Symptom Contextualization - SWEET INSTITUTE - Continuing Education for Mental Health Professionals

Why Are You Overweight?

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Tue, 01 Jun 2021 02:58:59 +0000

We know. You’re likely thinking: I’ve always been like that It runs in my family It’s in my genes I don’t eat well enough I don’t exercise enough I have no time for a healthy lifestyle Because of stress I eat too much sugar I eat too much junk food Because of my thyroid Because of my diabetes Because of my medications Because of my diagnosis Because I don’t know what to do anymore Because everything that doctors have told me to do has failed Because while I know what to do, I cannot get myself to do it [1] What if we told you that all these are merely correlations and not the reason you are overweight? What would you tell us? Yes, we can hear you right now, saying: That’s what my doctor told me That’s what I read That’s what the literature shows That’s what is commonly known That’s what known by everyone And again, what if we told you that all these are associated factors or correlations? What if we could gently remind you that correlation is not causation[2] despite this is the one biggest mistake we’ve been making in our field of healthcare, all along? By now, you may be more open to listening. You may be willing to hear the Real reason why anyone, any of our patients, any one of us, is overweight. But before we tell you, let us introduce you to or remind you of the Truth about Health: Your default mode is health. You were born in a natural flow of natural health. And even if you were one of the very low percentage of children who were born with a birth defect, this birth defect, which is a constellation of signs and symptoms, was simply part of your body’s intrinsic mechanism to restore your natural flow of natural health [3] Every single sign and symptom that you experience, including accumulation of fat in the body, which is what being overweight means, is simply part of a feedback mechanism that our intrinsic system is using to return to its natural state of health This feedback mechanism is for you to know; for you to be aware of; for you to be acquainted with, what is going inside you, in your inner world, in your internal state This feedback mechanism is not there to punish you, or make you suffer, or inflict pain – physical or psychological. This feedback mechanism has nothing to do with any of those. Of course, we have been interpreting them as such; however, it does not and will not change the intrinsic and intact nature of the system Overweight is one of these physical signs that are part of a feedback mechanism, that your body uses in its process of health restoration These signs are ways that your body is asking you to stop interfering with the natural flow of your natural state of health If you are overweight, how are you interfering? If you are overweight, it means you are oversensitive, fearful, and therefore find yourself in need to protect yourself. If you are overweight, it may mean you are fearful, and you may be using your fear to hide a series of underlying feelings. Here are three of such feelings your fear may be hiding that are all associated with being overweight: Anger Resistance to forgive Feeling of inadequacy Have you been overweight, have tried everything and anything, or have made progress, and always ended up sliding back? Or perhaps, do you know what you need to do but have not been able to do them? Then know this: Anger, resentment, or fear, interfere with integration of your organism’s intrinsic system; it therefore interferes with your state of health. Being overweight is part of the feedback mechanism from your body Having tried everything to no avail; or knowing what to do and not being able to, can help recognize that you are not overweight for the reasons you think you are. What to do: Address any form of anger and resentment Forgive yourself and others Take action towards self-love Take the above three steps, and see how your overweight, which is only a sign, starts dissipating. All you ask you is to please share your success story with us, and promise to help others who are also overweight. We send you love,Karen and Mardoche [1] Gunnars, Kris. “10 Leading Causes of Weight Gain and Obesity.” Healthline, Healthline Media, 4 May 2018, www.healthline.com/nutrition/10-causes-of-weight-gain#TOC_TITLE_HDR_3. [2] Geer Jr, Daniel E. “Correlation is not causation.” IEEE Security & Privacy 9.2 (2011): 93-94. [3] Tcim. “Is the Body Designed to Heal Itself?” TCIM, TCIM, 7 Aug. 2019, www.tcimedicine.com/post/is-the-body-designed-to-heal-itself.

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Trauma: Are We Being Attacked?

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Wed, 07 Apr 2021 14:00:00 +0000

Do you feel like you are being attacked when you see someone who looks like the person from the past who you reacted to as being dangerous, threatening, or deadly? Do you feel attacked when you are in a situation that reminds you of such a thing? Do you feel attacked when you hear a certain sound, or a certain word, or a certain color? [1] By now it may be obvious to you that the certain sound, color, or place is totally neutral; it has nothing whatsoever to do with how you are reacting to it, with what you are identifying it with, or with what meaning you are assigning to it. By now, it may be obvious to you that that thing that triggers you, that puts you on an alert, and that makes you ready to run away, or fight, or freeze [2], has nothing whatsoever to do with any of these reactions of yours. If you perceive the glass as half empty, the above may be really “bad” news for you. Yet, if you perceive the glass as half full, the above can be one of the most empowering insights you can be reminded of. But, whether you perceive the glass as half empty or half full has nothing whatsoever to do with glass, it also has nothing to do with how much water the glass has. It has everything to do with how you perceive the glass at any given time. This then helps us realize that when we perceive that we are being attacked, not only are we not being attacked, but our perception of being attacked has nothing to do with the person we think is attacking us, or with the situation, circumstance, time or space. This level of awareness may sound so radical that it may be a hard pill to swallow. Yet, it becomes rather simple once we have reviewed and fully understood the following Truths: Nothing we perceive has any meaning whatsoever. This includes anyone that we may perceive, any gesture that anyone may be making, any sound, any color, any place, situation, or circumstance. Note this is not a belief, rather the Reality about the world. And, if we resolve to truly live in the Truth, the Truth will surely set us free We and only we are assigning and can assign our meaning to anything that we perceive We assign meaning through the use of our attitude and belief, which takes place in the form of thought When we feel anything is being done to us, we are actually doing it to ourselves through our thoughts Truth # 4 may sound like we are to blame for anything and everything that happens to us. But if we do that, we will be attacking ourselves, and reinforcing our feeling of being attacked by others. The way it works is that we attack ourselves, unknowingly. Our protective personality helps us deal with that by projecting all these attacks unto the world. These attacks then are perceived as someone in the outside attacking us. And this makes it more tolerable for us, and our protective personality. It is much more bearable to us to know that we are being attacked or persecuted by others, by the outside, or by a specific group, then to come to the conscious understanding we and only are attacking ourselves, and we have been doing it to ourselves all along. This explains why many who have been traumatized are more likely to be retraumatized compared to the general population. This also explains why many of those who have been involved in accidents are more likely to be involved again and again in subsequent accidents compared to the general population. [3] All this takes place because this is an inside-out world. There is no world without us. There is no event without us. And we activate any event through our thought and our thought alone. The next time we feel we are being attacked, instead of turning to the outside stimulus, which is simply bearing witness to our inner world, let us turn inside, to our inner world, where it all started, where it all happens, and let us choose a different thought, and this is how we will be able to put an end to the cycle of flashbacks, hypervigilance, and intrusive thoughts in trauma and trauma reactivity [4]. Are you a clinician who would like to truly help your patients put an end to their cycle of trauma reactivity, if so, please join us on Friday, April 9th for our 6 CEU full-day webinar on trauma. Click here to register and See you then, Karen and Mardoche [1] Bhandari, Smitha. “What Are PTSD Triggers?” WebMD, WebMD, 11 Sept. 2001, www.webmd.com/mental-health/what-are-ptsd-triggers. [2] Nunez, Kirsten. Fight, Flight, or Freeze: How We Respond to Threats. www.healthline.com/health/mental-health/fight-flight-freeze. [3] Robinson, Lawrence. “Emotional and Psychological Trauma.” HelpGuide.org, www.helpguide.org/articles/ptsd-trauma/coping-with-emotional-and-psychological-trauma.htm. [4] Badour, Christal L, and Matthew T Feldner. “Trauma-related reactivity and regulation of emotion: associations with posttraumatic stress symptoms.” Journal of behavior therapy and experimental psychiatry vol. 44,1 (2013): 69-76. doi:10.1016/j.jbtep.2012.07.007

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The FEAR Steps for Fear:

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Mon, 15 Mar 2021 21:00:00 +0000

You have heard so many things about fear. Many of them are contradictory [1]. And, none of the ways we have been taught to deal with fear work. We know. We’ve been there both as human beings clinicians. Like you, we got tired of working with our patients on fear, without any real lasting progress. But, we used our frustration to find out what really works, and we are excited to give you a taste of it. Here are the 4 FEAR Steps to help your patients out of their revolving cycle of FEAR: ForgiveEngageAcceptRecover Fear starts as a thought. It is a thought, just like any other thought. It is neutral until it gets activated. There are many ways we consciously or unconsciously activate that thought. One way for us to stop doing it is to Forgive. How does that work exactly? Etymologically, the word, Forgive means to give, to grant, to allow, to give up, to give in, and to give and receive [2]. When we forgive a thought, we allow it to be. We give it space. We know it’s just a thought, and, therefore, we give up the need to do anything about it. We know that all thoughts are transitory; the only way a thought of fear would linger would be because we focus on it, dislike it, or try to do whatever is possible to make it go away. When we forgive we do not do that, and that’s the first step required to develop a healthy relationship with fear. As we forgive, it becomes clear that there is a difference between observing the fear thought and the thought of fear itself. We realize that there is a distinction, that we are not our thought, that we are not our fear, and this distinction is the most powerful one of all. For this is when we get to choose. We get to choose to ENGAGE. Etymologically, the word, engage means “to involve someone or something else.”[3] And we get to do so using one of the following: Thought Refocusing Cognitive Restructuring [4] Thought Substitution Thought Redirecting Any of the above four methods are ways for us to engage. If you are familiar with these methods, you will recall that you are not engaging the fear thought. Rather, you are either: 1. Choosing a different thought; 2. Working with the cognitive error related to the fear thought; 3. Engage in Thought Substitution Practice; or 4. Shift to Consciousness-Based-Thinking. While which one we choose is dependent upon our level of psychological mindedness; one thing for sure is that the more we use any of the above four methods, the more we will find ourselves developing a healthier relationship with FEAR. This, itself, leads us to the 3rd step of ACCEPT. Etymologically, the word “accept,” means “to take something to oneself, ”to receive without effort.”[5] Accepting fear does not mean “resigning.” Nor does it mean, “hopeless” or “helpless.” It does not mean “being disempowered.” On the contrary, accepting fear means entails: Knowing it is a thought – a neutral one, and only we get to activate it or not Knowing we are not our thought, and we can notice our thought, without having to do anything about it Knowing that the thought of fear is making its transitory way, and there are several ways we can engage Knowing that as we engage, we can just notice the thought of fear in the background, while we go on about our day. And this is ACCEPTANCE. As we have mastered this step of acceptance, we then enter the step known as RECOVER. Etymologically, to recover means “to regain Consciousness,” or “to return to health.”[6] First, we allow the thought of fear (Forgive). Second, we engage away from the fear of thought, without confronting or resisting (Engage). Third, we receive the thought of fear without any effort whatsoever (Accept). And then fourth, we regain Consciousness, or awareness; we become aware that fear started with a thought, that we need not be afraid of our thoughts, and we can do so by forgiving, engaging, accepting, leading us to recover, and recover each time, guaranteed. The best part is that each time we experience fear, we can use it as an opportunity to practice the FEAR steps. Relatedly, each time we practice, we get better and better at these steps. Lastly, as we get better at these steps, we not only become less and less afraid of our thoughts of fear, but also, these thoughts of fear become less and less present, and when they are present, they are just in the background, while we continue to go about our day. Isn’t this a piece of science worth spreading? The SWEET Institute is committed to make the latest in science available to all clinicians so they can help their patients, using what’s been shown to really work. Enough with all these techniques that are rooted in a misunderstanding of the mechanism of symptoms. It is time for clinicians and patients to get the best possible tools to live a fulfilling, authentically happy, and authentically successful life. Do you not want to be part of this vision? We look forward to welcoming you. Until then,Karen and Mardoche [1] Adolphs, Ralph. “The biology of fear.” Current biology : CB vol. 23,2 (2013): R79-93. doi:10.1016/j.cub.2012.11.055 [2] “Forgive (v.).” Index, www.etymonline.com/word/forgive. [3] “Engage (v.).” Index, www.etymonline.com/word/engage. [4] Boyes, Alice. “Cognitive Restructuring.” Psychology Today, Sussex Publishers, 21 Jan. 2013, www.psychologytoday.com/us/blog/in-practice/201301/cognitive-restructuring. [5] “Accept (v.).” Index, www.etymonline.com/word/accept#etymonline_v_109. [6] “Recover (v.).” Index, www.etymonline.com/word/recover.

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Health or Disease?

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Mon, 08 Mar 2021 04:50:51 +0000

The body would cease to be without oxygen. We obtain oxygen through respiration. We are required to do nothing for oxygenation, and it happens without us even noticing. Why would it be that our most vital, essential, and indispensable function takes place automatically, intrinsically, and spontaneously? Have you ever wondered why? When was the last time you’ve wondered why? [1] The body would cease without blood circulation. Blood circulates throughout our body, thanks to the heart. Our heart does so by contracting and relaxing. We are required to do nothing for our heart to contract and relax. Our heart beats even without our noticing, or paying attention. Why would it be that such a vital, essential, and indispensable function takes place automatically, intrinsically, spontaneously? Have you ever wondered why? When was the last time you’ve wondered why? [2] What about digestion. We ingest food. We swallow it. It goes to our stomach through our esophageal tube. From our stomach, it goes to our small intestine, from there to the bloodstream and the large intestine, and from our large intestine, it goes to the blood or to the rectum, where we have excrements stored, ready to be eliminated out of our body. During this whole process, our liver, our pancreas, kidneys are at work, all without our knowing, without our effort, and all automatically. [3] Furthermore, if we pay close attention, we will also realize that our body’s intrinsic system communicates through our senses regarding food intake, fluid intake, rest, urination, and defecation. Our body’s intrinsic system also communicates through our senses regarding movement, stretching, exercising. Is our body a system of health or a system of disease? If our body’s intrinsic system is so on point, accurate, and reliable, why does such a high burden of disease plague the world? Why so much disease, so much illness? And why so many diagnoses? There are over 10,000 diagnoses in medicine, yet there are barely between 200 and 300 symptoms [4]. What is that about? What does that tell us? Might that be an invitation to wonder about how we’ve been doing things? In the first two sections of this series, we cited the Mayo Clinic study, published in the Journal of Evaluation in Clinical Practice, as one example of research studies highlighting the extremely low level of reliability diagnostic rate in healthcare. For every 100 times a patient is evaluated, we are likely to render an incorrect diagnoses at least 88 out of these 100 times. [5] If signs and symptoms are our body’s way of communicating, its way of maintaining homeostasis, or its way or restoring our intrinsic health, might we want to pay closer attention to why we have about 200 and 300 signs and symptoms, while we have 10,000 different diagnoses, conditions, or labels? When we do what we do, and fail to pay attention to process, we can at least pay attention to outcomes or results. And when our results show that we are unsuccessful 88 percent of the time; that we are failing our patients 88 percent of the time, it means we may have forgotten why we got into this field to begin with. Is our body a system of health or a system of disease? If our body’s intrinsic system is so on point, accurate, and reliable, why does such a high burden of disease plague the world? Why so much disease, so much illness? And why so many diagnoses? What would it take for you to explore the above inquiries until our next section? We thank you, and until soon, Karen and Mardoche [1] Toro, Ross. “Diagram of the Human Respiratory System (Infographic).” LiveScience, Purch, 29 Aug. 2013, www.livescience.com/26825-human-body-system-respiration-infographic.html. [2] InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How does the blood circulatory system work? 2010 Mar 12 [Updated 2019 Jan 31]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279250/ [3] “Your Digestive System & How It Works.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 1 Dec. 2017, www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works#:~:text=Each%20part%20of%20your%20digestive,to%20where%20they%20are%20needed. [4] Bernstein, Lenny. “20 Percent of Patients with Serious Conditions Are First Misdiagnosed, Study Says.” The Washington Post, WP Company, 4 Apr. 2017, www.washingtonpost.com/national/health-science/20-percent-of-patients-with-serious-conditions-are-first-misdiagnosed-study-says/2017/04/03/e386982a-189f-11e7-9887-1a5314b56a08_story.html. [5] Van Such M, Lohr R, Beckman T, Naessens JM. Extent of diagnostic agreement among medical referrals. J Eval Clin Pract. 2017 Aug;23(4):870-874. doi: 10.1111/jep.12747. Epub 2017 Apr 4. PMID: 28374457.

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Symptom Contextualization: 3 Additional Reasons Why

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Thu, 26 Jul 2018 07:00:00 +0000

“I used to just equate hearing voices with schizophrenia,” said Clara, a clinician employed at the Hope Center. “Now, I know how naive of me that was. I walked in the room expecting it to be schizophrenia related psychosis, not realizing that it could have been a physical health or another mental health issue. I feel embarrassed and wonder how often I have misdiagnosed clients who have been under my care,” Clara added.

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Symptom Contextualization: 2 Reasons Why

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Tue, 24 Jul 2018 07:00:00 +0000

“I used to just equate hearing voices with schizophrenia,” said Clara, a clinician employed at the Hope Center. “Now, I know how naive of me that was. I walked in the room expecting it to be psychosis related to schizophrenia, not realizing that it could have been a physical or a different mental health issue. I feel embarrassed and wonder how often I have misdiagnosed clients who have been under my care,” Clara added.

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Symptom Contextualization: 2 Reasons Why

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Tue, 24 Jul 2018 07:00:00 +0000

“I used to just equate hearing voices with schizophrenia,” said Clara, a clinician employed at the Hope Center. “Now, I know how naive of me that was. I walked in the room expecting it to be psychosis related to schizophrenia, not realizing that it could have been a physical or a different mental health issue. I feel embarrassed and wonder how often I have misdiagnosed clients who have been under my care,” Clara added.

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Psychosis-Symptom Contextualization: 5 rule outs

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Fri, 20 Jul 2018 10:00:00 +0000

Farah is a 49-year-old female, who complains of difficulty sleeping (insomnia), feeling sad (depressed mood), and has held the belief that her daughter, Mia, was stealing her money and was trying to poison her food (paranoia). Ron, the psychiatrist seeing Farah for the first time, examined her and noticed a lump (nodule) in her neck, some hand tremors, and weight loss. Ron quickly assessed for acute risk, referred Farah to an endocrinologist, who confirmed a diagnosis of hyperthyroidism, treated Farah, and the psychiatric symptoms, including paranoia, subsided.

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