Dr. K Psychiatry

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

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

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

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

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

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

Recently one of my CBT clients came up with this rational response: "I am allowing an outside source to control my emotions." I had to say I felt chills and tingles in response, and felt proud that my client came up with this. Progress feels good!

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

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

This message is for at least one of you. You know who you are. Your life is not about the lives you didn’t touch; it’s about the lives you did (and do, and will).

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

One of the best things you can do with suffering is to turn it into something that helps someone else. - Dr. K

I had a conversation recently with a client about perfectionism. They were painting again after a long spell of reluctance because of the idea that it is very difficult to get it all just right. We talked about embracing imperfection, since perfection is impossible to achieve anyway. It’s better to do something imperfectly than to wallow and do nothing. Below is a vase I made some years ago. The first photo might leave the impression that it’s surface is perfect, but turnin...g around you can see that I encountered some nails and splits in the wood. What to do? Abandon it? Give up? No, I decided to highlight the imperfections instead of giving up or hiding them. Nobody is perfect and it’s a slippery slope to think you should always try to be perfect, or do things perfectly. Instead, consider doing things mindfully, and appreciate your qualities and talents as they are, and appreciate that variety, imperfection and diversity are things that make life interesting! - Dr. K See more

In CBT I often talk to clients about ways to think rationally when something bad happens. Some of you will know of the example of my snowmobile trailer theft story, where I skipped feeling angry and instead thought about what kind of life the thief or thieves must have had to make them think that trailer theft was the best thing to do. (Then I got Coleen Walsh to paint the Dark Side of the Moon album cover on a new one, making it essentially theft proof!) Anyway, today I was... reading about the philosopher Epictetus, on the Daily Stoic site and found this quote: As Epictetus put it and providing an important Stoic lesson: I keep an iron lamp by the side of my household gods, and, on hearing a noise at the window, I ran down. I found that the lamp had been stolen. I reflected that the man who stole it was moved by no unreasonable motive. What then? Tomorrow, I say, you will find one of earthenware. Indeed, a man loses only that which he already has. I had never seen this before but reflected with pleasure that I was able to adopt the same perspective as a philosopher whose teachings I try to spread because they fit with CBT. I think I’m on the right track.

This is inspirational and amazing. If you think there’s something that most people can do, that you think you can’t, think again.

These are wise words, nothing to do with religion.

I'd like to announce that our practice is now 100% virtual, for safety reasons. All visits are by phone, or computerized audiovisual connections. We routinely use Zoom, FaceTime, Ontario Telemedicine Network (most secure), and Facebook messenger (least preferable) according to your preference. Seeing nobody face-to-face in person ensures that none of us are at risk of transmitting a COVID-19 infection, and also better ensures your privacy, because you don't have to share a w...aiting room. Our contact information is the same. Robin takes calls at: 705-644-2226 during our working hours, and the answering machine takes messages. We are not able to exchange text messages, or emails for appointments, but we can communicate via the secure scheduling link, if you are one of our patients. Our fax number is the same: 1-888-326-9511. Dr. K

Happy Monday to all! Here's a thought to ponder, from "The Daily Stoic"...

I like mindfulness because it helps you to cultivate not judging. Judging in our day to day lives usually leads to unpleasant emotions and who needs more of those? But it occurred to me today that by not judging, I mean not to judge from an emotional mindset. When you are being careful, rational and thoughtful, maybe that's when judging could be ok. I think that's supposed to be how an impartial court judge looks at things. - Dr. K

Finding myself with a couple of minutes to spare between clients, I found the latest "daily stoic" email to be rather enlightening, and very consistent with the ideas about finding different perspectives on the same situation, which I usually cover during CBT. Apparently this idea has been around for centuries... - Dr. K "Seneca was not excited to be exiled to Corsica, a mountainous and rough-hewn island 60 miles off the coast of Italy, in 41 CE. It was over 190 miles from R...ome. It was a rock in the middle of the ocean with a single paved road. It was far from his friends and family. Anyone who reads the consolation he wrote to his mother during his time there can see that the person he was really consoling was himself. Because he was miserable in this godforsaken place. So it catches a student of history off guard to read Napoleon’s descriptions of his bucolic boyhood and beloved homeland of Corsica. This was a place he was willing to fight and die for. This is the place he wanted to see one last time before he was exiledthe place he wept to think he would never see again. That’s sort of how things go, isn’t it? It’s what that expression one man’s trash is another man’s treasure means. But also that one man’s nightmare is another man’s dream. What matters is how we choose to look at things, what matters is the perspective we bring to the situations we face. Seneca could have drank in the beauty that Napoleon did, he could have approached Corsica with more childlike eyesbut instead all he could see was what he lost, all he could do was compare his fate to his life in Rome. In so doing, he deprived himself of what was actually around him and he made his sentence more difficult. The question for you today is in, what way are you doing the same thing to yourself? With where you live? Or the job you have? Or the person you married? Or the punishment you’re enduring?"

Happy Thanksgiving to all. It’s a great day to eat turkey, if you aren’t a vegetarian, and a great day to be thankful if you have anything to eat at all. Many people in the part of the world where I live can barely afford to pay for housing. If you have a secure place to live, you can be thankful for that. If someone loves you, or cares about you, you can be thankful for that. If you have the ability to feel emotions and to think rationally, even if not all the time, you can... be thankful for that. If you are retitred, or have the ability some day to retire, you can be thankful for that. If you have the means to protect yourself from COVID 19, you can be thankful for that. If you are sad because you can’t share thanksgiving with others, because you have to be socially distant, you can be thankful that you and others are doing your part to flatten the curve. I recently pointed out to a patient who is beginning work as a contact tracer, that they can be thankful because they have a chance to make a profound difference in the ability to prevent the spread of COVID 19. Wow. Even during the pandemic we can find reasons to be thankful. What are you grateful for in your life? Name something that’s not the first thing that comes to mind...something perhaps not obvious! - Dr. K.

When you’re down in the dumps, the sunrise can be a promise that every day can be a new start, and that something beautiful and profound can be discovered in every moment.

Mental illness awareness week. I should have something profound to say, but for the present, "hang in" is the best I can come up with. In other words, apply the "rule of tens" (google it if you don't know it already!) These are turbulent times. More than ever in our lives, things are very unpredictable and stress levels are high for many reasons. These things predispose to mental decompensation. What heartens me is that many more people, at least among my own patients, ar...e showing stronger levels of resilience than I might have expected, given current circumstances. So keep on doing things that improve your resilience. You know what they are. If you have trouble figuring those things out, lean on exercise and mindfulness. Don't forget that talking is ok. Lots of people can understand what you're going through, because they have been through it too. Avoid toxic people. Don't expect them to change. They are the way they are for valid reasons, that have nothing to do with you and you'll never know the whole story. Keep this in mind, and continue to try your best not to judge when possible. Have a great day everyone. - Dr. K

Recently I've been discussing expectations of others, and of society, and justice, with some patients. I'm trying to figure out what's reasonable to expect. If I do good for you, does that mean you always must do good for me? What about "pay it forward"? How does that fit? What about "an eye for an eye"? That's ancient justice, but not part of current practices in most civilized countries. Yet, sometimes even when justice is doled out, it seems insufficient. Is it realist...ic to take a life for a life? What's the right price to pay when the ability to have a trusting relationship has been robbed? It seems that an eye for an eye is impractical, and it also does't necessarily lead to rehabilitation. I don't know what the answer is. All I can say is if you've been wronged, I think that someone else somewhere else may have been the recipient of a good deed, and maybe if you look at the biggest possible picture, things more or less even out. But not necessarily during the life of one individual, will things exactly even out. I don't know... Thoughts? See more

Borrowing from my friend Tamas Treuer, this visual guide may matter to many of you who are struggling to lose your COVID 19 pounds. Personally, I confess I’m heavier than I’ve ever been. But I’m not beating myself up about that. Everybody wants to improve in some way and nobody is perfect, not should they be. Anyway, given that an ounce of prevention is worth a pound of cure, it’s likely easier to lose the weight by not eating as much, versus exercising it off. That said, regular moderate exercise is good for you too.

Recently a patient reported success with a method I suggested for getting rid of PTSD-Related or OCD-Related intrusive obsessive thoughts, memories or images: Replace them with a totally ludicrous image, like a cartoon character doing something funny or foolish. My patient said it was both amusing and provided relief. I'd be curious to know if it works for others. If it was me, I'd imagine an anvil. (happy memories of the roadrunner and Wile Coyote... )- Dr. K

Even in the toughest of times, even in cold weather, the yellow hibiscus blooms. It is six degrees Celsius outside this morning.

Here's some pretty good advice from the daily stoic, based on ancient wisdom. We all deal with people like this from time to time. Followers of CBT will note the unfortunate use of labelling within the blurb, but the message is good if we can look past that. The bottom line is that there is no point worrying about things (or people) that we can't change. - Dr K "It’d be wonderful if everyone could agree on some very basic things. Like, you can’t use racial slurs. And no, you ...shouldn’t judge a person for their gender or their sexual orientation. It’d be wonderful if nobody littered, if people didn’t blast music at 2 AM, if we observed some standard rules of civility for behavior in public. It’d be wonderful if everyone wore a mask and socially distanced as much as possible until we kicked the ass of this pandemic that is killing hundreds of thousands of people worldwide. Obviously we’re not there. Not everyone can agree on these things, apparently. The line from Cool Hand Luke stands eternal: Some men you just can’t reach. It doesn’t matter how eloquent you are, how many times you explain it, how right you are, nothing will change the truth of that sentiment. As Marcus Aurelius writes, you can talk until you’re blue in the face, but they’ll just keep on doing whatever they want. Because a world without selfish or ignorant or unreachable people is impossible. What’s worse if you’re not prepared for it is that from time to time, we are going to bump into those people. Can you come to terms with that? Or are you going to let this drive you crazy? Is it going to make you bitter? Or can you be happy reaching the people you can reach, happy standing on the common ground with the selfless folks who are willing to gather with you there? And who knows, maybe eventually, belatedly, the others will come around. Whether they do or don’t, however, is not in your control, as you surely well know by now. So you can’t worry about it." - The Daily Stoic.

Struggling with your own conscience? Ruminating? Repeating rituals? Check out this website. https://iocdf.org/

I heard this song for the first time this morning. In the face of rising covid-19 cases, we'd all like to hear some good news. If you can't find anything else, this song is Good News. Enjoy.

Thank you Cathy for this.

Thanks for this Vicki Karagianis Power.

Two vital points about trust and trauma: Trauma eats trust. - Dr. K Trust and safety go hand in hand. - Client's realization.