Psychological Treatment for Migraines

If severe, recurrent headaches are putting a strain on your ability to live life your own way, mind-body psychotherapy may help you regain your physical comfort and peace of mind. For over a decade, I’ve used the tools of psychotherapy and hypnosis to help people overcome debilitating medical symptoms. On this page, I’ll provide information about how that works. Feel free to call or email me if you’d like to discuss your situation and set up an appointment.

There is no single underlying cause of chronic headache pain, but rather a constellation of contributing factors. There is a genetic component, so a family history of migraine headaches does predispose you to also have migraine headaches. But even if your identical twin has migraines, there is still only about a 50% chance that you will have them as well. Hormones also play a role: women of child-bearing age are two to three times more likely than men to experience migraine headaches, and the headaches often ease up after menopause. Nerve tissue inflammation, skeletal problems, muscle tension, and dietary intolerances can all contribute.

There are also psychological factors. Chronic pain has a strong, cyclical relationship with anxiety and depression. The experience of chronic pain causes anxiety and depression, and these heightened emotional states exacerbate the pain symptoms. On top of that, most chronic pain patients are surprised to learn that certain personality types are more likely to experience chronic pain.

Headaches are complex, and require holistic treatment

Early in my career, I spent a year training at the Diamond Headache Clinic’s inpatient unit in Chicago, which provides treatment for severe, chronic, and intractable headache cases. While mild cases can often be managed reasonably well with medications, more severe cases require a variety of treatment modalities that work synergistically. These may include medication, dietary adjustments, physical therapy, massage therapy, chiropractics, acupuncture, biofeedback, hypnosis, and psychotherapy. The types of treatment used are often selected based on the specific types of headaches you are experiencing and the way that the symptoms present. Migraine headaches with aura, for example, call for a different treatment approach than tension headaches or cluster headaches.

Pain perception is psychological

Most chronic pain sufferers assume that since pain is a physical condition, there is nothing that a psychologist could do for them other than to help them process the feelings of frustration of being ill. But it turns out that pain is not as strictly physiological as you might think.

To begin with, no matter what part of the body feels hurt, the pain itself actually takes place within the brain. The nerve endings that register pain throughout your body simply send signals back to the brain, which processes the signals and decides how much pain sensation it should produce in response. The amount of pain that results is not necessarily related to the amount of nerve damage or activation, but is instead regulated by context, emotional state, beliefs and social expectations about pain experience, and the amount and type of attention the pain is given.

Additionally, there are no pain receptors in the brain itself — no tissue has been damaged in the moments leading up to a headache. Instead, the part of the brain which creates pain has been activated for some other reason. It is very significant that fMRI studies have shown that “painful” emotional experiences such rejection and loss share the same neurological circuitry as physical pain. That is why sufferers of chronic pain are more prone to psychological distress, and those experiencing psychological pain are more likely to develop chronic physical pain. So in many cases, part of the chronic headache pain is a physical manifestation of psychological turmoil.

Has your doctor recommended therapy?

There are many different types of psychological interventions that may be helpful, depending on the nature of your headaches. After a thorough assessment, I develop an individualized treatment plan that may include any combination of the following:

  • Cognitive Behavioral Therapy (CBT)
    • Behavior plays an important role in headache management. By optimizing diet, exercise, sleep, stress management and other behavioral aspects of headache management, we can help to create a relaxed physical state that encourages natural healing.
    • Identifying external triggers for headaches is another important part of psychological treatment. By managing these triggers more effectively, we can reduce headache frequency.
    • Cognitive restructuring provides tools to help you process pain differently, decreasing pain awareness and increasing your ability to tolerate discomfort.
  • Mindfulness – By cultivating your ability to recognize and manage thoughts and feelings, mindfulness-based treatment strategies can be especially helpful for people suffering from emotional disruptions related to chronic pain.
  • Hypnosis – This powerful psychological tool can make it much easier to introduce new behaviors, new ways of thinking and feeling, and to directly modify physical processes. I have seen many patients respond extremely well to treatment which incorporates hypnosis into the psychotherapy.
  • Visualization – By creating new internal representations of pain processes we can change their meaning, and this changes the way that pain is dealt with at the neurological level.
  • Depth-oriented Psychotherapy – Unconscious psychological processes contribute to chronic pain. For example, many people experience more intense and frequent migraines within the year or so following a traumatic experience or a major loss. Certain emotions can’t be expressed, so they get represented in the body. This cycle can be broken by examining and resolving psychological conflicts that stand in the way of dealing with those emotions directly.

Studies have shown that psychotherapy can be very effective for relieving chronic headache pain, with most patients being able to return to work and go back to living normal, happy lives after treatment. In my experience, the key to successful treatment of headache pain is developing a clear picture of what is happening for you as an individual, and addressing the root causes using a customized, targeted, and holistic treatment program.

Mind-body psychotherapy is simply one component of your care that can help to enhance your body’s resilience, response to treatment, and rate of healing… as well as your emotional well-being. When you schedule your first appointment, I’ll ask you to sign a release form that will allow me to communicate with your physician, so I can coordinate with them to provide you the best care.

Treatment of Trauma and PTSD

An extremely frightening or distressing event such as a serious accident, assault, or rape can sometimes inflict a psychological injury that lasts much longer than the event itself. The emotional shock which follows is called post-traumatic stress disorder, or PTSD. The symptoms of this disorder fall under three categories:

  • Avoidance – After exposure to a traumatic event, many people begin avoiding situations and activities that remind them of the event. Additionally, you might begin to avoid emotional experiences that remind you of the trauma, and this can produce feelings of emotional numbness or difficulty remembering important parts of the traumatic event.
  • Hyperarousal – This includes a lot of more common anxiety symptoms like feeling jumpy, tense, or irritable; being easily startled; and having trouble sleeping or having poor quality sleep.
  • Re-experiencing – This can come in the form of nightmares; recurrent, intrusive thoughts or images; or suddenly feeling like you’re back in that traumatic experience.

A Neurological Explanation of PTSD

There are two memory centers in the brain, one of which controls the storage of sequential, autobiographical memories (the hippocampus) and another which controls the storage of emotional memory (the amygdala). Ordinarily, the two work in tandem, producing rich memories that unite the details of an event with its emotional flavor. However, severe stress causes problems in the hippocampus, preventing clear memories from being formed there. This results in powerful emotional memories that are dissociated from the context in which they were experienced. Therefore, the feelings of terror become generalized, and you begin to respond to a variety of loosely-connected situations as if they were a part of the traumatic experience.

The Role of Personality in Post-Traumatic Stress

Going by that neurological theory alone, the severity of the stressor should determine the severity of the PTSD symptoms. But the reality is that some people are more susceptible than others, and personality factors seem to be more predictive of PTSD severity. The characteristic ways that a person relates to themselves, the world, and other people — the attachment style — can either exert a protective effect  or create a heightened susceptibility to traumatic stress. Therefore, in my opinion a comprehensive treatment for PTSD should address not only the symptoms of trauma, but also the underlying vulnerability which allowed those symptoms to develop.

Approaches to Treating PTSD

While much of my clinical training focused on the assessment and treatment of complex and childhood trauma, I have also worked with combat veterans both within the VA system and in private treatment settings. recently spent a year training in a VA hospital where I gained a lot of experience working with veterans suffering from PTSD after exposure to acute trauma. The PTSD treatments in widest use at the moment are Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE). In practice, I prefer to incorporate aspects of these treatments into a more comprehensive and holistic treatment approach that includes attachment-based and relational psychotherapy. In cases where it is appropriate, hypnosis can often help to dramatically accelerate the healing process.

  • Cognitive Processing Therapy aims to re-integrate dissociated traumatic memories, so that the feelings connected to them will no longer generalize to other situations. This is done by examining the details of the traumatic event and the symptoms associated with it while in a relaxed state of mental detachment.
  • Prolonged Exposure Therapy is based on the behavioral principle of habituation, which just means that you can get used to the feelings of anxiety and so they won’t bother you as much. People experiencing PTSD avoid thoughts, emotions, and situations that remind them of the traumatic event because they fear they will not be able to withstand the intense anxiety these stimuli trigger. PET aims to help patients to confront their fears in a gradual, structured, and supportive way. I’m not a fan of exposure-based therapies for trauma, as in my experience many people are re-traumatized by them, causing symptoms to worsen. My work with PTSD focuses on fostering feelings of safety and security, rather than trying to extinguish fear and avoidance.
  • Attachment-focused and Relational Psychotherapy address problems with the way a person relates to self and other, by helping to reshape the social preconceptions formed in early life. This helps not only to relieve symptoms of PTSD, but to open the doors to more lively, spontaneous, and satisfying social interactions in daily life.
  • Hypnosis is a powerful psychological tool which can be used to enhance other types of therapy described above by eliminating mental distractions, interrupting habitual patterns of thought, and producing corrective internal experiences.

I believe strongly in the idea of treating the whole person, not just a collection of symptoms. That’s why, when I begin working with a person, I don’t just assess the symptoms. I need to know about their early life, core beliefs, and social and emotional functioning so that I can develop a customized treatment. Then you can address all the related factors — including the immediate symptoms, but also the underlying causes, and any systemic weaknesses that would be likely to cause more suffering in the future.

How to get help

There are few things more rewarding for a therapist than seeing a patient get their life back. For information about the trauma therapy that I provide, please follow this link: PTSD treatment.

Personal Life Coaching

Become a better version of yourself…

  • Discover your personal goals (and make a clear plan for attaining them)
  • Enhance your motivation, creativity, and personal effectiveness
  • Become more charismatic and enjoy life more
  • Cultivate better organization and time management
  • Enjoy better, deeper, richer relationships
  • Finally get the respect that you deserve
  • Develop your spirituality and sense of connectedness
  • Love what you see when you look in the mirror

How it works

The world is too big for any of us to ever really understand. So a lot of what we learn growing up, is just where to look — which parts are important. And over time, everything else just fades into the background.

That means that all through your life, when you take stock of the options available to you and make choices about how you want to live… there are other options, that you can’t see.

When a new client comes to me for coaching, the first thing I to do is to start figuring out where their habitual blind spots are. Then, I use a variety of advanced psychological techniques to help them begin to see those possibilities that never even existed for them before.

The problem with life coaches

You might already realize that life coaches are not required to hold any kind of mental health qualifications. And that may sound fine to you if you have no major mental health issues. But the problem is that each and every one of us has invisible barriers holding us back from being our best. We are all giants raised by midgets, all walking around with a perpetual mental crouch.

When you train to be a psychologist, you spend an entire year as a psychodiagnostic resident, which means that your whole job is to figure people out. You gain an immense set of tools and practical knowledge about the invisible barriers that stand between otherwise highly capable individuals and their dreams. Then, you spend your next three years of on-the-job psychological training learning how to help real people to overcome those very barriers.

Most “certified” life coaches have never had these types of invaluable training experiences. That means they just don’t have the skills that it takes to help you push beyond your limitations in a safe, ecological way.

The difference between psychotherapy and life coaching

Many people consider seeing a psychotherapist just to explore themselves and to cultivate personal growth and development. What they often find is that mental health services are not a good fit for them. Those services are designed to help people who have mental illness reduce their symptoms and learn skills for healthy living. If you have a mental illness, these services can be great!

But if you’re a highly functional person simply wanting to gain insight into your own inner workings and find a better sense of meaning in your life, you might end up disappointed. That’s where life coaching is really beneficial.

My coaching practice is a form of applied positive psychology. I work with clients to identify and amplify their personal strengths, examine and enrich their relationships, and cultivate a more satisfying sense of spirituality.

Applying for internships. Here’s the personal essay I want to submit.

I’m 31 years old now, and I’ve been in school for the last 8 years. For the last six of those, I’ve been focused on becoming a psychologist. That entails a lot of “professionalization,” which is a euphemism for becoming the sort of person that psychologists agree with and would like to be around. At every step through the extensive course of training, would-be psychologists are coerced into expressing particular views about themselves and society that are congruent with the prevailing politics of the field.

Well, I started out in this field because I thought it would allow me to cultivate and express my true self. I thought that was the ideal outcome for patients too – for them become the best and freest possible versions of themselves and learn to create meaning all around them. In my mind then, and still today, the profession of clinical psychology should be bursting with life. We should all be so absorbed into the applications of the incredible knowledge available today that everyone who comes near a psychologist should feel the sting of opportunity. I got into this field because I want to live artfully, and I want to be able to inspire the people around me to do the same. I want to be a psychologist because I want to live in a world that is beautiful and robust, filled with people who are strong, self-possessed, and empathic.

Last year I applied for internships. I did what I was supposed to do: I wrote essays that revealed more of my personal background than I was comfortable with. I submitted to months of excessive, probing interviews. I answered questions diplomatically. I did this because difficult experiences during my training had made me feel that my real self was unacceptable to the field of psychology.

In retrospect, it was foolish to try and present myself so neutrally. I turned my own strengths into weaknesses. My strongest connections in this field have all come to me by way of those same personal traits which alienated me from other potential mentors. I’ve learned my lesson.

The truth about me is that honesty and intellectual integrity are some of my most closely held values, and I’m no longer willing to compromise them for a career field that should love them as much as I do. I’m in this field because I believe that thoughts are worth something. My experiences and beliefs are worth more than this essay. I’m not ashamed of my past; I’m proud enough to save it for people I trust. All I can promise is to treat the experiences and beliefs of my patients with the same respect.

Counseling, Psychotherapy, and Coaching: What’s the Difference?

The terms psychotherapy and counseling are often used interchangeably, but many people believe that there is a difference between them that is important for both clients and clinicians. That is why there are separate degrees and professional organizations for counselors and clinical psychologists.

I personally am a Licensed Professional Counselor, with a Master’s degree in Counseling Psychology. I am working toward my doctorate in Clinical Psychology, which will enable me to seek licensure as a Clinical Psychologist. So I have been well educated in both counseling psychology and clinical psychology, and I see the distinction between them as this:

Clinical Psychotherapy aims specifically to address diagnosable disorders in a way which decreases the presenting symptoms. For example, a clinician operating from the framework of clinical psychology will diagnose Major Depressive Disorder based on a number of diagnostic criteria, and will introduce psychological interventions targeted at reducing such symptoms as poor sleeping patterns, hopelessness, and suicidal thoughts. The most common modes of treatment here are cognitive behavioral therapy (CBT), which focuses on the way that your thoughts affect your experiences, and relational psychotherapy, which focuses on the ways that your relationships and relational style affect your experiences. Psychodynamic psychotherapy has lost some popularity despite significant advances with substantial research support.

Counseling, while still a form of psychological treatment administered by a licensed healthcare professional, often takes a softer and more holistic approach. The focus on counseling tends to be more on facilitating the client’s own exploration of solutions for their problems. So you’ll often see counseling applied to more self-directed therapeutic goals, such as career counseling or drug counseling.

Personally, I see value in both of these approaches and will often switch between them as a therapy client progresses. Often people come to therapy for relief from a particular symptom, but then realize there are some other things they would like to work on in their lives. So a therapist needs to be flexible, in my opinion, to adjust to the changing needs of each client over time.

Coaching is not considered a treatment for any diagnosable disorder, but often resembles counseling. Coaching is usually aimed at generative change — ways to make your life better, rather than ways to fix things that are wrong. There are some specialized areas of coaching, such as business coaching, which should be administered by someone who is accomplished in both the areas of business that you’re seeking help with and the area of coaching. More commonly, people seek life coaching, and in my opinion this should be done only by people who are licensed psychology professionals. This is because the training that you receive in becoming a counselor or psychotherapist gives you the ability to understand the delicate psychological balance that makes up a person’s style of living, and how to safely make adjustments to that balance.

Did you ever know how to build a Tesla coil?

It’s not, as it appears,
a single wire wrapped tightly around its base.
It’s actually a number of separate circuits
that are never really connected at all.
But they’re tuned in to the same frequency.
They feed off of each other that way,
like a little planet directing itself by radio,
or like the fragments of a personality.

When he first developed this type of transformer,
Tesla had to keep the whole thing submerged in oil
to prevent those circuits from overheating and melting down.
You have to spread things out more:
you need more space between your circuits
if you want to be able to enjoy the open air.

The discharge from this contraption is,
in many cases, an afterthought.
However, you’ll find that you can really
fine-tune the voltage and directionality
by controlling airflow, capacitance,
and by holding yourself in a manner that is soft yet firm.

Waiting for the breath of life

I didn’t have a body so I built one out of scraps,
dragged it over rocks and beat it against mountains
until it was hard and smooth.

And I saw a vision
of earthquakes,
lava,
morbid obesity and sullen loneliness.

I saw the body of Christ as an ice sculpture,
saw wasted sex and empty generations.

I didn’t have a spirit so I stole one out of the wind,
held it captive in a dark room and fed it propaganda
until it was ready to submit and join the cause.

And I saw a vision
of bands and battalions,
drunk power,
angelic laughter,
of poetry and passion in disarray.

I saw the pain of soulfulness,
the way music forgets itself
and dreams dissolve into mystery,
longing.

I didn’t have a voice so I slept with demons,
soaking up their cries a single word at a time
until I had enough for an incantation of my own.

And I saw a vision
of worlds coming together,
a birthplace for gravity and
natural love.

I saw myself drawn with no outline,
a warm bath in the space between spaces,
saw words gather together and take arms.

I didn’t have a history so I invented one,
drew a name out of the waters and a face from the ages
and negotiated the terms of their surrender.

I saw a vision of you,
becoming your dearest wish.

I saw a vision of all of us,
building ourselves up out of dust,
forging our names into flesh.

I saw the truth growing out of nothing,
waiting for permission,
waiting for the breath of life.

The Use of Hypnosis in Psychotherapy

Many people think of hypnosis as a special type of therapy — hypnotherapy. However, when it comes to psychological interventions like psychotherapy and coaching, I think that hypnosis can usually be better thought of as a tool that is used to facilitate therapy. Just like there are many different styles of psychotherapy which reflect the underlying theories of the clinician, so there are many different ways that hypnosis can be used to treat symptoms and facilitate change. A psychoanalytic psychotherapist would be likely to use dynamically oriented hypnotic techniques, while a cognitive psychotherapist who used hypnosis would be likely to use a form of cognitive hypnosis.

Some people have even argued that the term “hypnotherapist” should not be used at all to describe a licensed healthcare professional. They assert that “hypnotherapist” is a term used to describe a lay hypnotist, or someone who has no healthcare training and practices only the use of hypnosis. This practice is not regulated by state licensing boards, and so is not subject to the same regulation as hypnosis administered by a licensed physician, nurse, psychologist, psychotherapist, or mental health counselor. It is widely accepted that no health professional should attempt to use hypnosis to treat a condition which they are not trained to treat without the use of hypnosis.

I have spent a great deal of time involved with the hypnosis community, and my experience has been that it is comprised of a group of uniquely flexible and goal-oriented clinicians. Particularly in the field of psychotherapy, there is often a lot of trepidation about asserting the effectiveness of psychotherapy techniques or ascribing the benefits of psychotherapy to the actions taken by the therapist. In my opinion, this is unfortunate. I think that when someone goes to see a therapist for help resolving a problem, they deserve to receive straightforward, rapid, and effective help. Hypnosis is an extremely powerful tool for providing that kind of help, because it allows the therapist to bypass many of the habitual patterns of conscious thought which prevent people from finding solutions on their own.

I have also found that this type of work allows a therapist to develop a particular type of insight about the way that people generate thoughts, behaviors, and beliefs. Even when I am not using hypnosis, I find that my therapy work is profoundly influenced by my knowledge in this area. I am always thinking about what kinds of processes are working to reinforce the presenting problems, and what new choices a client would need in order for the problem to naturally resolve itself.

Cannabis, Metabolic Syndrome, And Emotional Distress

Cannabinoids & Metabolism

Much attention has been paid to the emotional and cognitive effects of marijuana. However, we believe that these effects can only be understood in the context of the endocrine interactions which are initiated by marijuana’s ingestion. In this article we will examine the function of both endogenous and exogenous cannabinoids with an emphasis on metabolic functioning.

We will review evidence which points to endocannabinoids as critical components of the body’s energy balance apparatus, and implicates endocannabinoid dysregulation in the development of metabolic syndrome, type 2 diabetes, and mental illness. Finally, we will suggest that cannabis extracts may be useful in the treatment of metabolic dysregulation, and that illicit use of marijuana may in many cases constitute a form of self-medication for the emotional effects of metabolic disorder.

The Metabolic Disorder

The metabolic disorder is a constellation of prediabetes symptoms now recognized by the International Diabetes Federation. Its symptoms include central obesity, hypertension, fasting hyperglycemia, decreased HDL cholesterol, and elevated triglycerides. The metabolic syndrome is associated with the development of type 2 diabetes, gout, non-alcoholic fatty liver disease, polycystic ovarian syndrome, and an irregularity of skin pigmentation known as acanthosis negricans (IDF, 2006).

The etiology of the metabolic disorder is unclear and appears to be extremely complex. Some have argued that insulin resistance brought about by excessive dietary carbohydrate may be a primary cause of the metabolic syndrome, while others have pointed to obesity, chronic inflammation, or excessive uric acid levels caused by dietary fructose.

The Endocannabinoid System

Interest in the biological activity of cannabis sativa and its primary constituent, Delta(9) Tetrahydrocannabinol (THC), led to the discovery of an endogenous cannabinoid system. The endocannabinoids are natural phospholipids which bind to a pair of G-protein coupled cannabinoid receptors known as CB1 and CB2. THC primarily activates CB1 receptors, which are found in the hypothalamic nuclei, the mesolimbic system, and in peripheral tissues including fat cells and gastrointestinal organs (Pagotto, Vicennati, & Pasquali, 2005).

The hypothalamic nuclei is involved in regulating energy balance and body weight, and so it is believed that CB1 plays a role in up- and down-regulating the body’s metabolic rate in order to adjust to the amount of energy available. The mesolimbic system is believed to be involved in regulating the incentive value of food, and so is important for increasing and decreasing appetite as necessary. The peripheral tissues represent the final link in this chain of metabolic regulation, and are responsible for the absorption and release of nutrients. Because CB1 receptors are concentrated in these biological regions, and because THC administration is associated with increased appetite, the endocannabinoids have long been thought to be involved with regulating appetite (Pagotto, Vicennati, & Pasquali, 2005).

Biochemical Effects of Cannabinoids

The function of THC-activated CB1 receptors in adipose tissues has been clarified by laboratory experimentation. A recent study examined the biological effects of cannabis extract on both normal and insulin-resistant adipose tissue cultures. In cell cultures, THC increased insulin-induced glucose uptake, meaning that it essentially countered the effects of insulin resistance. These results support previous findings that smoking cannabis can reduce blood glucose in diabetics (Gallant, Odei-Addo, Frost, & Levendal, 2009). They also lend support to the hypothesis that cannabis and cannabis extracts may be useful in the treatment of type 2 diabetes and prediabetes metabolic disorders, which disorders are characterized by insulin resistance and consequent hyperinsulinemia.

The Metabolic Role of Cannabinoids

It appears that endocannabinoids play a central role in the metabolic process by mediating the effects of insulin and regulating the rate at which cells utilize insulin-induced nutrient uptake. For example, one study found that in healthy subjects who were not insulin-resistant, insulin reduced endocannabinoids levels. This effect was inversely proportional to the level of insulin resistance. (DiMarzo et al, 2009). The implication of this finding is that the popular understanding of type 2 diabetes as a disorder of insulin sensitivity may be incomplete.

It is well established that endocannabinoids plays a major role in the control of appetite and peripheral metabolism. CB1, which is activated by THC, is responsible for most of these effects. A natural hyperactivation of the endocannabinoid system results in a chronic positive energy balance and obesity. Drugs designed to block endocannabinoid reception reverse this effect, producing not only a decrease in appetite but also weight loss in excess of what could be explained by the reduction in caloric intake. In short, high levels of endocannabinoid activity induce energy storage while low levels induce energy expenditure (Despres, 2007). Further evidence for this relationship can be found in the characteristic accumulation of intra-abdominal fat that is seen in patients with type 2 diabetes and cardiovascular disease. CB1 reception appears to specifically mediate this effect (Cote, 2007).

Emotional Effects of Glucoregulatory Disorders & THC

Emotional distress has been identified as one of the two primary motives for marijuana use in young adults (Brodbeck, Matter, Page, & Moggi, 2007). However, the mechanisms by which marijuana alleviates emotional distress have remained mysterious. A study of high school students found that, among students with high rates of truancy, emotional distress was significantly associated with dysregulation of blood sugar levels. Students with hyperglycemia reported higher levels of distress (Iwatani et al, 1997). Since hyperglycemia is a result of insulin resistance, this study tells us that prediabetic conditions are significantly associated with subjective feelings of emotional distress.

Recent studies have demonstrated that metabolic syndrome is associated with the onset of depression (Takeuchi et al, 2009) and post-traumatic stress disorder (Jin et al, 2009). It is very possible that susceptibility to these disorders may be a result of endocannabinoid dysregulation, and could be treated by cannabis extracts. It is furthermore possible that chronic illicit marijuana use may represent a form of self-medication for metabolic dysregulation and its associated emotional effects.

Conclusion

As we have seen, the endocannabinoid system is intimately involved with the regulation of metabolic functioning. Cannabinoid receptors mediate insulin-stimulated glucose uptake, cellular lipogenesis, and energy balance. Type 2 diabetes and metabolic disorder are brought about by hyperinsulinemia, which in turn brings about insulin resistance and insensitivity to the effects of endocannabinoids.

Cannabis extracts, and specifically THC, exert a direct effect on insulin sensitivity and glucose uptake, resulting in lowered blood sugar. They also result in the alleviation of subjective feelings of emotional distress, although the mechanism for this effect remains unclear. Because the literature increasingly suggests a connection between metabolic dysregulation and emotional distress, we conclude that metabolic correction may be the means by which cannabis extracts provide relief from emotional distress.

Our conclusion is novel. Although others have suggested that cannabis may sometimes be used to self-medicate for symptoms of anxiety or ADHD, we are aware of no other researchers who have connected illicit cannabis use with self-medication for metabolic disorder. Nonetheless, we believe the evidence is compelling enough to warrant serious speculation and to prompt additional research. The evidence we have reviewed in this paper suggests that cannabis extracts may be effective treatments for metabolic syndrome, and may help to moderate the negative physiological, neurological, and psychological effects of glucoregulatory disorders.

The evidence furthermore suggests that treatment programs focusing on chronic marijuana use should give special attention to the medical and dietary implications that this drug use may have. It is possible that certain cases of marijuana dependence may be better conceptualized and treated if full metabolic assessments were performed concurrently with psychological assessments. This may be particularly true of those cases in which the reported reasons for marijuana use relate to emotional distress. The literature provides increasing evidence for mind-body interaction, and therefore suggests that quality of care will improve as medical and psychological treatment programs become more fully integrated.

References

  1. Brodbeck, J., Matter, M., Page, J., & Moggi, F. (2007). Motives for cannabis use as a moderator variable of distress among young adults. Addictive Behavior, 32(8), 1537-1545.
  2. Côté, M., Matias, I., Lemieux, I., Petrosino, S., Alméras, N., Després, J.P., & Di Marzo, V. (2007). Circulating endocannabinoid levels, abdominal adiposity and related cardiometabolic risk factors in obese men. International Journal of Obesity, 31(4), 692-699.
  3. Després, J.P. (2007). The endocannabinoid system: a new target for the regulation of energy balance and metabolism. Critical Pathways in Cardiology, 6(2), 46-50.
  4. Di Marzo, V., Verrijken, A., Hakkarainen, A., Petrosino, S., Mertens, I., Lundbom, N., Piscitelli, F., Westerbacka, J., Soro-Paavonen, A., Matias, I., Van Gaal, L., & Taskinen, M.R. (2009). Role of insulin as a negative regulator of plasma endocannabinoid levels in obese and nonobese subjects. European Journal of Endocrinology, 161(5), 715-722.
  5. Gallant, M., Odei-Addo, F., Frost, C.L., & Levendal, R.A. (2009). Biological effects of THC and a lipophilic cannabis extract on normal and insulin resistant 3T3-L1 adipocytes. Phytomedicine, 16(10), 942-949.
  6. International Diabetes Federation (2006). The IDF Consensus Worldwide Definition of Metabolic Syndrome. Retrieved from http://www.idf.org/webdata/docs/IDF_Meta_def_final.pdf on November 24, 2009.
  7. Iwatani, N., Miike, T., Kai, Y., Kodama, M., Mabe, H., Tomoda, A., Fukuda, K., & Jyodoi, T. (1997). Glucoregulatory disorders in school refusal students. Clinical Endocrinology, 47(3), 273-278.
  8. Jin, H., Lanouette, N.M., Mudaliar, S., Henry, R., Folsom, D.P., Khandrika, S., Glorioso, D.K., & Jeste, D.V. (2009). Association of posttraumatic stress disorder with increased prevalence of metabolic syndrome. Journal of Clinical Psychopharmacology, 29(3), 210-215.
  9. Pagotto, U., Vicennati, V., & Pasquali, R. (2005). The endocannabinoid system and the treatment of obesity. Annals of Medicine, 37(4), 270-275.
  10. Takeuchi, T., Nakao, M., Nomura, K., Inoue, M., Tsurugano, S., Shinozaki, Y., & Yano, E. (2009). Association of the metabolic syndrome with depression and anxiety in Japanese men: a 1-year cohort study. Diabetes/Metabolism Research And Reviews, 25(8), 762-767.

Robert Cialdini’s Principles of Influence Cheatsheet

Dr. Robert Cialdini is recognized as one of the world’s leading experts on social influence. What follows is a persuasion cheat sheet I put together based on his book Influence: Science & Practice.

“Weapons of Influence” Cheatsheet

All animals have built-in fixed action patterns that are triggered by specific stimuli. For example, a mother turkey’s mothering instincts are activated by a specific “cheep cheep” sound. If a chick fails to make this sound, it will be ignored or even killed. If an inanimate object, or even a natural enemy such as the polecat, makes this “cheep cheep” noise, it will be taken in and cared for. It’s like a recording. Click, Whirr.

Humans also have a number of these fixed action patterns. They are shortcuts that help us process our social environment more efficiently. For example, if you ask someone to do you a favor, you will have better luck if you provide a reason, even if the reason makes no sense or is unrelated to the request. Because the recipient of your request reacts positively to the word “because.” Listed below are empirically proven weapons of influence that you can use to create unconscious biases that will improve compliance with your requests.

Reciprocation

  • When people receive things from others, they naturally feel indebted. This is true in all cultures (Gouldner, 1960). Therefore unsolicited gifts increase compliance with future requests.
    • Example: A $5 check included with the survey produces more responses than the promise of $50 after responding (James & Bolstein, 1992).
      • Example: Waiters who give a piece of candy with the bill get 3.3% larger tips. Waiters who give two pieces of candy get 14.1% larger tips. Waiters who delayed the action of giving the second piece of candy, for emphasis, raised tips by 23% (Strohmetz, Rind, Fisher & Lynn, 2009).

Reciprocal Concessions: Rejection-Then-Retreat

  • The rule of reciprocity also applies to non-material exchanges. So that if you make a large request, are refused, and then make a smaller request as a concession, you are three times more likely to get compliance than if you asked for what you wanted straightaway (Cialdini, Vincent, Lewis, Catalan, Wheeler, & Darby, 1975).

Commitment

  • Once a person has made a commitment, they are likely to follow through even if they know that acting consistently with that commitment will not be beneficial
    • Example: Simply conducting a telephone survey asking people predict whether they will vote in an upcoming election is the most effective way to get them to actually do so (Greenwald, Carnot, Beach, & Young, 1987). Because when they answer “yes” it becomes a personal commitment.
    • Example: Toy manufacturers hype up a particular toy before Christmas, and then purposely undersupply it. That way, parents who have already promised it to their children buy an equal value of toys before Christmas, and then buy the requested toy in January after supplies are again made available.

Consistency

  • Each time we comply with a request, even a trivial request, it modifies our attitudes and self-concept such that we will tend to act more consistently with that type of action (Bem, 1972; Vallacher & Wegner, 1985).
    • Example: People asked to place a small “Be A Safe Driver” placard in their windows were 60% more likely to comply with a request, two weeks later, to allow a large poorly-lettered “DRIVE CAREFULLY” billboard to be placed in their front yards (Freedman & Fraser, 1966).
    • Example: Many groups who ask you to sign petitions never do anything with the actual petitions. Once you have signed the petition, your self-concept is modified to include related types of civic action.
    • Example: Tribal cultures in which members submit to the most dramatic and stringent initiation ceremonies are those with the greatest group solidarity (Young, 1965).

Social Proof

  • We determine what is correct by finding out what other people think is correct (Lun et al, 2007). This is particularly true in the presence of uncertainty (Sechrist & Stangor, 2007). We are particularly prone to follow the lead of people we perceive as similar to us (Park, 2001).
    • Example: Canned laughter causes people to rate shows as funnier (Provine, 2000)
    • Example: The use of shopping carts did not catch on until their inventor paid fake shoppers to push them around his store (Dauten, 2004).
    • Example: Publication of news stories about suicides increase both the number of suicides and fatal accidents among members of similar groups (Phillips, 1980).

Liking

  • People “prefer to say yes to the requests of people we know and like” (p.142). So increasing the degree to which you are liked by someone will increase the probability that they will comply with your requests. We like people better and believe them more when they: are more attractive (Chaiken, 1979); are similar to us (Burger et al, 2004); like us (Berscheid & Walster, 1978); are familiar to us (Mita, Dermer, & Knight, 1977; Grush, 1980; Borstein, Leone, & Galley); are engaged in a cooperative effort with us (Kamisar, 1980); are associated with things we like (Manis, Cornell, & Moore); are present while we are eating (Razran, 1938).
    • Example: At in-home Tupperware parties, the strength of the social bond between the host and attendee is twice as likely to determine purchasing decisions as preference for the actual product (Frenzen & Davis, 1990).
    • Example: The Guinness Book of World Record’s “Greatest Car Salesman” sent out monthly greeting cards to each of his previous customers which read “I LIKE YOU” (p. 150).
    • Example: Study participants reported a higher level of agreement with political statements they were exposed to while eating, even though they were not aware of which messages had been presented while food was being served (Razran, 1940).

Authority

  • Once someone has accepted you as an authority, they will follow your instructions even against their own judgement, ethics, and feelings (Milgram, 1974).
    • Example: Milgram’s (1974) obedience study
    • Example: Sanka made a commercial for decaffeinated coffee that was so successful that it ran for years, which featured an actor who had played a doctor on a medical show extolling the health benefits of decaf (p. 183)
    • Example: Nearly all pedestrians complied when an experimenter in a guard costume instructed them to pay someone else’s parking meter, even if the guard was no longer present (Bickman, 1974)
    • Example: 3½ times as many people will sweep out into traffic following a jaywalker dressed in a well-tailored business suit (Lefkowitz, Blake, & Mouton, 1955).

Scarcity

  • People are much more sensitive to potential losses than to potential gains (Hobfoll, 2001). Therefore opportunities seem more valuable to us when they are less available (p.200).
    • Example: A salesperson can easily secure a commitment to purchase an item when it is presumed that the item is unavailable, while the information that a desired item is in good supply can make it less attractive (Schwarz, 1984).
    • Example: After the passage of a law to ban phosphate laundry detergent was passed in Dade County, Florida, Miami residents came to believe that phosphate detergents were gentler, more effective in cold water, better whiteners and fresheners, more powerful on stains, and easier to pour than non-phosphate detergents (Mazis, 1975).
    • Example: College students had a greater desire to read a book, and a greater belief that they would enjoy the book, when they were informed that it was “for adults only, restricted to those 21 years and older” (Zellinger, Fromkin, Speller, & Kohn, 1974).
    • Example: People become more sympathetic to arguments when they learn that the argument has been censored—even when they have never been exposed to the argument’s justifications (Worchel, Arnold, & Baker, 1975).
    • Example: People given a cookie from a full jar enjoy it less and report that it is lower quality than an identical cookie from a mostly empty jar (Worchel, Lee, & Adewole, 1975).

Read The Rest of Cialdini’s Work

This cheatsheet gives you a nice quick reference on how to exert greater influence in your interactions, but it is no replacement for Cialdini’s excellent books and lectures. You can find Cialdini’s own site here, and can buy his books through Amazon by clicking here.

An Egodynamic Model of Hypnosis

Hypnosis is a spooky phenomenon. Through mechanisms that are not fully understood, this technique allows seemingly impenetrable barriers to be bypassed: repressed material can be recovered or manufactured; moments of imprint vulnerability can be relived and rewritten; psychological and physical symptoms can be alleviated or created; even involuntary physiological processes can be dramatically modified. In this article, we will explore hypnosis from a psychodynamic perspective in order to gain insight into the phenomenon’s effects on defensive functioning, and vice-versa.

There are as many explanations of the nature of hypnotic phenomena as there are schools of thought regarding the nature of the human psyche. The most popular model of hypnosis is the ‘altered state’ theory, which holds that hypnosis is a unique state of consciousness. This state tends to be viewed as one characterized by a relaxation of inhibition coupled with a type of intense focus that facilitates powerful associative and dissociative activity. This model has been generally accepted by psychodynamic practitioners going back to Sigmund Freud, who believed hypnosis to be a method of inducing a profound transference reaction, such that the patient could regress to a level of psychic process outside the range of experiences that are accessible to the ego.

Since the 1960s, it has been empirically demonstrated that hypnosis is not any single state, but rather a range of neurological and phenomenological states that are highly dependent upon the relationship between practitioner and subject, the motivations of both participants, and the general hypnotic susceptibility of the subject. More recent psychoanalytic theorists have often conceived of hypnosis as a nonmalignant ‘regression in the service of the ego,’ in which the ego gains access to primary processes in order to reorganize and reorient its defensive position. In contrast, other psychoanalytic theorists have more closely followed Freud in emphasizing the mechanism of transference through hypnosis, arguing that hypnotic induction allows for reparenting of the superego through identification with the hypnotist. It is interesting to note that these conceptions focus primarily on the psychologies of the id and superego, leaving the role of the ego secondary in each of the major psychoanalytic conceptions of hypnotic phenomena. These models each fall short to some degree: the regression model fails to explain the hypnotic subject’s advanced ability to defend against negative emotions, while the transference model fails to account for the success of self-hypnosis. There may be something to be gained by examining the role of ego functioning more closely.

One of the key features of the hypnotic experience is the feeling of involuntariness. In fact, recent hypnotic theorists tend to regard this as a measure of the depth of a hypnotic trance—the subject’s ability to willfully engage in involuntary actions. There is another type of psychic process which operates in this fashion: the defense mechanism. Defense mechanisms operate unconsciously by definition, and can only be observed by the individual after the defensive behavior has already been engaged. Also like hypnotic phenomena, defense mechanisms have a volitional quality; they occur in order to achieve some purpose of the individual as a whole.

Modern ego psychology generally positions the ego as a spectrum of processes which work to reconcile internal and external need-states. Some parts of this process are consciously available to the individual, while others occur outside of consciousness. At least some of those unconscious ego processes appear to remain outside of consciousness for specifically protective reasons, and the defense mechanisms can be seen as operations of the ego which serve to keep that which cannot be conscious from becoming so. But why should it be the case that certain intrapsychic occurrences necessitate this type of protection? What is being protected, and what is it being protected against?

It is difficult to attempt answers for these questions without risking reification of the ego. If we accept the ego as a process of reconciling the internal and external—that is, the biological and the sociological—then it is this balance itself which would be defended. The ego is, then, the semi-individual, who must be at once an organ of nature (the self-preserving and directly reproductive process) and an organ of society (the species-preserving and indirectly-reproductive process.) It is the central personage that must balance self-actualization with altruism. Therefore, the ego must be the decider, the part of the individual that is capable of perceiving and assessing the full range of need-states and their attendant variables, and implementing suitable compromises on an ongoing basis. If some of this central tendency remains outside of consciousness, then, it must be assumed that consciousness itself—and therefore the “person” who is identified with that consciousness—is something other than the ego and furthermore something which is mediated by the ego.

Let us now reconsider hypnosis from this egodynamic perspective. The general tendency of hypnotic phenomenology is toward an involuntariness of action that yet has a volitional quality. There are three primary ways of inducing this quality of experience: through a relaxation of the conscious processes, as in the standard ‘relaxation induction;’ through a disorientation of the conscious processes, as in a skillful ‘confusion induction;’ or through an overwhelming of the conscious processes, as in the highly directive hypnotic induction one might use with a hurt or frightened patient in an emergency situation. It would be easy to assume that hypnosis is the continued operation of the ego in a situation where consciousness has itself been relinquished. However, this is not the case; most hypnotic subjects experience themselves as fully conscious during hypnosis and are afterwards able to accurately remember the events which took place. However, the conscious experience of the hypnotic subject does tend to be significantly different from the normal waking state. Attention—the measure of what will ultimately become a part of conscious experience—tends to become highly focused, so that the subject’s consciousness can be fully absorbed by a relatively small range of real or imagined stimuli. The direction of attention and contents of consciousness become at once extremely flexible, capable of dramatic alteration upon the introduction of a suggestion, and remarkably stable, capable of being sustained far beyond the subject’s attention span in a waking state. So what has happened?

It is certain that the hypnotic induction has modified both the content and process of consciousness. It is also reasonably certain, that the ego—the conciliatory process—remains functional and in fact gains influence through this process. The resultant hypnotic state is remarkably lacking in the anxiety or tension that normal, moment-by-moment negotiation between need-states requires. It is as though the arbitrator of consciousness has come to exist in a vacuum, as though an armistice has been achieved in which the individual is devoid of opposing needs. In fact, it is as though the needs themselves have been withdrawn.

The most simple and tenable conclusion, then, is that the hypnotic state is one in which the ego has successfully wrested control of the entire human machinery from the hands of both nature and society at once. The id and superego are disallowed access to consciousness, and the ego—with its full range of access to both primary and introjected processes—determines autocratically what needs will and will not be expressed. In a sense, the ego becomes the consciousness.

Another way to consider this issue is through the lens of ego state theory, which holds that each “individual” psyche is actually comprised of a number of essentially autonomous personality structures—“ego states”—that are more or less integrated based on the individual’s level of systemic adaptation. Under this theory, even healthy people can have large numbers of highly differentiated ego states which may or may not manifest in consciousness. These ego states are seen as being capable of interacting with one another outside of conscious awareness, even acting out psychodramas between internalized figures. Ego state theory arose from Jack & Helen Watkins’ hypnotherapeutic work and tends to be put into practice in the hypnotic situation, as this situation allows individual ego states to be manifest in consciousness and behavior.

It is well-known in psychodynamic circles that an individual can use very different patterns of defense from one situation to the next, and that these patterns of defense tend to correspond to transferences from previous situations. It is a common experience to feel and act atypically in certain situations or around certain people, even to the point of feeling that one is ‘not oneself.’ Ego state theory would say that these experiences represent instances of emotional stimuli imbuing a previously unconscious ego state with the libidinal energy necessary to gain control of consciousness. In a poorly-integrated individual, the shift from one ego state to the next may be so rigid that we would diagnose a dissociative identity disorder. In the average, fairly well-integrated person, however, the changeover is far less dramatic, and ego states will tend to have access to large portions of one another’s experience.

Where does this leave us in terms of understanding what is taking place during hypnosis, with regard to the ego? If we accept the premise of ego state theory—and there is some good empirical reason to do so—then we might consider ego states to be representative of constellations of internal and external demands which have been balanced in the past. This is, essentially, transference, with the added twist that there is a differentiated personage—with attendant differences in cognitive and personality functioning—inside the “individual.” The transference then becomes not the act of transferring feelings from one situation to another, but of transferring libidinal energy to the actor who has previously played a similar part.

If this is the case, then the ego processes we have previously described gain a unique quality. The ego is still responsible for negotiating between id and superego, and in doing so it would have to create appropriate connections between the cognitive and emotive apparatuses necessary to complete the negotiation and thereby succeed in coping with the situation. If this pattern were to be imprinted in some lasting way, it could be reused, providing a rather economical solution for the ego to manage the infinite complexity of incoming and outgoing need-states. Neurologically, lasting imprints are created in two ways: through long-term potentiation by repeated use; and through short-term potentiation by highly charged, traumatic material. If the solutions reached by the ego are in fact crystalized in this way, it would help to explain the mechanism whereby trauma tends to result in dissociation and, occasionally, in dissociative identity disorder. Long-term potentiation of an adaptive cognitive-emotive pattern would tend to result in an ego state more fully integrated into the overall pattern of functioning, whereas traumatic potentiation would tend to result in a hasty and highly differentiated one. It would contain the memories and feelings of the traumatic event or events, but have little access to other ego states—and vice versa.

So what of the hypnotic situation, in which the ego has presumably become the consciousness, and otherwise inaccessible ego states can be rendered? Our previous hypothesis is actually strengthened: the mediating function appears to be isolated from the influence of the needs which it mediates during hypnosis. It becomes capable of both accessing and influencing the contents of any of its ego states independent of situational data, and therefore has the time and energy to reassess and rearrange any part of its defensive structure.

Adlerian Career Assessment & Counseling

The Individual Psychology of Alfred Adler and his successors has always purported to have implications for career choice and satisfaction. The techniques of Adlerian lifestyle analysis, such as the assessment of psychological birth order and the interpretation of early recollections, provides a great deal of information about an individual’s motivations, preferences, and general orientation towards self, other, and the world at large. In this paper we will examine the ways that this information can be used to develop an expedient and comprehensive view of our clients’ career paths and to assist them in making choices that will satisfy their conscious needs as well as their unconscious private logic.

Overview of Adlerian Theory

The basic premise of Individual Psychology is that all individuals strive to transform their perceived inferiorities into perceived superiorities. The specific types of inferiority that an individual perceives originate in his or her relationship to the early environment. Elements of this environment include what is called the family constellation, or the arrangement of parents, siblings, and other family members in relation to the individual. For example, the order in which a child is born into his or her family will tend to exert a strong influence on the types of opportunities and expectations that he or she experiences while growing up, and so will influence the development of the individual’s personality and style of living across the lifespan (Watkins, 1993).

Another major premise of Adlerian assessment and counseling is that behaviors of all kinds, including emotional and cognitive behaviors, are teleological. In fact, Individual Psychology holds that the purposive nature of each behavior can be fit within the framework of an individual’s overarching final goal, of which he or she is unlikely to have any conscious knowledge. The pattern of behaviors which build up in support of this final goal, in turn, constitute the individual’s style of life (Watkins, 1993).

Finally, Individual Psychology holds that the individual is inseparable from his or her social environment. Because the individual’s perceptions and purposes are seen to emerge from the social situation in which the individual is positioned, all of the actual and perceived problems of life are seen as social problems, The well-adjusted individual, therefore, experiences a strong sense of connection with his or her social environment. Adlerians refer to this sense of connectedness as the community feeling or the sense of social interest (Watkins, 1993).

Overview of Adlerian Assessment & Counseling

 

Adlerian assessment is fundamentally an assessment of the individual’s manner of relating to the world around him or her. One way in which this relationship can be understood is through an examination of the early social environment in which the individual’s style of life originated and developed. Because the individual is seen as an active force in his or her world from the very beginning, the lifestyle assessment focuses on the ways in which the young individual began to make a place for himself or herself within the family unit.

A major component of this adaptive process can be surmised from the individual’s ordinal and psychological birth order. A first-born child, for example, is often cherished and expected to fulfill the wishes of his or her parents, and so is likely to tend toward conventionality and conscientiousness. The second-born enters the environment several years behind his or her older competitor and is therefore unable to match the elder sibling’s skill in fulfilling the parents’ wishes. This child will therefore often learn to demand attention and recognition through originality and rebellion, and by developing skill in areas where the elder sibling has not excelled. A key point in the consideration of birth order is that it is the child’s experience of his position within the family that is important, rather than the actual order in which the child was born. A second-born who is five or six years older than the elder sibling may feel and behave as though he or she were a second-born, an only child, an eldest child, a middle child, or any combination of the four, depending on the interactional dynamics of the family as a whole (Leong, Hartung, Goh, & Gaylor, 2001).

A key projective technique of Adlerian assessment is the interpretation of early recollections. Because the individual is seen as an active participant in the creation of his or her environment, the memory itself is seen not as a passive storage of past events but rather as an active recreation which serves to reinforce the individual’s private goals. Therefore, by scrutinizing an individual’s recollections of early life, the clinician can get a sense for the private logic that emerged from the early situation and the ways in which it may be maintained in the present day.

From these techniques the individual’s style of living can be deduced. This lifestyle consists of the individual’s attitudes toward him or herself, toward others, and toward the world at large. It is through the exploration and evaluation of these attitudes that Adlerian counseling and psychotherapy aim to assist the client in cultivating an increased sense of interconnectedness with his or her social environment. It is precisely this social interest which is, in Individual Psychology, seen as the essence of health and adaptation.

Implications of Lifestyle for Career Assessment

An individual’s choice of career can be seen as an extension and expression of his or her total style of life. As Watkins (1993) explains:

It is saying, “This is who I am,” “This is how I see myself vis-a-vis others,” “This is how I see myself vis-a-vis the world at large.” For example, the person whose life-style is oriented around helping and assisting others might gravitate toward such jobs as counseling, nursing, or some other helping profession. The person whose life-style is oriented around knowing (to know, find out) might gravitate toward such jobs as science or academics. Further still, the person whose life-style is oriented around getting and acquiring (to have and to hold) might gravitate toward jobs that emphasize collecting, buying, and investing (p. 357).

There is some limited research to support these notions and to connect them with other, better-studied models of career conceptualization. A 1978 study compared the predictive power of Holland’s Self-Directed Search (SDS) against Mosak’s lifestyle typology. This study found that life style type was “essentially as effective as SDS in such predictions.” A study published in 1980 also supported a relationship between vocational orientation and lifestyle type. This study compared Thorne’s Life Style Analysis measure against Holland’s Vocational Preference Inventory and found a number of significant correlations between indices on the two measures. In particular, the authors of that study noted strong correlations between Holland’s Enterprising scale and the Aggressive-Domineering and Domineering-Authoritarian lifestyle configurations. Mosak’s Conforming lifestyle type also correlated positively with Holland’s Conventional scale and negatively with his Artistic scale (Watkins, 1984).

As self-selected representations of the life-style, early recollections can therefore be used as an expedient tool for collecting information about individuals’ vocational motivations as well as their individual vocational needs. A series of early recollections provides the skilled Adlerian counselor with a wealth of information about the client’s way of learning, of motivating him or herself, of approaching work as a basic task of life, and of relating to others in both collegial and authoritative capacities.

Lifestyle and Career Counseling

According to Watkins (1984), “the more consistent the person’s life style is with the realities and demands of an occupation, the greater the likelihood that the person will be satisfied in the occupation.” He further explains that the compatibility of an individual’s own lifestyle with those of his or her coworkers will be a great importance, due to its effect on the individual’s ability to find a place for him or herself within the interpersonal dynamics of the workplace. These ideas are not at all dissimilar from other theories of career congruence, such as Super’s “life-span, life space” model (Anderson, 1995).

One Adlerian approach to career counseling, called the “Career Goals Counseling” process and developed by McKelvie & Friedland (1978, as cited in Watkins, 1993) focuses on assessing and modifying clients’ personal goals, assessing and intervening with the obstacles that impede those goals, and assessing or modifying the strategies that clients are using to meet their goals. When we speak of personal goals in this context, it should be noted that we are speaking not only of situational or intermediate goals, but also of Adlerian final goals, or the basic strivings which characterize the client’s lifestyle. Such goals might be along the lines of “being good” or “being superior” (Newlon & Mansager, 1986, as cited in Watkins, 1993).

Likewise, the obstacles that an individual faces may not only be objective in nature, such as discrimination, lack of education, lack of information, and so on. Individuals also carry with them their own set of personal, internalized limitations that impede their ability to select and succeed in career that they will ultimately find fulfilling. These include “irrational ‘shoulds,’ ‘oughts,’ and ‘musts’ that we maintain” (Watkins, 1993).

Strategies, then, are the patterns of behavior that individuals engage in in order to advance their goals. These strategies are reflective of the unique manner in which an individual attempts to implement his or her lifestyle. While two workers might share the goal of “advancing,” one might seek to do so through consistent and conscientious work while another seeks to accomplish the same goal by finding fault with and criticizing co-workers (Watkins, 1993).

In order to discover a client’s unique system of goals, obstacles, and strategies, the McKelvie-Friedland approach calls for a complete lifestyle assessment interview. This procedure is a standard practice in all types of Adlerian counseling and psychotherapy, and it involves taking a detailed psychosocial history, including information about the client’s family constellation and a set of early recollections. In this model of career counseling, the counselor concentrates on helping the client to gain insight into vocationally-relevant psychosocial dynamics in his or her own life. For example, the client might be led to consider the career ramifications of his or her life goal, and to consider more effective choices given his or her current life situation and direction (Watkins, 1993).

The main shortcoming of the McKelvie-Friedland approach, according to Watkins (1993), is that it is essentially a direct translation of the standard Adlerian counseling approach into the area of career counseling. As noted, it involves a complete lifestyle assessment interview, which is often quite lengthy and may include elements which, Watkins argues, the average career counseling client will have trouble relating to because of its abstract, “experience-distant” orientation.

Watkins finds a more creative reinterpretation of Adlerian clinical technique in the work of Savickas, who states “…much of the data gathered with the Life Style Inventory [or interview pertains to career-adjustment counseling, that is, helping clients cope with problems at work. Although enlightening, data about family constellation and early recollections are not needed for career-choice counseling” (1989, as cited in Watkin, 1993). Savickas refers, then, to a “career-style counseling” method that fits within the framework of Individual Psychology.

Savickas’ career-style counseling utilizes an abbreviated “career-style assessment” designed to gather lifestyle information that is directly applicable to vocational choice in an experience-near fashion. In this assessment process, clients are first asked to describe their role models in order that the counselor can begin to understand their values and potential ambitions. Next, clients are asked about their favorite books and magazines, thereby gathering further information about role models and valued characteristics as well as preferred environments and types of interactions.

Clients are next asked leisure activities they enjoy; this line of inquiry provides insight into the clients’ interests, ways of self-expression, and coping strategies. Questions about clients’ preferred school subjects next provides the counselor with information about “work habits, work attitudes, and preferred work environments” (Watkins, 1993). Savickas’ model directs counselors to next inquire about clients’ favorite mottoes or sayings. Personal mottoes are likely to directly reflect pertinent lifestyle information and so provide insight into the client’s basic heuristics for evaluating situations.

The next step in the career-style assessment is to ask clients to share their “occupational daydreams” as well as the ambitions that their parents had for them. These questions will provide insight into the internalized meanings that occupational roles hold for clients. Finally, clients are asked about an important decision that they made, and the process whereby they came to make the choice that they made. This final line of questioning allows the counselor to understand what steps will need to be taken to assist the client in reaching a decision.

Conclusion

While the ideas and methods of Individual Psychology certainly seem to have a lot to offer to the career counselor, there are two major problems with each of the Adlerian approaches that we have examined: lack of empirical support, and lack of a clear model for intervention. Although there is some very limited research indicated significant correlations between Adlerian constructs and more widely accepted career development and assessment models, this research derives from only a handful of relatively small studies which have been spread out over significant periods of time.

Likewise, Adlerian career counseling has not yet found a clear model for intervening in the career development of clients. The available literature speaks to the value of Adlerian projective techniques such as lifestyle analysis and early recollections, but makes no mention of specifically Adlerian methods for making use of this information. This lack may reflect Individual Psychology’s psychoanalytic roots, pointing to an underlying assumption that insight into the causes and dynamics of psychological and practical difficulties will ultimately provide the client with more and better behavioral choices. However, this assumption is far from explicit in the available literature and would be surprising given Adlerian counselors’ reliance on concrete tactics and strategies in psychotherapy sessions (Mosak & Maniacci, 2006).

Therefore it is more likely that Adlerian career counseling methodologies are simply under-researched and poorly developed at this time. This is not to say that standard techniques of Adlerian counseling and psychotherapy could not be effectively adapted to the career counseling situation, but simply that doing so would require experimentation on the part of the practitioner. Individual Psychology has been enjoying a minor resurgence in the United States over the last five or ten years, and so the problem of Adlerian career counseling may be one that will yet be adequately addressed.

References

  1. Anderson, K.J. (1995). The use of a structured career development group to increase career identity: An exploratory study. Journal of Career Development, 21(4), 279-291.
  2. Leong, F.T.L., Hartung, P.J., Goh, D., & Gaylor, M. (2001). Appraising birth order in career assessment: Linkages to Holland’s and Super’s models. Journal of Career Assessment, 9(1), 25-39.
  3. Mosak, H.H., & Maniacci, M.P. (2006) Tactics in counseling and psychotherapy. Mason, OH: Thomson Brooks/Cole.
  4. Watkins, C.E., Jr. (1993). Psychodynamic career assessment: An Adlerian perspective. Journal of Career Assessment, 1(4), 355-374.
  5. Watkins, C.E., Jr. (1984). The Individual Psychology of Alfred Adler: Toward an Adlerian vocational theory. Journal of Vocational Behavior, 24, 28-47.

Medication vs. CBT for Generalized Anxiety Disorder

Citing a relative scarcity of research on the efficacy of CBT for GAD as compared to pharmacotherapy, Kristin Mitte conducted a meta-analysis of 65 controlled studies using a random-effects model to produce results that could be generalized beyond the selected studies. A “trim-and-fill analysis” was also conducted to correct for publication bias, several additional sensitivity analyses were performed to ensure the robustness of the selected studies, and methodological differences were controlled for. Studies utilizing new techniques in CBT such as mindfulness practices and interpersonal interventions were excluded due to insufficient research.

The analysis found CBT to be a highly effective treatment for GAD, “reducing not only the main symptoms of anxiety but also the associated depressive symptoms and subsequently improving quality of life.” Mitte determined that CBT was at least as effective as benzodiazapenes, and approximately as effective as SSRIs and azapirones (such as buspirone) while being far better tolerated than any of these three pharmacological treatments. It is concluded that, although methodological variations make it impossible to determine which of the  GAD treatments considered is the best, CBT is a valuable alternative to pharmacotherapy for treating GAD.

Citation:  Mitte, K. (2005). Meta-analysis of cognitive-behavioral treatments for generalized anxiety disorder : A comparison with pharmacotherapy. Psychological Bulletin, 131(5), 785-795.

Best Practices for Treatment of Anxiety Disorders

The Canadian Psychiatric Association (CPA) cites a number of meta-analyses which it recognizes as having “clearly demonstrated” the efficacy of cognitive-behavioral therapy (CBT) in alleviating anxiety symptoms. According to these Guidelines, the effectiveness of CBT in the treatment of anxiety symptoms in general is on par with that of antidepressant drug treatment. This appears to be the case in both individual and group therapy settings. For Generalized Anxiety Disorder (GAD) specifically, CBT is more effective than either placebo psychological treatment or no treatment at all.

Some of the common problems that have been identified in GAD sufferers, according to the CPA, include intolerance of uncertainty, inadequate approaches to problem-solving, and the belief that worry is an effective way to deal with problems. In response to these cognitive deficits, therapists commonly utilize psychoeducational tactics, cognitive interventions such as reappraisal of unrealistic beliefs, exposure experiences geared towards the development of tolerance for anxiety-provoking situations, emotion-regulation approaches, problem-solving skills development, and preparation for inevitable periods of increased anxiety. The CPA found that a greater number of these components being used in therapy was predictive of a better treatment outcome, while comparisons between individual components showed little difference. They also found that the addition of treatment components focused on increasing the client’s overall sense of psychological well-being is associated with better outcomes.

There is no current evidence to support routine combination of CBT with drug therapy, according to the CPA.

Citation: Canadian Psychiatric Association (2006). Clinical practice guidelines: Management of anxiety disorders. Canadian Journal of Psychiatry, 51(Suppl 2), 51S-55S.

Components of CBT For Anxiety Disorders

Borkovec, Newman, Pincus, and Lytle here cite prior reviews of outcome research as having well established CBT as an effective treatment for GAD with low drop-out rates and treatment gains that “routinely maintained or increased at long-term follow-up.” Regardless of this, CBT still fails to produce highly functional states in a large percentage of clients.

This five-year study was designed to explore potential avenues for increasing the efficacy of CBT by extending its duration, measuring the efficacy of two components—cognitive therapy (CT) and applied relaxation and self-control desensitization (SCD)—of the CBT therapy being used, and by measuring interpersonal factors contributing to the success of failure of the treatment.

Although previous research has demonstrated that CBT is more effective than its individual parts over a short duration, these researchers found that each of the components they studied became as effective as the full CBT over the course of a 16-week treatment. Furthermore, they found no improvement in the treatment outcomes of the group receiving both therapeutic components, indicating that an extended duration is unlikely to improve outcomes.

The study found a strong association between some interpersonal behaviors—such as being domineering, vindictive, or nonassertive—and retention of symptoms at followup. The researchers conclude that complementary interpersonal therapy may improve the efficacy of CBT, and cite some existing research which corroborates this theory.

Citation: Borkovec, T. D., Newman, M. G., Pincus, A. L., & Lytle, R. (2002). A component analysis of cognitive-behavioral therapy for generalized anxiety disorder and the role of interpersonal problems. Journal of Consulting and Clinical Psychology, 70(2), 288-298.