On the day I graduated and officially became a doctor, I wished that my grandfather could’ve been there to see it. I’ve noticed my tendency to get teary-eyed during therapy sessions, specifically when the issues are related to grief. I’ve told patients to write letters to their loved ones to aid in processing their emotions and work towards resolving issues associated with their loss. Now, if only I could get myself to write that letter…
When a patient dwells on a thought to the point of feeling extremely anxious and overwhelmed, I sometimes teach them to approach those thoughts with the following metaphor: Grab onto [the thought] briefly in your hand, then let it go like a feather. Perhaps I need to practice more of what I preach. I have several complex patients who require contant monitoring and found it difficult NOT to think about a few of them during recent trips out of town. Did I prescribe too high of a dose? Will my patient be suicidal and land in the ER? Will my supervisor think I was an idiot for giving that medication? No doctor is perfect, but I do need to learn how to leave work behind (for the sake of maintaining my own sanity).
{with our family dog, Sanka}
I remember trying to hold back tears as I watched the Oprah episode that highlighted the Puppies Behind Bars program (see video below). I have two legally-blind aunts, so my family felt extremely fortunate when given the opportunity to adopt a career-change dog that was initially trained as a guide-dog for the blind. There’s a strong connection between the calming, healing effects a pet can have on a person’s health, especially after witnessing my dad’s health improvements since adopting our yellow lab, Sanka. The process of certifying your dog as a therapy dog varies among states, but I’ve seen dogs certified by submitting a letter from a doctor or through a professional trainer. Even more proof that dogs truly are a (wo)man’s best friend!
[youtube=http://www.youtube.com/watch?v=7pK-enFgSLA&feature=related]
I used to hate it when people would tell me to “Stop PMS’ing!” during my snappy, pissed off moments until I discovered the cyclical nature of the times that I internally wanted to tell people to f*** off. This past weekend I found myself crying hysterically and feeling emotionally sensitive to things that normally don’t bother me. The sad part of me wanted to stay home and watch past seasons of “Sex and the City,” so I rejected every invitation to go out. I put on my pajamas and reached for the ice cream when one of my friends texted the following:
“Remember Opposite to Emotion Action.”
I honestly didn’t know what that meant until I googled “Opposite to Emotion Action” (link here) and found that it’s a technique used to change painful emotions. Basically, you should do the opposite action (i.e. go for a walk, talk to a friend) of what you’d normally do (i.e. sit on the couch crying and watching tv) in order to counteract the suffering you’d otherwise feel from the distressing emotion (i.e. sad, depressed).
I figured I’d give it a try, so I ran on the treadmill, met with a friend, cooked a healthy dinner, and thought about a few things that make me happy:
{my dog}
{the beach (Santa Monica pier)}
{shopping…or at least window shopping on Rodeo Dr}
I definitely felt better later that night and am excited to say that I feel quite chipper today. Check back with me in a month though (and no PMS jokes please).
Tip of the Day: Give “Opposite to Emotion Action” a try! Next time you get angry, avoid the person making you angry. Next time you’re sad, do something active. Next time you feel shameful, let it go. After all, you can’t feel any worse than you already feel, right?
I first tried Mindfulness to help with my attention issues, which I documented here . Yet, Mindfulness can be applied to nearly any aspect of daily life. Here’s a simple exercise you can try:
Do you recall the last time you truly savored a piece of food? And no, I don’t mean devouring a mouth-watering morsel, but instead, actually truly recognizing each component…each ingredient…each texture…each burst of flavor. Now, start by making an M&M (or Skittle if you’re not a huge chocolate fan like me) last in your mouth for about 2 minutes (or as long as you can) and be aware of every single sensation you experience in relation to that one piece of candy. Be aware of its texture. Notice your increase in salivation. Feel how it changes from smooth to slightly bumpy. Place it against the roof of your mouth with your tongue. Sense its temperature change from cool to warm. Recognize details of its flavor – sweet, rich, fruity, slightly bitter, etc. Feel the breaking of its shell as it splits into little pieces. Recall your sweet childhood memories of happily walking through the candy store, carefully selecting each yummy treat, sharing them with friends, or keeping it all to yourself.
Now apply this simple exercise to everyday life. Instead of stressing about the next minute, hour, or upcoming events, savor what you experience in the present time. Be aware of each moment. Focus on one thing. Let go of distractions.
Exercise derived from my residency’s associated Clinical Psychology Professor. Image via flickr.
I’m a perfectionist who tends to be very sensitive to criticism. As part of my residency, I began seeing outpatients 3 months ago to manage medications and provide psychotherapy, which was extremely anxiety-provoking during the first 2 months. My heart rate rose each time a patient burst into tears, told me they wanted to die, and disclosed traumatic experiences suppressed for years. Each time I watched my patient unravel, I felt immense pressure to say the magic words to make them feel better and provide a brilliant synopsis of their entire life story after a 30-minute session. Even more intimidating was knowing my supervisor was watching me through a 2-way mirror evaluating each statement I made. I felt dumbfounded each time I paused too long and resorted to asking the most annoying question in Psychiatry: “So how did that make you feel?”
Despite being so hard on myself, a moment of clarity came this week when I saw two of my very first patients that I’ve followed regularly since my outpatient clinic started. Three months ago, they isolated in their homes due to severe depression, had low self-esteem, and felt hopeless about life due to past trauma and abuse. Having the opportunity to observe even the smallest changes they’ve made is rewarding. Simple things such as going outside for a walk, cleaning the house, putting makeup on, and going on their first job interview in years, might seem like nothing to others, but for someone who’s reached rock-bottom to the point of suicide means the world. Perhaps I contributed somewhat to their improvement by providing an outlet for disclosure of pent up feelings or gave insight into how past events effect their current emotions. Ultimately, they gained inner strength to make such progress, which makes all the stress, palpitations, and criticism worthwhile. They demonstrate my purpose and the reason I went into Psychiatry.
{Moments before it started pouring in Seattle}
Around this time of year, I’m used to sunny skies and stocking up on colorful spring dresses. Unfortunately, the weather in the Northwest is keeping me glued to my winter coat and lounging indoors to avoid the rain. Many living in the Northwest (or anywhere with minimal sunshine) have a deficiency in Vitamin D, which your body makes after exposure to sufficient sunlight and has been shown to have a link to depression. Vitamin D can be detected by a simple blood test, and if low can be treated by supplements available over the counter. So, if you’re living in the dark (like me) and can’t make it to Hawaii anytime soon, try some Vitamin D until your next flight out or the sun breaks through the rain clouds…whichever comes first.
For more info on Vitamin D and depression, check out this link http://www.webmd.com/depression/news/20080505/depressed-older-adults-lack-vitamin-d
As kids, everyone thought my sister and I looked like twins. We still look somewhat alike and our voices sound similar with the same hint of valley-girl twang. Therefore, it’s no wonder that we share an interest in Psychology and ended up pursuing careers in mental health. When my sister decided to get her Masters degree in Marriage & Family Therapy, I immediately envisioned having an office together and referring clients to one another. Though we live in different states, I have her number on speed dial in case I’m in need of quick consultations on difficult patients. A knowledgeable psychiatrist might have the power to prescribe medications, but an intuitive psychotherapist has the ability to change the way a person thinks and views life. The effects of medications can only go so far. But, the combination of both meds and psychotherapy can more effectively improve the lives of many…
Everyone has something they’re thankful for. I spent the week struggling to help patients find the tiniest glimmer of hope…a reason worth living even when death seemed like the only option. Medical school doesn’t teach you the art of psychotherapy, so I found myself extremely overwhelmed compared to times when I cared for patients experiencing a heart attack or stroke. But, after a tough yet rewarding week of analyzing my patients’ lives, I realize I have to analyze myself. I need to acknowledge my own fears and unresolved issues (otherwise, it may interfere with my patients’ therapy), which can be a scary thing for anyone. No wonder so many mental health professionals have their own therapist. Cheers to a relaxing weekend of self-reflection!
I consider myself a morning person. I woke up at 12:30pm today, which is ridiculously late for me. My checklist of things to accomplish has not been touched because I missed the morning window to begin my tasks, and therefore feel lazy, tired, and moody. Even as I write this post (it’s 6pm), I’m laying on my couch watching my 4th rerun of “Man vs Food” and attempting to muster enough energy to go to the grocery store.
Which brings me to an important question: “How is your sleep?” I ask each of my patients this question since sleep has such a profound effect on mood. In addition to offering medications for insomnia (if necessary), I educate my patients on the importance of “sleep hygiene.” Sleep Hygiene consists of healthy habits one can develop in order to routinely sleep well, which includes the following:
1. Sleep only when sleepy – this reduces the time you’re awake in bed.
2. If you can’t fall asleep within 20 mins., get up and do something boring until you feel sleepy. (do a low stimulating activity such as readying something boring, etc., but be sure to avoid bright light)
3. Don’t take naps.
4. Get up and go to bed the same time every day (Even on weekends! I know this is hard, especially after a ridiculously tough week at work)
5. Refrain from exercise at least 4 hrs before bedtime.
6. Develop sleep rituals. (give your body cues that it’s time to slow down & sleep – listen to relaxing music, have a cup of tea, etc.)
7. Only use your bed for the 2 “S’s” — Sleep and Sex. (no work, reading, watching tv, doing bills, etc).
8. Stay away from caffeine, nicotine, and alcohol at least 4-6 hrs before bed.
9. Have a light snack before bed. (if an empty stomach interferes with your sleep)
10. Make sure your bed and bedroom are quiet and comfortable. (I love the peaceful quality of neutral tones with pops of black and muted blue in the bedroom below)
For more on sleep hygiene, you can check out this link http://www.sleepeducation.com/Hygiene.aspx. Typing this post made me realize how lazy I’ve been all day, so now I’m off to buy food! And time to take my own advice and head to bed by 11pm (instead of 4am like the night before).