By Allison Siebern, Ph.D.
A middle-aged patient who we will call Katy came to the Stanford Sleep Center's Insomnia & Behavioral Sleep Medicine Program seeking help for her sleep. Katy reported that she had tried everything to be able to sleep at what she called a "typical time." She presented with concerns about being unable to get to sleep until the a.m. hours, oversleeping in the morning, and feeling groggy and un-refreshed upon awakening. She would get into bed around 11 p.m. (some nights earlier) and not fall asleep until around 3-4 a.m. Katy would set an alarm for 7 a.m. and try to force herself awake but would turn the alarm off in her sleep and would sleep until 11 a.m. or noon. She was frustrated that so much of her 24 hours was spent "trying" to sleep, and she reported she had to fix her sleep situation as soon as possible because a family member recently became ill requiring her to drive the family member to early morning doctor's appointments.
The sleep issue was discussed with her primary care physician, and the offered treatment was sleep medication. She was reluctant about taking it, but tried for several nights with little to no effect and eventually discontinued it. Her primary care physician also offered her the advice that she just needed to relax at night, which led to her feeling that the problem was just dismissed and not taken seriously. She had read about sleep hygiene on the Internet. Based on what she had read she had eliminated caffeine, replaced her mattress with a new one, darkened her room, and ensured a comfortable room temperature during her intended sleep time. She had also started general psychotherapy several months prior to her first visit at the Stanford Sleep Center to try and help her sleep and had completed 12 sessions, which included elements of sleep hygiene and relaxation techniques. Katy reported none of these helped her sleep.
The patient also reported a long history of this sleep issue dating back to adolescence when she would oversleep and miss classes in high school and would sleep into the afternoon on weekends. In college she scheduled afternoon classes as much as possible since she knew she would oversleep and not make it to the morning classes. She reported times when her sleep would drift later and later until eventually she would periodically have a night that she would stay up all night. When asked about a family history of any sleep issues she indicated that her maternal grandmother had had a similar pattern of sleep. After completing an initial evaluation with the patient and gathering sufficient sleep history it was identified that the patient had delayed sleep phase syndrome (DSPS). Time was then spent educating the patient about DSPS and she became tearful as she heard the explanation. She stated it matched what she had been struggling with for so many years and she was so grateful to finally have a name for it.
The brain has an internal master clock that has a daily cycle that is approximately 24 hours. In delayed sleep phase the master clock oscillates longer than a 24-hour period leading to later sleep onset and later wake time. DSPS is a circadian rhythm sleep disorder that occurs when the timing is delayed several hours relative to the external 24-hour clock. Those with DSPS struggle with getting to sleep at a "typical bedtime" because their internal clock is sending high alerting signals at that time indicating they should be alert and awake. If the person waits to go to sleep much later (usually some hours after midnight) getting to sleep is faster as the alerting signals are quieting down.
The person will also report difficulty waking up at their desired morning wake time because their internal clock is not yet producing (nor sending) strong alerting signals. In addition, there remains sleep debt to be slept off due to falling asleep at a later hour. There is variation in the length of the oscillation period and thus how strong the delay is, with a mild to significant impact on sleep. Unless there is disruption in occupation, social, or other domains (or aspects) in life due to the timing of sleep a person, it is not considered to be DSPS, but the person is said to have a delayed circadian chronotype. (This basically means they are more of a night owl but it does not impact the above domains of their life.) In the general population the prevalence of DSPS is unknown but among adolescents and young adults it is approximately 10 percent. Most commonly, DSPS emerges during adolescence, but it can even occur during early childhood. Recent research indicates there is a genetic link with circadian chronotype, so it was not surprising that Katy could identify someone in her family that experienced a similar sleep pattern.
Recommendations were discussed with Katy that were tailored to where her current sleep time was and how to move the circadian timing to her goal of waking earlier. It involved an intensive two weeks of shifting her sleep time around the clock slowly enough to be effective, which is called sleep phase chronotherapy. (It is a common misconception that by staying awake all night that one can reset their sleep clock, which more often than not subsequently disrupts the sleep pattern more.) Additional treatment components for Katy included properly timed light exposure, limiting light exposure in the hours before her anticipated bedtime, and observing the activities she was doing two hours prior to her bedtime and being careful not to get over-activated, thus suppressing her sense of sleepiness. She found the above recommendations most helpful for her, although recommendations for delayed sleep phase can vary across patients.
Time was also spent examining beliefs and expectations around sleep given Katy's long history of frustrating experiences. It is worth noting that she reported feeling guilt and shame around the timing of her sleep, which started when she was a teenager. She received messages from her family about being lazy for missing classes and for sleeping later on the weekends. This was reinforced during her working years when she would be consistently late when working a 9 a.m. to 5 p.m. job. (She eventually found employment that allowed for a later shift.)
The patient had four treatment sessions over a six-week period. At the last session the patient expressed relief in finally having answers to what she was experiencing and direction in how to manage it more effectively. She recognized that the treatment did not change her genetics nor her biology, so this issue would always remain in the background. Nevertheless, she learned about the treatment recommendations and factors that were effective for her to help regulate her pattern. These could be put into place if her sleep pattern started to shift later and later.
The details of the above patient have been altered to preserve privacy and confidentiality. This case illustrates that sleep hygiene guidelines and non-specific treatment (general psychotherapy) are not typically effective in treating sleep disorders. It also illustrates that sometimes other sleep disorders such as a circadian rhythm disorder can masquerade as insomnia, but the treatment plans vary and so it is important to have an evaluation done by a sleep expert.
To find a certified behavioral sleep medicine provider please go to: http://www.absm.org/BSMSpecialists.aspx
Allison Siebern, Ph.D. is a clinical assistant professor at the Stanford Center for Sleep Sciences and Medicine. This Center is the birthplace of sleep medicine and includes research, clinical, and educational programs that have advanced the field and improved patient care for decades. To learn more, visit us at: http://sleep.stanford.edu/
For more by the Stanford Center for Sleep Sciences and Medicine, click here.
For more on sleep, click here.
Tuesday, October 8, 2013
Monday, October 7, 2013
12 Healthy Ways to Lose Weight for Good
You're 10, 20, 30 or more pounds overweight and you've dieted, on and off, for years. You've lost weight and then put it back on and more.
Why? Diets don't work. Today we know diets don't work. Even Weight Watchers says so. Restricting calories again and again alters your metabolism. That's why so many people put back the weight they lost while dieting, plus more.
Yet, desperate to lose weight, Americans keep going on diets. While there's no magic bullet for weight loss, there are steps you can take to lose weight, safely and for good, while increasing your health.
The common sense advice to "eat less, move more," isn't entirely correct. It matters what you eat.
And here's a dirty little secret: Consuming refined carbohydrates -- simple sugars and starches -- is one of the biggest reasons Americans are now battling obesity. Carbohydrates you don't burn get stored in your body as fat.
Since food manufacturers began lining supermarket shelves with "no-fat" and "low-fat" foods -- most of which have added sugars -- we have become fatter than ever.
This list of healthy eating habits is by no means complete. But here are 12 of the many recommendations in my new book to help you lose weight and gain the benefits -- more energy and a fitter, healthier you.
1. Eat a healthy breakfast every morning. Eating breakfast revs up your metabolism. If you skip breakfast you're likely to eat more calories by binging later in the day. In a study of people who lost weight and kept it off for more than five years, one major thing they all did was eat breakfast. But Pop-tarts, donuts and Hot Pockets don't cut it. Cooked oatmeal, whole grain cereals, whole grain breads, eggs and tofu with a salad are all healthy choices.
2. Stop counting calories and eat foods that nourish your body. A meal of fat-free, sugar-free, refined processed foods is also nutrient-free. Plus, it won't satisfy you for long compared to a meal of nutrient-dense whole foods like vegetables, lean meats, whole grains, and healthy fat. As you begin eating more nutritious foods and get a little more physical activity (if you aren't physically active now), your body will come to its natural healthy weight.
3. Always have some veggies and fruit washed and cut in your fridge. This way they're easy to grab when you're hungry (instead of reaching for that giant-size bag of potato chips) and you can throw them in your bag when you're on the go.
4. Replace diet soda with unsweetened beverages. Diet drinks keep your sweet tooth craving sweets. Plus, they make you feel virtuous. Many people who drink diet drinks actually reward themselves with extra calories through the day. Instead, drink iced teas or plain or carbonated water with a slice of lemon or lime.
5. Use the "Plate Method" to make a healthy meal. Fill half your plate with low or non-starchy veggies like broccoli, asparagus, cauliflower, Brussels sprouts, string beans, mushrooms, peppers, or leafy greens and some fruit. Fill one quarter, with a whole grain like brown rice, barley, bulgur, or quinoa, or a starchy vegetable like corn or potatoes, or beans. Fill the last quarter with protein like broiled, sauteed, roasted, or baked (not fried) fish, chicken or turkey without the skin, lean cuts of meat, tofu or eggs.
6. Cut down on carbs. Refined carbohydrates (cake, candy, cookies, muffins, scones, cupcakes, soda, fruit juice, syrups, chips, and most supermarket breads) you don't burn turn into fat. Even foods like fruit yogurt and many breakfast cereals have lots of added sugar. Replace fruity yogurts with Greek plain yogurt, choose high-fiber, lower carb cereal and add small amounts of healthy fat to your meals with avocado slices, unsalted nuts, seeds and olive oil.
7. Shrink your lunch and dinner plates. If you and your family eat off a plate larger than ten inches, replace them with plates that are nine or ten inches in diameter. We tend to eat what's in front of us. Using smaller plates there's less food in front of you to eat.
8. Enjoy less healthy foods now and then, in small portions, unless there's a medical reason not to do so. Not letting yourself eat something you love may make you feel deprived and frustrated and subvert your efforts to eat well.
9. When eating out ask your server to double the green veggies in place of the potato or rice. I always do this and benefit from more nutrition and less carbs. Also, share food at the table. My husband and I always share an appetizer and when with a group, if someone orders dessert, it comes with a spoon for everyone.
10. Keep tempting foods out of the house. Stock your fridge and pantry with healthy foods and you're creating an environment that will help make you successful. Enjoy treats occasionally when you're out.
11. Enlist family members and friends to eat healthier with you. It's easier
when it's a team effort, and, your family will also reap the health benefits along with you.
12. Talk positively to yourself and quiet your inner critic. Notice during the day your positive efforts and compliment yourself. "I chose a healthy vegetable plate instead of a slice of pizza. Great job!" The more you pat yourself on the back for what you're doing well, the more energy you'll have to keep doing it. If you notice you're telling yourself you'll never succeed, or beating yourself up for having two bowls of ice cream, stop! To quiet your inner critic head out for a brief walk, turn on some music and sway, and above all, tell yourself tomorrow is a new day and a new start.
My new book, Diabetes Dos & How-Tos, contains 65 "Dos" for people to manage their diabetes. But the 20 "Food Dos" in the book will benefit anyone.
If you don't have diabetes they will show you how to lose or maintain your weight and eat more nutritiously. If you are at risk for diabetes, or have pre-diabetes, (Stage 1 Type 2 diabetes), the book's "Food Do's" can help you prevent full-blown (Stage 2) Type 2 diabetes.
Riva's new book, Diabetes Do's & How-To's, is available in print and Kindle, along with her other books, 50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It and The ABCs Of Loving Yourself With Diabetes. Riva speaks to patients and health care providers about flourishing with diabetes. Visit her websites DiabetesStories.com and DiabetesbyDesign.com.
For more by Riva Greenberg, click here.
For more on weight loss, click here.
Why? Diets don't work. Today we know diets don't work. Even Weight Watchers says so. Restricting calories again and again alters your metabolism. That's why so many people put back the weight they lost while dieting, plus more.
Yet, desperate to lose weight, Americans keep going on diets. While there's no magic bullet for weight loss, there are steps you can take to lose weight, safely and for good, while increasing your health.
The common sense advice to "eat less, move more," isn't entirely correct. It matters what you eat.
And here's a dirty little secret: Consuming refined carbohydrates -- simple sugars and starches -- is one of the biggest reasons Americans are now battling obesity. Carbohydrates you don't burn get stored in your body as fat.
Since food manufacturers began lining supermarket shelves with "no-fat" and "low-fat" foods -- most of which have added sugars -- we have become fatter than ever.
This list of healthy eating habits is by no means complete. But here are 12 of the many recommendations in my new book to help you lose weight and gain the benefits -- more energy and a fitter, healthier you.
1. Eat a healthy breakfast every morning. Eating breakfast revs up your metabolism. If you skip breakfast you're likely to eat more calories by binging later in the day. In a study of people who lost weight and kept it off for more than five years, one major thing they all did was eat breakfast. But Pop-tarts, donuts and Hot Pockets don't cut it. Cooked oatmeal, whole grain cereals, whole grain breads, eggs and tofu with a salad are all healthy choices.
2. Stop counting calories and eat foods that nourish your body. A meal of fat-free, sugar-free, refined processed foods is also nutrient-free. Plus, it won't satisfy you for long compared to a meal of nutrient-dense whole foods like vegetables, lean meats, whole grains, and healthy fat. As you begin eating more nutritious foods and get a little more physical activity (if you aren't physically active now), your body will come to its natural healthy weight.
3. Always have some veggies and fruit washed and cut in your fridge. This way they're easy to grab when you're hungry (instead of reaching for that giant-size bag of potato chips) and you can throw them in your bag when you're on the go.
4. Replace diet soda with unsweetened beverages. Diet drinks keep your sweet tooth craving sweets. Plus, they make you feel virtuous. Many people who drink diet drinks actually reward themselves with extra calories through the day. Instead, drink iced teas or plain or carbonated water with a slice of lemon or lime.
5. Use the "Plate Method" to make a healthy meal. Fill half your plate with low or non-starchy veggies like broccoli, asparagus, cauliflower, Brussels sprouts, string beans, mushrooms, peppers, or leafy greens and some fruit. Fill one quarter, with a whole grain like brown rice, barley, bulgur, or quinoa, or a starchy vegetable like corn or potatoes, or beans. Fill the last quarter with protein like broiled, sauteed, roasted, or baked (not fried) fish, chicken or turkey without the skin, lean cuts of meat, tofu or eggs.
6. Cut down on carbs. Refined carbohydrates (cake, candy, cookies, muffins, scones, cupcakes, soda, fruit juice, syrups, chips, and most supermarket breads) you don't burn turn into fat. Even foods like fruit yogurt and many breakfast cereals have lots of added sugar. Replace fruity yogurts with Greek plain yogurt, choose high-fiber, lower carb cereal and add small amounts of healthy fat to your meals with avocado slices, unsalted nuts, seeds and olive oil.
7. Shrink your lunch and dinner plates. If you and your family eat off a plate larger than ten inches, replace them with plates that are nine or ten inches in diameter. We tend to eat what's in front of us. Using smaller plates there's less food in front of you to eat.
8. Enjoy less healthy foods now and then, in small portions, unless there's a medical reason not to do so. Not letting yourself eat something you love may make you feel deprived and frustrated and subvert your efforts to eat well.
9. When eating out ask your server to double the green veggies in place of the potato or rice. I always do this and benefit from more nutrition and less carbs. Also, share food at the table. My husband and I always share an appetizer and when with a group, if someone orders dessert, it comes with a spoon for everyone.
10. Keep tempting foods out of the house. Stock your fridge and pantry with healthy foods and you're creating an environment that will help make you successful. Enjoy treats occasionally when you're out.
11. Enlist family members and friends to eat healthier with you. It's easier
when it's a team effort, and, your family will also reap the health benefits along with you.
12. Talk positively to yourself and quiet your inner critic. Notice during the day your positive efforts and compliment yourself. "I chose a healthy vegetable plate instead of a slice of pizza. Great job!" The more you pat yourself on the back for what you're doing well, the more energy you'll have to keep doing it. If you notice you're telling yourself you'll never succeed, or beating yourself up for having two bowls of ice cream, stop! To quiet your inner critic head out for a brief walk, turn on some music and sway, and above all, tell yourself tomorrow is a new day and a new start.
My new book, Diabetes Dos & How-Tos, contains 65 "Dos" for people to manage their diabetes. But the 20 "Food Dos" in the book will benefit anyone.
If you don't have diabetes they will show you how to lose or maintain your weight and eat more nutritiously. If you are at risk for diabetes, or have pre-diabetes, (Stage 1 Type 2 diabetes), the book's "Food Do's" can help you prevent full-blown (Stage 2) Type 2 diabetes.
Riva's new book, Diabetes Do's & How-To's, is available in print and Kindle, along with her other books, 50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It and The ABCs Of Loving Yourself With Diabetes. Riva speaks to patients and health care providers about flourishing with diabetes. Visit her websites DiabetesStories.com and DiabetesbyDesign.com.
For more by Riva Greenberg, click here.
For more on weight loss, click here.
The Science Beneath the Untethered Soul: Defusion
I was in Oakland a couple of weeks ago to celebrate the 40th anniversary of New Harbinger Publications (my good friend Matt McKay started it, and they published my popular book Get Out of Your Mind and Into Your Life, so I am a bit of a New Harbinger fan). They were a pretty excited bunch -- not because I'd shown up but because their book The Untethered Soul was back at number one on the New York Times bestseller list.
The Untethered Soul is one of those backlist anomalies like Eckhart Tolle's The Power of Now that just happen to hit a chord. The book sits among New Harbinger's usual list of clinical guides, workbooks, and evidence-based self-help books, but it is a bit different. The founder of a multimillion-dollar software company, Michael Singer, wrote it for the lay reader. It claims no particular modality or theory -- instead, it offers a kind of spiritual narrative, citing bits from ancient yogic texts as resources and evidence.
In that perhaps it is like a lot of books in that genre, but as I read it I'm struck by the degree to which its wisdom is supported by modern clinical science. It beautifully expresses some of the ideas that empirically based treatments have carved out and tested over the last few decades. Because I've been involved in its development, I can most easily relate its ideas to Acceptance and Commitment Therapy (ACT) and the underlying basic science on which ACT stands, which an international community of clinicians and researchers has spent about 30 years creating and testing.
The goal of Acceptance and Commitment Therapy is to increase psychological flexibility -- the ability to contact the present moment more fully as a conscious human being, and to change or persists in behavior when doing so serves valued ends. Psychological flexibility is established through six core processes, which are skills one develops to become more flexible.
In The Untethered Soul the very first chapter is a lesson in cognitive defusion, one of those six core processes.
Singer writes:
If you're smart, you'll take the time to step back, examine this voice, and get to know it better. The problem is, you're too close to be objective. If you spend some time observing this mental voice, the first thing you will notice is that it never shuts up. When left to its own, it just talks.
Certainly this idea of "stepping back" is not new. Every mystical tradition in every major spiritual tradition has addressed it. The ancient practices of meditation and yoga have been taught for thousands of years in the east to develop the skill to watch the mind rather than get caught up in its relentless fluctuations. The use of silence, koans, chants, dancing, mantras, prayer, fasting and other methods are all to a degree linked to this process.
The importance of stepping back from the mind and learning to watch it is true of many forms of psychotherapy as well, even in forms of therapy that one might not think of first as based on that approach, such as behavior therapy and cognitive behavior therapy. When ACT was developed in the early 1980s as part of these traditions it embraced cognitive defusion as a keystone skill in creating more psychological flexibility. As one of the first popular books on the topic, when we published Get Out of Your Mind and Into your Life in 2005, we urged people to consider this approach. Instead of trying to change the form or frequency of thoughts, ACT uses "cognitive defusion" techniques to change the undesirable functions of thoughts. When you change how you related to the voice within, many of its unhelpful functions are diminished.
The idea of reducing cognitive fusion is so powerful that there are literally scores of such techniques that have been developed for use in clinical settings. For example, a negative thought could be watched dispassionately, repeated out loud until only its sound remains, or treated as an externally observed event by giving it a shape, size, color, speed, or form. A person could thank their mind for such an interesting thought, label the process of thinking ("I am having the thought that I am no good"), or examine the historical thoughts, feelings, and memories that occur while they experience that thought. These techniques attempt reduce the literal quality of the thought, weakening our automatic tendency to treat thought as meaning what they refers to ("I am no good") rather than what it they are directly experienced to be ("I am having the thought that I am no good").
We now know that reducing cognitive fusion can be a powerful contributor to psychological health. A recent summary of the research in the area (Levin et al., 2012) found that even single session interventions designed to reduce fusion produced a change that was just under the cut off agreed to among researchers for "large effects." Furthermore, in important clinical interventions for problems such as anxiety people get better in part when they first they learn to reduce cognitive fusion (e.g., Arch et al., 2012). In other words, Singer is not just speaking from his heart: He is speaking directly to scientifically established ideas about how the mind works. I've never met the man. I'm not sure he knows that. But it is important that readers know it. There is a science underneath The Untethered Soul.
The result of cognitive defusion is usually a decrease in believability of, or attachment to, private events rather than an immediate change in their frequency. Or, in other words, as Singer says it:
In the last part of that quote Singer begins to touch another flexibility process: perspective taking and the importance of distinguishing the person who is aware from the content of which one is aware. I will discuss that in a later blog.
The idea of freeing oneself from the constant activity of the mind is not only refreshing but also a quite realistic skill to develop through exercises used not only in ACT but across the board in modern psychotherapy in methods such as Dialectical Behavior Therapy (DBT), or Mindfulness-Based Cognitive therapy, and the like. Defusion is not the only way out of suffering -- but it is one of key stepping stones. Developing the skill to "step back" is an incredibly useful tool toward living life on your own terms, not just on the terms dictated to you by the voice within.
The Untethered Soul is one of those backlist anomalies like Eckhart Tolle's The Power of Now that just happen to hit a chord. The book sits among New Harbinger's usual list of clinical guides, workbooks, and evidence-based self-help books, but it is a bit different. The founder of a multimillion-dollar software company, Michael Singer, wrote it for the lay reader. It claims no particular modality or theory -- instead, it offers a kind of spiritual narrative, citing bits from ancient yogic texts as resources and evidence.
In that perhaps it is like a lot of books in that genre, but as I read it I'm struck by the degree to which its wisdom is supported by modern clinical science. It beautifully expresses some of the ideas that empirically based treatments have carved out and tested over the last few decades. Because I've been involved in its development, I can most easily relate its ideas to Acceptance and Commitment Therapy (ACT) and the underlying basic science on which ACT stands, which an international community of clinicians and researchers has spent about 30 years creating and testing.
The goal of Acceptance and Commitment Therapy is to increase psychological flexibility -- the ability to contact the present moment more fully as a conscious human being, and to change or persists in behavior when doing so serves valued ends. Psychological flexibility is established through six core processes, which are skills one develops to become more flexible.
In The Untethered Soul the very first chapter is a lesson in cognitive defusion, one of those six core processes.
Singer writes:
In case you haven't noticed, you have a mental dialogue going on inside your head that never stops. It just keeps going and going. Have you ever wondered why it talks in there? How does it decide what to say and when to say it? How much of what it says turns out to be true? How much of what it says is even important? And if right now you are hearing, "I don't know what you're talking about. I don't have any voice inside my head!" -- that's the voice we're talking about.
If you're smart, you'll take the time to step back, examine this voice, and get to know it better. The problem is, you're too close to be objective. If you spend some time observing this mental voice, the first thing you will notice is that it never shuts up. When left to its own, it just talks.
Certainly this idea of "stepping back" is not new. Every mystical tradition in every major spiritual tradition has addressed it. The ancient practices of meditation and yoga have been taught for thousands of years in the east to develop the skill to watch the mind rather than get caught up in its relentless fluctuations. The use of silence, koans, chants, dancing, mantras, prayer, fasting and other methods are all to a degree linked to this process.
The importance of stepping back from the mind and learning to watch it is true of many forms of psychotherapy as well, even in forms of therapy that one might not think of first as based on that approach, such as behavior therapy and cognitive behavior therapy. When ACT was developed in the early 1980s as part of these traditions it embraced cognitive defusion as a keystone skill in creating more psychological flexibility. As one of the first popular books on the topic, when we published Get Out of Your Mind and Into your Life in 2005, we urged people to consider this approach. Instead of trying to change the form or frequency of thoughts, ACT uses "cognitive defusion" techniques to change the undesirable functions of thoughts. When you change how you related to the voice within, many of its unhelpful functions are diminished.
The idea of reducing cognitive fusion is so powerful that there are literally scores of such techniques that have been developed for use in clinical settings. For example, a negative thought could be watched dispassionately, repeated out loud until only its sound remains, or treated as an externally observed event by giving it a shape, size, color, speed, or form. A person could thank their mind for such an interesting thought, label the process of thinking ("I am having the thought that I am no good"), or examine the historical thoughts, feelings, and memories that occur while they experience that thought. These techniques attempt reduce the literal quality of the thought, weakening our automatic tendency to treat thought as meaning what they refers to ("I am no good") rather than what it they are directly experienced to be ("I am having the thought that I am no good").
We now know that reducing cognitive fusion can be a powerful contributor to psychological health. A recent summary of the research in the area (Levin et al., 2012) found that even single session interventions designed to reduce fusion produced a change that was just under the cut off agreed to among researchers for "large effects." Furthermore, in important clinical interventions for problems such as anxiety people get better in part when they first they learn to reduce cognitive fusion (e.g., Arch et al., 2012). In other words, Singer is not just speaking from his heart: He is speaking directly to scientifically established ideas about how the mind works. I've never met the man. I'm not sure he knows that. But it is important that readers know it. There is a science underneath The Untethered Soul.
The result of cognitive defusion is usually a decrease in believability of, or attachment to, private events rather than an immediate change in their frequency. Or, in other words, as Singer says it:
The best way to free yourself from this incessant chatter is to step back and view it objectively. Just view the voice as a vocalizing mechanism that is capable of making it appear like someone is in there talking to you. Don't think about it; just notice it. No matter what the voice is saying, it's all the same. It doesn't matter if it's saying nice things or mean things, worldly things or spiritual things. It doesn't matter because it's still just a voice talking inside your head. In fact, the only way to get your distance from this voice is to stop differentiating what it's saying. Stop feeling that one thing it says is you and the other thing it says is not you. If you're hearing it talk, it's obviously not you. You are the one who hears the voice. You are the one who notices that it's talking.
In the last part of that quote Singer begins to touch another flexibility process: perspective taking and the importance of distinguishing the person who is aware from the content of which one is aware. I will discuss that in a later blog.
The idea of freeing oneself from the constant activity of the mind is not only refreshing but also a quite realistic skill to develop through exercises used not only in ACT but across the board in modern psychotherapy in methods such as Dialectical Behavior Therapy (DBT), or Mindfulness-Based Cognitive therapy, and the like. Defusion is not the only way out of suffering -- but it is one of key stepping stones. Developing the skill to "step back" is an incredibly useful tool toward living life on your own terms, not just on the terms dictated to you by the voice within.
Sunday, October 6, 2013
Loving-Kindness Meditation and Change
By Angela Wilson, MA, RYT
One increasingly popular form of meditation is loving-kindness meditation (LKM), the practice of wishing oneself and others to be happy, content and at ease. In the yoga tradition, loving-kindness is seen as an opportunity to "cultivate the opposite."
Where many meditation techniques encourage students to explore difficult feelings or emotions directly, in loving-kindness the invitation is to send well wishes to oneself (who is in distress) as well as the other (who we feel distress toward). This isn't meant to suppress the feelings as they arise, but instead it can be thought of as a soothing balm, something gently placed on a wound for healing.
Over the past several years, as meditation research has become more prevalent, science has become interested in the effects of loving-kindness practice on the mind and the body. Under the guidance of such well-known contemplatives as the Dalai Lama, researchers believed that LKM would offer similar benefits to other forms of meditation, such as breath meditation or open-awareness meditation.
As it turns out, LKM offers unique benefits that are subtly different from other kinds of meditation. What are those differences? Some just might surprise you.
LKM is a key tool for an optimal life.
One benefit of LKM is that loving-kindness reduces the stress response. Those who practice even a short course of LKM (say over the course of eight weeks) experience less distress than those who do not by the end of those eight weeks, according to this study. Probably no huge surprise there, right?
However, further exploration into this practice may intrigue you. The study on the effect of compassion meditation also investigated the impact of LKM on the body's inflammatory and neuroendocrine system. At first preliminary results revealed that LKM showed no discernable differences in inflammation compared to the control group.
However, when divided into high-practice group verses low-practice group (i.e., those who practiced LKM each day compared to those with minimal practice) the results became more striking. The high-practice group saw a significant decrease in inflammation compared to the low-practice and no-practice groups. This research highlights two important findings. First, that not only can LKM subjectively reduce distress, but it can impact the body's physiology as well (in this case, LKM reduced inflammation). The second, equally noteworthy finding is that this only happened for those who activity engaged in the practice of LKM. Simply attending a meditation class once a week was not enough to produce a change. Students had to practice at least a little each day.
Another pivotal study in the investigation of LKM was conducted by positive psychology researcher Barbara Fredrickson. Dr. Fredrickson and her team investigated the impact of LKM not only on emotions, but also on how this practice could actually build personal resources (cognitive, emotional and physical). Her research team invited a group of people to practice LKM over the course of nine weeks. Participants in the LKM group had to practice at least a little every day, and researchers measured subjects on a variety of outcomes -- including their experiences of positive emotions, their immunity to illness and their relationships to others. Her question: Could LKM actually build a person's personal resources?
It did. In their seminal research paper, Dr. Fredrickson and her team write,
These findings are powerful.
The Brain on LKM.
So we know that LKM positively impacts our emotions, our physical health, our sense of connection. But does that translate to an impact on the brain?
Neuroscientific meditation researcher Richard Davidson from the University of Wisconsin became interested in just that question. He has extensively studied the effect of meditation, including LKM, on the brain. He had a simple question. Would LKM change the brain? To investigate the exact implication of this practice on the brain he invited two groups of subjects into his lab: those who had at least 10,000 hours of LKM under their meditative belt and those who were interested, but new to meditation. He invited both these groups into the fMRI scanner to see how LKM would impact the brain.
The results were clear. The practice of LKM changed several important brain regions: both the insula and the temporal parietal junction (TPJ) lit up as a result of LKM. The insula is the part of the brain responsible for our ability to empathize with others, and to make oneself aware of emotional and physical present-moment experiences. While both groups saw an increase in insula activity, the group with 10,000 hours of experience showed significantly more activation than the other group. This group was experiencing higher levels of compassion than the non-practicing group.
A similar finding appeared for the TPJ. The TPJ, like the insula, is also related to our ability to process empathy and our ability to attune to the emotional states of others. Again, compared to short-term meditators, those with a long-term meditation practice showed significant activation of this brain region.
Loving-kindness creates feelings of social connection.
Given this research, it is no surprise that LKM has been shown to increase social connectedness, even for strangers. A study conducted by a group of researchers from Stanford University found that in just seven minutes of LKM, subjects reported greater social connection toward others. Other studies have shown that the feeling of social connection can predict changes in a person's vagal tone (a physiological measurement of resilience and overall well-being).
As a yoga teacher for Kripalu's Frontline Providers Program, I have the opportunity to teach the Loving-Kindness practice to members of a workforce who are at high risk for compassion fatigue -- health-care providers. In just the 10 minutes that I invite participants to practice LKM toward themselves and others, something powerful emerges. Some students begin to cry. Some bring their hand softly to their heart. Some physically relax. Afterward, when I invite the group to look around at each other, the sense of connection is palpable.
What is striking about the research and about the experience teaching is that these changes can happen in a short amount of time. Concentrated practice is essential. Even a few minutes creates a shift, and that shift is marked.
The Dalai Lama has been quoted as saying, "This is my simple religion. There is no need for temples; no need for complicated philosophy. Our own brain, our own heart is our temple; the philosophy is kindness." And indeed, it seems that in fact, with a little practice, LKM has the potential not only to improve our connection with ourselves, but to foster deeper connection and care for others as well.
For more from Kripalu, click here.
For more on mindfulness, click here.
One increasingly popular form of meditation is loving-kindness meditation (LKM), the practice of wishing oneself and others to be happy, content and at ease. In the yoga tradition, loving-kindness is seen as an opportunity to "cultivate the opposite."
Where many meditation techniques encourage students to explore difficult feelings or emotions directly, in loving-kindness the invitation is to send well wishes to oneself (who is in distress) as well as the other (who we feel distress toward). This isn't meant to suppress the feelings as they arise, but instead it can be thought of as a soothing balm, something gently placed on a wound for healing.
Over the past several years, as meditation research has become more prevalent, science has become interested in the effects of loving-kindness practice on the mind and the body. Under the guidance of such well-known contemplatives as the Dalai Lama, researchers believed that LKM would offer similar benefits to other forms of meditation, such as breath meditation or open-awareness meditation.
As it turns out, LKM offers unique benefits that are subtly different from other kinds of meditation. What are those differences? Some just might surprise you.
LKM is a key tool for an optimal life.
One benefit of LKM is that loving-kindness reduces the stress response. Those who practice even a short course of LKM (say over the course of eight weeks) experience less distress than those who do not by the end of those eight weeks, according to this study. Probably no huge surprise there, right?
However, further exploration into this practice may intrigue you. The study on the effect of compassion meditation also investigated the impact of LKM on the body's inflammatory and neuroendocrine system. At first preliminary results revealed that LKM showed no discernable differences in inflammation compared to the control group.
However, when divided into high-practice group verses low-practice group (i.e., those who practiced LKM each day compared to those with minimal practice) the results became more striking. The high-practice group saw a significant decrease in inflammation compared to the low-practice and no-practice groups. This research highlights two important findings. First, that not only can LKM subjectively reduce distress, but it can impact the body's physiology as well (in this case, LKM reduced inflammation). The second, equally noteworthy finding is that this only happened for those who activity engaged in the practice of LKM. Simply attending a meditation class once a week was not enough to produce a change. Students had to practice at least a little each day.
Another pivotal study in the investigation of LKM was conducted by positive psychology researcher Barbara Fredrickson. Dr. Fredrickson and her team investigated the impact of LKM not only on emotions, but also on how this practice could actually build personal resources (cognitive, emotional and physical). Her research team invited a group of people to practice LKM over the course of nine weeks. Participants in the LKM group had to practice at least a little every day, and researchers measured subjects on a variety of outcomes -- including their experiences of positive emotions, their immunity to illness and their relationships to others. Her question: Could LKM actually build a person's personal resources?
It did. In their seminal research paper, Dr. Fredrickson and her team write,
The practice of LKM led to shifts in people's daily experiences of a wide range of positive emotions, including love, joy, gratitude, contentment, hope, pride, interest, amusement and awe. These shifts in positive emotions took time to appear and were not large in magnitude, but over the course of nine weeks, they were linked to increases in a variety of personal resources, including mindful attention, self-acceptance, positive relationships with others and good physical health... They enabled people to become more satisfied with their lives and to experience fewer symptoms of depression.
These findings are powerful.
The Brain on LKM.
So we know that LKM positively impacts our emotions, our physical health, our sense of connection. But does that translate to an impact on the brain?
Neuroscientific meditation researcher Richard Davidson from the University of Wisconsin became interested in just that question. He has extensively studied the effect of meditation, including LKM, on the brain. He had a simple question. Would LKM change the brain? To investigate the exact implication of this practice on the brain he invited two groups of subjects into his lab: those who had at least 10,000 hours of LKM under their meditative belt and those who were interested, but new to meditation. He invited both these groups into the fMRI scanner to see how LKM would impact the brain.
The results were clear. The practice of LKM changed several important brain regions: both the insula and the temporal parietal junction (TPJ) lit up as a result of LKM. The insula is the part of the brain responsible for our ability to empathize with others, and to make oneself aware of emotional and physical present-moment experiences. While both groups saw an increase in insula activity, the group with 10,000 hours of experience showed significantly more activation than the other group. This group was experiencing higher levels of compassion than the non-practicing group.
A similar finding appeared for the TPJ. The TPJ, like the insula, is also related to our ability to process empathy and our ability to attune to the emotional states of others. Again, compared to short-term meditators, those with a long-term meditation practice showed significant activation of this brain region.
Loving-kindness creates feelings of social connection.
Given this research, it is no surprise that LKM has been shown to increase social connectedness, even for strangers. A study conducted by a group of researchers from Stanford University found that in just seven minutes of LKM, subjects reported greater social connection toward others. Other studies have shown that the feeling of social connection can predict changes in a person's vagal tone (a physiological measurement of resilience and overall well-being).
As a yoga teacher for Kripalu's Frontline Providers Program, I have the opportunity to teach the Loving-Kindness practice to members of a workforce who are at high risk for compassion fatigue -- health-care providers. In just the 10 minutes that I invite participants to practice LKM toward themselves and others, something powerful emerges. Some students begin to cry. Some bring their hand softly to their heart. Some physically relax. Afterward, when I invite the group to look around at each other, the sense of connection is palpable.
What is striking about the research and about the experience teaching is that these changes can happen in a short amount of time. Concentrated practice is essential. Even a few minutes creates a shift, and that shift is marked.
The Dalai Lama has been quoted as saying, "This is my simple religion. There is no need for temples; no need for complicated philosophy. Our own brain, our own heart is our temple; the philosophy is kindness." And indeed, it seems that in fact, with a little practice, LKM has the potential not only to improve our connection with ourselves, but to foster deeper connection and care for others as well.
For more from Kripalu, click here.
For more on mindfulness, click here.
Weekly Meditations for Healthy Sex (Oct. 4-10)
It's vital for mindful acts of emotional and spiritual intimacy to steadily develop as a daily practice for healthy sex. To that end, I've co-authored a book of daily meditations titled Mirror of Intimacy with a colleague at Center for Healthy Sex to help you reach your sexual and relational potential. (You can subscribe for free to receive the meditations by email, here.)
Even momentarily concentrating on healthy solutions rewires psychological patterns to receive and share healthy sexual love in the present. Here are three meditations with the themes of defects, denial, and exaltation for you to ponder and practice this week.
Meditation 1: Defects
"We don't love qualities, we love persons; sometimes by reason of their defects as well as of their qualities." -- Jacques Maritain
We've got every character defect under the sun, just as we possess every positive trait as well. This rich variety of our qualities creates a stumbling block for many who so fear judgmental "typecasting" that they are loathe to admit key characteristics, whether negative or positive. However, whatever enters our field of awareness is part of us, though we often perceive our own reality only when projected onto others. Early psychological differentiation involves defining ourselves in comparison with others. How many messages about unacceptable behaviors do we inherit along this journey! The ego emerges from adolescence with a definite set of attributes with which we identify, but this list is deceptive. If we were to catalogue all human character defects, we would each be able to recall at least one time at which we exhibited each attribute. And often, we are attracted to individuals whose over expression of defects that challenge us allows us to hide our own manifestation of the selfsame traits.
Recognizing the universality of every negative characteristic allows empathy and acceptance. The tricky part is to improve our character while accepting our faults. Denying imperfections to save face is counter-productive, for if we hide our real impulses to present an idealized version of ourselves, we're not presenting our real issues and we're avoiding emotional connection with others and our world. The reality of our inner thoughts and instincts can feel naked, shameful, raw or unwieldy. But exposed to the light with trusted others, these forbidden impulses underneath our defects become transformed. Then we can become integrated into a psychological wholeness. That great work is possible -- to contain and reconcile dissimilar extremes, orientations and aspects without losing our essential, potential unity.
Daily healthy sex acts
Meditation 2: Denial
"When we deny the spiritual dimension to our existence, we end up living like animals. And when we deny the physical, sexual dimension to our existence, we end up living like angels. And both ways are destructive, because God made us human." -- Rob Bell
Denial is an insidious habit that keeps us from learning painful truths. Whatever we can't admit, ironically, engulfs our experience of reality like quicksand. We become the proverbial ostrich with its head buried in the ground, refusing to recognize realities about a situation or person. When we deny any part of our selves -- past abuse, current problems or sexual identity -- we split ourselves into shards. And this splitting is the life-force of addiction, essential for it to grow, metastasize and suffocate us.
Borne out of unbearable pain, denial is constructed of distorted pieces of our psyche convincing us to minimize, justify and rationalize reality. Together, these workings of denial shield us from horrific memories or unacceptable present circumstances. When life becomes too heavy to bear we may turn to substances or processes to mitigate the misery. What may start out under the guise of youthful experimentation can lead to excess and even addiction, until one day we realize that our ability to choose vanished long ago, and shackles manifest around a wholly unrecognizable self. Empty and adrift, we flounder without direction, grabbing onto grandiose ideas of what we would like to be or who we would like to be with.
Often, the only way we can awaken from the stupor of denial is by "hitting bottom" -- experiencing an intolerably humiliating or near-death event. Waking up may mean we see that a toxic relationship we've been hanging onto must end. Facing the ensuing loneliness, along with the other unhappy realities of our life, is imperative for healing to begin. This process, sometimes called "withdrawal," sees the denied pain of the past rise to the surface once the object of desire -- person or substance -- has gone. Exploring the pain with trusted others is the next difficult task that lets us breathe free.
Daily healthy sex acts
Meditation 3: Exaltation
"True love is a discipline in which each divines the secret self of the other and refuses to believe in the mere daily self." -- William Butler Yeats
Exaltation signifies a peak experience -- functioning at full capacity in an elevated state. In astrology, a planet is exalted when it's in the sign allowing its greatest expression (so, only one twelfth of the time). We, too, long for exaltation, but like the planets, our lives achieve it only rarely. In love and sex, exalted feelings can easily overpower other emotions and experiences -- and thank the stars for that, since initial infatuation helps us overlook personal differences long enough for a loving bond to take root. We all have euphoric recall for our exaltations: when we hit the ball out of the park, when our words had meaning and were felt and understood, when our jokes made people laugh, when we thrived in joy.
Conversely, recalling peak experiences can dishearten us, convincing us that normal life is colorless or has passed us by. The vitality we feel one day to fulfill our potential can easily dissipate into doubt and despair. But the simple practice of acceptance is a great antidote for these fluctuations. True transpersonal exaltation is by definition bigger than any of us; it's not a state we can will or manipulate into being. Still, while much of the work we do to grow our hearts is an inside job, and while the experience of exaltation cannot be commanded, it can be encouraged through a benevolent focus on others. Through affirming others' potential with gentle, persistent knowing and support, we exalt the qualities we hold dear. And in time we will realize that we love in others exactly what we value in ourselves. Judgment or separation cannot coexist in true exaltation, which is the very best of us. And what's the best of us? It's all of us. Altruism is a distinct aspect of exaltation that we can all nourish and invite.
Daily healthy sex acts
For more by Alexandra Katehakis, M.F.T., click here.
For more on conscious relationships, click here.
Even momentarily concentrating on healthy solutions rewires psychological patterns to receive and share healthy sexual love in the present. Here are three meditations with the themes of defects, denial, and exaltation for you to ponder and practice this week.
Meditation 1: Defects
"We don't love qualities, we love persons; sometimes by reason of their defects as well as of their qualities." -- Jacques Maritain
We've got every character defect under the sun, just as we possess every positive trait as well. This rich variety of our qualities creates a stumbling block for many who so fear judgmental "typecasting" that they are loathe to admit key characteristics, whether negative or positive. However, whatever enters our field of awareness is part of us, though we often perceive our own reality only when projected onto others. Early psychological differentiation involves defining ourselves in comparison with others. How many messages about unacceptable behaviors do we inherit along this journey! The ego emerges from adolescence with a definite set of attributes with which we identify, but this list is deceptive. If we were to catalogue all human character defects, we would each be able to recall at least one time at which we exhibited each attribute. And often, we are attracted to individuals whose over expression of defects that challenge us allows us to hide our own manifestation of the selfsame traits.
Recognizing the universality of every negative characteristic allows empathy and acceptance. The tricky part is to improve our character while accepting our faults. Denying imperfections to save face is counter-productive, for if we hide our real impulses to present an idealized version of ourselves, we're not presenting our real issues and we're avoiding emotional connection with others and our world. The reality of our inner thoughts and instincts can feel naked, shameful, raw or unwieldy. But exposed to the light with trusted others, these forbidden impulses underneath our defects become transformed. Then we can become integrated into a psychological wholeness. That great work is possible -- to contain and reconcile dissimilar extremes, orientations and aspects without losing our essential, potential unity.
Daily healthy sex acts
- Reckless. Insatiable. Deceptive. Clingy. Vain. Dismissive. Trivial. Violent. Tactless. Controlling. Impractical. Fearful. Think of one example in your past where you exhibited each of these traits. Whatever memory comes to your mind first will usually provide you with a clear illustration. Know that you have the capacity to exhibit all defects, some more easily than others.
- Share yourself with your partner, who is probably more aware of your defects than you can imagine. Invite your partner to support your mindfulness of how and when your defects manifest, and allow all information received to bring your most hidden defects to light. Step into the light.
Meditation 2: Denial
"When we deny the spiritual dimension to our existence, we end up living like animals. And when we deny the physical, sexual dimension to our existence, we end up living like angels. And both ways are destructive, because God made us human." -- Rob Bell
Denial is an insidious habit that keeps us from learning painful truths. Whatever we can't admit, ironically, engulfs our experience of reality like quicksand. We become the proverbial ostrich with its head buried in the ground, refusing to recognize realities about a situation or person. When we deny any part of our selves -- past abuse, current problems or sexual identity -- we split ourselves into shards. And this splitting is the life-force of addiction, essential for it to grow, metastasize and suffocate us.
Borne out of unbearable pain, denial is constructed of distorted pieces of our psyche convincing us to minimize, justify and rationalize reality. Together, these workings of denial shield us from horrific memories or unacceptable present circumstances. When life becomes too heavy to bear we may turn to substances or processes to mitigate the misery. What may start out under the guise of youthful experimentation can lead to excess and even addiction, until one day we realize that our ability to choose vanished long ago, and shackles manifest around a wholly unrecognizable self. Empty and adrift, we flounder without direction, grabbing onto grandiose ideas of what we would like to be or who we would like to be with.
Often, the only way we can awaken from the stupor of denial is by "hitting bottom" -- experiencing an intolerably humiliating or near-death event. Waking up may mean we see that a toxic relationship we've been hanging onto must end. Facing the ensuing loneliness, along with the other unhappy realities of our life, is imperative for healing to begin. This process, sometimes called "withdrawal," sees the denied pain of the past rise to the surface once the object of desire -- person or substance -- has gone. Exploring the pain with trusted others is the next difficult task that lets us breathe free.
Daily healthy sex acts
- Do you find yourself minimizing, justifying, or rationalizing past situations or current people or behaviors in your life? If so, what are the distortions you tell yourself so as not to upset the status quo?
- What one thing do you need to give up in order to step out of denial?
- If you're unsure about a relationship or behavior you're engaging in, ask your closest friends what they think. Put down your defensiveness and listen with an open mind.
Meditation 3: Exaltation
"True love is a discipline in which each divines the secret self of the other and refuses to believe in the mere daily self." -- William Butler Yeats
Exaltation signifies a peak experience -- functioning at full capacity in an elevated state. In astrology, a planet is exalted when it's in the sign allowing its greatest expression (so, only one twelfth of the time). We, too, long for exaltation, but like the planets, our lives achieve it only rarely. In love and sex, exalted feelings can easily overpower other emotions and experiences -- and thank the stars for that, since initial infatuation helps us overlook personal differences long enough for a loving bond to take root. We all have euphoric recall for our exaltations: when we hit the ball out of the park, when our words had meaning and were felt and understood, when our jokes made people laugh, when we thrived in joy.
Conversely, recalling peak experiences can dishearten us, convincing us that normal life is colorless or has passed us by. The vitality we feel one day to fulfill our potential can easily dissipate into doubt and despair. But the simple practice of acceptance is a great antidote for these fluctuations. True transpersonal exaltation is by definition bigger than any of us; it's not a state we can will or manipulate into being. Still, while much of the work we do to grow our hearts is an inside job, and while the experience of exaltation cannot be commanded, it can be encouraged through a benevolent focus on others. Through affirming others' potential with gentle, persistent knowing and support, we exalt the qualities we hold dear. And in time we will realize that we love in others exactly what we value in ourselves. Judgment or separation cannot coexist in true exaltation, which is the very best of us. And what's the best of us? It's all of us. Altruism is a distinct aspect of exaltation that we can all nourish and invite.
Daily healthy sex acts
- Recall the exalted states and peak experiences of your life so far. Does the euphoric recall of your past inspire or inhibit your present?
- If you were to invite exaltation, what part of your life would you most like to thrive right now? Exalt in others that which you most desire in yourself. Make room to receive from life by freely giving your time, your truth and your love.
- Today, see the best in others. Imagine a warm, golden glow around everyone you meet. See beyond personalities to share in their spirit.
For more by Alexandra Katehakis, M.F.T., click here.
For more on conscious relationships, click here.
Saturday, October 5, 2013
Health Insurance 101: Know Your Options
This is second in a three-part "starter course" on the Affordable Care Act (aka, Obamacare)
Unless you've been living under a rock, you know that this week marked the opening of state- and federal-run insurance marketplaces ("exchanges"). While we don't know how they'll be regarded over time, initial reactions to them run the gamut from cynicism and uncertainty to measured optimism.
The exchanges are the centerpiece of the 2010 health reform law, called the Affordable Care Act (ACA) or, more commonly, Obamacare. The hope is to get health insurance to more than 40 million adults who don't have it now.
Beginning this week, Americans can start enrolling for insurance through the new exchanges. (Find yours by going to healthcare.gov.) The federal government is running or partnering with local officials to run these in 36 states in all. The remainder of states and the District of Columbia are operating their own exchanges. People can enroll through March, with coverage beginning on January 1.
Though now able to sign up for coverage, a new survey shows public confusion persists over how the ACA will work. It's important to know that help is available, from certified "navigators" to companies like ours, Maxwell Health, which aim to help consumers, employers, and even insurance brokers navigate the rapidly changing health care landscape.
Here are answers to some common questions that are being asked:
How will the exchanges change the way I get insurance?
Americans traditionally obtained insurance through an employer (or spouse's employer), or via Medicaid or Medicare; and if they couldn't get coverage this way they would go straight to the carriers themselves -- an often expensive proposition.
The exchanges are meant to provide relief by allowing millions of consumers to use an online marketplace to compare affordable insurance plans and buy coverage on the spot. People with pre-existing conditions will no longer be denied coverage or charged more (this applies to most plans outside the exchanges, too). In addition, no one with pre-existing medical conditions will be turned away, and all plans must cover 10 essential benefits like maternity care, mental health services and prescription drugs, without rating people according to their medical histories.
What's the difference between public marketplaces and private marketplaces (exchanges)?
You may have heard about public vs. private marketplaces/exchanges. The public marketplaces are those mandated by the ACA, and in 36 states those marketplaces are being run, at least in part, by the federal government. Private marketplaces, or exchanges, are privately managed, customized insurance marketplaces.
For instance, Walgreens, Sears Holding, and Darden Restaurants have all announced that their part-time (and some full-time) workers will be utilizing private exchanges, with workers given a defined contribution -- a set dollar amount -- that they can use toward the purchase of any health plan on the marketplace.
How can I differentiate between one plan and another?
The marketplace is divided into four categories to help simplify decision-making: Bronze, Silver, Gold, and Platinum. As you can imagine, the relative quality (and price) of each correlates to their name. (It's worth noting that expected premium amounts for plans in states with federally-run exchanges were recently announced and were actually lower than previous estimates.)
How do I pick the plan that's best for me?
If you're like most people, cost is your primary concern when it comes to buying health insurance. You don't want to pay too much each month, nor do you want to face huge bills in the event of a catastrophic medical emergency or event. Additionally, lifestyle and family makeup factor into your insurance decisions.
First, determine the highest amount you'd be able to comfortably afford if a major medical event were to occur. Is your threshold $1,000? $10,000? That number roughly corresponds to your desired deductible. (Of course the higher your deductible, the lower your monthly payments, or premium will be.) Then, factor in the monthly cost you're able to afford. Is it $100? $500? The higher that number, the lower the first number (your deductible) will be.
The final determination should be your own health risk factors. If you're relatively young and healthy (not yet middle-aged, no pre-existing medical conditions or chronic conditions), you're probably going to want to pay a lower monthly premium in exchange for a higher deductible, because the odds of a major health occurrence are lower.
If you know you'll be using health care fairly often, it may make more sense for you to opt for plans with built-in, predictable costs such as copays. These plans often have higher premiums and lower deductibles because you'll pay a fixed amount for doctor visits or procedures, versus paying a negotiated rate like you would with a higher deductible plan. Families with young children often choose these plans due to likely more frequent doctor visits, and common childhood incidents that may require care.
What if I can't afford health insurance?
If you can't fit a health insurance premium into an already tight monthly budget, that doesn't mean you won't be able to get coverage at all. A tax credit is available for people who fall under a certain taxable annual income threshold -- between 100 and 400 percent of the federal poverty level (FPL). (To find out where your income is in relation to the FPL, you can go here.)
To determine how much your tax credit and monthly premiums will be, you'll need to determine two things: your expected contribution and the cost of your "benchmark" plan. (The Kaiser Family Foundation has a handy calculator just for this.) Your benchmark plan is your state's silver-tier health plan with the second-lowest monthly premium. The tax credit you'll receive is the difference between your expected contribution and the price of the benchmark plan. (The tax credit functions like a gift card -- if you qualify, the government will send the funds directly to your insurance carrier, which in turn, lowers your monthly payment. You can also opt to receive the credit back in full on your tax refund, but then you'll have to pay the full premium amount each month.)
I'm still confused. Who can help me?
So-called "navigators" have been certified specifically to help people like you. They are trained to provide unbiased advice on how to compare health plan options as well as answer questions about enrollment, subsidies and federal programs like Medicare and Medicaid. You can speak with a navigator by calling the toll-free call center at 1-800-318-2596, or find local help by entering your zip code on this page.
Independent insurance brokers are another useful tool. Many are taking this opportunity to expand their range of services to in-person or over-the-phone assistance. One broker (interviewed this week by the Employee Benefit Adviser) in Corpus Christi, Texas, is using his office location as a way to attract individual consumers into what he's termed a "Health Insurance Enrollment Center." In this way, brokers are seeing a shift in their customer base -- from the HR director to employees and consumers themselves.
Lastly, for smaller companies and startups that are grappling with these issues, companies like Maxwell Health can help by leveraging technology and a concierge approach to health care to simplify the burden of researching and selecting the best insurance plans for their employees.
For more by Veer Gidwaney, click here.
For more on healthy living health news, click here.
Unless you've been living under a rock, you know that this week marked the opening of state- and federal-run insurance marketplaces ("exchanges"). While we don't know how they'll be regarded over time, initial reactions to them run the gamut from cynicism and uncertainty to measured optimism.
The exchanges are the centerpiece of the 2010 health reform law, called the Affordable Care Act (ACA) or, more commonly, Obamacare. The hope is to get health insurance to more than 40 million adults who don't have it now.
Beginning this week, Americans can start enrolling for insurance through the new exchanges. (Find yours by going to healthcare.gov.) The federal government is running or partnering with local officials to run these in 36 states in all. The remainder of states and the District of Columbia are operating their own exchanges. People can enroll through March, with coverage beginning on January 1.
Though now able to sign up for coverage, a new survey shows public confusion persists over how the ACA will work. It's important to know that help is available, from certified "navigators" to companies like ours, Maxwell Health, which aim to help consumers, employers, and even insurance brokers navigate the rapidly changing health care landscape.
Here are answers to some common questions that are being asked:
How will the exchanges change the way I get insurance?
Americans traditionally obtained insurance through an employer (or spouse's employer), or via Medicaid or Medicare; and if they couldn't get coverage this way they would go straight to the carriers themselves -- an often expensive proposition.
The exchanges are meant to provide relief by allowing millions of consumers to use an online marketplace to compare affordable insurance plans and buy coverage on the spot. People with pre-existing conditions will no longer be denied coverage or charged more (this applies to most plans outside the exchanges, too). In addition, no one with pre-existing medical conditions will be turned away, and all plans must cover 10 essential benefits like maternity care, mental health services and prescription drugs, without rating people according to their medical histories.
What's the difference between public marketplaces and private marketplaces (exchanges)?
You may have heard about public vs. private marketplaces/exchanges. The public marketplaces are those mandated by the ACA, and in 36 states those marketplaces are being run, at least in part, by the federal government. Private marketplaces, or exchanges, are privately managed, customized insurance marketplaces.
For instance, Walgreens, Sears Holding, and Darden Restaurants have all announced that their part-time (and some full-time) workers will be utilizing private exchanges, with workers given a defined contribution -- a set dollar amount -- that they can use toward the purchase of any health plan on the marketplace.
How can I differentiate between one plan and another?
The marketplace is divided into four categories to help simplify decision-making: Bronze, Silver, Gold, and Platinum. As you can imagine, the relative quality (and price) of each correlates to their name. (It's worth noting that expected premium amounts for plans in states with federally-run exchanges were recently announced and were actually lower than previous estimates.)
How do I pick the plan that's best for me?
If you're like most people, cost is your primary concern when it comes to buying health insurance. You don't want to pay too much each month, nor do you want to face huge bills in the event of a catastrophic medical emergency or event. Additionally, lifestyle and family makeup factor into your insurance decisions.
First, determine the highest amount you'd be able to comfortably afford if a major medical event were to occur. Is your threshold $1,000? $10,000? That number roughly corresponds to your desired deductible. (Of course the higher your deductible, the lower your monthly payments, or premium will be.) Then, factor in the monthly cost you're able to afford. Is it $100? $500? The higher that number, the lower the first number (your deductible) will be.
The final determination should be your own health risk factors. If you're relatively young and healthy (not yet middle-aged, no pre-existing medical conditions or chronic conditions), you're probably going to want to pay a lower monthly premium in exchange for a higher deductible, because the odds of a major health occurrence are lower.
If you know you'll be using health care fairly often, it may make more sense for you to opt for plans with built-in, predictable costs such as copays. These plans often have higher premiums and lower deductibles because you'll pay a fixed amount for doctor visits or procedures, versus paying a negotiated rate like you would with a higher deductible plan. Families with young children often choose these plans due to likely more frequent doctor visits, and common childhood incidents that may require care.
What if I can't afford health insurance?
If you can't fit a health insurance premium into an already tight monthly budget, that doesn't mean you won't be able to get coverage at all. A tax credit is available for people who fall under a certain taxable annual income threshold -- between 100 and 400 percent of the federal poverty level (FPL). (To find out where your income is in relation to the FPL, you can go here.)
To determine how much your tax credit and monthly premiums will be, you'll need to determine two things: your expected contribution and the cost of your "benchmark" plan. (The Kaiser Family Foundation has a handy calculator just for this.) Your benchmark plan is your state's silver-tier health plan with the second-lowest monthly premium. The tax credit you'll receive is the difference between your expected contribution and the price of the benchmark plan. (The tax credit functions like a gift card -- if you qualify, the government will send the funds directly to your insurance carrier, which in turn, lowers your monthly payment. You can also opt to receive the credit back in full on your tax refund, but then you'll have to pay the full premium amount each month.)
I'm still confused. Who can help me?
So-called "navigators" have been certified specifically to help people like you. They are trained to provide unbiased advice on how to compare health plan options as well as answer questions about enrollment, subsidies and federal programs like Medicare and Medicaid. You can speak with a navigator by calling the toll-free call center at 1-800-318-2596, or find local help by entering your zip code on this page.
Independent insurance brokers are another useful tool. Many are taking this opportunity to expand their range of services to in-person or over-the-phone assistance. One broker (interviewed this week by the Employee Benefit Adviser) in Corpus Christi, Texas, is using his office location as a way to attract individual consumers into what he's termed a "Health Insurance Enrollment Center." In this way, brokers are seeing a shift in their customer base -- from the HR director to employees and consumers themselves.
Lastly, for smaller companies and startups that are grappling with these issues, companies like Maxwell Health can help by leveraging technology and a concierge approach to health care to simplify the burden of researching and selecting the best insurance plans for their employees.
For more by Veer Gidwaney, click here.
For more on healthy living health news, click here.
The Seven Blessings That Come With Aging
Sister Joan Chittister is offering an online course on the blessings behind every aspect of growing older. Learn more about this opportunity here.
The one certain dimension of US demographics these days is that the fastest growing segment of the American population is comprised of people above the age of 65. We, and all our institutions, as a result, are a greying breed. At the same time, we are, in fact, the healthiest, longest lived, most educated, most active body of elders the world has ever known. The only real problem with that is that we are doing it in the face of a youth culture left to drive a capitalist economy that thrives on sales.
So, what we sell is either to youth, about youth, or for the sake of affecting youth. But after all the pictures of 60-looking 80 year olds going by on their bikes fade off the screen, the world is left with, at best, a very partial look at what it means to be an elder.
Especially for those who never did like biking much to begin with.
The truth of the matter is that all of life, at any age, is about ripening. Life is about doing every age well, learning what we are meant to learn from it and giving to it what we are meant to give back to it.
The young give energy and wonder and enthusiasm and heart-breaking effort to becoming an accomplished, respected, recognized adult. And for their efforts they reap achievement and identity and self-determination.
The middle-aged give commitment and leadership, imagination and generativity. They build and rebuild the world from one age to another. And for their efforts they get status, and some kind of power, however slight, and the satisfaction that comes from a sense of accomplishment.
The elderly have different tasks entirely. The elderly come to this stage of life largely finished with a building block mentality. They have built all they want to build. It is their task in life now to evaluate what has become of it, what it did to them, what of good they can leave behind them. They bring to life the wisdom that comes from having failed as often as they succeeded, relinquished as much as they accumulated. And this stage of life comes with its own very clear blessings.
PERSPECTIVE:
Given the luxury of years, the elders in a society bring a perspective on life that is not possible to the young and of even less interest to the middle aged whose life is consumed with concern for security and achievement. Instead the elders look back on the twists and turns of life with a more measured gaze. Some things, they know now, which they thought had great value at one age, they see little value in later. The elders know that what lasts in life, what counts in life, what remains in life after all the work has been completed are the relationships that sustained us, not the trophies we collected on the way.
The Elders are blessed with insight
TIME
For the first time in life, the elderly have time to enjoy the present. The morning air becomes the kind of elixir again that they have not known since childhood. The park has become an observation deck on the world. The library is now the crossroads of the world. The coffee shop becomes the social center of their lives. And small children a new delight and a companion, if not leaders, as they explore their way through life again.
The blessing of this time is appreciation of the moment.
FREEDOM:There is a kind of liberation that comes with being an elder. All the old expectations go to mist. The competition and stress that comes with trying to find a place in today's highly impersonal economy fade away and I can do what I like, wear what I like, say what I like without bartering my very survival for it. For the first time in years it is possible simply to be a person in search of a life rather than an economic pawn in search of a high-toned livelihood. The need to reek of competence and approval gives way to the need to enjoy life.
The awareness of life as liberating rather than burdensome is the most refreshing blessing a soul can have.
NEWNESS: The truism prevails that it is the young, that part of the social spectrum who stand on the brink of adulthood who have the opportunity to make the great choices of life: where to go, how to live, what to do with our one precious and fragile life. But if truth were told it is really the elderly who have the option to become new again. With the children on t heir own and the house paid for, with our dues paid to the social system and our identities stripped away from what we do to what we are, we have the world at our feet again. We can do all the things we've put aside for years: learn to play the guitar, go back to school, volunteer in areas we have always wanted to do more of like become a tour guide or a museum aid, go backpacking or become a children's reader at the local library. We can now get up every morning to begin life all over again.
The blessing of life now lies in the realization that life is not over but beginning again in a whole new way.
TALE TELLING: The elders in a society are its living history, its balladeers who tell the history of a people and the lessons of growth that come with them. The war veteran can talk now about the hell of war that belies its so-called glory. The mothers know what it means to raise children with less money than the process demands. The old couples know that marriage is a process not an event and that what draws people into marriage will not be what keeps them there. These are the ones who raise for the rest of us the beacons of hope that tell us the truth we need, on our own dark days, to hear: If these others could survive the depression, the losses, the breakups and breakdowns of life, we have living proof now, so can we.
The process of past reflection is one of the major blessings an elder can have because it crystallizes the value of one's own life and blesses the rest of the world with wisdom at the same time.
RELATIONSHIPS: In the lexicon of elders, all too often and all too late, a new event begins to take front and center where once work and the social whirl had held sway. Elders wake up in the morning aware that the only thing really left in life after all the schedules have disappeared are the people that have been left out of them for far too long: the adult children they haven't talked to for weeks--no, months--now. They remember the last old friend they met in the market who said "We really have to have coffee together some day" and begin to look around for the phone number. They recall with a pang the grandchildren they promised to take to the zoo and wonder with a pang whether or not the zoo is still open for the season--and whether the children still remember grandpa and the promise. Elders have the luxury of attending to people now rather than to things. And out of that attention comes a new sense of being really important to the world.
One of the great blessings of being elderly is not that it isolates us but that, ironically, it ties us more tightly to the people around us
TRANSCENDENCE: Finally, it is the elders in a society who distill for the rest of it the real meaning of life--and right before our eyes. The quality of their reflections on life are so different than ours, they must certainly be listened to. The serenity of their souls in the face of total change--both physical and social--give promise that behind all the hurly-burly lies a deep pool of peace. The devotion they bring to the transcendentals of life--to solitude, to prayer, to reading, to the arts, to the simple work of gardening, to the great questions of the age, to their continuing commitment to building a city, a country, a world that will be better for us when they move on, may be the greatest spiritual lesson of life a younger generation may ever get as well as the greatest insight they every have.
Indeed, to find ourselves on the edge of elderhood, is to find ourselves in an entirely new and exciting point in life. It is blessing upon blessing and it invites those around them to live more thoughtfully themselves by listening to them carefully now--while we all still have time.
If you are interested in learning how aging is really a great adventure and are looking for an online retreat, this just might be the thing for you.
Based on her book, The Gift of Years: Growing Older Gracefully, Sister Joan will use the themes of the book as launch pads for her reflections and discussion by eCourse
participants. During this month-long program which begins October 7 Sister Joan will focus on the blessings behind every aspect of growing older. It will be an opportunity to discover new perceptions and attitudes about growing older and their meaning for one's life. Look here for more information and to register.
The one certain dimension of US demographics these days is that the fastest growing segment of the American population is comprised of people above the age of 65. We, and all our institutions, as a result, are a greying breed. At the same time, we are, in fact, the healthiest, longest lived, most educated, most active body of elders the world has ever known. The only real problem with that is that we are doing it in the face of a youth culture left to drive a capitalist economy that thrives on sales.
So, what we sell is either to youth, about youth, or for the sake of affecting youth. But after all the pictures of 60-looking 80 year olds going by on their bikes fade off the screen, the world is left with, at best, a very partial look at what it means to be an elder.
Especially for those who never did like biking much to begin with.
The truth of the matter is that all of life, at any age, is about ripening. Life is about doing every age well, learning what we are meant to learn from it and giving to it what we are meant to give back to it.
The young give energy and wonder and enthusiasm and heart-breaking effort to becoming an accomplished, respected, recognized adult. And for their efforts they reap achievement and identity and self-determination.
The middle-aged give commitment and leadership, imagination and generativity. They build and rebuild the world from one age to another. And for their efforts they get status, and some kind of power, however slight, and the satisfaction that comes from a sense of accomplishment.
The elderly have different tasks entirely. The elderly come to this stage of life largely finished with a building block mentality. They have built all they want to build. It is their task in life now to evaluate what has become of it, what it did to them, what of good they can leave behind them. They bring to life the wisdom that comes from having failed as often as they succeeded, relinquished as much as they accumulated. And this stage of life comes with its own very clear blessings.
PERSPECTIVE:
Given the luxury of years, the elders in a society bring a perspective on life that is not possible to the young and of even less interest to the middle aged whose life is consumed with concern for security and achievement. Instead the elders look back on the twists and turns of life with a more measured gaze. Some things, they know now, which they thought had great value at one age, they see little value in later. The elders know that what lasts in life, what counts in life, what remains in life after all the work has been completed are the relationships that sustained us, not the trophies we collected on the way.
The Elders are blessed with insight
TIME
For the first time in life, the elderly have time to enjoy the present. The morning air becomes the kind of elixir again that they have not known since childhood. The park has become an observation deck on the world. The library is now the crossroads of the world. The coffee shop becomes the social center of their lives. And small children a new delight and a companion, if not leaders, as they explore their way through life again.
The blessing of this time is appreciation of the moment.
FREEDOM:There is a kind of liberation that comes with being an elder. All the old expectations go to mist. The competition and stress that comes with trying to find a place in today's highly impersonal economy fade away and I can do what I like, wear what I like, say what I like without bartering my very survival for it. For the first time in years it is possible simply to be a person in search of a life rather than an economic pawn in search of a high-toned livelihood. The need to reek of competence and approval gives way to the need to enjoy life.
The awareness of life as liberating rather than burdensome is the most refreshing blessing a soul can have.
NEWNESS: The truism prevails that it is the young, that part of the social spectrum who stand on the brink of adulthood who have the opportunity to make the great choices of life: where to go, how to live, what to do with our one precious and fragile life. But if truth were told it is really the elderly who have the option to become new again. With the children on t heir own and the house paid for, with our dues paid to the social system and our identities stripped away from what we do to what we are, we have the world at our feet again. We can do all the things we've put aside for years: learn to play the guitar, go back to school, volunteer in areas we have always wanted to do more of like become a tour guide or a museum aid, go backpacking or become a children's reader at the local library. We can now get up every morning to begin life all over again.
The blessing of life now lies in the realization that life is not over but beginning again in a whole new way.
TALE TELLING: The elders in a society are its living history, its balladeers who tell the history of a people and the lessons of growth that come with them. The war veteran can talk now about the hell of war that belies its so-called glory. The mothers know what it means to raise children with less money than the process demands. The old couples know that marriage is a process not an event and that what draws people into marriage will not be what keeps them there. These are the ones who raise for the rest of us the beacons of hope that tell us the truth we need, on our own dark days, to hear: If these others could survive the depression, the losses, the breakups and breakdowns of life, we have living proof now, so can we.
The process of past reflection is one of the major blessings an elder can have because it crystallizes the value of one's own life and blesses the rest of the world with wisdom at the same time.
RELATIONSHIPS: In the lexicon of elders, all too often and all too late, a new event begins to take front and center where once work and the social whirl had held sway. Elders wake up in the morning aware that the only thing really left in life after all the schedules have disappeared are the people that have been left out of them for far too long: the adult children they haven't talked to for weeks--no, months--now. They remember the last old friend they met in the market who said "We really have to have coffee together some day" and begin to look around for the phone number. They recall with a pang the grandchildren they promised to take to the zoo and wonder with a pang whether or not the zoo is still open for the season--and whether the children still remember grandpa and the promise. Elders have the luxury of attending to people now rather than to things. And out of that attention comes a new sense of being really important to the world.
One of the great blessings of being elderly is not that it isolates us but that, ironically, it ties us more tightly to the people around us
TRANSCENDENCE: Finally, it is the elders in a society who distill for the rest of it the real meaning of life--and right before our eyes. The quality of their reflections on life are so different than ours, they must certainly be listened to. The serenity of their souls in the face of total change--both physical and social--give promise that behind all the hurly-burly lies a deep pool of peace. The devotion they bring to the transcendentals of life--to solitude, to prayer, to reading, to the arts, to the simple work of gardening, to the great questions of the age, to their continuing commitment to building a city, a country, a world that will be better for us when they move on, may be the greatest spiritual lesson of life a younger generation may ever get as well as the greatest insight they every have.
Indeed, to find ourselves on the edge of elderhood, is to find ourselves in an entirely new and exciting point in life. It is blessing upon blessing and it invites those around them to live more thoughtfully themselves by listening to them carefully now--while we all still have time.
If you are interested in learning how aging is really a great adventure and are looking for an online retreat, this just might be the thing for you.
Based on her book, The Gift of Years: Growing Older Gracefully, Sister Joan will use the themes of the book as launch pads for her reflections and discussion by eCourse
participants. During this month-long program which begins October 7 Sister Joan will focus on the blessings behind every aspect of growing older. It will be an opportunity to discover new perceptions and attitudes about growing older and their meaning for one's life. Look here for more information and to register.
Subscribe to:
Posts (Atom)