Making the Decision to Pursue Therapy

There are myriad reasons why people decide to seek therapy. Some individuals want to explore recurring patterns in their lives. They may find themselves making the same mistakes or ending up in situations where they feel chronically dissatisfied and unfulfilled. Others may be searching for clarity or closure on an issue, desiring increased insight and self-awareness, or simply seeking a safe place to process their thoughts and emotions. Some folks may notice that they are not coping well with life’s stressors, such that they are consuming more alcohol than usual, using substances, or avoiding situations or people. Impairment in sleeping and eating habits, frequent conflicts with loved ones, decreased motivation to perform work and household tasks, and a sense of isolation may also be signs that professional support can be helpful. Seeking counseling may be about obtaining feedback about how one is doing and preemptively gaining support before reaching “rock bottom” (one’s subjectively lowest point).

The decision to begin the challenging, yet often rewarding process of psychotherapy can be a difficult one. It is normal to feel uncertain and to experience mixed emotions. This is known as ambivalence, which Merriam-Webster defines as: “simultaneous and contradictory attitudes or feelings (as attraction and repulsion) toward an object, person, or action.” As per Dr. Derek Lee, ambivalence is often characterized by uncertainty, indecision, and fear; he states, “it is a tension between opposing beliefs, feelings or behaviors.” He indicates that our motivation to pursue action may change depending on our complex and sometimes conflicting needs and priorities at a given moment. Rollnick, Miller, and Butler agree that competing motivations—“to simultaneously want and not want [change] are normal and common” (2008). Ambivalence may manifest as simultaneously wanting to lose weight, but hating exercise/diets or wanting to quit smoking/drinking alcohol for the personal health benefits, but needing the stress relief it provides.

The prospect of change can be exhilarating, while terrifying and overwhelming all at once. There may be a comfort in the familiar and a tendency to stay in the exact same situation, even when it is clearly dysfunctional or unhealthy. One need not hit “rock bottom” in order to decide that it may be helpful to seek the services of a mental health professional. If you recognize that something needs to change, but do not know what or how to make the change, you may benefit from professional counseling services. Perhaps you know that you are miserable in a relationship, job, or otherwise, but you cannot figure out how to resolve this dilemma or there is a discrepancy between your current self-perception and how you wish to see yourself. You might have a hard time identifying goals or overcoming the obstacles (i.e., low motivation/energy, poor organization) to achieving them.

Why is change in your life necessary and important? Achieving self-growth and actualizing one’s goals can be empowering and improve our sense of self-confidence and agency that we CAN achieve and are in control of our lives. The capacity to change demonstrates mental flexibility, which is believed to be a sign of emotional health and well-being (Ebberwein, 2010). Sometimes it can be helpful to stir things up in a positive direction. If you decide to pursue therapy, remember that you are not necessarily making a lifelong commitment. Try framing therapy as an opportunity to try something new. Imagine what you can learn about yourself! Of course, along with all the potential benefits of therapy, there are some intrinsic risks as well. Learning about yourself may be helpful in the long run, but it may also illuminate aspects of your personality or ingrained behavioral patterns that are not congruent with how you would like to see yourself, thus, potentially causing some temporary distress as you figure out how to reconcile this discrepancy.

These are some questions/issues to consider when deciding whether or not to begin therapy:

1)    What are your expectations of therapy? Clarify any misconceptions and get more information as needed.

2)    Consider your goals and what you hope to get out of counseling. This may be a collaborative process between you and your therapist, who may facilitate the development of realistic, achievable goals.

3)    What are you willing/able to afford on a weekly basis? Will you be using insurance or paying for services out-of-pocket?

4)    Does your health insurance cover mental health (also called “behavioral health”) services? What is your co-payment and deductible? The therapist’s office should be able to assist you in obtaining this information if you have difficulty.

5)    Consider the pros and cons of starting therapy. Pros may include: having an outlet to share concerns with an objective third party, working with a professional toward personal goals, learning new coping skills, becoming aware of patterns that may not have previously been clear. Meanwhile, cons may include: actively confronting the thoughts and feelings you may have been avoiding or repressing, in addition to investing time, financial resources, and energy “doing the work” required to effect desired changes.

6)    What are the motivating factors pushing you to seek help (i.e., what do you want to be different)? What values are perhaps incongruent with your current behaviors (i.e., you value health and quality of life, yet cannot seem to quit smoking)?

7)    What is your availability and willingness to commit to therapy, even for a trial period?

8)    Conduct research online to find a therapist who is both qualified and seems to be a good fit for your needs. Consider someone’s credentials and training relative to the problems you are hoping to address (i.e., a life coach may be suitable for certain concerns, whereas someone with a master’s or doctoral-level education may be better equipped to help you through more complex mental health or relationship issues). Do you want someone who specializes in a particular area (i.e., weight loss, medical illness, couple’s work, grief counseling, relationship concerns, LGBTQ issues)? Do you feel more comfortable speaking with a counselor of a particular gender, someone who is younger or more senior in the field, someone who shares a similar cultural background or speaks your native language? You may contact your insurance company for referrals and/or find referrals for local providers through comprehensive websites such as Psychology Today.

There is no right or wrong decision about whether to pursue therapy. Consider the above to determine if it is the “right” choice for you at this time. 

Dr. Jacquie Talesnick is a licensed clinical psychologist at the Rowan Center for Behavioral Medicine who has trained in both cognitive-behavioral and psychodynamic therapeutic approaches. She considers herself to be an integrative therapist, pulling from different methodologies and theories to tailor treatment to each individual with whom she works. She offers psychotherapy services to the adult population in individual and couples modalities. She specializes in working with individuals in the LGBTQ community. Her other specialties include treatment of relationship difficulties, trauma, depression, and anxiety. She has a special interest in the benefits of animal companions, as well as supplementing traditional “talk therapy” with creative approaches (i.e., writing, art). 

 REFERENCES

Ebberwein, C. (2010, May). Practicing Flexibility for Good Mental Health. Retrieved September 08, 2016, from http://www.yourmindyourbody.org/practicing-flexibility-for-good-mental- health/ 

Lee, D. (n.d.). Ambivalence in Therapy: Exploration & Resolution. Retrieved September 8,  2016, from http://www.psychodelights.com/pdfs/ambivalence1.pdf

Rollnick, S., Miller, W.R., & Butler, C. (2008). Motivational interviewing in health care: Helping patients change behavior. New York: Guilford Press.

Lions, Tigers and Bears……Oh My Stomach Hurts! The relationship between stress and digestion

Many people speak of the “fight or flight” response that occurs in the body when something stressful happens. Stress can be caused by upcoming exams, playing in game 7 of the world series (or watching the game as a diligent fan), running late for work, arguing with another person, paying the bills, running from a bear in the woods, having a big surgery, getting injured, or even just constantly being on the go and never taking the time to sit down and take a few deep breaths. There are many things that cause the body to kick in to high alert. The “fight or flight” response is a protective mechanism that our bodies do without thinking about it. This response is what kept our ancestors alive when they roamed the earth in need of food, shelter and safety a million years ago. 

Take a moment to think about any of the stressful situations mentioned above. During any of these situations do you think it would be helpful for the body to all of a sudden say “Hmmmm…I think this is a good time for me to poop.” Absolutely not! The last thing you would want to do when you are being chased by a lion is to have to think about where, how and when you will stop to use the restroom. This is another protective mechanism your body has inherited over time.

When we are in a “fight or flight” response, our bodies: 

  • Stimulate the sympathetic nervous system
    • Pupils dilate so we can see better
    • Heart rate and blood pressure rise so our muscles get the oxygen they need to work harder
    • Hormone levels shift to increase the feeling of adrenaline and decrease the body’s awareness of being tired, scared and/or in pain
    • Muscle is broken down to help provide energy for the response
  • Override the parasympathetic nervous system (rest and digest response)
    • Digestion is stopped so more blood can go to our muscles and so we don’t have to worry about going to the restroom
    • The ability to slow heart rate is turned off
    • The ability to save up energy is stopped
  • Other side-effects of the shift in our nervous system activity include:
    • Immunity is suppressed due to elevated hormone levels
    • The body’s inflammatory response is triggered
    • The body’s ability to prevent cell damage and detoxify harmful chemicals decreases due to the body’s inflammatory response
    • Fat digestion is impaired
    • Glucose and cholesterol are release in the blood
    • Fat and fluid are retained
    • Energy levels decrease (energy is used up by the “fight or flight” response resulting in less overall energy. Hence you want to take a nap after a long day at work.)
    • Mood fluctuations occur due to energy and hormone shifts

Most people do not think about how the stress in their lives is affecting their digestion, but many studies have found links between chronic stress and gastrointestinal symptoms. When the gastrointestinal tract and digestion are stopped, less stomach acid and digestive enzymes are released. This makes it difficult to break food down and absorb nutrients. Instead, the body learns to break down muscle and over time actually replaces it with fat and extra fluid. Also, as the body is constantly breaking muscle down and releasing glucose in to the blood for energy, the pancreas is forced to work in overdrive to secrete insulin to help the body’s cells use the glucose. Some scientists think that high levels of insulin may contribute to craving sugary foods when we are stressed. Who hasn’t thought about eating a whole pack of cookies or whole carton of ice cream when they are stressed?!  

What all of this means is that our bodies are not designed to be on high alert at all times. And when we are, our bodies do not know how to use the food that we eat. As you run to catch the bus, energy bar in hand, or eat lunch while checking email on your phone, or worry about the day, or think about negative emotions tied to a relationship, you are telling your body “Emergency! Do not digest!” The digestive system is turned off, which negatively affects the nutritional value of food. It can also lead to digestive symptoms, such as heartburn, bloating, belching, feeling like food is just sitting in your stomach, and stomach pain. So here is yet another reason to take the time to be mindful and de-stress everyday. It is important for your mind and body, including digestion and nutrition.

Jonae Perez is currently a clinical dietitian at Professional Child Development Associates providing nutrition counseling for children with special health care needs. She completed her Master of Public Health and nutrition training at the University of Washington, Seattle. She has a background in exercise science and is passionate about adult and pediatric wellness.

Feelings Part 3: Expressing and Communicating Feelings

In parts 1 and 2 of this blog series, we explored what feelings really are and the negative consequences of suppressing feelings. We also discussed some techniques to get in touch with and identify long suppressed feelings. In this blog, we will discuss how to express feelings and effectively and respectfully communicate them to others.

Feelings can be likened to charges of energy that need some sort of release from the body. Physical and psychological wellbeing is improved if you are willing to acknowledge and express your feelings relatively close to the time they occur. Release of feelings can come from talking to someone, writing your feelings out, or physically discharging your feelings

Talking with a supportive and trusted friend, partner or counselor is one of the best ways to express your feelings. It is important that you feel safe enough to let your feelings out rather than just talk about them. Expressing your feelings through talking works best when the person you are sharing with merely listens rather than jumping in with advice, opinions, or suggestions. 

Another way to express emotions is through writing them down. It is sometimes helpful to keep a feelings journal where you can enter your strong feelings. Tracking your strong feelings over time can be helpful in identifying patterns or themes in your life. Whether you choose to save what you’ve written or not, writing feelings down can serve as an effective outlet of expression.

Often people report greater difficulty expressing perceived negative emotions such as sadness and anger. When working with these emotions it is helpful to consider some specific techniques designed to assist with discharging these emotions. 

Sadness

People often report that they feel like they are on the verge of tears or have a lump in their throat but are unable to cry. Crying can be a very cathartic release of grief and sadness that helps people stabilize following a loss or disappointment. If you are having trouble letting out sadness, consider listening to evocative music that has personal significance to you. Watching an emotional movie or reading poetry and literature can bring unexpressed sadness to the surface. 

Anger

Often people chronically suppress anger because of fear of hurting others. As discussed in my previous blog, this can lead to psychological and physical illnesses. At times it can be helpful to engage in physical motions associated with aggression in order to bring anger to the surface. Examples of this include hitting a pillow, hitting a punching bag, throwing eggs against a wall or into a bathtub, yelling into a pillow, hitting a tennis racket against the bed or working out vigorously. A word of caution here though, these techniques are to be used sparingly and only when you are having a difficult time bringing anger to the surface. Evidence suggests that ventilating anger too frequently can lead to increased feelings of anger. 

Communicating Your Feelings

In the section above we were focused on expressing or discharging feelings. Now we turn towards communicating our feelings toward specific people, i.e. letting them know that your feelings are related to something they said or did. Communicating long-held feelings to the person you have them about can be the final step towards being able to release the feelings and move on. There are some important things to consider when communicating your feelings. First, you need to make sure that the person you are going to disclose your feelings to is willing to listen. If your feelings are miscounted or you leave the conversation feeling misunderstood, your sadness, fear or anger toward the person may increase. It is important that you clearly ask for the person to set aside some time to listen to you. You also need to be prepared to ask for the person to wait until you are finished if they interrupt you. 

You should avoid blaming or belittling the person. People are much more likely to listen if they are talked to in a respectful and non-blaming way. Using first person statements helps the listener to remain non defensive. By taking responsibility for your feelings, you avoid such statements as, “You made me so mad when you didn’t pick up the phone.”  A better way to express this is, “I feel angry when you don’t answer my phone calls.” 

A second rule of thumb is to remain focused on the person’s behavior rather than making a personal attack. It is important that you take the time prior to the discussion to clearly identify what the other person said or did that angered or frightened you. By focusing on specific behaviors, there is hope that something can change to remedy the conflict.

The third rule of thumb is to avoid judgments. If you begin judging others, there is less likelihood that they will be willing to hear you out and negative feelings and interactions are likely to continue or even escalate. 

By implementing the above strategies for expressing and communicating your feelings, you are cultivating a value of respecting yourself and those with whom you are in a relationship with. 

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.

Feelings Part 2: Identifying Feelings

As mentioned in my previous post on feeling, many people go through much of their lives ignoring or suppressing their feelings. This can be for a multitude of reasons including fear of falling apart through experiencing strong emotions and messages from childhood that labeled certain feelings as bad or unacceptable. Because suppressing feelings becomes so automatic for many, many report that they don’t even know what they are feeling. By learning to recognize the characteristics of suppressed feelings and tuning into your body, you can become much more adept at identifying what you are feeling. 

Even though feelings are suppressed, they typically don’t just go away. They often manifest in a number of bodily and psychological symptoms.

Free-floating anxiety: Anxiety is a very normal and common reaction to any multitude of situations. However, if you are feeling anxious and uneasy for no identifiable reason, it may be due to unexpressed feelings. If this is a state you are familiar with, try to observe if this free-floating anxiety arises the next time you hold in your anger toward someone. 

Depression: Depression can arise when we hold in grief or feelings of sadness over a loss. Indeed, a grief reaction that is not fully expressed can evolve into a depressive episode. Getting in touch with our grief, crying and fully mourning often allows us to feel better and begin the healing process. If you have not experienced a recent loss, your depression may be anger directed towards yourself. This is particularly true if your find yourself attacking and criticizing yourself. 

Psychosomatic symptoms: Frequent headaches, gastrointestinal symptoms, high blood pressure and asthma often occur as a result of chronically withheld feelings. Holding in feelings over the course of many years is a form of stress that takes a toll on bodily systems. Often people find that when they learn to identify and express strong feelings, their physical symptoms abate.

Muscle Tension: Tense muscles are a particularly effective cue that feelings are being chronically withheld. We tend to hold tension in different body groups depending on what feeling we are suppressing. Anger tends to lead to the tightening of the neck and shoulders, while grief and sadness often results in tightening muscles in the chest and around the eyes. Fear typically reveals itself through the tightening in the stomach and diaphragm. While these are typical patterns of muscle tightening, these are not absolute. That’s why it is important to get to know your own particular physical experience of various feelings.

Tune Into Your Body

Thinking about your worries and concerns keeps your primarily in your head. It is necessary to shift focus from your mind to your body. The following steps have been adapted from Eugene Gendlin’s work on experiential focusing can be quite helpful in getting in touch with your physical experience of feelings.

  1. Physically relax. Spend five to ten minutes using a relaxation technique such as progressive muscle relaxation or meditation to slow down the mind and relax the muscles of the body.

  2. Ask yourself, “What am I feeling right now?”

  3. Tune into the place in your body where you usually experience emotional sensations such as anger, fear and sadness. Often observing the area of your hear or gut will reveal some sensations, but this may be different for you. Try to identify your particular place where feelings arise in your body.

  4. Observe what you sense when you tune into your body. Don’t try to analyze, figure out, or judge what arises. Just allow your self to wait and observe any feelings that are surfacing.

  5. Many find that they get stuck in steps 3 and 4 and are inundated with racing thoughts. If this occurs for you, simply begin at step 1 as this may mean that you need some more time to relax. You might try a few minutes of slow deep breathing.

  6. Once you have come into contact with a sense of what you are feeling, ask yourself:

    • Where in my body is the feeling?

    • What is the shape and size of this feeling?

    • If the feeling had color what would it be?

Hopefully, this exercise will help you begin to get in greater contact with your physical experience of various feelings. If you are still having a hard time identifying what you are feeling, you might find the feeling list below helpful. 

Positive Feelings                Negative Feelings

Affectionate        Great                                                            Afraid            Hostile

Alive                   Happy                                                             Angry            Humiliated

Amused             Hopeful                                                         Anxious        Hurt    

Accepted        Joyful                                                               Apprehensive        Ignored        

Beautiful        Lovable                                                            Ashamed        Impatient

Brave            Loved                                                                  Awkward        Inadequate

Calm            Loving                                                                  Bitter            Incompetent

Capable        Loyal                                                                  Bored            Indecisive

Caring            Passionate                                                      Confused        Inferior

Cheerful        Peaceful                                                           Contemptuous        Inhibited

Cherished        Playful                                                           Defeated        Insecure    

Comfortable        Pleased                                                   Dejected        Irritated

Competent        Proud                                                        Dependent        Isolated

Concerned        Quiet                                                          Depressed        Jealous

Confident        Relaxed                                                       Despairing        Lonely

Content        Relieved                                                         Desperate        Melancholy

Courageous        Respected                                            Devastated        Miserable

Curious        Safe                                                                 Disappointed        Misunderstood

Delighted        Satisfied                                                    Discouraged        Muddled    

Desirable        Secure                                                        Disgusted        Needy

Eager            Self-reliant                                                   Distrustful        Outraged

Energized        Sexy                                                           Embarrassed        Overwhelmed

Excited        Silly                                                                 Exacerbated        Panicky

Forgiving        Special                                                       Fearful            Tired

Friendly        Strong                                                          Foolish            Touchy

Fulfilled        Supportive                                                 Frantic            Trapped

Generous        Sympathetic                                          Frustrated        Troubled

Glad            Tender                                                          Furious        Unappreciated

Good                                                                                  Guilty            Unattractive

Grateful                                                                             Hateful            Uncertain

                                                                                            Helpless        Uncomfortable

                                                                                            Hopeless        Uneasy

                                                                                            Horrified        Unfulfilled

In my next post, I will be providing some suggestions for expressing and communicating your feelings, so they no longer have to remain suppressed. 

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.

Self-Compassion

Many of the people we see in therapy are inundated with derisive, attacking, and at times, verbally abusive self-talk. So subtle and pervasive is the way that we deal with ourselves, that it is often invisible and nearly impossible to observe. Examining your relationship with yourself is almost like trying to see your eyeball with your own eye. As a psychologist, I have found that helping people to adjust this aspect of their inner life is extremely difficult and profoundly effective in moving towards greater wellbeing in life. 

Many contemporary theories of therapy incorporate self-acceptance as integral to making positive improvements in life. The wisdom traditions also emphasize the importance of self-acceptance. In Buddhism, mindfulness and awareness practices cultivate an openness and warmth to ourselves in a nonjudgemental way. It is important to note that acceptance and self-compassion is not the same as condoning destructive behaviors towards ourselves or others. Rather, it means acknowledging and allowing for our whole self to be present, including our flaws and limitations. In fact, without first accepting ourselves as we are, we cannot begin to move forward and live in line with our true values. Often, the practice of compassion is one that we are more than willing to extend to those friends and family members that we love; however, we struggle to offer that same generosity to ourselves.

There is evidence to suggest that self-compassion actually improves one’s motivation to make positive changes (Breines, & Chen, 2012). In one study, self-compassion exercises led to improved mood and decreased depression in participants (Shapira & Mongrain, 2010). Finally, self-compassion can reduce the negative emotional and cognitive impacts of difficult experiences as self-companionate people may be more able to acknowledge their own role in negative events (Leary, Tate, Adams, Allen & Hancock, 2007). Learning how to be kind to oneself is difficult at first, but the rewards are far-reaching. Explore the exercises below to begin to learn to be your own best friend.

Self Compassion practices to try: 

1.) Physical gesture: This can be incredibly powerful as there is something about touch that transcends verbal ways of communicating. Think of a supportive touch that you might use with a close friend, a hand on the shoulder, arms gently hugging, or placing your hand over your heart. Feel the physical sensations that you experience as you offer yourself these same gestures. Notice the sensations where you are touching your body, the sensations of your face and behind your eyes. Using this touch can be very helpful during times of stress, sadness or anxiety.

2.) Letter to Yourself: This evocative exercise is designed to help you nurture and accept yourself, just as you are, with all of your flaws. In the first part of the letter, you are to write about an aspect of yourself that you are ashamed of or that makes you feel inadequate. Describe in detail how it makes you feel, being as honest as possible. Next, express compassion and acceptance towards this aspect of yourself. It might help to think about how you might respond to someone you care deeply about. Consider all of the factors that play a role in the development of this aspect of yourself that you don’t like – unbringing, genes, opportunities, etc. In the letter, explore constructive changes you can make that would bring you greater fulfillment, happiness, and health. The most important aspect of this letter is to avoid judging or criticizing yourself. Save the letter in a special place and come back to read, especially if you are feeling troubled about the aspect of yourself that you’ve written about.

3.) Lovingkindness or Metta meditation: This ancient meditation practice is designed to develop the mental habit of altruistic love. It has been described as a meditation practice that systematically develops the quality of loving acceptance. Typically, the practice includes a series of loving phrases targeted toward 1.) someone you love dearly, 2.) a neutral person, 3.) a hostile person, and 4.) yourself. 

Click here for a link to a free guided meditations focused on self-compassion. 

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.

REFERENCES

Leary, M. R., Tate, E. B., Adams, C. E., Allen, A. B., & Hancock, J. (2007). Self-compassion and reactions to unpleasant self-relevant events: The implications of treating oneself kindly. Journal of Personality and Social Psychology, 92, 887-904.

Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the mindful self-compassion program. Journal of Clinical Psychology, 69(1), 28-44.

Shapira, L. B., & Mongrain, M. (2010). The benefits of self-compassion and optimism exercises for individuals vulnerable to depression. The Journal of Positive Psychology, 5, 377-389.

Savvy Internet Searching and Your Health

There have been many changes to the our healthcare system – managed care organizations are enrolling more individuals, providers are spending less time with patients and costs are being more carefully monitored. The United States healthcare system has maintained a fairly stable position as the most expensive healthcare system in the world (The World Health Report, 2013).  Though healthcare expenditure has increased in the past few decades, the quality of care has gone down. The United States ranks lower on health outcomes, quality and efficiency as compared to other countries. 

Physicians in the U.S. are constantly forced to deal with administrative hassles, care coordination and the difficulties in receiving timely information (Davis, 2014). A study from the University of California, San Francisco (UCSF) reported that the average U.S. patient-physician face-to-face time is about 1/2 the average of that in New Zealand and 1/3 of that in Australia. This has impacted the management of chronic conditions and helps to explain why Americans have poorer overall health outcomes compared to citizens of other countries (Bindman, Forrest, Britt, Crampton, & Majeed, 2007). The low relative ranking of our healthcare system shows there is an inverse relationship between quantity and quality. 

While all these changes have been taking place and continue to take place with the Affordable Care act, the internet continues to be the main source of health information delivery system for many individuals with chronic health conditions. The internet provides a diversity of health care information, including: online global network communities for individuals with common interests and support, e-mail, e-commerce, forming sites for consumers to share stories and experiences and also delivering the information and resources at a very low-cost (Mittman & Cain, 1999). This channel of information delivery has given the consumer more control of their own health (Pennbridge, Moya, & Rodrigues, 1999). 

Individuals are using the internet to research information about their medical conditions, treatment side effects, and for second opinions. Though there are many reliable health-focused internet sites, there are many sites that have misleading information. Even though many may be getting information from these unreliable sites, studies suggest that the majority of health information seekers are confident that they are accessing reliable information, and most do not share this information with their doctors. 

Despite the existence of many reliable medical and health-related web sites, several reviews have demonstrated that patients may encounter potentially misleading or inaccurate information when navigating the internet (Biermann, 1999; Sacchetti, Zvara, & Plante, 1999; Pandolfini, Impicciatore, & Bonati, 2001). The problem is that much of the health related information on the internet does not pass through an editorial review process and many websites do not even provide the author’s name (Ayonrinde, 1998; Lindberg & Humphreys, 1998).

Many difficulties exist when integrating the internet into health and health care. These difficulties include (Mittman & Cain, 1999).: 

  • Poor-quality of information on numerous websites

  • Not knowing the source of origin or authorship

  • More often than not there is no editorial review process on these sites

  • The uncertainty and uneven quality of publicly available information

  • The lack of universal standards for communications and transactions

What should you do and where should you look for accurate information? I have included the National Institute of Medicine/National Institute of Health link that discusses this in detail so please review this site and the video tutorial. In brief:

  • Always consider the source

  • When you go to a site look for an “about us” page and always check to see who is running the website. Is it …

    • A branch of the government

    • A university

    • A health organization

    • A hospital

    • A business

  • Focus on quality of information

  • Check for source citations. Are the authors referencing high quality studies? For example are they quoting journal articles from peer-reviewed publications? If unsure always check with a health-care professional.

  • Check to see if the site has an editorial board.

  • Is the information reviewed before it is posted?

Resources to help you evaluate the health information you are finding online:

http://www.nlm.nih.gov/medlineplus/evaluatinghealthinformation.html

16 Minute Video Tutorial from National Institute of Health

http://www.nlm.nih.gov/medlineplus/webeval/webeval.html (you can watch it directly on their website)

OR

http://www.nlm.nih.gov/medlineplus/webeval/webevaldownload.html  (you can download the video and watch it later)

Dr. Narineh Hartoonian is a Clinical Health and Rehabilitation psychologist at the Rowan Center for Behavioral Medicine. She has several years of interdisciplinary clinical and research experience in health and rehabilitation psychology and has served the needs of many individuals with chronic medical conditions and disability. Dr. Hartoonian received her Bachelor and Master of Science in Physiology from the University of California, Los Angeles (UCLA) and her Doctorate in Clinical Psychology from Loma Linda University (LLU). She has taught various graduate and undergraduate courses in the physiological sciences, health and psychobiology.

REFERENCES

  1. Ayonrinde O. (1998) Patients in cyberspace: information or confusion? Postgrad Med J. 74:449–50.

  2. Biermann JS, Golladay GJ, Greenfield ML, Baker LH. (1999) Evaluation of cancer information on the Internet. Cancer. 86:381–90.

  3. Bindman, A. B., Forrest, C. B., Britt, H., Crampton, P., & Majeed, A. (2007). Diagnostic scope of and exposure to primary care physicians in Australia, New Zealand, and the United States: cross sectional analysis of results from three national surveys. British Medical Journal, 334(7606), 1261. doi: bmj.39203.658970.55 10.1136/bmj.39203.658970.55

  4. Davis, K. Stremikis, K. Squires, D. and Schoen, C (2014). Mirror, Mirror on the Wall: How the Performance of the U.S., Health Care System Compares Internationally. The Commonwealth Fund

  5. Lindberg DA, Humphreys BL. Medicine and health on the Internet: the good, the bad, and the ugly (1998). JAMA. 280:1303–4.

  6. Mittman, R., & Cain, M. (1999). The Future of the Internet in Health Care: Five-Year Forcast. Oakland: Institute for the Future, Written for California Healthcare Foundation.

  7. Pandolfini C, Impicciatore P, Bonati M. (2000) Parents on the web: risks for quality management of cough in children. Pediatrics. 105(1):e1

  8. Pennbridge, J., Moya, R., & Rodrigues, L. (1999). Questionnaire survey of California consumers’ use and rating of sources of health care information including the Internet. The Western Journal of Medicine, 171(5-6), 302-305.

  9. Sacchetti P, Zvara P, Plante MK. (1999). The Internet and patient education resources and their reliability: focus on a select urologic topic. Urology. 53:1117–20.

Part 2: Advanced Hug Physiology

Some of you may remember my earlier blog titled “Part 1: Hugs Not Drugs”. The blog explained that simply hugging someone can boost a range of hormones and chemicals in your body, including oxytocin. A quick synopsis of how oxytocin impacts our body is provided below:

1)     Protects our cardiovascular system (Grewen et al. 2003 & 2005).
2)     Reduces free radical production and other inflammatory markers lowering the risk for heart attacks. 
3)     Increases nitric oxide production causing the dilation of blood vessels, which decreases blood pressure, inflammation and plaque build-up.
4)     Helps with depression (Scantamburlo, 2007; Arletti and Bertolini, 1987; Andeberg and Uvnas-Moberg, 2000).
5)     Helps with decreasing anxiety symptoms (Scantamburlo, 2007; Andeberg and Uvnas-Moberg, 2000).
6)     Acts as an anti-stress neuropeptide (Legros, 2001; see figure 1).
7)     Reduces the production of cortisol (Ditzen et al. 2009; Taylor, 2006; Heinrichs et al. 2003).
8)     Improves sleep quality by decreasing levels of cortisol.
9)     Boosts your immune system (Gimpl & Fahrenholz, 2001; Carter, 2014).
10)  Lowers pain sensitivity (Dunbar et al. 2012; Mazzuca et al. 2011).

The last blog focused on WHAT oxytocin does. Today’s blog focuses HOW oxytocin works in our body and how it positively impacts our stress response and improves our mental and physical health.

This figure may seem a bit overwhelming, but I promise I will explain every step the best I can. Enjoy! 

There are two main pathways in this figure that I will discuss. The first pathway is the stress-response pathway that ultimately leads to the release of cortisol. The second pathway is the oxytocin pathway that leads to the release of oxytocin and is typically activated when you give someone a hug, during intimacy, childbirth and is involved in the milk let-down reflex and social bonding.  

The Paraventricular Nucleus (PVN) is located in our hypothalamus (a region of the brain responsible for coordinating and controlling homeostasis). Neurosecretory cells and other neurons, located in the region of the PVN are responsible in releasing neuropeptides and hormones, including oxytocin and Corticotropin releasing hormone (CRH), into the systemic venous and hypopheseal portal system (a collection of blood vessels that connects the hypothalamus to the pituitary). Depending on the situation, one of those two pathways may be it activated.

Let’s start with the stress response pathway. During the stress response, the cells located in the PVN release CRH which then act on cells of the anterior pituitary to release Adrenocorticotrophic Stimulating Hormone (ACTH). ACTH then acts on the adrenal cortex to release cortisol (cortisol is a natural occurring steroid called a glucocorticoid). Cortisol is also known as the stress hormone. Chronic elevation of this hormone can negatively impact our mental and physical health including memory, sleep, depression, metabolism, immune system, wound healing, electrolyte balance, gastric secretion etc.

Now, if you look to the right of this figure (the second pathway) you will see that the PVN also releases oxytocin neuropeptide into the blood stream. Oxytocin is associated with lowering the release of CRH and ACTH (look at the arrows with the red [-] sign). If CRH and ACTH are suppressed, then glucocorticoid (cortisol) production decreases. In addition to acting on the Hypothalamic-Pituitary-Adrenal Axis (HPA Axis), oxytocin acts on the parasympathetic nervous system (PNS) and the sympathetic nervous system response (SNS) which make up our Autonomic Nervous System (ANS). More specifically, it increases the PNS activity and decreases the SNS activity. The PNS is responsible for “resting and digesting,” lowering heart rate and blood pressure. The SNS on the other hand prepares us for “Fight or Flight” by increasing heart rate above 100 beats per minutes, stress response, and shutting down our digestion when signaled. However, with the release of oxytocin the SNS activity is lowered to its original threshold. This can be achieved by a simple hug.

How is this related to mental health:

In individuals with anxiety, the SNS and HPA Axis are often being activated and the release of the stress hormones increase, resulting in the symptoms that many individuals with anxiety experience (i.e., increase in heart rate, dizziness, excessive sweating, sleep difficulties, shortness of breath, increased alertness, excessive worry, restlessness, etc.). Hence, when you activate the oxytocin pathway the activity of the SNS and the HPA decrease, resulting in lowering your stress-response (Carter, 1998; Insel, 1997). Also being able to control the chronic elevation of cortisol can limit memory impairment, sleep difficulties, and depression and can also help with metabolism as well as immune system functioning etc.  

*Tips for General Public: remember in order to feel and benefit from the effects of a hug you must hug for at least 20 seconds with each hug. Also the more hugs you give and receive (resulting in repeated exposure of oxytocin release), participation in social bonds might gradually bring about long-term changes in stress reactivity (decrease in SNS and increase in PNS activity) that promote not only psychological feelings of comfort and security, but also cardiovascular health.

*Tips for Mothers: More often than not mothers give their little ones frequent hugs and adequate caregiving, which is important because even a  simple hug has many benefits for your child. In contrast, inconsistent caregiving and not providing infants with adequate care has been shown to increase insecure attachment in children, lowering vegal tone, increasing anxiety, depression, anger and stress for the child. So providing consistent caregiving and care is vital for a child’s health. In animal studies, simple maternal touching reduces the entire stress response in children (Pihoker, Owens, Kuhn, Schanberg, & Nemeroff, 1993; Wang, Bartolome, & Schanberg, 1996) so as so continue to give your little ones a hug at least 1-2x per day.

***Note. A hug is not intended to substitute for conventional medicine. If you have been prescribed medication by a physician please follow your physicians recommendation. You can always use a hug as a complimentary method but not as an alternative treatment method to reduce the above mentioned effects.

Dr. Narineh Hartoonian is a Clinical Health and Rehabilitation psychologist at the Rowan Center for Behavioral Medicine. She has several years of interdisciplinary clinical and research experience in health and rehabilitation psychology and has served the needs of many individuals with chronic medical conditions and disability. Dr. Hartoonian received her Bachelor and Master of Science in Physiology from the University of California, Los Angeles (UCLA) and her Doctorate in Clinical Psychology from Loma Linda University (LLU). She has taught various graduate and undergraduate courses in the physiological sciences, health and psychobiology.

REFERENCES

1.     Andeberg, A.M., Uvnas-Moberg, K., 2000. Plasma oxytocin levels in female fibromyalgia syndrome patients. Z. Rheumatol. 59, 373–379. 

2.     Arletti, R., Bertolini, A., 1987. Oxytocin acts as an anti-depressant in two animal models of depression. Life Sci. 41, 1725–1730.

3.     Bartz, J.A. et al. (2010) Oxytocin selectively improves empathic accuracy. Psychol. Sci. 21, 1426–1428.

4.     Carter, C.S. (2014). Oxytocin pathways and the evolution of human behavior. Annu Rev Psychol.

5.     Carter, C.S. (1998). Neuroendocrine perspectives on social attachment and love. Psychoneuroendocrinology, 23, 779–818.

6.     Ditzen, B. et al. (2009) Intranasal oxytocin increases positive communication and reduces cortisol levels during couple conflict. Biol. Psychiatry 65, 728–731.

7.     Dunbar RIM, Baron R, Frangou A, Pearce E, van Leeuwen JC, et al. 2012. Social laughter is correlated with an elevated pain threshold. Proc. R. Soc. B 279:1161–67.

8.     Gimpl G, Fahrenholz F. 2001. The oxytocin receptor system: structure, function and regulation. Physiol. Rev. 81:629–83.

9.     Grewen, K.M., Anderson, B.J., Girdler, S.S., Light, K.C., 2003. Warm partner contact is related to lower cardiovascular reactivity. Behavioral Medicine 29, 123–130.

10.  Grewen, K. M., Girdler, S. S., Amico, J., and Light, K. C. (2005). Effects of partner support on resting oxytocin, cortisol, norepinephrine, and blood pressure before and after warm partner contact. Psychosom. Med. 67: 531–538.

11. Heinrichs, M., Baumgartner, T., Kirschbaum, C., Ehlert, U., 2003. Social support and oxytocin interact to suppress cortisol and subjective responses to psychological stress. Biol. Psychiatry 54, 1389–1398.

12.  Hurlemann, R. et al. (2010) Oxytocin enhances amygdala-dependent, socially reinforced learning and emotional empathy in humans. J. Neurosci. 30, 4999–5007.

13. Insel, T.R. (1997). A neurobiological basis of social attachment. American Journal of Psychiatry, 154, 726–735.

14. Legros, J.J., 2001. Inhibitory effect of oxytocin on corticotrope function in humans: are vasopressin and oxytocin ying–yang neurohormones? Psychoneuroendocrinology 26, 649–655.

15. Mazzuca M, Minlebaev M, Shakirzyanova A, Tyzio R, Taccola G, et al. 2011. Newborn analgesia mediated by oxytocin during delivery. Frontiers in Cellular Neuroscience. 5(3); 1-9.

16. Pihoker, C., Owens, M. J., Kuhn, C. M., Schanberg, S. M., & Nemeroff, C. B. (1993). Maternal separation in neonatal rats elicits activation of the hypothalamic-pituitary-adrenocortical axis: A putative role for corticotropin-releasing factor. Psychoneuroendocrinology, 18,485-493.

17.  Scantamburlo G, Hansenne M, Fuchs S, Pitchot W, Marechal P, Pequeux C, Ansseau M, Legros JJ. (2007). Plasma oxytocin levels and anxiety in patients with major depression. Psychoneuroendocrinology. 32:407–410.

18.  Singer, T. et al. (2008) Effects of oxytocin and prosocial behavior on brain responses to direct and vicariously experienced pain. Emotion 8, 781–791.

19. Taylor, S.E. (2006) Tend and befriend: biobehavioral bases of affiliation under stress. Curr. Dir. Psychol. Sci. 15, 273–277.

20. Wang, S., Bartolome, J. V., & Schanberg, S. M. (1996). Neonatal deprivation of maternal touch may suppress ornithine decarboxylase via downregulation of the proto-oncogenes c-myc and max. Journal of Neuroscience, 16, 83-842.

Stop Forgetting to Remember!

Remembering to complete tasks that we have planned or intended to do is something that most people’s lives require every day- but despite our best efforts, nobody can keep on top of everything little thing 100% of the time!

Remembering intentions, or “remembering to remember,” is a special type of memory called prospective memory. Some examples of prospective memory tasks are:

•       Remembering to send an email or place a phone call;
•       Taking medications correctly;
•       Grabbing object X to bring along before leaving the house;
•       Stopping at the store on the way home from work to pick up milk

Some researchers think prospective memory might be the most important type of memory we have. This is because prospective memory is all about FUNCTIONALITY– using your memory to accomplish a goal, rather than just remembering information for its own sake. We usually experience memory as a “recording” of our past, but constantly storing information about our experiences for no specific reason has suspicious evolutionary value to a species. Scientists think that our memory system ultimately serves to help us prepare and plan for the future (Schacter & Addis, 2007). Successful prospective memory involves using parts of our episodic memory, and other cognitive skills such as attention, to do just that.

Prospective memory generally requires 4 steps (according to a leading theoretical model; Kliegel et al. 2002):

1.     Form the intention (e.g., I think to myself that after dinner, I will call my sister)
2.     Retain the details (e.g., when = after dinner, what = call my sister)
3.     Notice the correct circumstances (e.g., recognition that after dinner, I am supposed to do something)
4.     Perform the task (e.g., pick up the phone and dial my sister’s number)

Want to improve your prospective memory? Here are some of the important factors and some tips for success!

•       Forgetfulness isn’t an inevitable result of getting older. In fact, for some prospective memory tasks, older adults perform better than younger adults. To be fair, this finding is most robust for simple and/or highly salient tasks and age may not benefit performance on complex tasks (Ihle et al, 2012). On the other hand, some of the most critical tasks fall into the first category, including medication adherence. Research suggests that younger adults actually make more medication adherence errors than older adults!

•       Stress affects our prospective memory. It’s probably no surprise that when we are stressed out, we are more likely to forget things that need to be done. Things like interruptions to our routines, unexpected circumstances, and multitasking make prospective memory errors more likely to occur (Dismukes, 2012).

•       Form good intentions! No, I don’t mean the intention to do good (although generating good karma is never a bad thing!). I mean form strong, memorable, cue-able intentions that work for you. One technique that is relatively easy to learn and apply is called Implementation Intentions, which Wikipedia defines as “a self-regulatory strategy in the form of an ‘if-then plan’ that can lead to better goal attainment.”  This website outlines the technique nicely. Another relatively simple strategy that can be used alone or alongside implementation intentions is visualization- using sensory imagery to imagine yourself enacting the intention in vivid detail. NOTE: Both of these strategies sound simple but require a lot of practice to be truly useful, so don’t get frustrated if they don’t work perfectly right away!

•       Use your devices. Our brains can only process and store so much information at a time, and as our world arguably becomes ever more complex at an unyielding pace, technology can help take some of the pressure off of our cognitive systems. Use those iPhone/Android calendar and reminder apps, Google or Outlook calendars, etc., even if the task seems simple. If the OS-native apps don’t work for you, there are many more options out there. See the following pages to learn more:

•       12 apps to help forgetful people remember things
•       10 apps to stay on time
•       Pillboxie, a medication reminder app
•       Physical “tags” that prevent you from forgetting your keys, etc.  

•       Try not to beat yourself up if you forget something! These errors are common, and most people of any age or ability level are likely to commit them daily. Getting older, experiencing medical problems or psychological difficulties, or being under a lot of stress can make us extra sensitive and more likely to attribute mistakes to these problems rather than to normal variations in our attention and memory throughout the day. If you are worried about your memory, talk to your doctor or other medical provider and ask for an evaluation.

Dr. Joshua McKeever is a Postdoctoral Fellow in Rehabilitation Psychology at the Palo Alto Veteran’s Affairs Medical Center. He has several years of clinical and research experience in rehabilitation psychology/neuropsychology and currently works primarily with veterans and individuals with multiple sclerosis. Dr. McKeever received his Bachelor of Arts in Psychology and English at Bowdoin College and his Master of Science and Doctorate in Clinical Psychology from Drexel University.

Disclaimer: References herein to any specific commercial products, process, or service by trade name, trademark, manufacturer, or otherwise, does not necessarily constitute or imply its endorsement, recommendation, or favoring by the VA or the United States Government. The views and opinions of the author expressed herein do not necessarily state or reflect those of the VA or the United States Government, and shall not be used for advertising or product endorsement purposes.

REFERENCES

Kliegel, M., Martin, M., McDaniel, M. A., & Einstein, G. O. (2002). Complex prospective memory and executive control of working memory: A process model. Psychologische Beiträge, 44, 303–318.

Schacter, D. L., & Addis, D. R. (2007). The cognitive neuroscience of constructive memory: remembering the past and imagining the future. Philosophical Transactions of the Royal Society B: Biological Sciences,362(1481), 773-786.

Dismukes, R. K. (2012). Prospective memory in workplace and everyday situations. Current Directions in Psychological Science21(4), 215-220.

Ihle, A., Schnitzspahn, K., Rendell, P. G., Luong, C., & Kliegel, M. (2012). Age benefits in everyday prospective memory: The influence of personal task importance, use of reminders and everyday stress. Aging, Neuropsychology, and Cognition19(1-2), 84-101.

Wilson, E. A. H., & Park, D. (2008). Prospective memory and health behaviors: Context trumps cognition. In M. Kliegel, M. A. McDaniel, & G. O. Einstein (Eds.), Prospective memory: Cognitive, neuroscience, developmental, and applied perspectives (pp. 391–407). New York, NY: Erlbaum.

Part 1: Hugs Not Drugs

What happens to you physiologically when you give someone a hug?

I am guessing everyone who is reading this blog has either given or received a hug at least one time in their life. If you haven’t that is okay too. Hopefully after reading this blog, you will be convinced to get out there and find someone to hug.

I am assuming that a majority of you have never questioned what actually happens to your body physiologically when you engage in the act of hugging. This is not something we ever think about but the truth is that there is an entire cascade of reactions that happens in our body that has scientifically been shown to induce positive health outcomes.

Simply hugging someone can boost a range of hormones in your body. The focus of today’s blog will be looking at the physiological benefits of hugging. I will focus on the main hormone that is released when you simply touch another person (appropriately that is!). Simply touching another being releases oxytocin causing healthy changes to happen in our body.

            Oxytocin, the bonding hormone, has been found to:

1)     Play a strong role in protecting the cardiovascular system (Grewen et al. 2003 & 2005). First, oxytocin alone reduces free radical production and other inflammatory markers lowering the risk for heart attacks.  Oxytocin also causes an increase in nitric oxide production. Nitric oxide then causes the dilation of blood vessels leading to a decrease in blood pressure while also lowering inflammation and plaque build-up.
2)     Inversely correlated with depression (oxytocin goes up, depression goes down; Scantamburlo, 2007; Arletti and Bertolini, 1987; Andeberg and Uvnas-Moberg, 2000)
3)     Inversely correlated with anxiety (oxytocin goes up, anxiety goes down; Scantamburlo, 2007; Andeberg and Uvnas-Moberg, 2000)
4)     Act as the body’s own anti-stress hormone (Legros, 2001)
5)     Reduce levels of cortisol (Ditzen et al. 2009; Taylor, 2006; Heinrichs et al. 2003; Carter, 1998; Insel, 1997)
6)     Create a sense of belonging and social connection (Heinrichs et al. 2003; Taylor, 2006)
7)     Increase positive communication (Ditzen et al. 2009)
8)     Improve the length of relationships (couples who hug more stay together longer)
9)     Improve quality of sleep (by lowering our stress-hormone cortisol)
10)  Boost your immune system (Gimpl & Fahrenholz, 2001; Carter, 2014)
11)  Increases your pain tolerance (Dunbar et al. 2012; Mazzuca et al. 2011)
12)  Be involved in the development of the human brain (Carter, 2014)
13)  Increase empathy (Hurlemann et al. 2010; Singer, T. et al. 2008; Bartz, J.A. et al. 2010)

In sum, a simple hug can assist in lowering an individual’s level of stress, pain sensitivity, and heart rate. Hugs also improve sleep, positive communication, a sense of belonging, and social connectedness, as well as empathy. Sounds easy, doesn’t it? Well get out there today and give someone a hug. Even if you don’t think you need it, the other person might.  

***Tip: the hug must be for at least 20 seconds

***Note 1. Please remember, always ask permission if you approach a stranger and give them a hug. Proceed at your own risk. 

***Note 2. A hug is not intended to substitute for conventional medicine. If you have been prescribed medication by a physician please follow your physicians recommendation. You can always use a hug as a complimentary method but not as an alternative treatment method to reduce the above mentioned effects.

***Part 2: Advanced Hug Physiology

Dr. Narineh Hartoonian is a Clinical Health and Rehabilitation psychologist at the Rowan Center for Behavioral Medicine. She has several years of interdisciplinary clinical and research experience in health and rehabilitation psychology and has served the needs of many individuals with chronic medical conditions and disability. Dr. Hartoonian received her Bachelor and Master of Science in Physiology from the University of California, Los Angeles (UCLA) and her Doctorate in Clinical Psychology from Loma Linda University (LLU). She has taught various graduate and undergraduate courses in the physiological sciences, health and psychobiology.

REFERENCES 

1.     Andeberg, A.M., Uvnas-Moberg, K., 2000. Plasma oxytocin levels in female fibromyalgia syndrome patients. Z. Rheumatol. 59, 373–379.

2.     Arletti, R., Bertolini, A., 1987. Oxytocin acts as an anti-depressant in two animal models of depression. Life Sci. 41, 1725–1730.

3.     Bartz, J.A. et al. (2010) Oxytocin selectively improves empathic accuracy. Psychol. Sci. 21, 1426–1428 

4.     Carter, C.S., Oxytocin pathways and the evolution of human behavior. Annu Rev Psychol, 2014.

5.     Carter, C.S. (1998). Neuroendocrine perspectives on social attachment and love. Psychoneuroendocrinology, 23, 779–818. 

6.     Ditzen, B. et al. (2009) Intranasal oxytocin increases positive communication and reduces cortisol levels during couple conflict. Biol. Psychiatry 65, 728–731

7.     Dunbar RIM, Baron R, Frangou A, Pearce E, van Leeuwen JC, et al. 2012. Social laughter is correlated with an elevated pain threshold. Proc. R. Soc. B 279:1161–67

8.     Gimpl G, Fahrenholz F. 2001. The oxytocin receptor system: structure, function and regulation. Physiol. Rev. 81:629–83

9.     Grewen, K.M., Anderson, B.J., Girdler, S.S., Light, K.C., 2003. Warm partner contact is related to lower cardiovascular reactivity. Behavioral Medicine 29, 123–130.

10.  Grewen, K. M., Girdler, S. S., Amico, J., and Light, K. C. (2005). Effects of partner support on resting oxytocin, cortisol, norepinephrine, and blood pressure before and after warm partner contact. Psychosom. Med. 67: 531–538.

11.  Heinrichs, M., Baumgartner, T., Kirschbaum, C., Ehlert, U., 2003. Social support and oxytocin interact to suppress cortisol and subjective responses to psychological stress. Biol. Psychiatry 54, 1389–1398.

12.  Hurlemann, R. et al. (2010) Oxytocin enhances amygdala-dependent, socially reinforced learning and emotional empathy in humans. J. Neurosci. 30, 4999–5007

13.  Insel, T.R. (1997). A neurobiological basis of social attachment. American Journal of Psychiatry, 154, 726–735. 

14.  Legros, J.J., 2001. Inhibitory effect of oxytocin on corticotrope function in humans: are vasopressin and oxytocin ying–yang neurohormones? Psychoneuroendocrinology 26, 649–655.

15.  Mazzuca M, Minlebaev M, Shakirzyanova A, Tyzio R, Taccola G, et al. 2011. Newborn analgesia mediated by oxytocin during delivery. Frontiers in Cellular Neuroscience. 5(3); 1-9.

16.  Scantamburlo G, Hansenne M, Fuchs S, Pitchot W, Marechal P, Pequeux C, Ansseau M, Legros JJ. (2007). Plasma oxytocin levels and anxiety in patients with major depression. Psychoneuroendocrinology. 32:407–410

17.  Singer, T. et al. (2008) Effects of oxytocin and prosocial behavior on brain responses to direct and vicariously experienced pain. Emotion 8, 781–791.

18.  Taylor, S.E. (2006) Tend and befriend: biobehavioral bases of affiliation under stress. Curr. Dir. Psychol. Sci. 15, 273–277. 

Accepting Support with Grace

I was enjoying dinner with a cherished group of old friends when we began talking about how to help someone who is going through a health crisis. Specifically, we were talking about a friend of a friend who had recently been diagnosed with cancer but had found it difficult to reach out for help. This discussion led to an “aha” moment for me when I realized both how difficult and necessary it is to be able to receive help from others, particularly when crisis strikes in your life. Asking for, and accepting, help from others can be particularly troubling in our Western society which emphasizes individuality and independence as cultural values. Relying on others can often bring up feelings of shame, guilt and inadequacy. However, research has demonstrated that one’s perception of connectedness to their social network is a reliable indicator of well being (Cohen & Willis, 1985; Helgeson, 2002). As my friends and I discussed our experiences with both being the recipient of, and giver of, support, we reflected that it was very helpful as a support person to be able to offer something concrete to our loved ones during times of crisis. This also supports the well known relationship between giving to others and levels of happiness (Diener & Seligman, 2004).

Within our clinical practice we often see people in a state of crisis who have recently encountered extreme stressors such as a diagnosis of cancer or infertility or an accident that has resulted in ongoing disabilities. Central to our work as psychologists at the Rowan Center is helping our patients build and nurture robust support systems. I thought I would highlight some concrete ways to offer and ask for support. These are general ideas but would be applicable to most medical challenges such as surgery, cancer treatment, infertility treatment, or even the birth or adoption of a new child. I’ve been a recipient of many of these types of support and can attest to the power of having your place in the social circle affirmed by these concrete acts. At the opposite end, I also know that being able to offer support in specific ways has been very important to me during times of crisis in the lives of my friends.

Ways to offer support:

– Meal train (www.mealtrain.com)
– Help with transportation
– Offering to babysit
– Accompanying friends to Dr’s appointments
– Grocery shopping
– Walking the dog or caring for pets
– Taking out and bringing in the trash
– Gassing up the car
– Cleaning the house or hiring a cleaning service
– Scheduling a masseuse to come to the home

Ways to ask for support:

– Choose people you trust to ask for help
– Be specific about what would be helpful
 -Be honest about what would not be helpful
– Remember that people in your life want to support you
– Reflect on times when you were able to help others that you love
– Join a support group for education and social support
– Though it can be difficult to accept support, try and say thank you and allow others to help you
– Make sure to connect to people directly rather than relying on Facebook or other social media posts

Though, in our individualist culture one of the most difficult things to do is accept help from others, remember to accept help with grace and be grateful for your friends and family. Receiving and giving help in times need cements the social bonds that help us to thrive in our lives.

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives. 


 REFERENCES

Cohen, S., & Willis, T.A. (1985). Stress, social support, and the buffering hypothesis, Psychological Bulletin, 98, 310-357

Diener, E., & Seligman, M. (2004). Beyond Money: Toward an Economy of Well-Being, Psychological Science in the Public Interest, 5 (1), 1-31.

Helgeson, V. S. (2002). Social support and quality of life.  Quality of Life Research, 12 (1), 25-31

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