Tag Archives: Q&A


Dr Shyam K Bhat MD is a
Psychiatrist and Integrative
Medicine specialist.

He is board certified in
Psychiatry, Internal
Medicine, and
Psychosomatic Medicine,
with additional certification
in clinical hypnosis

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SOAR


After my last post on decision making, I got a lot of emails. Being “stuck” seems to be a recurring theme – many people feel like victims of their situation and find it challenging to make a positive change.

Usually in these situations, a therapist might try a cognitive approach – getting the person to look at the underlying, often negative thoughts, that are causing distress. And while cognitive therapy makes sense theoretically, I find that people often get caught up in their thoughts and instead of being able to extricate themselves from the situation, they get entangled in the complexity of the situation, their feelings and thoughts.

Instead, I recommend an approach based in mindfulness, at least in the initial stages of problem solving.

Whenever you find yourself “stuck” or troubled in a situation that seems not to have a solution, I suggest that you try the following steps. In practice, these steps are aided by guided meditation for each of the cognitive/emotive sequences, but meanwhile, here are the 4 steps.

The SOAR technique:

Stop

Stop thinking about the problem. Stop trying to distract yourself. Stop trying to think of solutions. Just stop. Don’t run away. Don’t retreat into the past or into fantasies of the future. No
“should’ves or could’ves”.
Stop.

Observe

See what is. Look at situation, not to analyse, but to understand, to witness, to observe. This is often the most difficult step of the SOAR technique and it is useful to practice mindfulness techniques.
In this step, you become mindfully aware of the situation – able to see the situation without minimizing it or blowing it out of proportion

Accept (Serenity Prayer):
Accept what you can change and what you cannot, and the wisdom to know the difference. (thanks to the great Reinhold Neibuhr)

Transform:
This is the easy part. Transformation – either of yourself, or the situation, but often both – will occur as a consequence of steps 1, 2, and 3. Once you calm your fears and anxieties, once you are able to see and observe

So there it is, Stop Observe, Accept , repeat as necessary.

Best wishes

Shyam Bhat MD


Integrative Stress Management: Part 1


Q: “Can you please tell me some integrative treatments for stress?”

RK, Mumbai

A: By “stress”, I am assuming you mean the emotional effects of stressful conditions.

An integrative approach to stress would have to begin by an exploration of the causes and effects of stress in your life.

Body: What is your lifestyle like? Diet, sleep-wake cycles, use of alcohol, tobacco or other substances, the amount and nature of exercise, or lack of it, posture, and weight – all of these can cause, or be affected by, stress in your life.

Mind: Your thoughts about life and your goals in life. Your assessment of your self, and others. Your world-view. Your temperament. Your ability to understand and modulate your own emotional responses.

Spirit: Your concept of your place in the world and universe. Your feelings about the nature of life and existence. Your concept of meaning and purpose in life.

Therefore, the exploration of the causes of stress in your life will itself be revelatory. Recognition of the causes of stress will help you formulate a plan for stress management.

If you are like most urban dwellers, some useful stress management strategies are:


Exercise

30 minutes a day 3/week . Plenty of research that has examined the role of aerobic exercise in improving mood. In addition, meditative exercises such as Qi Gong or Tai Chi, and Yoga asanas are useful.


Diet

There is a lot of individual variation, but in general I recommend the following diet:

50% of your calories from carbohydrates. However, eat only low glycemic index, unprocessed or minimally processed carbohydrates.

Eat vegetable protein over animal protein. Fish would be ideal but it is becoming harder to find fish that are not overly contaminated by heavy metals such as mercury. Avoid mackerel and tuna, for this reason.

Adequate hydration, with clean room temperature water. No soft drinks. Drink fruit juice if you must but only if it is not full of concentrate. Only 100% juice with no additives. And even then, remember that whole fruits are more nutritious (not to mention cheaper) than juices. Ensure that your total dietary fructose content is not more than 10% of your daily caloric intake at the most.
Remember that in many countries, several products have high fructose corn syrup (HFCS). Stay away from them (The products, not the countries).

Low sodium – not more than 3grams per day (and less than 2 g/day if you have hypertension, or heart disease). The sodium content in pre-packaged food can easily reach dead-sea proportions. This is true even for many organic and otherwise nutritious sounding products – always check the label.

Small frequent meals rather than sporadic large ones.

A daily breakfast. Yes, yes, it’s cliche. But it’s true. Breakfast is the most important meal of the day. Eat wisely and do not miss it. A good breakfast for your mood and your heart – a bowl of oats, bran, or muesli along with a tablespoon of milled flaxseed (for the omega 3 fatty acids).

The judicious use of spice – Spicy food can be good for you. Ensure that the spices are of good quality though. I will write more about spicy food in subsequent posts. Use spicy food more if you are suffering from apathy and decreased energy. Avoid spicy food if you are suffering from anxiety and restlessness.

Yogurt and other dairy products: Eat at least 2 cups of yogurt a day with live cultures. (as in bacteria, not art)

Avoid sugar – avoid sugar. Use honey as a sweetener instead if you have to.

Not more than 2 drinks at a time, and not more than 6 a week. Alcohol does have beneficial effects on the heart and mind in low doses but if you are unable to regulate your use, then abstinence is the best policy.

Supplements

Ensure adequate micronutrients and vitamins, preferably from dietary sources. But sometimes supplementation with folic acid, Vitamin B complex, zinc, Calcium and Vitamin D might be indicated.
Fish oil supplements (from a manufacturer who tests for mercury and PCBs) – 2 grams per day for most people, except those with bleeding problems is a very important supplement, as well as Ashwagandha (Withania somnifera) 2- 3 grams per day for chronic anxiety (stress that has lasted for more than 1 year).

Regular Circadian Rhythms

Sleep is the most obvious manifestation of your circadian rhythm. Sleep as much as you need to feel refreshed – this is usually between 6-8 hours. Sleep and wake up at the same time everyday, preferably closer to dawn.

Pay attention to your body clock. Some people need a siesta in order to function better. If your work permits that, then by all means ensure an afternoon nap.

Body work

A daily massage with warm sesame oil is helpful in reducing stress and anxiety. If you have access to an Ayurvedic facility, Abhyangam and Shirodhara are very useful. (more about shirodhara in a subsequent post)

Also, stress affects postural muscles, resulting in shoulder pain, neck pain, and back pain. In addition a particular posture “locks-in” the mood, anchoring negative emotional energy (to borrow a new-age term) in depressed physical postures. Changing and improving your posture and gait will help your mood. The Alexander’s technique and Feldenkrais are 2 methods that are useful in this regard.

Meditation

    Stress and the pressures of everyday life prevents many people from really experiencing life around them and within themselves. Through various meditation practices, you will feel a remarkable lessening of your stress.
    For example, a useful stress reduction strategy is to be mindful of, and to fully experience one’s own emotions. I will describe this and other meditations related to stress reduction in a subsequent podcast/post.

    Understanding and Changing Your Thoughts

Psychiatrists refer to this as cognitive therapy. But the basic tenets of cognitive therapy are intuitively practiced by most people. When you try and change a negative thought into a more balanced one, you are practicing cognitive therapy.

Practicing the Golden 3

    Forgiveness of yourself and others
    Acceptance of yourself and others
    Gratitude for the good in your life and for the good in everyone’s life.

    ________________________


    Part 2: Spirit – Transcendence of the Negative 3: Existential Fear, Guilt and Shame; The Experience of Meaning, Purpose, and Optimism