Tag:

psychology

Restful Week

Have you ever felt guilty about having an unproductive week? That’s how I initially felt regarding this week, but in retrospect, I believe it was necessary to take it easy.

To be easier on myself (which is difficult for a self-critical person like me), I had to keep in mind two of my goals for 2015 (which I discussed in my previous post):

be mindful
be aware of my need for self-care

I felt ill this week and wanted to sleep most of the days, and therefore, couldn’t complete most of my tasks. However, I needed to listen to my body and its need for rest and recovery, whereas in the past, I’d push myself to go to the gym and stay up late until I completed everything on my to-do list. I also had insightful, yet emotionally-draining group and individual psychotherapy sessions, which resulted in me not wanting to write a blog post due to how much thought and psychological overtones I put into my posts. Yet, this is a pattern that has occurred in the past since I first started blogging in 2010, which resulted in large gaps between posts. I am trying to avoid those large gaps this time around and want to let you all know of the reason I’m late with this weekly posting.

What made me feel better was reading statements such as “it’s okay to not be okay,” which is definitely true, however, society makes you feel as if you have to be running on all cylinders ALL OF THE TIME. Which is fine, as long as you take necessary breaks and don’t wear yourself out. However, we are all human, and I often try to help my patients overcome barriers towards being less judgmental on themselves.

As you can see, I’m trying to take my own advice 🙂

January 18, 2015 7 comments

Psychiatry

Holiday Mental Break

written by freudandfashion

{With our new family dog, Levi}

Whenever I visit my parents’ home, I regress to a childlike state and become the complete opposite of how I am in my normal, adult life (i.e. instead of my usual high stress, on edge, active, rigid self, I wake up late, lounge around in sweats, and enjoy writing “nothing” on my to-do list). Hence, I’ve taken a brief mental break to reset/recharge and in my relaxed state, I realize this is the first time in eight years that I’ve had time off during the holiday (consider 2 years of hospital rotations during medical school, 4 years of residency training, and 2 years being the newbie doctor at my first job). I initially felt guilty about being away from the clinic for so long, but am aware that my ability to provide quality care declines the more burned out and overwhelmed I feel. I know how hard it can be to prioritize yourself, especially if you’re the caregiving type who’s used to putting others’ well-being before your own. I hope you are able to find time to care for yourself during the remainder of the year, and if not this year, then consider as a possible New Year’s resolution to put self-care amongst the top of your list.

December 28, 2014 11 comments

Psychiatry therapy

Mind Over Meds

written by freudandfashion

{Claremont, California}

Some of you may have noticed that although I am a psychiatrist, I rarely comment nor write about my thoughts on psychiatric medications in my blog. I did write a post as a resident physician-in-training in 2010 titled Pill Pusher, which briefly describes my general approach to simplify, minimize, and streamline medication regimens to the least amount of meds needed to provide symptom relief. In some cases, I have successfully worked with my patients to wean off and discontinue all of their psychiatric medications, though the process requires much patience, toleration of uncomfortable withdrawal symptoms, and numerous non-medication approaches to maintain stability off of meds. And most importantly, I believe a trusting doctor-patient relationship is needed to provide education of potential withdrawal symptoms, encouragement to push forward, and processing fears that may arise from being off medications for the first time in years.

Now, please do not mistake me for a protester against pharmaceuticals — I witness the positive impact that medications can have on enhancing the quality of life of my patients on a daily basis. However, I do not attribute the improvements primarily to medications. My treatment plans generally promote the development of insight and self-awareness of mood patterns, anxiety triggers, etc, and oftentimes explore how past suppressed emotions may contribute to current symptoms, all of which are topics I aim to emphasize in my blog. Medications may stop working or provide temporary relief, but knowledge of one’s self can last a lifetime.

Photos by Marlon Santos

December 20, 2014 2 comments

Psychiatry

Happy, Crappy Holidays!

written by freudandfashion

{Photo with my sister in Fairfield, CA}

While skimming research articles for scholarly information to include in a blog post on Seasonal Affective Disorder (SAD), I put the information aside for a bit in order to write about my own observations and experience dealing with seasonal mood changes.

Long story short…basically, A LOT of people get depressed during the holidays, fall, and winter seasons. But not everyone meets enough criteria to be formally diagnosed and treated for SAD . Yet, a lot of people feel BAD (no acronym…just “bad”) and guilty that they’re not as happy as expected to be during the joyous holiday season. Several of my patients say they feel down, need to force themselves out of bed, and lack motivation. Many also attribute feeling depressed due to missing family members and loved ones, especially since holiday celebrations tend to make their absence even more apparent.

I read quotes that spread throughout social media with phrases along the lines of “December is the last month of 2014…get off your butt and make it count!” Honestly, I myself would be content if I made it through December 2014 by accomplishing the bare minimum of my daily tasks.

And don’t get me wrong — the holiday seasons are a joyful time for many, and I love when people go all out with their decor, gift-giving, and traditions. But I want to acknowledge that there’s a range of how people feel this time of year and that it’s okay if you don’t feel peppy, super motivated, holiday cheery, and overjoyed because there are a lot of people who feel the same way. With my patients, I try to normalize and validate their feelings, focus on the general progress they’re making, and if their mood declines this season, we try to to work on ways to get through this difficult time of year and hopefully move forward once the holidays are over.

Now, here are some bullet points on SAD:

to meet criteria for SAD, one must experience at least 2 yearly consecutive episodes of depression (with a seasonal pattern), which causes significant impairment in daily functioning (for example: calling in sick for work, negatively impacting relationships, feeling suicidal, etc). For more details, please click here for a good summary on the NAMI website.
About 5% of the U.S. population experiences SAD, with symptoms lasting approximately 40% of the year
Cause may be due to a combination of factors, both biological and psychological which may include the following:
- One of the chief biological causes found in the literature is due to changes in our sleep/wake cycle (circadian rhythm) which tend to occur with seasonal changes (Anyone else struggle with winter daylight savings time? I definitely do). For more details, check out this research article by Dr. Alfred Lewy.
- more vulnerabilities to stress this time of year (as I mentioned above)
There are treatments that have been researched to help: light therapy, psychiatric medications, psychotherapy (specifically cognitive behavioral therapy)

If you are struggling with symptoms, you shouldn’t have to go through this alone. Please seek help by reaching out to your doctor, who can discuss possible treatments or even refer you to a psychiatrist or therapist.

And if you know someone who might be struggling with symptoms, you can help by showing them your support and encouraging them to seek help.

References:

Seasonal Affective Disorder

Rohan KJ, Roecklein KA, Haaga DA. Biological and psychological mechanisms of seasonal affective disorder:
a review and integration. Curr Psychiatry Rev. 2009;5(1):37-47.

December 8, 2014 8 comments

therapy

Thanksgiving Weekend

written by freudandfashion

{Fairfield, CA}

For Thanksgiving weekend, I could say I’m thankful for my family, job, friends, etc, though I’m thankful for these things every single day. This weekend, I’m especially thankful for the breakthroughs and insights I’ve had through therapy and life experiences I encountered this year, which have made me become more self-aware, mindful of my actions, confident in my strengths, accepting of my weaknesses, and appreciative of the many facets that make me who I am.

Hope you all had a wonderful Thanksgiving and enjoy the rest of your weekend!

November 28, 2014 0 comment

Psychiatry therapy

Happy Enough?

written by freudandfashion

When my patients struggle to identify reasons for a decline in mood, I try my best to help them make sense of their distraught emotions. In the last week, I’ve had patients share that they feel depressed due to difficulty finding a job, having injuries that prevent them from participating in sports, and the moving away of a best friend. Though there are several theories that can be applied to depression, one theory I often use is derived from Martin E. P. Seligman’s theory of Positive Psychology (Seligman spearheaded research to determine factors that contribute to happiness). One component of the theory involves the pursuit of living a life fully engaged in the following 3 domains:

work (not just having a job, but having one that utilizes one’s strengths/talents)
meaningful relationships (close friends, significant other, family, etc)
leisurely activities (participating in enjoyable activities such as hobbies, sports, etc)

For example, Mr. C comes from a loving, supportive family, feels passionate about art, and obtained a degree in graphic design. He rigorously searches for a job and is unable to obtain one that utilizes his degree. Despite having his family’s emotional and financial support, he falls into a depression when he realizes that he must settle for a job that has nothing to do with his talent in graphic design.

Now, does this mean that Mr. C must find a job in graphic design in order to be happy? Not necessarily because he may strike a balance by immersing himself more in leisurely activities that support his artistic talents such as painting or joining a local art group.

Thought of the Day: Do you participate in activities that utilize your strengths and talents?

References:

Seligman, M.E.P., Parks, A.C., & Steen, T. (2004). A Balanced Psychology and a Full Life. Phil. Trans. R. Soc. Lond, 359, 1379-1381.

Disclaimer: this post describes one therapeutic technique and should not be used to replace treatment with your primary clinicians

October 24, 2014 6 comments

Psychiatry

You Are Not Alone

written by freudandfashion

{OCD Awareness Week}

As a kid, I guess I had strange habits: tip toeing on floors to avoid picking up germs, blinking each eye a certain number of times on each side, tapping my fingers as if I was playing an imaginary piano, and the list goes on. I never thought my habits were a problem until kindergarten when my mom was called to pick me up at school. Apparently, it was wrong for me to pee in my pants because I thought the bathroom in my classroom wasn’t clean enough to use. Fortunately, I outgrew most of these habits (yes, I no longer pee in my pants), but some of my symptoms still persist to some degree. Though I do NOT have OCD (Obsessive Compulsive Disorder), I have several patients who suffer from the disorder and feel tormented by their debilitating symptoms.

In support of OCD Awareness Week (October 13-19, 2014), I want to share some knowledge and facts about OCD.

In the United States, OCD is the 4th most common psychiatric diagnosis
- this means that 1 out of every 40 people in this country may suffer from OCD
Internationally, 1 in 100 adults, and up to 1 in 200 children likely have OCD

Therefore, if you have OCD YOU ARE NOT ALONE.

OCD is more detailed to discuss in one post, but the explanation I give my patients includes some of the following points:

Everyone experiences anxiety to some degree. Some may cope with the anxiety by cleaning, organizing, and checking behaviors (such as checking doors to make sure they are locked), but those with OCD repeat these behaviors to the point that their symptoms cause impairment in their day to day lives. Their symptoms can be quite distressing, time-consuming, and debilitating to the point that relationships, school, and work are negatively impacted.
One misconception is that people with OCD are perfectionists, rigid, controlling, domineering, and have a “my way or the highway” mentality. This is not necessarily true because most people with OCD recognize that their symptoms are excessive and problematic, and more often feel embarrassed, ashamed, and far from perfect.

Now, if you’re wondering about my mismatched socks outfit — I’m wearing them to show even more support for OCD Awareness Week. Though the week is almost over, you still have time to show your support and participate in promoting the discussion of OCD by wearing mismatched socks and posting a picture through social media (use hashtags #sockittoocd, #ocdweek).

For more details on OCD and its symptoms, please visit the International OCD Foundation website.

October 16, 2014 4 comments

therapy

Thankful Thursdays

written by freudandfashion

My aunt’s guide dog, Walnut

Meet Walnut, a wise, reactive, and protective guide dog by day; warm, playful, and attention-craving yellow lab by night. For Thankful Thursdays I’m proud to list Walnut, for I am thankful for the service and unconditional love she has provided my aunt since 2004. Walnut retires this month from her duties as a seeing eye dog so that she can enjoy her life as a playful pet with less stress (pretty much what we hope to achieve as humans when we retire!).

I also wrote a previous post on our family dog, Sanka, a career-change dog who grew up with Walnut and was also trained as a guide dog for the blind.

FYI Service dogs may be certified as Psychiatric Service Dogs and are individually trained to perform tasks to mitigate the psychiatric disabilities of their partners.

How about you? Would love to hear what you are thankful for this week!

(For more info on the background of my Thankful Thursdays series, click here).

October 2, 2014 6 comments

therapy

Thankful Thursdays

written by freudandfashion

IMGP0257

Malibu Beach

People who meet me tend to perceive me as a positive person, but I’ll admit that I wasn’t always that way. I was quite the complainer growing up and blamed others if things didn’t go my way. My negativity improved through maturation over time, but my four years of psychiatric residency training certainly helped me become more self-aware. Learning about different psychotherapy techniques sharpened my skills even further, and one modality that I use involves Positive Psychotherapy.

What is Positive Psychotherapy (PPT)?

In a nutshell, Dr. Martin E.P. Seligman spearheaded the development and research of PPT as an intervention for treatment of depression and the theory consists of some of the following concepts:

– focus on the POSITIVE (factors that contribute to happiness and build upon one’s strengths)

– build POSITIVE EMOTIONS (about the past, present, and future)

– identify and utilize your STRENGTHS

for example, if you’re a creative person, do things that bring out your creativity (such as writing, photography, etc). If you’re competitive, consider joining a recreational group or league

– instead of letting your strengths and talents go to waste, apply them towards something MEANINGFUL (such as in your job, community, family, religious institution, etc)

Naturally, this can take a lot of work/effort especially since our minds may automatically take us down a negative spiral in the face of challenge and negativity. With our often stressful and hectic lives, when something goes wrong, it seems like it requires more time and energy to switch to a positive mindframe. With that in mind, Seligman’s team developed a series of exercises to help shift your mind towards more positive thinking, one of which includes listing “3 good things” that went well during your day.

So, with a slight twist and in the spirit of PPT, I created a new series on my blog called “Thankful Thursdays” where I will list 3 things I’m thankful for from the week and I encourage all of you to do the same!

Here’s my list from this week:

1. Took advantage of living a few miles away from the beach and spent some time there to escape the triple digit California heat wave (picture above).

2. I’m thankful for my family stopping by my office to visit and instead of my usual routine of going home to check email and watch tv, I enjoyed quality time with them over a delicious meal.

Dinner in West Hollywood

3. Received a “sign” today which steered me in a different direction regarding a work project. I truly believe that when one door closes, another one opens, so I’m staying focused and optimistic!

On a boat in South Lake Tahoe

What 3 things are you thankful for?

References:

Seligman, M. E. P., Rashid, T., & Parks, A.C. (2006). Positive psychotherapy. American Psychologist, 61, 774-778.

Photo Credits: Marlon Santos (Diamond Reel Media), Alex Manipod

Disclaimer: this post describes one therapeutic technique and should not be used to replace treatment with your primary clinicians

September 18, 2014 9 comments

Psychiatry therapy

Stay or Leave?

written by freudandfashion

Office Balcony Sunset

I recently made a difficult decision regarding my job, which triggered feelings of uncertainty, fear, and self-doubt. In the process of contemplating my decision, I recalled one of my patients, a college student who struggled with depression. Despite going to a prestigious university, his overwhelming fear of not getting accepted into law school further exacerbated his depressive symptoms. I responded with seemingly consoling statements such as “you’re still young…you’ll get there…you have a lot going for you…I went through the same situation and it worked out okay.” However, my attempts to reassure really weren’t reassuring at all (it’s well known in psychiatry that reassurance generally doesn’t reassure mostly because the statements fail to validate the patient’s current experience). Reflecting back, I realized that in the moment I didn’t want to relive my own pain, uncertainty, and fears that I experienced in my process of applying to medical school. I recalled the discouragement I felt with each rejection letter I received. And I was still feeling discouraged at my current job. Since I gained insight from connecting his experience with my own, I looked forward to validating his feelings at his next appointment. Unfortunately, he cancelled his appointment and never returned.

I realize that contemplating decisions regarding a career path, relationships, love, and pretty much anything pertaining to life in general, makes us vulnerable and uncomfortable. The idea of change can trigger fear and act as a barrier towards future ventures. After a year long process, I finally decided to resign. My anxiety peaked even more because I felt uncertain of the next step to take. Where do I go from here? Will I feel happier? Will I regret my decision?

Seeking motivation to push forward and take risks, I read quotes by famous writers, all with similar themes to never give up, choose the “road less traveled,” try new things, and learn from your mistakes.

The dangers of life are infinite, and among them are safety. ~ Goethe

Yet, it took being on a plane last night watching The Amazing Spiderman 2 hearing Gwen Stacy (played by Emma Stone) give her valedictorian speech to make me realize how mainstream and pervasive this dilemma is:

“…I say it today of all days to remind us that time is luck. So don’t waste it living someone else’s life, make yours count for something. Fight for what matters to you, no matter what. Because even if you fall short, what better way is there to live?”

As mentioned above, my decision involved resigning from my highly-desired, well-paid job in order to take control of my life, practice, and career. Since my last day, I have mixed emotions of feeling liberated, hopeful, excited, yet completely scared at the same time.

I made the right decision.

“…you can fail at what you don’t want, so you might as well take a chance on doing what you love.”

~Jim Carrey

Putting in work at my new office in West Hollywood

Photos courtesy of Marlon Santos (Diamond Reel Media)

September 10, 2014 24 comments

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