The Role of Spirituality in Health Care by Dr. Victor Sierpina, MD

Lone Tree in SnowSpirituality and religious beliefs may seem like an inappropriate topic to discuss in the health care setting. Perhaps such conversations are best held by a pastoral counselor, clergy, or the hospital chaplain. Patients and their families always have some value system in place, whether based in traditional religious structures, personal spirituality, or some philosophy of life. It is often helpful to elicit these beliefs in order to understand a person’s support system, how and why they make health care choices, and how they might affect palliative care or end-of-life choices.
One model for addressing spiritual belief systems has been developed under the auspices of the John Templeton Foundation and is taught to health professionals through the George Washington Institute of Spirituality in Health. It is called FICA. This is a rather straightforward approach that allows a neutral, non-threatening, and supportive approach to inquiring about the patient’s beliefs. FICA is an acronym for:
Faith and Belief. A question like, “Do you consider yourself spiritual or religious?” can open up rich dialogue on personal values and beliefs.
Importance. A physician or health provider might ask, “What importance do your faith or beliefs have related to your health.”
Community. “Are you part of a spiritual or religious community?” This helps determine the support system.

balanceAddress in care. “How would you like me, as your healthcare provider, to address these issues?” They may not want to go any further at this time, but at least we now have permission to enter into this level of conversation.
In my experience, patients are eager and open to discuss spiritual beliefs with their doctor, yet most physicians feel uncomfortable initiating such discussions. By normalizing this kind of conversation and including it in the routine intake history with a patient, it becomes a matter of record and, with practice, easier to discuss. This requires more than dutifully recording the patient’s religious affiliation in the medical record. It also helps to avoid making the patient feel like they are at death’s door, as their doctor is suddenly talking about their belief system or religion.
Of course, healthcare professionals must be cautious not to proselytize their own religious beliefs on patients and to be diligently mindful of any conscious or even unconscious bias about someone of a different faith or spiritual belief than their own. We are there to explore the patient’s support system, to understand how they process the mysteries of life, and how they make decisions. If a patient and provider share the same religious outlook, patients often feel reassured by discussion, prayer in the office, sharing scriptures of relevance, and the like. Be attentive for “faith flags,” like religious symbols, certain verbal expressions, religious jewelry, T-shirt mottos, reading materials, even tattoos, as these might give a clue to a patient’s spiritual orientation and thus occasion a deeper discussion.

In his landmark book, Victor Frankl, a Jewish psychiatrist and death camp survivor, observed that even under the horrific conditions of the concentration camp, those who held onto some kind of personal goal, hope, or meaning for their life frequently survived. Often, those right next to them without such a spiritual construct were the first to die. Without hope, without meaning, without spirit, the body shuts down.
Our goals as health providers are to value our patients as human beings, mind, body, and spirit; to relieve both physical and metaphysical suffering; and to offer love, support, and caring on as many levels as the patient is ready to accept. Spirituality belongs in the clinical setting for these reasons.

Sierpina_Victor_5x7About the Author: Dr. Victor Sierpina is currently the director of the Medical Student Education Program at UTMB, Galveston. He is a WD and Laura Nell Nicholson Family Professor of Integrative Medicine, and also a Professor in Family Medicine. He is a University of Texas Distinguished Teaching Professor. His clinical interests have long included holistic practices, wellness, lifestyle medicine, mind-body therapies, acupuncture, integrative oncology, nutrition, and non-pharmacological approaches to pain.

Marriage After Retirement by Dr. Rick Miller

?????????????????????How do you enjoy Marriage after Retirement? With mixed emotions, you finish packing up your things from your office and carry the box with you to your boss’s office, where you turn in your office keys. It all seems so surreal; you have been working for decades, but today is your last day at work. After a quick goodbye to your colleagues, you walk out to your car and officially begin your retirement.
Now what? After being in the workforce for so many years, you are about to experience the biggest change in your life since you graduated from high school or became a new parent. What is it going to be like spending most of each day with your spouse? For decades, spouses have spent most of each day apart, with at least one spouse working full-time outside the home. Suddenly, you are both at home, all day, nearly every day.
What do these changes mean for your marital relationship? As a university professor, I have been doing research on mid-and later-life couples for over 30 years, including looking at relationships during the transition to retirement. Here is what I have learned:
First, most couples will not experience a significant change in the quality of their relationship. The research shows that most couples who are happy before they retire remain happy post-retirement. Likewise, couples that struggle pre-retirement will likely struggle after they retire. Even though retirement will bring about huge changes in couples’ daily routines and schedules, the basic, core dynamics of the relationship (how couples “dance” together) remain relatively unchanged. The patterns of communication, styles of managing conflict, and patterns of expressing affection and appreciation will remain constant, despite changes in how they spend each day together. In short, the routine changes, but the basic relationship dance doesn’t.
Second, although the overall quality of the marriage after retirement will generally reflect its pre-retirement quality, the actual adjustment can sometimes be difficult. For example, wives of newly retired husbands often struggle with what has been called the “husband underfoot syndrome,” where wives become annoyed when their husbands open the refrigerator for the 12th time before lunch hoping, apparently, that something new has magically appeared since they last looked 10 minutes ago. This annoyance, though, is usually minor and subsides over time as they adjust to their new circumstances.
mid section view of a woman cutting vegetablesThird, housework matters. Or I should say that husbands’ involvement in housework after they retire matters because it has a significant influence on their wives’ satisfaction with the marriage. When husbands step up the work that they do around the house, their wives are more likely to perceive that their husbands are supportive. These wives have a sense that the relationship is fair, which leads to them feeling good about the relationship.
Finally, the great majority of older couples enjoy retirement. The research shows that most post-retirement couples like each other, and they enjoy spending time together. With fewer stresses in their lives and fewer demands on their time, they are at the stage of life where they can enjoy more leisure time together.

Rick Miller headshotAbout the Author: Dr. Richard B Miller is a Professor in the School of Family Life at Brigham Young University. His research focuses on the importance of healthy marital relationships on societal well-being and on marital relationships in mid- and later-life. He is also a licensed marriage and family therapy, and he maintains a private practice.

Stay Confused in Relationships by Kurt Attaway

stay confused 2When it comes to marriages, families and any relationship, one thing is pretty certain: conflict will arise at some point. Because relationships are about connection, it is essential that we learn the art of resolving conflict. Conflict creates distance, separation and strain on a relationship. On the flip side, resolved conflict creates closeness, connection and confidence that the relationship can persevere through challenges. Learning how to deal with conflict in a relationship is a vital skill for growing a healthy, vibrant relationship.

So how do you do it? How do you resolve conflict? Simply put…”Stay Confused!” Conflict often arises out of misunderstanding, miscommunication or simply when two people miss each other. If the goal of a relationship is connection, then we must remember to stay confused during moments of conflict so that we can work toward communication, understanding and, ultimately, connection.

I encourage people to stay confused during conflict because it results in questions. Additionally, it helps to limit defensive interactions. If you are confused, you have not made up your mind about the situation. You do not have a position you are trying to defend. Instead, you will seek the other person in conversation through asking questions. Throughout my life, whenever I find myself confused, my natural tendency is to ask questions. During conflict, asking questions and seeking the other person through a process of communication and sharing can help build interactions that naturally combat conflict and help bring the relationship through the issue being discussed.

So, the next time conflict emerges in your important relationship, don’t too quickly jump to a conclusion; instead stay confused and ask questions until the issue is addressed and connection is discovered. Staying confused can help you turn conflict into connection.

Kurt leadershipAbout the Author: Kurt Attaway is a Licensed Marriage and Family Therapy Associate in Texas. Kurt graduated with his Master’s from UHCL. Kurt works in private practice at The Center for Couples and Families, and serves as the Director of the WholeFit Leadership Team.

The “Mosquitos” of Inaction: Dealing with the Problems in Our Life by Kenneth Jeppesen

stress 4We’ve all experienced a summer evening outside ruined by relentless mosquitos. Eventually we realize that no amount of swatting will stop the onslaught, and that we’ll die of exhaustion before we ever smash enough to make a difference. We quickly find the price of sitting still is a fight that never ends.

On the other hand, runners don’t have to worry about mosquitos. Mosquitos have a pathetic top speed of 1.5 mph; runners simply move too quickly to be caught. Even walking with purposeful speed can keep us ahead of the bloodsuckers.

I have found that the same is true of life. When we stop moving toward our dreams and values, and do only enough to survive, worries and fears descend on us. We sleep in, drag ourselves through work, go home in exhaustion and spend the rest of the night in front of a screen, hoping it will distract us from the reality of the next day. We begin to dread our lives. We begin to fear even little things like eye contact with strangers. The mosquitos of inaction suck the energy out of us, and often our confidence and hope too.

business womanWhen our problems are buzzing thick around us, we can feel trapped and powerless. But all that we need to do in those moments is get moving. Just by having a goal and moving toward it we can avoid having the life sucked out of us by a thousand tiny worries. The mosquitos of inaction cannot catch us when we pursue our dreams. While we can never fully escape problems in life, we can upgrade them for better ones. The problems of inaction stagnate and stall us, but the better problems of progression help to push us forward. Those better problems are opportunities to grow and gain greater happiness.

Kenneth-Jeppesen-Headshot-e14380277335081About the Author Kenneth Jeppesen is a Licensed Associate Marriage and Family Therapist and a member of the American Association for Marriage and Family Therapy. He earned a bachelor’s degree in Child and Family Studies from Weber State University, and a master’s degree in Marriage and Family Therapy from Converse College in Spartanburg, South Carolina. Kenneth is a therapist at the Provo Center for Couples & Families.

Nothing Mellow About Yellow! by Camille Olson

yellow flowerJust the other day I found myself at the shoe store buying ballet shoes for my daughters. I don’t know a woman on earth that can be at a shoe store and not “just look” for her own size. So next thing I knew, there I was, trying on shoes for myself. On the bottom of the rack and on clearance was a pair of yellow shoes. I could not believe my luck! I loved them and bought them without another thought. It wasn’t until I brought them home, did I start thinking about why I loved that bright and vibrant color so much. To me, there is nothing “mellow about yellow.” Here are a couple things I learned from the color YELLOW.
1. Yellow is bold and confident. Confidence is power. People are drawn to others who are confident in themselves. Does this mean we have to be “fake” and pretend we are confident when we are not? No! This just means celebrate the talents you have to offer this world! Hold your head up high. Be bold and secure that you are enough. It is easy to feel inadequate, especially in the “social media” world that we live in. At our finger tips we have access to the good things in everyone else’s lives. We need to remember that very few people are posting their struggles and hardships online, rather they are more often trying to make their lives look perfect. We cannot compare our challenges to someone else’s success. It is not fair to YOU!

yellow 32. Yellow is a happy color. Surround yourself with things and people that make you happy. I believe that gratitude goes hand and hand with happiness. When we are busy looking for the good and appreciating things, we have little energy left to be critical. When my boys were little, I spent five minutes a day writing down three things that I was grateful for. At first, it was really hard for me to come up with different things to be grateful for. Little by little, it became easier, and before long I could fill up half a page with little or no effort. I found that my heart was more grateful for the little things. I was quicker to recognize small blessings in my life. Many interesting things happen to us when we are grateful. Here are my favorite three things: (see below for reference)

  •  People with an “attitude of gratitude” are in better physical health, sleep better, and spend more time exercising.*
  •  People with an “attitude of gratitude” have lower levels of stress hormones in their blood.**
  •  People with an “attitude of gratitude” undo the cardiovascular after effects of negative emotions.***

 

yellow flower 23. Yellow is uplifting. No one has ever said (to my knowledge) “Oh great, here comes another beautiful ray of sunshine to lighten my day.” We should all splash a little color into our lives by taking time for ourselves. Spend that extra minute or two in the shower relaxing or tuck yourself into bed an hour early so you can read that chapter you have been waiting to read. Take a walk with a friend or just enjoy the peace and quiet of the day. When we color our lives with things that make us a feel better, we act and treat others better.

 

“Taking time for yourself gives your brain a chance to reboot, improves concentration, increases productivity, helps you discover (or rediscover) your own voice, gives you a chance to think deeply , and helps you problem solve more effectively. It also gives you a better sense of balance and self-awareness that can lead to a better understanding of yourself–what drives you, what inspires you, what excites you. This, in turn, can have a positive effect not only on the quality of your relationship with yourself, but also on the quality of your relationships with others.”****

 

Next time you see something bold and beautifully yellow, remember the quest to be more like that dynamic color and reflect its values in our own lives. Is it any wonder why some of the most beautiful creations of this earth are yellow?

* Emmons, R. A. & McCullough, M. E. (2003) Counting blessings versus burdens: An experimental investigation of gratitude and subjective well being in daily life, Journal of Personality and Social Psychology 84: 377-89.
** R. McCraty, B. Barrios-Choplin, D. Rozman, M Atkinson & A. D. Watkins (1998) The impact of a new emotional self-management program on stress, emotions, heart rate variability, DHEA and cortisol. Integrative Physiological & Behavioral Science. 32 (2) 151-70.
*** C. Branigan, B. L. Fredrickson, R. A. Mancuso, & M. M. Tugade (2000) The undoing effect of positive emotions, Motivation and Emotion 24: 237-58.
****Sherrie Bourg Carter is the author of High Octane Women: How Superachievers Can Avoid Burnout(Prometheus Books, 2011).
camille2About the Author: Camille Olson is currently working in the marketing department at the South Shore Center for Couples & Families. She received her B.S. degree from Brigham Young University in elementary education. She is married and is the mother of five children.

Avoiding Abusive Relationships (and Building Good Ones) by Jonathan Decker, LMFT

stock-1In my work as a therapist and relationship educator the most frequently-recurring issue I see among single adults is the belief that all of the good men/women are already taken. Many seem stuck in a pattern of abusive, controlling, neglectful relationships that they desperately want to escape. Others have heard the horror stories of their friends and are understandably reticent to enter the dating scene themselves.

Fortunately, there is a way to avoid getting into negative relationships and develop healthy ones instead. Dr. John Van Epp, a counselor with decades of experience working with single adults, has developed a research-based program, charmingly titled “How to Avoid Falling in Love with a Jerk” (based on the book of the same name) that offers essential tools for dating well.

MP900309139As a certified instructor of this “No Jerks” class, as well as a marriage and family therapist who was single for years, I’m well aware that it’s a jungle out there. Allow me to offer four keys to help the never-married, the divorced, the widowed, and the struggling to date with confidence and caution, but without fear.

1. Don’t allow your level of touch to exceed your level of commitment.
2. Don’t trust someone more than you actually know them.
3. Be the type of person that you want to attract.
4. Live a life worth living on your own.

Let’s dig a little deeper on each of these:

1. Don’t allow your level of touch to exceed your level of commitment.
In popular media we frequently see couples entering very early into a physical relationship; the decision to enter (or not) into a committed relationship often comes much later, if at all. This seems to work fine on the page and screen, but remember that those are fictional destinies, determined by authors and screenwriters instead of by reality. In real life, explains Dr. Van Epp, early physical involvement creates a false sense of intimacy. In other words, you think that you’re more in love than you actually are.

Couple holding hands.This is because physical intimacy triggers the release of bonding hormones that make you feel intensely attached to the other person. Of course, if you don’t really know the other person and haven’t developed a pattern of reliably meeting each other’s needs over time, the sensation of “love” is actually a mirage that may or may not actually materialize. The other person may not be dependable, they may not be who you think they are, or they may be lying to you. A breakup after physical intimacy is usually far more painful than one where things didn’t go as far.

2. Don’t trust someone more than you know them.
Dr. Van Epp describes trust as the mental image you have of the person, i.e. who you “think they are.” We don’t trust others, we trust our idea of them, which may or may not be accurate. This is why, when someone betrays our trust, we say “You’re not who I thought you were!” Early on, we gather bits and pieces of a person’s identity from what we observe and what we’ve heard about them. If we’re not careful, we may rush to fill in the gaps with what we hope they are or who we assume them to be, based on limited information.
What’s more, they may be, at best, trying to make a good impression or at worst actively deceitful. This is why it’s important to take time to get to know somebody before entering into a relationship. Build a friendship. Talk frequently and observe them in a variety of situations. See if their actions match their words and if they are who you think they are. Watch carefully how they treat other people. It generally takes at least 90 days for true behavioral patterns to reveal themselves.

3. Be the type of person that you want to attract.
I once had a client in my office for therapy (story shared with permission) who told me that he’d probably never marry because his standards were too high. When I asked him what those standards were, he offered to bring me a list he’d prepared, which he did in the next session. The lengthy list of traits required of his “perfect woman” went on and on. With each requirement this dream female was sounding more and more like a cross between Mary Poppins and Wonder Woman. I took my client’s list, turned it towards him, pointed at it, and said: “Here’s the thing. The woman you describe here… what her list look like?”

The man looked like ice water had been thrown on his face. He realized that he wasn’t living up to the standards that he had set for his mate. He had to be the type of person that he wanted to attract, and if he expected her to embrace and tolerate his imperfections, he’d better be prepared to embrace and tolerate hers. If you want an honest person, be an honest person. If you want a loyal partner, be loyal. If you want someone hard-working, work hard. If you don’t want to be pressured into a relationship, respect the right of others to make their own choices as well.

yellow flower4. Build a life worth living on your own.

It’s fine to want someone to hold and to make memories with here and now, but as soon as that want becomes need, you’re likely to get hurt. Why? As soon as you need to have a man or a woman in your life right now, you’re in love with the idea of being in love. That’s when you scare people away by coming across as desperate. That’s when shady characters can use your neediness to manipulate and use you.

I look at it this way: if you aren’t able to swim on your own, if you’re afraid of drowning in loneliness and despair, you’re going to cling to whatever piece of slimy driftwood comes floating by. The best way to combat this is to build a life worth living on your own. You can still love your life by helping others, developing your relationships with friends and family, and pursuing worthwhile goals. This will make you less desperate, less needy, more attractive to others, and more able to swim on your own. That way, if you end up with someone, it will be because you choose to be with that person, not because you need someone right this moment or you’ll fall apart.
While I’ve much more to share on the subject (and will in the future) these four keys are essential to dating well. Good luck, and happy hunting!

jonathan - CopyAbout the Author: Jonathan Decker is a licensed marriage and family therapist at the St. George Center for Couples and Families and is the Clinical Manager of the Online Center for Couples and Families. He can be contacted at jdeckertherapy@gmail.com or by phone at (435) 215-6113.

Stress: the Good, the Bad, and the Ugly by Dr. Mike Olson, LMFT

stress 1The Good. We often think of stress as a bad thing, something that we must eradicate from our lives. Yet, without it, we would not be able to survive a single day. There is, deep within our brains, an amazing little factory called the hypothalamus that produces/secretes thousands of very powerful and potent chemicals called neuropeptides and neuro-hormones. The hypothalamus works with the pituitary and adrenal glands to secrete these hormones which include cortisol and epinephrine or adrenalin. The levels of these neuro-hormones rise and fall naturally daily (diurnal rhythms) and help us to wake up in the morning, focus and deal with the challenges of each day and finally allow us to drop off into sleep at night.

The Bad. The problem that most of us have is not the presence of stress or the stress hormones that flow through our blood stream each day. It is however, the excess of these hormones as they build up in the body without release. Take a car engine for example. The engine revs and shifts as the gas pedal is pressed. The RPMs continue to climb as the demands rise on the engine. If the pedal remains pressed down without release, the RPMs will reach a critical level and eventually the engine will overheat and breakdown. The brain and body work in a similar way. When the stressors of life place demands on us our brain produces the chemicals necessary to deal with that stress. The branch of the central nervous system (CNS) called the autonomic nervous system controls the “gas pedal” and the “braking system” of the body, called the sympathetic and parasympathetic nervous system. The beauty of these systems is that they are self-regulatory and will, if left alone, rebalance.

Power Struggle Between a Man and a WomanThe Ugly. The problem is that with repeated stressors (worries, financial stress, work and family problems, etc.) these systems fail to rebalance and keep the “gas pedal” pressed. Chronic elevation of stress hormones has been shown to lead to a host of health problems including auto-immune disorders, skin problems, musculo-skeletal pain, arterial/heart disease, inflammation, and the list goes on. The relationship between stress and performance is not linear; meaning that increase in stress will lead to increase in performance or functioning only to a point and then it deteriorates, leading us to function less and less effectively.

balanceWhat to do? Dr. Herbert Benson, a cardio-vascular surgeon and researcher from Harvard and founder of the Benson-Henry Institute for Mind-Body Medicine has spent the last 30+ years studying what he calls the “relaxation response.” His work has shown that with a few simple steps, entirely within our control, we can activate this relaxation response, or brake system in the body.

The first step is diaphragmatic breathing (slow inhaling breath through the nose, slow exhaling breath through the mouth with pursed lips to slow flow of air down). Deep and slow breathing increases and decreases pressure on the vagal nerves and flow of blood from the heart to the brain. The rhythm of the heart is affected (more variability or change in the rhythm) which is connected to the brake system of the body as well.

The second step is to focus on a word, a number or a short phrase that is repeated in the mind as you take deep breaths. As thoughts come into your mind (random, distracting, intrusive, worrying thoughts), you passively disregard or let these thought flow through your mind and then return to your repetition (word, phrase, number). Dr. Benson has shown that within 3-5 minutes of following these steps, there are measurable reductions in cortisol, epinephrine, increased oxygen in the blood, increased delta/theta waves in the brain (slow, undulating, relaxed brain frequencies), among others. Finding the place/time to practice this basic skill on a daily basis can have measurable positive effects on health by significantly reducing stress in the body.

If any of our therapists or health coaches can be of assistance in your quest for wellness and stress reduction, let us know and we will be happy to help. Our staff has experience and training working with stress reduction and management using this technique among others (biofeedback, psychotherapy or talk therapy, autogenic techniques, EEG neurofeedback, etc.).

MikeAbout the Author: Dr. Michel Olson is a licensed Marriage and Family Therapist. He is the clinical director of both WholeFit and the Centers for Couples and Families in TX. He earned a doctorate degree from Kansas State University and completed a post-doctoral fellowship in Behavioral Medicine at UTMB, Galveston