Stress Remedy

How to Save Many Billions on Medication

Jay Winner, M.D. — Fri, 21 Aug 2009 04:53:25 +0000

The bad news: with the exception of the biopharmaceuticals, there have not been a lot of real breakthroughs in medicines lately. The good news: with the exception of the biopharmaceuticals, there have not been a lot of real breakthroughs in medicines lately. How can the good and bad news be the exact same news?

Of course, it would be better news if there were a lot of recent advancements with whole new classes of medicines. But as it turns out, most new medicines are what might be called "me too" drugs - that is, similar to drugs already on the market. Where bad news also becomes good news is when it comes to saving money. Over the past several years, I've been impressed that most all of the major classes of medications have generic options. Every week it seems more patents expire and medications become generic and about six months after becoming generic the price drops dramatically. Often a brand name medication costing $150 soon becomes a generic selling for under $10.

Now pharmaceutical companies don't give up profits without a fight. Often, soon before a medication goes generic, they'll try to modify the drug just a tiny bit to have something new to sell. Then the pharmaceutical representatives speak to physicians in an effort to convince them that this very small change is worth ten times the price of a generic product. The companies also advertise in magazines and on television encouraging people to ask their doctors for the brand name medication.

There are certainly times when a brand name medicine has important advantages over similar generic medication. However, many times the advantages are not significant. More often then not, the companies do not do head to head studies showing the superiority of their product (perhaps because they don't want to risk proving that their brand drug is no better than other cheaper generic medication in that class).

In order to encourage patients to ask for generic products, insurance companies typically charge higher copays for brand name medicine. So now pharmaceutical companies have started giving coupon books to offset the higher copays. Nevertheless, the healthcare system typically still pays much more for the brand name medicine.

When it comes to the biopharmaceuticals, the good and bad news is a little different. The good news is that there have been a slew of new biopharmaceuticals over the past decade. The bad news is that virtually none of them have generic equivalents and they are much more expensive than conventional medications (as in thousands of dollars a month). Even when people have insurance, at times it is difficult to afford the copays for these medications. Fortunately, most people do not require biopharmaceuticals.

What can we do to maximize the "good news" and minimize the effect of the "bad news"?

1. Education: Both doctors and patients need education to offset advertisements from pharmaceutical companies. Many times the theoretical advantages of a brand name medication don't translate too much of a real advantage. If patients just believe in what they hear on television commercials, they will be mislead. If physicians just believe what they hear from either pharmaceutical representatives or from talks sponsored by pharmaceutical companies, they will also be mislead. Unbiased research and education are vital.
2. When brand name medications are needed, often there are several alternatives that are equally efficacious. The new health care reform proposals talk about both public and private insurance options. What if the public option and private insurance companies bargained as a unit to get the best drug prices. A pharmaceutical company would cut quite a bargain if its medication was recommended as the first brand to try for a particular disorder. Would this interfere with my autonomy as a physician? Perhaps, but actually less so than what is happening now. Now each insurance company strikes its separate deals leaving physicians trying to keep track of perhaps ten or twenty different formularies. Having more uniformity would actually make our jobs easier (and potentially save billions of dollars).
3. Right now doctors are drowning in paper work. If a certain brand name is indicated, the pharmacies could track the medications already tried so no authorization form would be needed.
4. For biopharmaceuticals the problem may be more difficult to solve. Some of them have several medicines in a class. In those cases, negotiation would be easier. For the more unique products, it seems a larger entity should be able to negotiate a deal similar to those other Western nations have obtained.

There are times when the right medicine to use is a branded product. However, the large influx of new generic medications can help significantly decrease health costs. When making medication choices, unbiased education and research are vitally important. Additionally, if a cooperative of private and public insurance companies bargained with pharmaceutical companies, it could save billions of dollars and decrease physician paperwork and confusion.

Healthcare Reform and Primary Care

Jay Winner, M.D. — Sun, 16 Aug 2009 17:18:27 +0000

As a practicing physician, I have a view from the trenches. The current healthcare system is broken! I've seen people placed in horrible situations: a woman with multiple sclerosis who, despite her insurance, couldn't afford her medicine. The medicine would likely prevent progression of a disease that could put her permanently in a wheel chair. Another woman with rheumatoid arthritis faced a similar problem -- not being able to afford the medicine that could stop the progression of her disabling and painful disease. The stories of people without insurance are even worse! A few days in the hospital can bankrupt a family.

One of the biggest threats to our healthcare system is the quickly worsening primary care physician shortage. In my first blog entry on the subject of health reform, I'd like to discuss this issue. In communities with more primary care, people are far healthier and healthcare is delivered much more economically. Why is this so? There are several reasons. People with a primary doctor will have better health screening. Therefore, breast cancer, cervical cancer, and colon cancer will more likely be caught at treatable stages. Osteoporosis will be more likely treated before the hip or vertebral fracture. High blood pressure, high cholesterol, and diabetes will be treated better and therefore strokes and heart attacks will be prevented. And costly coronary artery bypass operations will not be needed as frequently.

To further explore how primary care can provide good cost effective medicine, consider a typical visit to a family doctor in which a patient discusses his headache, diabetes, depression, and asthma. Cost of this visit might be $70 to $150. Let's compare this to the price of that same person being inconvenienced by having to go to four separate doctors to deal with his problems. The sum of the consultant fees from a neurologist, endocrinologist, psychiatrist, and pulmonologist could easily add up to several thousand dollars. And if one of those problems gets out of control the resultant emergency room visit would likely cost several thousand dollars for one visit. If a hospitalization is needed the cost would quickly go to tens of thousands of dollars or even hundreds of thousands of dollars. All of the sudden, $70 to $150 seems like quite a bargain, doesn't it?

So here's the big problem: we don't have enough primary care doctors and the problem is just getting worse. As baby boomers age, the need for primary care physicians will markedly increase. As health care reform increases the percentage of the population with health insurance, more primary care physicians will be needed. However, if the current trend continues, there won't be more primary care doctors - there will be A LOT less! Doctors are leaving primary care. Even more concerning is that, according to a recent survey, only two percent of medical students plan to go into primary care. (Ideally 30 to 40% of physicians would be in primary care.) Why should medical students chose primary care? There is satisfaction with getting to know people and their families and caring for them. However, when medical students look at primary care, they also look at working harder and doing more paperwork than they would in another specialty. And their reward may be getting a fraction of the pay. Over the course of his career, a primary care physician may get paid 5 to 8 million dollars less than he may have if he chose another specialty (such as radiology, dermatology, ophthalmology, or many others). (The history of this pay discrepancy may be partially the blame of the RUC - a panel which made reimbursement recommendations to Medicare. Interestingly, only 3 of 26 physicians on this panel were primary care physicians and subsequently reimbursements for specialty procedures far outpaced those of primary care visits.) In order to avert a worsening primary care crisis, this pay discrepancy needs to be fixed. The current health care reform bill makes a small (but probably inadequate) step in the right direction.

A critical component of a healthy United States is to have a healthy primary care system. An investment in primary care will pay off many fold in improvement in both the quality and affordability of health care!

Remember to Reduce Stress

Jay Winner, M.D. — Wed, 20 May 2009 04:31:26 +0000

Stress can ruin our days and shorten our lives. It ages us, harms relationships, impairs job performance and affects health. It can worsen almost any medical problem, including heart disease, obesity, headaches, chronic pain, skin conditions, and high blood pressure.
However, the news is not all bad. Remember that there are some simple things we can do to Reduce stress:

1. Do Not Resist: Don't get stressed about being stress! That will only complicate the problem. Instead of resisting the adrenaline, use it. At the minimum, enjoy the extra energy coursing through your veins. Let go of the thoughts about how you should feel different or how life should be different.
2. Relax: Focus on a diaphragmatic breath - feeling that abdomen expand with each in breath. As you breath out relax a muscle group. You can relax a different muscle group with each breath (which could include your shoulders, neck, jaw, face, back and/or arms).
3. Refocus: Place you full attention on your current activity. If you are walking, tune into this step. If you are eating, focus on the aroma, texture and taste of this bite.
4. Repeat: Repeat steps 1 through 3 frequently throughout the day.
5. Regain Perspective: When you think that everything is going wrong, focus on what is right. Would you sell both your arms for a million dollars? Both legs? Both arms? Make a list of all your blessings (including friends, family, health, the ability to learn and think, etc.) and you'll realize that what you have is worth more than all the gold in the world.
6. Reframe: Bummed out about a wait - enjoy the break from your busy day. Someone rude - instead of getting stressed, realize that rude people are usually suffering in one way or another. Something go wrong and you think you're a failure - use it as an opportunity to learn from your mistakes.
7. Relationships: Social support from friends and family can be invaluable.
8. Reconsider: Reconsider some of your choices. Are there ways you can change your work or home environment to reduce stress?

Make these few easy changes in your life and you will reduce your stress and improve your health!

For more information about stress reduction and the book and CD set Take the Stress Out of Your Life: A Medical Doctor's Proven Program to Minimize Stress and Maximize Health see www.stressremedy.com.

How Can Repeating Obsessive Thoughts Decrease Suffering?

Jay Winner, M.D. — Thu, 16 Apr 2009 05:35:22 +0000

In obsessive-compulsive disorder, people are bothered by recurrent troublesome thoughts. For people with panic disorder, certain thoughts can help to precipitate severe anxiety attacks. Pretty much everyone else, to a lesser extent, has occasionally been bothered by repetitive thoughts. Depending on how these thoughts are handled, they may result in feelings of anxiety, sadness, worry, guilt and/or regret. How can an exercise in which one repeats "bothersome thoughts" actually decrease suffering?

My recent article in the March/April 2009 issue of The Therapist describes that the secret lies in how the thoughts are repeated. First for some background: to "decenter" is to take a figurative step back from our thoughts. Instead of a reality of "I'm not good," one learns that he had a thought "I'm not good." In cognitive therapy people are then taught to dispute irrational thoughts (sometimes called "cognitive distortions"). In mindfulness practice thoughts are non-judgmentally noticed and let go. So in both mindfulness practice and cognitive therapy it is key to learn that we do not need to believe all our thoughts. An important component of mindfulness practice is also to not resist our thoughts. Otherwise marked frustration may ensue. If we resist our thoughts, the object of frustration may change from "not being able to do anything right" to having too many thoughts that one can't do anything right. "If only my situation were different, I would be happy" becomes "If only I did not have so many distracting thoughts, I would be happy." Therefore, although decentering is an essential first step of mindfulness, it is only a first step. A second step is not resisting our thoughts.

In the "letting go meditation," one first relaxes by noticing his breath and progressively relaxing his muscle groups. Once relaxed, previously bothersome thoughts can be repeated with the instructions that the participant not believe or resist the thoughts. After each thought, the person again focuses on a relaxing breath and relaxes a muscle group. After doing this exercise, (more explicitly described in the article in The Therapist and demonstrated in the book and CD set Take the Stress Out of Your Life), the participant is almost always more relaxed. Despite repeating one's most bothersome thoughts, he ends up feeling very relaxed.

The letting go meditation shows people that it is not the thoughts themselves that create the anxiety and suffering, but rather the way we deal with the thoughts can contribute to the problem. Through this exercise people get a chance to practice dealing skillfully with very thoughts that they blamed for their suffering!

For more information about the letting go meditation, please check out the first article at this link: "New Ideas About an Ancient Practice: Novel Techniques to Enhance Mindfulness in Psychotherapy" and the book and CD set Take the Stress Out of Your Life.

Palpitations: Anxiety or Heart Disease?

Jay Winner, M.D. — Tue, 06 Jan 2009 06:22:13 +0000

In his thoughtful post, Dr. Steven Hayes discussed (among other things) an episode in which he felt his heart race. Feeling your heart race, or palpitations, is a very frequent symptom of anxiety. On the other hand, certain types of palpitations are a signal of heart disease. How can we tell whether palpitations represent a symptom of anxiety or heart disease? And finally, when one has palpitations from anxiety, what are some very practical steps to address them?

A study in the Archives of Internal Medicine looked at 107 consecutive patients with a heart rhythm problem called "paroxysmal supraventricular tachycardia" or "PSVT." [Lessmeier, et.al., Archives of Intern. Med. 1997; 157:537-543] With PSVT, the heart rate suddenly jumps to a very high rate. In the above study, the diagnosis of PSVT was missed in 55% of the initial medical evaluations. It is important to properly diagnose PSVT, since its treatment is different than the treatment of anxiety disorders.

To be on the safe side, a resting heart rate going much above 100 (or below 50) may warrant a medical evaluation. In general, a resting pulse of 160, like Dr. Hayes had, would make the diagnosis of a heart rhythm problem fairly likely. I have seen circumstances in which someone has an episode of PSVT that so unnerves him that he then has a panic attack. The extra adrenaline from panic attack, in turn, can worsen the PSVT. Therefore, it's not infrequent that a combination of PSVT and panic disorder can occur, and for the best health care, both conditions should be diagnosed and treated.

In addition to a very fast or slow pulse, there are a couple of other signs/symptoms that should signal the need for a cardiac evaluation:

Chest pain or shortness of breath (can happen in panic disorder, but cardiac evaluation should be done as a precaution).
A very irregular heart beat. An occasional missed or extra beat is usually not a big deal. But if you don't have any consistent rhythm, a condition called "atrial fibrillation" is possible.

If palpitations are bothering you a lot, a chat with your doctor is worthwhile. Even if the palpitations are from anxiety, you now have some extra reassurance. If you have been evaluated medically and there is no sign of a cardiac rhythm problem or other medical condition (such as a high thyroid hormone level), what do you do then?

Let's look at the common way in which one might deal with anxiety and palpitations. If you don't like the palpitations and anxiety, it seems quite natural to resist your feelings and push them away. Common approach... yes; effective...no! The more you wish your heart rate would slow done, the faster it goes. In essence, you're getting anxious about being anxious. If you want to make it even worse, you can come up with all the reasons that you could be anxious. Listing and ruminating about all your problems is another way to get that heart pumping even faster.

What's the alternative? Allow your heart to race as fast as it likes. Without judging or resisting your thoughts, simply let go of the thoughts wishing your heart would slow down. If those thoughts come back 100 times, just gently let them go 100 times... no big deal. Instead of resisting the anxiety, enjoy the feeling of the energy coursing through your veins. Place your full attention and focus on a present moment sensation like your breath. Focus on your abdomen expanding with the in breath and contracting with the exhalation. Really taste or luxuriate in the sensation of each full inhalation and each exhalation. Perhaps tune into your body. With each exhalation you can let one of your muscle groups relax. Relax your neck, your jaw, your face, your shoulders, etc. By accepting your current feelings and tuning in to the present in this way, your palpitations will likely pass much more quickly. (And of course, if they are needed, there are a variety of both pharmacological and non-pharmacological treatments for anxiety disorders.)

For more detailed info you can check out Take the Stress Out of Your Life.

Wishing you much peace, health, and happiness!

Fast Forward??

Jay Winner, M.D. — Thu, 01 Jan 2009 00:34:14 +0000

As we approach a new year, it's a good time to reflect on time itself. In the movie Click, the main character gets hold of a remote control that can let him fast forward or skip unpleasant times. In certain situations, we've all had an urge to fast forward past a moment. In fact, for many this is a very frequent desire.

One may want to rush through his work to get home. Then he gets home only to want to rush through helping his child with homework. This desire to fast forward is embodied by a sense of being a little (or a lot) on edge. These are times of unease and irritation.

It is useful to put that desire to fast forward under the microscope. If one takes an honest and careful look he sees that this sense of uneasiness is not just dependent on what you are doing. Rather it has more to do with your state of being. In essence, the desire to try to fast forward our lives creates this feeling of unease. In contrast one can act efficiently and quickly, but with a sense of ease.

Unless you have the magic remote control from the movie Click, you cannot actually fast forward time. This is a good thing, since if we could skip parts of our lives, before we knew it, life would be over. Since we don't have the magic remote control, it leaves us with two choices: unsuccessfully trying to make life move faster, or just enjoying the activity you are doing right now.

Whether you're taking out the trash, or doing paperwork, or whatever else, let go of your desire (and thoughts) to fast forward and enjoy what you're doing at this moment! John Lennon said, "Life is what happens while you're busy making other plans." Try to fast forward and you miss it!

Happy 2009 and beyond!
For more hints on living in the present see this post.

Jay Winner's Blog

Jay Winner's Website

Physical and Psychological Posture

Jay Winner, M.D. — Sat, 15 Nov 2008 00:44:33 +0000

We usually talk of posture in the physical sense. Are there ways to use the concept of posture to enhance our psychological and emotional well-being?

Let's start with the more traditional way of thinking about posture - our physical posture. In both meditation and yoga, practitioners are advised to sit or stand with a relaxed, yet dignified posture. The spine should be straight, but the rest of the body soft and relaxed.

During our day-to-day life, it is helpful to frequently tune into your body, reminding yourself to keep your spine dignified, yet your other muscles relaxed. While you walk around, let the muscles in your face, jaw, and shoulders relax. When you relax your body, you will find that your mind also relaxes.

The posture of a relaxed body with a firm spine can also serve as metaphor to improve our psychological, emotional, and spiritual well-being. Good psychological posture involves meeting each moment with a softness. The present moment can only be as it is; why waste time or effort wishing it different? As discussed in my previous post "The Only Thing to Fear is Fear Itself", the more we wish our emotions were different, the more we get sad about being sad and stressed about being stress. As discussed in "The Challenge of Living in the Present" and "Decenter to Be Centered", resisting our thoughts can make us just as miserable. In fact, obsessively wishing anything be different in the present moment sets us up for suffering. By meeting the present moment with a "softness" and welcoming attitude, we reduce our suffering.

However, being soft without a "spine" might leave us like a slug. As an invertebrate, we may lack the drive to make important changes in our life. Therefore we need a strong spine of compassion, ethics, determination, and wisdom. Just as you keep our spine firm, be firm in your resolve to pursue your goals - firm in your ethics and values. Act compassionately and wisely, and in the vernacular "have a spine." Of course, if your spine is totally inflexible, you will likely be in suffer. As we learn more about ourselves and our world, we also need flexibility in our goals, and values. However, a core of compassion still needs to run through our deeds.

Let's explore the metaphor of posture a little further. How do we become practiced at being soft to the present moment? The obvious answer is by practicing - by practicing in both meditation and in the rest of our life.

How do we strengthen our metaphorical spine? Just as a physical therapist may recommend exercises to strengthen the muscles around your spine, there are a variety of ways you can strengthen your intention to be ethical, compassionate, and wise. Seeking knowledge and education can help. Regularly praying for the well-being of others can also strengthen your metaphorical spine. In the Buddhist loving-kindness meditation, one visualizes a scene that brings forth compassion and then wishes health and happiness to people he deeply cares about. The well wishes gradually expand to include all individuals.

In summary, it is important to regularly tune into your physical posture, letting your most of your muscles soften, as your spine keeps your head high. Concurrently, utilize the metaphor of psychological posture to, with a softness, accept all that arises in the present moment. As you do so, have a backbone of compassion and wisdom.

Dr. Winner's website www.stressremedy.com.

Take the Stress Out of Your Life

Beginner's Mind

Jay Winner, M.D. — Wed, 05 Nov 2008 20:43:16 +0000

Psychology Today initially entitled my blog "Beginner's Mind." What does that title mean? Did Psych Today mean that at that time, I was a beginning blogger for them, so don't expect too much? You know - set a low bar and then I'll look better. That could be one meaning, but there's a better one. I didn't come up with the phrase "Beginner's Mind;" nor did Psych Today. It's an old Zen term made popular by Shunryu Suzuki.

When we experience something for the first time, we enjoy the novelty. See a great movie for the first time and it almost seems worth the nine-dollar movie ticket and the dollar-a-kernel popcorn. See the movie ten times and you'd pay 90 bucks not to have to see it for the eleventh time. Why is that so?

What keeps us from enjoying something as much the tenth time as we did the first? The answer lies in the running commentary in our minds. For instance, most of the time we don't simply taste a hamburger. As you eat your food, you might have thoughts comparing the food to other food ("It's not as good as the hamburger I had last week."), or you might think about something besides the food ("Work's been so busy lately."). There's certainly nothing wrong with thoughts. Without your thoughts, you wouldn't be able to use your computer, do your job, or understand what you are reading. However, the non-stop commentary keeps you from fully enjoying your life. Continuing our example, when people eat, they seldom just experience the taste, texture, and aroma of the food. In summary, you likely spend much more time thinking about food than tasting it. Even if you ate the best cookie in the world, you might only taste the first bite. After that it's: "That was great... I should get more of these cookies... but then again, it will ruin my diet... I wonder how many calories per cookie." Before you know it, the bag is empty and you only really enjoyed the first bite of the first cookie.

When we have a beginner's mind we enjoy the tenth bite of the cookie just as much as the first. We appreciate walking barefoot on a grassy lawn with the exuberance of a young child, enjoying each step.

Another word for "beginner's mind" is "mindfulness." If you've read much psychology lately, you've probably run across the term mindfulness. In a way, it's the ultimate in psychology retro fashion. You know, for a while Freud was so in, then it was Jung, then Gestalt was in style... and now, psychology is going back to a concept thousands of years old! Somehow I think this trend is a keeper.

Mindfulness is non-judgmentally paying attention to your current experience. In addition to the quality of enjoying an experience with the curiosity and interest of a beginner, there is also an affectionate quality of mindfulness. There is the sense of welcoming all emotions, thoughts, and physical sensations. We aren't welcoming them to stay for all eternity, but just for this moment. By doing so, we don't get depressed about being depressed or stressed about being stressed.

In addition to beginner's mind, other descriptive terms and metaphors can help us understand mindfulness a little better. Since the experience of mindfulness is hard to put into words, it can be helpful to have other ways of talking about it. See if any of these descriptions speak to you:

· Non-clinging and non-grasping. That is, enjoying life as it comes without always trying to have events be a little (or a lot) different.

· Resting in awareness. As one learns to be mindful he may learn to non-judgmentally focus on various aspects of experience including sound, breath, and physical sensation. Eventually, one can develop the skill of focusing on and resting awareness itself. When doing so, even in the midst of chaos, there can be a sense of ease.

· Metaphors. Some have used the metaphor of a body of water such as a lake. Typically people experience life as if they were on the surface of a lake, being buffeted by the winds, waves, and storms of their emotions, physical sensations, and thoughts. When one learns to rest in awareness, there is an identification not just with the commotion on the surface, but also with the depth of the lake which is undisturbed by winds and weather.

· Some people view mindfulness in terms of their experience with God. They might increase their ability to be mindful by thanking God for whatever is in the present moment, and thereby deepen their appreciation of what is in front of them. Others increase mindfulness by seeing God in all things (and people). In this way they increase their sense of awe.

· Love. I'm not talking about obsessive clingy infatuation sometimes described as love. I am talking about the deep feeling of looking into another's eyes with unconditional acceptance.

· Sense of being one with all. Mindfulness has been described as a feeling of no longer being separate from the rest of life.

Just like describing the feeling of balancing on a bicycle, mindfulness can be hard to describe. One or more than one of these descriptions may currently ring true for you. If none of them speak to you, be patient. Each time you let go of the thoughts of how life should be and enjoy it just as it is, you strengthen important connections in your brain. Each time you look at this moment with curiosity and interest you also build those vital brain connections. Ultimately, you can increase mindfulness the same way you get to Carnegie Hall: "Practice, practice, practice..." Practice both in the midst of meditation and also in the midst of life!

More hints about meeting the challenges of living in the present.

By the way, my blog title was later changed to Stress Remedy giving me the opportunity to blog about all aspects of stress reduction. It also reminds people about my website www.stressremedy.com which includes links to find mindfulness retreats, classes, and my book and CD set Take the Stress Out of Your Life.

Decenter to Be Centered

Jay Winner, M.D. — Wed, 29 Oct 2008 14:28:34 +0000

Decentering in order to be centered? Most of us know what it means to be centered. When someone is centered he enjoys the present moment and is comfortable in his own skin. What is decentering?

One of the first prerequisites common to both cognitive therapy and mindfulness practice is learning that we do not have to believe all of our thoughts. This has been described as decentering. In essence, to decenter is to take a figurative step back from our beliefs and thoughts. Instead of a reality of "I can't do anything right," one learns that they had a thought "I can't do anything right."

In cognitive therapy one then disputes irrational thoughts (sometimes called "cognitive distortions"). In mindfulness practice thoughts are non-judgmentally noticed and let go. So in both mindfulness practice and cognitive therapy it is key to learn that we do not need to believe all our thoughts. An important component of mindfulness practice is also to not resist our thoughts. Otherwise marked frustration may ensue. If we resist our thoughts, the object of frustration may change from "not being able to do anything right" to having too many thoughts that one can't do anything right. "If only my situation were different, I would be happy" becomes "If only I did not have so many distracting thoughts, I would be happy."

How can one be taught the skill of mindfully noticing thoughts and decentering? Traditional exercises for cultivating mindfulness include the "concentration meditations" in which one focuses on the breath, body sensations, or sound. When the attention drifts from the object of concentration is patiently and repeatedly returned. Then one learns "mindfulness meditation" in which one non-judgmentally focuses on whatever arises - be it breath, sensation, emotion, thought or sound. Other traditional mindfulness exercises include walking meditation and mindful eating.

For the past 16 years, I have also had success teaching what I call a "letting go meditation." In that meditation, students/clients can practice letting go of thoughts that were previously contributing to distress. The exercise serves several functions:

1. It demonstrates that thoughts in themselves do not cause distress or depression. It is the way in which the thoughts are dealt with that causes the distress. This technique allows people to gain this insight through their own experience.
2. One gains experience and practice in non-judgmentally noticing thoughts. One can include thoughts that have been bothersome. If someone has been getting panic attacks, typical thoughts might be "I might die," or "This is horrible," "I wish my heart would slow down." In that way he gets practice in mindfully noticing the thoughts that are a component of his problem.
3. Not only does one get practice in mindfully dealing with thoughts, as he practices the letting go exercise, the physical reaction to the thoughts can continue to decrease. In a sense, the exercise can act as desensitization to the thoughts. The thoughts that were formally very "charged," become no big deal.

People benefit from using traditional mindfulness exercises for daily practice. The letting go meditation can be used when the situation warrants.

1. Before doing the exercise, it is ideal if one has some background information and, if possible, experience with mindfulness.
2. Then start a relaxation exercise in which you focus on the breath, repeatedly letting go thoughts and returning to the breath. Then you can relax one body part at time.
3. Once someone is relaxed, the next instruction is to repeat certain phrases/thoughts. This technique can be used to teach people without any psychological illness to mindfully deal with thoughts. For patients with certain psychopathology, someone may eventually choose phrases that have been associated with that pathology. For instance, with agoraphobia the thoughts may be something like "I hope I don't have another panic attack. That would be horrible." For panic disorder it might be "Oh no; I hope my heart would slow down." For OCD, the thought might be "I need to count."
4. Before introducing the statements, the participant is specifically instructed not to believe the thoughts or resist the thoughts. It is essential to do this several times during the exercise. We do not want the repetition of the thought to actually strengthen the belief. Instead we want to strengthen the ability to decenter, mindfully notice thoughts, and let them go.
5. The student silently repeats the thought and then lets it go. I usually vary the thoughts throughout the exercise. However, I also have the student repeat certain thoughts more than once. In that way, they learn that a certain thought can be mindfully attended to and let go again and again.
6. After he repeats a thought once and lets it go, he is instructed to pay full and complete attention to a diaphragmatic breath. Suggest he enjoy or even luxuriate in the breath. He can relax a muscle group. With subsequent thoughts the procedure is repeated and a different muscle group can be selected.

Almost universally, people are more relaxed at the end of the letting go exercise. Therefore, they realize that it is not the thoughts themselves that cause the problem, but rather the most important issue is how they deal with thoughts. In a relaxed atmosphere, they have practiced letting go of previously bothersome thoughts and bringing their attention to a present moment sensation (like a diaphragmatic breath and relaxing a muscle group). When the thoughts occur during their day-to-day life, they have already practiced how to effectively deal with them.

(Further discussion of this topic is in Take the Stress Out of Your Life and the letting go excercise is one of the ten exercises on the accompanying CD set.)

Communications Skills and Politics

Jay Winner, M.D. — Mon, 27 Oct 2008 01:41:26 +0000

Do communication guidelines that make sense for our families and work, make sense for international politics? It seems they should -- after all, the leaders of countries are people!

Listen. The first important part of communication is to be a good listener. As former U.S. Secretary of State Dean Rusk said, "One of the best ways to persuade others is with your ears - by listening to them." Once people are convinced that you understand them, they'll be more likely to listen to your points.

Avoid demeaning statements. If your spouse tells you that you are inconsiderate or mean (or something much worse), you will likely get defensive and will be less responsive to your spouse's request. I'm not an expert on international relations, but I would think if you call a country's leader evil, he would likely be defensive and suspicious and thereby also less responsive to a request. Since "rears his head" is a phrase usually reserved for animals and monsters, using it to describe a leader of state could also be considered demeaning. It may also be demeaning to tell someone that he is not important enough to meet with you. Even if you believe a demeaning statement to be true, saying it out loud can be counterproductive to achieving a non-violent solution.

Feedback should be given about a specific behavior, not about traits. If you tell a co-worker that he is clumsy, he'll likely get defensive and really not benefit from your feedback. You will be more successful by giving feedback about a specific behavior. For instance, you might recommend that he hold a particular tool with two hands. It seems to follow that insulting a country's leader will be less successful than saying what specific behaviors you would like changed.

Also give positive feedback. When someone behaves in a way that you like, make sure and give them feedback to increase the likelihood of repeat behavior. A carrot can be at least as effective as a stick.

These hints won't solve all problems, but they may help our family, work, and maybe even political environments. Perhaps, they'll even be helpful when responding to bloggers' posts. ;-)

By being careful with language we all may benefit and positive outcomes are more likely.

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