Tag Archives: cognitive behavior therapy

Cognitive Pearl #096 Time & Mother Earth

Don't Look At The Jug

 

 

 

 

 

 

 

 

In my previous post, I introduced two ways to help reorient clients to the present moment. Here’s one more:

3. Strengthening their executive functions. Our minds are complex chaotic systems within systems. Yet, somehow our minds sustain us physically, emotionally, and so forth. This is all due to the blessing of our executive functions. You can read more about them here. Anxiety, depression, psychosis, as well as psychosis and many other states (including bereavement) levy a heavy price on these functions. Here are some of the things that I do with my clients to strengthen them, 

Get them writing. Shopping lists, budgets, schedules, reminders, sudoko games, and journaling help organize frenzied minds. Whether it’s with paper and pencil or using an app on a phone, the physical act of writing grounds and organizes. Grounding reduces cognitive stress so they can more easily focus on the challenges and opportunities of the moment. 

Get them physical. Anxiety, depression, psychosis, you name it, are states that remind me of a scene in the movie 2001: A Space Odyssey when one of the astronauts has been severed from the tether that connects him with the space ship. We see him horribly and helplessly floating away. My clients always relate to that image. My answer is to get them reconnected with Earth. They do this through bathing, cooking, cleaning, walking, peeling potatoes, dancing in their living rooms, or tossing a ball from hand to hand. Anything that gets them out of their ‘lost in space’ mind set and back to Earth will help them reorient to the now. 

Use Prostheses. Without getting into the spiritual and psychological downsides of smart phones, tablets, and all the rest, technology can really help our clients. Calendar apps, To Do List, apps, Journaling apps, and even Cognitive Therapy apps (here’s a good one). And let’s not forget how the convenience of music, lectures, and guided imagery meditation in the palm of the hand. This technology is no different than the prosthetic arms and legs and eyes that we use to the limited live again. And living brings people back to the now. 

To be continued!

Shabbat Shalom!

Cognitive Pearl #087 Sivan 20, 5775 Schizophrenia, Cognitive Therapy, & Possibilities

All truth Schopenhauer

 

 

 

 

 

 

 

 

 

 

 

Over the last 25 years of work with adults suffering from schizophrenia in all of it’s manifestations, I’ve seen some wonderful turn-arounds. By turn-around, I’m speaking of individuals who either made full recoveries or who made unexpected improvements in their functioning.

Let’s consider two of the full recoveries (1). In both cases the clients resumed their previous vocational activity (students) and social functioning. They remained in some form of aftercare and continued to take low maintenance doses of antipsychotic medications; as of this writing they still do. Interestingly and not surprisingly, both were young women in the early twenties. Both experienced a sharp descent into psychosis which lasted about six months; during this time there was increasing paranoia, irritability, depression, and then florid psychosis leading to hospitalization. In one case, there was heavy use of marijuana as a way to self medicate away anxiety; predictably it had  negative effects as well.

That’s the bad news. Now the good news.

Both of these women were fortunate to have parents who they were close with. Both had access to high quality hospitalization, well trained clinicians, and great aftercare. Both had social networks and extended family relationships so that their care didn’t fall only on their parents. Both had vocational arrangements which by law and basic human decency they could return to as they became more and more capable.

In addition to all of these blessings, both of these women participated in a ‘first break’ group, an educational program for young adults going through their first episode of severe psychiatric illness. Along with the manic, the severely depressed, and one soul terribly tortured by obsessions and compulsions, these two women learned skills to reduce stress, increase mastery, and intensify focus.

Cognitive therapy was an integral part of that. 

More on that in my next post!

Shavua tov to all!

 

(1) Aside from the fact that I met both of these individuals while I worked in various day treatment programs in the United States, all of the details have been obscured.

Cognitive Pearl #083 Sivan 10, 5775 May 28, 15

greatest fear

 

 

 

 

 

 

 

 

Over the years the New York Times, a newspaper celebrated by intelligentsia the world over, has introduced a surprisingly intelligent discussion about mental health and psychotherapy. So it was fascinating to read of a case vignette in which poetry was a central prop in the dynamic between healer and client. You can read the article here.

To be sure, the management of the case was problematic. The comments, when you look past the snideness and the rage so common to comment sections, raise some very valid questions. While there is no doubt that the client’s poetry and the discussions that revolved around it played a major role in this case, it’s seems that the central axis here was the client’s wounded narcissism and the therapist’s valiant and impotent efforts to ‘domesticate it’.

What this write up triggered for me was a reflection on the integration of artistic expression into treatment. I am not by any means an art therapist. However I’ve long believed that one enormous value of artistic expression is that it allows us to become rulers and gods of the crazy universes that we inhabit. For one beautiful expressive moment we ‘own’ whatever threatens to destroy us or we hold the reins of an otherwise fleeting mysterious dream. Whether it’s our own creations or the visions and words of others, we are no longer unwanted visitors in this world; we are the kings and queens. 

And what could be better than that?

 

Cognitive Pearl #080 Sivan 2, 5775 May 20, 15

q

As a cognitive therapist, helping relieve insomnia requires getting into the thoughts and beliefs that otherwise make sleep impossible. Mind and body are connected; what the mind thinks it ‘translates’ into physical reactions. The body is a captive eavesdropper on the thoughts, worries, regrets, and impulses that criss-cross the mind.

An example:

Last week a client made an important decision which would have great influence on her future. Without going into the details if this decision fell in between ‘what-to-order-for-dessert’ (trivial) and ‘who-to-marry’ (super not trivial), this particular decision would fall closer to the who to marry direction. Not surprisingly she complained of sleep difficulties. In this specific case, she was able to fall asleep literally when her head hit the pillow but awakened two hours later and then not be able to fall asleep again.

It didn’t take a rocket scientist or advanced, experienced cognitive therapist to understand why this was: her mind, after a two hour nap, began percolating with activity. The body, ever ready to help out, heard the mind, and threw some coals on the fire. By coals on the fire, I mean acetylcholine, the neurotransmitter of physical activity. It also stopped dumping adenosine, the neurotransmitter of sleepiness, into the blood stream. The result was a body ready to go and buy a dress (oops! I’ve said too much already!). 

What we did about however was pretty cool. More on that later. 

Cognitive Pearl #076 Iyar 23, 5775 May 12, 15

Between Stimulous & Response

 

 

 

 

 

 

 

 

 

The integration of cognitive behavior therapy into the treatment of insomnia has received lots of coverage in the general press as well as in the professional literature. The results reported have been positive regardless if the client was suffering from comorbid depression, anxiety, or addictive disorder or if sleep medication was also used.

The model that I’ll be sharing in coming posts is taken from the protocol developed by the United States Department Of Veterans Affairs. They have an immense amount of experience treating veterans, their families, and their communities for a variety of comorbid disorders. 

The protocol has three components. They are:

Psychoeducation about sleep, insomnia, and the conditions that interfere with sleep.

Treatment of environmental, psychological, and physical factors that get in the way of sleep.

Monitoring and follow up of those in treatment.

In following posts, we’ll briefly review what you need to know about sleep (psychoeducation). Then we’ll get into stimulus control, quieting the mind, and relaxation techniques. 
 

 

Welcome & Shalom

 picjosh

 

 

 

 

 

Are you or someone you know in need of effective psychotherapy?

Are you going through an especially difficult passage?

Do you want the assistance of a qualified and compassionate psychotherapist?

Do you suffer from depression, anxiety, eating disorders, addictions, insomnia, medical problems, or post traumatic stress disorder?

Are you and your spouse or child in conflict? Do you want your relationship to get back on track?

Have you heard about cognitive therapy and its ability to bring bliss and joy to life?

Do you want practical ways and tools to integrate the ideas of mindfulness and cognitive therapy into your life, marriage, and family?

Are you looking for a qualified and licensed professional who speaks your language and shares your values?

 My name is Rabbi Dr. Joshua Mark, PhD. I’m a psychotherapist and teacher.

 And I am here to help.

 

 

Located In Jerusalem