Tag Archives: therapy

Using Google Drive to Track Client Behaviors

9 May

I came across an article at Lifehacker recently that included a downloadable Google Drive form billed as a “Daily Personal Inventory.” The article, titled “Fill Out This One-Minute Form Every Day and Find Out Why Your Life Sucks (Or Doesn’t),” got me thinking about the countless ways Google Drive could be used to track client mood, eating patterns, self-care, or other behaviors related to therapeutic goals. Because spreadsheets on Google Drive can be shared and mutually edited, I could increase accountability by periodically checking client progress and leaving comments in a designated column. Client data could also be graphed for a quick visual assessment of progress, and it could ultimately be used as a rough measure of therapist effectiveness. Google Drive documents could even be shared with psychiatrists or other health professionals involved with a client to increase integration of care.

I’ve been playing around with a simple mood-tracking spreadsheet format, and I may try creating tracking documents for other behaviors. Although confidentiality could be an issue – Google’s confidentiality policy is relatively solid, but not water-tight by any means – clients could be informed of the risks and benefits and given the opportunity to sign a consent form prior to data tracking.

Have any of you ever used Google Drive as a therapeutic aid?

 

Exercise is Depressingly Awesome

20 Dec

I hate exercising for the sake of exercise. I wouldn’t be able to pass my high school’s Presidential Fitness Test today – I mean, I barely passed it back then, and I only passed because our gym teacher let us all cheat at pull-ups – and the idea of “running for fun” is mystifying and unsettling. The only forms of exercise that truly appeal to me involve large, expensive animals that I cannot currently afford (horseback riding, doing stuff with my future giant dog), swimming leisurely, dancing, or actively accomplishing things (i.e., gardening). I also like the playground game Four Square, but it’s really hard to get a group together to play now that I’ve graduated from middle school, and these days everyone wants to do the online kind of Four Squaring anyway.

So when I finally caught up with my backlog of APA Monitors this week, I was pleased to read this month’s Questionnaire section, in which Dr. Howard Friedman was interviewed about his longevity research. As a person who is always searching for justification to avoid the gym, I especially liked the following quote:

“…our studies suggest that it is a society with more conscientious and goal-oriented citizens, well-integrated into their communities, that is likely to be important to health and long life. These changes involve slow, step-by-step alterations that unfold across many years. But so does health. For example, connecting with and helping others is more important than obsessing over a rigorous exercise program.”

Excellent, I thought, chortling to myself. The Presidential Fitness Test can suck it. But a few pages later, I ran into Kirsten Weir’s “The Exercise Effect,” which briefly and convincingly summarizes some recent research supporting the effectiveness of exercise as an intervention for major depression and anxiety disorders. Weir’s article is the latest in a stream of exercise-related literature that has made its way into my hands in the last couple months, and while the notion that exercise can be helpful for depression and anxiety isn’t new, it seems that interest in the focused use of exercise as a behavioral intervention has been on the rise lately. So much for my plans to connect with and help others solely from a sitting position.

This isn’t to say that I neglect discussion of exercise’s benefits when working with clients who are depressed or anxious. It always shows up somewhere in the  “Here-are-some-things-that-we-know-can-be-effective” speech, and sometimes I help clients develop brief behavioral plans to get them moving. But if clients express little interest in exercising, I focus on other interventions and don’t push the issue – because after all, who am I to push someone else to exercise? Yet the research I’ve been exposed to lately suggests that maybe I should be pushing… and not just pushing clients. Weir quotes Dr. Michael Otto, who claims that “failing to exercise when you feel bad is like explicitly not taking an aspirin when your head hurts.” A physician who refuses to use aspirin because it’s “too hard” or “not interesting” would be ridiculed. Should the same level of ridicule be directed at a psychologist who explicitly refuses to exercise?

I’m admittedly biased, but I don’t think Otto’s analogy is a fair comparison. A physical workout is usually a  sweaty, gaspy, time-consuming set of behaviors that requires organizing on the part of the individual and produces effects that aren’t always immediately apparent. (I have never, ever experienced a runner’s high, and there have been times when I have tried to make exercise a serious part of my life.) Taking an aspirin is a three-second endeavor… maybe six seconds, if you have a hard time with the child-proof cap. We’re not talking about similar behavioral investments. There’s also still a lot we don’t know. Should we all be running six miles a day, or will a brisk 20-minute walk a few times a week do the trick? Does it matter if we exercise alone or with others? Weir notes that “researchers don’t yet have a handle on which types of exercise are most effective, how much is necessary, or even whether exercise works best in conjunction with other therapies.”

Despite the questions that remain, the research I’ve been reading lately has encouraged me to make more of an effort to engage my clients in exercise, and to get myself more engaged too. But if my own hate-hate relationship with exercise has taught me anything, it’s that for most of us, exercise must be rewarding in the moment for it to be truly sustainable. If you legitimately enjoy going to the gym or training for 10Ks, then that’s awesome, and I really wish I had a share of your crazy exercise-loving genes. But I don’t think there’s anything wrong with making exercise a secondary component to some other goal, whether that goal is doing something fun with your dog or doing yardwork or getting to the grocery. For me and the clients who despise the gym as much as I do, it may be worthwhile to create behavioral plans that focus on adding exercise to already-enjoyed or necessary activities rather than instituting a “traditional” exercise plan from scratch. Some examples of what I mean:

  • Primary goal: hang out with friends, family, or your partner. Exercise addition: hang out while swimming, walking, window-shopping, dancing or hiking. Or take a movement-based class with friends through a university or community center.
  • Primary goal: have a phone conversation with a family member. Exercise addition: stretch or walk around building during conversation.
  • Primary goal: make a difference in the community. Exercise addition: choose a volunteer activity that requires movement (e.g., cleaning cages at the humane society, participating in fun runs/walks for charity, helping with a Habitat build, etc.)
  • Primary goal: have a romantic evening with your partner. Exercise addition: sex, duh.
  • Primary goal: make apartment/house more attractive. Exercise addition: incorporate active DIY projects, like painting, landscaping, thorough cleaning, etc.
  • Primary goal: cook dinner. Exercise addition: turn on music that makes you want to dance and bust a move while cooking. Ke$ha and LMFAO, though not exactly highbrow, produce some pretty irresistible dance music.
  • Primary goal: play video games. Exercise addition: play games on a console that requires movement (like the Wii or Playstation Move)
  • Primary goal: keep dog from getting bored and chewing up all your stuff. Exercise addition: go on interesting walks or hikes, play frisbee at the dog park, take an agility training class.
  • Primary goal: make extra money during grad school. Exercise addition: babysit an active child or children.

Exercise doesn’t have to involve weights or running shorts to count as exercise, and even small “doses” of exercise seem to produce measurable mental health benefits (see Weir’s article). And if we conceptualize exercise in a simple, essence-based way – as sustained, purposeful movement, separate from the very specific types of movement promoted by Fitness Magazine spreads and Nike commercials  – then maybe I don’t hate exercise at all. It’s the word itself that’s the problem for me, and its connotations of in-the-moment pointlessness and endless striving toward weight- or muscle-based goals that my genes never meant for me to achieve. But dancing while cooking dinner? I can do that. I can like that. And I think some of my clients could too.

Does anyone else have ideas for making exercise a natural addition to primary goals?

Psych Q&A: ADHD vs. Asperger’s, Hormonal Imbalances, Why Living Location Matters, and Bad Therapy

21 Nov

A friend teaching an abnormal psych course at a local community college asked me and a couple of my cohort members to serve as an “expert panel” for her class. I told her I’d be happy to help as long as the word “expert” stayed firmly between a pair of quotation marks. Her students ask great questions. Here are a few of them, with my two cents in response:

“On paper, ADHD and Asperger’s seem very different.  However, can a misdiagnosis happen to these patients?”

Kids with ADHD often miss the social cues their peers are able to catch, which can result in poor understanding of appropriate social behavior. They tend to have a hard time forming age-appropriate friendships, and eye contact is often poor. For these reasons (and possibly because Asperger’s is something of an “in vogue” diagnosis at the moment), we have quite a few parents who come into my departmental clinic for a child Asperger’s eval and leave with an ADHD diagnosis. In structured diagnostic observations, it’s usually not difficult to differentiate between the two. Kids with ADHD are more interested in reciprocal social interaction than kids on the spectrum, are more expressive, gesture normally, use normal intonation, and don’t have a clearly defined special interest. Autism spectrum disorders and ADHD are frequently comorbid, however.

“It seems like lots of disorders involve mood swings.  Are patients ever treated for hormonal imbalances?”

Psychologists who have had  exposure to integrated care models and cross-disciplinary research (and these days, most psychologists have) are very likely to consider the possibility of medical causes, although they can’t administer medical treatments themselves. When conducting intakes with clients in my departmental clinic, I usually ask about personal/family history of both medical and mental health conditions and any current medication or substance use. If a client has no relevant medical problems or family medical history, and did not begin using a new type of hormonal birth control or treatment around the time mood issues began, I usually abandon hope that a simple hormonal issue is implicated, especially if there’s a family history of mood disorders. (To be honest,  I’m always secretly hoping that clients struggling with fatigue or apathy will turn out to have hypothyroidism, because it’s so beautifully easy to treat. Unfortunately, hypothyroidism is much less common than mood disorders, and this rarely happens.)

 “Does where you live matter for developing mental illness?  Like in the city vs. suburbs, or East Coast vs. West Coast?”

That’s a tough question to answer. Cities often provide better access to care than more rural areas, so mental illness may be more quickly diagnosed and treated there. Poverty is more likely to be seen in inner cities or rural areas than suburbs, and since poverty is associated with increased risk of mental illness, you might see better mental health in suburbs if only because the people who live there tend to have a higher socioeconomic status. Supportive social networks serve as a protective factor, so living in isolation might put a person at higher risk for mental health problems than living near or among other people. Seasonal affective disorder (which isn’t a disorder in itself, but a depression modifier) is more common in less sunny states (like Washington state… might explain why no one in the Twilight movies ever seemed that cheerful). If you can find a relatively sunny place to live near people you like, a job with a middle-class salary, and good access to mental health care, your risk for mental health problems will be lower, although you’ll still be stuck with your genes.

“Does therapy ever make a person worse?  How often?  Why?”

Therapy can sometimes make things worse. I have no idea how often this happens, or how you’d track it. Sometimes it comes down to therapist variables – a therapist may behave unethically (it’s rare, but therapists do occasionally take advantage of clients), leading questions or comments might be directed toward a suggestible client, or a client may be so put off by a therapist’s personality, technique, or ignorance to cultural variables that he doesn’t seek psychological services he needs in the future. Sometimes it comes down to errors in treatment: some interventions are helpful for some disorders but contraindicated for others (ex: behavioral activation in the form of intense exercise can produce great results for a person with anxiety or depression, but it’s a bad choice for a client with an eating disorder). Psychology has a long history of unhelpful and dangerous treatments, including but not limited to rebirthing, “boot camp”/”scared straight” interventions for conduct disorder, recovered memory techniques, conversion therapy, and so on. Researchers can do a pretty good job of identifying treatments that don’t work, but it takes a lot of time and money to do this. As a client, you always have the right to ask your psychologist what techniques he/she plans to use and whether there’s research support for them. If a technique isn’t research-supported, it doesn’t necessarily mean it will be harmful, but it has yet to be proven that it works. On the whole, research indicates that therapy is an effective treatment for psychological disorders, and people with mental health conditions will generally benefit from it. You’re more likely to get worse by not going to therapy than you are by going.
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