Dr Robert London

Quality of Life, Not Life or Death

Clinical Psychiatry News - Volume 34, Issue 5, Page 30 (May 2006)

We read in newspapers, hear on the radio, and see on television, over and over again, that there are ways we can make our lives better. From exercising to dieting to improving sleep habits and lowering stress levels, we are told that following certain routines will enable us to live longer, be stronger, fight disease better, and, of course, reduce stress.

But which form of exercise, diet, or stress reduction is best? Do we walk for 20 minutes vigorously, or is a less vigorous 40-minute walk just as effective? Which of the multitude of diets is best?

When it comes to stress reduction, the number of ideas and suggestions out there boggles the mind. Anyone who enters a popular bookstore will see myriad books and programs that claim to offer the perfect answer on this subject.

In my experience in helping patients address quality of life issues that do not relate to illnesses or disorders connected to DSM configurations, I have been able to work successfully with three different groups of people, all looking for some improvement in specific areas of their lives.

In this column, I would like to discuss my work with a medical student who needed to improve his study habits and test taking, several serious athletes who sought better performance, and a number of attorneys who wanted to be more effective in the courtroom.

My learning, philosophizing, and action (LPA) technique, particularly the action part, proved very useful when the medical student asked me to help him improve his memory of material needed to perform well on tests. He was very bright but had had the experience of blocking information needed for test taking while in college.

This student's thinking on this matter was very clear. He knew that the stress of the exam kept him from thinking clearly and remembering all that was necessary. He was not a psychiatry patient, but he fit neatly into the action phase of the LPA technique. No learning or philosophizing was necessary. I taught him a relaxation technique.

First, I taught him a simple method of entering a relaxed state using the hypnotic induction profile, described in “Trance and Treatment: Clinical Uses of Hypnosis” by Dr. Herbert Spiegel and Dr. David Spiegel. This technique, in itself, reduced some of the stress and anxiety that in the past had clouded the student's memory of test material. This training takes about 10 minutes.

With this done, I had him imagine a large movie screen, on which he could project information that was being asked on the exam. He did not have to project each and every question, but when he felt blocked he could take a deep breath, exhale slowly, and envision a large movie screen. On that screen, he could project material he had studied in a text, review book, or notes.

This was done in a matter of seconds, and the results were very clear. He was able to see the material on the screen that was in his memory bank in a clear, nonstressful way and, therefore, was able to recall the knowledge he had. The new technique made him feel better and more confident. I have used the same technique with several other students, and the results have been equally gratifying.

I have found, however, that using the same technique to help people remember past events or experiences has not been as rewarding. For example, on two occasions in my career, I was consulted to use memory techniques to help people remember where they had misplaced items. In both cases, the items misplaced were pieces of jewelry. And in both cases, those items were engagement rings that had been misplaced—before the weddings. Go figure.

Once it became known that I was willing to help patients work through certain quality of life or life improvement issues, other types of consultations were requested. I opted to pass on the cases in which people wanted to revisit past lives or go back in time.

Referrals did come in, though, for people interested in improving their performance in sports. The sports in which I was most able to affect positive results were tennis and golf. In both sports, I worked with serious players who wanted to find a method of improving their game.

Once again I used the screen technique. Using the quick relaxation method of the hypnotic induction profile, I was able to get them to imagine a great big movie screen where they could see themselves playing the sport of their choice: tennis or golf. In both sports, the aim is to hit the ball accurately. So as they saw themselves on the screen, I had them imagine that the tennis racket or the golf club as an extension of their arm. Instead of hitting the ball, they would try to place the ball at the spot they wanted.

In other words, as an extension of the arm, it was possible to place the ball on the screen instead of just hitting it. The hope was that, with practice on the screen, this approach was transferred to the actual sport. I had read years earlier that the success of Zen Buddhist archers was due, in part, to the practice effect of just that: placing the arrow where they wanted it and not just letting it go. Transferring this technique to both of those sports seemed a natural modification.

In this method, of course, the practice effect is critical. That's why I made sure to get the golfers and tennis players to practice several times in the 1.5-hour office visit. Again, they were taught how to do this relaxation technique and the accompanying strategy, so that a regimen of 1− or 2-minute practices, 10 times a day, was the ongoing learning and reenforcement method used.

I also was able to help several attorneys who wanted more flow in their courtroom presentations. After much practice out of the courtroom, they were able to use the screen technique to visualize the facts of the case in a matter of seconds and sequence them in a manner that they thought flowed better.

Athletes generally have a wider time frame to adopt these approaches than do lawyers, so it is critical that lawyers be able to go quickly to this imagined screen and block out a sequence before actually making the presentation.

In all three examples, the action phase of the LPA technique was used effectively to improve situations in which people were willing to use a new technique to improve certain aspects of their lives.

I have found working in these areas to be both challenging and rewarding. Not everything we do needs to be related to disorders, illnesses, or dysfunctional behaviors, as many dermatologists, ophthalmologists, and plastic surgeons will tell us.

Let me know what you think about working with people who do not have “disorders” but want help in improving their quality of life. I will try to pass these ideas along to my readers.

PII: S0270-6644(06)71421-7