Frequently Asked Questions (FAQs)

You have probably discovered that you may have been taking more and more of your sleep medication over time, or if you don’t take it, your
problem falling asleep seems to get worse.  You are correct if you suspect your brain has adapted to the medication
to the point that you are having trouble discontinuing its use.  This will happen pretty quickly if you have been taking one of the benzodiazepines as a sleep aide, but trouble discontinuing sleep medication also happens with any of the commonly-prescribed
or over-the-counter medications. 

To get off your medication, we would want to work with the provider who is prescribing your medication to work out a very gradual tapering
schedule.  It has been my experience that most physicians try to get patients to cut back too quickly, and the effort fails.  By tapering, we mean taking perhaps only ¾ of the prescribed dose for say, a week, then reducing this to ½ of the dose for a week, etc.   It is best done slowly over time if you have been taking medication for a long time.  Stopping abruptly or tapering too quickly causes what we call an “insomnia rebound” (this is insomnia returning with a vengeance when one stops taking sleep meds).    Also, abruptly stopping some medications people take for sleep is quite dangerous if they have been on high doses (e.g., risk of seizures). 

As a prior university researcher, I am always investigating new ways to help improve  treatments in the area of health psychology.  In the case
of tapering sleep medication, some principles discovered by psychologists who study learning are relevant here.  One of these principles is called classical conditioning (you can read about this anywhere on the internet).   My informal work with physicians who prescribe
sleep medication suggests that tapering medication is much easier if we ca develop a strong association between the physiological effects of the medication (drowsiness, sleepiness) and an external, situational cue, such as something wecan listen to, an auditory cue.  Working with your provider, we would coach you to never again take the medication at night without pairing it with a sound source.  The audio source could be an electric fan you would use only night or using ear buds to have you listen at a very low volume to repetitive sounds of the ocean, the rain forest, etc.   If you opt for soft nature sounds, you’d obtain a recording lasting about an hour (download from YouTube).  It is important to play the very same audio track every night, or turn on the electric fan or other “white noise” source only at bedtime.  If you sleep with a partner, wearing soft earbuds will isolate the sound so you won’t disturb them.  (The earbuds will harmlessly fall out of your ears sometime during the night).  The learning principle is that night after night, you repeatedly become drowsy from the medication and your brain also associates drowsiness with the sound of the very same low volume audio.   Over time, the audio will acquire drowsiness properties and help signal your
brain to prepare for sleep. 

Some other details:  
You would take your medication about 20 min before bedtime, climb into bed, and start the audio, at very low volume.  It is very important to
concentrate on the sounds
.  In the case of an electric fan for example, you will notice a very slight rhythm to the sound and would concentrate or track this in your mind.  In the case of say, sounds of the ocean, you would imagine seeing what you hear.  You would concentrate on what you imagine the waves look like, what it feels like to walk on the beach as you listen to the audio.  

Another very key point is that for people with insomnia, concentrating on the audio is  incompatible with your night time thinking, worrying,
problem-solving, planning etc.  You cannot do both at the very same time.  We want the audio to effectively disrupt your usual night time trains of thought.  You will find that at first, your mind will want to quickly shift away from the audio/sounds and back to your usual trains of night time thinking and worrying.  However, with practice, you can pull your mind back to focus only the audio.  In fact, patients report to me that this battle for attentional focus almost always happens many times at first.  However,  with practice, you will be able to “stay with” the audio for longer and longer periods of time.  At first, it will be only a minute or so, but with continued practice, two, three, minutes, etc.  We want you falling asleep to the sounds.  

After several weeks of associating the drowsiness effects of the medication with the audio procedure, your brain will begin to associate listening to the audio with “getting sleeping”.   You will now more easily be able to taper your sleep medication.  However, you need to continue listening to the audio, every night.  As I have mentioned the audio will start to become a signal to your brain that it is “time to sleep”.   You should eventually find that the sleep preparation behaviors you have practiced, relaxation training, and listening to your conditioned audio that signals “sleep” can now substitute for effectively for sleep medication and that tapering your medication becomes much easier.      

I want to emphasize that as far as I know, there are no systematic research studies investigating the effectiveness of this classical conditioning procedure.  I developed this approach independently,  based on my knowledge of various psychological principles and continue informal case studies.   It is certainly a harmless procedure, as it contributes to the  goal—helping make medication tapering much easier.  Also,  it is always a healthful goal to reduce one’s use of sleep medication, as meds usually disrupt healthy sleep cycling.  I can attest to the fact that in the past 6 years of my work in primary care settings, several dozen patients who have not been able to get off their sleep medication for many years tried the procedure and either greatly reduced their use of medication, or stopped it altogether.  I can also tell you that full compliance with the procedure has unfortunately, been low.  Only about 3 in 10 patients actually follow the procedure consistently. They seem to either give up (this does take some sustained effort over time), or continue working the procedure “off and on”.   Commonly. they report that they ‘forget’ to do the procedure.  I speculate that it is a bit anxiety-provoking for most people to think about giving up medication that has helped them for many months or years, though rationally, they know they should.

Everyone’s sleep problem is unique and I would welcome the opportunity to talk to you further about what will work best for your insomnia problem.   

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Copyright 2019  David M. Stein, Ph.D.  Readers are welcome to llink to this article.   Coping this article without the written permission of the author is not permitted.  Coping the article and presenting it on one’s website without appropriately crediting the present author is considered plagiarism.  This action will be reported to state or provincial licensing boards as an ethical violation. 


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Several things affect how long, or how many appointments clients require. You have probably hear of some individuals who have been going to therapy continuously, every week or so, for several years. This is a fairly with an approach like long-term psychoanalysis. However, most therapists have learned to use briefer forms of therapy. This is due in part, to the fact that insurance companies like to limit the number of sessions they are willling to pay for. However, it is very clear based on a large number of quality research studies that the rate of improvement in counseling often starts to decrease after about five to six appointments.

A second factor involved in determining the duration of therapy is the severity of your condition, and the number of problems you face. Relatedly, whether or not a particular diagnosis tends to be chronic is most strongly associated with long-term therapy. So, for example, bereavement episodes tend to be shorter term in duration than a condition like true bipolar disorder, which is often a life-long condition. Also, some problems such as addictions (alcohol, pathological gambling), tend to involve a great many relapses along one’s way toward recovery. Furthermore, in many cases, when one’s life situation suddenly changes for the better, e.g., a client secures a better job after being fired, his or her behavioral health can improve significantly. Situational or life circumstances can cause counseling to become shorter or longer in duration.

Unfortunately, a third factor that promotes longer-than-necessary therapy is some counselors’ motivation to keep clients in therapy as long as possible, as their financial livelihood depends on it. I am not sure how often this happens but of course, it is not an ethical use of clients’ time or their financial resources. I clearly found this overuse of to be the case quite often when working in a primary care clinic, where the expectation was to see as many patients as possible, for the least amount of time necessary to provide the most benefit. We could not see all of the patients that needed help and so we referred many to therapists in the community spent far longer in counseling that the ones we saw in the primary care clinic, with about 25% of them using up all of the appointments allowed by the insurance company for the year.

A fourth factor that leads to longer-than-needed therapy has to do with the use of inefficient approaches to helping. Having had the opportunity to review over 1000 full medical records of social security disability patients in the past 15 years, I have found that the vast majority of therapists (over 90%) never provide evidence that they are actually applying the empirically-supported form of therapy they claimed to be using. If they did, the duration of therapy is very likely to be shorter and improvement, greater. For example, while a therapist claimed to use “Cognitive-Behavioral Therapy (CBT)”, yet their case notes nearly always read like a running diary of the life events experienced by the client since the last appointment. Nothing was ever mentioned about the outcome of CBT procedures, whether symptoms were improving since the last appointment, whether the client had completed a “homework” assignment, etc. Apparently, CBT is not actually occurring in the sessions, which was almost certainly inefficient and needlessly extended the duration of therapy.

In summary, the factors mentioned above all contribute to the duration of therapy. Here are some rough guidelines for you: 1) After completing an initial appointment with your therapist, you should ask how long therapy for a problem such as yours normally takes. 2) Your therapist should be able to outline what sorts of things you will be doing in future appointments to promote improvement. They should be able to outline goals. Relatedly, I believe clients should never leave any appointment without having something specific to be working on they feel motivated to do. (What will you be doing, when, for how long, etc……). 3) You should leave the first appointment or two with a sense of hopefulness, sensing that on the right track toward resolving your problem. 4) You may want to check with your insurance company to see how many appointments they will initially authorize. 5) If your counseling is occurring in conjunction with taking medication for your conditions, your therapist should ask you to sign a release form so he/she can touch base with your medication provider. Collaborating with your medication provider will make your therapy more effective, and vice/versa.

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Severe overweight is associated with a vast array of health problems, including chronic pain, diabetes, etc.  Over the past 75 years or so, two behavioral themes have dominated approaches to losing weight.  The most common but erroneous theme continues to be that finding the “best” commercial diet can provide a path to permanent weight loss for most people.   Another false theme is that the quantity of food one eats, whatever it is,  accounts for weight gain.  The fact is that over 80% of people who attempt to lose weight gradually gain it back, and then some.   I would like to highlight some of the valid themes and facts about weight loss and its relation to eating behavior and activity choices.   My claims here are based on my understanding of the large research literature that exists on weight loss and especially, weight loss failure and success. 

First, it is critical to reject the idea that most people can lose weight through a diet that lasts a few months, and that following weight loss, one can then return to his or her prior eating and activity levels, with little consequence.  This belief is utterly false because your body uses a large number of physiological mechanisms that are specifically designed to retain body fat. Literally, your body is built to fight your efforts to lose weight.  You have probably familiar with the idea of “yo-yo” dieting, in which people regularly spend years losing weight, gaining it back, attempting to lose it again, regaining, etc.  Nearly all people who attempt weight loss find that in the end their body is more persistent in retaining fat than dieters are in losing it. The first general behavioral principle suggests that successful long-term weight loss involves an array of interactive permanent lifestyle changes, usually adopted in “baby steps”. Relatedly, the individual has to find them pleasant and rewarding to do or they will tend to stop doing them at some point.

A second, quite valid behavioral aspect of weight loss is that most people can in fact, lose weight (short term) by adopting any of the generally popular commercial programs that have been around a long time, such as Weight Watchers, Jenny Craig, a “paleo” eating regimen, etc.  Studies that compare the effectiveness of different programs fail to show meaningful differences in long term outcomes.  Also, successful outcomes in these programs are on average, modest (up to about an average of seven pounds lost); and are nearly always short-lived. People nearly always gain the weight back when they leave the program.  I believe that one of the key elements to permanently altering your eating behavior lies in finding one of the effective programs that you really like and that you believe you can “live with” for the rest of your life.

Given the above, note that I am not interested in debates about whether one diet program is superior to another. However, some general food choices are extremely important to permanent weight loss, and they include the following.  Thus, our third behavioral theme suggests that we shop only in the “simple food” areas of the grocery store, avoiding the “prepared foods” (which incidentally, tend to take up over 50% of commercial grocery isle space; soft drinks, candy, chips, snack foods, bakery goods, etc).  The simple food areas include vegetables, meat a fruit and some dairy products.   The goal is to restrict purchases of products that contain added sugar and high levels of refined carbohydrates. Our high intake of processed sugar and carbs and our tendency to allow others to prepare the food we eat (e.g., “fast food”) contributes heavily to the obesity epidemic in the U.S.   Drastically reducing daily intake of carbohydrates and sugar will help your weight loss efforts tremendously.   In summary, significant increases in the proportion of food containing fats, protein, vegetables, with severe reductions in carbohydrates and sugars, is an important weight loss guideline. 

Second, most people I have worked with over the years have found that a permanent lifestyle change in eating behavior requires serious conscious attention to portion control.  I generally coach people who want to lose weight permanently that if they do nothing else, they will benefit from simply reducing  food portions of meals by roughly 30%, to start with.  In conjunction with consuming smaller portions, it is also helpful to allow enough time (maybe, 10-20 seconds) to deliberately assess whether you are minimally, feeling comfortably “full”.  In fact, slowing the pace of your eating and strictly reducing portions, plus, taking a few seconds to assess whether your are comfortably full are a series of fairly easy “first steps” to helping lose weight.

Third, we know that taking small, gradual steps e.g, incorporating new foods into one’s diet, a little at time, works better than making a radical change from a primarily high carb diet (to one that is sparse on carbs and sugar).   An interesting case study involving Type 2 diabetes patients illustrates this point.  A group of diabetic volunteers started a month-long eating and activity regimen change at an Arizona retreat center.  All were immediately placed on a strict, “raw foods” diet, emphasizing vegetables and some whole grains, with no added sugars or carbs.  Several individuals dropped out rather quickly because they could not adjust to such a radical change to their “American Diet” (e.g., OJ for breakfast, bread, hamburgers with French fries, pizza, etc.). The best approach is to make sure that your dietary changes are gradual, and that you like eating what you are transitioning to.  A simple example might be eating a hamburger with only ½ of the bun, later fading this to eating hamburgers with no bun over time.  Another example of easing into portion control can occur when dining out i.e., every time you visit a restaurant, you plan in advance how you will divide the meal in half and take the uneaen half home with you. You then enjoy the other half the next day for lunch or dinner.   After doing this a few times, many will report they start to look forward to having a favorite meal “twice”, because they exercised portion control. Most people greatly overeat when dining out.

Fourth, two other well-known lifestyle changes that aide permanent weight loss are getting enough total sleep at night, and increasing one’s activity level. A number of credible research studies suggest that quality sleep helps a person lose weight.   Most adults probably need 7-8 hours per night of quality sleep but achieve only about 6-7.  The positive impact of sleep on weight loss is due to factors scientists do not yet understand. However, it is well known that if we get enough sleep, we are much more likely to engage in higher levels of physical activity the next day (because we are not chronically tired).   And, with regard to physical activity level—-there is simply no doubt that strength training and aerobic conditioning play a role in helping a person maintain muscle mass that may decline during weight loss. Though it doesn’t appear to be a major contributor to successful weight loss, increasing physical activity seems to be one of the proven lifestyle changes persons who lose weight long term have adopted. It is recommended that you increase your activity level at least enough to achieve improved aerobic conditioning and to maintain your muscle mass.

Fifth, there is a universal behavioral health theme that is supported by thousands of psychological research studies involving many different types of behavior change goals.  Not surprisingly, the theme has huge implications for long-term, permanent weight loss and maintenance.  The theme is that all behavior change occurs more easily and is more easily sustained if one enjoys high social support for the behavior..  In the area of weight loss and fitness, his means that is helpful to have a friend or loved one who positively encourages, supports, or engages with you in the lifestyle changes you are making.  It is very hard to “go it alone”. For instance, an obese child almost certainly will never lose weight on their own.  The entire family needs to change its food-shopping, meal planning, eating habits and activity level.  Similarly, going on walks or visiting the gym is vastly more likely to occur for most people if they have a work-out partner.   One’s meal changes are more likely to become permanent if his or her partner or family also engages in meal planning and cooking. 

Why do over 80% of people who successfully lose weight regain it?  I now want to introduce a simple hypothesis about what I think accounts for most weight regain following successful “dieting”.   This is an educated speculation that is consistent with all of the best long-term studies examining successful versus unsuccessful  weight loss patients.  The primary reason people gradually regain weight is because they ever-so-gradually abandon the eating and activity behaviors that helped them lose weight in the first place.   While vigilant and consistent for many months, they invariably begin to experience very slight, minor “slips” in their weekly sugar or carb intake, or sleep or activity level..  Or, sooner or later, life circumstances may start to interfere with their lifestyle changes e.g, their usual exercise regimen.  They may start to become just a bit less vigilant about portion control and begin to experience “portion creep”.  They may relapse a bit in the habit of slowing the pace of their eating.  They may more often, grab a quick fast food meal during a busy week more and more often.  Or, recently, if under stress, they may begin to fall back on the old habit of de-stressing by eating a favorite “comfort food”.  They may allow themselves to “overindulge” on more frequent occasions than they did during their weight loss period. 

Researchers find that the most successful, long-term weight loss patients are unusually persistent and consistent.  To sustain weight loss over the very long term, the successful group tends to eat a small, healthy breakfast every day.  They weigh themselves regularly, (about once a week).  They have meal plans that they truly “stick with”, enjoy, and which are healthy. They tend to prepare their own meals, consistently. They watch fewer than 10 hours of TV per week (avoid being sedentary).  They have permanently and consistently cut back on how much they eat in a given day and do not stop monitoring what and how much they eat.  Nearly all make sure they maintain an exercise program,. Generally, this is simply walking many times each week.  In general, their frame of thinking has shifted from “trying to be thin”, to being as strong, well-rested and as “healthy” as they can be.  In summary, my speculation about weight regain after dieting emphasizes the idea that over time, patients ever so slowly fall back into patterns of eating, activity, sleep etc., that promoted their weight gain in the first place.   They tend to not realize it is happening. Given the fact that your body is 100% committed to restoring its fat stores, the successful weight loser cannot afford to relapse much in terms of their lifestyle changes.  He or she will catch themselves very quickly when the first few pounds return.  They reassess where they are reverting to old patterns or habits with eating, grocery shopping, activity, sleep, etc.  They then “go back to what got them here” quite consistently.

One starting point for valid information:

www.youtube.com/watch?v=da1vvigy5tQ

www.youtube.com/watch?v=ktQzM2IA-qU

Copyright 2019  David M. Stein, Ph.D.  Readers are welcome to llink to this article.   Coping this article without the written permission of the author is not permitted.  Coping the article and presenting it on one’s website without appropriately crediting the present author is considered plagiarism.  This action will be reported to state or provincial licensing boards as an ethical violation. 

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Choosing the right doctor or behavioral health provider can be a confusing task. One person may prefer to talk to someone who has spent much of their career training other counselors or doctors because they assume that such a person really knows the theory, procedures etc., related to particular treatments. Some may want a therapist who has vast experience developing the very latest techniques and publishes research on these techniques in respected professional journals. Still others may simply want to see someone who has exceptional breadth of experience helping lots of people with multiple problems, much like a highly experienced family health physician.

I am confident I offer a combination of all of the above attributes: 1) unique advanced training; a Ph.D. clinical psychologist, with a specialty area (health psychology). 2) 20+ years of experience as a professor and trainer of counselors and Ph.D. psychologists at major universities; 3) a treatment perspective that incorporates new knowledge I have developed as a university researcher; 4) the skills obtained through years of applied practice in clinics, hospitals, etc. Thus, I am confident I can help you with your concerns and would be a good match for what you are looking for in a behavioral health practitioner or consultant.


Most recently, I have been serving as a Ph.D. clinical health psychologist with the U.S. Air force, working with active duty members and their families in medical facilities. My unique combination of training and experience has effectively assisted clients with such challenges as depression, anxiety, sleep problems, chronic pain, Type 2 diabetes, and marital problems, ADHD, and many other difficulties. I work well with individuals who are reluctant to talk to a therapist about personal problems or are very ambivalent about making changes in their life.
On a personal level, outside of work, I enjoy simple, outdoor pleasures such as hiking and visiting national parks. However what I have loved best in my life has been my role as a father. Now…I say ‘has been’, because very recently, I have discovered that the absolute best role in life is grandfather.

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Dr. Stein has extensive experience working with clients, patients and students in online or video formats. You will find no real difference in the experience of sitting down face-to-face, versus a video interaction.

Advantages over face-to-face meetings include: 1) Convenience! First, think about the amount of time it takes for you to leave work or home, travel to a doctor’s office, then complete your appointment and drive back. With online video therapy, you will easily save over one hour of travel time to and from a therapist or doctor’s office. Second, you complete your confidential appointment in the safety and comfort of your own home or office. Third, online appointments are generally available either before or after your normal workday—no need to take time off work for a doctors’ appointment Third, we have the ability to send and receive helpful resources through the internet in real time, at the moment in time it is most relevant.

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For persons residing in the state of Utah, both PEHP and Blue Cross are accepted. We hope that Medicare, Medicaid, Tricare, EMI will be accepted starting about May 1, 2019 in both Utah and Arizona.

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The individual counseling and psychotherapy services are restricted to residents of Utah and Arizona. This is due to the fact that state licensing laws in the U.S. typically do not allow psychologists or other therapists to see clients outside the state in which they hold a license to practice.

Other services such as consultation on thesis and dissertations, or consultation about employee behavior problems are available to anyone.

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When you scheduled your appointment, you were automatically sent an email that confirms the appointment and includes instructions for connecting with the secure, online video counseling system. Please follow these instructions. You can use any mobile device and opt for either an audio-only appointment or audio + video appointment.

If you have any questions, send them through an email response or use the Contact Form (located on the Home page and other pages).

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You can obtain assistance with behavioral management of difficult employees, as Dr. Stein has over 12 years of personnel management experience, particularly in the public sector e.g., higher education.

Dr. Stein will also contract with individuals regarding developing graduate program theses and research dissertations. He can help you with all stages, from idea development, proposal composition, research design and data analysis expertise, planning a research thesis or dissertation document, preparing for a dissertation defense meeting, etc. This assistance can help students who feel they have an inactive or less-than-engaged major professor or dissertation chairperson and need more guidance. Dr. Stein has successfully chaired over 50 research thesis and dissertation committees at major, publicly-funded universities. Assistance in these domains must be limited to topics in education, social sciences and health, i.e., topics within the areas of our expertise.

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If you scheduled counseling or therapy appointment, what would your experience be like? 

First, I believe I provide clients with the experience of being listened to far better than they have likely encountered with other health care providers.   Clients and patients need an opportunity to put their problems or difficulties into their own words.  I exercise great patience helping them do just that.  You need to a chance to hear themselves think out loud in a safe, nonjudgmental setting

Second I tend to focus on helping clients identify and then reframe their problem, either as an internal conflict they have been unable to resolve or, a situation they feel they cannot cope with.  In other words, I think the most important part of your first appointment is helping you put into words what you think, feel, but cannot find the words to accurately express.  I can guarantee there are imporant aspects of your problem you have not been able to put into words!  A related aspect of counseling or therapy is helping clients articulate what they say to themselves i.e., their internal dialogue or ‘self-talk’, which reflects the conflicts and problems they have not yet resolved.   In summary, much of what I do falls under the technical term, “cognitive therapy”

Third, I think clients find me to be highly practical.  I tend to help them focus on the ‘here and now’.  I will not inquire much about the happened during an adult client’s childhood or other ‘history’, unless it is truly relevant to their current problem.   I realize many therapists think it is helpful for clients to gain insight into the causes and history of their problem.  However,  I don’t find it to be particularly useful or necessary to understand  ‘why’ something happened.  Rather, I primarily focus our therapy effort on ‘what to do about it’.  This is is a more efficient use of your therapy time.  Similarly, spending time finding a label for a problem e.g., a diagnosis, is not as important as finding solutions to it. 

I think you will find that I am unlike others you may have talked to about your problems.  I look forward to meeting you. 

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Yes, in the past 20 years, Dr. Stein in particular, has worked with individuals of all ages, and in the past few years, he has increasingly worked with seniors. He has special expertise and understanding of persons with serious, chronic medical conditions, and active duty military from all branches (their families, and veterans).

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