What a shame.

Children are meant to be running free in open spaces, climbing trees, finding frogs and turtles, biking to the playground, and being hard to find at dinnertime.

Today’s child is most likely to be found sitting in front of a screen — TV, video games, computers. 8-10 year olds reportedly spend an average of 6 hours a day staring at a screen. Given an additional 6 hours spent in school plus eating, sleeping, homework and we have taken our children’s worlds and turned them into tiny, structured spaces with little physical activity and almost no free play time.

Organized sports have become the play of many children but actually only about a quarter of all children are playing an organized sport during any season of the year. So the vast majority are just sitting around, growing obese at an alarming rate and missing out on important socializing.

How did we come to such a place where the lives of our children are so restricted and isolated? Well, we can start with the lives of their parents. American adults, as chronicled in Robert Putnam’s “Bowling Alone,” have become isolated from their community. Participation in all aspects of community life has dropped dramatically over the past 30 years.

One of the interesting points in Putnam’s book is that bowling remains very popular, but bowling leagues have virtually disappeared. Adults no longer feel they have time to make commitments to be with others on a regular basis. A colleague of mine just remarked about how she wanted to start playing bridge again, found some friends with a similar desire, found a teacher, and then discovered her friends were unable to commit to a regular time for lessons.

What has happened to American adults? Changes in family structure are a major factor. With so many divorces, we have a much higher percentage of single heads of households and blended families, resulting in much more complex life schedules for parents and children. Further, dual career parents have become the norm and work has increasingly encroached on the privacy of home life with the advent of cell phones and computers. Americans work longer hours than any other industrialized nation.

In this context of reduced hands on parenting and overwhelming schedules, the current generation of parents has evolved into an anxious group who are overly concerned about the safety and the academic/intellectual development of their children. Too bad – for the parents and the children. We end up with smarter fat children who are more stressed and growing up too fast. Higher rates of anxiety and depression are no accident.

So where have all the bicycles gone? Getting that first 2-wheeler used to be one of childhood’s most exciting moments. It meant an expansion of the child’s world. The opportunity to travel beyond one’s street and meet friends at the playground, ball field, or just go to someone’s house on your own was an exciting new stage of independence. It also meant lots of exercise. But bicycle sales are plummeting — over a 20% decline in just the past 5 years. Now less than half of children ages 7-11 regularly ride a bike. This is a serious change in the culture of our children’s lives.

But it is not just the crazy schedule of parents or the increased temptation of “screens” to play with. A major role in the narrowing world of children is parental fear. Surveys indicate parents have a distorted expectation of the risk that if they allow their children to roam freely about the town, those children may be abducted by child molesters. School playgrounds are no longer deemed safe places to hang out. The woods are no longer a great place to explore. Biking across town has come to mean an increased possibility of being abducted.

Parents couldn’t be more wrong. In fact, there are only 100-130 stranger abductions a year in the U.S. This is a minuscule number. I’m not being insensitive to the pain of those parents who have had a child abducted and molested or killed but please, let’s keep some perspective here. You and your child are 3 times more likely to be hit by lightning at a soccer game than your child is likely to experience a stranger abduction!

Notice I keep emphasizing “stranger abduction.” 75% of all abductions are carried out by people the child knows, most of which are done by divorced parents who are upset about custody arrangements. Children running free – meeting at the playground or in someone’s yard – are very safe. Not only safe, but these children are learning to make creative use of their time, being physically active, and improving their social skills. And it’s free!! Now what more could you ask for.

So please, restrict access to screens, send your children out of the house, encourage them to go places on their own, and don’t just smile when your child opts to use instant messaging to talk to her friend next door. Turn off the computer and send her next door! Consider it a pleasure to yell down the street or call a friend to find your child at dinnertime instead of simply having to pry him away from his Xbox. Let’s make bicycles something special for children once again.

Such may be the case for you as well with Better Than Normal:  How What Makes You Different Can Make You Exceptional.  This offering from Dr. Dale Archer, a board-certified psychiatrist and distinguished fellow of the American Psychiatric Association, will change the way you look at “the box called normal.”  Dr. Archer states that he is “… driven to spread an empowering new message about mental disorder that places responsibility for identity and mental health back where it belongs – in your hands.”

The message Archer delivers in Better Than Normal is indeed new.  For each of eight fundamental behavioral traits he identifies, he then assigns another term that conjures up far more positivity than the terminology assigned by the Diagnostic and Statistical Manual of Mental Disorders (DSM). If you have been diagnosed as having ADHD, wouldn’t you rather be seen as “Adventurous”?  How about those with a diagnosis of social anxiety disorder or generalized anxiety disorder?  Wouldn’t the terms “Shy” or “Hyper-Alert” elicit more hope on a patient’s horizon?  A diagnosis of being bipolar or schizophrenic could paralyze someone’s hope for recovery, but what if you were, instead, referred to as being “High Energy” or as a “Magical” thinker? 

Also looked at through a new lens is OCD (Perfectionist); histrionic personality disorder (Dramatic); narcissistic personality disorder (Self-Focused).  Dr. Archer provides a continuum model for these traits from 0 to 10, with 0 representing that the trait is absent; 5, the trait is dominant; and 10, the trait is superdominant.  Because a great many of us have these traits in varying degrees, he suggests that we stop looking at them as negative and see, instead, their positive aspects.  Prior to reading the book, he suggests completing the eight questionnaires in the Appendix to determine your own personality’s dominant traits.

“Ascendant strengths” are identified for each trait and is where the positive spin on diagnosis and treatment really comes into play.  I can only imagine someone’s surprise at being diagnosed with one of these disorders and then their subsequent elation at being told that there are not only strengths inherent with the disorder, but that you can use them to your advantage.  Gone would be the person’s perceived stigma of having a mental disorder.  For his book Dr. Archer interviewed people whose acknowledgement and employment of the ascendant strengths of their disorders have helped them be successful in their lives.  All names in those stories have been changed, with the exception of one.  Marc, who is bipolar, requested that his real name be used as he “puts himself and his story in the public eye every day to live his message and destigmatize mental illness.”  Dr. Archer defines him as a “model of what it means to live and be successful with a diagnosis” and a reason he was invited to be included in the book.

In the chapter on social anxiety disorder, we learn that anxious people sometimes use alcohol (referred to as a “social lubricant”), marijuana, or tobacco to help with their social phobia.  In one woman’s story of her addiction to alcohol, she tried Alcoholics Anonymous meetings but disliked the group setting – remember, she is shy – found the meetings depressing, and she just was not “a joiner.”  Using her ascendant inner strength, she overcame her alcohol addiction by an intentional shift in her mindset to one in which alcohol was poisonous, and then supplemented that mindset with hypnosis tapes, prayer, and books.  It would be interesting to know what advocates of Alcoholics Anonymous think about this approach, especially since she was able to overcome her addiction to alcohol without attending meetings or having a sponsor.

Better Than Normal has its roots in the group theory of evolution, according to Archer: 

…because humans live in interdependent groups, evolution has favored the kind of personality specialization that we’re talking about.  When one person is particularly adventurous, for example, or especially well organized, or an exceptionally charismatic leader, everyone else in the group benefits.  But when we seek out diagnoses and medications so that we can stuff everyone back into the box called normal, we stifle the full range of human diversity.  As individuals, our potential for personal satisfaction decreases.  As a group – as a society – we suffer.

Rest assured that Dr. Archer is not saying that medication no longer has a role in treatment and should be thrown by the wayside.  However, when it comes to treating these disorders he is asking that we also look at them in a new and different way, with a view that may fall outside of what we think of as normal.  Whether you are the one diagnosed with a mental disorder or you are treating someone with such a diagnosis, the treatment approach in Better Than Normal could be the catalyst for beneficial change in the lives of many.

Better Than Normal:  How What Makes You Different Can Make You Exceptional
Crown Archetype: March 13, 2012
Hardcover, 256 pages
$25

But this isn’t PMS, also known as premenstrual syndrome. According to Andrea Rapkin, M.D., a professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA, there’s confusion over the true definition of premenstrual syndrome – and it seems to get applied to everyone who has a period.

In actuality, only about 8 to 18 percent of women struggle with PMS, she said. The American Congress of Obstetricians and Gynecologists (ACOG) defines PMS as severe enough to significantly disrupt a woman’s day-to-day life.

About 5 to 10 percent of women struggle with an even more debilitating form of premenstrual syndrome called premenstrual dysphoric disorder (PMDD), which impairs social and occupational functioning, according to Samantha Meltzer-Brody, MD, MPH, director of the Perinatal Psychiatry Program at the UNC Center for Women’s Mood Disorders. PMDD begins one to two weeks before menstruation and stops within four days after the onset of menstruation (called the luteal phase).

Women struggle with a variety of symptoms, such as irritability, anxiety, anger, sadness or loss of interest. Some may be argumentative, lash out at loved ones (and feel guilty afterward) and even feel paranoid.

According to the DSM-IV, in order to be diagnosed with PMDD, a woman must have five of the following symptoms for at least a year (* with at least one of these symptoms).

• Irritability*
• Mood swings*
• Loss of interest in activities
• Difficulty concentrating
• Lack of energy
• Depressed mood or hopelessness*
• Tension or anxiety*
• Sleep changes
• Appetite changes
• Feeling out of control or overwhelmed
• Physical symptoms, such as bloating

Diagnosing PMDD

PMDD often gets confused with major depression (MDD) because of their similar symptoms. “At least 50 percent of women who self refer for PMDD actually have MDD,” according to Dr. Meltzer-Brody. For this reason, a diagnosis is only made after a woman keeps daily ratings of her symptoms for at least two months, she said. Retroactive recall, she said, is not accurate.

But it can still get tricky, because women with major depression may notice that their mood sinks even more during the luteal phase, Meltzer-Brody said. “However, women with MDD will not return to normal mood in the follicular phase [the first half of the menstrual cycle] – they will continue to exhibit mood symptoms all month to some degree,” she said.

Also, women with PMDD tend to respond faster to medication – usually within days – in the luteal phase than women with MDD, Meltzer-Brody said.

The Role of Serotonin & GABA in PMDD

The precise cause of PMDD is not known. But research has pointed to both serotonin and gamma–aminobutyric acid (GABA) in contributing to the disorder, according to Dr. Rapkin.

Serotonin controls mood, eating and sleep. In one study, Rapkin (1992) found an association between decreased serotonin transmission and premenstrual symptoms, such as mood swings, irritability, anxiety and difficulty concentrating. Women who struggle with premenstrual symptoms exhibit changes in serotonin function during the luteal phase. Also, estrogen and progesterone impact the availability of serotonin in the brain.

GABA is a neurotransmitter that inhibits the activity of nerve cells in the brain and regulates anxiety and stress. A progesterone derivative called allopregnanolone (ALLO) regulates GABA. Research has suggested that GABA activity differs between women without PMDD and women with the disorder.

Effective Medication for PMDD

Fortunately, PMDD is highly treatable. SSRIs (selective serotonin reuptake inhibitors) are typically the first-line treatment. Numerous studies have demonstrated their efficacy. (SSRIs also are FDA-approved to treat PMDD.) For instance, one meta-analysis looking at 15 randomized placebo-controlled studies found that SSRIs effectively reduced symptoms of PMDD.

According to Rapkin, research has specifically shown that fluoxetine and sertraline reduced both physical and affective symptoms and improved quality of life and psychosocial functioning.

Women may take medication during the luteal phase only, or some take medication all month and increase the dose during the luteal phase, Meltzer-Brody said. Studies have found that both intermittent and continuous use is effective.

“Some women need more aggressive treatment with adjunctive agents for mood or anxiety during the worst of their cycles,” Meltzer-Brody added.

The oral contraceptive YAZ (drospirenone 3 mg and ethinyl estradiol 20 mcg in a regimen of 24 active pills followed by four inactive pills) is effective for treating PMDD, Rapkin said. YAZ is especially helpful for women who also have painful or irregular periods, she said. Contrary to media reports, Rapkin noted that YAZ doesn’t increase blood clots any more than other newer oral contraceptives.

Struggling with PMDD Symptoms?

If you think you have PMDD, Rapkin suggested recording your five worst symptoms, and rating each as none (0) mild (1), moderate (2) or severe (3) throughout the month. (Or download a copy of the Daily Record of Severity of Problems.) Then take this information to your gynecologist or primary care physician. Another options is to see a mental health professional or a psychiatrist for an accurate diagnosis. Importantly, if your practitioner seems to minimize or dismiss your concerns, see someone else, Rapkin said.

Further Reading

Cunningham, J., Yonkers, K.A., O’Brien, S., Eriksson, E. (2009). Update on research and treatment of premenstrual dysphoric disorder. Harvard Review of Psychiatry, 17, 120-137.

Eriksson, O., Wall, A., Marteinsdottir, I., Agren, H., Hartvig, P., Blomqvist, G., Långström B, Naessén T. (2006). Mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria. Psychiatry Research, 146, 107-16.

Rapkin AJ. (1992). The role of serotonin in premenstrual syndrome. Clinical Obstetrics And Gynecology, 35, 629-36.

Rapkin AJ, Winer SA. (2008). The pharmacologic management of premenstrual dysphoric disorder. Expert Opinion on Pharmacotherapy, 9, 429-45.

Sundström-Poromaa, I., Smith, S., Gulinello, M. (2002). GABA receptors, progesterone and premenstrual dysphoric disorder. Archives of Women’s Mental Health, 6, 23-41.

“The psychiatrist and Holocaust survivor Viktor Frankl said, ‘In between stimulus and response there is a space, in that space lies our power to choose our response, in our response lies our growth and our freedom.’” (p. xi)

Dr. Elisha Goldstein, author of The Now Effect: How This Moment Can Change the Rest of Your Life, clearly feels passionately about his subject and essentially forms the entirety of his book around the above quote. His central premise, that one can change life by embracing mindfulness, is not new to the psychology community; however, by focusing on the ‘spaces’ and the resulting techniques and insights, The Now Effect eases the reader into a fuller understanding of mindfulness.

Dr. Goldstein, a PhD in private practice as well as the author of the Mindfulness and Psychotherapy blog on Psych Central.com and a co-founder of the Mindfulness Center for Psychotherapy and Psychiatry, has written previously on these issues in the well-regarded A Mindfulness-Based Stress Reduction Workbook.

He introduces the book with his personal journey, leading to the “Top Ten” benefits the reader can expect to gain. These include becoming more flexible, increasing emotional intelligence, and of course, changing your life. The chapters are then divided into sections. These include basic training in mindfulness; learning how the mind and body interact to affect our perceptions; and means to employ this information in difficult situations to expand quality of life.

The reader is introduced to many of the book’s concepts in Parts 1 and 2. Dr. Goldstein suggests finding what you value that is crucial to your happiness, then finding what motivates you. Intention is the starting point of the mindfulness path, which ultimately leads to positive life change:

Intention > Attention > Connection > Balance > Health > Happiness (p. 10)

He goes on to explain specific exercises and behavioral modifications that can put this “Now Effect” into action. Goals include turning resistance into acceptance by saying “Yes!,” stopping emotional autopilot with mindful checkins, and connecting with the physical. Dr. Goldstein posits that it is hard to maintain mindfulness without also maintaining awareness of our physical being, and in fact, “a flexible body can lead to a flexible mind (p. 37).”

The second section of The Now Effect begins with the concept of neuroplasticity, or how the brain has the ability to change itself. This is how we can consciously and anatomically change the narrative of our lives. Using this understanding, we can then recognize how our memories influence reactions and that the same event can be interpreted very differently based on our previous experiences with similar or earlier events. Dr. Goldstein summarizes: “The bottom line: thoughts aren’t facts; they are […] dependent on our mood, attitude, and beliefs;” therefore, “…we don’t need to believe everything we think (p. 78).” If we do, we fall into the “mind traps” of anxiety, guilt and blame, among others.

In fact, our brains are evolutionarily built to interpret incidents in a negative light. This was useful when we needed to avoid constant danger outside our caves, but it has become a hindrance. The lesson here is to be kind, even to oneself (often harder than being kind to others); be positive; and be grateful. By taking on these attitudes, we can make ourselves more resilient to the automatic negative.

Still, we are all imperfect. Dr. Goldstein insists that we can and should accept this. Pain is a conduit to learning and fear is “part of human experience. It is not good or bad (p. 173).” Sadness is necessary in order to reach joy (p. 183).

At this point, Dr. Goldstein expands his focus on connecting to others. The need for relationships also evolved throughout time. Although relationships can bring much good, emotional and behavioral “contagions” also can occur. Bad energy or behavior among your friends most likely will make its way to you. Contrarily, “…each additional person in your life who is feeling well boosts your chances of feeling well by 9 percent (p. 201).”

Parts 6 and 7 of The Now Effect — the final sections — offers ways to improve our connections. Dr. Goldstein emphasizes the difference between hearing and listening, bringing curiosity to the interaction. He also touches on mindful parenting as “stepping into the spaces of awareness (p. 215)” before continuing with an explanation of how being open and nonjudgmental can help diffuse arguments, deescalate bad situations, and help us remain empathetic in our closest relationships.

Dr. Goldstein presents his material in short, easily digestible chapters that include research from leaders in the scientific study of mindfulness. He writes well and uses relatable anecdotes and metaphors such as the Japanese martial art of aikido or “The Red Lights in Life” to expand upon his main points. He also supplements the text with literary inclusions from both historical and contemporary authors on the subject, most evocatively with Portia Nelson’s poem “Autobiography in 5 Short Chapters” on page 82.

By ending each chapter with a “Now Moment,” Dr. Goldstein encourages the reader to take the time to fully absorb what has just been explained by immediately employing the techniques therein. Similarly, he has included tags linking to YouTube videos of techniques, an online community, and CD and MP3 downloads at his website — all of which make actually understanding and using his methods on a daily basis much more realistic.

Dr. Goldstein does a wonderful job of bringing mindfulness to a reachable and practical level, noting its recent broader acceptance into new communities such as sports and politics: professional basketball coach Phil Jackson is known as “Zen master,” and Congressman Tim Ryan said that after practicing becoming more present to the moments of his life, he began to become more present with his constituents. Combined with Dr. Goldstein’s application of the “Now Effect” to specific life areas, including eating and the workplace (in Part 3), this approach makes mindfulness less of a mystery understood only by monks and gurus and more of a useful tool in navigating everyday life.

Some of the book’s exercises are repetitive, using different acronyms and techniques to present the same basic notions: breathe deeply and consciously, stop and notice your reactions before taking action, etc. It occurs to this reader, however, that perhaps repetition is exactly what’s needed when trying to absorb what can feel like an impossible task — that of staying in the moment, in the now.

To a similar point, there is a danger in seeking simple solutions to complex problems. The idea of having “Cheat Sheets” (found in the Appendices) seems to be antithetical to the very essence of mindfulness, but again, maybe these reminders, when placed in a wallet or on the refrigerator, are exactly what some readers need to fully embrace a permanent change.

The Now Effect is certainly not the first book to delve into this subject (there are nearly 3,000 books on Amazon.com with ‘mindfulness’ in the title), nor is it the first to focus in detail on the ‘Now’ (see Eckhart Tolle and Thich Nhat Hanh), but Dr. Goldstein brings a clarity and practicality to his subject matter that is sometimes lacking in the more mystical, spiritual takes on the practice.

We are all searching to alleviate the stress we feel in our fast-paced, often overwhelming world. Some readers find one perfect book that leads them to a mindful state of living; others require a collection that fills shelves. There is no right or wrong way, and The Now Effect could be extremely helpful when added to one’s journey. After all, the goal remains the same:

If…when we are entrapped by our unhealthy habits that keep us stuck in perpetual avoidance of what’s uncomfortable or foreign, we can drop into a space of awareness and stay with that discomfort, [we open] up to […] compassion and love.” (p. 222)

The Now Effect: How This Moment Can Change the Rest of Your Life
Atria Books: February 21, 2012
Hardcover, 269 pages
$23

An old Cherokee told his grandson: “My son, there is a battle between two wolves inside us all. One is evil. It is anger, jealousy, greed, and resentment, inferiority, lies and ego. The other is good. It is joy, peace, love, hope, humility, kindness, empathy, and truth.”

The boy thought about it, and asked, “Grandfather, which wolf wins?”

The old man quietly replied, “The one you feed.”

Regardless of whether this is really an old Cherokee folk story (I do have my doubts that a long-ago Cherokee elder would use the word “ego”), it does not detract from the lesson.

The wolf within that we feed is the one that grows. Those who manipulate others through fear and terrorize others with their anger can attain a fair amount of power and control, it’s true. Ultimately, though, it is the wolf who is really in control. Those who are most ferocious in their desire to be on top are usually plagued by feelings of inferiority and paranoia that they are going to lose stature and the freedom to do as they want. The Evil Wolf’s appetite is never satisfied. In order to feel equal in the world, his feelings of inadequacy and resentment demand that others be increasingly subjugated. It’s not pretty.

Strangely, the Good Wolf is never so hungry. Those who love openly and generously, who treat others with kindness, and who live by clear and steadfast principles don’t need to feel better than others to feel equal. Their sense of well-being and positive self-esteem comes from being true to themselves, not from feeling superior. Their joy in life is untainted by jealousy and resentment.

Helping Your Children Find Their Way

Clearly we want our children to find and feed the good wolf within. But how do we put that ideal into practice, especially when the evil one is so hungry? Children do learn what they live, so it falls on parents and other adults in their lives to show them how to make the right choices.

The evil wolf brings all sorts of bad behaviors. Here are some of them, with ideas for starving him:

• Anger. Being angry is never an excuse for poor behavior. Yelling, screaming, name-calling and swearing fatten that wolf up fast. Yes, we need to express our anger to be healthy. But expression of frustration doesn’t require hurting others. Our children need to be taught how to both acknowledge their feelings and to solve problems constructively.
• Jealousy undermines relationships. Be glad for what others have and achieve. Encourage sportsmanship.
• Greed. Curb the very human desire to have the most toys. Show kids how to share generously and how to be truly glad for others when they acquire something we wish we had.
• Resentment. Holding a grudge for a real or imagined slight or wanting to get even with someone keeps us engaged in negativity. This can lead us into depression within ourselves and hatred for others. The secret to lasting relationships is the willingness to forgive others and let things go. Model the importance of making and accepting apologies.
• Inferiority. Feelings of inferiority can fester and become the basis for resentment. Those same feelings can be used as motivation to improve. Find personal strengths and talents and build on them. Study. Practice. Work hard. Emphasize progress toward personal goals rather than how we measure up, or don’t, with others.
• Lies. There’s no “undo” button for lies. Once a person has been caught in a lie, especially when caught in a self-serving lie, it’s hard for others to trust again. We parents need to be scrupulously honest if we expect the same of children.
• Ego. Conceit and self-importance often are used as an antidote for feelings of inferiority. Egotistical behaviors are intended to demonstrate superiority. Having a balanced and appreciative sense of what we can and can’t do is healthier for us and for our kids.

The good wolf deserves the best of life’s banquet. Here are ideas for feeding him tasty treats.

• Joy. Count your blessings every morning and every evening. Tell the kids about it. Ask them to name theirs.
• Peace. Make room in every day for some quiet. Turn off the TVs and computers. Help children learn the value of quiet reflection.
• Love. Show it. Make loving physical contact with family members often. Write love notes. Say the words “I love you” out loud.
• Hope. Model optimism. Find the silver linings in the dark clouds of life. Yes, be realistic. But also be realistically hopeful.
• Humility. By all means celebrate achievements and successes. But there’s no need to do it at the expense of others.
• Kindness. Practice those random acts of kindness. Encourage the kids to do the same. Buy a coffee for the person next in line. Pick up, without comment, the litter someone else has dropped. Send cards for all occasions. Call your friends often.
• Empathy. Teach your children how to walk in others’ shoes. By thinking about how others feel, they can make kinder, healthier relationships.
• Truth. Make honesty a core family value.

Parenting well requires being mindful of the good and bad wolves circling within us and the choices we make about which we feed. Human beings being as they are – human – are vulnerable to the evil wolf’s wiles. Because we’re not perfect, we’ll slip him a tidbit under the table every now and then. But we can make every effort to feed the good wolf as much and as often as we can. When we do, our families and our children become more psychologically healthy and happy.

As director of the UCLA Longevity Center and professor of psychiatry, Dr. Gary Small hears questions like these every day. He also hears them at parties, from friends, and even in the airport. Most of us experience forgetfulness as we age, and Alzheimer’s looms large in our worries. Even though 60 percent of us who are middle-aged or older experience memory loss, only 1 in 5 of us mentions it to our doctors — we’re scared of what we might learn (or maybe we forget to mention it!). And Alzheimer’s is increasing in the population, which doesn’t help our fears: There are 36 million people now suffering from Alzheimer’s, and in 40 years there will be 115 million cases worldwide.

Dr. Small and Gigi Vorgan have written an authoritative, accessible, and engaging book reporting on what we know about Alzheimer’s disease in terms of potential causes, development, and prevention, which is the book’s real focus. It is encouraging to read about the real benefits that can be gained from relatively simple lifestyle changes: incorporate physical activity into your daily routine; eat foods that are good for your brain; reduce your stress; sharpen your mind with mental workouts. The authors walk you through the research on each of these factors in straightforward and simple language, illuminated by stories of their patients, their friends, and even themselves.

An important point the authors make repeatedly is that it’s not too late (or too early!) to take care of your brain. Although it might be a little scary, establish your starting point – find out just how well your memory is working before you begin the program. The authors provide a number of brief questionnaires to assess each of the four areas addressed by their program: subjective memory, physical fitness and activity, diet, and stress levels (and management skills). The questions are simple to answer (e.g., how often do you have trouble finding the correct word for something; how often do you have trouble falling asleep), and are focused on behaviors that will be affected by your participation in the program outlined in this book.

Each chapter that focuses on a specific prong of the program opens with an anecdote, followed by a summary of the current research and understanding of the issue at hand. This material is presented as simply as possible, with references in an Appendix for readers who want to dig more deeply into the research.

The chapters’ real value lies in the very specific steps you can take to help keep your brain working well for as long as possible:

• The chapter on strengthening memory skills provides details about developing good memory habits and presents the reader with easy-to-do exercises that will help practice and develop the skills.

• The chapter on physical exercise includes photographs of very simple exercises you can do at home, without equipment.
• The chapter on healthy brain nutrition includes handy tables outlining potent antioxidant foods, healthy protein options, and antioxidant spices.
• The mental workouts chapter is fun, offering page after page of brain teasers designed to “train but not strain your brain” (and an Appendix lists a number of websites that provide additional brain teasers).
• Finally, the stress management chapter outlines very specific things you can do to minimize and reduce stress.

In the event you are overwhelmed by all the information, the authors put it all together for you in a useful chapter titled “Your First Seven Days.” This illustrates just how easily these changes can be incorporated into a busy life. For instance, on Day 1:

• Begin with a morning mental warmup – something as simple as noticing a detail of the clothing of the first person you see that day.

• Do five minutes of aerobics (perhaps you park a little farther away from your office).
• Drink a glass of water when you get to work.
• Have a midmorning snack (suggestion is provided), and spend 4 minutes with a brain training exercise.
• Eat lunch (suggestion is provided).
• In the mid-afternoon spend 3 minutes with your eyes closed, visualizing your breath.
• Eat an afternoon snack (suggestion is provided) and spend 1 minute writing down the clothing detail you noted that morning.
• Have dinner (suggestion is provided), walk for 10 minutes after dinner, and spend 2 minutes at night doing a brain training exercise.

Throughout the book, memory tricks or Q&As appear as pull-quotes in the margins. For example:

Q: I have heard that some people have their dental fillings replaced or removed to avoid Alzheimer’s. What’s that about?

A: For many years people have expressed concern that the mercury and other toxins……

I found these distracting on the page, and wished they had been placed in an Appendix.

The book’s design is light, with a relatively large font, wide spacing, and a cluttering of different fonts on the page. This is a small complaint, certainly, but just thumbing through the book I had the mistaken first impression that the book was filled with fluff, which is certainly not true.

Although I have no family history of Alzheimer’s disease and experience memory loss relatively infrequently, this book encouraged me to incorporate these simple steps into my life – why not! The changes are easy to make and have proven benefits for memory, and I’m not getting any younger. Although the material was presented at a level that sometimes felt too simple for me, I appreciate the difficulty of writing about such complex material for a general audience, and turned to the Appendix for scholarly references to the material that most interested me.

For my friends who do have family members with Alzheimer’s, or who are worrying about their own memories, I’ll be heartily recommending this book. The friendly and positive tone of the book left me feeling hopeful about a topic that is generally frightening: it’s not too late to start, and the authors will help you make these simple changes that will keep your brain as healthy as possible, for the rest of your life.

The Alzheimer’s Prevention Program: Keep Your Brain Healthy for the Rest of Your Life
By Gary Small, MD and Gigi Vorgan
Workman Publishing Company: December 17, 2011
Hardcover, 288 pages
$24.95

Morrison’s book takes readers through her spiritual evolution and growth process by using various case studies and personal real-life examples. The book reads as a novel, but presents the audience with insightful and thoughtful concepts of spiritual enlightenment. Although the book does not present as a “how-to,” or even a linear equation for enlightenment, it still takes the reader on a journey of personal reflection and growth. I believe the goal of Morrison’s work is to help readers develop their own personal definition of an otherwise elusive Eastern spiritual concept.

The audience for this book could include mental health professionals, clients, or simply people who are interested in developing their own understanding of spirituality. Overall, my reaction to Morrison’s book is positive. The intensely detailed narrative accounts of people she has encountered along her spiritual journey help broaden the context of the topic for the reader. This also serves to make the book that much more relatable to all types of people — from the person just exploring the fringes of Eastern spirituality to the fully self-actualized spiritual guru. Either way, this book is highly applicable to those who are interested in fleshing out the spiritual concept of enlightenment in their personal or professional lives.

The book’s structure is relatively linear. Following the introduction and beginning notes, Morrison divides the bulk of the book into three distinct parts: “Glimpsing My Ignorance,” “Helping Others Help Me,” and “Through the Portal of Self-Knowledge.” Within each part, Morrison presents various case studies and real-life stories that help readers conceptualize the information and reflect on their own current levels of understanding the process of enlightenment. We later see that these three parts of the book mirror the three parts of Morrison’s own theory of development.

Morrison uses Piaget’s Cognitive Developmental Stages as a framework to inspire the basis of her work throughout the novel. Ultimately, Morrison coins her own developmental theory, or staging system, which is explained in detail in the introduction.

Evolutionary in nature, Morrison’s theory consists of six dysfunctional stages, with the first being psychosis. Following these six stages of dysfunction, Morrison discusses six neurotic stages. She closes out her theory with six stages of enlightenment.

Mirroring Piaget’s ideas, Morrison uses various case studies throughout the book to demonstrate that content aside, everyone goes through what she sees as the same developmental process. To avoid getting stuck in any one stage, the end result of each stage must always be resolution.

By the end of the book, Morrison believes herself to have achieved some level of enlightenment and self-actualization. If nothing else, she believes that this is an on-going process that she will be continually working toward. The book does lack some of the scientific support behind her theory in some cases, but the overwhelming case study support does supplement her credibility to readers.

The book also gets much heavier at the end, with more in-depth spiritual ideas and Eastern spiritual language. This may lose the reader or turn the reader away at one of the most important parts of the book. Perhaps a more cohesive language and tone throughout the book would have been more beneficial in aiding in the layman’s understanding of such profound spiritual ideas. Overall, though, the book was a positive, quick read. Morrison succeeds in bringing the concept of enlightenment to life for the Western world.

Seeking Enlightenment: The Spiritual Journey of a Psychotherapist
By Catherine Morrison
Two Harbors Publishing:
Paperback, 232 pages
$26.99

Enter Dr. Jane Baxter and her book, Manage Your Depression Through Exercise.  With her career in psychotherapy and as a personal trainer, Dr. Baxter tackles depression head-on, incorporating the physical, mental and spiritual aspects of living a healthy lifestyle.  She provides a five-week workout plan in order to cement an exercise routine.

So how is her book any different from other exercise books?  Many exercise books and programs can make beginners feel like they are being thrown into the deep end of a pool to learn to swim.  Dr. Baxter takes a slower approach; she holds your hand and guides you into the pool using the steps in the shallow end.  Do not misconstrue this as coddling or babying.  In her first chapter, she clearly states, “excuses are not welcome.”  She explains that everyone must take responsibility for his or her own life and actions.  Enough blaming and finger-pointing; she lays it out and tells readers that if they want a change, it is up to them. 

The program begins light in the first week; workouts are only 5 to 15 minutes a day.  She even lays out the exercises with pictures included.  Each week the exercises progress in intensity.  Dr. Baxter also includes exercises other than the ones that she specifically refers to in her book.

What exercise book would be complete without the section on nutrition?  Rather than go to an extreme, Dr. Baxter advises to “find a diet and exercise plan that works for you.”  She encourages readers to “eat like a pig;” what she means is to stop counting calories, worrying about what other people are eating, or feeling ashamed on the scale. 

In regard to nutrition, balance is key.  Balancing proteins and carbohydrates will help keep energy levels maintained, rather than riding a roller coaster ride of sugar highs and crashes.  She addresses the issues of food addiction but there is not a sense of pity in her words.  Rather, she is matter-of-fact, explaining the process of food addiction as it relates to the various areas of the brain:

Motivation is a junction of brain signals and those signals depend on reliable messengers and intact nerve pathways.  When we look at addiction as a neurological malfunction rather than as a moral failure, it suddenly takes on the form of something that can be fixed.

She encourages her reader to look at the role that food plays in his or her life.  Do you eat when you are bored?  Sad?  Lonely?  Stressed?  How do you feel after you eat?  Gross?  Unhappy?  Delirious?  At this point in her book, there is a chart to fill out when you are hungry, how hungry you are, and how you are feeling emotionally before, during and after you eat.

The most important aspect of the Manage Your Depression Through Exercise is the constant attention to readers’ emotions.  There are charts for the reader to track their emotional state before, during, and after each workout.  Dr. Baxter includes areas to write any distracting thoughts and emotions that may be getting in the way of the workout.  There are personal exercises that provoke readers to look at what they want out of their lives and how they express their emotions. Do you vocalize your anger in a healthy manner?  Alternatively, do you explode and throw objects?  Each chapter has at least two or three sections to remind the reader to pay attention to what they are feeling. 

Although this sounds redundant, Dr. Baxter addresses various emotions in each section in order to cover the full spectrum by the end of the book.  Therefore, regardless if the real issue is loneliness, food addiction, or anger, Dr. Baxter provides questions and suggestions for working through emotional blocks.

I found Dr. Baxter’s book truly motivating.  Although I personally do not suffer from depression, I can say that I understand being emotionally wrapped up and unable to motivate myself to move.  Within the first few pages of her book, I felt like going for a jog.  During my workouts, I remembered many of the things that she discussed; for example, she comments on working through any emotions that come up during a workout because, physiologically, I have turned up a notch by going for a run.  I feel that Manage Your Depression through Exercise is an excellent book to have on hand for anyone who has struggled with being overwhelmed emotionally. I have already put my copy in the mail to a friend.

Manage Your Depression through Exercise: The Motivation You Need to Start and Maintain an Exercise Program
Jane Baxter, PhD
Sunrise River Press: August 15, 2011
Paperback, 192 pages
$14.95

This is a beautifully illustrated book that tells the story of a princess and the “gardening” lessons she learned early on from her parents, the king and queen, and a prince who comes courting later in her life.

The lives of the princess, the king, the queen, and the prince are metaphors for gardens, and the princess discovers that “what we learned in childhood may not serve us well as adults.”  By tending to others’ “gardens” – their wants, their needs, their expectations – she neglects the necessary task of caring for her own.  The princess attempts to do what is necessary to ensure everyone’s happiness and thereby remain in their good graces.  Unfortunately, that practice comes with a hefty price — that of her own happiness.  It is only when a child enters her life that the princess learns how to tend her own overgrown and ignored “garden.”

While the first part of the book is the fable itself, a suggestion from the author’s daughter allows readers to personalize the second part. “A Guided Journal” is the product of their collaboration.

The journaling portion of A Princess and Her Garden is divided into four sections, each referring to a specific life stage: “Then,” “The In-Between,” “Now,” and “From Now On.”  Thought-provoking questions are presented and readers then are asked to write down their answers. Once your personal beliefs begin to surface, you will see how the process has the potential to foster insight for meaningful change.  All it requires is that you take to heart the questions asked and answer them honestly, without embellishing or minimizing your responses.

If not already in the works, in the near future perhaps Adson can make an online version of “The Guided Journal” available for those of us who cannot bear or even fathom the thought of writing in a book.  This would be especially helpful when A Princess and Her Garden becomes available for download to the Kindle, Nook, or iPad.

“The weeds in your garden are all the things that take space in your life and your mind and use up the energy and time you require to live your life to the fullest.”  The weeds of resentment, rejection, and regret are cleared from the garden using the tools of forgiveness and boundaries as well as identifying and nourishing the best-growing “crops” for self-care.

Adson states that “the self-care concept is difficult for many to grasp as we view it as a question of ‘either/or’ rather than ‘both/and.”  It seems to me that this distinction and reversal of perspective may be just what caretakers of others’ gardens need in order to come to the realization that the health of one’s own garden does not have to suffer while the garden of another flourishes under your care.

While it may be that women will comprise the majority of this book’s readership, it is certain there are “princes” who could also benefit from reading A Princess and Her Garden.  It is reasonable to assume that some of them may have grown up learning these same lessons.

The fable of A Princess and Her Garden and “The Guided Journal” strike me as perfect partners in what could easily be a course in mindfulness.  A quote I had read elsewhere by Thich Nhat Hanh, a Buddhist monk and teacher, says “For things to reveal themselves to us, we need to be ready to abandon our views about them.”  This quote seems to go hand in hand with the foundation and objective of Adson’s book.

In order to awaken from the “trance of childhood,” the author says we need to “open our eyes and see all that is around us and then to look inside with a new perspective.”  A Princess and Her Garden and “The Guided Journal” facilitate that process so well that you may not be able to look at the landscape of your own life in quite the same way again.

A Princess and Her Garden:  A Fable of Awakening and Arrival
Center for Applications of Psychological Type, Inc.; 2nd edition: November 30, 2011
Hardcover, 135 pages
$19.95

That’s why we talked to several clinicians who not only have busy practices but also write books, teach, talk to the media and give lectures around the country — just to name a few. They reveal how they make time for both professional and personal pursuits and navigate the obstacles that inevitably come up.

Balancing Work & Life

For Stephanie Sarkis, Ph.D, a psychotherapist and author of several books on ADHD, including 10 Simple Solutions to Adult ADD: How to Overcome Chronic Distraction & Accomplish Your Goals, work is just another significant part of life. “My work is an important part of my life — along with my relationships, my health, and my community activities — so I look at it as ‘how can I balance all aspects of my life?’”

She follows Hettler’s “6 Dimensions of Wellness Model,” which consists of emotional wellness; occupational wellness; physical wellness; social wellness; intellectual wellness; and spiritual wellness. She regularly considers whether she’s meeting her needs in each of these areas. If she’s not, then she identifies the specific changes she can make.

Psychotherapist and author Jeffrey Sumber , M.A., also doesn’t delineate work and life. Instead, he sees the need for “a large notion of balance.” He evaluates his days in their entirety by considering: “What will it take for me to feel centered and relaxed in my day? How much am I giving versus receiving? Do I have undefined ‘me’ time?” He added, “Free time is truly how I define wealth, so the more opportunities for free time in my day, the more successful I feel.”

John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens, reflects on his values and then drafts a personal mission statement. His current mission statement is “To live fully and joyfully, making full use of my gifts and talents.” From there, Duffy creates his goals and action plans.

Ari Tuckman, PsyD, a clinical psychologist and author of Understand Your Brain, Get More Done: The ADHD Executive Functions Workbook, balances a thriving practice with a four-year-old. Since his work requires staying past five o’clock, Tuckman makes the most of his mornings with his wife and son. He also avoids working on the weekends to enjoy more family time.

For Kim Boivin, MEd, a registered clinical counselor at Positive Change Counseling Services in Vancouver, BC, Canada, the right schedule also is key. “I began to experience more work-life balance when I created a weekly schedule that works well for me and committed to it.” She works four days a week and sees five clients max each day. “I find this work schedule gives me enough time and energy to work with clients with enthusiasm as well as to be able to enjoy other areas of my life.”

Boivin also doesn’t over-identify as a therapist. “I enjoy my work as a therapist and I see it as part of me but it’s not all of me,” she said. She follows the advice of a former professor who emphasized the importance of having a life outside of work. “I have organized my life so that I have time and space available every week to meet with family [and] friends and have fun.”

Terri Orbuch, Ph.D, psychotherapist and author of Finding Love Again: Six Simple Steps to a New and Happy Relationship, keeps clear-cut boundaries between work and life. At home, she doesn’t answer her phone until the kids go to bed. She also eats dinner with her family every weeknight and doesn’t work on vacation.

For Orbuch self-care is one of the most valuable ways she copes with the potential stress of balancing work and life. That’s how she’s able to perform her best in all areas of her life.

Overcoming Work-Life Obstacles

Continuous demands. The hardest part of making time for both professional and personal pursuits is “The feeling that there are always unfulfilled demands on both sides, no matter what I do,” Tuckman said.

He remedies this by remembering the bigger picture. For instance, he reminds himself that right now his son requires more hands-on attention than he will in the future. And that’ll mean more together time with his wife and more alone time to pursue interests. “By reminding myself of the bigger picture and that nothing in life stays the same forever, I can enjoy the good parts of this stage now.”

Loving your work — too much. Enjoying your work can become an obstacle. According to Tuckman, “The line between work and play becomes much blurrier and it’s easy to talk oneself into justifying some work activity as being somewhat a ‘fun’ activity.” But as he said, “it isn’t quite the same as doing something purely recreational, so it’s important to make time for those, too.”

Lack of time for self-care. For Orbuch self-care, including getting enough sleep, is vital. But finding the time isn’t easy. She puts self-care on her schedule and typically catches up on sleep on Sundays.

Saying no to extra tasks. “It is hard to say no to additional responsibilities, but I have to,” Orbuch said. She tries to “say no to friends, children and to work obligations that pile on the pressure and deadlines.”

While some people may not like it, being overwhelmed makes you more scattered and less effective. “It is better to do a few things well, than many things not well,” she said.

Sarkis feels the same way. “You say no to what is not fulfilling you or making your life better, and that frees up time for what makes you a happier and more well-balanced person.”

Time for enjoyable pursuits. Sarkis can have a tough time fitting in all the activities she enjoys into her life. She overcomes this hurdle by incorporating fun activities wherever she can. For instance, when she goes on business trips, she often stays several extra days to explore the sights.

Working weekends. “I used to work every Saturday, but then I noticed that sometimes I was missing out on opportunities to develop personal pursuits on the weekend,” Boivin said. She started taking one Saturday off each month.

Sticking to the same routine. Another challenge for Boivin is adjusting an already set routine. She continuously re-evaluates her schedule and tries to remain flexible.

Unplugging. Duffy has a hard time limiting his professional availability. “Most of us in this field with busy practices find that there are always calls to return, reports to read and/or write, e-mails to go through,” he said.

He picks a time in the evening when he turns off his phone and computer, so he’s truly “off the clock.” Not only does this let him spend quality time with his family but it also makes him more effective and available the next day. Plus, he decides ahead of time the number of hours he’ll be available to clients each week. This helps him avoid both preparing for work and working too much.

“As a psychotherapist I know that I have a limit on how much suffering and sadness I can hold and my after-work time needs to provide pleasant, soothing, joyful energy to replenish myself from being empathic with my patients’ struggles,” said Roseann Adams, LCSW, a psychotherapist with an independent practice in Chicago.

Stephanie Sarkis, Ph.D, a psychotherapist and author of 10 Simple Solutions to Adult ADD: How to Overcome Chronic Distraction & Accomplish Your Goals, views self-care as preventative — as her defense against burnout.

Ari Tuckman, PsyD, a clinical psychologist and author of Understand Your Brain, Get More Done: The ADHD Executive Functions Workbook, believes that knowing yourself is key to preventing burnout. He underscored the importance of spotting the early signs of overwhelm.

John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens, defined self-care as “attending to your own needs such that you are content, focused, motivated, and ‘on your game.’”

Many people feel guilty about making time for themselves. But when you’re stressed and exhausted, you have less energy to give to others. According to Kim Boivin, MEd, a registered clinical counselor at Positive Change Counseling Services in Vancouver, BC, Canada, “We are interdependent so what I do to take care of myself has an impact on all who I interact with. When I care for myself, I care for others better too.”

As Terri Orbuch, Ph.D, psychotherapist and author of Finding Love Again: Six Simple Steps to a New and Happy Relationship, said, “Everyone needs to make sure they take care of themselves; they need to make their own wel-being and happiness a priority in their life. If you don’t, who will?”

How Clinicians Practice Self-Care

Self-care is a top priority for Sarkis, who practices an assortment of activities — from working out to spending time with loved ones.

I exercise daily, I practice healthy eating, I socialize, I spend time with my loved ones, I engage in activities I enjoy, I take time out for myself, and I say no to things that are not meeting my needs. I also think humor is a very important part of life. Having an optimistic outlook also is an important part of self-care.

Boivin’s self-care routine also consists of various activities, such as meditating, seeing a therapist and savoring a sweet treat.

My regular self-care behavior also includes mindfulness meditation (on my own and with a group); yoga at least twice a week; personal therapy; professional supervision; consultation with colleagues; going on retreats/holidays; making healthy meals and bringing them to work; laughing; going for walks around the block, looking for beauty to connect with, and breathing deeply. Oh, and eating dark chocolate with a cup of hot tea and only doing that. No multitasking, just enjoying that.

Orbuch schedules enjoyable activities ahead of time, including a massage session every six months and a weekly appointment with a trainer. If she doesn’t, she works right through her self-care time. And exercise serves as a major stress reliever.

I try to practice self-care on a daily basis by exercising [such as] bik[ing], [lifting] weights [and] walking…Some days it might be 30 minutes, and other days it might be 60 to 75 minutes. For me, it can be any type of exercise as long as it is something. Exercise allows me to relax, focus on me and just think.

She also sets realistic expectations for her accomplishments. “I try to feel good about what I do accomplish every day, instead of expecting more or looking to what I haven’t done. I do not take disappointments personally.”

Tuckman often works late but he’s adamant about protecting his sleep. “Sleep deprivation really kills me, so I try really hard to honor my bedtime, even though it means stopping something fun,” he said.

He’s the same way about exercise and rarely misses a workout. “I block out in my schedule to work out three times a week, as well as hopefully getting a bike ride or two in on the weekends,” he said. “Working out and listening to music on my iPod fires me back up for the rest of the day.”

Duffy described his self-care routine as a work-in-progress. But he tries his best to make time for the activities that are important to him, including being with his family, writing, reading and playing and listening to music.

For Adams, self-care includes everything from regularly scheduling medical appointments to hiring help to taking in the arts to seeing new places to avoiding stress-inducing people and experiences.

Psychotherapist and author Jeffrey Sumber limits the number of client hours he schedules each week. He views self-care as “the line between giving and taking as a healer.” At some point, giving to others becomes depleting, which diminishes a therapist’s effectiveness.

How You Can Practice Self-Care

Clinicians also shared their suggestions on how readers can incorporate self-care into their busy routines.

1. Identify what activities help you feel your best. Self-care is individual. As Duffy said, “Self-care for one person will mean something completely different for someone else. One person may need more alone time, for example, while another may nurture herself by spending more time out with friends.”

2. Put it on your calendar — in ink! Take a close look at your calendar and carve out one or two hours for self-care and stick to it, Boivin said. This may take extra prep, but it’s worth it. For Adams, the mornings are the best time to exercise, so at night, she lays out her workout and professional gear and anything else she needs for her day.

Keep an eye out for special events, too. “When I see information about a cultural event that I would enjoy, I make a reservation or purchase tickets so that I have something pleasurable on my calendar,” Adams said.

If you’re crunched for time, Orbuch suggested gradually increasing your self-care each month by a few minutes.

3. Sneak in self-care where you can. If you don’t have huge chunks of time, you can still fit in little moments of relaxation. As Boivin said, don’t wait to add self-care to your life until your schedule frees up. (You might be waiting a while to forever.) She suggested starting where you are. “Starting is the most important step to take.”

“Even if you take just five minutes to close your eyes and take a few deep breaths, it can help your stress level,” Sarkis said. A 10-minute walk makes a big difference to Boivin.

Don’t hesitate to get creative either. Boivin uses her time between client appointments to listen to music and dance. Once a client arrived early and heard the music. Boivin shared her self-care tip and the client loved the idea.

4. Take care of yourself physically. According to Orbuch, this means getting enough sleep, eating nutritious foods and exercising. “When you physically take care of yourself, you will reap the benefits emotionally, psychologically, health-wise, and in your relationships,” she said.

5. Know when to say no. “Your health and well-being come first,” said Sarkis, who suggested nixing anything that doesn’t feel fulfilling. If you have a hard time saying no, here are some tips along with advice for building and preserving better boundaries.

6. Check in with yourself regularly. Duffy suggested asking yourself the following critical questions: “Are you working too much? Do you feel tapped out? What do you need to take away, and what would you like to add?”

7. Surround yourself with great people. Make sure that the people in your life are “upbeat, positive and know how to enjoy life,” Orbuch said.

8. Consider the quality of self-care. “Go for quality, especially when the quantity is lacking,” Tuckman said. For instance, rather than getting sucked into channel surfing for hours, Tuckman only watches the shows he’s recorded. “By minimizing my TV time, I have more time for other better things.”

9. Remember that self-care is non-negotiable. “In order to live a healthy and rewarding life, self-care is a necessity. With that attitude, it becomes very natural and easy to do,” Boivin said.

Dr. Uy Hoang of Oxford University, UK, and colleagues looked at hospital and death records from 1999 to 2006. By 2006, the mortality rate for patients with schizophrenia or bipolar disorder was about double the average for the population. What’s more, this mortality gap has widened over time, they report on the website of the British Medical Journal.

For schizophrenics, the risk was raised by 60 percent in 1999, but more than twofold by 2006. For people with bipolar disorder, it was 30 percent higher in 1999 and ninety percent higher by 2006.

About three-quarters of all deaths were classed as natural causes. Circulatory disease and respiratory disease were the main components of this increase.

The authors say, “There is a need for better understanding of the reasons for the persistent and increasing gap in mortality between discharged psychiatric patients and the general population, and for continued action to target risk factors for both natural and unnatural causes of death.” They conclude: “Optimizing the general health of people with schizophrenia warrants urgent attention.”

Commenting on the findings, Dr. Brian Miller of Georgia Health Sciences University points out that the well-documented link between schizophrenia and bipolar disorder and increased early death from natural causes “is an important public health problem.”

He calls for better integration of mental and physical health services after hospital discharge, “because integrated primary medical care is associated with improved outcomes.”

Over the past ten years, the raised rate of coronary heart disease, stroke, and cancer among people with severe mental illness has been the focus of much research. This raised rate is not clearly linked to medication, smoking, or social deprivation.

The reasons are “are little understood and likely to be complex,” say Dr. Hoang and colleagues, but “are likely to be influenced by adverse lifestyle and social factors associated with the presence of mental illness such as alcohol and illicit drug use, and exposure to poor housing.”

“There is an urgent need for more research to understand the contribution of the six leading global risk factors for mortality identified by WHO, namely, hypertension, smoking, raised glucose concentration, physical inactivity, overweight and obesity, and high cholesterol concentration, to excess mortality in people with severe mental illness, including schizophrenia and bipolar disorder,” they warn.

Late diagnosis and inadequate treatment of physical illnesses may also be contributing to the problem for people with schizophrenia, add the experts.

The finding that mortality for people with schizophrenia has widened recently is reflected in the findings of a systematic review by Dr. Sukanta Saha and colleagues based at the Queensland Center for Mental Health Research in Australia in 2007.

The team reviewed 37 studies based in 25 countries and found that most of the major causes of death were elevated in people with schizophrenia, and this has “worsened in recent decades.” It seems to affect men and women equally.

Risks increased during the three decades examined in the study. This finding is consistent with earlier studies, suggesting that “people with schizophrenia have not fully benefited from the improvements in health outcomes available to the general population,” say the researchers.

They point out that several of the newer, second-generation antipsychotic drugs can trigger metabolic syndrome, which is associated with a two- to threefold increase in death from cardiovascular disease and a twofold increase in deaths from all causes combined.

“Adverse health outcomes associated with weight gain and/or metabolic syndrome (e.g. heart attack or cancer) may take decades to fully emerge,” they warn. “In light of the rising risks already identified by this review, the prospect of further increases in mortality for schizophrenia is alarming.”

They conclude, “It is sobering to reflect on this paradox of schizophrenia treatment. As we become better at detecting and treating the core symptoms of schizophrenia, patients have worsening mortality rates.

“Given the potential for an even greater disease burden as a result of the introduction of second-generation antipsychotic medications, research aimed at optimizing the physical health of people with schizophrenia needs to be undertaken with a sense of urgency.”

References

Hoang, U., Stewart, R. and Goldacre, M. J. Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999-2006. The British Medical Journal, 2011;343:d542.

www.bmj.com/cgi/doi/10.1136/bmj.d5422

Miller, B. J. Editorial: Hospital admission for schizophrenia and bipolar disorder. The British Medical Journal, 2011;343:d5652.

www.bmj.com/cgi/doi/10.1136/bmj.d5652

Saha, S., Chant, D. and McGrath, J. A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Archives of General Psychiatry October 2007, Vol. 64, pp. 1123-31.

Enter Dr. Jane Baxter and her book, Manage Your Depression Through Exercise.  It is a five-week plan to assist depression sufferers in starting an exercise routine and battling through their depression.  She is a cheerleader and friend through the book, motivating and encouraging the reader in their journey.  With her career in psychotherapy and as a personal trainer, Dr. Baxter tackles depression head-on in her book, incorporating the physical, mental and spiritual aspects of living a healthy lifestyle. 

So how is her book any different from other exercise books?  Many exercise books and programs can make beginners feel like they are being thrown into the deep end of a pool to learn to swim.  Dr. Baxter takes a slower approach; she holds your hand and guides you into the pool using the steps in the shallow end.  Do not misconstrue this as coddling or babying.  In her first chapter, she clearly states, “excuses are not welcome.”  She explains that everyone must take responsibility for his or her own life and actions.  Enough blaming and finger pointing; she lays it out and tells readers that if they want a change, it is up to them. 

The program begins light in the first week; workouts are only five to 15 minutes a day.  She even provides pictures of the exercises.  Each week the exercises progress in intensity.  Dr. Baxter also includes other forms of exercise other than the ones that she specifically refers to in her book. 

What exercise book would be complete without nutrition advice?  Rather than go to an extreme, Dr. Baxter advises to “find a diet and exercise plan that works for you.”  She encourages readers to “eat like a pig.” What she means is to stop counting calories, worrying about what other people are eating, or feeling ashamed on the scale. Balance is key.  Balancing proteins and carbohydrates will help maintain energy at a constant level, rather than riding a rollercoaster of sugar highs and crashes.  She addresses the issues of food addiction but there is not a sense of pity in her words.  Rather, she is matter-of-fact, explaining the process of food addiction as it relates to the various areas of the brain:

Motivation is a junction of brain signals and those signals depend on reliable messengers and intact nerve pathways.  When we look at addiction as a neurological malfunction rather than as a moral failure, it suddenly takes on the form of something that can be fixed.

She encourages readers to look at the role that food plays in their lives.  Do you eat when you are bored?  Sad?  Lonely?  Stressed?  How do you feel after you eat?  Gross?  Unhappy?  Delirious?  There is a chart to fill out when you are hungry, how hungry you are, and how you are feeling emotionally before, during and after you eat.

The most important aspect of Manage Your Depression Through Exercise is the constant attention to readers’ emotions. There are charts for the reader to track their emotional state before, during, and after each workout.  Dr. Baxter includes areas to write any distracting thoughts and emotions that may be getting in the way of the workout.  There are personal exercises that provoke readers to look at what they want out of their lives and how they express their emotions.  Do you want to get out of your depression?  Do you vocalize your anger in a healthy manner?  Alternatively, do you explode and throw objects? 

Each chapter has at least two or three sections to remind readers to pay attention to what they are feeling.  Although this sounds redundant, Dr. Baxter addresses various emotions in each section in order to cover the full spectrum by the end of the book.  Therefore, regardless if the real issue is loneliness, food addiction, or anger, Dr. Baxter provides questions and suggestions for working through emotional blocks.

I found Dr. Baxter’s book truly motivating.  Although I personally do not suffer from depression, I can say that I understand being emotionally wrapped up and unable to motivate myself to move.  Within the first few pages of her book, I felt like going for a jog.  During my workouts, I remembered many of the things that she discussed. For example, she comments on working through any emotions that come up during a workout because, physiologically, I have turned up a notch by going for a run. 

I feel that Manage Your Depression Through Exercise is an excellent book for anyone who has struggled with being overwhelmed emotionally. I have already put my copy in the mail to a friend.

Manage Your Depression Through Exercise: The Motivation You Need to Start and Maintain an Exercise Program
By Jane Baxter, PhD
Sunrise River Press: August 15, 2011
Paperback, 192 pages
$14.95

In addition to nourishing your body and participating in physical activities you enjoy, there are many other ways you can improve your mental health.

According to clinical psychologist Ryan Howes, Ph.D, “well-being is associated with balance, understanding, acceptance and constant growth.” Below you’ll find 15 ways to help you flourish and bolster your well-being.

1. Accept your emotions. “Some would argue that most of our physical, mental and relational problems come from our inability to adequately experience emotions,” Howes said. “We deny, bury, project, rationalize, medicate, drink away, smother in comfort food, sleep off, sweat out, suck (it) up and sweep under the rug our sadness, anger and fear.”

Some people spend more energy on avoiding their emotions than others do on actually feeling them, he said. So the key is to give yourself unconditional permission to feel your feelings. “When you feel safe enough to let your guard down, whether that’s alone or with someone you trust, you can focus on the situation, fully experience the feelings and may then be able to better understand why it hurts and what you want to do about the situation,” Howes said.

Writing about negative emotions also helps. According to clinical psychologist Darlene Mininni, research has shown that people who write about their deepest emotions are less depressed and more positive about life than before they started writing. To reap the benefits, it’s important to follow a few guidelines. Here’s Mininni’s emotional writing guide.

2. Take daily risks. Structure and routine are important. But you also might get stuck in a rut. And that means you’re not growing, Howes said. Taking certain risks can be healthy and rewarding, he said.

“Challenge yourself to take a risk each day, whether it’s talking to someone new, asserting yourself, trusting someone, dancing, setting a tough workout goal or anything that pushes you out of your comfort zone.”

3. Live in the present. “Mental health tends to become challenged when we get sucked into what used to happen or what people ‘did to me’ rather than taking responsibility in what I am doing or creating today, right now,” according to psychotherapist Jeffrey Sumber. He encouraged readers to live in the present without hyperfocusing on the future or the past.

4. Be introspective. Avoid coasting through life without assessing yourself, Sumber said. For instance, he periodically asks himself questions such as “Am I in denial about anything or resisting anything anywhere in my life?”

Duffy also suggested stepping back and considering where your thoughts, feelings and behaviors are coming from. You might ask: Is that thought helpful? It that behavior necessary? Is there a better option?

5. Laugh. “Sometimes, we take life far too seriously,” Duffy said. Need proof? Duffy ran across information that revealed that kids laugh about 200 times per day; adults laugh an average of 15 times per day. He suggested everything from seeing a funny movie to playing games like Charades or Apples to Apples.

6. Determine and live your personal values. “[Your values] serve as an ‘inner GPS system’ that guides you through life, helping you make the right decisions and keeping you on track,” said Megan Walls, CPC, PCC, ELI-MP, a certified executive and life coach and owner of Conscious Connection. “Knowing and living your values will lead to a sense of balance, confidence and fulfillment.”

7. Identify and use your individual strengths. Using your strengths, Walls said, helps you feel energized and empowered. Not sure what your strengths are? Walls recommended Tom Rath’s StrengthsFinders 2.0, which features 34 strength themes and an assessment.

8. Keep tabs on your thoughts. Without even knowing it, you might be caught in a vicious cycle of negative thoughts, which seem to sprout naturally. Not only do these thoughts sink our mood but we also start to see them as truths.

Fortunately, we can work through these thoughts and see them for what they are: untrue and changeable. Walls suggested monitoring your thoughts and challenging and replacing negative ones. (Here are four questions to ask to reduce automatic negative thoughts.)

9. Practice gratitude. “You’ll find you shift your overall outlook on life when you come form a perspective of gratitude,” Duffy said. He suggested readers make a list of three things they’re thankful for every morning.

Another idea is to recite at least 10 reasons why you’re grateful for your job, according to Master Certified life and career coach Kristin Taliaferro. “Look for unexpected surprises such as ‘my sunny office window’ or ‘cool work friends to have lunch with.’”

For inspiration, you might check out Living Life as a Thank You by Mary Beth Sammons and Nina Lesowitz. It’s filled with inspiring stories of gratitude, according to Duffy.

10. Discover or rediscover a passion. Take the time to consider your passions. For instance, Duffy’s wife recently tried painting, and found that she loves it and is really talented. “Without a doubt, it has done great things for her overall sense of well-being,” he said.

11. Do what makes you happy first thing. Sometimes it can feel like you’re going through your days on autopilot, and that can get tedious and depressing. Start your day off on a positive note by engaging in an enjoyable activity every morning.

One of Taliaferro’s clients started swimming at a YMCA pool in the a.m. She told Taliaferro that it’s completely shifted her outlook and lifted her mood.

12. Get rid of rotten eggs. “There’s usually at least one rotten egg in your life that’s dragging down your mental outlook,” Taliaferro said. For example, some of Taliaferro’s clients are especially affected by the news. One of her clients decided that if it’s not on the AOL homepage then she doesn’t need to know about it.

Identify your rotten eggs and figure out how to remove them. Your rotten eggs might seem small. But even annoyances can add up and chip away at your mood and well-being.

13. Surround yourself with positive scents and sounds. Our surroundings can affect our well-being. “You can create a positive feeling at home with lemon, peppermint or other essential oils you love,” Taliaferro said. She plays different kinds of music regularly depending on what she’s in the mood for.

14. Get inspired. Find inspiration in everything from subscribing to a daily quote (like this one) to listening to uplifting audio books on the way to work to reading magazines with exciting ideas, Taliaferro said. Duffy also suggested reading Inspiration by Wayne Dyer, which is one of his favorites.

15. Carve out time to meditate. “Protect a few minutes each day to sit, relax and breathe,” Duffy said. People tend to think that meditation is complicated. But you don’t need much time or effort to meditate, and it’s quite soothing. Try this super simple meditation from Mininni.

As the years progressed, the American family began to change. Divorce rates soared and the number of single-parent households rose. Families began to take on a different shape. Stepfamilies — families with one or both parents married previously with children–became more and more common.

As the times changed, TV changed along with it. Shows centered on stepfamilies began to air. These shows rarely portray what a stepfamily is like in reality, however. One TV sitcom about a stepfamily in particular, “Step-by-Step,” is exceptionally fictitious.

As with many TV shows that are supposed to merely entertain, many situations are exaggerated for effect and plots are stretched to inconceivable limits. The characters seem unbelievably naive and get involved in ridiculous predicaments.

“Step-by-Step” is no exception. The two parents of the show, Carol and Frank, had each been married before and had children from these marriages. Carol has three kids, and Frank has two. During the first season of the show, only a few episodes focused on the issue of the new family, such as the kids not getting along or everyone having to make adjustments because of the new situation. Halfway through the first season, though, all family problems seemed to be resolved and the plots began to resemble a typical sitcom’s. Being part of a stepfamily myself, I know firsthand that the short-lived “problems” the characters in “Step-by-Step” experienced don’t resemble at all what the members in a stepfamily must go through in real life.

Along with having “normal” family problems, such as raising teenagers and staying on a budget, stepfamilies have many other issues to deal with. No mention was ever made in the show about ex-spouses, child support, or visitation rights, yet all these things play a large role in a typical stepfamily. This could simply be because Carol’s and Frank’s ex-spouses weren’t in the picture for one reason or another and never posed a problem, but the children never mentioned their other parent either, which again seems highly unrealistic.

The biggest discrepancy between the TV stepfamily and a real life stepfamily is the relationships of the family members with one another. Everyone on the show gets along pretty well, even for a traditional family. In the beginning, Carol’s oldest daughter didn’t get along well with Frank (which is not at all uncommon in a stepfamily); there were also a few problems with Carol’s girls and Frank’s daughter not getting along. But these situations were handled in the typical TV fashion — rather lightly and very short-lived.

In reality, however, such circumstances are not so easy to deal with. One important problem in a stepfamily is the relationship between stepparents and stepchildren. If the children’s biological parents keep in contact with them, the kids might not regard their stepparents as legitimate parts of their life. If the children have a “real” mom or dad, why would they need a step-dad or step-mom? The child might resent the new stepparent for trying to take the place of their natural parent. The biological parent, in turn, might try to pull the child away from the stepparent, feeling threatened by the new parent’s presence. If a child’s natural parent is no longer around, the child may feel that there is no true parent for him or her and not accept the new stepparent.

This very problem happened in my family. Sharon, my mother, commented on this, saying, “My husband made no effort to reach out to my older kids. My youngest didn’t even remember his father at all, so my husband became a father to him, but not to the older ones, who never considered him to be their real father. He has two daughters himself and the same thing happened with them toward me. They had a mother, so I was just considered to be their father’s wife.”

These kinds of attitudes that children and stepparents might have toward each other create other hassles for the family as well. Discipline problems are extremely common. Is the child going to be disciplined by the new stepparent, the natural parent, or both? In cases where there are children in the family from both the stepparent and the natural parent, favoritism may occur, in discipline and elsewhere.

The “her kids, my kids” syndrome becomes all too familiar in this kind of situation among stepfamilies, causing tension not only among the parents, but affecting the children’s relationships with each other. My mother and stepfather would argue constantly about punishments given to us kids. My step-dad would intervene and not be so strict with his own kids, but with my brothers and me, he would never get involved.

This eventually started affecting my relationship with my stepsisters. I began to resent them for it, but I never wanted to start anything with them, so I kept my mouth shut. I would complain to my mother, who claimed she understood but couldn’t do anything about it and my relationship with her worsened too. My family was extremely volatile. Bitter arguments could erupt at any given time, so everyone was careful to tiptoe around the house so as not to offend anyone.

The stress of dealing with family problems is probably not unfamiliar to anyone. In a stepfamily, the stress level is even greater because of the greater number of problems involved. Many stepfamilies go through counseling to help everyone deal with the issues that come up. About a year after my two stepsisters began to live with us, my family was having a lot of problems. They weren’t respecting my mother as a parent and my stepfather would constantly take their side against my mother.

My family was divided down the middle. Counseling helped us through some tough times and I believe it was beneficial to all of us. Today we still have some problems beneath the surface that haven’t been dealt with yet, but overall, things are better.

When I asked my mom what she thought of shows that depicted stepfamilies (in particular, “Step-by-Step”) she answered, “Well, it’s all right. Sometimes it’s funny, but I wouldn’t go any further than that. No one should look at this show and assume that that’s how a typical stepfamily is.” She says that if shows that were realistic about stepfamilies were aired on TV and people could see the emotional trauma and problems involved, maybe people would think twice about getting divorced and remarried.

“It’s not that easy,” Sharon said.

While TV today is trying to reflect the changing times, it’s not always doing a good job. “Step-by-Step” is simply a sitcom shown for entertainment, but what makes the show unique is that it involves a stepfamily. At the same time, however, it doesn’t give a realistic picture of what a typical stepfamily is like.

A true portrayal of real life could be beneficial for everyone and while some other current issues are being addressed, to my knowledge, an honest picture of a stepfamily has yet to come. I agree with my mom in saying that perhaps if people knew what to expect concerning forming a second family that maybe they’d be a little more hesitant to end a marriage. Since television plays a large role in Americans’ lives, it seems to be the only way to convey the message. Shows like “Step-by-Step” just don’t serve any purpose in this endeavor.