The Xanax Equivalency: Translating Medication Into Lifestyle

The Xanax Equivalency: Translating Medication Into Lifestyle


Back in the 60’s, according to Mick Jagger, Valium was “Mother’s Little Helper.” Other than alcohol, it was probably the number one coping tool. An appropriate dose would relax and calm the recipient, make everything feel ok. Valium is very addicting. By the 90’s it was mostly replaced by Xanax.  Although it is even more addicting than Valium, Xanax has its benefits: it’s better at lifting the mood and less likely to accumulate in the body. Both are basically “band aids” to numb the recipient and manage symptoms simply and quickly.


Yesterday I was talking to a patient about the value of her yoga class, her swimming, and her social time. We got into comparing how she felt after these activities, versus how she felt after taking a Xanax. Of course these activities require prioritization, time, and effort. Way easier and faster to take a pill. But it was clear that these activities led to feelings of relaxation, inner peace, and pride in self. These and similar routines also begin to address areas that have been neglected in life.


Are you using chemicals, such as tranquilizers, alcohol, or caffeine, to help manage stress or anxiety? Would you rather use more natural and sustainable methods of regulating your moods? Shifting from chemicals to a healthier lifestyle takes some work but if it’s important to you, then you can modify your routines. Making these changes will not only reduce your need for chemicals, it will also elevate your quality of life to a whole new level!


Many activities and routines can help optimize body and mind. That means that if you prioritize and give these activities special attention you will function at your best, feel better, and live longer. Likewise, ignoring these important activities can cripple you. Here is a partial list:




Nutrition/Diet- Healthy meal planning, shopping, cooking and eating


Exercise- Every other day, stretching, aerobic, cardiovascular, musculoskeletal


Outdoor Recreation- Your doses of sunlight and fresh air


Body/Mind- Yoga, T’ai Chi, others


Sleep- Healthy sleep schedule and routines (look up “Sleep Hygiene”)




Mindfulness practice- Routine practice of being in the moment and disengaging from judging


Self-soothing activities- On a regular basis!


Creativity- Music, art, dance, writing, inventing…


Self-Challenge- Stimulating activities that are challenging but do-able


“No self”- Activities that get you so absorbed you don’t think about yourself

Life Of Values- Living and acting on your values


Love and Compassion- Giving and receiving




Sense of community, belonging- Spending time connecting with others


Working on circles of relations- Improving relationships, getting closer (or more distant and setting boundaries)


Family- Bonding time


Fun with others




Meditation- Doesn’t have to be sitting still!


Contemplation/inquisitive- Asking “Why?”


Contemplation/appreciative- Accepting, gratitude


Religious/Spiritual practice



Which of these areas are working well for you? Which are not?


Living healthier includes examining your values… What’s important and what you consider the “right” way to live. If you’re considering making changes to your life, the best place to start is to examine and solidify your values. Everything will fall into place from there. When you live your values you can be guilt and anxiety free, and feel good about yourself.


When you do review your values, you will find that self-care is up there. That’s what this article is about. Most people can see it would be hard to be depressed or unhappy when living a life that includes these activities on a regular basis. When engaging in these activities, and for a time after, we often forget about our pressures, give our body a chance to unwind and rejuvenate. That includes stabilizing hormones and the immune system.


What gets in your way of making the lifestyle changes necessary in order to be “Optimally well?”


Here are common excuses:


1. “I don’t have enough time”


2. “I feel guilty”


3. “Nothing will change”


4. “No money”



Let’s address these.


1. “I don’t have enough time.”


There are 24 X 7 = 168 hours in a week. Let’s subtract out 8 hours sleep per night (- 56) and let’s consider if you work more than 40 hours, let’s say 70 including travel or if you’re a stay at home parent. 168 – 56 – 70 leaves about 40 hours per week when you are not sleeping or working.


How do you use that time?




-Schedule your time wisely. Little by little learn what you need in order to function optimally, and prioritize those activities.


-Follow through on those activities whether or not you “feel like it.”


-Set boundaries on what you do for others.


If necessary, practice in front of a mirror:


“I’m sorry I can’t do that because if I don’t  _________  (exercise, meditate, etc.) then:


a) “I won’t be able to function well.” Or,

b) “You won’t wanna be around me.”


-Combine activities to cross categories and save time. For example;


A walk = Biological and Psychological

A walk with a friend = Biological, Psychological, and Social

A nature walk with a friend = Bio-psycho-socio-spiritual!



2. “I feel guilty.”


This is about self worth, and setting boundaries.


It means that you consider needs of others, and deny your own. Often people say they feel like they don’t “deserve” to put their needs before those of others.


The pros and cons exercise is an eye opener. You could do this with every activity. We’ll do a general practice here:


What are the pros of prioritizing wellness activities? What are the cons?

What are the pros of not prioritizing wellness activities? What are the cons?


Pros Prioritizing Wellness Activities Cons
I feel better Takes effort
My body and mind work better Less time to give others


I have to say “no” more often to people

I’ll probably live longer, less likely to get ill People will be mad at me
Better quality of life I have to do things for myself even if I don’t feel like it
I feel more in control of my life I have to plan my day, week and be more deliberate  and intentional about my time




Now we flip it:


Pros NOT Prioritizing Wellness Activities Cons
I don’t have to say “no” as much More stress, anxiety, depression, unhappiness
No one gets mad at me I won’t function that well
Just do whatever comes up Probably have shorter life and get ill more often
Easier Worse quality of life
I don’t have to take responsibility for my body I don’t feel in control of my life
I feel resentful




3. “Nothing will change.”


Everything will change. See #2.


4. “No money.”


Many healthy activities can be done cheaply or at no cost. You can spend a lot of money on a health club, or walk or jog for free. Similarly, you can pay for a meditation class, or many churches, synagogues, and Buddhist centers give free classes. Activities with friends can be expensive or cheap.


It’s very easy to make excuses for not taking care of our basic needs. It’s very easy to take a pill and suck it in. It takes more effort to make lifestyle changes.


Which pills do we need, and which can we potentially get off of?


Most people have a lot of judgments about psychiatric medications, and those who take them. Medications can be useful, even necessary for some. They are not good or bad. Those who take psychiatric meds are not any more “defective” than those of us who don’t, and often they are less “defective” than people who afraid to take meds because of how they’ll be judged. If you are on prescription medications you should work closely with a doctor and potentially a psychotherapist.


I see many people who would suffer less and be more effective if they were on the right meds. I also see many people taking medications who would not need them if they changed their lifestyle, priorities, and learned to be assertive about their needs.


We know what “Illness” is. You are sick, you have symptoms. “Health” is when you are not sick. That does not mean you are well. “Wellness” is when you are actively living your Bio-psycho-socio-spiritual program. Work out your Wellness Program and strive to stick with it!

GET A-HEAD SERIES: Updates and Bug Fixes For Our Brain #2

GET A-HEAD SERIES: Updates and Bug Fixes For Our Brain


#2: “Social Anxiety And The Brain”  Or, “Shed The Shame”


The first article in the GET A-HEAD SERIES, called “The Fear Switch,” explained how the amygdala has evolved to be prone to false alarms. Once the alarm is activated, the sympathetic nervous system kicks in to “fight or flight” mode. Fight or flight mode is a healthy response to some situations, such as when we’re about to be hit by a bus. However, many other situations and thoughts can activate the fear switch inappropriately, causing unnecessary distress, anxiety, or panic.  Examples include:


-Thinking of something bad that may or may not happen in the future.

-Thinking that we might be rejected or abandoned.

-Fear of not being normal.

-Fear of humiliation.

-Fear of being a failure.

-In chronic stress, fear that we’ll drop a ball and everything will come crashing down.


Article #1 also described the irrational “toxic judging” that our brain does so automatically. Everything is judged in black or white categories. A person is either normal or not normal, good or bad, strong or weak, a success or a failure. When we feel insecure about our self we think that if we are not normal… or good… or strong… or successful, then we will be rejected and alone forever. That thought sets off our fear switch big time! While the first article focused on the alarm itself and what happens, the focus here will be on the “judgment generator,” which is the source of our insecurities. I encourage the reader to review the “Patches” at the end of Article #1 related to fear.



Many of the situations that set off false alarms are related to toxic judging and shame. Shame is about being rejected by our “tribe.” The Ventral Medial Prefrontal Cortex (VM-PFC) in our brain can be called the “judgment generator” or, “The Shame Center.” This part of our brain focuses on how people will judge us, and whether we “fit in” or not. Its job is to protect us from rejection. But it doesn’t know when to stop! We experience the VM-PFC as that little “voice in our head” which brings up our self-doubts and insecurities. Perhaps you can see how this might be involved in social anxiety. In fact, the VM-PFC is also hyperactive in other anxiety disorders such as obsessions, compulsions, and eating disorders, with low self-esteem and when we lose our motivation.


When toxic judging is in high gear, your VM-PFC might say to you “If you embarrass yourself people will think you’re a fool and not take you seriously… you’ll be shunned and alone forever.” That thought, and the images in your mind of people who are written off and forgotten, sets off the fear alarm. This can include racing thoughts, racing or pounding heart, tension, shortness of breath, and butterflies in the stomach. This whole process can be reinforced by further “emotional reasoning” if you conclude, “Wow, if my body is reacting this way there must really be something wrong with me!” We can get so caught up in the automatic negative thoughts and the corresponding physiologic reactions that we can’t get out.


Evolutionarily, there have been benefits of an active VM-PFC, along with its adjoining networks. In pre-modern times when people lived in tribes, what happened to those who did not “fit in”? Ostracism or banishment could mean death in the wilderness. Fitting in was life or death.  Although our VM-PFC still believes this is the case, it no longer is. Our shame center still acts as if we live in a tribe surrounded by wilderness, which most of us don’t. It still carries on with all the same judging and fears. When active, this area is judging you and worrying about how others are judging you.


Some types of judging evolved to keep us safe. For instance, judging is useful in deciding if others are trustworthy or dangerous, and for evaluating our own actions, in order to guide us to be true to our own values. However, toxic judging amplifies and exaggerates the “classification” into absolutes. It is hyper-concerned about how others will classify us, causing us to be fearful that we will be “classified” as not-normal.


Bad news: The more you listen to your VM-PFC and it’s black or white judging the more you strengthen it. Even arguing with that voice in your head strengthens it.


Good news: You can learn to disengage from that part of your brain, and thereby reduce its energy and power. Practicing mindfulness makes it easier and easier to step back, label the toxic judging and not get hijacked by it.


Shame generated by “toxic judging” is irrational and not based on facts. Shame is “justified” if ones’ behavior causes ejection from the group. On the other hand, guilt is “justified” if we have violated our own values. Defining your values and connecting with people who share similar values can reduce shame, and fears of rejection. You can then live a life of values instead of a life of fears (of rejection). We can replace toxic judging with healthy judging, discerning what behaviors, and which people are healthy and wholesome for you.


Brain Patch #2


1) The “voice in our head” is a remnant from tribal living plus the black or white beliefs we formed as children. Its only concern is to protect you from shame. It can hold you hostage.


  • Separate what your “Shame Center” is saying to you versus what’s really happening.
    • Would people you care about really reject you for certain things?
    • Do you agree with the values of these people? 
    • Ask yourself:
      • “Is this toxic judging?”
      • “What am I really afraid of?”
      • “Have I been true to my moral code?”
    • You can learn to step back from the voice and consider it as “just one opinion….” And you can respond to it “thank you for sharing.”


2) Unnecessary stress comes from worrying about what people will think of you if you:


    • Can’t handle everything put on you.
    • Let something fall through the cracks, or make a mistake.
    • Tell them “No that’s too much for me.”
    • Ask for help.


If you feel stressed, step back and listen to what you’re telling yourself.  If you’re hearing words like “failure,” “weak,” or “inadequate” these are indications that your stress is shame-based. 


3) Challenge any “all-or-nothing” thinking, labels, categorizing, judging, or jumping to conclusions. Practice NOT buying into them. It’s even better to laugh at our tendency to do this so automatically! Over time, the goal is to learn to shrug off that critical voice in our head with minimal effort.


4) Spend time developing your values, your own belief system about the “right” way to live, and what is most important to you for the future. Think about what character traits you want to develop in yourself. {Character traits template}


    • Example: What kind of “judging” do you believe is ok?
      • Judging if someone is “normal” or not? “Defective”? “Worthy or worthless”?
      • That people shouldn’t have faults or that we have to prove something?
      • Or do you think it’s better to be non-judgmental?
    • Don’t go by how you think others judge; it has to be your code of what’s right.
    • Then connect with people who share your values. Work around those who don’t.
    • What is more important, acting according to your values or being liked?


5) Consciously shift from blaming, faulting, and defensiveness to humility and compassion, for our self and others.


    • Accepting weaknesses and mistakes in our self and others.
    • Loving unconditionally
    • Healthy boundaries
    • Compassionate assertiveness
    • Awareness of inter-dependence and inter-connectedness.


6) People’s judgment isn’t what gets us banished; it’s breaking the code. Usually if you act on your values and get rejected, you can find others who share your values. It’s breaking laws of the land that get you removed from society.


A hypersensitive fear switch and overactive shame center combine to cause a huge amount of avoidable suffering. The next article in the series will help you improve your confidence, assertiveness, and intentionality. By practicing Mindfulness and following my blog you will learn to calm your fears and shed your shame!

Grow Yourself! (so you can take control of your life)

Ok, so we’ve made our New Years’ resolutions and it’s now the end of February. Most of us want to improve our lives—by improving ourselves, our health, physical and emotional, our relationships, and our effectiveness in life. We know what we “should” be doing, but…

Making changes in our lives– changing routines, habits, and overcoming dysfunctional patterns— all involve learning to think differently. In doing so we can become more efficient and effective, more focused and deliberate; healthier both physically and emotionally.

Why do we put off what we know is best for our body physically and emotionally? The things that we know would help us function more effectively?
Continue reading

Synergies in Treatment

A series of articles written by Dr. Gelbart for the Northern California Psychiatric Society Newsletter. These articles are a bit more “technical” than others on this blog, but they can help anyone interested in how mindfulness, positive psychology, Wellness approach, and skills training can help with self-esteem, anxiety, depression, motivation, and other difficulties. It may help you in choosing a therapist, and/or bring up questions for discussion with your therapist or friends.

  1. Introduction
  2. Judgmental Thinking
  3. Mindfulness and Psychiatric Treatment
  4. Teaching The Patient To Swim
  5. Focusting On The Positive
  6. Changing The Shoulds To Wants
  7. Mindfulness Psychotherapy And The Brain
  8. Which Tool When

Introduction: Harnessing the Power of your Mind

from the text version of the Potent Mind audio CD

Do you understand your emotions? Do you judge them? Do you ever wonder if you’re going crazy, or what your mental disorder might be? Would you like to understand yourself and your emotions better? If you did, you would probably learn that you’re more normal than you think.

Do you ever ask yourself: why do I feel the way I do? Is what I feel important? In what ways? When can I trust what I feel and when should I not? How can I “feel better?” How can I make other people feel better?

Have you ever had difficulty letting go of resentments toward others about things that happened? Do you ever blame yourself, perhaps beating yourself up or kicking yourself emotionally, repeatedly, even when you can see there’s no benefit to it? Do you find yourself obsessing around and around, about the past, or perhaps about what’s going to happen in the future? Do you ever feel insecure, about whether you are “good enough”, or “adequate”, or whether or not other people will judge you as such? Are you afraid to say no? Are you afraid of people who might “emotionally persecute” you? Do you ever feel like you’re marked with a “V” for victim? Do you tend to jump in and rescue people? Do you ever lose control of your anger and say or do things that you later regret? In addition to the emotional suffering this causes it wastes much of our precious mind resources with preoccupations and unnecessary concerns. That removes so much of our consciousness from out of the present, where it’s really needed. I’ll teach you specific techniques and skills which can eliminate those obstacles.

In this course I’ll teach you how to:

  • let go of hostility, resentment and guilt
  • worry and obsess less
  • reduce stress. Even better, do more and have less stress
  • find tranquility in this chaotic world
  • be more present, enjoy life more, and have more clarity in decision-making
  • accept yourself and also strive to become better
  • have more love and compassion in your life

What do we mean by a Potent Mind? We would want clarity of thinking, being able to focus on what we want to focus on when we need to, thinking objectively even in the midst of distracting information and emotions. We would want to be able to relate to, but act independent of what’s going on around us. We would want to have a sense of calmness, peacefulness in our mind, to be relatively free of negative emotions such as guilt, resentments, hurts, or fears. We might also want a sense of comfort with our self, and adaptability to varying situations. You can have this!

We can be most effective and healthy mentally when our mind is clear, our emotions calm, our attention is in the present, and we are aware of our goals and priorities. It is said that we only utilize 10% of our brain. If we could learn to utilize another 5% that would be a huge increase! You can learn to utilize parts of your brain that have been mostly dormant, or used only spontaneously or accidently.

New technology such as functional MRI can show us live in real-time what areas of our brain become active (or quiet) when we relax, or when we feel certain emotions such as anger, fear, or compassion. We can now connect findings of these scans with what we know about sickness and wellness and understand what we need to do in order for our mind to be healthier and more effective. By strengthening our mind, we will also be strengthening our body, our relationships, and our potential to contribute to society, the planet, and the universe.

Evidence is increasing that stress and anxiety are costly in terms of physical damage to our body, via cortisol, the cardio-vascular and immune systems, and direct damage to brain cells. Most people would agree that holding in anger, resentment or other emotions creates many problems in terms of tension and frustration, hostility, and sometimes depression. This can also become distracting, reducing our effectiveness, and interfere with our relationships and goals. Most would also agree that low self esteem– lack of confidence, excessive self-doubt are handicaps. Anxiety, stress, maintenance of dysfunctional and sometimes self-destructive patterns, pride, resentment, as well as other emotions and impulses frequently get in the way of reaching our full potential.

A recent article in a neuropsychiatric journal described functional MRI studies involving resentment and forgiveness. A study using cognitive therapy for post-traumatic stress disorder showed improvement in symptoms related to learning how to be more forgiving. That is, letting go of resentments. These exciting scientific studies are starting to bridge huge gaps between Buddhist and religious themes of forgiveness, compassion, and mindfulness, on the one hand and Western psychological models of emotions and psychodynamics on the other.

Studies with similar types of scanners have shown that a specific part of the brain lights up when we focus on ourself as different and unique from others, versus another part of the brain which is utilized when we lose track of ourselves, and focus more on the universe, our interconnectedness, and more cosmic and spiritual types of things. Each has advantages and disadvantages and there are times when one focus is more beneficial than the other. We can learn to utilize the part of our brain that will be most useful to us in the moment.

I hear some people say, in effect, I don’t do feelings. We may often wish that we didn’t feel, or that we could only feel positive and not negative emotions. Emotions have evolutionary value. Doing feelings wisely can reduce the suffering from negative emotions and give you a sense of peace and fulfillment. Doing feelings wisely can help you not only to survive but to thrive.

There are many skills that you can learn and practice wherever you are in the spectrum of psychological wellness to psychological illness. The model that I present, and the skills I introduce can be put to use by most anyone. If you’re serious about this, apply what you’re hearing, seek additional guidance through books and CDs (see bibliography), workshops and groups when you can find them. If you run into trouble a therapist might be helpful. The rewards for your work to strengthen your mind will be multiplied as you see the effects on your body and physical health, on your relationships and your career, in having a better sense of a place in the universe, and overall quality of life. In a practical, nuts and bolts fashion, this audio will outline how to get from here to there.