Author Archives: Josh Mark

About Josh Mark

Always looking in between the lines to find the inner truths and beauty, I feel blessed to live in a time of such wonderful promise. My story begin in Stamford, Connecticut and has taken me around the world to Jerusalem.

Cognitive Pearl #078 Iyar 25, 5775 May 14, 15

Its not the circumstances

 Reflecting on the common physical causes for insomnia which I encounter with my clients, they all share one common root: disregard for connection between mind and body. It seems that we all live without regard to the body which so cares for us.

So for instance, the amount of artificial light which we fill our living spaces can have cumulative devastating impact on our health (this was brought home to me by some frightening data about breast cancer and light pollution which you can read about here). Yet as much as we read about how important it is to ease the body towards sleep by decreasing exposure to light, we keep the lights on and use our phones, computers, and tablets to stimulate ourselves late into the night. 

I mention this disconnection here because for most of our clients, insomnia is another manifestation of their negative relationship with their bodies. While deeply delving into this relationship is not always required, it’s important to at least raise the issue. 

Cognitive Pearl #077 Iyar 24, 5775 May 13, 15

You either walk inside your story

 

 

 

 

 

 

 

 

 

 

 

 

 

In every area of clinical practice of cognitive therapy, psychoeducation is critical. Useful, relevant, and accurate information changes lives. This is especially so in the treatment of insomnia and all sleep difficulties. Seeking relief have most likely become so frustrated with themselves that they’ve overlooked many of the basic rules of sleep.

So we start from the beginning. 

We speak about the importance of sleep. We speak about the benefits of sleep. We speak about the conditions that make sleep possible. We speak about ways to create a sleep conducive environment. We speak about sleep supporting life style changes. 

As a matter of practice, I generally give my clients some simple literature about sleep hygiene.  Sleep Hygiene Tips is a form which I came across sum time ago. It’s clearly and engaging. Most of my clients however suffer from comorbid depression or anxiety or bipolar disorder or post traumatic stress disorder (or all of the above). For them I prepared the Zzzzz Sleep Help sheet. 

While psychoeducation alone won’t relieve your clients’ insomnia, it will get them started on redesigning their lives for their own benefit. Furthermore, psychoeducation also acts as a catalyst to get at the deeper issues that might otherwise not be found. 

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. 
 

 

Cognitive Pearl #075 Iyar 22, 5775 May 11, 15

jealousy

 

 

 

 

 

 

 

 

In the world of cognitive therapy, upgrading is fundamental. With that in mind, (hopefully!) with today’s post, you’ll notice improvements which will make the content even more exciting and useful. Let me know what you think!

Today’s Tachlis Takeaway: many sleep problems can be helped with the methods of cognitive therapy.

When we think of sleep, we may often think of a necessary evil which we must ‘put up with’. Just look at the coffee section of my local supermarket: there’s a solid eight meters of valuable shelf space devoted to a bitter beverage whose most important redeeming quality is that it can keep us awake. Looking back on my forty year love affair with coffee, I’ve got some serious doubts that I would have been able to start and complete even one degree without the steady drip of stimulants into my veins.

Sleep however gets a bum rap. It’s quite telling that the Bible tells us that Adam was asleep when he was matched up with Eve. Marriage, the most important event in a human’s life; and here a central protagonist was out cold. But it’s not just the Bible that tells us something about sleep; modern science continues to inform us of the many, many blessings of sleep.  Or, r’l, the terrible ills that can befall the human mind and body when we don’t sleep enough.

Where we psychotherapists come in is that many of the barriers to the blessings of restful sleep respond to the skills which we offer. In the coming posts we’ll consider some of cognitive therapy techniques which can help our clients (and ourselves) to sleep and to heal. 

 

Cognitive Pearl #074 Iyar 18, 5775 May 7, 15

Lag BoOmer BonFire

 

 

The dizzying smoke of a million bonfires lingers in the air of Jerusalem. For some Lag BaOmer was a magical evening; for others it was a night of noise, irritation, closed windows, and coughing.

Isn’t that a fitting epitaph for Rabbi Shimon Bar Yochai (you can read more about him and Lag BaOmer here)? An all eclipsing hero to some; a dangerous and tiresome rebel to others.

Counting myself among the former, Lag BaOmer is a quintessential cognitive therapy holiday. Granted that such a statement seems counter-intuitive; after all, cognitive therapy advocates empiricism (the school of philosophy which holds that only that which can be seen can be truly understood) and Lag Baomer is a celebration of the mystical, of the unseen, of the unknowable mystery of the Universe.

For me however empiricism has it limits just like every body of human knowledge. Everything, perhaps with the exception of death, is subject to the law articulated so poetically by another fantastical character of much more recent vintage, Forrest Gump, ‘it happens’. As much as we strut about with our data, statistics, predictions, and all the other synonyms for human hubris we just don’t know.

Lag BaOmer and its mystical traditions remind me that no matter how clever we get, humanity will never fully know the whole score. As close as we get to figuring it all out, the loving Designer of all stays just beyond our grasp. He sprinkles beauty as a leads us deeper and deeper into the cosmos. 

So what then is the place of cognitive therapy when each of us is immersed in a universe so much out of our control?

There are of course many reasons to do what we can to make our lives better. For me, cognitive therapy has offered one unparalleled gift and for this it is supremely relevant. That is is the pure pleasure of clear thought and the joyous life that results. Once I get all of the traps and tricks of misery-making-embodied-pseudo-thinking out of my head the sky turns blue, the universe opens itself, and I’m swept into the mystery of it all.

So pass me a marshmallow and throw another log on the fire. 

Bar Yochai, the holiest oil has anointed you; you’ve ascended to the loftiest of levels; glory encompasses you. 

Cognitive Pearl #073 Iyar 17, 5775 May 6, 15

Most people take the limits of their vision

 

 

 

 

 

 

 

 

Robotic doctors. Robotic surgeons. Robotic Nurses.

How about robotic psychotherapists?

Yikes!

For those who are worried about our long term career prospects, there’s some good news. Despite many elaborate efforts to program a computer ‘to do’ psychotherapy, unless there’s some dramatic change in our humanity, a caring, loving, real human healer will never go out of style.

The reason for my optimism?

Oxytocin and the essential nature of human attachment.

And here’s the explanation: way back in Genesis we are told that ‘it is not good for Man to be alone’ (2:18). This Biblical observation isn’t simply about the need for companionship for safety and reproduction and other technical needs. This observation is about a core of human need: we need companionship to be human.

This observation came home to me as I read of a Japanese study on dogs and oxytocin featured in the New York Times (you can read it here). Researchers found that as a dog looks into the eyes of a human, oxytocin levels in both dog and human rise. (Oxytocin is the the most well known neurochemical of attachment.) The longer the gaze, the more then oxytocin levels rose, bonding the two together in trust and in the camaraderie known to those of us dog owners. 

To be sure, it’s not just dogs that evoke this oxytocin response. Far more dramatic is the shared neurochemistry formed between mommy and baby as each lovingly gazes into each other eyes in that most elemental of human bonding behaviors. What this finding however highlights is that human trust can only be evoked in the dyadic feedback loop between carbon based life forms. That dear friends can only happen in between a loving, accepting healer and his or her client. 

Robots therefore need not apply. 

Happy Lag BaOmer everyone!!

Cognitive Pearl #072 Iyar 16, 5775 5 May, 15

A terribly tortured client complained about her feelings. Not a specific feeling. She simply hated the whole idea of feelings; they were inconvenient; bothersome. Not surprisingly, she was suicidally depressed, full of self hatred, and utterly confused by why she was so miserable.

There’s good news. She’s doing great now; cognitive therapy has helped her far more than all of the hospitalizations and medications. She’s come to understand that feelings are wonderful teachers and friends. Instead of repressing them she lives her life joyfully by respecting the wisdom they offer.

Her story comes to mind as I reflect on my trip (told in a previous post) to Meron. Instead of taking our car, I decided on public transportation (it was actually really nice!!). One major difference between going in a private car and public bus is that on a bus there are no bathroom breaks. Otherwise, the driver would be forced to pull over every second; tachlis, a three hour trip would take three days. So instead we must all ‘hold it in’, cutting ourselves from our the messages that our bodies tell us.

The same is true of the family which my client comes from. Many children. Harried parents. A culture which indoctrinates towards sameness and ostracizes difference. In a world like that who has time for feelings? Who has time for inconvenient truths spoken by the heart. ‘Onward!!’, she was told again. Onward towards where? To a place whose entry fee was the cruelest kind of amputation: the person from herself.

Cognitive Pearl #071 Iyar 15, 5775 4 May, 15

Be Somebody

 

 

 

 

 

 

 

 

 

 

 

 

 

During this Jubilee year, you shall return, each man to his property.

From this week’s portion, Behar. VaYikra 25:13

It is human nature that we collect stuff. Bags and bags of stuff, both literal and metaphorical. Books, clothes, tools, identities, debts, hurts, and resentments are just a few that crowd my home and my head. People tell us to ‘let it go’ but that’s hard. Life gets weighted down, almost impossible to navigate. We keep on doing things, not because they’re smart, but simply because of inertia and the deep attachment to symbols of the one truly universal illusion of humanity: the past. 

The Mitzvah Of Jubilee is the antidote to our despair. 

Human societies stratify themselves along the lines of ‘have’ and ‘have not’. Those who have (and you fill in the blanks: land, tenure, money, looks, yichus, job, whatever) get to rule over those who don’t have. Stratifications are quite stable; they’re multigenerational. The rich stay rich and the poor stay poor. 

This is an arrangement that, despite the few good things that can emerge from it, is terrible for humanity. Human growth requires upheaval. We are all most alive when we are improvising, changing in a dynamic environment. 

The Jubiliee and the social engineering implied by it liberates us. It breaks the economic stranglehold of social class giving the have nots a new chance and the haves peace of mind. Returning to our property is not only about returning to our ancestral land; it’s about returning to our basic selves, that pristine moment before we were kidnapped by social class and indoctrination. In so doing it compels each of us to clean out our lives, to rid ourselves of our baggage, to reclaim the only transcendent truth: we are what we are.

Because who we are is the only property that is truly ours. 

Cognitive Pearl #070 Iyar 12, 5775 1 May, 15

We rise by lifting others

 

 

 

In considering the depth of cognitive treatment I take the approach that above all, my efforts must ultimately lead to positive social reintegration. Humans are a social animal; we can do amazing things when we’re attached to others. From a cognitive therapy perspective, social connectedness forms the bridge that allows the transfer of new ideas between people. These are the ideas that save our lives. 

Consider depression. Or schizophrenia. Both share features in common: thought disturbance and  emotional disconnection are the most visible. When most of us think of schizophrenia, delusions and hallucinations come to mind. Or when we think of depression we think of the immobilizing heaviness of self hatred and despair. Yet in both cases, social disconnectness is the most important determinant of outcome. That connectedness provides the leverage to keep the client connected to reflection, reality testing, and the magic of community. 

So tachlis, as a cognitive therapist, my treatment plan and its length, intensity, and depth is designed around getting the client back in touch with others. 

After all, life is with people. 

More on this next week.

Shabbat Shalom!

Cognitive Pearl #069 Iyar 11, 5775 20 April, 15

What You Say 

 

 

 

 

 

A bit of a digression.

As I write these post I’m on my way to Meron, the location of the grave of Rabbi Shimon Bar Yochai (you can read about him here). Hoping to skip the crowds next week (it’ll be Lag BaOmer which you can read about here), I decided to make my pilgrimage a week early. While this isn’t the place for a discussion of the mystical dimensions of this pilgrimage (and visits to the burial sites of other saints and sages) it is an opportunity to touch on culture and cognition.

Culture is universal. Wherever you find two humans you’ll find culture. Manifestations of culture are nearly infinite. My pilgrimage to the grave of a culturally designated saint is not unique; people the world over visit similar sites. And there are many other kinds of cultural pilgrimages too: cinco de mayo in Spain and Saint Patrick’s Day in Ireland come to mind. Sporting events are also cultural pilgrimages. As are festivals and annual gatherings.

So the question we need to ask is what is all of this culture about? Why do humans have his need to abandon all sense and sensibility, their jobs, their families, and the opprobrium of their normal lives and go nuts?

For me the answer begins with something I heard from Dan Siegal, a developmental psychiatrist, in an interview a few years back on Shrink Rap Radio (an excellent resource which you can find out more about here). Siegal was speaking about the mind as a process (as opposed to a thing) which regulates the flow of information within the organism and with other organisms. At one point he said something that still makes my ears ring:

Yes, I study the way energy and information flow is shared in relationships across generations. That’s what culture is!

The implications of that idea is that culture is what one generation tells another. Culture teaches ideas (we call that indoctrination) that are central to the continuation of that culture. So while pilgrimages to holy sites of every ilk fulfill our needs for belonging, entertainment, and so much more, they are primarily about absorbing the ideals of those who came before us.

And as cognitive therapists who assert that the ideas that we hold are what makes us or break us, our clients’ culture is enormously relevant.