Sunday, April 29, 2012

Over-coming Fear And Increasing Achievement; The Basis of The Self Help Industry

Dale Carnegie would tell you that he made a living all those years, not by teaching public speaking - that was incidental. His main job was to help people conquer their fears and develop courage.  For the purpose of this writing I'm defining fear as a state of purposeful inactivity (escape and avoidance behavior) and courage as a state of observable action (exposure to feared situations).

As of 2008, the self help area of books, video's and public speaking was considered to be a $11 billion industry and still growing.  A quick search of listed almost 150,000 current titles related to self help.  A cursory review of titles suggests that self help materials could be broken down into 4 or more distinct area's including self improvement, relationship building, work related behavior, and business improvement; the list could go on and on.  Visual inspection suggests that self help books and audio tapes cost an average of $11 each and well known associated names include Tony Robbins, Dr. Phil, Deepak Chopra, and Marianne Williamson among others.

At the end of the day, what all these resources share is an unwavering belief that courage towards our specific fears results in the success we desire.  This is a premise I wholeheartedly support and encourage.  Whether or not self help resources are the best delivery system for this message is another issue.

Perhaps the most vocal and well known detractor of the self help movement is Steve Salerno, author of Sham: How the Self-Help Movement Made America Helpless (  Salerno believes, as the title suggests, we have become less self reliant due in large part to a growing belief we are either victims of some wrong inflicted upon us or a victim of a disease process outside of our own control; in either case a victim who may not be responsible for our own behavior.

The basic conflict put forth by those who do not espouse the self help movement is that our society values and morals are eroded by today's brand of victimology and that as a society we are more self reliant when we adhere to more traditional values of personal responsibility and self determinism.  

In other words, take responsibility for our own actions and step up to correct the things in our life we do have control over.  Face our fears and act courageously.  Sounds to me like the exact nature of people who make successful changes in their life.

Sunday, April 22, 2012

Complementary and Alternative Medicine: A Psychologists Perspective

According to The National Center For Complimentary and Alternative Medicine (NCCAM) defining CAM is difficult because the field is very broad and constantly changing. NCCAM defines CAM as a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Conventional medicine (also called Western or allopathic medicine) is medicine as practiced by holders of M.D. (medical doctor) and D.O. (doctor of osteopathic medicine) degrees and by allied health professionals, such as clinical psychologists, and registered nurses. The boundaries between CAM and conventional medicine are not absolute, and specific CAM practices may, over time, become widely accepted.

“Complementary medicine” refers to use of CAM together with conventional medicine, such as using acupuncture in addition to Traditional Medicine (TM) care to help lessen pain. Most use of CAM by Americans is complementary. 

“Alternative medicine” refers to use of CAM in place of conventional medicine. 

“Integrative medicine” combines treatments from conventional medicine (TM) and CAM for which there is some high-quality evidence of safety and effectiveness. It is also called integrated medicine. 

Almost all American Medical Schools have incorporated CAM into their curriculum.  According to a 2007 study (Med Educ. 2007 Feb;41(2):205-13.), the overall response to the integration of CAM curricular elements into the medical school curriculum was positive among all faculty and graduating medical students. Participant experiences were often dependent on the perceived rigor of alternative approaches to a presenting patient problem, along with the importance attributed to openness to patient perspectives as part of evidence-based practices. There was an appreciation of the importance of developing increased awareness and utilization of CAM in medical practice, as well as a recognition of resistance by some medical school faculty to CAM approaches. 

In essence CAM may include Acupuncture, Chiropractic, Massage, Yoga, Meditation, and the use of herbaceuticals and dietary supplements (OTC compounds found in most pharmacies and health food stores).

Having had the opportunity to teach graduate level courses on psychology in medical settings and psychopharmacology, I've found myself drawn even closer to the use of CAM in the treatment of both psychological disorders and traditional medical diseases.  I recall with a smile, my eagerness as a graduate student when I purchased my first book on vitamins and supplements.  Dr. Earl Mindells "Vitamin Bible" was, at the time, the holy grail of OTC's (over the counter vitamins, minerals and herbs).  Thankfully much has been learned since then and positive changes have happened that I fully support.

It makes sense to me and is supported by research that massage in the hospital is a plus, Yoga has benefits for both psychological and medical disorders, acupuncture has benefits in pain relief over and above traditional pain medications, and that the judicious use of botanicals (OTC's) can have significant benefits in both prevention of and alleviation of borderline disease processes.

I know that in many European Countries the typical prescription for depression or anxiety is likely to be an herb and not a medication formulated by a pharmaceutical company, with the same or even greater effectiveness than the expensive antidepressants or addictive anti-anxiety agents prescribed in the US.

It is hypothesized that CAM treats the whole person while TM treats only the disease process and because of this there is better acceptance, lower medical costs, and increased treatment adherence when CAM in incorporated into treatment programs.

The next time you seek TM for a psychological or medical problem take the time to ask about CAM.  Your practitioner should be able to tell you about multiple functional and beneficial options.  If they can't you might want to consider an alternative practitioner who is open to treating the whole person and not simply a disease process.    

Saturday, April 14, 2012

Police Shift Work And Healthy Sleep

10 Steps to Staying Sleep Healthy During Rotating Shift Work

It’s good news for Police Departments forced to use rotating shift schedules that major progress has been made in understanding and treating Circadian Rhythm Sleep Disorders (CRSD’s).  It’s now time to put this understanding and the resultant treatment recommendations into practice.  The benefits of which should likely include a reduction in nighttime department vehicle accidents and an increase in nighttime officer alertness.

CRSD’s are currently broken into 6 categories; Delayed Sleep Phase Type (DSPT), Advanced Sleep Phase Type (ASPT), Irregular Sleep-Wake Phase Type (ISWPT), Free Running Type (FRT), Jet Lag Type (JLT), and Shift Work Type (SWT).   The basic feature of a CRSD is a persistent or recurrent pattern of sleep disturbance due primarily to alterations in human circadian rhythms brought on by changes in light and darkness that accompany shift work changes.  At a basic level Circadian Rhythm is the body’s internal clock related to alertness, sleep, hunger, body temperature, and general activity level.  The main driver of circadian rhythm is light and for most of us that means awake and alert during day light hours with decreased alertness and sleep during nighttime hours.

Here at our Police Department officers rotate shifts every 49 days in a clockwise fashion.  Shift 1 starts at 0600 hours, shift 2 starts at 1400 hours and shift 3 starts at 2200 hours.  Every effort is made to provide for at least some family and spouse time as well as time for conducting personal business during the normal 9 to 5 business hours most of society operates under.  Even with the officer benefits of such a schedule, special attention needs to be paid to every officer getting a restful and uninterrupted period of sleep. 

When all goes well the outcome is 3 shifts of equally alert and physically prepared officers ready to provide for the health and safety of the community.  When all is not well, alertness decreases, vehicle and other equipment accidents are more likely and the potential for serious injury, disability or death looms larger.

A diagnosis of shift work disorder (SWD) is made upon a persistent and recurrent pattern of sleep disruption which results in the mismatch between the individual’s internal sleep-wake cycle and the external demands of their work.  Individuals with this disorder may complain of insomnia at certain times of the day and excessive sleepiness at others with a resultant impairment in social or occupational functioning or a verbal report of marked subjective distress.  When the disorder persists for a significant amount of time additional physical health issues can arise including cardiac and psychological problems.  In fact it is not uncommon to talk with retired officers who are still trying to sort out sleep issues long after leaving the force.

Normal sleep for humans is around 8 hours per session (night) and it is theorized that one third of our lives is spent sleeping or trying to.  Physiologically, sleep originates in the suprachiasmatic nucleus (SCN) in the hypothalamus which is the main control center of the circadian rhythms of sleep and temperature.  Light resets the SCN via a small branch of the optic nerve known as the retinohypothalamic path which travels directly from the retina to the SCN.  The SCN regulates waking and sleeping by controlling activity levels in other areas of the brain. The SCN regulates the pineal gland, an endocrine gland located posterior to the thalamus.  The pineal gland secretes melatonin, a hormone that increases sleepiness.  Melatonin secretion usually begins 2 to 3 hours before bedtime.  Melatonin feeds back to reset the body’s circadian rhythm through its effects on receptors in the SCN.

Although there is a constant mismatch between light, darkness and work responsibilities for shift work individuals, much can be done to set and re-set circadian rhythms that provides for a normalized pattern of sleep regardless of the actual hour of the day it begins or ends.  Because the needs of police departments in providing for public safety will not change, shift work is always likely to be part of the equation, especially in smaller departments.  Therefore the following are recommendations based upon current sleep research and the practice parameters and treatment guidelines of the American Academy of Sleep Medicine.

1.        Aim for one, uninterrupted 8 hour segment of sleep in every 24 hour period.*
2.       Ensure the sleeping environment is as dark as possible and free from noise or other sleep interrupting stimulation.
3.       A prescribed sleep-wake schedule (an 8 hour time block for sleep and awakening) should be devised and adhered to, even on off days.   It may be your weekend but keep the same sleep schedule, even though it might mean staying up from 2200 hours until 0700 hours.   For those on clockwise rotating shifts, pick a time block that gets you up two hours before your shift so the rotation is easier when it happens.
4.       Melatonin, an over the counter supplement found in most pharmacies, in amounts from 3 mg’s to 5 mg’s has been shown to be effective in producing sleep.  It often produces the best benefits when taken 2 to 3 hours before desired sleep onset.  Effective dosage often varies between individuals so starting at the lower dose and working up is likely to be most advantageous.
5.       A 20 to 60 minute nap prior to the start of night shifts has been shown to be of benefit for those who wake up 8 or more hours before their shift.
6.       Replacing a meal break with a 20 minute nap during a night shift has been shown to be beneficial.
7.       Increasing the available light inside the station or work area during night shifts has shown good effectiveness.  Available light should exceed a minimum of 1000 Lux and adding extra lighting for the midnight shift is a very good idea.
8.       Caffeine is often beneficial to maintaining alertness on shift.  If you’ve already come close to exceeding your normal 24 hour intake, cut back some and save it for the difficult 0300 hour time period.  Eliminate caffeine several hours before desired sleep onset. **
9.       Although easily gotten and willingly prescribed, sedative hypnotic sleep agents are not recommended to bring about sleep.  The possibility of addiction and undesired interference with normal sleep cycles makes this a bad idea.  Sleeping pills are still the number one culprit in producing and maintaining long term sleep disorders.
10.   Practice good sleep hygiene and stimulus control.  Beds are for sleep and physical intimacy.  No TV watching from bed, eating in bed or internet surfing.  If you do not fall asleep within 20 minutes or so, get up and do something until you feel you can fall back to sleep.  Repeat as often as necessary until you’ve taught yourself good sleep habits.

* Older officers may need less sleep or notice nightly awakenings for bladder issues.  Try and get back to sleep after using the washroom and be willing to settle for 2 long periods of sleep interrupted by one bathroom break.

** A prescribed medication called Modafinil (Provigil) is used to treat excessive sleepiness caused by shift work sleep disorder (and narcolepsy).  I do not recommend the use of this prescribed agent to maintain alertness by police officers.  It is relatively new to the market and more needs to be learned before it can be said to be 100% safe for professions which require a high state of alertness with few side effects.

Friday, April 6, 2012

Lake Forest Suicides; Remembering Why I Became a Psychologist

It was 1980 when the movie Ordinary People was released and today I decided to watch it again after watching a video of a community wide effort (Helping Parents in Difficult Times) put on by a Lake Forest Task Force in response the three recent public suicides in the Lake Forest community.  

Doing a short bit of research I also found that Sheridan Road magazine published an article today online titled "Ordinary People, Extraordinary Experience" (  So much for me being one of the few to remember the connection.

My own two son's made time today to poke their heads in as I watched (and for those that know me, yes it was a pirated copy found online and played through HDMI).  In response to their inevitable questions I informed them that this movie was one of the basic reasons I'd chosen Clinical psychology as a profession and the North Shore as the location of my practice.  Having moved them from Northbrook to our summer in Lake Geneva before they hit the upper grades of elementary school, I'd always felt that I'd gotten them out of harms way from the north shore but still felt the need to add that the movie was a fairly accurate portrayal of the north shore entitlement program I knew as a child and know so much about today.

When I watched the video of the Lake Forest presentation on youtube (!) posted by "enjoylakeforest" ( what struck me first was the effort that went in to making sure participation included all the possible stake holders.  Community Hospitals (Northshore University Heath System, Lake Forest Hospital) youth programs (CROYA), community outpatient programs, suicide prevention groups, etc.  What struck me next were the things that were not included.  Before I go on let me say I had no problem with the program or with the important ongoing effort being put forth to try and ensure that everything possible that can be done, is being done to try and ensure there are no repeats or additional losses.

What disappointed me was the lack of openness regarding the real nature of suicide and the environmental elements that accompany it.  That's where the movie, Ordinary People, came in.  Why is it that 30 years ago Robert Redford could make an Oscar winning best film (four Oscar's actually) and yet none of it's themes or honest portrayal make it into such an important discussion?  Having run a highly successful junior high program in Kenilworth for over 8 years, I know first hand about the level of work and responsibility that goes into living in an elite suburb.  I also know about the concept of "Lace Curtains" where a home (and what goes on inside) can have the appearance of being transparent but in actuality is very much closed off.

If you really want to learn about the suburbs and the mental health issues that effect it, take the time to watch Ordinary People.  32 Years later the film is just as accurate in all it's portrayals as it was then......except perhaps the idea of a bus as part of public transportation in Lake Forest.  That I believe is still a fallacy.

Sunday, April 1, 2012

We Don't Seem To Be Learning About Suicide Clusters And Contagion

The recent loss of another young person in Lake Forest to an apparent suicide appears to have taught us little. Lake Forest Illinois has now had three highly publicized deaths of adolescents since January 1st of this year. Before that it was Barrington Illinois where 5 individuals took their lives over a three year period and where the media focused it's attention. Before that it was St. Charles, Naperville and Elgin that caught our attention.

Many have rightfully suggested that suicide clusters have been spurred by contagion, also known as the "Werther Effect" (a synonym for media induced imitation effects of suicidal behavior).

A suicide cluster is defined by scientists as three or more suicides in a specific location that occur over a short period of time. Contagion is a term used to identify those situations where there is some linkage between the deaths such as personal knowledge of each other, a shared identity as in school attendance or simply an age range within a specific geographical location. While the term cluster denotes a linkage of location, contagion describes an hypothesized relationship that is in some way related to cause and effect.

As a police psychologist in an affluent northern Illinois suburb I am directly aware of the various numbers and types of death that occur within our Village limits. Some are suicides, some due to accidents and some related to the normal aging process and health deterioration. Few of them are publicized except when the local press takes special interest such as obvious suicides or car accidents. I can tell you that each and every year there are more than enough self inflicted deaths that meet the criteria of a cluster, yet are not publicized. If I include the number of attempted suicides in our town (as well as others that touch our Village limits, based on the radio traffic of dispatchers) then there are easily 4 or more per month within a population of approximately 50,000.

An interesting side point here is that for years, local writers have tried to get at some measure of how many actual suicides there are in the affluent North Shore Suburbs. When you combine that number with the suicides of persons who live here but take their life at other locations (downtown, at weekend homes or on trips of various types) my educated prediction would be it easily tops two per month and more. This prediction covers all age ranges and is not limited to adolescents who comprise a much smaller segment. A careful review of the local obituaries for a 6 month period should get you all the information necessary to concur.

Getting back to the issue at hand; are we learning from any of this? The answer is sadly, no. We continue to publicize suicides, especially those of adolescents and young adults, in a manner and fashion that promotes contagion. But please, before you try and burn me at the stake for my position consider the studies that have been done and the information learned from them. Then decide for yourself if we have learned anything.

Johansson, Lindqvist, and Eriksson (2006) found in Sweden that it is important to bear in mind the risk of further suicides and the risk of cluster formation in a society struck by a teenager suicide.

Niederkrotenthaler, Herberth, and Sonneck (2007) found that in "Austria, "Media Guidelines for Reporting on Suicides", have been issued to the media since 1987 as a suicide-preventive experiment. Since then, the aims of the experiment have been to reduce the numbers of suicides and suicide attempts in the Viennese subway and to reduce the overall suicide numbers. After the introduction of the media guidelines, the number of subway suicides and suicide attempts dropped more than 80% within 6 months. Since 1991, suicides plus suicide attempts - but not the number of suicides alone - have slowly and significantly decreased. The increase of passenger numbers of the Viennese subway, which have nearly doubled, and the decrease of the overall suicide numbers in Vienna (-40%) and Austria (-33%) since mid 1987 increase the plausibility of the hypothesis, that the Austrian media guidelines have had an impact on suicidal behavior."

The Austrian guidelines can be found here;

The World Health Organization (WHO) has also published guidelines for media coverage of suicidal acts (2008).
  1. Avoid language which sensationalizes or normalizes suicide, or presents it as a solution to problems.
  2. Avoid prominent placement and undue repetition of stories about suicide.
  3. Avoid explicit description of the method used in a completed or attempted suicide.
  4. Avoid providing detailed information about the site of a completed or attempted suicide.
  5. Photographs or video footage of the scene of a given suicide should not be used, particularly if doing so makes the location or method clear to the reader or viewer.
  6. Use of the word ‘suicide’ in the headline should be avoided, as should be explicit reference to the method or site of the suicide.
  7. Take particular care in reporting celebrity suicides.
  8. Show due consideration for people bereaved by suicide.
  9. Provide information about where to seek help.

When you take both guidelines into consideration, you can see that our press has learned very little when judging the reporting of the most recent Lake Forest tragedy.

I for one, fully expect even more sensational headlines and the resultant increase in adolescent suicides. I wish it wasn't so but it doesn't look like anyone is putting into practice what we've learned. I wish they would learn.