The Sports Doc Chalk Talk

The Diagnostic & Statistical Manual (DSM), published by the American Psychological Association, is widely accepted as the bible for mental health descriptions and conditions.  The book has been updated several times over the years, and is slated for it’s next update in 2013.  If you have never seen the DSM before (and it’s likely you haven’t), you might be surprised at the depth and breadth of the number of “disorders” presented, and if you look close enough you might even find that you fit the criteria of one of them.  In fact, critics have argued that the DSM has become too liberal with identifying “new” disorders, as well as loosening the criteria needed to “qualify” for a disorder.

Mental Illness

So, what is mental illness, anyway?  Interestingly, there are many different ways to examine mental illness, and to some extent, what one person might see as “mentally ill” the next person might see as “quirky,” “creative,” or just “different.”  In fact, it is from this perspective that some are wondering if the DSM is becoming so loose in its defining mental illnesses that nearly everyone could be diagnosed with something — leaving conspiracy theorists to surmise that once these “disorders” are labeled, pharmaceutical companies end up being the true winners as the manufacturers of the drugs that psychiatrists recommend their patients use to address their problems.

If you were to develop a continuum of people ranging from those who seem relatively healthy and stable on one side, to those with clear mental problems/limitations (i.e. of harm to oneself or others) on the other, it’s actually all the people in the middle who are the ones that seem to be of the greatest interest to mental health professionals.  Who is “normal” versus “abnormal?”  And who needs to be “put on something” versus who might benefit from just a couple lifestyle changes and possibly therapy?  It is here where the debates rage, and where the DSM (and it’s ever-changing criteria) end up having real consequences for real people.

Having taught clinical psychology at the college level, it has always been an entertaining classroom discussion to hear students ponder over what’s normal, abnormal, quirky, odd, and different — as well as what people should be diagnosed with something, and what people should be put on something.  As the DSM evolves and spells out “disorders” for clinicians, decisions are made that in many cases lead to the prescription of one (or many) medications – some that include serious side effect concerns.  The other problems that often occur when a person is diagnosed with a mental illness are the following:

• Patients often overly-value the benefits of their new medication, and as a result place less emphasis on behavioral changes (after all, only the drug can fix their problems, right?)
• Patients often believe they are permanently “branded” with the mental disorder for the rest of their life (and therefore need to continue on using their medications forever).  Of course, in some cases medications may be needed to protect the patient from danger to himself (or others), but in many other cases positive changes occur in the patient’s life, leaving him less needy of the drug (i.e. he is no longer depressed).

The Impact of the DSM, Treatment Decisions, and Future Consequences

Unfortunately, for potential clients in the United States today seeking therapy they will likely need a DSM mental disorder code in order for their insurer to reimburse.  This is unfortunate for a number of reasons, including the fact that a disorder needs to be “found” – which often leads to an even bigger problem of a self-fulfilling prophecy.  For example, the person seeking assistance after going through a tough divorce may come to believe that she is depressed – and depression lasts for a lifetime – and the only way to control the depression is by taking several different pills each day.  Without a DSM diagnosis, the odds of an insurance company helping out a patient who is simply going through a tough time in life is almost zero.  Sadly, once a patient receives her diagnosis, it often only serves as a really bad lifelong tattoo, re-emerging during times like when the individual applies for future life and/or health insurance (she will now be a “high-risk,” and pay a ton more for her coverage).

Getting back to the original discussion, it’s interesting to see what the new DSM will evolve into in 2013.  If, as critics warn, the diagnoses become even more liberal (you should read some of the criteria to see what I am referring to), more people will soon learn they have “something,” and likely will feel the immediate need to remedy and temper their condition by quickly going on some kind of drug(s).  Skeptics wonder if it will be this new disorder discovery, coupled by the new drugs these patients take, that end up causing the real problems — and not the initial concern for the call to the doctor.  Interesting to think about, isn’t it?

Check out our Life Success Audio programs – designed to help with human happiness, health, and life productivity!

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As 2011 comes to an end and the new year approaches, millions of people worldwide are giving thought to what resolutions they would like to achieve in the coming year.  For many, the goals will be fairly common ones, such as losing weight, quitting smoking, or getting back in shape.  For others, the goals may be more unique and include ideas around becoming a better spouse, or earning a promotion at work.  Regardless of what resolutions you set for 2012, the bigger challenge that looms for all goal setters is adhering to the goals (also known as goal compliance).  In other words, developing mental toughness and actually doing what you want to do.

Throughout my life I have always appreciated little tidbits of motivational advice – one that I think about almost on a daily basis is the following:

“Ideas are a dime a dozen, but putting ideas into action is priceless”

It is from this perspective that I have studied others (and myself) as to why the “action” step to reaching the goals stated always seems to be the challenge.  So often we start out with great intentions, but then something happens – and we fall short of reaching our goals.  Over the years I have written extensively about what I have learned, and have even developed various life success programs to help others with their efforts.  Admittedly, answering all the reasons why people sometimes fail to reach their goals in just a few paragraphs here is impossible, but there are a few quick key tips that I think can immediately help those out there who are eager to reach their 2012 new year resolutions:

• Life changes – especially ones you are serious about – don’t need a target date to get started (meaning you don’t need to wait until January 1st).  Change can actually begin in a moments notice - and often does – so if you are really, really serious about your new goals, you are free to get started!
• When hurdles arise (and they will, like when a family member brings home junk food and you are trying to lose weight), the key is to train your mind to view these situations as challenges, not as threats. How you perceive the world around you will determine the actions that you take — roll your sleeves up for the challenge.  It’s also a good idea to think about the challenges that are ahead of you, an effective technique therapists call stress inoculation.
• Be realistic. Research studies have consistently found that when people set goals that are too difficult or unrealistic, they often become demotivated and eventually quit.  Instead, set challenging goals that you really believe you can achieve.
• Pay attention to daily, or micro-goals. Don’t overlook the little things as they will serve as strong building blocks for the months ahead.
• Go after your resolutions with conviction! Get excited and share your enthusiasm with others – not only will they cheer your efforts but also give you support during the tough times.

For more professional tips and advice on changing habits and developing balance and resiliency in life, check out the Advanced Human Performance Systems Life Success Package!

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Life stress can come in the form of negative events (like losing a job), as well as positive events (like planning for the holidays).  Unfortunately, regardless of the source of the stressor (good or bad), our bodies often react and respond by breaking down physically and emotionally — unless we learn how to safely and effectively cope with stress.  Fortunately, help is on the way in the form of our exciting new app, The Life Stress Test!

The Life Stress Test (.99 in the Apple apps store) is a professionally designed test you can complete in just a few minutes, and will provide you with specific results and feedback along a number of potentially stressful dimensions, including time management, assertiveness, organization skills, resiliency, and self confidence.  By learning how to recognize and effectively respond to stress, you will learn how to better plan and navigate your life — resulting in a happier, healthier, and more productive life.

Take control of your life and beat life stress — get started today with the NEW Life Stress Test!

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As a clinician who regularly assists people trying to overcome various mental, emotional, and behavioral problems, I have long been fascinated by the power of the placebo effect.  Honestly, “fascinated” doesn’t even begin to describe how in awe I am by the power of belief — and how powerful belief and suggestion can be when it comes to self-healing and improvement (Changing Habits for Life Success). Hey, who wouldn’t want to relieve stress, improve weight loss motivation, and decrease the likelihood of future mental health issues because of the help of placebos?!

A recent study by Kaptchuk (2010) has revealed an even more amazing discovery, one that offers even more hope when it comes to the efficacy rates when using placebos to help people overcome various pains and problems.  Until recently, most experts agreed that the “magic” of placebos (i.e. sugar pills, irrelevant suggestions, token products, etc.) lied in the deception portrayed by the healer.  In other words, if your doctor suggested that you eat blueberries to help with the headaches you have been experiencing (assuming there has been no empirical evidence blueberries help with headaches), and your headaches immediately disappear after eating blueberries, then it can be assumed that it was the suggestion by the doctor – and not the blueberries – that accounted for the healing.  Of course, most patients will immediately say it was the blueberries that caused the headaches to stop, but in reality this is an example of how the placebo effect deceptively works.

Interestingly, when “experts” tell us how to address our problems we almost always believe them, and often things do in fact get better — but whether the change is due to the intervention or belief about the intervention will always be the question.  Experts can be doctors, but they can also be mechanics, computer technicians, or police officers — so long as someone is viewed as an expert, people tend to stop using critical thinking skills and instead start believing just about anything the expert says if it sounds like it could help.  For example, a mechanic might tell you to constantly run your fan inside your car to prevent carbon build up in your motor — if you know little about cars, would you believe him?    Assuming you never have engine problems in the future, you might really believe that your car has been maintained because of always running the fan — even though this has nothing to do with engine performance.

When it comes to medicine, placebos would really help patients overcome a lot of their problems, but it is also unethical to deceive patients into believing something about a product that has no medicinal value (like a sugar pill).  Of course, this saddens a lot of physicians as they know that:a) more patients would heal faster, andb) there are no side effects with placebos.This has led to quite a conundrum, but Kaptchuk’s recent study may have shed new light on how we can use the placebo while avoiding ethical concerns and still see the same positive effects!

Kaptchuk’s study revealed that when subjects were recommended to use a placebo for their irritable bowel syndrome (IBS) but told that while the placebo pills had no direct medicinal value, the pills could improve IBS symptoms through the “mind-body healing process.”  Amazingly, 59% of the subjects in this condition reported adequate relief, versus only 35% for the control group who did not receive the placebo.Think about that for a moment — the patients knew they were receiving an inactive drug (a sugar pill), but told that the “mind -body healing process” would still kick in, helping patients overcome their IBS symptoms.  Amazingly, even when patients knew they were receiving a placebo, they still showed marked improvement versus subjects not prescribed a placebo!

This new finding is quite incredible as it may remove the deception variable that has always been assumed to be the main agent of change when it comes to the placebo effect.  In the future, it’s possible more doctors, clinicians, and various other helping professionals may turn to placebos, but instead of tricking their patients they might actually tell them they are prescribing placebos!

For more about this research study check out the May 2011 issue of Psychology Today.

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As we begin 2011 with high hopes for a terrific year, many people establish New Year resolutions designed to bring future prosperity and happiness (Changing Habits for Life Success). Better physical health driven by weight loss motivation is one common resolution, easily witnessed by the dramatic increase in numbers at your local gym at the start of each new year. Unfortunately, the goals that were first met with great enthusiasm sometimes get forgotten, leading to the same old patterns and habits.

you have set some new goals for 2011, and want to give yourself the best chance at reaching those goals, check out the following tips designed to help:

1. The first thing to think about when setting a new goal is the relative importance of the goal to you. More simply, for true, long-lasting change to occur, you cannot “kinda want” to change. Think about that for a minute – most of the goals people set center around over-eating, over-drinking, over-eating, and other challenging human experiences. For example, if you have smoked cigarettes regularly for 20 years, you are going to really, really want to stop in order to have the resolve needed for the change. In my professional experiences, I have found that only when a person becomes desperate or inspired that true changes occur. Without this type of conviction, it becomes too easy to fall back into old habits.

2. Once you are ready for change, specific, measurable goals need to be set. Unfortunately, many people set vague goals that cannot be tracked, often leading to frustration and failure. For example, rather than setting a goal to “get in better shape,” try to instead set a specific weight or pant size to measure. This way, your progress can be more readily seen, leading to even more motivation and resiliency toward stress.

3. After your goals have been set, talk to important people in your life to get their support. Many research studies show that social support is a mediating variable when it comes to behavior modification, meaning that when people support and encourage our efforts, we are more likely to stick with our goals.

4. When you begin working on your goals, it is also important to work out any issues that might get in the way as you move forward. It is important to ward off future stressors by inoculating yourself to them – this mans to think ahead and plan out strategies for success when adversity eventually gets in the way.  Stress inoculation is an invaluable tool that can really help when working toward future goals.

5. Finally, set goals that you feel are important! Sometimes in life we do things for others, which works in the short run but usually dissipates quickly. Extrinsic motivation can be effective for short-term change, but it usually requires intrinsic motivation for longer change. When a person is intrinsically motivated, goals are usually looked at as life changes because they have much more meaning to the individual compared to simply doing something to pleas others.

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“I Hate This Time of Year!”

Have you ever said that to yourself when dealing with stress? For a teacher it might be when grades are due at the end of the term; for an accountant it might be the days leading up to when income taxes are required to be completed; and for a person with seasonal affective disorder it might be anytime during the cold and dark winter season. The point is we all have times during the year when we feel especially “stressed out,” whether it is due to unique work tasks, habit change, global requirements we all face (i.e. taxes), or even seasonal times of the year. The question, therefore, becomes how we handle these stressful times and learn successful coping strategies rather than allow ourselves to become defeated by the circumstances we inevitably face (Optimal Balance).

Stress Inoculation

Stress Inoculation is a therapeutic tool, developed by Dr. Donald Meichenbaum, used by mental health clinicians designed to help clients prepare themselves in advance to successfully handle stressful situations with a minimal amount of personal disruption. Similar to how a vaccination works to make people resistant to the effects of a particular disease, stress inoculation, in theory, helps people prepare for challenging situations resulting in greater resistance when these situations eventually occur.For example, if a leader is required to make an annual “state of the company” type of address to various important stakeholders, it is likely that many different opinions will surface (and also likely that some opposite views will emerge as well). In these types of situations, it is quite normal for the leader to feel “stressed out” by trying to spontaneously communicate ideas and solutions that are attractive to all parties involved. Using this example, stress inoculation might involve the following:

• Prior to the meeting, take time to draft as many different types of responses the leader is likely to face, as well as the pros and cons of each of these responses so that a professional rebuttal is ready to go. For example, if finances are a likely target of differing views, the leader may consider discussing some of these concerns even before they are voiced so that her audience is aware that she has fully prepared for this issue. This type of preparation is a form of cognitive stress inoculation (also a form of mental rehearsal).

• A second type of stress inoculation is behavioral in nature. Using the same example of a potentially stressful meeting, the leader might consider learning a behavioral technique to have on-hand for when things get dicey in the meeting. One example of an arousal-reducing technique is deep, systematic breathing that will slow the body down and guard against debilitating anxiety. The leader may wish to practice this technique days/weeks leading up to the meeting so that she can stay poised and in control for when the first opposite opinion surfaces.

How Stress Inoculation Helps Us Cope

Stress inoculation can help people in a number of ways, but primarily by providing an additional sense of personal control. When people feel as though they have personal control over situations, they are far less likely to fall victim to negative stress. For example, if you had a reasonably confident expectation that an upcoming meeting was going to be especially difficult, by knowing ahead of time that you have both cognitive and behavioral techniques for handling the situation you will likely be more confident (and at the same time less nervous).Stress inoculation also prompts people to be proactive and think through potentially stressful situations before they occur. If nothing else, this type of planning is certainly healthier than simply being reactive to difficult situations as they occur. Stress inoculation relies on having people think ahead and rehearse what stressors they might likely face, as well as appropriate means for handling the stressors.

Stress Inoculation Techniques

There are a number of stress inoculation techniques a person can use to guard against unhealthy, distressful situations. A brief list of three very effective techniques is provided below:

• Imagery. Simply seeing in your mind situations that are likely to be stressful will help your mind strengthen neural connections for immediate, automatic, conditioned responses when problems occur. Imagery also includes senses beyond vision, including tactile, auditory, and kinesthetic to name a few. By putting yourself in difficult situations (in your mind) and using as many senses as possible, your body will be prepared for when the real stressors emerge.

• Self Talk. A very simple, yet incredibly effective tool is self talk. Making it a point to say positive, healthy things to yourself will lead to healthy emotions and increased levels of confidence. Keep your internal dialogue positive and productive and your spirits and attitude will follow, giving you greater resiliency during difficult times.

• Deep Breathing. Perhaps the easiest and most effective way to control nerves is to engage in deep, systematic belly breathing. Rather than breathe in through your lungs (as you would normally), try taking a deeper breath directly into your diaphragm. The result of deep breathing is more oxygen into your body, resulting in an automatic calming response for your entire body.

Tips & Strategies

• Forewarned is forearmed. As a leader, make it a point to proactively prepare ahead of time for likely stressful situations rather than going into situations only prepared to react when problems occur.

• Develop a personal approach to stress inoculation that is suited to your personality. For some people cognitive techniques like imagery and self talk are most effective, while others prefer to slow their bodies down with systematic, rhythmic deep breathing.

• Imagery can be an incredibly powerful tool for a number of reasons, but perhaps most importantly because it literally puts your mind in a situation before it has even occurred, allowing your body to react more confidently when the real events take place. Consider using imagery days and weeks before a big event, as well as moments before you are required to perform.

• Remind yourself that personal control is the arch enemy of stress, and by taking control of situations you will minimize negative stress!

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Yesterday Florida Head Football Coach Urban Meyer unexpectedly announced his coach sports retirement from his position, citing the stress and demands from the job preventing him from spending important time with his family.   While Coach Meyer may not have specifically used the word “burnout” as his reason for leaving Florida, it’s clear to sport psychologists that burnout is precisely what stopped his coaching career at this time (Peak performance for Coaches).

Today, I wrote an article for The National Examiner that includes my thoughts on coaching burnout, and some of the issues coaches commonly experience when faced by big expectations from both themselves and their team.  While Urban Meyer is in the news for talking about his reasons for needing to leave Florida, many more thousands of less visible coaches nationwide not at the D1 level continue to struggle with keeping a balanced lifestyle that includes success both on and off the field.  Unfortunately, no coach is immune from coaching burnout, regardless of what level they coach.In order to prevent coaching burnout from happening, coaches can benefit dramatically by following the tips provided below:

• Before taking a coaching job, be sure to balance the likely expectations that will come with the job.  It’s no secret that with high profile positions comes more expectations, and more people to answer to as well.  Coaches need to think about these factors before quickly jumping into a job that might soon jeopardize their health, or time that they will have to spend with their family and other loved ones.
• All coaches can benefit by making down time a priority, and not an afterthought.  When coaches make it a point to regularly leave the office, shut off the cell phone, and steer clear of discussions around their sport, in essence it “recharges the battery” and helps ward off coaching burnout.
• Coaches who learn how to communicate effectively (both verbally and through other electronic means), as well as learn how to successfully multi-task and delegate duties to subordinates, are far less at risk for coach burnout.  Fortunately, these are skills that can be learned and mastered.
• Coaches who feel the stress of the job also need to develop healthy and effective means for coping with stressors.  When thinking about ways to cope, it is important that the activity is effective (in that it allows your mind to get away from things for a short while), as well as healthy (obviously using alcohol or drugs would not qualify).
• In really tough times, coaches should consider professional assistance – especially if the job is contributing to health problems or negative issues at home.  Professional counselors can help in a number of ways, including by teaching life skills that can assist with all the non “X’s and O’s” that come with the job.

Coach burnout is a very serious concern, and one that is not going away anytime soon.  It is very likely that we will only see more coaches step down in the future, as the demands of coaching and expectations for positive role modeling continue to increase – especially in high profile positions.  Fortunately, there are many things coaches can do to both prevent burnout from occurring, as well as respond successfully when experiencing the symptoms of burnout.

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While most people readily agree that steroids are dangerous and should be avoided by athletes competing in varsity sports, not everyone feels the same way about all the other seemingly safe performance enhancing supplements on store shelves today – especially energy drinks. In fact, did you know that while kids nationwide consume energy drinks (i.e. Red Bull) on a daily basis, these very same drinks are now being banned from interscholastic athletics in some states?  Just this fall Virginia passed a vote nullifying their usage , and it is expected many more states will soon follow.  Prior to hearing this news, did you ever think Red Bull would be on the same list of banned products as steroids?

Read the rest of Dr. Stankovich’s post for The Examiner here

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One of the things people struggle with in life is losing weight — or more specifically, losing weight and keeping the weight off. There are hundreds of various weight loss diets, programs, and systems that show varying levels of efficacy, but for the most part they all seem to “work” fairly well if you follow the guidelines of the diet. After all, if you eat less food and exercise more, you will inevitably lose weight (Changing Habits for Life Success).

Initially losing weight doesn’t seem like that big of a deal when you think about it, even if it does require eating and exercise changes in order to experience weight loss. The question, however, is why so many people put the weight back on over time rather than keep it off forever?As a counselor who treats people challenged by the task of losing weight (and keeping it off), the following are a few of the reasons as to why keeping weight off is the tougher than losing weight:

Set Point theory – but more…

Set Point theories focus largely on our physical body system, and how our unique genetic traits communicate automatically on a regular and consistent basis and “set” at our natural level. Personally, I do see merit to this assertion, at least to some degree, as we often go through periods in our lives where we seem to “settle” at a specific weight while living a “normal” life – kind of like a car running on idle.

The “more” part I would like to add to the Set Point theory is that we seem to also “set” with our ways of behaving and thinking, meaning that we need to focus on our ways of monitoring our automatic thinking, and remember we need to change our thinking if we are to change our behaviors – and therefore, lose weight.

As human beings, we often follow the path of least resistance like an electrical current when it comes to living our lives, using our minds to help us take short cuts to navigate successfully through the world around us. We are creatures of habit, enjoying consistent patterns of behavior that are “tried and true,” and likely to bring happiness into our lives. When a person sets a goal to lose weight, behaviors and thinking must be adjusted and improved upon, thereby disrupting “set” patterns. If the individual can re-establish a new, life-long set point, a new body weight will be established and more importantly, kept forever.

Lose the challenge

My second theory as to why keeping weight off is tougher than losing the weight in the first place has to do with goal setting theory. The good news is that goals work, as hundreds of scientific studies support the notion that people who set goals almost always out-perform people who do not set goals. When people working on weight-loss programs set specific, measurable, realistic goals; they usually reach their weight-loss goals.The problem, however, is not whether goals are effective or not, but instead an issue of how goals often diminish, or become easily forgotten about, after the initial goal has been reached. In other words, when people are in the process of losing weight, there is the metaphorical “carrot” to follow, similar to how race dogs follow the rabbit around the track. Most people reach their weight loss goal, grab the carrot, and eventually go back to – you guessed it, their “set” point where the weight eventually is regained.

Food is a fire extinguisher to stressMy last big reason why people have trouble keeping weight off after they lose it is that food is one of the most gratifying ways to deal with stress! There’s no way around this one – very often our favorite foods come to mind when we feel “stressed out,” as the time enjoying food provides a tasty respite to our busy lives. Ironically, eating food is an effective method to deal with stress, as we do enjoy the act of eating delicious foods in the moment. The problem, however, is that eating food may not always be a healthy method to cope with stress, as over-eating can lead to weight gain (as well as many other physical and emotional problems).Learning and using effective and healthy means to cope with stress allows people to lose weight, as well as keep the weight off for the long-run.

Combining all 3

It is quite probable that we have unique “set points” when it comes to our automatic ways of growing as people, and that to lose weight, we must “re-set” our ways of behaving and thinking. Most theories tend to focus on the behaviors needed to be re-set, overlooking the significance of changing our thinking set points as well.When setting goals, we must regularly prioritize the goals we have already reached instead of forgetting about them, even if the original “carrot” is no longer in front of us. Without doing this, we inevitably go back to our original set point.Finally, life stressors must be responded to by using effective and healthy ways to cope and overcome. When we do this, our focus, motivation, and resiliency improves, allowing us to establish happier and more successful ways of living our lives.

For more information please visit www.drstankovich.com and check out Optimal Balance for Life Success, and Changing Habits for Life Success (audio downloads).

We recently launched the “Life Success Package” audio download series designed to help with achieving optimal balance in life, alleviating stress, increasing self-leadership skills and strategies, and changing bad behaviors.  This package will help with many common life challenges, including weight loss motivation, habit change, and coping with life challenges in healthy and successful ways.All audio programs are conveniently delivered to your computer and are designed to help you make massive, positive changes in your life. You can immediately pick up the Life Success Package at Advanced Human Performance Systems.All three audio downloads were developed using the latest theories and research findings from a number of social sciences, including psychology, sociology, and philosophy. Easy to follow and packed with lots of hands-on tips, this series has been discounted to $29 (from $40).Improve the quality of your thinking, behaviors, and overall daily life by learning about the science of performance psychology and how it can work for you!www.drstankovich.com