Dr. K Psychiatry

If you have a copy of the list of potential rational responses for CBT, and you haven't had a look at them lately, have another look and tell me if any more of them resonate with you than the ones that did at first. I'm curious. Thanks. - Dr. K

Recently a patient reported fear of uncertainty. CBT helps you become more comfortable with uncertainty, but it doesn't mean you have to stay in the dark! One resource that is reliable is pubmed. If you google pubmed, it connects you to a near infinite source of searchable medical peer reviewed literature. If you go to pubmed and search for a treatment or disease, and the word "review", you'll find good summaries. You may have to learn medicalese language to make sense, bu...t if you want me to interpret something you don't know, feel free to ask. Pubmed helps us beat uncertainty. We almost never become TOTALLY certain in medicine, or in life, for that matter, but we keep trying to get closer, and some knowledge is better than none. These days there is a lot of medical uncertainty, especially about COVID-19 and vaccinations. Some people are afraid of vaccination because of the fear of long term side effects. But there are long term negative side effects that we already know about COVID-19. We know a lot about vaccinations and almost all side effects are evident within a couple of weeks. The COVID-19 vaccinations aren't released unless the research is adequate to justify that the benefits (fewer cases of COVID-19 and fewer deaths) on average are much more likely than side effects. Fortunately we can still talk about probability, and the probability of population benefit greatly exceeds the probability of population harm. There are no guarantees but the probabilities are sufficient to follow the recommendations and get vaccinated. - Dr. K

Seeing is believing. A client came up with a great idea to try to see connections between events and symptoms of depression. He started a chart that measured or gave 0-10 ratings on sleep, energy, mood and stress. For him, the stress was watching the news. He discovered, that high stress was correlated with low energy and mood. He found that low mood was correlated with low energy. Poor sleep was correlated with low energy. Lower stress levels were associated with higher ...mood. Anybody can do this, and it can be very useful in discovering these things for yourself. With depression, it has biological components, but also may change based on how you think about stress. Note that I emphasize how you THINK about the stress, not just the occurrence of the stress. This is a key benefit of CBT. Rationality of thoughts could be added as another column in the chart. Wouldn't it be cool to do this for a few weeks in a spreadsheet and draw graphs? It could produce convincing visuals. If you can't change a situation, you may still be able to change your view of the situation. Lastly you could add a column for mindfulness meditation. Did you practice it that day? If so, record that you did it, or the number of minutes, and look for things that are also positively correlated with it. You could also do this with minutes of exercise done each day. Maybe keep it very simple to start with, 2-3 columns for example. Seeing is believing. - Dr. K

This is a bit of fun for you. Life can suck if you get too serious about it! Try it - no catch, no purchase required! - Dr. K

Today has been a day of revelations. Here's one, two more will follow. With new medications or medication increases, side effects typically begin before benefits begin. With medication decreases, loss of benefits tend to occur before loss of side effects. Therefore, with medication changes, be patient.

This blurb explains very well the math behind the reason that getting vaccinated against COVID-19 makes sense.

A while back, a client of mine was having trouble figuring out the point of existence. She wasn't depressed, and was doing well in her job, but was extremely busy, perhaps too busy to even evaluate the potential impact of her work. Her work in general was in a technical field, but I thought that it was indirectly benefiting people with mental illnesses, although I hadn't said this. Then at the next meeting, my client told me that she received completely unexpected national ...recognition for her work, by her company. She hadn't realized it was all that important, but she was putting her all into it, because that was how she saw her level of responsibility and commitment to the company and her job. Her company was working in semi-close association with those who care for disadvantaged people, and immediately after it began, those people began to see the potential benefit of my client's work. My client realized that as a result of her work, other people can feel safer in their jobs and work more effectively without worrying. She did a pleasure predicting worksheet to prove to herself that it was all worth the effort, even though it was difficult. The moral of the story is don't quit. Something great might be just around the corner! And also, don't sell yourself short! - Dr. K

Just a few thoughts about PTSD. When I first started to treat disorders associated with trauma, I honestly felt little hope that things would change much. That was when I was younger and less experienced as a psychiatrist. Now that I have had many more patients who have had severe trauma in their past, I see that many have found ways to navigate, process and get through it. Are they changed? Yes, absolutely. But not for the worse. Are they Broken? Absolutely not, even tho...ugh they all felt like that for a while. Many of you have gone on to resume employment in some helping field, even if it isn't with the original employer. Some of you have returned to working with traumatized people yourselves, despite the flashbacks it might bring, the joy and relief of helping others who might have gotten into trouble if not for you, is worth it. You might not be ready for that right now, and that's ok. But when you are ready, be ready for the growth and joy that comes with it. We help ourselves heal when we help others. - Dr. K

I came across another email from The Daily Stoic which resonated with me, and is reflected in CBT teachings. Pay particular attention to the last paragraph. What I got from this is that life will humble you, and you have no choice in that. Your choice is in how you respond, and in recognizing that you do in fact have a choice. - Dr. K "You’re smart. You’re experienced. You’ve made a bunch of money. You have a few prestigious letters before or after your name.... You’re a citizen of this country or that one. You’re got an impressive physique. You have a large following. We can start to feel pretty good about ourselves and then life has a way of reminding us how meaningless these things really are. Seneca was the brightest mind of his era, from an important family, totally innocent, and then bam, exiled by Claudius. Theodore Roosevelt was happy as could be, and then boom, the light went out of his life. Zeno was in the prime of his merchant career when a shipwreck drove him out of business. Marcus Aurelius was chosen out of nowhere to be emperor...and then out of nowhere a plague disrupted all his plans for a philosophical and peaceful reign. It doesn’t matter how smart or experienced or rich you are. Your job title or your ambitions or the size of your fan base doesn’t matter. Life can humble you. Life will humble you. Nothing insulates you from getting dumped or dumped on. Nothing exempts you from pain or pandemics. No one can promise you ease or safety, no insurance or government can make you whole. You are not powerful. Not of us are. Everyone is at the mercy of events. All we control is how we respond. All that’s up to us is what we do next."