Strength from the Past

Working with someone a few days ago, was talking about resilience building and had a good conversation regarding remembering the positives from the past- things that people do that have given them rewards, their past successes and achievements. In Transactional Analysis, we call them Positive Strokes. And this colleague picked up an old newsletter for me that helped me raise my self-esteem further! So going back in life to count all the good things and stroking yourself for those achievements can help in rejuvenation.

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Am I Depressed?

The World Health Organisation (WHO) considers depression as becoming the second most common cause of morbidity by 2020. It affects various aspects of the individuals life- social, work, the prospects to work, the carers and friends around the sufferer and thus lowers the overall quality of life. In addition, it is also linked with an unfortunate mode of death i.e. Suicide amongst other causes of suicide.

But if screened early, it can be treated early. There have been advances in the modalities of treatment of depression including pharmacological i.e. medications, psychological therapies. More recently, there are non- invasive neuromodulation treatments like Transcranial Magnetic Stimulation (TMS) to help with depression and other psychiatric & neurological disorders. This new treatment is a major step towards the use of other non-invasive techniques in the future before one needs to consider ECT (Electric Convulsive Therapy). ECT brings up all sorts of debates but as a practicing Consultant Psychiatrist, I am of the opinion that it remains an efficient treatment when considered at the right time of depression treatment.

So if we can pick it up early, the prognosis is better. Here’s a tool to help you screen for depression and seek help early.

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Laughter is still the best medicine

Let’s end the 12 posts today with the best medicine- Laughter. Laughter does a lot of good to our mood and health. And a healthy mind is one that has the capability of seeing humour in most things and being able to see the lighter side of life.

Thinking of the old adage Old is Gold, here’s Abbott & Castello lightening up the mood with their classic baseball video.

Keep smiling always!

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Visualisation for Achieving Goals

Imagination is everything. It is the preview of life’s coming attractions

~ Albert Einstein

So you are motivated and have set goals. Now let us see if visualisation can help reinforcing the outcomes you wish to achieve.

We use visualisation in various models of psychotherapy including therapies for psychological trauma eg for PTSD, for health behaviour change eg using Solution Focussed Therapy in Addictions to name a few. Visualisation in simple terms simply means mental image rehearsal of the desired outcome. Not only used in Psychiatry, it can be used in everyday life by anyone to keep a positive attitude and reinforce behaviour required for the goals set by them.

For this to work, there are two essential elements

1. Detail

A detailed picture or image is needed. Carrying on from the original example of improving fitness, one has to develop a detailed image in their mind of what all would be done and how would it be achieved. The more the specific and detailed the image, the better are the chances of its achievement.

2. Rehearsal

After a detailed image, the next step is to practice visualising yourself doing that on any opportunity as possible.

So if you have made some resolutions for the New Year, make them SMARTand practice Visualisation to achieve them.

All the best!

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Staying Motivated- Goal Setting and Achievement

So after you have motivated yourself using the skills described and have decided to take action then a good way is to step back, think through in detail what you want to do (visualise the intended change in your mind) and set some Goals.

Whilst I will cover the issue of visualisation in tomorrow’s post, let’s look at Goal Setting. I’d like you to imagine a situation where you have decided (example from yesterday’s post) that you want to join a gym to improve your physical strength or fitness. Now imagine 2 possible scenarios- first, where you say you want to improve your fitness but are vague about your target or goal vs the second situation, where you have specific targets in your mind, a time period by which you want to achieve your goal, you can clearly visualise yourself doing the required activities, you have set aside time in your week to do those, you have a personal trainer lined up to support you and keep a log of your food and exercise. Which out of these 2 scenarios would have a better and/or desired outcome? If you are amongst the majority, then it wouldn’t be difficult to agree with the second scenario. So there we go, setting goals with certain characteristics and the necessary action plan becomes the obvious task to do. And to help you do that, (whilst many of you may have already come across this little pneumonic) I would simply say- “be SMART“-

1. Specific– Yes your goals need to be defined as clearly and as specifically as possible. Break the outcome down into chunks and have smaller specific goals.

2. Measureable– What ever goal you set, you need to be able to measure it. That measure can be designed by you yourself or be objectively quantified by significant others. Here it helps to ask ‘How would I know that I am moving in the right direction?’ and/or ‘How would others know I am achieving my set goals?.

3. Achievable/Attainable– Any goals that you decide on need to be obviously achievable and realistic. Unrealistic goals do not ever get met in the real world (wow! I copyright that quote I just wrote).

4. Relevant– This word doesn’t need any explanation really. Simply put, there is no charm in doing irrelevant activities to the goals and expect your goals to be still met.

5. Time Bound– Putting timescales and time boundaries for the goals is absolutely crucial to keep the motivation and the drive to achieve the goals.

In addition to these, logging your progress in a record or diary is very useful.

I wish you all the best to keep up your motivation levels and achieve what you have set out to achieve!

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Motivating Yourself

If you want something, go get it ~ Will Smith

Motivation lies at the heart of activity and any health behaviour change. There may be many external motivators such as peers, work colleagues, family to name a few for anyone to consider changing. But the change happens predominantly when internal motivators weigh up more than others. So how can one tip the balance of the motivation scale towards actual positive change? As a Consultant Psychiatrist in Wales, I use Motivational Interviewing (MI) routinely and in MI, we use the concept of helping people through the MI Hill. So have a look and see where you are on this hill- imagine you want to make a positive health behaviour change by wanting to commence a fitness program (most common at this time of the year), answer the following and as you go down the numbers with your answers, you are travelling down the MI Hill. Record your answers for your own benefit-

1. What change do you desire?

2. Do you think you have the ability to make the change? Think of past successes to help you here.

3. Are there any reasons for you to make this change? Record all of them.

4. What is the need for you to change?

5. How can you demonstrate commitment towards the desired change? Remember here that wanting to change is different from willingness to do something for that want.

6. What action and steps would you take to bring about the change?

Once you have answered these, look at setting goals and remaining focussed. I will cover that in tomorrow’s post.

Let the Motivation begin!

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Being Assertive- Part 3

This final post on assertion describes some common techniques than you can practice to become more assertive (these are adapted from Systematic Assertive Therapy book- When I Say No, I Feel Guilty by Manuel J. Smith)

1. Broken Record

Persistence is a fundamental theme in assertion and one can learn that from children- they would go on and on, and be persistent till the time they can get what they want. They are just like a Broken Record. The crucial point to practice in this technique is to first decide what you want to say, then ‘hear’ what is being said without getting emotionally involved and then go for the ‘Broken Record’. An example- an individual keeps coming and pestering his uncle for money, who keeps on obliging but feeling down and frustrated due to him not being assertive. With a decision that he would say ‘I can’t give you any more money’ and with practice of Broken Record in session, the next time the nephew comes to ask for more money, the uncle applies the technique and no matter what the nephew says, in a calm, relaxed, emotionally detached manner, the uncle keeps repeating the line he he decided. After a few repeats, the nephew got the message and stopped bothering the uncle with money again.

2. Fogging

Manuel J Smith describes this technique beautifully in his book. Essentially, it involves dealing with criticisms by offering no defence to the critical comments and simply accepting the truth or possible truth in the critical statement. Just like a fog doesn’t offer any resistance to anything passing through it, similarly by applying the above, critical comments don’t become upsetting which is quite common in people who lack assertive skills (they tend to take things to heart easily).

3. Negative and Positive Assertion with Negative Enquiry

When dealing with close relationships, Positive assertion for compliments eg someone complimenting on the new hair style or any other personal attribute, practice asserting the complement positively- such as “I agree, I think the hair style looks good on me”.

And when there is a comment that critics someone, then without being sarcastic and getting emotionally detached, a negative assertion such as “yes, that’s very silly of me…or how dumb of me….” (you understand the idea here) helps in building confidence to accept that no one is perfect. It also lowers the chances of the other person to be critical.

Finally, Negative Enquiry deals with asking in detail about the negative comments or criticisms in a calm, relaxed and emotionally detached way. This helps in breaking down the person comments into more detail enabling them to reflect and explore their own issues of discord.

For more details, it may be worth having a look at the book itself and follow the workbook from the previous post. All the best.

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Being Assertive- Part 2

First of all wishing everyone a very Happy New Year 2014!

And to keep it short and crisp there are some good resources to start using. This podcast gives an introduction of principles of increasing confidence and being more assertive.

Once you have seen this, then you can also use this workbook by Dr Chris Williams.

More on some techniques to practice in the next post.

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Being Assertive- Part 1

On the last day of 2013, it may be useful to understand how you interact with the world- whether you are Passive, Aggressive or Assertive? Which out of these three ways of communication do you think is the most healthy way? Yes, you are right, it is none other than being assertive. By being assertive, one is able to put their needs across confidently, without feeling guilty and without offending the other person. So let’s see what these terms mean and what are the characteristics of each?

Click on the table to see what style is predominant for you.

You can also take a self- screening inventory to help you decide where you stand.

Over the next 2 days, we’ll discuss how to become more assertive using some techniques of CBT and Systematic Behaviour Therapy.

Wishing you all a very Happy New Year!

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Improving Mental Fitness- Resilience Building Part 2

So we talked about Acceptance, Responsibility, Emotional Awareness, Tackling Fear and Being Tigger yesterday. Continuing from where we left, here are 5 more principles to help build resilience.

6. Exercise

It would very difficult to argue against the fact that physical health is related to mental health. So improving physical fitness helps in improving mental health. Any form of exercise- be it a sport, be it hitting the gym, cycling, running or any other form of regular exercise helps in releasing endorphins and other neurochemicals that improve mental health.

7. Attitude

Much of the time or rather most of the time, our attitude in life defines how we approach adversities and challenging situations. In a book titled Attitude is Everything I particularly liked two fundamental aspects of a positive attitude- Forgiveness and Gratitude. If one learns to forgive easily and expresses gratitude about whatever one has, and the crucial point here in my view is- if one reminds themselves often about working to change to a positive attitude, that helps in dealing with stresses and challenges more easily.

8. Humour

A good laugh and maintaining a sense of humour is always healthy. It lightens up the environment around you and helps in bringing a different perspective. So make it a point to smile and indulge in humour- share a joke, see the lighter side of life, express problems with a humorous tinge, think of some fun with friends, relatives or close ones.

9. Network

Having a positively supporting network around you is important to keep focussed and positive. This network needs to be one where one can discuss issues freely and be able to trust their opinion. So be around people who are full of energy, positive, carry a spirit of enthusiasm with them, are always there to support others. Not only does their company help in resolving issues but their attitude may rub against yours as well.

10. Mindfulness

Practicing moment- to- moment awareness by mindfulness meditation helps keep one grounded. People often ask what and how to be mindful and learn meditation. Both these can be achieved by understanding the simple principle that in these one is trying to be aware of all that is happening around them in the present moment without worrying about the future or the past. There are many books, smartphone applications available online now but going to a local group for a few sessions can be helpful if the online sources are less than the individual’s requirement. In the beginning when one starts mindfulness practice and meditation, the mind may wander a lot and that is actually a sign that the mind is working- so don’t struggle to quieten it, just be aware of it and bring your focus back. With practice and regularity, you will get better with being mindful.

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