Who Needs A Therapist? I Have a Dog

The heading above refers to a car bumper sticker that I saw once, and it has some merit. As a clinical psychologist and psychotherapist, I am occasionally asked to provide clients with a letter confirming that their pet is an emotional support animal. Usually, I've worked with a client long enough to know whether their pet really performs this function. I also know that there is a wealth of research that shows how the companionship provided by a pet is good for our health. In fact, the more attached you are to a pet, the greater the protective benefits may be. Most of the research has been conducted around dogs and shows that dog ownership reduces blood pressure, cholesterol and triglyceride levels, and the risk of heart disease. Of course, there are also the health benefits that come from walking your dog twice a day. And simply petting a dog releases positive neurotransmitters, such as dopamine and serotonin, that make us feel good. Anxiety sufferers and people who have experienced trauma (PTSD) can really benefit from having a pet. One theory is that our attachment to and interest in animals stems from the strong possibility that, in the past, human survival was partly dependent on signals from animals in the environment, indicating safety or threat. The biophilia hypothesis suggests that now, if we see animals at rest or in a peaceful state, this may signal to us safety, security, and feelings of well-being, which in turn may trigger a state where personal change and healing are possible. A friend of mine has benefited so much from having a dog that he decided to help others by enrolling his latest pet, a Scotty dog, in a service animal training program. His dog is now part of the wag brigade at San Francisco International Airport, helping to make air travel less stressful. I think most of us can benefit from that.

Are You Having Fun Yet?

When I meet with new couples I'm always keen to hear about how they create time to have fun together. It's inevitable that, once people have been together for a while, there is a risk of falling into regular patterns of behavior that become more functional than fun (think: 'it's Saturday so it must be date night'). Having regular time set aside to do things together is essential but it's not much good if the things you are doing are not much fun anymore. This becomes even more true when kids, work, and other obligations start to crowd out your schedule. Relationships, like gardens, need nurturing and part of tending to a relationship must involve spending time together that both partners find enjoyable. Some psychologists say that every couple needs five hours a week of one-on-one time (which does not include watching TV together!). I suggest that a good chunk of that time is spent doing something fun. Think back to what you used to do together when you first met or try a new activity. How about taking a cooking or exercise class, going rock climbing, planning a trip together, trying a comedy club, going to a concert or gig, singing Karaoke, visiting a museum or art show, being a tourist for a day, going bowling.........you get the picture. Whatever activity brings a smile to your face, or hopefully makes you both laugh at some point, is like adding fertilizer to a garden. Your relationship will keep blooming.  

Love Ain't Easy

A significant part of my practice is dedicated to working with couples. I often find that couples come to counseling because their relationship has become so fraught that they are contemplating splitting up. Research shows that couples tend to wait about 10 years after they first start having problems to get professional help. I often wish I could have met with couples earlier in their relationships as there are many elements of couples therapy that can help people avoid some of the smaller aches and pains of coupledom. Successfully handling some of these smaller issues can often prevent more significant problems arising over time. For example, we all have different ways of handling emotions. Some people prefer not to share their feelings too much because they have not found it to be very helpful or productive. It's a 'stiff upper lip' mentality that leads you to roll with the punches and get on with life. This might work fine until you fall in love with someone who does like to express and explore their emotions and uses feelings as a guide to life. Two people with different emotional styles can find it a challenge if they don't recognize what's going on and communicate accordingly. For example, an emotionally expressive partner who feels anxious or sad will need the other partner to pick up on these feelings automatically and empathize with him or her. Yet the other partner, through no fault of their own, may not know how to respond or may not even be aware of the other person's feelings. Either way, the first partner feels emotionally lonely and misunderstood while the other feels negatively judged and possibly blamed for being uncaring. The issue is that close relationships, unlike casual acquaintances or professional relationships, do require emotional engagement. And that means engaging with the negative as well as positive feelings. When one partner has difficulty with this (or when a partner is too demanding emotionally), things can head south real quick. But understanding each other's emotional style can help to create a new framework, and a more compassionate way of looking at each other that minimizes misunderstandings and maximizes effective communication. 




Headline Stress Disorder

I wrote in a blog post below how it is more important than ever to engage in self care if, like many people, you are feeling the strain of the continuous news cycle regarding events in D.C. A couples therapist writing in the Washington Post, Dr. Steven Stosny, has coined the term 'Headline Stress Disorder,' and, joking aside, he makes some good points about the impact of constant news alerts, FaceBook posts, Tweets, and blogs on our emotional health. He is absolutely right that feelings of shock and anger can, over time, give way to anxiety and depression. I mentioned in my post the need to get out and be with friends, sometimes to allow us to vent to a receptive ear but often just to connect and reinvigorate our sense of community. In his article, Dr. Stosny explains why connection is so important, and I like his explanation about the three levels of connection: community, intimacy, and spirituality. Check out the full article here.



UCSF Leads The Way To Help Students With Disabilities

I recently attended a meeting hosted by UCSF Student Disability Services where we looked at some of the reasons why medical students with disabilities are getting their applications for accommodations turned down by the National Board of Medical Examiners (NBME). It seems that, even when students have a well documented history of disability and psychological testing that demonstrates current disability (such as ADHD), their applications can still get rejected. This has tremendous implications for students who are on a tight deadline to get through their step exams and onto residency. I was heartened to see the dedication of the UCSF Medical Student Disability Services team, particularly its director, Dr. Lisa Meeks, who is a fearless advocate for the rights of students with disabilities. Dr. Meeks, together with her colleagues in the field, has published some very useful resources to help both students and assessors, such as myself, to navigate this difficult terrain. UCSF is lucky to have such a dedicated (albeit swamped) resource.


When Self Care Is More Important Than Ever

The strain of a grueling general election campaign last year has failed to let up for many people. In fact, judging by comments I hear every day, the political climate in the country is creating such fear and tension that many feel emotionally exhausted.... and worry that it is only going to get worst. While none of us know exactly what the next four years will have in store for us, we do have control over how we take care of ourselves. Now more than ever we need to use tried and tested strategies to ensure we don't burn out. As blogger Mirah Curzer put it: "while it's obvious and mundane, we have to take care of the basics." Exercise, getting enough sleep, talking (venting) to friends, eating well, and getting outside are the mainstays of self care. If we overlook some of these when things are going well, so be it. But, when we hear news every day that upsets us, it's crucial that we double down on these basics. If you are energized by activism, that's great. But make sure you don't get stretched so thin that you stop taking care of yourself. There will be plenty of demands for your time and energy. Curzer suggests picking one or two issues that you are passionate about and focusing on them. Try to make them fun. Whenever possible, bring humor into your activism, and commit to doing small things frequently. This way commitments don't seem so overwhelming when other areas of life get really busy. And finally, know when to take a real break. In other words, when things get too much, unplug for a while. Turn off the news feeds, stop refreshing Twitter, take a vacation from FaceBook. Get distracted by other things - go to the movies, binge watch Netflix, take the dog for a real long walk, get into nature, go to yoga. You'll feel refreshed and ready to face another day - whatever that may bring.

How You Argue Could Make You Sick

Another research study shows a connection between our emotional health and physical wellbeing. This time, researchers at UC Berkeley and Northwestern University followed couples over 20 years to see how their interactions might impact their physical health.  The study is one of several led by psychologist Robert Levenson Ph.D., and looked at the inner workings of long-term marriages. The relationships of over 150 middle-aged and older heterosexual couples in the San Francisco Bay Area have been tracked since 1989. 

Making A Connection

We are fortunate to live in the Bay Area where so many start-ups and tech companies often launch and publicize their services or products before they go global (think Uber). One new service that has launched in the South Bay is about helping people to connect. Called linkAges, the program was created by the Palo Alto Medical Foundation and strives to build healthy communities through an online network that connects people of all ages. The program works by allowing you to post online that you need help with something, such as learning to play the piano or getting a ride to the dental office. Someone then volunteers to help and, once the task is completed, they get to bank the time it took, and use that time when they need something themselves. It's a particularly helpful way for older adults to connect with others. For example, an older person may need help with gardening or cleaning. A student or younger adult volunteers to help out for two hours. A few weeks later, the student then needs a ride to the airport and can use the banked hours to request help from someone else. To learn more, visit the linkAges website at community.linkages.org.




Disclosing Mental Health Problems

Interesting article in the Guardian on the dilemma of revealing mental health problems to an employer. This is such a difficult area and one that, unfortunately, varies so much depending on the employer. We can only hope that, as the stigma surrounding mental health issues decreases, more people will find it possible to be open and honest about such problems. 

100 and Counting

I recently had the pleasure of meeting a wonderful lady who was 100 years old.  Quite amazing to think that she was born during the final years of the First World War. It got me thinking about the increasing number of people who are living to be 100 or older - do they have anything in common besides their age? Research finds that they have little in common physically beyond being physically active, most not smoking, and most maintaining a fairly constant weight throughout their lives. We also know that 85% of centenarians are women. Women do tend to live longer than men and there are various hypotheses as to why. Some think it may be because of the protective benefits of female hormones or better social networking. Others suggest it may be because women generally engage in fewer risky behaviors. Genetics also play a part. A study comparing 2,800 identical and fraternal twins in Denmark found that genetics accounted for 26% of male longevity and 23% of female longevity. From a psychological perspective, studies show that centenarians do share similar personality traits. For example, they tend to be more independent-minded and self reliant. They have a love of learning that accompanies them throughout their lives. They are resilient in adapting to change and loss, and they have an ability, or willingness, to forgive and let go of grievances. They share a sense of gratitude and optimism. And, last but not least, they tend to have a good sense of humor.  What this research tells me is that the stereotypes about aging are wrong. Every age has its benefits - the trick is to focus on the benefits of your current age and experience your current age as the best of times. Optimists tend to put the positives in the foreground and the negatives in the background. With age comes benefits: more wisdom, less peer pressure, more time, better quality friendships, pride in age, greater emotional stability, and an appreciation of the circle of life. While we may not have all of the traits mentioned above, changing our thinking about aging can help to reinforce the notion that life at any age can be fun. When we start with this presupposition, we are more likely to find enjoyment in whatever we do. Enjoying life in turn fosters good health, happiness, and......longevity. Here's to reaching 100!  

Know Your Stressors

Great article in the Huffington Post about stress and what we need to know to improve our quality of life.  According to the American Psychological Association, 73% of workers experience stress-induced psychological problems, such as depression. Even more (77%) experience physical symptoms, such as headaches. The article has some interesting tips on what to do to keep stress under control. 



Tummy Trouble

Soaring stress levels can have a terrible impact on our digestive system. Our emotions and our digestive functions are tightly interwoven because when we are anxious our body releases adrenaline. This is the 'fight or flight' hormone that prepares us for action. But it also diverts the blood supply away from our stomach and towards the heart and lungs, which means we effectively shut down our digestive system. This is helpful when our body wants to divert all energy to dealing with the crisis. But, it also means we do not produce enough digestive enzymes to help our food travel through the digestive tract. We end up feeling bloated, often with painful cramps and inflammation of the gut wall. For women, this can be exacerbated by changes in female hormone levels. And, of course, lifestyle and diet can play a big part. Lack of sleep or too much sugar, caffeine, and alcohol can play havoc. So, if you find yourself with stomach aches, bloating or cramping, check your stress levels. Finding healthy, effective ways to deal with stress can help reduce and possibly even eliminate tummy trouble.