WHAT IS SO GOOD ABOUT LISTENING TO OTHERS WITHOUT OUR PERSONAL REACTIONS INTERFERING?

People who have come to me for help have taught me the importance of actually listening to others without our reacting to what we are hearing. This can be very difficult to do unless we actually tell ourselves that this is what we want to do. It is easy to react [and self righteously respond] in order to inform or educate or castigate the other person. The outcome is to disrupt the relationship to the other person and make it easier for the other person to put the responsibility for their actions onto you. If we listen to someone, without reacting, then we are actually with that person, sharing their life experiences and acting like their lives really matter. Another reason that it is hard to listen without reacting is that we can convince ourselves that our reacting is necessary and the right thing. This is either because we are protecting ourselves from our fears by taking on responsibility for others or feeling like we are doing the right thing by confronting that person as if that actually helps change the other person's view or outlook. An example is when people feel that they must react and confront people who are saying or doing bad things as this is required of us. Unfortunately, even with good intentions based on trying to right wrongs that are being promoted or actually happening, when we react we are allowing the other person to avoid taking responsibility for themselves. So what can we do? I believe that we can still listen without reacting and also respond to what we are hearing in a helpful manner. If we are able to not react then our brains will tell us what we need to do, if we are able to listen to ourselves as well, without reacting. We then are responding and not reacting and by responding we are able to encourage and support these people so that they are more likely to take responsibility for themselves and make changes that are good for them and likely for the universe as well.`

For us to realize how important listening without reacting is no matter what we are hearing does require that we give it a chance and if we start reacting then we should walk away from the interaction and return after we are again able to listen without reacting. It is also important that frequently we react to things in self defense as past stresses have programmed our brains to instantly react. This happens frequently in people who have had traumatic events happen in their lives and are suffering from post traumatic stress disorder [PTSD]. I have helped many people to stop this automatic reacting by helping them understand what is happening, supporting coping skills that reduce the likelihood of them responding to stresses and I have also identified a few medications that reduce the frequency and intensity of reactions to past stresses. This makes it much easier to not react to past stresses and allows them to be more themselves as their stress reactions are temporary and not their typical way of responding. 

What do yopu think?

CROSSES TO BEAR?

I was recently listening to a sermon being delivered by a minister at Fifth Avenue Presbyterian Church in New York City. The sermon was on" carrying your cross," connected to the saying that "we all have our cross to bear." I do not want to discuss the Chrisitan meaning ascribed to this but the meaning it might have for all of us. I especially want to explore the possibility that it can help us to move away from the sadly comforting blaming others for our problems and instead recognize that we really are all [wonderfully] connected to each other.

So, is it possible to understand this cross idea as support for all of us being one, big, [happy?], family. It is like being brave enough to choose to be open to possibilities and therefore to see what happens each day. Instead of being stuck in fear and worry every day, reassuring ourselves by blaming others for our fears because of what they are doing. Maybe our cross is the moments [periods] of self doubt that we experience. The weight of self doubt can be like the weight of carrying a cross. If we recognize this doubt within ourselves and that we are responsible for feeling it, then it should be easier to believe that everyone might have these doubts. We might also be able to see that sometimes self-doubt leads to blaming others for our own problems and that blaming others does not help us to feel any better. 

If we take responsibility for our doubts it might be easier to see others also having doubts and fears and feel a connection to them versus feeling separated from them and even suspicious of them.

DOES A "THERAPEUTIC RELATIONSHIP" MAKE A DIFFERENCE?

One of the reasons that I am not a provider for medical insurance [so my patients have to pay out of pocket for my services] is that reimbursement is very restricted and the medical insurance companies justify this by suggesting that a reasonable and customary amount of time with a patient to help them with their medications is 10-15 minutes. That is not enough time for me to help my patients determine if the medication is helping and if the dose is appropriate. I am convinced that I need to have established a relationship with my patients so that they feel comfortable telling me things and trust my judgement about their medications. This takes more than 10-15 minutes, initially taking 60 + minutes and after that a minimum of 30 minutes. When 30 minutes has been scheduled helping my patients can take longer and I will then add another 15 minutes and even another 30 minutes sometimes. I hesitate to do this if I am scheduled without an immediate break and yet my patients have been understanding if I am running late due to needs of one of my patients as they know that I would spend extra time with them if it were needed.

What if therapeutic relationships with patients is not important to how well they do with medications? There was an article in Psychiatr Serv. 2018 Jan 1;69(1):41-47 by Totura, CMW, et al. entitled "The Role of Therapeutic Relationship in Psychopharmacological Treatment Outcomes: A Meta-analytic Review". This study looked at the role of therapeutic relationships in the delivery of effective psychopharmacological treatment.

The authors reviewed many publication sites looking for articles addressing the above question. They found eight independent studies that were empirically based [involving 1065 patients] in which measures of the therapeutic relationship were administered and psychiatric treatment outcomes were assessed. They found that the overall average weighted effect size for the association between the therapeutic relationship and treatment outcomes was z = .30 indicating a statistically significant, moderate, positive effect of the alliance on outcomes of psychopharmacological treatments. 

So, the above review of 8 studies supports the benefit of a therapeutic alliance [relationship] on the outcome of psychopharmacoloical treatments [treating people who have psychiatric disorders with medication].

I see the benefit everyday in my work with people who come to me.

ROLE OF PSYCHIATRIC DISORDERS AND AUTOIMMUNE DISORDERS

Recently the Washington Post had an article about a woman named April who after a traumatic event had suddenly become psychotic and unresponsive being diagnosed with catatonia [a condition often associated with schizophrenia often with severe withdrawal from human contact, odd behaviors and often being nonresponsive. Then twenty years later still unresponsive she began to be able to interact with others and have aspects of her old self return after she had begun to be treated for neuro systemic lupus erythematosis [SLE] which is an autoimmune disorder where the immune system attacks it's own tissues oncluding the brain. Brain symptoms include behavior changes, clouded thinking, confusion and impaired memory. 

So what is the role of neuro SLE [NSLE] in development of catatonia? Is there a role for traumatic experiences or is it the nature of the brain damage from NSLE or ? 

I have seen psychotic symptoms after traumatic events that then will subside when their traumatic memory symptoms are successfully treated. This is without an underlying psychotic disorder like schizophrena. 

Regarding April, she apparently did not show any early symptoms related to schizophrenia and functioned very well until the traumatic event that was not specifed and then she became noncommunicative and started having psychotic symptoms. After 20 years of being unresponsive she began to have her recently diagnosed neuro SLE treated. This treatment involved repeated IV steroids for five days and then a single dose of cyclophosphamide a strong immunosuppressive medication. This was followed by treatment with rituximub [a targeted cancer medication called a myoclonal antibody that targets proteins on the surface of cancer cells] initially used to treat lymphomas. She had six rounds of these treatments needing a month in between to recover. April improved dramatically.

Questions remain regarding the role of traumatic events and autoimmune disorders [especially NSLE] in the develoopment of catatonic disorders. Regardless, there is the possibility that some people with catatonia have autoimmmune disorders caused at least in part by traumatic events and treating these disorders can lead to amazing improvement in the catatonic symptoms that even look like this disorder may be able to be cured. 

I have had people who have come to me for help who have been diagnosed with an autoimmune disorder and when I have been able to help them to very significantly lower their anxiety related to past traumatic experiences have not had any more symptoms of their autoimmune disorder. 

PTSD AND PMS...IS THERE A CONNECTION?

A woman who comes to me mentioned that every month she has intense emotions and irritability during the 5-7 days before the onset of her period representing symptoms of a premenstrual sydrome [PMS].  This person also has post traumatic stress disorder [PTSD] and I wondered if there is a connection between her PMS symptoms and PTSD. I was aware that stress and anxiety can influence hormones. I started to research the possible influence of estrogen and progesterone on PTSD symptoms. There have been a number of studies that have suggested that PTSD symptoms intensify when estrogen and possibly progesterone levels are lower and conversely PTSD symptoms are lower when these levels are higher. During the prementrual period estrogen levels rapidly decrease and it is possible that this triggers an increase in PTSD symptoms. The monthly cycle for women starts with menses when estrogen and progesterone are lowest followed by the follicular phase with an increase in estradiol that triggers the release of follical stimulating horomone [FSH] that stimulates follicle [egg] development. Then leutinizing hormone [LH] increases triggering the release of the egg [ovulation] with a rapid drop in estradiol. This is. followed by the luteal phase when estradiol increases again in preparation for fertilization of the egg. Without fertilization, estradiol and progesterone levels drop late in the luteal phase triggering prementrual symptoms followed by the onset of menses. Estrogen levels increase in the later follicular phase and then drop around ovulation with leutinizing hormone peaking and then increases again halfway through the luteal phase before dropping rapidly leading to onset of menses. The progesterone increases in the late follicular phase and then peaks and levels off during the middle of the luteal phase with rapid drop off just before menses. Leutinizing hormone and follicular stimulating hormone both peak in late follicular phase and then rapidly drop off after ovulation. 

What is the point of elaborating on the fluctuations of hormones during the mentrual cycle? Well, PTSD symptoms are reported to increase with decreasing estrogen and progesterone levels and this is correlated with later luteal phase of the cycle including the several days leading up to menses. So if PMS is accentuated by PTSD symptoms then these PMS symptoms will be increased especially during the luteal phase until just before menses. This is when my patients experience their PMS symptoms. 

So, if the PTSD symptoms increase as they are triggered by the hormone level changes and if these symptoms are lower with increased estrogen levels then they should be lower during pregnancy and other times when estrogen levels are high. Focusing on the hormone levels  would support the liklihood of PMS occuring during a signficant part of the luteal phase up until near the onset of menses. This seems to be true for the woman who came to me for treatment. 

I wonder if it is possible to reduce PMS by lowering PTSD symptoms. This would make sense if for some women PMS represents a coping mechanism dealing with traumatic memories. 

What do you think?