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22/Mar/2018

price-of-admission

“Discomfort is the price of admission to a meaningful life.” – Susan David

Dr. Susan David is a Psychologist at Harvard Medical School and is a founder and co-director of the Institute of Coaching at McLean Hospital of Harvard Medical School.  In her Ted Talk about emotional agility, which you can find here, she discusses the concept of emotional agility, how society has made a push towards positivity, and inadvertently, how this may have led to additional suffering.

There is a push in our media, in our society, and in our homes to be positive; think positive, look on the bright side, or simply, smile!  Dr. David posits that this push towards positivity often leads to denial of the truth and denial of our emotions.  We can end up feeling bad about ourselves for experiencing negative emotions and negative thoughts because we’re supposed to be happy and positive all of the time.

The truth is, life isn’t always happy and positive.  Certainly there are times in our lives when we are happy and things are going well and we feel good, but there are also times when things do not go our way and we just feel bad.  Dr. David suggests that instead of trying to be positive during these times, and pushing those negative thoughts away, we need to embrace them, to learn to deal with and cope with them rather than trying to run away from them.  Dr. David’s Ted Talk mirrors much of what is discussed in Acceptance and Commitment Therapy and, in particular, the idea that we must accept, rather than try to push away, negative thoughts and feelings.  These things are a way of life and like a rollercoaster, sometimes we have to just wait it out.

I like to use grief as an example in my practice with clients.  Our society treats grief as something that is normal – we are expected to be sad or to cry when someone close to us passes away.  We also know that people we love may pass away, and as much as we do not like that thought, we have no choice but to accept it.  We treat grief with a lot of respect, in most cases, and allow it to come and go naturally.  I believe that we need to learn to treat the rest of our emotions with the same type of respect that we treat grief.  When we are feeling anxious or sad, rather than beating ourselves up for these feelings we should be accepting that this is how it is right now, and allowing those feelings to come and go.  Often, the more we try to control these feelings, the worse off we become.  Either we actually end up enhancing the feelings that we started with, or we add additional distress, such as shame or frustration when we do not succeed in getting rid of the feelings.

I would like to challenge you to you try accepting your negative thoughts and feelings, and treating them with the same respect that you would grief.  Listen to Dr. David’s Ted Talk, and reflect back on your own experiences of trying to get rid of your negativity.  Try something new, and see what happens.

jenny-thomson

Source: Click


13/Feb/2018

hearts

With Valentine’s Day fast-approaching, and the holiday seasoning winding down, I found myself reflecting on the important people in my life, and how we choose to celebrate these people.  When we think of birthdays, anniversaries, Valentine’s Day, Christmas, and other important holidays, what do we think of?  For me, the first thing that pops into my mind is gifts.  Chocolates and flowers for Valentine’s Day and anniversaries, expensive presents, gift cards, and even money for other important occasions.  But is this how we really want to celebrate the most important people in our lives?

While gift-giving can be a great way to show a loved one that you’ve been thinking about them, spending quality time with loved ones is also extremely important.  A study outlined by NPR in a December article suggested that people felt most loved during times of interaction rather than when receiving gifts.  However, during busy holiday times, such as in December, people often feel additional stress at having to rush to spend time with people close to them.

During these times of high stress, such as Christmas, we often lose sight of being present.  We become consumed with worries about making it to every family gathering, getting the right gifts, and planning out every detail of our holidays that we may forget to stop and enjoy the moment.  Christmas may be over for this year, but we can still practice being more present with our loved ones.  Take some time to breathe and ground yourself before attending that birthday party or anniversary dinner – leave the stress from work and home where they belong, and practice being in the moment.

Instead of focusing on gifts for your upcoming anniversary or birthday, why not begin a tradition that involves spending time with one another, or going on an adventure every year?  Maybe you and you partner decide that every year on your anniversary you will try a new restaurant in a different city, or that every Christmas you will plan your annual trip together.  Try shifting your focus from giving and receiving material items, to making new memories and living a fulfilled life.

holding-hands

All in all, I think we sometimes lose sight of why we take time out of our busy lives to see the people who are important to us.  We want them to feel loved and appreciated, and know that they are important to us.  So maybe try something new – make some great memories that will last a lifetime with the people that are most important in your life.

jenny-thomson

Source: https://www.npr.org/sections/health-shots/2017/12/09/568834440/what-s-better-than-expensive-presents-the-gift-of-presence 


26/Jan/2018

To start off the New Year, I thought writing about finding self-compassion for oneself could be quite beneficial.  When creating resolutions we often think about health and perhaps setting a goal for going to the gym more or eating better.  I think in addition to this, learning to find self- compassion could create a huge positive impact on your life and well-being.

I am sure, just like me, there are times when you can be quite hard on yourself and judgmental.   I have often discussed with clients that it is not uncommon for us to speak negatively internally to ourselves and that we find our brain saying things that we would probably never even say to a perfect stranger or even someone we dislike.

So much inner turmoil can stem from criticizing ourselves.  As humans, we all go through difficult times and we can be easily hooked by re-hashing these events by questioning what we could have done or should have done or what we did wrong.

Finding self-compassion is about feeling loved, accepted and appreciated.  Learning that deep down we are okay and recognizing that no matter what is happening in our lives we deserve love, happiness and appreciation.  Through finding and building self-compassion we can also be working on creating a tool for ourselves to utilize when we are suffering or experiencing distress, and it can be that supportive voice that helps us find beauty and meaning.

A simple way to look at self-compassion is the opposite of being self-critical.  Practicing noticing this difference when life is going well, and when it is hard, is very important.  Self-compassion takes time to build, but awareness and practice of using a self-compassionate attitude can give you an internal source of emotional regulation and resilience.  It can help you to be more connected with the present and the beauty of life.

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The following is a simple mindfulness practice you can start today to begin working on cultivating self-compassion:

Arrange yourself in a comfortable position, eyes opened or closed.  You might place your hands on your heart or lap.

You are going to start by thinking about different objects – it can be a person, animal or anything else – until you find one that brings up natural and uncomplicated feelings of warmth and love.

Now continue to concentrate on this object you feel love towards.  Let the image of it, in your mind, become clearer.  Do you notice any relaxation, tension, or lightness?  Just note that.

Now try saying the following phrases to the object you are picturing.  Feel free to change the phrases:

  • May you be happy
  • May you be healthy
  • May you be safe
  • May you be loved

Repeat these phrases a few times and allow the positive feelings in your body to be as strong as they want to be (continue for about 5 minutes).

Now picture that person saying the following phrases to you:

  • May you be happy
  • May you be healthy
  • May you be safe
  • May you be loved

Picture the person saying these phrases a few times and allow the positive feelings in your body be as strong as they want to be (continue this for about 5 minutes).

kathryn-camacho1

Sourced from The Self-Compassion Skills Workbook by Tim Desmond


29/Dec/2017

res·o·lu·tion

 noun; a firm decision to do or not to do something.


That time of year when our use of the word RESOLUTION tends to skyrocket is just around the corner. As a new year approaches, we often naturally find ourselves thinking about what goals we would like to set for ourselves in the upcoming year.  We make promises to ourselves, and perhaps also to our friends or family, about what we plan to do differently, what we plan to start, and what we plan to stop.  Creating New Year’s Resolutions can be a great way to not only make plans or set commitments for the upcoming year, but also to reflect on the past year.

2017

Although it may sound like a simple task, many of us struggle with it.  Some of us may feel that we cannot narrow down our list and may feel overwhelmed by the number of things we would like to accomplish, while others may feel that they cannot think of anything they would like to start, stop or change in the New Year.  Even for those of us that have a clear idea of what we would like to achieve, we may find ourselves doubting whether we can actually do it, or whether we actually will.

We would like to provide you all with some useful steps to follow when setting your New Year’s Resolutions this year.  These strategies will help you to narrow down what you value in life and set commitments in accordance with those values.

STEP 1:  REFLECT MINDFULLY

First and foremost, take some time to reflect on the past year.  Take out a blank piece of paper and answer the following questions:

  • What did you accomplish this past year that you are proud of?

Remember, this is something that YOU are proud of accomplishing and not only something from which you received recognition from others. What is important is not the size of the accomplishment or the reward of that accomplishment, but rather that it was an accomplishment at all.

Accomplishments may not always provide pleasure or reward and they may not always be recognized by others as accomplishments, and that’s okay.  For example, if you had been avoiding asking someone out on a date, but then did it, even if they rejected your invitation and left you feeling let down and embarrassed, you may still consider the act of asking the person out an accomplishment.

  • What were you grateful for this past year?

Thinking about what you are grateful for can highlight areas of life that are important to you.  It can identify people or things that you value and cherish, which can act as foundations upon which you set goals for the future.  For example, if you identify that you are grateful for your job and the lifestyle it allows you to live, you may be more inclined to set New Year’s Resolutions that help you to grow within your job or further develop your skills for your job.  Whereas if you find yourself noticing that you are not grateful for your job at all, perhaps that realization will allow you to set resolutions for change in that area of your life.

  • On a scale of 0 to 10 (0 = not at all, and 10 = completely), how connected did you feel within each of the domains listed below over the past year?

If any of these domains are not at all important to you, feel free to skip them, however, if you hold any value in the domain, reflect on how connected you were in that area of your life this past year.  Also, feel free to add your own domains if you think of one that is not listed here and is important to you.

Family relationships
Intimate relationships
Friendship
Work
Health
Spirituality
Community involvement
Leisure
Personal growth

See if you can identify some domains that were lacking compared to others this past year, and perhaps that will help you to set New Year’s Resolutions targeted to improve that domain in the upcoming year.

STEP 2:  IDENTIFY VALUES

Once you have finished reflecting on the past year, use the information you gathered to identify who and what is important to you.  This will help you later on when you are ready to set some resolutions because you will be able to recognize who and what you want to move towards in the New Year.  For example, if you noticed that you were proud of your accomplishment of asking someone out on a date, you were grateful for your friends who supported you when you were turned down, yet you were still feeling disconnected in the intimate relationship domain of life, perhaps you can use this information to set a resolution that will help you move towards becoming more connected in that domain despite the disappointment you had endured in the past year.  It is a New Year, a perfect time to try again, and it is always worth it if it is something that really matters to you.

STEP 3:  SET S.M.A.R.T. RESOUTIONS

Setting New Year’s resolutions, in more generic terms, is goal setting.  Some of you may have heard of SMART goals in goal setting.  Making your goals SMART increase the likelihood that you will be successful in achieving them.  It allows you to structure them in such a way that they almost feel that they can be held in your hands as an object rather than feeling like they are floating somewhere in the clouds.

** In brackets I added some substitute words that I found on Project Smart which I felt are also relevant to the objective of SMART goals, and particularly in setting New Year’s Resolutions (https://www.projectsmart.co.uk/smart-goals.php).

S – Specific (Significant)

Make sure each resolution that you set is clear to you and that it is specific enough that you would be able to explain it to someone else in just one sentence leaving as few unknowns left as possible.  See if you can answer who, what, where, when, why, and how for each goal you set.  For example, saying that your goal for the New Year is to be healthier is not a specific goal, whereas saying that your goal is to be healthier by exercising four days a week for at least 30 minutes and eating at least one serving of fruits and vegetables a day IS a specific goal.

M – Measurable (Meaningful, Motivational)

Make sure that you are able to measure your progress with your goal.  Are you able to identify when you are moving towards that goal or away from that goal?  For example, are you able to measure if you are being healthier if you don’t have anything to reference that goal with?  What does ‘healthier’ mean to you?  A measurable goal would be like the example above of exercising 4 times per week for at least 30 minutes – you would easily be able to measure whether you had done this or not.

A – Achievable (Attainable, Adaptive, Action-oriented)

Make sure that you have the means to achieve your goal.  Are there barriers to achieving your goal that are completely out of your control?  If you are setting a New Year’s Resolution that has the time-frame of one year, is this goal achievable in that time-frame?  For example, if your goal is to become a doctor, is it possible to complete all the necessary education and training to do that in just one year?  This does not mean that you should not set resolutions that will take longer than a year, but perhaps the end goal needs to be broken down into smaller, more achievable goals.  For example, if becoming a doctor is your end goal, then perhaps your New Year’s Resolution could be to have all your medical school applications submitted by the end of the year.

R – Relevant (Realistic, Reasonable)

Make sure to check in with your values to identify whether the goals you are setting are actually relevant to YOU.  Do not set your goals based on what other people want you to do (unless your underlying reasoning is because it is important to you to make that person happy), and do not set goals based on things you feel you should do.  For example, if you set a goal to attend Church weekly solely because your family is very religious and want you to attend Church regularly, is this goal truly relevant to YOU?

T – Time-based (Trackable)

Make sure your goal has a target date.  With New Year’s Resolutions, this target date is usually sometime within the year, but the more specific you can get with your time-frame, the better!  You can ask yourself questions like:  What can I do this week?  What can I do in the next month?  What can I do in 6 months? And so on, that may help you move towards a long term goal.

A new year provides opportunity to reflect on the past year and plan for the year to come.  We understand and can appreciate first hand that setting New Year’s Resolutions can seem like a daunting or overwhelming task, but we hope that the strategies above help you to identify what is important you through mindful reflection and set goals that are in line with what you value.


From all of us at JMA, we wish you a very Happy New Year full of values guided living!

jessica-rickus1


17/Nov/2017

Obesity, dieting and weight loss – what do we know? 

In Part 1 of this series, we looked at the effectiveness of weight loss programs and diets by people who feel fat and want to lose weight.  We concluded that losing weight is not the solution.  Even after losing weight, guilt, deprivation and “feeling fat” can persist.  The solution is to acquire the skills to control when you start eating and when you stop eating.

In Part II of this series, we looked at what it is that starts and stops us from eating – the determinants of eating behaviour – and why it is that we have to eat in the first place.  We will discover that “the real problem” has nothing to do with willpower.

In Part III of this series, we will look at the extremely complex internal mechanism that regulates our eating behaviour.

Willpower. on Pocket Watch Face with CloseUp View of Watch Mechanism. Time Concept. Film Effect. Pocket Watch Face with Willpower Text on it. Business Concept with Vintage Effect. 3D Render.

PART III:  The Internal Automatic Regulatory Mechanism (ARM)

We now recognize that the balance needed for the existence of life is extremely ‘delicate’ and that the control of this balance is simply too important to be left to conscious control.  To think that humans regulate their weight and their food intake by consciously thinking about it and making calculated decisions, is simply absurd.  It is important to keep these things in perspective.

Obviously, there must exist some type of mechanism – a regulator – which controls the balance of energy.  The analogy which is often made is to a thermostat in your house.  The thermostat in your house controls the temperature of your house or the quantity of heat in your house.  It does this by measuring the temperature – a measure of heat energy.  Something in the thermostat – a type of metal or mercury or some other substance – changes with temperature (it expands or contracts) and this can turn on a switch which turns on the furnace which generates more heat.  When heat is generated and the temperature rises, it changes the thermostat which in turn shuts off the switch.

This is known as a “negative feedback system”.  That is, the more the furnace works, the more it shuts itself off.

A similar system must be operating in your body.  When you need energy, something measures the need and turns on ‘hunger’- the drive to eat.  This is also a negative feedback loop in that the more food you consume, the less eating you should want to do – eating should shut itself off.  When there is enough energy, eating is shut off – i.e. ‘satiety’

But how does this system work?  Let us look at this in more detail.

What Is Being Controlled

In your house we know that what is being controlled (the controlled quantity is heat as measured by the temperature of your house).  But what is it that is being controlled in your body?  Think about it.  What is it in your body that is being measured and controlled?  Is it your body weight?  Is there something inside which can measure your body weight and when you begin to lose weight you start to eat and as you gain weight you are compelled to stop eating?  Or is it your body temperature?  Or is it energy in general, as measured by calories?  What is it?

Before we begin to try to answer this question, let us look at some of the research studies that have been done so that we can get a better idea of just how well the system works and what affects it.  The studies that will be discussed here are just a very brief summary of the many studies that have been done with a variety of different types of animals as well as with humans.

The first step is just to gather more information so that we can get a better idea about what is going on.

  • Random Diet

What do you think would happen if you take animals (e.g. laboratory rats) and give them a ‘cafeteria’ diet?  That is, if you give them many different types of foods that they can partake of freely in a fairly comfortable and relaxed environment.  You could give them chocolate chip cookies, bananas, specially prepared well-balanced laboratory diets, and all sorts of other foods that humans eat.

What do you think happens when animals are put into such environments and allowed to eat as much as they wish at any time?  Do you think that they gain weight?  Lose weight?  Binge on only specific types of foods?  Maintain a well-balanced diet?  Maintain their weight?  What do you think?

Well, unless the circumstances are very abnormal or extraordinary, you would find that the animals tend to eat a well-balanced diet, maintain their caloric intake and maintain their weight.  The regulator works very accurately under these circumstances.

  • Artificial Weight Gain

Animals can be made to gain weight artificially through a number of means including such things as force feeding (as is done with geese and other animals which are bred to produce certain types of foods) or through injecting insulin which increases the uptake if sugar and causes animals to eat more and gain more weight.  What do you think happens when animals who have had their weight artificially raised are allowed to eat food freely without continued insulin injections or force feeding?  Do you think that they continue to gain more weight?  Maintain their elevated weight?  Lose weight?

Animals in this situation will decrease their food intake below what they normally eat until their weight decreases and levels off back within a normal range.  They will then maintain their food intake and caloric intake at an appropriate level to maintain their weight.

The regulator continues to work!  Even when animals are made artificially fat, their weight returns to normal and their eating is maintained at an appropriate level.

  • Artificial Weight Loss

Animals can be made to lose weight by decreasing the amount of food they are given – i.e. depriving them.  What do you think happens when rats are artificially made to lose weight by being deprived of food and then given their food back freely?  Do you think they continue to maintain a lower weight?  Do you think they gain weight?

When allowed to eat freely again, the animals actually increase their food intake beyond their regular levels until their weight comes back into the normal range.  They then level off their caloric intake to maintain their weight within the normal range.

Again, the regulator works very accurately even if you try to trick the system by artificially decreasing body weight.

  • Caloric Dilution

It is possible to dilute the number of calories in an animal’s food by adding non-nutritive bulk such as cellulose to dry food or water to a liquid food like Metrecal.  What do you think happens to the rats if you dilute their food in half by adding non-nutritive bulk?  Obviously, in order to eat the same number of calories they would have to eat twice the quantity of food.  Do you think the animals eat more?  Eat less?  Eat the same?  Do you think they gain weight?  Lose weight?  Stay the same?

Studies clearly demonstrate that animals increase the amount that they eat in relation to how much you dilute to food.  If you dilute the food in half, they eat twice as much.  They maintain their caloric intake at a constant level; they maintain their weight; and the regulator continues to work even though they have to eat twice as much.

  • Concentrate Calorie

It is possible to increase the number of calories in an animal’s food (the calorie density) by mixing very high caloric substances in with the regular food.  For example, one can include glucose in with the regular food.  In fact, animals prefer this mixture if given a choice between their regular food and food mixed with the sugar solution.  But now, the same quantity of food has significantly more calories.  What do you think animals do in this situation?  Do you think that they eat more food and gain weight, or do you think they eat less food and maintain their weight?

Again, the regulator works!  Animals in this situation, even when presented with food that they find appealing and prefer, will actually decrease the total amount that they eat in order to maintain a constant caloric intake and maintain their weight.

  • Aversive Flavour

Obviously, one factor which affects eating is the taste of the food.  Just as sugar makes the food more appealing or preferred, the same food can be made less appealing and even aversive by adding some substances.  Quinine, for example, is an extremely bitter substance which animals and humans find very distasteful if added even in small amounts.  If you add a very small amount to the regular food of a rat and give the rat a choice between a quinine adulterated food and another food, the rat will never eat the quinine flavoured food.  However, what do you think the animal does if you don’t give it a choice and it only has the quinine flavoured food to eat?  Do you think it eats less?  Do you think it eats the same?  Do you think it loses weight?

Well, as you may have guessed, the animals will continue to eat the same caloric quantity even though they appear to hate the food – to the point where the food literally becomes poisonous and makes them ill.  The regulator works again!  Animals will continue to eat the number of calories required to maintain their weight even when the food is very aversive and bad tasting.

In summary, therefore, we can see that the regulator works very well indeed.  Even when extraordinary attempts are made to ‘trick’ the system, the system still works very accurately.  While there are always exceptions, this is generally the rule for all animals under normal situations and, if you think about it, it is true for most people as well.

How does it work?

It is quite clear that caloric intake is being regulated very carefully.  So is weight.  The question is now, how does it work?  If you were going to build a system inside the body to monitor and regulate the caloric intake, how would you do it?

Going back to our example of a thermostat in the house, we know that mercury expands with increased quantity of heat (temperature).  The mercury will vary exactly with the amount of heat – the quantity we wish to control – and we can connect a switch to the mercury level and consequently it is easy to measure and control the amount of heat in our house.

But how would we measure the amount of energy being taken in or used up by our body?  What would be equivalent to that column of mercury in our body?  What system or systems in our body do you think could be used to tell us when we need or do not need energy?

This very question has been the centre of much interest for more than 100 years of scientific investigation.  There are volumes written about this.  Let’s just look at some of these briefly.

  • Gastric Motility – Stomach

The stomach and its activities is an obvious possibility.  Stomach ‘growling’ and sensations are frequently associated with ‘hunger pangs’.  Not surprisingly, this was one of the earliest areas of research.  Many years ago some researchers felt that hunger was in fact simply the sensations of stomach contractions.

While there is absolutely no doubt that the stomach plays a very important role in controlling and monitoring our eating, there is already some evidence that indicates that the stomach, by itself, cannot be the controlling factor.

Remember what we observed with our rat?  When food is diluted of calories, the animals eat much more.  Stomach distention by itself, therefore, cannot be the ruling factor.  In addition, there is clear evidence that humans with partial removals of their stomachs as well as those with denervation of their stomachs regulate their weight very well, although meal patterns change somewhat.

Therefore, the stomach, although it may be important, is by itself not even necessary for accurate regulation.

  • Oral pharyngeal Factors

The mouth and throat, chewing and swallowing, taste and smell, all play significant roles in affecting our eating.  There have been numerous studies which indicate a significant involvement of all of these factors.

For example, the simple acts of eating and swallowing alone, even without the food entering the stomach, will have the effect of stopping the eating of an animal (for a short term).  Similarly, our taste buds are affected by many aspects of the physiological condition of our body, including our specific needs for various nutrients or what we have just eaten.  This in turn influences how different things taste to us – sweet, salty, good or bad – and consequently affects our ‘appetite’ for different types of food.  It has also been demonstrated, for example, that when certain substances such as sugar are taken into the mouth, these substances may permeate the lining of the mouth and actually enter into the blood and brain well before the food becomes digested in our stomachs.  This allows our brain to monitor what we are eating very rapidly.

However, other studies indicate that actually eating the food is not even necessary for maintaining caloric regulation and weight.  Studies on animals with tubes inserted directly into their stomachs indicate that animals will learn to press levers to have food injected directly into their stomach without even tasting or swallowing the food.  These animals will maintain appropriate caloric intake and maintain their weight.  Even if you dilute their food, they will increase their intake appropriately.

Therefore, although oral pharyngeal factors are clearly important and significant, they also cannot fully explain how the system maintains caloric intake and weight regulation.

  • Body Temperature

The various temperatures of different parts of our bodies have a major effect on our eating behaviour.  When our ‘core’ (deep internal body) temperature rises, eating behaviour becomes inhibited.  For example, when people have fevers, there is a definite suppression of appetite.  The relationship between core temperature, brain temperature, and body surface temperature is quite complex and its effect on eating is also very complex and unclear.

However, there is also evidence which indicates that temperature and eating can be separated.  For example, many drugs which are used to supress appetite actually decrease temperature.  So it can be seen that body temperature and eating behaviour can be separated and temperature by itself cannot be the controlling factor.

  • Lipostatic – Fat Metabolism Rates

There have been suggestions that the metabolism of fat in our body is a critical factor in affecting our eating behaviour and the regulation of calories.  We already know that when we have excessive calories, physiological changes can take place to convert excess sugar into fat.  When we require energy and have a deficit of readily available calories, our physiology shifts in the other direction to convert fat to sugar.  There have been some suggestions that this mechanism itself is the critical factor indicating hunger (fat to sugar) and satiety (sugar to fat).  The most obvious limitation with this particular theory is that the process is so slow it would not begin to stop eating during a meal until far too many calories had been consumed.  Therefore, while this metabolic cycle may in fact be important, it by itself cannot account for the precise and delicate control of eating behaviour and caloric regulation.

  • Blood Borne Factor

It has been well known for many years that factors in the blood affect eating behaviour.  There have been numerous studies which have shown that such things as infusing the blood of a hungry animal into the body of a satiated animal will cause that animal to begin eating.

While there are numerous possibilities as to what these various blood-borne factors might be, one obvious factor is the blood glucose (sugar) level.  The ‘glucostatic’ theory suggests that the amount of sugar in the blood controls whether a person is hungry or satiated.  Increasing the amount of sugar in the blood of an animal which is eating will cause eating to stop.  However, there is no relationship between the amount of sugar in the blood and the beginning and cessation of eating.

The glucose utilization (A/V ratio) suggests that the critical factor is not the absolute concentration or amount of sugar in the blood, but rather the amount of sugar in the arteries (the blood vessels that take the blood to the cells of the body to nourish them) and the amount in the veins (the blood vessels which take the used blood away from the cells).  Obviously, if your body does not need energy and is not using sugar, the amount of sugar in the arteries will be the same as the amount of sugar in the veins.  However, if your body does need energy and is using sugar to provide that energy, then the amount of sugar in the arteries will be greater than the amount of sugar in the veins.  There is a good relationship between this ratio and onset and cessation of eating behaviour.

However, there are problems with these theories as well.  Diabetics who have notoriously high blood sugar levels are also well known for having voracious appetites.  The fact is, that eating behaviour and blood sugar levels can be separated and although this is clearly an important factor, it too by itself cannot be the only factor which controls and regulates our caloric intake, our eating behaviour and consequently, our weight.

  • Brain – Hypothalamus

It is obvious that our brain is intimately involved in the control of eating behaviour.  In particular, a small area of the brain known as the hypothalamus is critical in controlling and integrating not only our eating behaviour, but other behaviours such as drinking, temperature regulation, and other behaviours critical for survival.

So what is the conclusion?  It is obvious that the regulator – the internal automatic regulatory mechanism (ARM) – is expectedly complex.  Although a great deal is known about this, it is still poorly understood.

The regulation of eating behaviour is even more complicated than simply regulating calories.  For example, the body must also carefully control the balance of salts and water, and what we eat affects this.  If, for example, the concentration of salts in our bodies is too high, and we do not have enough water, we become thirsty.  However, if there is no water available for us to drink, it would be detrimental for us to eat foods.  That would increase the salt concentrations in our body.  Consequently, when we are in need of water, there is an active suppression of appetite.  There is decreased eating.  Similarly, temperature regulation also plays an important role.  Since it is critical that our temperature levels are carefully guarded and that our concentrations are maintained in addition to our energy balance, all of these factors interact in an extremely complex way.

The fact is that the system is simply too complicated to be left to our willpower or conscious control.  To think that humans regulate their weight and their food intake by consciously thinking about it and making calculated decisions, is simply absurd.  The internal automatic regulatory mechanism cannot be corrected and there is no magic solution.

its complicated, 3D rendering, traffic sign

In Part IV of this series, we will discover the solution to the problem.  At the present time, the solution may not appear to be obvious to you and you may not have the skills.  But, be patient, the solution will become obvious and the skills are easily acquired.

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SOURCES

Chaput JP, Tremblay A. (2008, November 11). The glucostatic theory of appetite control and the risk of obesity and diabetes. International Journal of Obesity. Doi:10.1038/ijo.2008.221

Garcia, J., Hankins, W., Rusiniak, K. (1974, September 6). Behavioral regulation of the milieu interne in man and rat. Science. Vol. 185, Issue 4154, pp. 824-831.  DOI: 10.1126/science.185.4154.824

Jordan, H. A. (1969). Voluntary intragastric feeding: Oral and gastric contributions to food intake and hunger in man. Journal of Comparative and Physiological Psychology, 68(4), 498-506.  http://dx.doi.org/10.1037/h0027664

Stunkard, A., Fox, Sonja. (1971, March). The relationship of gastric motility and hunger: A summary of the evidence.  Psychosomatic Medicine

White, C, Purpera, M, Ballard, K, Morrison, C. (2010, June 6). Decreased food intake following overfeeding involves leptin-dependent and leptin-independent mechanisms. Physiology and Behavior, Volume 100, Issue 4, Pages 408-416

 


20/Oct/2017

meditate

To Begin I’d like you to watch THIS VIDEO.

What thoughts came up for you as you watched this video?  Were you able to relate to what the individuals were saying?  Did you understand why they answered the way they did?  I’d like you to take a moment to reflect on a time when you made a mistake, and some of the things that you said to yourself.  What sort of words did you use?  How did those words affect you?  Now think of the last time a loved one came to you and told you about a mistake.  How did those words differ from the ones you told yourself?  I’m willing to bet that there is a big difference in how you speak to yourself versus how you speak to others.

Why Self Compassion?

I’m sure you’ve heard the term self-compassion before.  Maybe you wondered why it was important, or why people even bother talking about it.  Maybe you thought you didn’t need to be self-compassionate, or that it simply wasn’t something that would impact your life.  Kristin Neff (2012) suggests that self-compassion is more than looking on the bright side or attempting to avoid negative feelings.  Self-compassionate people are able to recognize when they are suffering, but act kindly towards themselves.  Neff (2012) further explains that studies have indicated that individuals with higher levels of self-compassion experience less anxiety and self-consciousness when asked about their weaknesses, display more wisdom and emotional intelligence, and often experience higher levels of social connectedness and overall life satisfaction.

If we can learn to be kinder to ourselves, we can learn to let go of our mistakes and shortcomings, and move forward from them.  This doesn’t necessarily mean ignoring them, but rather not allowing them to hook us into a pattern of self-depreciation and dislike.  Instead, we can accept our mistakes/shortfalls/situations for what they are, learn from them, and move forward.

So how do I be Kinder to Myself?

Being compassionate towards oneself is similar to the way that we express compassion for others.  As in the video above, it is clear that many of us are better able to be compassionate towards our loved ones than we are to ourselves.  Learning how to be self-compassionate will not happen overnight; it may take time, practice, and trial and error.

Neff (2012) posits that there are three main components to having compassion for oneself:

  1. Self-kindness
  2. A sense of common humanity
  3. Mindfulness

compassion-components

In short, these three aspects of self-compassion involve being understanding towards ourselves and our downfalls; recognizing that we are not alone and that other people struggle as well; and practicing living in the moment and accepting some of our thoughts, feelings, and emotions.  What self-compassion is not, is self-pity, self-indulgence, or self-esteem (Neff, 2012).  To learn more about how you can be more self-compassionate, click here to read Kristin Neff’s chapter on The Science of Self-Compassion.

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Source:  Neff, K. D. (2012). The science of self-compassion. In C. Germer & R. Siegel (Eds.), Compassion and Wisdom in Psychotherapy (pp. 79-92). New York: Guilford Press.



Every day, we are faced with difficult thoughts and feelings that are uncomfortable.  Whether it’s sadness, fear, shame, guilt, or anxiety, these feelings can take on a life of their own and feel overpowering.  Soon enough, we may start to have other unpleasant feelings as a result of our struggle with the initial feeling.  For example, we may feel frustration over the fact we are anxious, or guilt over the fact we are sad. That’s the problem with many of our feelings – the more that we struggle with having the feeling, the more the feeling takes hold of us.

What if there was an alternative?  What if there’s a chance that these feelings are here because there is something that is meaningful, something that is so important we hurt because of it?

If struggling with the feelings isn’t working, the only other alternative we have is to create space to allow them to be present.  Give this a try:

Take a few breaths.  Notice how it feels when you breathe, and how the air feels as it flows in through your nose when you inhale, and how it feels when it exits when you exhale.  Notice the speed of your breath, and how your rib cage moves slightly up as you inhale, and falls again when you exhale.  Now see if you can locate the difficult feeling.  Is it in your stomach?  In your chest?  In your heart? Your head?  Notice where you feel it.  Notice how big it feels – does it feel large and heavy, like it’s weighing you down?  Does it feel small?  Notice if it feels like it has any movement – is it pulsing, or vibrating?  Is it still?  If it had a colour, what colour would it be?  What kind of texture would it have – would it be smooth, or spikey?  See if you can create a picture of a creature for this feeling using these qualities. 

You don’t have to like the creature or want it there, but see if you can allow it to just hang out.  As ugly or undesirable as this creature may be, it is telling you that something is important.  We hurt where we care, and this creature’s presence is a sign that something is very important to you.  In other words, struggling with the creature is only struggling with an essential part of yourself.  What’s more, struggling with the creature ties up energy and resources that you could be using to do things that bring you closer to the life you want.

creatures

So, next time you see the creature, see if you can hold it lightly.  See if you can soften a little around it, and provide yourself with self-compassion like what you would feel for a friend experiencing the same thing.  Notice that you are always larger than the creature.  And maybe, it is okay to have this little creature along for the ride with you after all.

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28/Sep/2017

Kerry Foster wrote an excellent blog, Best Practice: Is Your Injured Worker With A Psych Injury Too Sick To Work?’, summarizing two compelling articles: ‘Is your patient too sick to work?’ by Dr.’s Gregory Couser and Gabrielle Melin of the Department of Psychiatry and Psychology at the Mayo Graduate School of Medicine Rochester; and ‘If Work Makes People with Mental Illness Sick, What Do Unemployment, Poverty, and Social Isolation Cause?’ by Joe Marrone and Ed Golowka from the Institute for Community Inclusion in Portland.  Foster and the authors of these articles have, in our opinion, hit the mark on the topic of staying off work due to psychological illness or difficulties.  We have been working with a population of individuals who are off work due to chronic mental and/or somatic health difficulties for many years and the trends we see are directly in line with what these authors are speaking of.

First of all, when we meet with clients for our initial assessment and we ask them what led up to their leave from work, they start off by listing the stressful events and/or the limiting symptoms, and then go on to say that when they met with their doctor, their doctor suggested that they take some time off work to recover.  In many cases, through going off work, the client has now eliminated from their life a key part of their identity or role in this world.  They have deleted the human interaction that may have accompanied their job, they have opened the door to possible financial pressures and isolation, and they have closed the door to productivity, financial contribution to the family, and maybe even a sense of accomplishment and purpose that they may have once obtained from their job.  They have also now entered the mindset that the difficulties they are facing and their work cannot co-exist, and that they must wait until they feel better in order to do their job.  The problems here are that with chronic conditions, the individual may in fact never feel completely better with symptoms at times persisting regardless of treatment. It is the case that until these individuals resume working and actually immerse themselves into their work environment again, they will never be able to learn how to allow their difficulties and their work to exist simultaneously.    Whether it was a decision made independently, or one made by their doctor, it is often one that can hinder a client’s recovery rather than encourage it.

The next problem that arises is that as people continue to sit at home waiting to feel better enough to return to work, the time keeps passing, the challenges continue to exist or become even worse, and the idea that they are disabled from doing their job gets further and further reinforced.  Often times, when we see clients who have been off work for two years or more, we are automatically faced with additional challenges in helping them Portrait of an upset businessman at desk in office. Businessmanget back to work, primarily because this notion and conditioned belief that their symptoms and work cannot co-exist has been carved into their minds.  The earlier clients are referred to us, the better results we see.  If we see clients at the point that they go off work, or even when they are still working but are having challenges, we can work with them to learn how to manage and cope with their difficulties in such a way that they do not have to give up a pivotal part of their life.  We can provide strategies to manage their difficulties while AT WORK, and can teach them how to address and deal with issues as they arise.  Furthermore, we can help them identify the value that their work brings to their life.   Even if someone does not go into work every day thinking I LOVE MY JOB, we can often still help them identify what it is about working that is meaningful to them – whether it is financial security, status, sense of accomplishment, financial contribution within the family, setting an example for their children, the ability to live a comfortable lifestyle, or the means to keep their family healthy – there is rarely an empty response.  From there, the client may notice that in being off work, they are moving away from that value rather than towards it, which is causing additional suffering to their already quite full plate of difficulties.

Early intervention is important, but is not always granted.  There are a number of reasons for this, but one that I will discuss is the issue of individuals needing to feel that they CAN open up early on and that they will be heard.  In order for early intervention to be possible, it is essential that the individual suffering feels that they have someone they can open up to as soon as they start to notice their struggles so that they can be dealt with immediately rather than allowing them to persist and likely bring on additional suffering.  Workplaces need to create open and inviting environments that make employees feel comfortable to speak up about their difficulties and to receive the support needed, rather than having to go off work to deal with things in the privacy of their own home.

At JMA we offer intervention services to individuals at any stage, whether they are still working and are struggling or whether they have gone off work and are looking for help to get back on track.  If you, or someone you know could use some support and guidance towards getting back to where you want to be, please do not hesitate to get in touch with us.  We are also able to provide educational programs to employers about mental health at work and about how to best support your employees if they approach you with challenges they are experiencing to lessen the risk of prolonged disability.

Kerry Foster’s full blog is available here: Best Practice: Is Your Injured Worker with a Psych Injury Too Sick to Work?

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References

Crouser, Gregory, P. & Melin, Gabrielle, J. (2006). Is your patient too sick to work? Current Psychiatry 5(9):17-25.

Foster, Kerry. (2014, April). Best Practice: Is Your Injured Worker with a Psych Injury Too Sick to Work? Retrieved from https://activeohs.com.au/best-practice-2/best-practice-is-your-injured-worker-with-a-psych-injury-too-sick-to-work.

Marrone, Joe & Golowka, Ed. (2000). If Work Makes People with Mental Illness Sick, What Do Unemployment, Poverty, and Social Isolation Cause? Speaking Out (Psychiatric Rehabilitation Journal) 23(2): 187-193.


21/Sep/2017

guilt

I’m sure that just hearing those words, your mind took you to a particular incident that you’re not proud of.  Psychology Today explains that shame happens when you fall short of “societal moral standards”, whereas guilt is when you fall short of your own.

Many people who struggle with feelings of guilt and shame are often stuck in a cycle that they can’t seem to get out of.  The unfortunate part is that it is often paralyzing, and can lead to resentment and depression.  The torment that we feel limits us from fully engaging in what life has available for us, strains relationships, and can leave us questioning our self-worth.

The truth is that dwelling on the past hurts us more than it helps us.  Our minds have an unfortunate way of hooking us into unhelpful cycles by recalling memories that are hurtful and painful.  Constantly feeling guilty and ashamed can then cloud our judgement and stagnate our personal growth.  Whether what you’re guilty or ashamed of was something small or something that had huge consequences, ruminating over our thoughts to the point that we can’t see the good in ourselves and hope for the future doesn’t make things better.

Take these steps today to overcome the sting of guilt and shame, and move towards a more fulfilling life:

Accept Mistakes

A part of living life is making mistakes.  You’ve made many mistakes in your past, and will make many more in the future!  Accepting that no one’s perfect can be difficult, but understanding this can help to reduce your suffering.

Improve the Future

How can you take what you’ve learned from your experience to better yourself in the future?  We can’t change the past, but we have the ability to shape our future.  How can you apply the lessons you’ve learned towards future actions so that you can live a life that you’re proud of?  How can you inspire others to overcome their guilt and shame?

Exercise Self-Compassion

It can be difficult to feel good about ourselves when we’ve done something we’re not proud of, but self-compassion is vital to overcoming guilt and shame.  Forgiving yourself starts with acceptance and the commitment to be better.  Challenge negative thoughts about yourself and practice positive self-talk to encourage healing.

renee-raymond

Source: Burton, N.  (2017, March 16).  What’s the Difference Between Guilt and Shame?  Retrieved from https://www.psychologytoday.com/blog/hide-and-seek/201703/whats-the-difference-between-guilt-and-shame


13/Sep/2017

In Part 1 of this series, we looked at the effectiveness of weight loss programs and diets by people who feel fat and want to lose weight.  We concluded that losing weight is not the solution.  Even after losing weight, guilt, deprivation and “feeling fat” can persist.  The solution is to acquire the skills to control when you start eating and when you stop eating.

In Part II of this series, we will start by looking at what it is that starts and stops us from eating – the determinants of eating behaviour – and why it is that we have to eat in the first place.  We will discover that “the real problem” has nothing to do with willpower.


PART II:  WHAT IS HUNGER?

We use the term ‘hunger’ all the time.  But what is hunger?  Have you ever spent any time thinking about it?  Put yourself in the position of a scientist who wants to discover and understand what hunger is.  Is hunger simply a feeling?  Where does this feeling come from?  Is it always related to a true state of need?  If so, are overweight people experiencing a feeling of hunger when they are driven to eat?  They certainly are not in a state of need.  Is hunger a primitive instinct with which we are all born?  Is it identical for all of us?  Is it a feeling that is always the same and is related to specific physiological events (e.g. stomach contractions)?  Or is hunger something that we may learn?  Is hunger different for different people?  Are there different types of feelings that we tend to call hunger?  Do different people call different feelings hunger?  What is it?  What causes it?  What effects it?  How do you know what someone else calls hunger is the same as what you call hunger?  Does it even exist as a simple singular well-defined entity?  How do you know it exists?  Have you ever seen it?

Hunger is a concept.  It is a notion that has been invented by human beings.  Although we commonly use the term and we have feelings we often label as hunger, it is not something which is a simple fact, in that it is not directly observable by others and we are uncertain what others mean or feel when they say they are hungry.

HUNGER is a term we use to explain that which starts or ‘drives’ people to start eating.  Generally, it is a notion or concept that refers to a need state which results in a motivation or drive.

SATIETY is something which is rarely talked about, but is probably more important than the concept of hunger.  Satiety is the ‘drive’ state that stops or actively inhibits people from eating.  As you will discover, satiety is probably more important than hunger in the control of eating behaviour.

First, let’s begin at the beginning – the basics.  Let’s look at some simple biological principles and facts.

Life – what is it?  It is all those millions of chemical reactions that take place in living cells that we call life.  Most people do not appreciate the fact that these chemical reactions – life – can only exist under a very narrow set of conditions.  Think about it.

The sea is the best example of the conditions necessary for life to survive.  This was described a century ago by the French physiologist, Claude Bernard.  Life cannot survive much outside the boundaries of a sea environment.  Life requires a very delicate balance of electrolytes (various chemical salts in water) and if balance changes only slightly, life cannot survive.  That is why, for example, salt amongst other things is used as a preservative because it prevents all forms of life including bacteria.  The balance of various salts to water in the sea is that necessary for all forms of life.  The range of temperature is also critical and again best described by the sea environment.  Look at the range of temperature in the sea.

It obviously does not get colder than the freezing point of water, and it clearly does not become extraordinarily hot.  Don’t confuse this with the temperatures that occur outside of our bodies.  If our internal body temperature (where chemical reactions of life take place) changes only a few degrees from normal (e.g. a fever), our lives hang in a critical balance.  Our temperature cannot fluctuate like the outside temperature fluctuates.  Life exists within a very narrow range.  There are many other factors and conditions necessary for life including energy balances, the presence and absence of different chemicals (e.g. waste product in the form of nitrogen and urea which must be eliminated) and so on.

But what of animals and organisms that do not live in the sea?  They have to take the sea environment with them and maintain it within the critical boundaries of life or they will not survive.  So even though temperatures are ranging from well below freezing to well above critical fever level in the outside environment, these organisms must maintain their internal environment like the sea.  They must have systems for getting rid of waste products and maintaining salt water balances.  They must have systems for maintaining the critical chemicals required for life.

Claude Bernard termed this internal environment – the internal sea environment which land animals have – the ‘INTERMAL MILIEU”[1].

The Internal Milieu pertains to the very delicate and narrow set of conditions which are required for life to survive.  All living organisms must maintain this very carefully and very accurately or they simply will not survive.  Few people think about this very much and fail to realize how narrow and delicate the range of conditions are.

But how is this internal environment maintained?  Obviously, we must have some kind of a mechanism or process which allows us to maintain the delicate balance of all those conditions necessary for life to survive.  The process by which this is maintained is called Homeostasis.  “Homeostasis”, a term coined by the great physiologist Walter Cannon, MD Sc.D., of Harvard University.  In his famous book, The Wisdom of the Body (1932, W.W. Norton Publishers), Dr. Cannon explained how, regardless of conditions that may vary widely, the “bodywisdom” works constantly to maintain homeostasis.

So, homeostasis is the process by which our bodies maintain this critical balance that is complicated, delicate, and vital for the survival of life.  The range of conditions in which we can move is much narrower than most people think.  It is critical that the balance is guarded very, very carefully and very accurately.

So what role does eating behaviour and food play in homeostasis and maintaining life?  Let us begin by looking at why we eat in the first place.  Why do we need food?  What does life require that food supplies?

1.  Essential building blocks for growth and repair

A major reason we have to eat is to supply the various chemicals needed for the biological reactions within our body.  Our body has a structure which requires building blocks.  As we are growing we need to supply these building blocks and later we need to repair or replace damaged or continuously changing structures.  We are constantly growing new skin to replace the surface skin which naturally dies and is replaced.  You are probably familiar with many of these needed building blocks such as the vitamins, minerals, and proteins.  This will be discussed later under Nutrition.  The important point is that we need to eat to supply ourselves with the building blocks required for growth and repair that are essential for life.

2.  Energy (calories)

The second important reason that we require food is for energy.  Energy is measured in calories.  One calorie is the amount of energy that is required to heat up one millilitre of water one centigrade degree.  The commonly used term ‘calorie’ to describe the amount of energy in food is really a thousand of these calories.  It is really a kilocalorie.  In other words, the calorie (kilocalorie) that you eat is enough energy to heat up one litre of water one centigrade degree.

Why do we need energy?  Energy is essential for life and is the fuel that is required for the following:

  • Movement and work – muscles and glands;

Everything that we do requires energy.  All the work that our muscles do requires energy and the amount of energy varies with the amount of work.  Our glands require energy.  We sweat and shed tears just to clean our eyes.  All this requires energy.  Obviously the amount of work that our muscles and glands do varies from time to time considerably.

  • Temperature regulation;

As mentioned earlier, maintaining temperature is critical for the survival of life.  Heat is a form of energy and is needed to maintain temperature.  In cool environments we require energy to produce heat, while in very hot environments we require energy to allow our glands to generate sweat and keep us cool.

  • Metabolism – catabolism, anabolism;

Metabolism is a term that refers to the biochemical processes necessary to maintain life.  It is the breaking down (catabolism) and building up (anabolism) of the various chemicals and structures needed for life.  All of these chemical reactions which take place in our body require energy.  Often, the term ‘basal metabolic rate’ refers to the minimal amount of fuel that is required just to keep the chemical reactions going.  This in fact, requires a considerable amount of energy.

In summary, energy is critical for our survival.  We need it for movement and work, for temperature regulation and heat, and for metabolism to fuel all the activities of our body needed for the existence of life.

The balance of energy is very delicate and very critical.  Obviously, the amount of energy we use from time to time and day to day varies considerably.  Some days we are doing a considerable amount of work and carrying heavy loads, walking long distances for long durations, while on other days our activities may be drastically reduced.  Similarly, we may be in a very cold environment requiring a great deal of heat energy an on other days require very little energy for heat maintenance.  Therefore, the amount of energy you use from day to day varies considerably.

What happens if we take in more energy through eating than we use up?  What happens if our input is greater than our output?  You gain weight.  When energy input exceeds energy output, the energy can be stored in the form of fat and our metabolism shifts to produce more fat and stores it.  Consequently, there is a net weight gain.

What happens if we take in less energy through eating than we use up?  You lose weight.  When your body requires more energy than can be obtained through input by eating, the energy that is stored in the form of fat is then converted and used to meet the body’s needs.  In more extreme cases or with extremely rapid changes, energy can be obtained from other tissue types including protein as well.  This can have detrimental effects on your body.

Weight, therefore, is simply an index of how well the balance of energy is being maintained – whether input is balancing output.  If you use up more than you take in, you lose weight; if you take in more than you use up, you gain weight.  It is as simple as that.

Most people know this.  But do they realize how delicate the balance is?  The balance is so delicate that if you took in only 1% more energy than you used up, you would probably gain over 50lbs in a year!

In summary, it is quite clear that the balance needed for the existence of life is extremely ‘delicate’ and that the control of this balance is simply too important to be left to conscious control.  To think that humans regulate their weight and their food intake by consciously thinking about it and making calculated decisions, is simply absurd.  It is important to keep these things in perspective.

In Part III of this series, we will look at the extremely complex internal mechanism that regulates our eating behaviour.

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[1] Gross, C. G. (1998, September). Claude Bernard and the constancy of the internal environment.  Neuroscientist, 4(5): 380-385.  DOI: 10.1177/107385849800400520


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J Marlin and Associates Inc. offers Cognitive Behavioural Therapy services to help individuals increase their sense of vitality, well-being, and fulfillment.

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