Ann Arbor therapist offers counseling, helping clients achieve satisfying life.

Effective Psychotherapy

Counseling for Individuals and Couples

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7 Effective Coping Mechanisms for Adults who suffer from ADD

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In my experience ADD in adulthood is often misdiagnosed, especially if the person happens to be intelligent, a female, or both. Many times the person is diagnosed as suffering from depression. The diagnosis of depression may be correct, but it is the result of the problem, not the root cause. ADD in  adults often leads to recurring failure and under-achievement and this may lead to depression.

Recommended book on coping with ADD as  adults:
Mastering Your Adult ADHD: A Cognitive-Behavioral Treatment Program Client Workbook (Treatments That Work)

This book brings helpful coping mechanisms for people that suffer from ADD. Almost anyone could benefit from using these skills.

The main skills discussed in the book are:

1. Get a calendar, whether a paper one, or a computerized. My inclination is to direct people to a computerized system, unless they are not computer Savvy. Most people with ADD have awful handwriting, and their writing tends to be very messy.

2. Get a to do list, organized by priorities, and with a deadline. People with ADD tend to go for low priority tasks because they are easier, or more attractive. Putting a formal list in place with priorities, helps people organize their day in a more appropriate way.

3. Learn how to break each task into small steps, so that they are not overwhelming.

4. Mange your environment, to minimize sources of distractions.

5. Find out  how long you can work on a single  task without being distracted. Use a watch for that purpose, studying your own performance as you go about your daily tasks. Once you have an idea of the optimal period in which you remain focused, break any task you need to do to smaller ones that can be accomplished in that time frame.

6. Deal with the depression that is associated with ADD, otherwise you will find it difficult to make the necessary changes in your life.

7. Learn better study skills.

While medication prescribed for ADD can be helpful, it is insufficient. Additional work is often required for the person suffering from ADD to reach his or her full potential.

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Defficiency in Vitamin D is Linked to Depression, Parkinson Disease, and Cognitive decline

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Deficiency in vitamin D is linked to depression, Parkinson disease and to cognitive decline according to a new article in Scientific American. According to the article, about three quarters of the population in the USA suffer from vitamin D deficiency. Here, in Michigan, the percentage may be even higher because of the lack of sunlight.

If you suffer from depression, it would be prudent to ask for a blood test, to determine whether your blood levels are within normal limits. Do not take extra supplements of Vitamin D without consulting your primary care physician, as it can be toxic in large doses.

 

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Grief and Loss

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Recommended movie: Up.

This poignant movie describes the grief process of an older man who has  lost his wife, the love of his life. We witness both his pain and despair and his  process of recovery.   His recovery is initiated by his determination to carry out a dream that they had together, in spite of his wife’s absence. Underneath  the adventure story and amusing animation lies a deeper truth about the need, not to forget but  to continue living , forming new bonds and connections while remembering .

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Creativity and Mental Health

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Recommended book:

The New Drawing on the Right Side of the Brain: A Course in Enhancing Creativity and Artistic Confidence

This book was written by an experienced art teacher. She shares her teaching methods and understanding of the process of creation.  The basic assumption, that underlines  her method, is that learning to draw is not so much learning physical technique or coordination but it is mainly learning the ability to see. In seeing the author does not mean the passive act of gazing at the world, but a deeper sense of sight as if seeing things for the first time. As a rule we tend to look at things without noticing. We  recognize, but we don’t really see.  The exercises in the book are directed at making us look at the world  in a fresh way, to cast off the conventions that limit us. Her book is full of testimonies and pictures of people that have learned to draw for the first time in their lives.

It is intriguing to take her basic tenant in a more abstract, or metaphorical,  way. To learn to sense what is really out there, in our world, instead of being captives of our past, conventions and belief systems.  There are many approaches, or traditions, that hint at this journey under different theoretical and philosophical guises. For example, Buddhism recommends the practice of  mindfulness, living in the present and being aware of both thing internal and external to us.

How can studying to draw contribute to our mental well being? It is my belief, that the more we learn diverse skills, particularly those that are new to us,  we learn to utilize unused areas of our brain. This in turn enhances our brain functioning, and ultimately our  well being.

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Cognitive Distortions of Depression

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Depression contributes, and is maintained by common distorted thought patterns. It is a vicious circle, which keep us depressed.

This checklist is taken from the Wikipedia, “Feeling Good” book  and other sources, with some changes and additions. As you go through this list try to  identify these patterns that you tend to use. It may be an  eye opener: You will realize that what sounded like “the reality”,  is indeed very subjective. This is the first step to start controlling those thought patterns, and influence your mood. You may want to keep track of these thought patterns in a journal. There is some overlap between the different thought distortions.

  1. Black and white thinking – No shades of grey. Thinking of things in absolute terms, like “always”, “every”, “never”.     If it is not perfect, it is a failure.
  2. Overgeneralization – Taking isolated cases and using them to make wide generalizations. Generalization from one detail , or aspect of a situation, to the whole situation.
  3. Mental filter – Focusing almost exclusively on  negative or upsetting aspects of an event while ignoring other positive aspects.
  4. Disqualifying the positive – Continually deemphasizing  positive experiences.
  5. Jumping to conclusions – Drawing negative conclusions  from little  evidence. Two specific subtypes:
    • Mind reading – Assuming you can read the feelings and thoughts of others. You know for sure what other people think of you, and of course is it negative.
    • Future reading –  Catastrophizing.  You expect the worst possible outcome, however unlikely. You ruminate about “What if”.
  6. Magnification and minimization – Distorting aspects of a memory or situation through magnifying or minimizing them such that they no longer correspond to objective reality.  If you are depressed, often the positive characteristics of other people are exaggerated and negative characteristics are understated. The reverse  happens when you think about yourself.
  7. Emotional reasoning – Accept your emotions as a valid evidence.  “I feel therfore it is true”. If you feel stupid , than you are  stupid.
  8. Should statements – You know the way things “should” be.  You have rigid rules which  always apply, no matter what the circumstances are. Using “should” statement  leaves you and others feeling preasured, guilty, and on the long run  jeopardizes any motivation for change. It does not allow you to be flexible and adapt to  changing circumstances.
  9. Labeling –  Rather than describing  a  specific behavior, you assign a negative  label to yourself.  it is not the action that was a mistake, you are the mistake. Frequntly, you judge others as harshly as you judge yourself.
  10. Personalization – Attribution of personal responsibility and guilt to yourself   for events over which you have no control.
  11. False expectations: Assuming that other people should be able to read your mind, without any need of your part to express your emotions and needs.  Assuming that your happiness depends on somebody else.

© Wikipedia
A depressed person

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Premature Ejaculation – Sex Therapy

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First it may be useful to define what premature ejaculation is. Although it may seem self explanatory, one problem may be that you or your partner’s expectation of sexual stamina, often nurtured by popular culture, are unrealistic.

Usually, premature ejaculation is diagnosed when a man frequently  ejaculates sooner during intercourse than he or his partner wishes, either  before penetration or shortly after.

If you do suffer from premature ejaculation there are behavioral approaches to the problem and medication. While medication, such as SSRI, may help – they  are effective only while being taken. Once you stop taking the medication the effect also passes. The other downside of taking these medications is that you will need to cope with their side effects. This is why it is better to start with the behavioral methods rather than start with medication. Those can be added later if needed.

Contrary to common beliefs the behavioral approach does not involve either mental numbing, such as distracting yourself from the sensations, or physical numbing with some form of  numbing cream. Somewhat surprisingly, the most successful approaches involve heightening your awareness to your physical sensations, while maintaining physical relaxation. Only by increased awareness and mindfulness, you can learn to regulate better your arousal level, and hence your ejaculation.

These two  self help books teach the basic sex therapy techniques for dealing with this problem.
How to Overcome Premature Ejaculation by Helen Kaplan

Coping With Premature Ejaculation: How to Overcome PE, Please Your Partner & Have Great Sex by Dr. McCarthy and Michael Metz.

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Breathing Exercises and Mental Health

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The art of breathing exercises is an underutilized discipline that can contribute to your well being. From my clinical experience, breathing exercises are helpful in   decreasing symptoms of depression,  anxiety, panic attacks, insomnia, and  improving concentration. They are a great tool for stress management in your life, if you go through tough times or life transitions.

Most breathing exercises come from Pranayama  – a fundamental part of Yoga. The basic book on this subject  is  Light on Pranayama: The Yogic Art of Breathing by Ayengar, a renown Yoga teacher. From these exercises,  “Alternate breathing”  is   the most beneficial  one for people that suffer from anxiety and panic attacks, according to my professional experience.

Most Yoga teachers do not teach breathing exercises in regular yoga classes, so you may need to ask for a private lesson. If you have never done it before, It is  advisable to learn under guidance.  If you have any medical condition, you may want to consult your health practitioner.

I know that there are similar exercises in martial arts. but I have not explored those. You may want to check with a local martial art teacher.

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Low Sexual Desire – Women

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One of the most common reason that women and couples seek sexual counseling is the women’s low sexual desire.

Surprisingly enough, many times the cause is the birth control pill. If you are on the pill, and you suffer  from low sexual desire, try to switch to a different birth control method, that does not involve hormones. You may want to consult your OB/GYN practitioner, or go to Planned Parenthood. Often the counselor at Planned Parenthood will dedicate more time to hear your concerns, and may suggest a wider selection of options to choose from. Be aware that it may take several months for your body to recover.

There are many other causes for  low sexual desire. But this one is relatively easy to eliminate.

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Post Traumatic Stress Syndrome – Veterans

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Recommended movie: Waltz with Bashir

“Waltz with Bashir” is an  examination of post traumatic stress disorder in veterans. This Israeli animated film is a documentary on the Lebanon war, that took place in the early 1980’s.  The movie documents  the  journey of the director back  into the horrors of that war.  The director is driven to delve into his past  in an effort to fill in a period in his life that he has blanked out, but fills him with unease

The movie consist in interviews of people that were there, in Lebanon. The “animated” people in the movie are real people, identified by their real name.

As the director searches out friends from that period in his life he comes across the many forms that PTSD can take. Some have recurring nightmares they cannot shake off; or flashbacks that disturb their daily activities. One of the veterans could go through the day only by smoking marijuana incessantly. He left Israel , distancing himself from this environment, probably to avoid any trigger that could remind him of the war.

Most veterans felt guilt. Guilt for what they have done, or have not done, or failed to prevent. Sometimes even guilt for surviving, while others died.

The movie shows that  PTSD may be caused not only by  traumatic events that were personally experienced but horrors that were witnessed and events that fundamentally violate the ethics on which we were raised.

Sometimes PTSD takes the form of being alienated of daily life. One of the protagonists came for vacation from the war. He walks down the familiar street, but everything he sees seemed  strange, different. He cannot engage in the regular mundane life, with all its trivialities.  When I worked with veterans in Israel, many times this was the most disturbing symptom. As if they are not fully alive any more.

Many of the protagonists would be considered  “functional”. They manage to work and to have family. They probably do not fulfill the full criteria of PTSD as defined in the DSM. Nevertheless, they suffer. Their quality of life is diminished. Sometimes they are not able to apply their full potential, even if they seem from the outside as functioning people.

Now, that American soldiers are coming back from Iraq, this movie is more important than ever. It helps the victims of PTSD and their families understand  what they are going through. Hopefully, this movie will help them see that they are not “crazy” and will reduce their loneliness.

Warning: In spite of the movie’s  striking  beauty, it is not an easy movie to watch.

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Ingathering – a Portrait of Depression and Recovery

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This little known book describes the inner experience of depression, in a very sensitive and authentic way. Its charm lies in the fact that in spite of the very real description of depression, It is full of hope.
In the beginning Lea, The main character, is in her deepest moment of despair. The world seemed bleak, senseless and cruel. She feels complete alienation. Her pain was so great, that she tried to jump from a bridge, in a futile attempt to commit suicide. An alien caught her and saved her life.
The first step to her recovery was numbing her emotional pain. The alien temporarily numbed Lea’s pain and locked her in a house, in order to protect her. (Fantasy equivalent to psychotropic medication? Hospitalization?) Lea felt better, though numbed. She knew that the numbness was a temporary relief, a crutch to support her during the process of recovery.

The alien brought her to a secret gathering of a community of aliens, the “people”. The people are human-like aliens endowed with psychic powers, who live in a deeply spiritual community. They were scattered around after crash landing on Earth. Some individuals were separated and had to cope by themselves, hiding their real identity a coping with their “otherness”. Lea participated in many night gatherings, During these night gatherings the participants told their life stories.
Hearing the stories, in the context of a community, was the beginning of her recovery process. Lea initially did not want to believe in the wonder of life. She was reluctant to relinquish her pain and loneliness. Those, at least, were familiar. It took time before she really committed herself to the recovery process, and started to fight depression on her own.
Henderson’s prescription for recovery is twofold. She sees community and faith as the two prescriptions of recovery and life.
Lea’s recovery took place in the context of a community. When Lea looked around and heard so many stories about suffering , she asked herself where their strength comes from. And she answered herself: “ When anyone of them cries out the others hear – and listen. Not just with their ears but with their hearts. No matter who cries out – someone listens-“
Henderson sees depression as lack of faith. The lack of faith makes the world so bleak. Only faith can restore meaning to so much suffering. Only faith can mitigate the sense of loneliness.
There are other traditions within the mental health realm that consider faith and community as central components of recovery, such as all the self help groups that are AA based. Faith and participation in community are considered a prerequisite for recovery.
Henderson’s prescriptions for recovery are challenging. As a therapist myself, Can I prescribe faith or community? I do not know. Is faith, or community, always beneficial? Probably not. However, I find her intuition, that probably stemmed from her own experience, very inspiring.
Ingathering: The Complete People Stories of Zenna Henderson

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