fundamental values of the companies issuing stocks and bonds, they are better equipped to make wise buying and selling decisions.

It’s funny because as I ask this question, I realize I’m not so sure depression is winning that unpopular race anymore. In my clinical experience I’d have to say that anxiety is perhaps pulling ahead. In our modern society with the plethora of stresses, many of which are financial by the way, I think experiencing anxiety may now be the ‘common cold’ of American mental health. Have you found anxiety impacting people’s financial decisions – budgeting, saving, spending, etc. – more so over the past 10 years than previously?

We see many people who begin to question their ability to achieve their financial goals, especially given the barrage of negative news in the media. Everything from the crisis in the Middle East, to the looming “fiscal cliff” to the inability of congress to work together in a bipartisan way can create feelings of extreme anxiety. Often, people feel insecure about their careers as a result of the changing world around them. In our experience, the very best anecdote to this type of anxiety is a good financial plan, with multiple scenarios that include both “upside” and “downside” scenarios . If we can get people comfortable with their financial future, even in a “downside” scenario by saving enough, investing wisely, living within their means and taking the steps necessary to protect their earnings power, then they often feel a great sense of relief.

Do people with wealth to invest do so, or do people avoid this task?

Often, people are not as conscious about investing as they could be. Sometimes we see people with large amounts of cash sitting in checking or savings accounts, earning little to no interest. Often these folks are simply extremely busy with their careers and have little time to manage their assets. It’s important to know that putting your money to work for you, as early as possible, can have a tremendous positive impact on your overall wealth. For example, a person aged 35 who saves 10% of their $50,000 salary per year into a 401k, will have over $900,000 at age 65. A full two thirds of this amount, $600,000, is due to compound earnings, while only $300,000 equals contributions (includes 3% company match). Pre-tax vehicles such as 401k and IRA accounts further leverage compound earnings, because assets are earning on higher pre-tax savings.

It’s December and people are thinking ahead to how to make 2013 better. What are some important behavior changes a person could begin or one thing they could do to begin improving their financial health?

As important as a good investment strategy is, there is no substitute for savings. A solid financial plan will help you determine if your savings will ultimately meet your needs in retirement and will answer questions such as “when can I retire?”, “can I afford a bigger home?” or “can I start my own business?”. A plan such as this is, perhaps, the best investment you can make, because it informs every other major life decision.

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Psychiatry and Depression

How do I distinguish between depression and normal variations in mood?

Everyone has felt fed up, miserable, or sad at times. These feelings can come and go and don’t interfere too much with all of life’s activities and responsibilities. There may or may not be a clear reason for the feelings, but regardless, people usually figure out a way to manage them. In depression, however, these feelings don’t readily improve. They can last for weeks or months, and start to interfere with daily responsibilities. People with depression can struggle with persistently low mood, low energy, loss of enjoyment in activities, difficulty sleeping and eating, feelings of guilt, poor concentration, irritability, and even thoughts of suicide. Some may experience other symptoms, such as agitation, anxiety, and physical problems like headaches and stomach aches. Children also can have depression, but it tends to be more characterized by irritability and loss of interest in previously enjoyed activities.

What causes depression?

There are several factors that can cause or contribute to depression. Stressful circumstances, physical illness, genetics, prior negative life experiences, and alcohol and drug use can all play a role in causing or perpetuating depression.

What can I do to help myself?

Depending on your individual circumstances, finding someone to talk with about your problems can be helpful. Finding ways to reduce stress, such as by reducing your obligations and responsibilities can also be an option. Other strategies for helping your mood might include exercising regularly, practicing relaxation strategies such as meditation or prayer, eating well, avoiding alcohol and drugs, and getting enough sleep. Other forms of self-help include reading books or leaflets and looking for self-help computer/internet programs.

When should I seek help?

You should consider seeking help if you notice your feelings seem worse than usual or don’t seem to be getting any better. Also, you should seek help if your feelings and symptoms interfere with your work, interests, and relationships. Finally, you should seek help if you are struggling with thoughts life isn’t worth living or thinking of suicide.

What kind of help is available?

Besides self-help strategies, two forms of professional treatment are therapy and antidepressant medications. There are several empirically-validated forms of therapy for treating depression to include cognitive-behavioral therapy (CBT), problem-solving therapy, and interpersonal psychotherapy. These forms of depression therapy can be provided in different settings such as individual therapy, couple’s therapy, family therapy, and group therapy. For mild to moderate depression, any of these therapies are good options. Antidepressant medication can also be a good option, particularly in moderate to severe depression. In these cases, a person may be more able to benefit from therapy when taking medication, as antidepressant medication can lift some of the fog and sadness of depression that can sometimes interfere with successful therapy. Studies have shown in general, people with depression have the best chance of getting better by using a combination of both therapy and medication. Relapse rates have been found to be higher when antidepressant medication is used alone without therapy, likely because in therapy you also learn and improve coping skills and strategies. Many people choose to take an antidepressant because of ease of use and cost, depending on the medication.

What Can I Expect From an Antidepressant?

Antidepressants work by altering the concentration of brain neurotransmitters in the synapses. Two neurotransmitters in particular, serotonin and norepinephrine, have been associated with mood. Newer antidepressants can be categorized into those medications that primarily affect serotonin (called selective serotonin reuptake inhibitors or SSRIs) such as Prozac, Zoloft, and Celexa, and those medications that affect serotonin and/or other neurotransmitters such as norepinephrine and dopamine (non-SSRIs). These include medications like Effexor, Wellbutrin, Cymbalta, and Remeron.

In addition to depression, antidepressants can be helpful for several other diagnoses, including anxiety disorders, panic attacks, obsessive-compulsive disorder, posttraumatic stress disorder, and eating disorders. In general, SSRIs are usually the first choice for treating depression due to their mild side effects and lower cost. Side effects, such as nausea and anxiety, tend to be mild and wear off after a few days to weeks. SSRIs can have sexual side effects, too. There has also been controversy regarding whether antidepressants worsen suicidal thinking and behavior in children and teens. At this point, the general consensus is for most people, these medications can be safe and helpful when taken as prescribed, but for a small percentage of people, the medication can make things worse. For this reason, children prescribed these medications should be monitored closely, which is a good reason to have a trained child psychiatrist work with your child.

Your psychiatrist might choose one of the non-SSRIs for a variety of reasons, including a person’s preference, wanting to avoid certain side effects (for example, Remeron has a side effect of sleepiness and weight gain), having a history of a family member responding well to a certain antidepressant, wanting to target concurrent medical problems (Cymbalta is thought to help treat the pain associated with fibromyalgia, and Wellbutrin is helpful for people wanting to quit smoking, for example), wanting to avoid any drug interactions with other medicines a person is taking, and finally, lack of success with the SSRIs.

Antidepressant medication, like therapy, does not work immediately. In general, it can take four to six weeks of consistent use before a person obtains maximum benefit from the medication. For people with other psychiatric conditions, such as obsessive-compulsive disorder, panic attacks and anxiety, the medication can take up to six to twelve weeks to have full effect. A given antidepressant typically has about a 50-65% chance of being helpful and is dependent on a person taking it as prescribed. Though these medications are not addictive, stopping them abruptly can lead to withdrawal symptoms such as flu like symptoms, vivid dreams, dizziness, stomach upset, anxiety, and a return of the depression. It is therefore recommended you discuss a taper off the medication with your doctor and engage in therapy during that time period. Psychiatrists can work in concert with your therapist to manage your care, so your use of medication and therapy is well-coordinated and most beneficial to you.

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THERAPY AT A GLANCE
(CBT, DBT, & Family Therapy)

COGNITIVE-BEHAVIORAL THERAPY is a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do.

Cognitive-Behavioral Therapy (CBT) is a general term for different types of therapy such as Rational Emotive Behavior Therapy and Dialectic Behavior Therapy. Most cognitive-behavioral therapies have similar characteristics.

• CBT is based on the idea that our thoughts cause our feelings and behaviors rather than external things, like people, situations, and events. The benefit of this idea is that we can change the way we think in order to feel or act better even if the situation does not change.
• CBT can be brief and time-limited. CBT is considered among the most rapid in terms of results obtained. The average number of sessions clients receive (across all types of problems and approaches to CBT) is only 16. Other forms of therapy, like psychoanalysis, can take years. What allows CBT to be briefer is its highly instructive nature and the fact that it makes use of homework assignments.
• CBT is time-limited in that we help clients understand at the very beginning of the therapy process that there will be a point when the formal therapy will end. The ending of the formal therapy is a decision made by the therapist and client. Therefore, CBT is not an open-ended, never-ending process.
• A sound therapeutic relationship is necessary for effective therapy, but not the focus. Some forms of therapy assume that the main reason people get better in therapy is because of the positive relationship between the therapist and client. CBT therapists believe it is important to have a good, trusting relationship, but that is not enough. CBT therapists believe that the clients change because they learn how to think differently and they act on that learning. Therefore, CBT therapists focus on teaching rational self-counseling skills.
• CBT is a collaborative effort between the therapist and the client. CBT therapists seek to learn what their clients want out of life (their goals) and then help their clients achieve those goals. The therapist’s role is to listen, teach, and encourage, while the client’s role is to express concerns, learn, and implement that learning.
• CBT teaches the benefits of feeling, at worst, calm when confronted with undesirable situations. It also emphasizes the fact that we have our undesirable situations whether we are upset about them or not. If we are upset about our problems, we have two problems — the problem, and our upset about it. Most people want to have the fewest number of problems possible. So when we learn how to more calmly accept a personal problem, not only do we feel better, but we usually put ourselves in a better position to make use of our intelligence, knowledge, energy, and resources to resolve the problem.
• CBT uses the Socratic Method. CBT therapists want to gain a very good understanding of their clients’ concerns. That’s why they often ask questions. They also encourage their clients to ask questions of themselves, like, “How do I   really know that those people are laughing at me?”  “Could they be laughing    about something else?”
• CBT is structured and directive. CBT therapists have a specific agenda for each session. Specific techniques and concepts are taught during each session. CBT    focuses on the client’s goals. We do not tell our clients what their goals “should” be, or what they “should” tolerate. We are directive in the sense that we show our clients how to think and behave in ways to obtain what they want. Therefore, CBT therapists do not tell their clients what to do — rather, they teach their clients how to do.
• CBT is based on an educational model. CBT is based on the scientifically supported assumption that most emotional and behavioral reactions are learned. Therefore, the goal of therapy is to help clients unlearn their unwanted reactions and to learn a new way of reacting. Therefore, CBT is more than just talking. The educational emphasis of CBT has an additional benefit — it leads to long term results. When people understand how and why they are doing well, they know what to do to continue doing well.
• CBT theory and techniques rely on rational thinking that it is based on fact. Often, we upset ourselves about things when, in fact, the situation isn’t like we think it is. If we knew that, we would not waste our time upsetting ourselves.   Therefore, CBT encourages us to look at our thoughts as being hypotheses or guesses that can be questioned and tested. If we find that our hypotheses are incorrect (because we have new information), then we can change our thinking to be in line with how the situation really is.
• Homework is a central feature of CBT. If when you attempted to learn your multiplication tables you spent only one hour per week studying them, you might still be wondering what 5 X 5 equals. You very likely spent a great deal of time at home studying your multiplication tables, maybe with flashcards. The same is the case with psychotherapy. Goal achievement could take a very long time if a person were to only think about the techniques and topics taught for one hour per week. That’s why CBT therapists assign reading assignments and encourage their clients to practice the techniques learned.
• Cognitive Behavioral Therapy has been found to be effective with mood, anxiety, personality, eating, substance use, and psychotic disorders. There are different goals for different disorders. CBT has been found to be more effective than medication alone for mild to moderate depression and anxiety. CBT in conjunction with medication (not medication alone) is the best course of treatment for severe depression and anxiety. CBT with personality disorders is often more behaviorally focused at first, meaning, focusing on changing behavior and then looking at deeply ingrained beliefs. CBT with psychosis helps people develop social skills, problem solving skills, decision making skills, and countering delusional thoughts. CBT and SSRIs is the best combination for anorexia.

DIALECTICAL BEHAVIOR THERAPY was originally developed for people with Borderline Personality Disorder. Clients with BPD who received CBT found the focus on change that is inherent to CBT invalidating of their emotions.

• DBT was developed as an acceptance-based intervention. Validation strategies were developed to communicate to the client their feelings were acceptable and understandable, including those that were self-harming, and made real sense in some way. Further, therapists learned to highlight for clients when their thoughts, feelings, and behaviors were “perfectly normal,” helping clients discover that they had sound judgment and that they were capable of learning how and when to trust themselves. The new emphasis on acceptance did not occur to the exclusion of the emphasis on change: Clients also must change if they want to build a life worth living. Thus, the focus on acceptance did not occur to the exclusion of change based strategies; rather, the two enhanced the use of one another.
• In order to balance the strategy of acceptance versus change, dialectical strategies served to prevent both therapist and client from becoming stuck in the rigid thoughts, feelings, and behaviors that can occur when emotions run high, as they often do in the treatment of clients diagnosed with BPD. Dialectical strategies look at all parts of a situation in a holistic, rather than black and white, manner.
• DBT includes group skills training, individual therapy, telephone check-ins, and a consultation group for the therapist. This was how it was developed and conducted in a research setting. Many people find it useful to have DBT skills training in individual therapy or to attend a group but not have individual therapy. It is best to evaluate individual needs to determine what format is the best fit.
• DBT is not just for people with Borderline Personality Disorder anymore! It has been found helpful for people with anxiety and depression as well as Antisocial Personality Disorder.
• The general goals of skills training are to learn and refine skills in changing behavioral, emotional, and thinking patterns associated with problems in living that are causing misery and distress.
• The Specific Goals of skills training are:

1. Core mindfulness training: Learning to go within to find oneself and learning to observe oneself.
2. Interpersonal effectiveness: Learning to deal with conflict situations, to get what one wants and needs, and to say no to unwanted requests and demands. It focuses specifically on doing this in a manner that maintains self-respect and other’s liking and/or respect.
3. Emotional regulation training: Enhancing control of emotions.
4. Distress tolerance training: Discusses the connection between the inability to tolerate distress and impulsive behavior which reduces intolerable distress such as alcohol, drugs, eating, spending, and self harm.

FAMILY THERAPY is a form of psychotherapy that involves all the members of a nuclear or extended family. It may be conducted by a pair or team of therapists. Although some forms of family therapy are based on behavioral or psychodynamic principles, the most widespread form is based on family systems theory. This approach regards the family, as a whole, as the unit of treatment, and emphasizes such factors as relationships and communication patterns rather than traits or symptoms in individual members.
Family therapy is often recommended in the following situations:

• Treatment of a family member with schizophrenia or bipolar disorder. Family therapy helps other family members understand their relative’s disorder and adjust to the psychological changes that may be occurring in the relative.
• Families with problems across generational boundaries. These would include problems caused by children being reared by grandparents.
• Families that may not have internal problems but may be troubled by outsiders’ judgmental attitudes such as gay couples rearing children.
• Families with members from a mixture of racial, cultural, or religious backgrounds.
• Families who are undermining the treatment of a member in individual therapy.
• Families where the identified patient’s problems seem inextricably tied to problems with other family members.
• Blended families with adjustment difficulties.

Family therapy tends to be short-term treatment, usually several months in length, with a focus on resolving specific problems. It is not normally used for long-term or intensive restructuring of severely dysfunctional families.
In family therapy sessions, all members of the family and the therapist are present at most sessions. The therapists seek to analyze the process of family interaction and communication as a whole; they do not take sides with specific members. They may make occasional comments or remarks intended to help family members become more conscious of patterns or structures that had been previously taken for granted. Family therapists, who work as a team, also model new behaviors for the family through their interactions with each other during sessions.
Family therapy is based on family systems theory, which understands the family to be a living organism that is more than the sum of its individual members. Family therapy uses “systems” theory to evaluate family members in terms of their position or role within the system as a whole. Problems are treated by changing the way the system works rather than trying to “fix” a specific member. Family systems theory is based on several major concepts:
The identified patient (IP) is the family member with the symptom that has brought the family into treatment. The concept of the IP is used by family therapists to keep the family from scapegoating the IP or using him or her as a way of avoiding problems in the rest of the system.
Homeostasis (balance) means that the family system seeks to maintain its customary organization and functioning over time. It tends to resist change. The family therapist can use the concept of homeostasis to explain why a certain family symptom has surfaced at a given time, why a specific member has become the IP, and what is likely to happen when the family begins to change.
The extended family field refers to the nuclear family, plus the network of grandparents and other members of the extended family. This concept is used to explain the intergenerational transmission of attitudes, problems, behaviors, and other issues.
Differentiation refers to the ability of each family member to maintain his or her own sense of self, while remaining emotionally connected to the family. One mark of a healthy family is its capacity to allow members to differentiate, while family members still feel that they are “members in good standing” of the family.
Triangular relationships occur whenever any two persons in the family system have problems with each other. They will “triangle in” a third member as a way of stabilizing their own relationship. The triangles in a family system usually interlock in a way that maintains family homeostasis. Common family triangles include a child and its parents; two children and one parent; a parent, a child, and a grandparent; three siblings; or, husband, wife, and an in-law.
Family therapists will usually evaluate a family for treatment by scheduling a series of interviews with the members of the immediate family, including young children, and significant or symptomatic members of the extended family. This process allows the therapist to find out how each member of the family sees the problem, as well as to form first impressions of the family’s functioning. Family therapists typically look for the level and types of emotions expressed, patterns of dominance and submission, the roles played by family members, communication styles, and the locations of emotional triangles. They will also note whether these patterns are rigid or relatively flexible.
Preparation also usually includes drawing a genogram, which is a diagram that depicts significant persons and events in the family’s history. Genograms also include annotations about the medical history and major personality traits of each member. Genograms help in uncovering intergenerational patterns of behavior, marriage choices, family alliances and conflicts, the existence of family secrets, and other information that sheds light on the family’s present situation.

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