Jenny had been successfully managing the diet she started several weeks ago. Today was an unusually hectic day. With all of the stress she encountered, she was no longer able to resist temptation; her cravings got the better of her. She overate at dinner and continued to eat throughout the remainder of the evening. She was ashamed about what she had eaten and became highly critical of herself for her lack of willpower. She felt defeated and within days her old eating habits reemerged.
When it comes to unsuccessful efforts at habit change, Jenny is not alone. Every year, millions of people make New Year’s resolutions and in less than 60 days about 75% or these resolvers have resumed their old habits. Most cite lack of willpower as the barrier to their success.
The conventional belief about willpower is that it is a character trait that you either have or you don’t have. Willpower is not a character trait. Willpower could be more accurately defined as the effort needed to resist temptation and make positive change. This effort requires having the awareness and skills necessary to address a complex interaction between psychological, biological, situational forces. Habit change is then framed in the context of a process of change rather than just a goal to be achieved.
Motivation is a primary psychological component necessary to making behavioral change. This seems like a bit of a no-brainer, but motivation is complicated. We become motivated to change a habit for the better. But there is also a part of us that is motivated to stay the same. Thus, we are faced with competing motivations. The habits that we are trying to change have served a purpose in our lives.
For example, it might have provided a means of coping with stress or a source of pleasure and this habit has the advantage of offering immediate rewards or benefit. Conversely, the benefits of habit change are usually goals that usually are not going to be immediately realized and serve purposes not related to pleasure or coping with stress.
Old habits also have the advantage of being well rehearsed and can be set in motion with little or no thought. New habit behavior involves mindful effort, which requires considerable energy to successfully plan, execute, and maintain. Choosing between old habit behaviors versus new habit behaviors might be thought of as choosing between gently floating down the lazy river compared to swimming upstream against a heavy current.
As we go through our daily routines, there are environmental or internal cues that trigger habit behavior into action: a work break could be a cue for a cigarette or a snack; the beer vendor at a sporting event could trigger the desire for a drink; and the sight of scratch-off tickets in the gas station might prompt a return to gambling. Internal experiences such as boredom, loneliness, and at times even happiness also can influence the emergence of old habits. Often these cues are subtle and capable of automatically triggering behaviors before we even know we are engaged in it.
So how do we tilt the “willpower odds” in our favor? There are a number of strategies that can be adopted to greatly improve our chances for success.
It is important to learn to transform self-criticism into self-compassion. After Jenny overate, she proceeded to emotionally berate herself and in the process deflated her motivation to continue her weight loss plan. We are taught to be self-critical at an early age, to shame ourselves, and devalue ourselves when we make mistakes. It is commonly assumed that being self-critical is motivating.
If we punish ourselves, we’ll be more motivated to do the correct thing the next time. Research has consistently demonstrated that this is a harmful approach to habit change and that it will likely lead to failure. Self-criticism is emotionally hurtful and stressful. Our chances of resorting to old habits to cope with those feelings are greatly increased. A better approach will be to develop an attitude of self-accountability and mindfulness that begins with the recognition that successful habit change is a process.
There are going to be bumps in the road. When these temporary setbacks occur, they should be viewed as learning opportunities to first identify what went wrong and then to develop strategies to address similar “bumps” in the future.
Limit the number of major habit changes you plan to make to just one at a time. People who simultaneously choose to lose weight, exercise, give up smoking, and stop gambling, stretch their willpower resources too thin. This results in having little willpower reserve in the face of temptation. Choose to work on just one habit at a time. Stress and willpower can be competing forces for the body’s energy. Learning effective ways to develop resilience to stress can reduce its energy demands.
When these energy demands are lowered, more energy is available for willpower. Common strategies to deal with stress include: exercise, especially activities such as yoga or tai chi; getting sufficient rest; mindfulness meditation; spending time with friends and family; engaging in daily leisure activities that exclude television or video games; and spending daily time outside in nature. Even brief involvement in these activities when they are done consistently can have a significant impact on our ability to handle stress.
Having a better understanding of willpower and developing effective strategies to maintain it will greatly enhance your ability to change habits and achieve your goals.
Picking at your skin can be more disabling than the occasional mosquito bite. Some people suffer from picking at their scalp, blemishes, and bites to a point that can be disabling or disfiguring. Two illnesses in psychiatry suffer similar consequences - Excoriation Disorder and Trichotillomania (hair pulling disorder).
Various forms of treatment can be used to treat these conditions. Cognitive behavioral therapy is the most evidence-based treatment. This type of therapy is available online at ww2.stoppicking.com. This service is purchased for approximately $30 a month and helps patients achieve remission from nail biting, skin picking, lip chewing, etc. without medication. A similar online therapy is available for those with debilitating hair pulling (Trichotillomania) at ww2.stoppulling.com.
Sometimes, prescription medications like antidepressants and an over-the-counter supplement called N-acetyl-cysteine can be beneficial for treating these illnesses. Speak with your mental health provider if you think you are suffering from one of these illnesses to discuss what might be most helpful for you.
Excoriation disorder or otherwise known as, skin-picking disorder or dermatillomania, affects about 2% of the adult population over their lifetimes. It can be a bothersome disturbance which often occurs without full awareness of the one who does it. It is usually connected to some level of anxiety which is exacerbated by heightened levels of stress. Its habitual nature can lead to significant levels which may include picking which causes physical pain and can lead to scarring.
While most individuals are fairly open about this behavior if asked by a professional, many medical professionals do not ask in an intake session or do not explore the behavior fully. So the first tip in addressing this is to let your medical provider know if this behavior is a concern of yours.
Recommended therapy includes a combination of traditional cognitive therapy (replacement of irrational thoughts with rational), behavioral exposure and response prevention (acceptance of the feeling while changing the behavior).
Tips for Dealing with a Skin Picking Disorder:
1. Become aware of the amount of time spent skin picking
2. Become aware of events, thoughts or feelings which may result in picking.
3. Become aware of activities done in which skin picking does not occur.
4. Try to increase time in activities in which skin picking does not occur.
5. Learn relaxation techniques and practice them to develop a less anxious life style.
Talk to your healthcare provider, or therapist, about your problem. The staff at Providers For Healthy Living are available to answer any questions.
As prescribers at Providers for Healthy Living, we strive to practice evidence-based medicine (EBM). What is evidence-based medicine? EMB is the conscientious, explicit, judicious, and reasonable use of modern, best evidence in making decisions about the care of individual patients (1). This means that each time we evaluate a patient, we integrate our patient's wishes, our own clinical experience and expertise, and the best modern evidence before making a treatment recommendation.
Sometimes, this recommendation may include pharmacologic therapy (medication), and sometimes it may not. For example, current evidence suggests that pediatric patients with anxiety benefit from a 12-week course of Cognitive Behavioral Therapy (CBT) for anxiety prior to trying any medication.
Research also shows us that insomnia is often best treated with CBT for Insomnia rather than with medication. And, sometimes behavioral changes to correct unhelpful or harmful behaviors are necessary and we know medications won't make a difference, so we might recommend individual and/or family therapy to address the concerning behaviors. Should therapy interventions fail to provide relief of symptoms, we then will turn to possible pharmacologic options as a last resort.
In all cases, our goal is to find the best-fit treatment while using as little medication as possible.
REFERENCE - (1) Masic I, Miokavic M, Muhamedagic B. Evidence Based Medicine - New Approaches and Challenges. December 2008. Acta Inform Med.
What is genetic testing for medications?
Providers for Healthy Living uses GeneSight to provide genetic testing services for patients. GeneSight is a laboratory-developed genetic test that uses DNA collected from a cheek swab to analyze genetic information and match it with information about available treatment options. It is available for children, adolescents, and adults.
Who qualifies for genetic testing?
In order to have insurance consider paying for genetic testing, patients must show a history of treatment failure with numerous medications, bothersome medication side effects with previous medication trials, or both.
Will insurance cover genetic testing?
This, like all insurance-related services, is patient-specific. Patients can call their individual insurance plans to ask about genetic testing coverage. However, GeneSight requires each patient to pay a nominal fee for genetic testing, regardless of what insurance will or won’t pay.
Does genetic testing help with my treatment?
The information obtained from genetic testing can streamline the process of medication management as it gives a guideline for treatment. Although this kind of testing is relatively new, four published, peer-reviewed studies confirm that GeneSight can double a patient’s odds of getting on the right medication.
How often is genetic testing necessary?
Since genetic material doesn’t change, it is only necessary to have genetic testing done once in a lifetime. Obviously testing profiles improve and more medications are added, but the results obtained are good for a lifetime and should be kept in a safe place and shared with all treatment providers.
If you meet the above criteria and would like explore genetic testing, call your insurance company and discuss it with your medication provider at your next visit.
It seems like we are hearing about mindfulness all of the time, but what is mindfulness exactly? “Mindfulness is moment-to-moment non-judgmental awareness. It is cultivated by purposefully paying attention to things we ordinarily never give a moment's thought to (Full Catastrophe Living, Jon Kabat-Zinn).”
There are many great benefits derived from practicing mindfulness; these range from relief of stress, depression, and anxiety, to improvements in learning and memory, to boosting our immune function and relief of chronic pain.
According to Marsha Linehan, we can begin to understand mindfulness with these three concepts:
How do we practice mindfulness?
Mindfulness is an internal resource that all of us already have within us. We just need to practice! We can engage in formal practices such as yoga and stretching, or breathing and meditation. We can also use informal practices including mindful eating, awareness of pleasant moments, awareness of unpleasant or stressful moments, awareness of falling into old habits, and awareness of emotional reactions.
Try some of these mindfulness tips:
Self-control, or willpower, is a key aspect of nearly every component of life. This is especially true for young adults and children. With this in mind, here are a few strategies the parents and caregivers can use with children who struggle with self control.
First Strategy: Give words to feelings:
Second Strategy: Identify the trigger to their emotion:
A study published in 2017 has found that depressed people who also use marijuana are less likely to recover from their depression. It has been shown that marijuana use is associated with poor physical health, worsening of depression, anxiety, and an overall decline in mental health functioning.
Although marijuana may produce instant euphoria, there are potential consequences including:
Some persistent effects of marijuana include:
Some long-term effects of marijuana include:
While there are no current medications FDA approved to treat marijuana use disorders, research indicates that effectively treating (if present) the underlying mental health disorder with both medication management and therapy may help reduce use and improve functioning.
Some medications have shown promise in early research studies which include the anti-anxiety medication, buspirone and the anti-epileptic medication called gabapentin.
Both buspirone and gabapentin have been shown to improve sleep and executive functioning during the withdrawal period from marijuana. In early studies, N-acetylcysteine has been linked with reducing withdrawal effects by inhibiting the breakdown of cannabinoids.
Folate is a B vitamin found in a variety of foods and over the counter/prescription supplements. It is metabolized by the body into a form called L-methylfolate. This form of folate can cross the blood brain barrier where it aids in the synthesis of neurotransmitters like serotonin, dopamine and norepinephrine. These neurotransmitters serve as pivotal players in regulating our mood and anxiety.
Recent research links L-methylfolate deficiencies to depression, noting that there is an inverse relationship between low mood and this metabolized form of folate. Furthermore, research indicates there maybe as a high as 70% of individuals with depression are inadequately metabolizing folate to L-methylfolate, all of which could
detract from antidepressant medication/therapeutic interventions.
Please talk to your current prescriber, or a mental health professional at Providers For Healthy Living; about folate conversion testing if you feel L-methylfolate is something that could benefit your current treatment plan.
One of the most common issues discussed in therapy with children and teens is appropriate discipline. Parents want to establish and improve the parent-child bond, but some behavioral can make this a challenge. Many parents struggle with this, especially parents whose children have mental health and behavioral difficulties. Effective discipline can significantly help children and teens improve their behavior, while ineffective discipline can cause chaos in families. Below are four principles that can help parents discipline effectively.
Effective discipline should be...
One of the best tools you can give your child/teen is effective discipline, and following these four principles you will go a long way toward accomplishing that. Obviously there can be no guarantees of good behavior, but these principles will keep the family power structure intact, and teach your child the important life lesson that all choices have consequences.
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