Thursday, January 21, 2010

Keep New Year's Resolutions and Get Things Done

As a therapist, one way I keep up to speed with psychiatric findings is through regular emails from Medscape. This week the Medscape psychiatry newsletter had a thoughtful and highly practical item from Shyam Bhat, who's an internist and psychiatrist.

Dr Bhat's article showed he was thinking about ways to help his patients with a greater degree of practicality and willingness to step outside the official psychiatric box than I usually see in the literature.

The article was entitled, simply, "New Year's Resolutions," and in the lead paragraph he noted his own resolution "is to write two blog posts per week." (Mine is 14, but it's not a compettion.)

Bhat notes people with mild to moderate depression or chronic dysthymia experience a mood lift in the first few weeks of a new year, speculating it is analogous to "wiping the slate clean...and forgetting the difficulties of the past."

But, notes, Bhat, while new year's resolutions seem "to offer these patients a chance to reinvent themselves, to see themselves in new a light," the problem is "the effects don't always last."

Especially when people like his patients, and I, who have lived long lived with depression, don't keep our resolutions. Readers familiar with my other blog, Unsticking Joe's Life, will know how I'm trying to deal with the reality of broken resolutions, of intention that just seem to fizzle out.

And it's here that Bhat wins my respect for going beyond the bounds of conventional psychiatry.

"I was looking for a webapp that I could share with my patients as a means of renewing their motivation," he writes.

Wow! That's impressive.

His search lead him to a web-based program called HabitForge.

I checked out this web-based app, and it's kind of neat. The headline on the site is pretty clear:

"It takes 21 days to form a habit. HabitForge will help you get there."

I joined HabitForge, thinking it was worth an experiment.

Once a day HabitForge will send me an email asking if I was successful in doing what I committed myself to do.

One of the goals which I have identified for my 101 Day Count Down is to spend 15 minutes in "home care," which means taking time to make my place more livable.

I put that into HabitForge. The program asked me to identify a downside of not doing that, and I wrote: "The apartment will be more unlivable, inhospitable to the guy who pays the rent: me."

Asked to state the upside of doing 15 minutes of homecare a day, I wrote: "I'll feel good, and my appartment will be a more pleasant place for me, and I'll start to invite people over again."

I checked an option box saying I wanted HabitForge to remind me every third day of the up and down sides to my resolution.

We'll see how it works. I like the concept. It's simple, and easy to set up. So far, 11,565 people have become HabitForge members.

Monday, January 18, 2010

Join the World in Supporting Haitian Earthquake Relief

Tuesday the Earth shook, and Haiti, our hemisphere's poorest country, felt the full brunt of our planet's shifting plates. If you're like me you probably already know how serious things are for the Haitian people, so I won't try and summarize what has been seen and heard on countless news reports.

But, I will ask you to pause, and to consider contributing to earthquake relief efforts. There are 100s of blogs around the world who've agreed to support this important appeal for funds, and Lerner's Notebook is one of them. I'm pasting below an article from WAMU 88.5 FM American University Radio. Normally, it's poor etiquette to cut and paste a whole article; in this case, I think it's the right thing to do, because it lists many worthy and trusted organizations now active in Haiti.

Haiti Earthquake Disaster Relief

The earthquake in Haiti – a 7.0 on the Richter scale – is a major humanitarian emergency and could be responsible for as many as 100,000 deaths when all the damage is assessed. Tens of thousands have been left homeless by the disaster.
Governments, organizations and nonprofits around the world are mobilizing to provide relief. If you would like to help, the American Red Cross is encouraging donations to its International Response Fund, which provides immediate relief and long-term support through supplies, technical assistance and other support. Also, Doctors Without Borders is in Haiti and is seeking volunteers and donations.

Organizations Helping With Haiti Relief

Tuesday, January 12, 2010

101 Day Plan to Reauthor My Life Starts Thursday

Readers of Unsticking Joe's Life know I am starting a 101 Day Count Down to once and for all deal with problems which have plagued my whole adult life. Problems such as depression, ADHD, and executive function issues. These problems have lead to many, many lost days when I am stuck - stuck like a car sunk in mud to the top of the wheels.

I've had a great therapist, a psychiatrist who has used everything he knows in terms of psychotherapy and medications, to help me. And believe me, the problems would have been far worse without his skilled and compassionate help during the last 20 years.

As a therapist myself, I have been able to learn many things which have helped. And I've spent countless hours reading the psychological literature for clues as to what might help, for corners I could play to have a more productive and satisfying life. Throughout years of doing this, my notebooks have kept me loyal company, being there to record references and quotes, my feelings and my ideas.

Thursday is the first day of the 101 Day Count Down.

There are some major goals, designed to impact every area of my life. And there is a protocol for tracking results throughout the whole process. You can get all the details at Unsticking Joe's Life. I hope you'll join me for this journey. I don't know what the outcomes will be and, frankly, I'm more than a little nervous that I have set too high a bar for myself. But then, nothing else has done the job and, at age 60, I want this job done - done well, once and for all.

Throughout the 101 Day Count Down my Moleskine reporter's notebook will play a more important role than ever. Some of what I write in it will be fodder for posts on the other blog - and some will show up here.

Narrative therapists talk about a process of working with clients to help them reauthor their lives. In a sense, that's really what I'm trying to do with the 101 Day Count Down. I am creating a new narrative for my life, a narrative in which I am clearly the subject who takes action and responsibility for my mental health baggage. For too much of the last 60 years I have been the object that has been on the receiving end of psychological problems.

It's imperative that throughout the 101 Day Count Down I remember my subject-hood, that I don't slip back into object mode. The more I remember that, the more clearly the new narrative will be authored.

The role of the little black Moleskine notebook is central to this whole process, a reminder that I am writing a new story of my life. In preparing for the 101 Day Count Down I have already noted in my Moleskine interesting shifts in awareness, thinking, behavior, and feelings. I'm sure there will be many more such notes in the days ahead.

Please know you're welcome to join me on this journey into some new territory, a journey of exploration and action to get out of the mud, and to experience new freedom in all the different movements of my life.

As always, your comments, thoughts, and insights are welcome. I very much appreciate the comments I've so far received on both my blogs. Thank you.

Monday, January 11, 2010

Two Excellent Terrorism Blogs

Since Christmas Day I've noted two good sources for counter terrorism information which go far beyond the surface detail offered by the news media.

As everyone knows by now, the Christmas Day attempt to bring down a Northwest/Delta flight during its approach over southwest Ontario to Detroit has again ignited spirited media discussion about Al Quaida and international terrorism.

Much to my chagrin a lot of the discussion seems to be a repetition of the same basic information. One commentator who appear with some frequency on MSNBC is Evan Kohlmann, an acknowledged expert on terrorism. His reports provide greater depth and understanding than most. Having some interest in going deeper myself, I  checked out his blog called Flashpoint Intelligence.

According to information Kohlmann provides on his blog, he's spent more than 10 years following Al Quaida and other terrorism groups. He "has amassed one of the largest and most extensive open source databases in the world of original documents, communiqu├ęs, and multimedia. He currently works as a senior investigator for the Nine Eleven Finding Answers (NEFA) Foundation--and has also served at various times as a contract consultant in terrorism matters on behalf of the U.S. Department of Defense, the U.S. Department of Justice, the Federal Bureau of Investigation (FBI), the Office of the High Representative (OHR) in Bosnia-Herzegovina, the International Criminal Tribunal for the Former Yugoslavia (ICTFY) at the Hague, the Australian Federal Police (AFP), the U.K. Crown Prosecution Service (CPS), Scotland Yard's SO-15 Counter Terrorism Command, the Central Scotland Police, West Yorkshire Police, and the Danish Security and Intelligence Service (PET)."

This guy is well qualified to speak about international terrorism, and the battle to stop it.

I've returned to Flashpoint Intelligence several times, always finding something new and relevant. Another excellent blog I keep returning to is Counteterrorism Blog which describes itself as, "The first multi-expert blog dedicated solely to counterterrorism issues, serving as a gateway to the community for policymakers and serious researchers." Its goal is to provide "a one-stop gateway to the counterterrorism community." It is even more information-laden than Kohlman's blog.

Taken together, these two blogs probably offer as much information as is anywhere readily available to those of us who don't have access to government intelligence briefings. The information is offered in a professional and objective manner. Check it out.

Sunday, January 10, 2010

Mindfulness Works in Depression Treatment

The London Times Online  today had an interesting article entitled Mindfulness therapy pushes the bad thoughts to one side. I read the article, liked it, and sent off a brief comment, which now appears after the article using the above link.

The article describes the experience of Kathy Andrews, a 48 year old woman with a long depression history:

"After years struggling with the ongoing trauma of depression and rising doses of antidepressants, Kathy Andrews, 48, found out about mindfulness therapy and spoke to her GP for a referral. Since taking the course more than two years ago, she has yet to suffer a relapse and has been able to cut down her medication. "

Mindfulness has indeed shown itself as an effective way of preventing relapse for people who suffer with depression issues. As well, the professional literature documents how many therapists use mindfulness in their work with patients, whose diagnoses include depression, post traumatic stress disorder, and anxiety, to name but a few.

The practice of mindfulness began thousands of years ago in the Buddhist tradition, and has become known in North American health care circles largely due to the work of Jon Kabat-Zinn who is founding executive director of the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School.

During the 1990s, three clinical psychologists, Zindel V. Segal, J. Mark G. Williams, and John D. Teasdale were seeking new ways to deal with a major problem faced by patients with depression, namely the high relapse rate.

They were familiar with Marsha Linehan's dialectical behavior therapy which includes a variation of mindfulness training for treating individuals with borderline personality disorder. She mentioned Kabat-Zinn's work to the three psychologists, and that lead them to the UMass Stress Reduction Program and Kabat-Zinn.

As a result of meeting Kabat-Zinn a most productive relationship developed, leading to a book the three psychologists authored and which, in the forward he authored, Kabat-Zinn calls "courageous" and "a seminal book."

Indeed it was. Very quickly after publication by Guilford Press in 2002, Mindfulness Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse, found favor among psychotherapists. To this day, it is still the leading book for using mindfulness to work with depression. As well, it presents as good an introduction to mindfulness as one may find anywhere.

An interesting observation made by the authors is that mindfulness is not just a technique. For it to be taught, those teaching it need to be meditators themselves, because in dealing with issues that arise in teaching mindfulness, the instructors themselves must be able to embody mindfulness. They can only do that if they are experienced in mindfulness.

I had the pleasure of doing a seven day intensive training in mindfulness for health care professionals with Kabat-Zinn in 2008. Though I'd be lying if I said I practice mindfulness regularly, I can say from personal experience that the more I meditate, the more I use it with clients, and in both their lives and mine I can see the benefits.

On my other blog, Unsticking Joe's Life, I'm describing a self-experiment to overcome my own life-long issues with depression, ADHD, and executive functioning. The major part of that experiment is a 101 Day Count Down, and mindfulness is a significant part of it. Yet, even though I am confident there will be great benefits from the part mindfulness plays, I am trying to have no expectations of mindfulness per se. As I wrote in my comment to the London Times Online:

"The ironic challenge of mindfulness is that while it is a very simple technique to learn, it is very nuanced and rich in the results it may yield. The yield, however, is inversely proportional to one's expectations. In other words, if one begins mindfulness with expectations and is attached to the notion of results, disappointment often follows."

The books and tapes pictured here reflect Kabat-Zinn's genius in making the ancient practice of mindfulness accessible to our times. A major part of his work has been documenting in contemporary terms the myriad benefits of mindfulness meditation. Those who use any of Kabat-Zinn's books or tapes will find them a gentle introduction to mindfulness practice.

I'd be most interested in learning how readers of Lerner's Notebook have experienced mindfulness or other meditation practices. Your comments are welcome.

Sunday, January 3, 2010

Hacking My Notebook for 2010

I was surprised at the number of people who responded to my posts on the value of keeping a notebook, so I decided to write some more about this beneficial habit.

For most of 2009 I carried a pocket Moleskine, a hard cover notebook with a cardboard pocket in the back, a book mark, and an elastic to keep it closed. Previous years I have used the reporter version of this notebook. The reporter notebook is the same size, but it opens upward, in the same way that a steno pad does. It has a cardboard pocket on the back, and an elastic to keep it closed.
Though it still had many pages to go, I decided to start a new Moleskine for the new year. And I decided to return to the reporter version of the Moleskine. I prefer the reporter Moleskine because it's easier to use the full width of the page because they are not bound in the middle like a book.

I thought about the different ways I could set up the notebook. On various websites I have seen some pretty elaborate notebook hacks. Knowing my own tendencies to not follow through on something I start, or simply to get stuck, I decided to keep it simple.

On the inside front cover there is a place for my name, and the words "As a reward: $___." I wrote my name, and put in the amount of $25.

Below that, I have written seven or eight of the phone numbers I call most, people that I am close to, including my daughter, a few friends, my therapist, and my rabbi.

I then numbered all the pages in the right hand bottom corner. This is a boring exercise, but it's also the secret of getting the most from your notebook.

At the top of the first line page I wrote, "Contents." Leaving ample room for Contents entries I skipped to the top of page 6 and wrote, "Phone Numbers." I split the alphabet into quarters, and wrote the letters for each quarter at the top, and halfway point of pages 6 and 7. I'll have space for 40 to 60 names and phone numbers, depending on how many snail and email addresses I include.

As the first Contents entry, I wrote, "Phone Numbers   6 to 7."

My first note for 2010 was written at the top of page 8, and my second entry halfway down the page.

Beneath the Phone Numbers entry on the Contents page , I wrote, "January 1 - 8," and on the line below it, "January 2 - 8."

When I have a specific note I don't want to forget, I can also enter its subject, as well as date and page number, on a contents page.

The other useful notebook hack is use of plasticized tabs, available at any Staples, to bookmark pages of specific interest.

I'm still thinking about whether to start working from the back of the Moleskine to track all money expenditures. Given my tendency to spend carelessly, it makes sense to track my money. The beauty of a pocket notebook is being able to do it where ever the expenditure is made, rather than waiting until later when I may forget or just not feel motivated to make the notation.

So that's it, a simple way of hacking a Moleskine. Some people have more sophisticated approaches, and you'll find their hacks at:

For those interested in David Allen's Getting Thins Done ThePigPogPDA incorporates a simplified GTD system called "Doing GTD Without Doing GTD."