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Tuesday, 28 June 2011

How Worry Seems to Prevent Disaster

Everyone worries, some of us more than others.  But why?  Sometimes it just seems to happen.  Suddenly our minds are filled with future catastrophes.

Sometimes, though, it can seem important to worry – as though the act of worrying can actually prevent disaster.  We can sense ourselves conjuring up images of bad outcomes in a compulsive way.  This tendency can become habitual in some people, and can contribute to a life consumed by worry.

But surely the simple act of imagining disaster doesn’t actually reduce its likelihood unless it actually affects our behaviour.  Perhaps a concern about skin cancer will motivate us to use sunscreen and hats, but the worry itself probably doesn’t stop cells from growing out of control.  How does this idea take root?

One of the main influences is statistical.

Even people who claim to worry “about everything” don’t.  They worry about specific things.  The cab to the airport will be late.  The plane will crash.  There will be an earthquake upon our arrival.  The list of worries is long, but finite.

The list of catastrophes that could actually happen is much much longer.  The cab could get in an accident.  The airport will be shut down due to a bomb threat.  The airline could go bankrupt.  There could be antigovernment riots at our destination.  There could be a hurricane, but no earthquake.  The hotel will have no air conditioning.  We will come down with the flu.  And a thousand other possibilities.

What happens over time?  The specific things we worry about tend not to happen.  Most of them are, after all, only remote possibilities.

The things that DO happen to us come from the long list of possibilities that we never considered.  A moose darts in front of our rental car.  We twist an ankle in the shower.  Our spouse brings up a disagreement from five years ago.

Result:  When we worry about something, it seldom seems to happen.  When we have bad outcomes, it’s almost always something we did not worry about.  Gradually it begins to seem that our worry actually prevents disaster.  Worry feels important, magical, helpful.

Human beings are bad at intuitive statistics.  We do not automatically take the “base rates” of possible outcomes into account in our calculations.  Consequently, we are prone to developing erroneous connections between our behaviour and its results.

One solution is to be more diligent in our attempts to worry about everything.  More of the things we dwell on will come to pass, and we may learn that worry doesn’t help.

A better approach is to remind ourselves that our thoughts do not control reality.  We can plan, we can problem solve, we can set goals. But envisioning a kitchen fire does not keep our home safe. And neglecting to stress about something doesn’t make it happen.

After all, you’ve never worried about Woody Allen coming to steal your toothbrush in the night, and thus far it hasn’t happened, has it?

Thursday, 23 June 2011

June 28 '11 PsychologySalon at UBC Robson Square: Exercise and Mood

“Why don’t you go get some exercise? It’ll be good for you.” Echoes of our childhood ring in our ears every time our friends, family, and physician tell us about the importance of fitness. But how important is it, really? 

In this talk we’ll review the surprisingly powerful evidence supporting the use of exercise in the treatment of mood disorders, anxiety problems, and general life stress. We’ll consider questions including: 


  • How much exercise is necessary?
  • Is exercise as effective as Celexa?
  • Does it have to be aerobic?
  • Does walking count?
  • If you don’t have any energy, why would spending energy on exercise be helpful?

7 pm to 9 pm June 28 2011 at UBC Robson Square, Room C400


Tickets $15 at the door, or reserve ahead at www.changeways.com.

Tuesday, 21 June 2011

Does LTD Make Depression Worse?

Depression has become one of the chief reasons that people in North America are home receiving Long Term Disability (LTD) benefits.  Why is this?

One answer, of course, is that depression appears to have become steadily more common over time.  The reasons for this are numerous and best left to other posts.

Another is a shift in what we might call health culture:  the belief-based practices that become common among health practitioners in the absence of evidence.

Send a dozen people to their healthcare practitioners with instructions to recite standard symptoms of mild to moderate depression.  When they return, count how many have been encouraged to take time off work.  “I’ll write you a note.”

What happens when we send depressed people home on leave?

The fantasy is that they will use all of that extra time to take care of themselves.  Self-care will become the new, and temporary, full-time job, and recovery will be much faster as a result.  The person will snap back and return to work invigorated and rested.

I’ve looked and I can’t find any evidence suggesting that this actually works.  Perhaps I am looking in the wrong places.  But I suspect there isn’t any.

The treatment for depression, in most instances, is an enhanced engagement with life.  Exercise, structure, tasks to complete, social contact, a reason to leave home in the morning.  Sure, we can all benefit from an examination of our distorted thinking, the resolution of childhood traumas, a consideration of our ultimate values.  But eventually the task is to re-engage.

Does stress leave or long term disability promote these goals?

By sending people home, we remove perhaps the biggest element of structure in their lives.  We take away the need to go to bed and get up at a regular time.  We alleviate the necessity of getting oneself cleaned up, organized, and out of the house.  We eliminate most of the contact with other people.  In effect, we give free rein for the depression to become the person’s master.

The symptoms of depression are problematic in part because they spiral.  I don’t sleep at night, so I catch up with a long nap in the afternoon, which makes it more difficult to sleep the next night.  My energy level is low, so it’s hard to pull myself together to get out of the house, so I stay home, bored, ruminating, and chastising myself for being lazy.

Without any external need to get going, my activity level is dictated entirely by my will, motivation, and self-discipline – all of which are impaired by the depression.

So what am I supposed to do?  If this is my first time on leave, I may automatically use my existing understanding of what it means to be off sick.  What is a sick person supposed to do?  Stay home, preferably in bed, and do relatively little.  But this is how to make depression worse, not better.

I may actually fear leaving the house, doing the shopping, seeing my friends, doing volunteer work, taking cross-country ski lessons – all of which are reasonable therapies for depression.  What if someone sees me?  “I thought you were off sick.  You must be faking.”  Far from encouraging anti-depression activity, sick leave makes it more difficult.

There are two additional problems.  First, getting sent home from work can get interpreted, by the depressive mind, as further evidence of one’s failure, incompetence, and worthlessness, thus reinforcing the problem.

Second, the prospect of eventually returning to work becomes a fearful barrier in itself.  “Will I be able to do it?”  “Will they think less of me now that I’ve proven I can’t take it?”  “Will everyone I work with grill me about the reason I was off?”  “Will they be looking for reasons to fire me?”

In other words, stress leave can be an iatrogenic cause of even deeper depression.  We worsen the problem we intend to solve.

I’m not suggesting that we want seriously depressed individuals on the job as air traffic controllers.  But most of us are not in such sensitive positions.  Most can benefit from cutting back a bit on responsibilities and working to enhance life balance.  Sending people home “sick” for six weeks (or longer) is often counterproductive.

Depression exists, independently of long-term disability.  And LTD can be a useful tool.  But it is used far too readily, and often produces more problems than it solves.


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Want more information on operating a private psychotherapy practice? 

Check out my book Private Practice Made Simple.  It contains information on starting a practice, creating a space, designing a website, getting referrals, managing finances, avoiding burnout, and much more.

The book is available at bookstores, from the Changeways Clinic website, and through Amazon here.

Tuesday, 14 June 2011

The Reality Ratio

When was the last time you went an entire day without looking at a screen of some kind?

No, really.  When?

It’s interesting to watch television and realize how seldom the characters are portrayed watching television.  It’s an inherently dull activity, and if portrayed would make us think that the characters do not have very interesting lives.  Instead, the characters on television are usually portrayed doing other things:  interacting with friends, spending time out of their homes, playing sports, enjoying romance, solving crimes – something. 

In other words, we watch television to see other people live human lives.  If it’s not a fictional drama, then we might tune in to see other people play sports, as a substitute for playing them ourselves. 

With the increased prevalence of screens in our lives, perhaps it is no surprise that the threshold for “entertainment” has dropped over time.  Today there are entire programs, even networks, devoted to people playing cards, renovating their homes, and cooking.  We no longer need to endure the strain of holding our own cards – we can watch minor celebrities do it for us.  An activity that we might formerly have thought too dull to engage in becomes acceptable when we can sit back and passively watch others do the same thing.

And if we are not watching television, what are we up to?  We stare at computers, surfing the internet.  We wander through the universe of knowledge available on an iPad.  We chat with people using text messaging, as a substitute for actually spending time with them.  With the miracles of modern technology we play games involving catapulting angry birds at enclosed pigs.  

And the rate of depression in our culture continues its apparent rise, fueled in large part by inactivity, isolation, and a powerful ennui coming from a loss of meaning in our lives. 

Is there a link?  This, as they say, is an empirical question.  And it is a question not only for the mythical “average person”, which could be determined by someone else’s research, but also for the individual.  In your own life, does the amount of time you spend looking at a screen correlate with your mood?  And does the relationship seem even partly to be a causal one?

Screens have their place.  But it’s worthwhile monitoring our screen time to see just how much of our lives are spent viewing electronic devices rather than friends and family. 

To this end:  The reality ratio.  The percentage of waking hours NOT spent before a screen of some sort.

[(Hours awake – Screen time) / Hours awake] x 100 = The Reality Ratio

Screen time, by this definition, is the time we spend gazing at a computer, iPad, smartphone, or television.  Given that we often go out to films with friends, let's overlook the time spent in front of movie screens.

It would be interesting to know the norms for the ratio.  What is the average for men?  For women?  For children or teens?  And is there, in fact, a relationship with mood or life satisfaction? 

Having spent years helping people cope with depression, I suspect the relationship operates both ways.  Depression robs us of energy and will, and makes sitting in front of TV or computer all the more tempting.  But spending a life in isolation, watching other people live their lives, or interacting with random, unconnected bits of information, seems also to promote depression and a sense of having lost one’s way.

How could someone assess this?  For a few weeks, you could keep a sheet of paper on the bedside table.  Before turning in, rate your mood for the day on a 0-100 scale (given the variability in mood over the course of the day, this can be tricky but eventually gets easier); and guess the number of hours spent before a screen of some kind.  Set aside at least a few days for a deliberate media fast, in which you will not turn on the computer or TV, and will use the phone only for, you guessed it, phone calls.

Is this a perfect test?  Of course not.  Maybe we hate our computer-based job, and the correlation has more to do with the amount of time we spend at work than anything else.  But it’s a hint.

For anyone prone to depression or ennui, my own recommendation is always the same.  Cut back on the screen time, and replace it with more energetic activities, with social time, with goal-directed activity, and with time spent out of the house.  On the whole, this seems to help.

Tuesday, 7 June 2011

Soundproofing Your Office Space - Part 2

In a previous post (May 24 2011) I discussed two strategies for increasing the soundproofing between the offices in a therapist's suite: filling the walls with sound-dampening insulation, and replacing one side of each wall with a dense drywall product called QuietRock.

Both strategies worked well for us when renovating our new suite, but more was needed. In this post, let’s consider some additional measures.

Insulate your light switches and power outlets.  Beneath the cover plates in both are recessed boxes, usually metal, that can serve as amplifiers, transmitting sound to the other side of the wall.  Consider having an expert add a putty-like product to these sockets to dampen the vibration.

Insulate above office walls.  Most office suite walls go only as high as the suspended ceiling rather than to the concrete pad of the next floor.  Lift a ceiling tile and you can see above the office next door.  Sound travels up through the acoustic ceiling (and through vents and lighting panels), over the tops of the walls, and down into adjacent offices.

One strategy is to have a builder add sound-dampening drywall up to the next floor slab.  An easier (though slightly less effective) strategy is to stuff the gap above each wall with sound dampening insulation (such as Roxul's SafeNSound).  Make sure there are no gaps, and don’t skimp.  Use full-width pieces (12 to 18 inches wide) so they extend at least a few inches on either side of the top of the wall above the suspended ceiling.

Inspect continuous windows.  Many office buildings have continuous panels of windows all the way around the building, each pane separated by a metal frame.  Walls between offices in these buildings typically step down to the width of the window frame, creating a narrow separation with excellent sound-transmitting qualities.

Stand in the middle of one office and speak directly to the centre of the wall.  Have a colleague next door listen to where the sound seems to come from.  If it seems to come from the windows, the frame is likely transmitting your voice.  One option is to stuff the stepped-back portion of the wall between offices (the narrow bit by the windows) with foam.  An easier alternative that we discovered was to use black foam tape designed for wrapping and insulating pipes.  This is available from most hardware stores.  We got a width that matched the window frame and installed it from top to bottom on both sides of every window frame that divided offices.

Insulate your doors.  Knock on your office doors to determine whether they are solid-core or hollow.  Solid doors are more soundproof.  Consider replacing hollow ones. On the top and open side of the frame, install weather-stripping on the jamb that the door strikes as it closes.  On the hinge side of the door, install the weather-stripping on the side of the frame so that the edge of the door doesn’t peel it away as it closes. You’ll have to close the door more firmly to get it to latch, but it will give a satisfyingly secure thunk that will tell your clients that the room is reasonably private.

Install door sweeps.  Sound can obviously travel under your doors if there is a gap.  Consider installing a door sweep on the bottom of the door so that the gap is minimized or eliminated.  There are various types of these; the one you want will depend on the size of the gap, your carpet, and your budget.

Have wall to wall carpet.  Most office suites come with wall to wall carpet, but some don’t, and some clinicians like the idea of a scattering of area rugs.  Nice concept, but bad soundproofing.  Carpet absorbs sound.

Add white noise.  No matter what you do, you probably won’t make your offices completely soundproof.  Adding white noise to your waiting area will help mask louder voices.  You can buy white noise generators, but you can just as easily use an air purifier in your waiting area that will do the same thing while performing double duty.  Add a sound system playing gentle music in your reception and waiting areas, and you will make it even more difficult to make out voices in your consulting rooms.

Is there more?  Of course.  You can spend tens of thousands of dollars making your space absolutely soundproof.  But with these measures you will reduce the sound transfer in your suite by a significant amount.  Your clients will sense it and will feel a little more comfortable discussing their private matters in your office.


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Want more information on operating a private psychotherapy practice? 

Check out my book Private Practice Made Simple.  It contains information on starting a practice, creating a space, designing a website, getting referrals, managing finances, avoiding burnout, and much more.

The book is available at bookstores, from the Changeways Clinic website, and through Amazon here.


Vancouver Workshop November 29 2013

Click here for information and registration for the one-day workshop Private Practice Made Simple being held in Vancouver Canada Friday November 29. 

Monday, 6 June 2011

The Fatabase

The Vancouver Sun has posted an extensive database listing the nutritional content of the various meals served by more than 80 restaurant chains operating in British Columbia Canada.  

For each meal the database provides the calories, grams of fat, grams of trans fat, mg of sodium, grams of carbs, and grams of sugars.  Want more?  Click on DETAILS beside each item and you can get additional info on fibre, protein, calcium, and more.

This is a great resource for those attempting to lose weight, and for those providing health services to them.  

Don't live in BC?  Most of the chains are national or international, so the information is likely to be of use to almost anyone - certainly in North America.