psychology

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SharingClinic, To Help Patients Tell Their Stories, Opens At Mass. General Hospital

Four years ago, Dr. Annie Brewster had a vision.

Brewster, a Boston internist, who was diagnosed with multiple sclerosis in 2001, had become frustrated that a crucial element of medicine — the human connection between patients and doctors — seemed to be lost in the modern era of 15-minute appointments and overly burdensome record-keeping. As a patient and a doctor, Brewster yearned for a therapeutic arena in which patients could tell their full health stories and feel they were actually heard, not rushed out the door; and where doctors, as well, could share a little more with patients.

Now, with the launch this week of the SharingClinic, an interactive “listening booth” stocked with audio stories from patients facing a range of illnesses, Brewster is a little closer to realizing her vision. Housed at the Paul S. Russell Museum of Medical History and Innovation at Massachusetts General Hospital, Brewster expects SharingClinic will continue to grow over time as more stories are collected and added to the kiosk. Eventually, she says, trained staff will begin to facilitate the storytelling in regularly scheduled “clinics” in a way that research suggests might offer an actual health boostContinue reading

Earlier:

Analysis: Can Mindful Eating Really Help You Lose Weight Or Stop Binging?

(t-mizo/Flickr)

(t-mizo/Flickr)

Updated 1/23

By Jean Fain
Guest Contributor

Mindfulness is all the rage. But does mindful eating — paying very close attention to your food and to your body’s signs of true hunger and satiety — really help you lose weight or stop binging?

On the one hand, paying closer attention to how you eat and why seems like a no-brainer for improved health. But in fact, mindful eating is steeped in controversy — pitting doctors against nutritionists, parents against children, therapists against clients, even colleagues against one another.

Proponents of mindful eating (also known as intuitive eating) like nutrition researcher Linda Bacon and other advocates of “Health at Every Size” — a self-described political movement promoting healthy habits and self-acceptance, rather than diets — recite a lengthy list of benefits related to mindful eating.

Critics of mindful eating offer a number of negatives: some say such navel-gazing about food makes it unappetizing, while others say mindful eating is superficial and ineffective, even irresponsible when it supplants traditional treatments for life-threatening eating issues.

Still others, like many who posted comments on my recent NPR interview with Jean Kristeller, author of the book, “The Joy of Half a Cookie,” dismiss mindful eating as a joke. One example: “Yes, let’s add more dietary neurosis to the babel of nutritional advice. How about this: eat the whole cookie. Have two, even. Just eat cookies less often, and eat nutritious food as the rule rather than the exception.”

According to Dr. James Greenblatt, an eating disorder expert, chief medical officer of Walden Behavioral Care and the author of “Answers to Binge Eating,” mindful eating is not only pointless in some cases, it’s potentially dangerous.

“Mindful eating clearly has a place in our treatment plans,” Greenblatt explained in a recent email exchange. “But, as a sole intervention for some of our patients, it is like asking opiate abusers to utilize mindful heroin detox. Many eating disorders reflect a severe neurochemical abnormality that needs to be addressed with biological interventions first, before adding other psychotherapeutic strategies and mindfulness.”
Continue reading

Commentary: When Sexual Violence Survivors Give Birth, Here’s What You Should Know

By Sarah Beaulieu
Guest Contributor

Sarah Beaulieu (Courtesy of the author)

Sarah Beaulieu (Courtesy of the author)

It shouldn’t have been a surprise that childbirth would leave me traumatized.

In retrospect, it seems obvious that when a survivor of sexual violence feels pain in her vagina caused by a strange being inside of her, the experience might trigger memories of an earlier trauma. But what wasn’t so obvious were the many ways that the childbirth and medical professionals didn’t prepare me for these unexpected and painful emotions related to giving birth.

With 20 years of therapy under my belt, I consider myself to be a fairly confident survivor with many tools in my resilience box. None of these tools prepared me for what happened during the birth of my son. After 12 hours of relatively peaceful labor in the hands of midwives, I dozed off, preparing for a long night. I woke up with at least two sets of hands inside of me, alarms ringing and a sense of panic in the room. My son’s heart rate had dropped dangerously low, and I needed an immediate C-section.

This experience — traumatic for even the healthiest woman — wrecked me, surfacing old post-traumatic stress disorder symptoms and pulling me into depression and anxiety. With the help of a hospital social worker, I emerged from my emotional dark place a few months later, and immersed myself in learning more about birthing as a sexual assault survivor. My experience was scary, but it couldn’t be that uncommon, I thought. After all, 1 out of 4 women share a sexual abuse history like mine, and U.S. women gave birth to nearly 4 million babies last year.

My research led me to Penny Simkin and Phyllis Klaus, two legendary birth educators who compiled much of the existing research into a single manual, “When Survivors Give Birth.”

I learned that, in fact, there were approaches to childbirth that were especially helpful to survivors of sexual violence. Not only that, but it was fairly common for pregnancy and birth to re-trigger memories and emotions related to past sexual violence. Yet despite this, the topic of sexual violence wasn’t typically covered by my midwifery practice, recommended childbirth literature or my natural childbirth class.

First and foremost, health care providers can adopt a trauma-informed approach to care for laboring mothers. Knowing that 25 percent of patients in labor and delivery will have a history of sexual violence, there is a benefit for all staff to be educated about sexual violence and its impact on birth. There are medical reasons too: Childhood trauma, including child sexual abuse, is a documented risk factor of postpartum depression and anxiety, which impacts 10 to 15 percent of new mothers — and their babies and families — each year.

Knowledge starts with screening for a history of sexual violence on standard intake forms and first visits. It also means creating a health care environment where survivors feel comfortable disclosing such histories. In my midwife’s office, there were pamphlets for every possible pregnancy complication, from gestational diabetes to heartburn to exercise during pregnancy. So, why not a pamphlet on giving birth as an abuse survivor?

Cat Fribley, an Iowa-based sexual assault advocate and doula whose practice focuses specifically on sexual violence survivors, describes trauma-informed care as “supporting the whole person with collaboration, choice and control, cultural relevance, empowerment and safety — both physical and emotional. This requires making certain adjustments to the way they work with survivors, acknowledging both the challenges that arise from sexual trauma, as well as unique coping skills — such as dissociation — that may help the survivor through the process of childbirth.”

Here’s an example: At one birth Fribley attended, “the birthing mother became visibly upset when new and unknown staff would enter the room while she was laboring. A simple sign on the door asking people to knock and announce themselves before entering helped make the birthing mom feel more in control of her environment — and the exposure of her body.” Continue reading

When It Comes To Happiness, Time Trumps Money, Study Suggests

(Amanda/Flickr)

(Amanda/Flickr)

By Joshua Eibelman
CommonHealth Intern

What do you value more: your money or your time?

A new study by researchers at the University of British Columbia suggests that those who place a greater value on their time, rather than their money, are happier.

Among the study’s 4,600 participants, there was an almost even split between those who prefer money and those who put a higher value on their time.

While the participants’ median age ranged from 20-45, older people tended to value time over money, possibly because over the years, their priorities shifted, and they feel greater satisfaction from quality time with friends and family, researchers found.

The study, published in the journal Social Psychological and Personality Science, looked at what kinds of trade-offs people were willing to make to achieve “happiness.” For instance, participants were asked whether they would prefer a higher paying job farther from home or a lower paying job closer to home.

College students surveyed at the University of British Columbia were asked various questions about what fields of study and jobs they’d choose and how they would prioritize time commitments versus potential salaries.

Participants were told that they’d been admitted to two graduate programs and had to decide between a higher starting salary with more more work hours, or a lower salary with fewer hours, the study said.

Those who are willing to make trade-offs in favor of time, the study found, tend to be happier. Interestingly, researchers report, “These findings could not be explained by materialism, material striving, current feelings of time or material affluence, or demographic characteristics such as income or marital status.”

Happiness was measured though a number of self-reporting tools and questions about the number of positive emotions people feel in a day, said lead researcher Ashley Whillans, a doctoral student in social psychology at the University of British Columbia.

Whillans likened preferences for either time or money as “personality characteristics.” Continue reading

Deep? Or Pseudo-Profound B.S.? Psychologists Explore Why Some Can’t Tell

(Anynobody/Wikimedia Commons)

(Anynobody/Wikimedia Commons)

What do you think of the following sentences?

“The universe is the wisdom of objective external reality.”

“Experiential truth embraces the expansion of actions.”

“Death is only possible in intrinsic possibilities.”

Are they profound wisdom? Or are they bull?

If you thought they were profound, you might need your BS detector checked.

Created from the website wisdomofchopra.com, this “wisdom” was generated by randomly putting together words found in the tweets of Deepak Chopra, the physician and author.

Who is more likely to see such bull as profound? And why? These are the questions that motivated Gordon Pennycook, a psychology PhD student at the University of Waterloo in Ontario, Canada, and his colleagues to publish a paper this week called “On the reception and detection of pseudo-profound bulls—.” (They spelled out the full word, which academic psychology allows but the AP Stylebook we use does not.)

The researchers took quotes like those above and tested whether people could see pseudo-profound statements for what they were — bulls—. Their findings suggest that people with higher intelligence and better critical-thinking skills are likeliest to detect BS. And more than one-quarter of the population they studied were particularly prone to buying in to it — and to holding, shall we say, “alternative” beliefs on topics from medicine to magic.

At first, this may seem like — you know — bull, but Gordon Pennycook is a real person. (Yes, Pennycook is his real name, despite its similarity to “poppycock.”) And if you wonder whether studying susceptibility to BS is important, just consider the possible effects on everything from votes in next year’s election to purchases of purported cure-all supplements.

The paper, published in the journal Judgment and Decision Making, is a remarkable study, not only in profane language — using the word bulls— about 200 times — but also in finally applying empirical analysis to the study of bull. Much has been written about it previously, but mostly just musings on the topic: “bulls— about bulls—,” Pennycook joked. Continue reading

Parents: Kids Spurn Emotional Help For Fear ‘They Might Think I’m The Next Shooter’

Candles spelling UCC -- for Umpqua Community College -- are displayed at a candlelight vigil for those killed during a fatal shooting at the school, Thursday in Roseburg, Oregon. (Rich Pedroncelli/AP)

Candles spelling UCC — for Umpqua Community College — are displayed at a candlelight vigil for those killed during a fatal shooting at the school in Roseburg, Oregon. (Rich Pedroncelli/AP)

By Lisa Lambert
Guest contributor

Lisa Lambert is the executive director of the Parent/Professional Advocacy League, which is subtitled “The Massachusetts Family Voice For Children’s Mental Health.”

“He doesn’t want to take the risk and have someone think he could be a shooter,” one mother said, “just because he has a mental health diagnosis.”

I was at a meeting with other parents whose children have mental health needs. This mother told us her son was reluctant to leave his high school classroom for an important evaluation, which included psychological testing.

Like much of America, we were talking about the recent and not-so-recent shootings on campuses and in communities across the country. For this mother, as with many parents whose children have mental health issues, the conversation is far more personal and troubling than for most.

Some parents said that in response to recent shooting incidents, their children are dropping out of services or refusing school supports so they won’t risk their peers or teachers finding out why they get treatment.

As a parent, this breaks my heart. Young adults shouldn’t have to choose between the safety found in avoiding treatment and the healing found in seeking it.

Lisa Lambert (courtesy)

Lisa Lambert (courtesy)

During our discussion, another mother reported that her son was in his first year of college and struggling to complete all his coursework. Freshman year is a stressful time for many students and even more so for students with depression. Because her son had had special education services in high school, he could access supports there to help him manage his academic and emotional stress.

She encouraged him to go to the college student services office to get help. He responded, “I’d rather drop the classes I am most behind in. If I go there, the professors and other students will know I have mental health problems. They might think I could be the next shooter.”

Often, as a news channel covers the latest shooting, the speculation immediately jumps to mental illness. Continue reading

Healthy Narcissism? 8 Ways To Be (A Bit) More Like Donald Trump

Donald Trump displays a copy of his net worth during his announcement that he will seek the Republican nomination for president, on June 16, in the lobby of Trump Tower in New York. (Richard Drew/AP)

Donald Trump displays a copy of his net worth during his announcement that he will seek the Republican nomination for president, on June 16, in the lobby of Trump Tower in New York. (Richard Drew/AP)

Donald Trump is often described as a textbook case of the downsides of extreme narcissism — the cruelty, the conceit. But the Republican presidential front-runner’s success in business and politics raises this uncomfortable question: What if he also exemplifies the upsides of narcissism? And what if it would behoove many of us to be a bit more like him?

Your knee-jerk response may be, “I don’t want to emulate Donald Trump in any way!” But can we take just the useful pages from his playbook and leave out the ugly parts?

I put that query to Dr. Craig Malkin, author of the new book, “Rethinking Narcissism: The Bad — And Surprising Good — About Feeling Special.” A clinical psychologist and instructor at Harvard Medical School, he begins with a massive disclaimer: “I would not advise anyone to emulate Donald Trump in a lot of the ways that he behaves.”

But broadly speaking, he says, it’s a myth that narcissism is all bad. In fact, narcissism is a trait, not a diagnosis, Malkin says; it’s a drive to feel special. And it exists on a spectrum, unhealthy mainly at the extremes.

“We are surrounded by this idea of empty, soulless, dangerous narcissists, and there are people like that out there,” he says. “But the reality is, what we see in the research is that there are healthy aspects, and they coexist, often, with the unhealthy in people who are extremely narcissistic. So you get the good with the bad.” Continue reading

CDC: One-Third Of Children With ADHD Diagnosed With The Disorder Before Age 6

(Vivian Chen/Flickr)

(Vivian Chen/Flickr)

One-third of children diagnosed with ADHD were diagnosed young — before the age of 6 — according to a new national survey from the U.S. Centers for Disease Control and Prevention.

Earlier, the CDC found that based on parental reports, 1 in 10 school-aged children, or 6.4 million kids in the U.S., have received a diagnosis of ADHD, a condition marked by symptoms including difficulty staying focused and paying attention, out of control behavior and over-activity or impulsivity.

The percentage of children diagnosed with ADHD has increased steadily since the late 1990s and jumped 42 percent from 2003-2004 to 2011-2012, the CDC says. Last year, concerns flared when a report found that thousands of toddlers are being medicated for ADHD outside of established pediatric practice guidelines.

In the current analysis, also based on parental reporting, and using data drawn from the 2014 National Survey of the Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder and Tourette Syndrome, the CDC also found:

•The median age at which children with ADHD were first diagnosed with the disorder was 7 years old

•The majority of children (53.1%) were first diagnosed by a primary care physician

•Children diagnosed before age 6 were more likely to have been diagnosed by a psychiatrist

•Children diagnosed at age 6 or older were more likely to have been diagnosed by a psychologist

•Among children diagnosed with ADHD, the initial concern about a child’s behavior was most commonly expressed by a family member (64.7%)

•Someone from school or daycare first expressed concern for about one-third of children later diagnosed with ADHD (30.1%)

•For approximately one out of five children (18.1%), only family members provided information to the child’s doctor during the ADHD assessment

What are we — parents, educators, doctors — to make of all this? In particular, what does it mean that so many very young kids are being diagnosed with an attention disorder? (Has anyone ever encountered a 4- or 5-year-old child who is not hyperactive, impulsive and inattentive??)

I asked two doctors — a pediatrician and a psychiatrist — for their impressions of the CDC report. Both agreed that we seem to have two problems when it comes to ADHD: over-diagnosing and under-diagnosing. Here, lightly edited, are their responses.

First, the pediatrician:

James M. Perrin, MD, is a professor of pediatrics at Harvard Medical School and associate chair of MassGeneral Hospital for Children. Dr. Perrin is also the immediate past president of the American Academy of Pediatrics and chaired the 1990s committee that wrote the first practice guidelines for ADHD (and he was on the committee for the 2011 revision).

RZ: How difficult is it to diagnose ADHD in children under 6 years old?

JP: In the pediatric community, we have worked over last 15 years to train general pediatricians to make diagnoses of ADHD reliably and follow very clear, specific guidelines on how to do so. In 2011, the AAP revised its practice guidelines for ADHD and included the opportunity to diagnose children ages 4 and 5 years old.

At the same time we recognize it’s very hard to do that well in that age group…because a lot of children are inattentive at 4 — you don’t expect them to work hard and read a Hardy boys book for an hour and half. Five is often impulsive, active, so it’s not unusual to have symptoms that children with ADHD would also have at age 4, 5. So, it’s not easy.

We did say [in the guidelines] pretty clearly that you shouldn’t make the diagnoses without significant impairment of normal behavior. What we mean by that is a child whose symptoms impair her ability to play with other children, or whose behavior is so out of control that it’s dangerous, for instance she runs out in front of cars, or has many accidents, that’s when the symptoms become impairing. Continue reading

Workout Supplements: Does Overuse Signal An Eating Disorder Among Men?

(USMC/Flickr)

(USMC/Flickr)

By Marina Renton
CommonHealth Intern

You’ve seen them at the gym: extremely body conscious men, driven to achieve a level of physical perfection through grueling workouts.

Well, new research suggests that overusing popular supplements like whey protein and creatine to improve workout performance may signal an emerging eating disorder.

Researchers presented their findings at the American Psychological Association’s annual convention in Toronto earlier this month.

Almost 200 18- to 65-year-old men who consumed legal appearance- and performance-enhancing drugs (APEDs) and worked out at least twice a week participated in the study, led by co-authors Richard Achiro and Peter Theodore, both from the California School of Professional Psychology at Alliant International University, Los Angeles. In addition to asking about their supplement use and eating habits, researchers surveyed the participants about their psychological well-being, asking about their body image, self-esteem and gender role conflicts.

Almost 30 percent of the people surveyed said they were worried about their supplement use. Over 40 percent had increased their supplement intake over time. Twenty-two percent said they consumed the supplements instead of a meal, even when that wasn’t their intended use. Eight percent had been advised by their doctor to curb their use of supplements, and 3 percent had been hospitalized for kidney or liver problems stemming from their supplement intake.

Continue reading

Sexting Among Adults May Be More Common Than You Think, Survey Suggests

A middle-aged woman I know recently confessed that she’s been doing quite a bit of provocative, R-rated texting with a man she’s involved with.

When I referred to it as “sexting” she was shocked. “It’s not like we’re sending naked pictures back and forth,” she said. “Just a little suggestive ‘What are you wearing?’ kind of thing. It’s fun.”

Welcome to the new world of sexting.

It turns out grownups in committed relationships are, increasingly, doing it for pleasure and “fun,” as one survey found. Also, according to researchers, the whole concept of “sexting” has evolved, or at least is evolving: from a risky, sordid and sometimes-dangerous activity among teens, to, as one therapist (more below) says, a way to add some sexual “simmering” to a relationship that may need spicing up. Even the AARP acknowledges the trend: “…the reality is that more and more of the 50-plus set, both single and married, routinely use text messaging to send tantalizing pictures and provocative words to their partner…”

Reframing Sexting

Indeed, sexting may be more popular among adults than you think.

A new survey on sexting found that 88 percent of respondents, ages 18-82, said they’d done it, and 82 percent said they’d done it in the past year (including the 82-year-old). Also, nearly 75 percent said they sexted in the context of a committed relationship, while 43 percent said they sexted as part of a casual relationship. (On the darker side, 12 percent reported sexting someone “in a cheating relationship.”) The findings were presented at the American Psychological Association annual convention in Toronto earlier this month in a paper called: “Reframing Sexting as a Positive Relationship Behavior.”

(Photo illustration by Mike Licht/Flickr, taking inspiration from the artist Edward Armitage)

(Photo illustration by Mike Licht/Flickr, taking inspiration from the artist Edward Armitage)

The survey of 870 heterosexual individuals in the U.S. also found that in general, more sexting was associated with a higher level of sexual satisfaction. More than half of the responses came from women; the average age of participants was 35, according to the study authors.

On one level, it’s not surprising that sexting is becoming more mainstream.

“If we look at how technology has been integrated into our society — it’s so much part of our daily lives — it makes sense that it would become part of our dating and sexual lives as well,” said Emily Stasko, MPH, a doctoral candidate in psychology at Drexel University in Philadelphia and the survey’s co-author, along with Pamela Geller, PhD, associate professor of psychology, ob/gyn and public health at Drexel.

Attitudes about sexting seem to be changing too. The survey found that people who sexted more rated it as more “carefree and fun” and had higher beliefs that sexting was expected in their relationships.

(Sexting, for the purposes of the survey, was defined broadly as sending or receiving sexually suggestive or explicit content via text message, mainly using a mobile device, Stasko said.)

Of course, this doesn’t mean that every grownup out there is under the covers with their phone at night shooting off racy texts. These survey findings are preliminary, and come with big caveats, Stasko says. The findings may not be representative: Participants were recruited online and responded to a posting asking them to take a survey about sexting, so the sample could be skewed toward more seasoned sexters.

Don’t Forget Pleasure

The main goal of the study was to look at sexting through a new filter, Stasko said. The practice has historically been viewed as a risky activity among teens, associated with other sexual risk-taking (like having unprotected sex) and negative health outcomes, like sexually transmitted infections. She said she and her colleagues wanted to reevaluate sexting in a new light — as a potential positive force in a relationship and a way to potentially enhance open sexual communication. “There seems to be a missing discourse about pleasure,” Stasko said. “We wanted to talk not just about risk, but also introduce the idea that pleasure is a part of it.”

The takeaway, she said, is that when sexting is wanted by both parties, is can be a good thing. “The findings show a robust relationship between sexting and sexual and relationship satisfaction,” the study concludes.

Sexual ‘Simmering’

Aline P. Zoldbrod, Ph.D., a certified sex therapist in Lexington, Massachusetts, agrees that sexting can play an important role in adult relationships.

I asked her for her thoughts on the survey, and here’s what she wrote:

Sexting is not just for hookups, as a follow up to an interlude on sex chat roulette or for trolling on Craigslist. Sexting actually has some amazing benefits for people in ongoing relationships.  Continue reading