Procrastination is the practice of carrying out less urgent tasks in preference to more urgent ones. We all procrastinate to some degree. There are only 24 hours in a day to accomplish all we need to and some tasks are more of a burden than others. If you want to manage your life with less stress and more time for the things you want to do, then it is time to get a better handle on procrastination.

I have a patient we will call Sam for confidentiality purposes. Sam is a husband, a father and an accountant who works 60 plus hours a week. He told me that he came to therapy because he cannot stop procrastinating about his need to diet and exercise.

Psychotherapy allowed Sam to face some tough realities. He realized that his top priority was his work and career. This was above spending time with his family and attending to his overall health. Sam said that all that had to change. He also told me he had 30 pounds to lose and avoided facing this fact by procrastinating about it for years.

I am pleased to report, that within a short period of time, Sam began using some of the following therapeutic strategies to address his procrastination (You can too!):

Acknowledge that you are procrastinating:

The initial step involved in any behavioral change is to become aware of behavioral patterns. One must admit they are stalling rather than moving forward on a desired task or action.

Admit reasons for procrastination:

If you are disorganized: Break down tasks into manageable small steps and develop to-do lists and schedules.

If you fear failure: We learn from our mistakes just as much as we do from our successes. Take note of self-sabotaging thoughts and replace with more optimistic and realistic thoughts.

If you think a task or action is unpleasant or undesirable: Use the 10 minute rule. You can do anything for 10 minutes. If you procrastinate about riding a stationary bicycle, do it for 10 minutes and, once you get yourself moving, you will most likely do more minutes.

If you are a perfectionist: Most daily tasks do not require perfection. Learning to accept good enough may take practice, but it is something that can be accomplished.

If you are physically and/or emotionally drained: See your healthcare provider for a thorough check- up. I discuss self-care with patients and recommend various ways for each individual to do things that increase daily relaxation and joy.

If you need to develop better decision-making skills: Focus on asking for more support. Learning how to have more patience as well as being more assertive can help.

Psychotherapy has helped Sam use strategies to reduce his procrastinating behaviors. Use of time management skills allow Sam to plan more quality time with his wife and children. He is making better food choices and has started a weight training and exercise program.

Today, Sam is 20 pounds lighter and determined to lose 10 more pounds to reach his weight loss goal. Procrastination is no longer in Sam’s way. He is moving forward. Change is always possible!

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, visit www.drjuliabreur.com .

Do you want to lose weight this year? Are you the same person who wanted to lose weight in 2018, 2017, 2016….? I am going to discuss a patient of mine we will call Miriam who discovered why she has not been able to lose weight for a number of years. This month’s Therapy Room column may help you begin a new and achievable weight loss journey.

Miriam has been primarily working with me on her hoarding disorder. This disorder is a persistent difficulty discarding or parting with possessions and causes distress due to perception that these possessions need to be saved. We are working on Miriam’s thoughts, feelings and behaviors that relate to hoarding and, in doing this, it allowed Miriam to see a relationship with her thoughts about holding onto extra body weight. Miriam told me that her extra weight is her protection. People do not look at her and, therefore, no one can hurt her. She cried saying that, in reality, she has not truly looked at her body for a long time and that she is hurting her overall health carrying this extra weight. Such breakthrough conversations in therapy made Miriam decide that she wants to lose weight. She then asked me, “How do I do this?”

How Miriam (and anyone who wants to lose weight) can do it is by doing the following:

• Create an Action Plan

Developing such a plan is work, but even harder work will be required to act upon a new action plan. But it is worth it.

• Define Goals

Sit down and write out what you want to accomplish by having structured weight loss goals. Creating three goal types is important and they can be set up as short-term, mid-term and long-term goals. This will provide a focused and workable weight loss roadmap.

• Organize and Prioritize

I told Miriam that as she organizes and prioritizes her weight loss goals, she will be prepared and better able to manage and discuss in therapy any problems that may happen. I told her to keep in mind that “the art of planning helps uncover potential problems before they occur!”

• Create A Journal

Planning will help you to stay focused and to keep things in perspective. I told Miriam that her perspective must be on her purpose and her future. She will then see success and be rewarded for her planning.

Miriam did develop an action plan with specific goals. She continues to work during therapy sessions on her thoughts, feelings and behaviors that relate to hoarding and weight loss. She recently consulted with a licensed nutritionist for information on food choices and an eating plan, and she began exercising three times a week at a gym. Miriam also enjoys walking along the beach at sunrise and tells me this helps her “begin her day on a positive note.”

I hope that Miriam’s story inspires you and helps you to realize “change is possible!”

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, visit www.drjuliabreur.com.

In therapy, a female patient of mine has been discussing the depression she has been experiencing since her mother’s death. Her mother was diagnosed with stomach cancer and died within a short three month period. We have been able to reflect on her mother’s life and the close relationship they shared. This week, the same patient told me her depression reached new heights. She finds herself thinking obsessively about how lonely she will be this holiday season without her mother. She has been crying excessively and even called in sick to her employer.

The holiday season is a time of celebration, joy, reflection, hope and love for many people. It is also a time of loneliness for many other individuals. It can be a time when people feel emotional distance from acquaintances or relatives. Be cautious of that feeling of loneliness further developing into depression and/or isolation.

Rethink expectations:

Loneliness can develop with thoughts relating to the absence of a romantic partner or not having a big family holiday gathering, and such thoughts rarely seem as uncomfortable as they do during holiday periods. We are supposed to be invited to spectacular holiday parties and enjoy gift exchanges. Very few lifestyles compare to what magazines, cable television shows and movies project. If you rethink your expectations, you can alleviate loneliness by inviting a good friend or relative to dinner versus wishing for a romantic dinner. Seeing the good in a difficult family member and showing them kindness can also help some individuals be relieved of loneliness.

Connect with others:

You can feel lonely even in a crowded room of people, but it is harder to continue to feel lonely in that room of people if you reach out to them. Whether you say hello to a neighbor you normally do not take time to say hello to or direct message a friend, versus just liking their recent social media posting, reaching out and connecting with others is a solution for loneliness.

Attitude of gratitude:

My patient also told me during her therapy session she realizes that she is distancing herself from her co-workers and calling in sick to avoid any interactions with them. She said she is grateful for her co-workers and she must express her gratitude for all their understanding and kindness since her mother’s death. I suggested she maintain a gratitude journal. This exercise will help her to cultivate an attitude of gratitude and provide a written record of what she values to read and re-read anytime she feels sad, depressed or lonely.

Self examination:

If you feel lonely, it may be a cue for change. Talk to a professional about how you feel; this can often be more helpful than people expect. Change is possible!

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Further information is available at www.drjuliabreur.com.

Social media sites such as Instagram, Facebook, LinkedIn and Twitter have become primary channels for entrepreneurs and corporations to promote their products and services. The loyal digital audiences they engage are turning to social media influencers to better identify specific products and services that align with their tastes and lifestyles.

Defining a Social Media Influencer

A social media influencer is a user on social media who has established credibility in a specific industry and has access to a large audience. An influencer can persuade others by virtue of authenticity, expertise, credentials and social reach.

Marketing strategy company Olapic (www.olapic.com) conducted a survey in 2017 noting that Baby Boomers within the 55-61-year-old range did not identify with any definition of a social media influencer, while Millennials (also known as Generation Y) ages 21-36 were the most engaged and Generation X ages 37-52 and Generation Z ages 8-22 close behind.

The Psychological Power of Persuasion

The psychological tactic behind influencer marketing is about incorporating the power of persuasion to convince people to make purchasing decisions. A social media influencer cooperates in marketing a product or service to make money and grow a base of followers. The followers purchase an influencer’s campaign because they are connected and persuaded by the product or service recommendations the influencer promotes.

Influencers do not need to be well known celebrities with millions of followers. Often, trusted influencers are smaller in scale and are human in appearance and activities. They cultivate a community of their own on social media and leverage their friends, co-workers and family members and the connections those friends, co-workers and family members have as well.

Jodi Riley @jojo_fit is a south Florida gym owner, trainer, coach and athletic champion with over 100,000 Instagram followers. She promotes her brand to include online and onsite training, coaching packages, various nutritional products and athletic workout gear. I contacted Jodi and asked her to describe the pros and cons of being a social media influencer. Jodi’s top pro and con were the same — exposure. The exposure she receives on various social media platforms has helped Jodi develop a successful and profitable brand, but exposure has also brought some unexpected postings from her followers. She tells me that she simply ignores any negative postings because she does not allow negativity to be part of her life and she may even choose to block individuals, with one simple click from being able to make future postings on her social media accounts.

Are you under the influence(r)? You may be! Understanding the interrelationship between social media, talented influencers and the psychological and masterful art of persuasion — a new and powerful marketing strategy exists in our world today that has a huge impact on our decision making when it comes to purchasing products and services.

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Further information available on website at www.drjuliabreur.com

There is no doubt that there is a need for better integrated physical and mental health services, especially in order to support people with long-term health conditions. The King’s Fund, an independent charity that works to improve healthcare, reports that people with long-term physical health conditions are two to three times more likely to also experience mental health disorders. This month’s Therapy Room column focuses on migraine headaches and various mental health conditions.

Peter Goadsby, a professor at King’s College in London, defines migraine as an inherited tendency to have headaches with sensory disturbance. It is an instability in the way the brain deals with incoming sensory information, and such instability can become influenced by physiological changes, such as sleep, exercise and hunger. There is no known cause for a migraine, although most people with it are genetically predisposed to it. There are certain common triggers, which include stress, lack of food, alcohol, female hormonal changes, lack of sleep and one’s environment.

Jodi Langston, a migraine sufferer for the past 3 ½ years and a contributor to The Mighty (www.themighty.com), shares “I am disabled and while misunderstanding individuals claim that I am faking it, migraine is my scary monster in the closet and it has friends. It is bad enough to have a migraine, but depression and anxiety have become my migraine’s constant companions. Depression takes away my will to fight another day and anxiety tells me my pain will spike if I try to do anything besides hiding out in the darkness of my bedroom.”

The Anxiety and Depression Association of America (www.adaa.org) explains that migraine headaches can precede the onset of mental disorders. In a 2009 study, researchers found that 11 percent of participants with migraines also had various disorders, including major depression, general anxiety disorder, bipolar disorder, substance abuse disorders, agoraphobia and simple phobias. New research suggests that people who have migraines are more susceptible to developing post traumatic stress disorder (PTSD) when exposed to trauma, like a car accident or an abusive partnership, than those who do not experience migraines.

Special treatment challenges exist for physicians treating those with migraines and mental health conditions. A physician may select medication because it is effective for an anxiety disorder as well as headache pain and then the physician must closely monitor the patient for possible side effects caused by the prescribed medication.

Research also suggests that people with migraines and a mental health disorder, such as PTSD, consider seeing a licensed psychotherapist who practices Cognitive Behavioral Therapy (CBT).

CBT, along with relaxation training and medication specifically prescribed for migraines, can also improve the conditions.

One can certainly manage migraines and mental health disorders in order to lead a full life. Change is possible!

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton, FL. Further information is available on the website: www.drjuliabreur.com.

The impact of your body image on your self-esteem can be powerful at any stage of life. In today’s world of selfies and social media, it is not uncommon at times to think negatively about one’s physical appearance, such as wishing for a thinner body, longer legs or a muscular mid-section. Finding ways to be positive about your body image is important and will help you develop one that is realistic and help to improve your self-esteem.

Body Image & Self-Esteem defined:

• Body image: The mental picture you have of your body as well as how you perceive your body when you look in a mirror or at a photo of yourself.

• Self-esteem: How you respect and value yourself as a human being. Your self-esteem affects how you take care of yourself in every aspect of your life. It also relates to how you demonstrate your individual strengths and character. People with positive self-esteem have a confident attitude about who they are mentally and physically.

Teenagers with a positive body image and good self-esteem tend to find their life enjoyable and have better overall relationships with their parents, siblings and peers. Adults with positive body image and good self-esteem can better manage life’s curve balls and disappointments and are able to stick with difficult tasks until they are accomplished.

Positive Self-Esteem provides:

• Courage to try new challenges and see new opportunities

• Confidence to believe in yourself

• Healthy mental attitude

• Pride in physical strength and appearance

• Self-acceptance and the recognition of your unique, and special, qualities.

Suggestions for times you feel low or frustrated about your body image and self-esteem:

• Go for a walk or run

• Listen to music

• Get physically active and move

• Plan meals that are more nutritious

• Drink more water throughout the day

• Call/Text/FaceTime/Skype or visit a friend or relative

Suggestions to help you develop a positive attitude about your body image and self-esteem:

• Education — learning allows you to make a difference in your life and in the lives of others

• Sports and Activities — health and fitness only adds to a better body image

• New Hobby — take time to explore something you might like to do and uncover your hidden talents

• Be Inspirational — share your life’s experiences and offer encouragement to others.

We all feel low at times about who we think we are. Learn what triggers such thoughts and take positive action to provide yourself with the comfort you deserve and ultimately new solutions. If you are feeling extremely sad or depressed, it might be best for you to contact a mental health provider for their professional help and guidance. Change is always possible!

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, visit www.drjuliabreur.com.

There is help for individuals and families to recognize and cope with depression, including major depression or dysthymia, and manic depression or bipolar disorder. We must provide better knowledge to those who suffer with depression in order to get proper help and to prevent any suicidal thoughts or behaviors.

According to the Anxiety and Depression Association of America (ADAA), depression is a serious and treatable medical condition that affects almost 18 million Americans a year. Everyone gets sad, but depression and sadness are different. When an individual is sad, depressed or irritable for at least two weeks, it can be a sign of clinical depression. Depression does not discriminate and it causes suffering not only to an individual but to that individual’s family, co-workers and friends. There is good news and that is depression is treatable and relief can be experienced within weeks or months.

Many factors cause depression and include a chemical imbalance of mood regulation in the brain, genetics, substance abuse, illness and life events. Whatever the cause, depression needs treatment. According to the National Institutes of Mental Health (NIMH), one half of people with depression get treatment, but only one third of people with depression get treatment that helps. We need to understand depression, what good treatment looks like and how to monitor the treatment so it works.

Depression can be hard to recognize because every person is unique and has different feelings. Some feel sad; some are quiet and others become withdrawn and anti-social. Many of my patients have told me during a psychotherapy session that they feel anxious, lonely, full of fear and empty.

Symptoms for depression:

• Persistently sad, empty or irritable mood

• Reduced interest and pleasure in doing things

• Tired, trouble falling or staying asleep or sleeping too much

• Lack of appetite or overeating

• Medically unexplained aches and pains

• Abusing drugs or alcohol

• Wanting to hurt self or thoughts of suicide

Symptoms for bipolar disorder or manic depression:

(when not in a depressive state):

• Increased energy with decreased need for sleep without feeling tired

• Severe and sudden changes in mood

• Increased talking

• Impulsive behavior

• Difficulty concentrating

The initial step to help someone with depression is a clinical evaluation. A licensed clinician will be able to differentiate normal episodes of sadness from depression. The clinician will recommend a physical examination by a healthcare provider to rule out thyroid conditions, hormonal imbalances and viral infections that can cause symptoms of depression. A psychosocial evaluation is also important to detail a patient’s depression and discuss any alcohol or drug use, any suicidal thoughts, family history of depression and home/school/work life.

Finding the right clinician to help you or a loved one with depression can be challenging. Be selective. A clinician should be available to answer questions and provide care. As a licensed clinical psychotherapist, I offer complimentary, brief phone or office consultations to discuss such matters. Please visit my website www.drjuliabreur.com for contact information.

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Further information available at www.drjuliabreur.com.

According to the Center for Disease Control and Prevention (CDC), suicide rates in the United States increased 30 percent between 2000 and 2016 and, according to a June 2018 CDC separate analysis, suicides have risen in almost every state.

The recent suicides of the well-know fashion designer Kate Spade, age 55, and celebrity chef Anthony Bourdain, age 61, bring forth the sad reality that suicide rates for middle aged people are now higher than almost any other age group in the United States … and rising.

According to the American Journal of Preventive Medicine, the most common stressors linked to middle age suicides include problems with partners, job and finances, health, family and legal issues. Other links have been made to using alcohol and drugs as coping mechanisms, physical and chronic pain, untreated depression and other mental health problems and isolation. It is isolating to be a well-known figure where people want to know you for social opportunities and not always for social connections.

Bridget Phetasy a stand-up comedian and freelance writer explains, “If you’ve never wanted to kill yourself, it’s hard to comprehend the feeling, but it’s insidious and ever-present and, once the idea of suicide got in my head, it was like a worm that infected the network, exploiting the vulnerabilities in my operating system. When I was deep in that darkness, the thought was always with me, haunting me, waiting for just the right moment or excuse to tip me over the line from ideation to planning to action.”

There is a call to action for every state in the United States to intensify the focus on implementing suicide prevention policies and programs to save lives! Twenty-seven states note that 54 percent of those who died from suicide were not diagnosed with a mental health condition (CDC, 2015).

Dr. Jerry Reed, an executive member of the National Action Alliance for Suicide Prevention, says that the alliance is working with more than 250 hospitals nationwide to ensure that someone brought into their facilities after a suicide attempt is connected to long-term mental healthcare. He advocates that churches, schools and police need to improve recognizing people at risk for suicide and help them get proper treatment and to feel less isolated.

Dr. Reed believes that limiting access to guns for people who are unwell is also a priority. He states, “People at risk for suicide must be asked if they have firearms and it might be a good idea to have someone hold onto their firearms while they are in treatment.”

Help and hope:

The number for the National Suicide Prevention Lifeline is 1-800-273-TALK (8255). Veterans can dial 1. People are available to talk 24 hours every day. The website (www.speakingofsuicide.com) offers important resources. If you or someone you know feel suicidal, contact a doctor or a mental health professional, family, clergy or friends and dial 911 if necessary. When it comes to thinking about suicide — there is help and hope.

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Further information is available at www.drjuliabreur.com.

Self-sabotaging behaviors create problems and interfere with goals such as dieting. Do you repeat the same patterns of behavior over and over again expecting different results? You might be demonstrating self-sabotaging behavior.

Weeding through endless weight loss or dieting information can leave a person feeling lost, desperate and overwhelmed since losing weight means you must invest time and understand what health, nutrition and fitness means specifically for you.

Many people jump from diet to diet to include ones endorsed by medical and mental health experts, celebrities and professional athletes. Such qualified and well-known people would never think about steering us in the wrong direction? Or, would they be promoting a diet because they are rewarded for agreeing to associate their celebrity to a weight loss diet program? The simple truth is that we need to truly comprehend what dieting or fat loss, and the physiology of metabolism, means specifically for us.

According to The Bulletproof Diet by Dave Asprey, 90 percent of people who work out in gyms do not train properly and people who join fitness clubs on average quit after 3-4 months. It is humbling to face the fact that, when it comes to a successful health and fitness lifestyle, one must demonstrate daily motivation and commitment.

Why do we give up so easily on our diet goals? Why do we blissfully indulge in many self-sabotaging behaviors? One must reprogram thinking to make harder choices and that can be very uncomfortable.

Saying ‘I will’ allows one to consciously think, feel, behave and move away from doing something one might regret, such as going through a fast food drive-thru to buy a breakfast sandwich versus making a healthy breakfast at home. One must also say no to a midnight snack or getting up in the middle of the night to eat. ‘I want’ is the ability to remember why when temptations strike and one can therefore focus on long term goals and learn to want more than a fast food breakfast sandwich or a midnight, or middle of the night, snack. Leaning into ‘I will’ and ‘I want’ empowers one to look temptations right in the eye and say, “No way, not now…” and those temptations will lose their power.

Stress is yet another factor causing self-sabotaging diet goals. The more stress we feel, the more likely we are to overeat, over-spend or over-indulge and soon we sadly regret such actions. Mental or physical stress drains us and anything we can do to reduce stress in our lives will help eliminate the potential of self-sabotaging diet goals.

Becoming conscious of any self-sabotaging behaviors that interfere with dieting goals can be the beginning of a new and successful journey in achieving weight loss goals. Remember, change is always possible!

Dr. Julia Breur is a licensed marriage and family therapist with a private clinical psychotherapy practice in Boca Raton. Further information is available at www.drjuliabreur.com.

(Part 3 in our series on Dementia)

The good news is that there are many advances being made in both the mental health and medical fields when it comes to dementia. Let’s examine some of these new advances.

Dementia and Mental Health advances:

The Dementia-Directive

Dr. Barak Gaster, an internist at the University of Washington School of Medicine, spent three years working with specialists in geriatrics and devised a dementia specific mental health advance directive (https://dementia-directive.org). This directive provides a map for mild, moderate and severe dementia and asks dementia patients to decide what medical interventions they want and do not want at each phase of their dementia.

It is estimated that between 20 to 30 percent of us at some point will develop dementia. As patients turn 65 and qualify for Medicare, which covers a visit to discuss advance care planning, the dementia- directive can be a useful tool that acts as a supplement to other directives.

The dementia-directive has many positive aspects. We know that many patients move into advanced stages of dementia prior to anyone identifying it and, therefore, being able to discuss with the patient what exactly is happening to them and asking them how they would like their dementia managed is beneficial. It is difficult for dementia patients to express their wants and needs as their dementia progresses and the dementia-directive can be a helpful tool for better management as the disease progresses.

Dementia and Medical advances:

Medical Devices

Neural Devices are electrodes that penetrate top layers of the brain and act as mini-microphones to record brain activity. Some neural devices are currently being tested to diagnose Alzheimer’s and Parkinson’s based on what is called a fingerprint or activity patterns recorded directly from the brain. It’s interesting to note that Facebook and Elon Musk’s company Neurolink are currently looking to invest in neural device companies.

Medications

Cholinesterase inhibitors, such Aricept, Exelon, Razadyne and Memantine or Namenda, are used to treat the common cognitive symptoms of Alzheimer’s, such as memory loss, confusion and problems with thinking and reasoning. There is also a Namzaric that combines one of the cholinesterase inhibitors Donepezil with Memantine.

As Alzheimer’s progresses, brain cells die and connections among brain cells are lost causing cognitive symptoms to worsen. Current medications cannot stop the damage Alzheimer’s causes to brain cells, but they may help lessen or stabilize symptoms for a limited time by affecting certain chemicals involved in carrying messages among the brain’s nerve cells.

Exercise

According to Neurology Times, a study of over 1,400 women over age 44 years were observed to determine a correlation between midlife cardiovascular fitness and the risk of developing dementia. It appears there was a 9.5 year delay determined by using an ergometer cycling test and this study supports research that exercise is a reliable strategy to prevent dementia.

Dementia Series summary:

We have explored dementia in our three part series over the past three months. Dementia is a complex condition with many possible causes, but what many people want to know is can dementia be cured? Recent developments and understanding of how the disease progresses have been encouraging. Researchers believe more effective treatments will continue to be realized.

Additional information is available to you online at www.Alz.org. This website will help you find your local Alzheimer’s chapter, direct you to a 24/7 helpline (800-272-3900) and provide you with access to a virtual library with over 5,000 library books, journals and other Alzheimer’s resources.

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. Further information available at www.drjuliabreur.com.