DBT Made Simple – by Sheri van Dijk

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This book offers very clear explanations of DBT. In fact, a more fitting title might have been “DBT made clear”, because it does it without oversimplification.

This is a way in which van Dijk’s work stands out from that of many writers on the subject! Many authors oversimplify, to the point that a reader may wonder “is that all it is?” when, in reality, there’s rather more to it.

This work is, therefore, refreshingly comprehensive, without sacrificing clarity.

Van Dijk also takes us through the four pillars of DBT:

  1. Mindfulness
  2. Distress tolerance
  3. Emotional regulation
  4. Interpersonal effectiveness

Each of these can help an individual alone; together, they produce a composite effect with a synergy that makes each more effective. Hence, pillars.

On the topic of “an individual”, you may be wondering “is this book for therapists or the general public?” and the answer is yes, yes it is.

That is to say: it’s written with the assumption that the reader wants to learn DBT in order to practice it as a therapist… and/but is written in such a fashion that it’s very easy to apply the skills to oneself, too. As it’s an introductory guide—a comprehensive one, but without assuming prior knowledge—it’s a perfect resource for anyone to get a good grounding in the subject.

Bottom line: if you’ve been hearing about DBT (possibly from us!) and wondering where you might start, this book is an excellent place to begin.

Click here to check out DBT Made Simple, and start making many parts of life easier!

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Recommended

  • Intuitive Eating – by Evelyn Tribole and Elyse Resch
  • ‘Emergency’ or Not, Covid Is Still Killing People. Here’s What Doctors Advise to Stay Safe.
    The pandemic isn’t over just because the emergency response is. Covid infections are still surging, so follow guidelines, get vaccinated, and wear masks to stay safe.

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  • Are You Eating AGEs?

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    The Trouble of the AGEs

    Advanced Glycation End-Products (AGEs) are the result of the chemical process of glycation, which can occur in your body in response to certain foods you ate, or you can consume them directly, if you eat animal products that contained them (because we’re not special and other animals glycate too, especially mammals such as pigs, cows, and sheep).

    As a double-whammy, if you cook animal products (especially without water, such as by roasting or frying), extra AGEs will form during cooking.

    When proteinous and/or fatty food turns yellow/golden/brown during cooking, that’s generally glycation.

    If there’s starch present, some or all of that yellow/golden/brown stuff will be a Maillard Reaction Product (MRP), such as acrylamide. That’s not exactly a health food, but it’s nowhere near being even in the same ballpark of badness.

    In short, during cooking:

    • Proteinous/fatty food turns yellow/golden/brown = probably an AGE
    • Starchy food turns yellow/golden/brown = probably a MRP

    The AGEs are far worse.

    What’s so bad about AGEs?

    Let’s do a quick tour of some studies:

    We could keep going, but you probably get the picture!

    What should we do about it?

    There are three main ways to reduce serum AGE levels:

    Reduce or eliminate consumption of animal products

    Especially mammalian animal products, such as from pigs, cows, and sheep, especially their meat. Processed versions are even worse! So, steak is bad, but bacon and sausages are literally top-tier bad.

    Cook wet

    Dry cooking (which includes frying, and especially includes deep fat frying, which is worse than shallow frying which is worse than air frying) produces far more AGEs than cooking with methods that involve water (boiling, steaming, slow-cooking, etc).

    As a bonus, adding acidic ingredients (e.g. vinegar, lemon juice, tomato juice) can halve the amount of AGEs produced.

    Consume antioxidants

    Our body does have some ability to deal with AGEs, but that ability has its limits, and our body can be easily overwhelmed if we consume foods that are bad for it. So hopefully you’ll tend towards a plant-based diet, but whether you do or don’t:

    You can give your body a hand by consuming antioxidant foods and drinks (such as berries, tea/coffee, and chocolate), and/or taking supplements.

    Want to know more about the science of this?

    Check out…

    Advanced Glycation End-Products in Foods and a Practical Guide to Their Reduction in the Diet

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  • How they did it: STAT reporters expose how ailing seniors suffer when Medicare Advantage plans use algorithms to deny care

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    In a call with a long-time source, what stood out most to STAT reporters Bob Herman and Casey Ross was just how viscerally frustrated and angry the source was about an algorithm used by insurance companies to decide how long patients should stay in a nursing home or rehab facility before being sent home.­

    The STAT stories had a far-reaching impact:

    • The U.S. Senate Committee on Homeland Security and Government Affairs took a rare step of launching a formal investigation into the use of algorithms by the country’s three largest Medicare Advantage insurers.
    • Thirty-two House members urged the Centers for Medicare and Medicaid Services to increase the oversight of algorithms that health insurers use to make coverage decisions.
    • In a rare step, CMS launched its own investigation into UnitedHealth. It also stiffened its regulations on the use of proprietary algorithms and introduced plans to audit denials across Medicare Advantage plans in 2024.
    • Based on STAT’s reporting, Medicare Advantage beneficiaries filed two class-action lawsuits against UnitedHealth and its NaviHealth subsidiary, the maker of the algorithm, and against Humana, another major health insurance company that was also using the algorithm. 
    • Amid scrutiny, UnitedHealth renamed NaviHealth.

    The companies never allowed an on-the-record interview with their executives, but they acknowledged that STAT’s reporting was true, according to the news organization.

    Ross and Herman spoke with The Journalist’s Resource about their project and shared the following eight tips.

    1. Search public comments on proposed federal rules to find sources.

    Herman and Ross knew that the Centers for Medicare and Medicaid Services had put out a request for public comments, asking stakeholders within the Medicare Advantage industry how the system could improve.

    There are two main ways to get Medicare coverage: original Medicare, which is a fee-for-service health plan, and Medicare Advantage, which is a type of Medicare health plan offered by private insurance companies that contract with Medicare. Medicare Advantage plans have increasingly become popular in recent years.

    Under the Social Security Act, the public has the opportunity to submit comments on Medicare’s proposed national coverage determinations. CMS uses public comments to inform its proposed and final decisions. It responds in detail to all public comments when issuing a final decision.

    The reporters began combing through hundreds of public comments attached to a proposed Medicare Advantage rule that was undergoing federal review. NaviHealth, the UnitedHealth subsidiary and the maker of the algorithm, came up in many of the comments, which include the submitters’ information.

    “These are screaming all-caps comments to federal regulators about YOU NEED TO SOMETHING ABOUT THIS BECAUSE IT’S DISGUSTING,” Ross says.

    “The federal government is proposing rules and regulations all the time,” adds Herman, STAT’s business of health care reporter. “If someone’s going to take the time and effort to comment on them, they must have at least some knowledge of what’s going on. It’s just a great tool for any journalist to use to figure out more and who to contact.”

    The reporters also found several attorneys who had complained in the comments. They began reaching out to them, eventually gaining access to confidential documents and intermediaries who put them in touch with patients to show the human impact of the algorithm.

    2. Harness the power of the reader submission box.

    At the suggestion of an editor, the reporters added a reader submission box at the bottom of their first story, asking them to share their own experiences with Medicare Advantage denials.

    The floodgates opened. Hundreds of submissions arrived.

    By the end of their first story, Herman and Ross had confidential records and some patients, but they had no internal sources in the companies they were investigating, including Navihealth. The submission box led them to their first internal source.

    (Screenshot of STAT’s submission box.)

    The journalists also combed through LinkedIn and reached out to former and current employees, but the response rate was much lower than what they received via the submission box.

    The submission box “is just right there,” Herman says. “People who would want to reach out to us can do it right then and there after they read the story and it’s fresh in their minds.”

    3. Mine podcasts relevant to your story.

    The reporters weren’t sure if they could get interviews with some of the key figures in the story, including Tom Scully, the former head of the Centers for Medicare and Medicaid Services who drew up the initial plans for NaviHealth years before UnitedHealth acquired it.

    But Herman and another colleague had written previously about Scully’s private equity firm and they had found a podcast where he talked about his work. So Herman went back to the podcast — where he discovered Scully had also discussed NaviHealth.

    The reporters also used the podcast to get Scully on the phone for an interview.

    “So we knew we had a good jumping off point there to be like, ‘OK, you’ve talked about NaviHealth on a podcast, let’s talk about this,’” Herman says. “I think that helped make him more willing to speak with us.”

    4. When covering AI initiatives, proceed with caution.

    “A source of mine once said to me, ‘AI is not magic,’” Ross says. “People need to just ask questions about it because AI has this aura about it that it’s objective, that it’s accurate, that it’s unquestionable, that it never fails. And that is not true.”

    AI is not a neutral, objective machine, Ross says. “It’s based on data that’s fed into it and people need to ask questions about that data.”

    He suggests several questions to ask about the data behind AI tools:

    • Where does the data come from?
    • Who does it represent?
    • How is this tool being applied?
    • Do the people to whom the tool is being applied match the data on which it was trained? “If racial groups or genders or age of economic situations are not adequately represented in the training set, then there can be an awful lot of bias in the output of the tool and how it’s applied,” Ross says.
    • How is the tool applied within the institution? Are people being forced to forsake their judgment and their own ability to do their jobs to follow the algorithm?

    5. Localize the story.

    More than half of all Medicare beneficiaries have Medicare Advantage and there’s a high likelihood that there are multiple Medicare Advantage plans in every county across the nation.

    “So it’s worth looking to see how Medicare Advantage plans are growing in your area,” Herman says.

    Finding out about AI use will most likely rely on shoe-leather reporting of speaking with providers, nursing homes and rehab facilities, attorneys and patients in your community, he says. Another source is home health agencies, which may be caring for patients who were kicked out of nursing homes and rehab facilities too soon because of a decision by an algorithm.

    The anecdote that opens their first story involves a small regional health insurer in Wisconsin, which was using NaviHealth and a contractor to manage post-acute care services, Ross says.

    “It’s happening to people in small communities who have no idea that this insurer they’ve signed up with is using this tool made by this other company that operates nationally,” Ross says.

    There are also plenty of other companies like NaviHealth that are being used by Medicare Advantage plans, Herman says. “So it’s understanding which Medicare Advantage plans are being sold in your area and then which post-acute management companies they’re using,” he adds.

    Some regional insurers have online documents that show which contractors they use to evaluate post-acute care services.

    6. Get familiar with Medicare’s appeals databases

    Medicare beneficiaries can contest Medicare Advantage denials through a five-stage process, which can last months to years. The appeals can be filed via the Office of Medicare Hearings and Appeals.

    “Between 2020 and 2022, the number of appeals filed to contest Medicare Advantage denials shot up 58%, with nearly 150,000 requests to review a denial filed in 2022, according to a federal database,” Ross and Herman write in their first story. “Federal records show most denials for skilled nursing care are eventually overturned, either by the plan itself or an independent body that adjudicates Medicare appeals.”

    There are several sources to find appeals data. Be mindful that the cases themselves are not public to protect patient privacy, but you can find the number of appeals filed and the rationale for decisions.

    CMS has two quality improvement organizations, or QIOs, Livanta and Kepro, which are required to file free, publicly-available annual reports, about the cases they handle, Ross says.

    Another company, Maximus, a Quality Improvement Contractor, also files reports on prior authorization cases it adjudicates for Medicare. The free annual reports include data on raw numbers of cases and basic information about the percentage denials either overturned or upheld on appeal, Ross explains.

    CMS also maintains its own database on appeals for Medicare Part C (Medicare Advantage plans) and Part D, which covers prescription drugs, although the data is not complete, Ross explains.

    7. Give your editor regular updates.

    “Sprinkle the breadcrumbs in front of your editors,” Ross says.

    “If you wrap your editors in the process, you’re more likely to be able to get to the end of [the story] before they say, ‘That’s it! Give me your copy,’” Ross says.

    8. Get that first story out.

    “You don’t have to know everything before you write that first story,” Ross says. “Because with that first story, if it has credibility and it resonates with people, sources will come forward and sources will continue to come forward.”

    Read the stories

    Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need

    How UnitedHealth’s acquisition of a popular Medicare Advantage algorithm sparked internal dissent over denied care

    UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care

    UnitedHealth used secret rules to restrict rehab care for seriously ill Medicare Advantage patients

    This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.

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  • A Guide to the Good Life – by Dr. William Irvine

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    “Living well” is a surprisingly underrated part of wellness. We spend much of our lives in turmoil. Some of us, windswept and battered by the storms of life; others, up in quietly crumbling towers, seemingly “great” but definitely not feeling it. Diet and exercise etc will only get us so far. What else, then, can we do?

    For Dr. Irvine, the key lies in two main things:

    1. Deciding how we intend to live our life (and doing so)
    2. Remaining tranquil in the face of external stressors

    In Japanese terms, these things can be seen in ikigai and zen, respectively. This book puts them in Western terms, specifically, that of Stoic philosophy. But the goals and methods are very similar.

    Far from being an abstract tome of wishy-washy philosophy, this book offers down-to-earth practical exercises and easily applicable advice. There was even an exercise that was new to this reviewer who has been reading such things for decades.

    The writing style is also, true to Stoic principles, unpretentious and simple. This is an easy book to read, while being nonethless very engaging from start to finish—and thereafter!

    Bottom line: so far as we know, we only get one shot at life, so we might as well make it a good one. Applying the ideas found in this book can help any reader to live better, and take more joy in it along the way.

    Click here to check out a Guide to the Good Life, and live your best!

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Related Posts

  • Intuitive Eating – by Evelyn Tribole and Elyse Resch
  • The Conquest of Happiness – by Bertrand Russell

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    When we have all our physical needs taken care of, why are we often still not happy, and what can we do about that?

    Mathematician, philosopher, and Nobel prizewinner Bertrand Russell has answers. And, unlike many of “the great philosophers”, his writing style is very clear and accessible.

    His ideas are simple and practical, yet practised by few. Rather than taking a “be happy with whatever you have” approach, he does argue that we should strive to find more happiness in some areas and ways—and lays out guidelines for doing so.

    Areas to expand, areas to pull back on, areas to walk a “virtuous mean”. Things to be optimistic about; things to not get our hopes up about.

    Applying Russell’s model, there’s no more “should I…?” moments of wondering which way to jump.

    Bottom line: if you’ve heard enough about “how to be happy” from wishy-washier sources, you might find the work of this famous logician refreshing.

    Click here to check out The Conquest of Happiness, and see how much happier you might become!

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  • Rose Hips vs Blueberries – Which is Healthier?

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    Our Verdict

    When comparing rose hips to blueberries, we picked the rose hips.

    Why?

    Both of these fruits are abundant sources of antioxidants and other polyphenols, but one of them stands out for overall nutritional density:

    In terms of macros, rose hips have about 2x the carbohydrates, and/but about 10x the fiber. That’s an easy calculation and a clear win for rose hips.

    When it comes to vitamins, rose hips have a lot more of vitamins A, B2, B3, B5, B6, C, E, K, and choline. On the other hand, blueberries boast more of vitamins B1 and B9. That’s a 9:2 lead for rose hips, even before we consider rose hips’ much greater margins of difference (kicking off with 80x the vitamin A, for instance, and many multiples of many of the others).

    In the category of minerals, rose hips have a lot more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc. Meanwhile, blueberries are not higher in any minerals.

    In short: as ever, enjoy both, but if you’re looking for nutritional density, there’s a clear winner here and it’s rose hips.

    Want to learn more?

    You might like to read:

    It’s In The Hips: Rosehip’s Benefits, Inside & Out

    Take care!

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  • The Art of Being Unflappable (Tricks For Daily Life)

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    The Art of Being Unflappable

    From Stoicism to CBT, thinkers through the ages have sought the unflappable life.

    Today, in true 10almonds fashion, we’re going to distil it down to some concentrated essentials that we can all apply in our daily lives:

    Most Common/Impactful Cognitive Distortions To Catch (And Thus Avoid)

    These are like the rhetorical fallacies with which you might be familiar (ad hominem, no true Scotsman, begging the question, tu quoque, straw man, etc), but are about what goes on between your own ears, pertaining to your own life.

    If we learn about them and how to recognize them, however, we can catch them before they sabotage us, and remain “unflappable” in situations that could otherwise turn disastrous.

    Let’s take a look at a few:

    Catastrophizing / Crystal Ball

    • Distortion: not just blowing something out of proportion, but taking an idea and running with it to its worst possible conclusion. For example, we cook one meal that’s a “miss” and conclude we are a terrible cook, and in fact for this reason a terrible housewife/mother/friend/etc, and for this reason everyone will probably abandon us and would be right to do so
    • Reality: by tomorrow, you’ll probably be the only one who even remembers it happened

    Mind Reading

    • Distortion: attributing motivations that may or may not be there, and making assumptions about other people’s thoughts/feelings. An example is the joke about two partners’ diary entries; one is long and full of feelings about how the other is surely dissatisfied in their marriage, has been acting “off” with them all day, is closed and distant, probably wants to divorce, may be having an affair and is wondering which way to jump, and/or is just wondering how to break the news—the other partner’s diary entry is short, and reads “motorcycle won’t start; can’t figure out why”
    • Reality: sometimes, asking open questions is better than guessing, and much better than assuming!

    All-or-Nothing Thinking / Disqualifying the Positive / Magnifying the Negative

    • Distortion: having a negative bias that not only finds a cloud in every silver lining, but stretches it out so that it’s all that we can see. In a relationship, this might mean that one argument makes us feel like our relationship is nothing but strife. In life in general, it may lead us to feel like we are “naturally unlucky”.
    • Reality: those negative things wouldn’t even register as negative to us if there weren’t a commensurate positive we’ve experienced to hold them in contrast against. So, find and remember that positive too.

    For brevity, we put a spotlight on (and in some cases, clumped together) the ones we think have the most bang-for-buck to know about, but there are many more.

    So for the curious, here’s some further reading:

    Psychology Today: 50 Common Cognitive Distortions

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