Synergies #7: Mindfulness, Psychotherapy, And The Brain

Mindfulness, Psychotherapy, And The Brain Part I

Dialectical Behavior Therapy and Mindfulness-based CBT are more familiar psychotherapies that utilize mindfulness training (MFT).  MFT teaches the user to regulate the flow of energy and information in the mind.  This leads to changes in the patterns of activity in the brain. With practice certain patterns and pathways can be inhibited and others amplified. Initially this requires effort and is state dependent, but with practice it becomes effortless, a trait. MFT helps the user identify separate “streams” of information flow in the mind, to shift attention, and learn the difference between the “bottom-up” experiential input (ie. “Just the facts”) versus the “top-down” chatter of our narrative– the stories and meanings we’ve made up. This helps to “objectify” the mind, and separate ourselves (“dis-identify”) from the mental activities of the mind.

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Synergies #6: Changing The Shoulds To Wants


Everybody knows what we “should” be doing to be healthy. This goes for all of us, “patient” or not. Exercise, proper nutrition, healthy sleep habits, pacing ourselves, taking time for relaxation and de-stressing—creativity, working on relationships with family and friends, and working with our spiritual strengths and deficits. There is accumulating evidence that active lifelong upkeep in these areas reduces emotional and physical illnesses, and keeps our body and brain working better longer.

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Synergies #4: Teaching The Patient To Swim

The goal of psychotherapy is wellness. For some, that includes “fixing a disorder.” For others, perhaps taking a medication for life. Either way wellness is the goal.

Wellness practice (WP) is prioritization of behaviors that put the individual’s basic physical and emotional needs first. This includes exercise and healthy nutritional habits, setting up boundaries that allow relaxation, creativity and play, social interaction and spirituality. These behaviors help to reduce the effects of stress over time on our mind and body, including cardiovascular, G.I., and immune systems. WP also includes learning to be present and future oriented, and nonjudgmental toward our self and others.

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Synergies In Treatment: For Psychiatrists, Therapists, and Everyone


What is Emotional Wellness? Just as the concept of physical wellness doesn’t necessarily mean that exercising and healthy nutrition will get rid of your diabetes or hypertension (although it sometimes will) an emotional wellness program won’t necessarily cure someone’s mood disorder.  Such a program might however help prevent someone from getting depressed in the first place, or keep them from relapsing once their episode is treated.

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National Wellness Proposal

Dear Administration, Congress, Media, and others,

My name is Jerry Gelbart M.D., a Psychiatrist in the San Francisco Bay Area. I practice with medication, psychotherapy, and a “wellness model” that focuses on proactive lifestyle modification by helping people change their thinking, priorities, and behaviors.   Additional information and samples of my audio work are available at my website and blog,  I have several recommendations to contribute toward clarifying the substance of “Wellness and Illness Prevention” on a National level.


Medical groups such as Kaiser, Cleveland Clinic, and others are rightfully being delegated the responsibility of motivating their members to shift behaviors toward illness prevention.  However, outside of medical groups, and perhaps Medicare, there is no other unified national effort to direct and motivate people to change their behaviors.

National Wellness (or “Illness Prevention”) Campaigns can be far more effective.  They should include attention to Biological, Psychological, Social, and Spiritual self-care. Instead of telling people what to do (“exercise, eat healthy, do yoga”, etc.) there are specific ways to motivate people and teach them how to change the way they think and the priorities they set. An effective National campaign would provide many incentives to change, address what gets in the way of people prioritizing self-care, and include entertainers, doctors, therapists, clergy, and others.  The current HHS website has information on healthy lifestyle (very limited) with nothing at all to address behavior change.

Specific Recommendations

Establish a panel of experts on wellness, illness prevention, and lifestyle change.  It might be called WELP for Wellness, Effectiveness, and Lifestyle change Panel, or could be within a “Lifestyle Change” sub-section of HHS. Please see what HHS currently has on-line (what to do) versus the potential of focus on HOW to change behavior, from the perspective of behavior change experts.

The tasks of this panel would be to:

1)      Recommend healthy versus unhealthy habits, activities, foods, etc.

Examples: Learning and practicing Mindfulness helps people calm themselves and stay focused on priorities.  Establishing a weekly schedule that includes time for family/social and spiritual needs will pay-off with less stress (and the related physical and emotional consequences) as well as increased productivity.

2)      Recommend best ways to change behaviors to increase healthy habits and decrease unhealthy.

Examples: De-stigmatize changing, address self-esteem issues that get in the way of changing.  Provide education and coaching to motivate and implement lifestyle changes incrementally.

3)      Recommend changes to tax structure to incentivize people to increase healthy and decrease unhealthy behaviors.  This will make people much more conscious of what they’re doing.

Examples: No taxes or tax rebates for health club costs, classes in mindfulness, yoga, relaxation training.  Higher “sin taxes ” (alcohol, cigarettes, etc.) as well as on foods the panel judges as “unhealthy”

4)      Develop national campaign with entertainers, doctors, therapists, clergy, others to educate and motivate behavior changes.

Examples: Once panel develops clear message, National media campaign should include entertainers such as actors and musicians.  National program should be developed for Middle-schoolers to educate and promote healthy patterns.

Please address any questions or comments to Dr. Gelbart at the above address, or e-mail below.


Jerry H. Gelbart, M.D.

Recessional Holiday Stress and Blues


This year’s holiday stress and blues are sure to hit harder for most of us as the economy has tanked and our nation is at a turning point. There are a lot of scary things going on in the world, and I don’t have to name them for you.

As a psychiatrist I’m already seeing some of the toll in my outpatients and those in the hospital: there is a lot more anxiety, fear, overwhelm, confusion, and despair.

What can we do to get through all of this emotionally? A lot.

First, it will help to understand a few practical aspects of how the brain works.

Fear causes the brain to:

  1. Go into a “Danger” or “Threat” state
  2. In this state, our thinking:

    Becomes narrowed

    Becomes black and white, “all or nothing”

    It’s difficult to focus the mind on other things until we no longer feel threatened.

Fear puts a strain on our coping mechanisms

  1. We all fall apart in different ways:

    Trouble concentrating, distractibility

    Obsessing, anxiety, overwhelm, irritability, trouble sleeping, guilt

    Depressing, despair, hopelessness, helplessness, worthlessness

    Panic attacks, confusion

  2. Our insecurities come out

    About our financial independence

    And about whether or not we’re “good enough”, a “success” or a “failure”

Fear is future oriented, depression is past oriented.

Stress is related to fear, fears about not being able to do what we need to, or is expected of us. Stress tells us we’re trying to do too much. If we listen to it and set limits it can be healthy. If we don’t regard it as a healthy signal of our limits we ignore it by telling ourselves we “should” be able to handle it, that we’re “less than” if we can’t. This is the path to anxiety, panic attacks, depression, insomnia, feelings of inadequacy, and can also cause physical symptoms such as headaches, muscle tension, cardio-vascular, abdominal or breathing problems. Get professional help with that!

Depression comes from believing that you are helpless, that you are worthless, or inadequate, and perhaps that there is no hope.

Sadness comes from acknowledging a loss, grieving, accepting in our heart that something or someone is gone, or that we can’t have something we want.

Depression is related to how we judge ourselves or how we believe others would judge us if they knew our details. Depression is related to shame and low self-worth, and is full of distorted thinking. Depression is an illness, which can be treated, while sadness is a normal human emotion.

Sadness, loss, not being able to have or hold onto what we want, not being able to give more to those we love, this is painful for all of us. Accepting these limitations without judging or blaming helps us move through it, while depressing, judging ourselves as inadequate or as a failure creates suffering which is totally unnecessary. In fact it also creates suffering for those around us.

Blues” may be simply feeling sad, or may be more like feeling depressed, with a lot of self-judgment.

Are you feeling sad, or depressed?

Expectations play a major role- these include our expectations of ourselves, and what we think others expect of us. If we cannot meet these expectations we can feel frustrated, ashamed, guilty, and judged, which leads to more negative feelings.

We can all see that this year there is more need than usual. Our partner, our kids, our society, the planet… humanity. Not to mention ourselves. And while there is more need than ever we probably have less to give– materially, as well as emotionally.

While taking better care of ourselves may or may not make us financially more productive (it probably would) it is likely to help us feel less stressed and less depleted, and we will have more to offer others. Self care is for everyone, “psychological problems” or not. Self care includes taking care of our Biological, Psychological, Social, and Spiritual needs. The concept is accepting our limits, financially, emotionally– not having to feel ashamed or judged about it. We will have more to give others when we put ourself first. We will be more present, focused, compassionate, and available.

Mindfulness Practice is now crossing over from East to West and becoming incorporated into mainstream psychological treatment. I believe it benefits EVERYONE to learn and practice it, and in many ways it is an antidote for these “afflictions.”


  1. Helps you get out of the past, out of the future, into the present.

    Increases awareness, focus, prioritizing, “presence,” connection with others

    Decreases depression, blues (past-oriented) and fear/anxiety (future-oriented)

    Feel relaxed

  2. Helps you clean out your “mental garbage”

    Reduce and eventually eliminate your self-judging, and fears of how others judge you

    Reduces insecurities, stabilizes self-esteem

    Feel more compassion for yourself and for others

    Improves intimacy and spirituality

  3. When we learn and practice mindfulness we have more inner “brain” resources for ourselves (problem solving and self-care) and for others!


  2. Learn and practice Mindfulness. See Bibliography.
  3. Spend focused time problem solving financial issues, budgeting, getting through current recession versus planning for future. Remember to save a little for yourself. Get consultation as needed. Plan to spend the minimum over the holidays.
  4. When not problem solving, tell your brain that there is NO CURRENT THREAT, that YOU ARE DOING ALL YOU CAN and YOU ARE NOT GOING TO DIE. You have to work at consciously turning OFF your BRAIN FEAR SWITCH so that you will function better and suffer less.
  5. Learn a relaxation technique. Practice it regularly. Breathing, Yoga, Progressive Muscle Relaxation, Guided Imagery, Self Hypnosis. See Bibliography.
  6. Learn to take routine care of your Body, Mind, Social, and Spiritual needs. Get help with that.
  7. Make the holidays YOUR time. ACTIVELY CONTROL AND SET BOUNDARIES on how much time and energy you spend on yourself versus others.
  8. BE SAD about what you can’t do for others. Grieve it. Cry about it if you feel like. Then let it go. Tell people you love how sad you feel that you can’t do more for them. They will likely tell you the same. When you do that you are being present, real, intimate.
  9. Instead of stressing, depressing, blaming you can put your energies and time into CONNECTING with people you care about, honestly, expressing your sadness and love and also being able to get into the meanings and joys of the holidays rather than the materialism.
  10. Spend a few minutes each day acknowledging who and what you feel grateful for. Do something to appreciate yourself. Express gratitude to others.

Dr. Gelbart