Anorexia Nervosa

ladyinlakeAnorexia nervosa is an eating disorder wherein people severely obsess about weight and food. They attempt to weigh far below normal for their age and height. In order to keep from gaining weight or to continue losing weight, they may starve themselves and/or exercise excessively, and purge on occasion using diuretics, laxatives, and enemas as well as vomiting after eating.

Anorexia nervosa isn’t about food. It’s unhealthy, misguided, injurious behavior constructed to achieve and maintain a sense of emotional stability. People with anorexia often equate thinness with self-worth.

Anorexia nervosa can be difficult to overcome. That said, with professional treatment and counseling a person can gain a healthier sense of self, embrace nutritious eating habits and reverse some of anorexia’s serious complications.

There are a number of physical, emotional and behavioral signs and symptoms of anorexia:

Physical signs and symptoms of anorexia nervosa:

  • Extreme weight loss–approaching 75%-85% of normal weight
  • Thin appearance–often hidden under layers of clothing unsuitable for the temperature
  • Abnormal blood counts
  • Fatigue
  • Insomnia
  • Dizziness or fainting
  • A bluish discoloration of the fingers
  • Hair that thins, breaks or falls out
  • Soft, downy hair covering the body
  • Absence of menstruation
  • Constipation
  • Dry skin
  • Intolerance of cold
  • Irregular heart rhythms
  • Low blood pressure
  • Dehydration
  • Osteoporosis
  • Swelling of arms or legs

Emotional and behavioral characteristics associated with anorexia include:

  • Refusal to eat
  • Denial of hunger
  • Extreme fear of gaining weight
  • Lying about how much food has been eaten
  • Excessive exercise
  • Flat mood (lack of emotion)
  • Social withdrawal
  • Irritability
  • Preoccupation with food
  • Reduced interest in sex
  • Depressed mood
  • Possible use of laxatives, diet aids or herbal products

For Your Austin Counseling Convenience

For more information, please call (512) 306-9992, or send an email to ann@annmcintoshcounseling.com. All inquiries are held in strict confidence. Please understand that no counseling will be provided via the Internet or e-mail. Working with you in person is the best way to help you achieve your goals.

Daytime and selected early-evening sessions are available, Tuesday through Thursday 10:00am to 6:30pm. You may choose from three types of sessions: individual, couples, and family. Please feel free to ask about other possibilities to fit your lifestyle and needs.

Ann McIntosh, MA, LCSW, Counseling and Psychotherapy

4407 Bee Cave Road
Building 5, Suite 513
Austin, Texas 78746

512-306-9992


Video produced by Michael Quick of QuickOne Media
Ann McIntosh is also listed on the following Web site directories:
Psychology Today | YellowPages.com | Eating Disorder Referral and Information Service

Bulimia Nervosa

autumn-creekThis eating disorder involves frequent episodes of binge eating, almost always followed by purging and intense feelings of guilt or shame. The individual feels out of control and recognizes that the behavior is not normal.

Bulimia commonly begins in the late teens or early twenties over concerns about weight and body image. Bulimia can quickly escalate to behaviors used to gain control over troubling emotions. This is one of the most common eating disorders and seeking the proper counseling in Austin can help a person gain a healthier lifestyle.

Eating Disorders | Bulimia Danger Signals

  • Binge eating or eating uncontrollably
  • Purging by strict dieting, fasting, vigorous exercise, vomiting or abusing laxatives or diuretics in an attempt to lose weight
  • Using the bathroom frequently after meals; using sound to mask behavior
  • Preoccupation with body weight
  • Depression or mood swings, irritability, anxiety or depression relieved by purging
  • Changes in regularity of menstrual periods
  • Developing dental problems, swollen cheeks and glands, heartburn and/or bloating
  • Experiencing personal or family problems with alcohol or drugs
  • Excessive and/or underage use of alcohol; use of recreational drugs

Cognitive Therapy May Normalize Brain Abnormalities in Bulimia

By Karla Gale

NEW YORK (Reuters Health) – Women with bulimia nervosa have altered opioid receptor binding in their brains compared with healthy women, the results of positron emission tomography (PET) imaging study demonstrate. However, treatment with cognitive behavioral therapy and counseling  appears to normalize the brain chemistry, according to study findings presented at the Society of Nuclear Medicine’s 52nd Annual Meeting in Toronto in 2005.

Dr. James Frost, from Johns Hopkins University School of Medicine in Baltimore, and his team performed PET scanning on brains of 13 women with bulimia and 8 female controls, repeating the scanning in the bulimic patients after they underwent 12 sessions of cognitive behavioral therapy (CBT).

Results were presented by Dr. Peter Herscovitch, a vice chair of the Society’s Scientific Program Committee and chief of the PET imaging section at the National Institutes of Health in Bethesda, Maryland.

Prior to cognitive behavioral therapy, opiate receptor binding was lower in patients than controls in the prefrontal cortex, the cingulate cortex and insular cortex, Dr. Herscovitch told Reuters Health.

“The areas of the brain that were involved are also involved in positive emotions in the rewards system of the brain,” he noted. “There was a correlation between the degree of receptor abnormality and the severity of symptoms of binging and vomiting, their urges to do so, and their bodily preoccupation.”

After treatment, increases were observed in the prefrontal and cingulate cortex and in the temporal cortex.

“If you want to treat a disease, the first step should be understanding of the underlying physiology and biochemistry that’s abnormal in the disease. Then the next step is to use that information to decide on therapy,” Dr. Herscovitch said. PET scanning offers the opportunity to do both.

Source: This Reuters article was posted on Medscape Medical News Jun 21, 2005.

For Your Austin Counseling Convenience

For more information, please call (512) 306-9992, or send an email to ann@annmcintoshcounseling.com. All inquiries are held in strict confidence. Please understand that no counseling will be provided via the Internet or e-mail. Working with you in person is the best way to help you achieve your goals.

Daytime and selected early-evening sessions are available, Tuesday through Thursday 10:00am to 6:30pm. You may choose from three types of sessions: individual, couples, and family. Please feel free to ask about other possibilities to fit your lifestyle and needs.

Ann McIntosh, MA, LCSW, Counseling and Psychotherapy

4407 Bee Cave Road
Building 5, Suite 513
Austin, Texas 78746

512-306-9992


Video produced by Michael Quick of QuickOne Media
Ann McIntosh is also listed on the following Web site directories:
Psychology Today | YellowPages.com | Eating Disorder Referral and Information Service

Successful Therapy

Successful Therapy | Austin, TX

Mountains-Waterfalls1Many psychotherapists share how-to-do-therapy guidance with their patients over time, letting the awareness of these basic principles develop gradually to ensure a deeper understanding of the process because the patient lives it rather than being told about it.

Some patients, however, appreciate written information in advance. We are pleased to offer the following Austin Therapist guidelines for how to get the most out of psychotherapy and achieve your goals. These concepts were derived by George Pazdral, M.D., J.D.

Requirements for Successful Therapy

1. Keep your appointments

  • Commit to a series of regularly scheduled appointments and make your sessions a priority.
  • Honor and value the opportunity to come in, relax, and talk about your life and any concerns you may have with a therapist.
  • For missed appointments, be willing to discuss the “whys and wherefores” that led to the miss.
  • Discuss any anticipated needs for schedule change, or any aspect of your therapy with your therapist in person.
  • Understand that anything and everything having to do with you, your thoughts, feelings, and behavior is grist for the mill in your therapy.

2. Talk openly and deeply about yourself

  • Say as much as you can about spontaneous subjects that come to mind during discussion with your therapist. Try not to hold back any ideas or feelings that cross your mind.
  • To paraphrase Freud: “. . . tell me out loud everything that goes through your mind while you’re here; don’t censor anything—share all your thoughts, feelings, dreams and fantasies.”

3. Pay for your appointments

  • The pursuit of self-growth through therapy is a valuable professional service by a highly trained professional therapist.
  • In paying a professional fee, you value and honor the hard work of focused concentration on what you present in the session and the derived input of the therapist, along with the personal commitment of yourself, your time, effort, and resources.
  • Be willing to pay for your appointment slots that you reserved and your therapist held exclusively for you on their calendar.

4. Keep yourself together between appointments

  • Mountains-Waterfalls2Pursuing psychotherapy for any reason is an endeavor best pursued with a degree of calmness and reflectivity.
  • Repeated or frequent wild emotional activities, dramatic events, and extreme negative uses of personal energy to quiet intense emotional experiences take up large amounts of talking time in therapy, and most often detract from a focus on growth and understanding of your patterns of behavior, trends in thoughts and feelings, and causes of reactions rather than thoughtful responses.

5. Resolve to be curious about your feelings and thoughts

  •  Allow yourself time to think before you choose to respond to your therapist.
  • Endeavor to think before you act.

6. A Good Therapist Will . . .

  • Encourage your legitimate feelings of trust and confidence, both in yourself and in therapy process.
  • Always be respectful of you. In well-timed therapeutic moments, your therapist will also confront you about patterns of thoughts and behaviors apparent to the trained professional.
  • Support your aspirations for healing, wholeness and growth.
  • Be realistic with you about your strengths and successes, along with your weaknesses and challenges.
  • Never use the therapy interaction for personal ends, neither accepting nor initiating personal or social relationship.

7. Making Progress

  • Nature_Forest_StreamTrust the psycho-therapeutic process, which is somewhat slow and gradual (despite what the media and insurance companies would have you believe). Know that growth and evolution to move away from lifelong problems occurs over months, sometimes many, many months, rather than days or weeks. Slow growth is more real and lasting than rapid, often quite illusory and transitory changes in feelings.
  • Make a commitment to talk first, rather than act first. While participating in psychotherapy, discuss all anticipated major life changes with your therapist.
  • Be committed to allow your therapist to share in decisions about changing your treatment. This especially applies to increasing or decreasing your psychotherapy sessions when considering adding other treatments or experiences and engaging in any other situations oriented toward mental and emotional development and change.
  • Understand that negative feelings will occur about the therapy or the therapist. These are in-the-moment-rich opportunities for discussion and are a part of the therapy process. Do not avoid or hide these feelings, which are natural and common and can be very useful to your therapy efforts when handled openly. These feelings are generally not an indication to stop or flee the therapy experience, but an opportunity for growth.
  • Allow the therapist to give you their professional expert opinion. A good therapist should be understood and trusted to have advanced psychological knowledge and expertise in the guidance and shaping of your care.
  • Allow the therapist to confront you, tell you, and work deeply with you regarding hard truths about yourself.
  • Discuss and list, in the presence of your therapist, goals for your therapy and your life.
  • Discuss nighttime dreams, daydreams, fantasies, and aspirations with your therapist.

8. Between Sessions with your Therapist

  • Think and reflect about yourself and your therapy.
  • Remain in the moment, the here and now.
  • Live intentionally.
  • Observe and reflect upon experiences that give you joy, are difficult to navigate, or add chaos to your living.
  • Process thoughts and feelings that allow you to choose behaviors that reflect what you say you value.
  • Be curious about thoughts, feelings, and behaviors and be willing to explore them.
  • Write down your thoughts about your therapy meeting shortly after the session.

9. Other Keys to Successful Therapy

  • Weight Loss CounselingResolve to sleep normal hours, seven to eight hours nightly and at consistent times over weekends. Being rested helps you take advantage of human physiology’s healing powers.
  • Eat fresh, clean, nutritious food, limiting processed foods. Eat every three to four hours while awake.
  • Participate in exercise appropriate for you and the time of year.
  • Draw cartoons or art about your therapy, life, concerns, interesting events or things that catch your attention or matter to you.
  • Commit to writing about as many of your dreams as you can.
  • Keep a journal about thoughts, feelings and observations of interest to you.

For Your Austin Counseling Convenience

For more information, please call (512) 306-9992, or send an email to ann@annmcintoshcounseling.com. All inquiries are held in strict confidence. Please understand that no counseling will be provided via the Internet or e-mail. Working with you in person is the best way to help you achieve your goals.

Daytime and selected early-evening sessions are available, Tuesday through Thursday 10:00am to 6:30pm. You may choose from three types of sessions: individual, couples, and family. Please feel free to ask about other possibilities to fit your lifestyle and needs.

Ann McIntosh, MA, LCSW, Counseling and Psychotherapy

4407 Bee Cave Road
Building 5, Suite 513
Austin, Texas 78746

512-306-9992


Video produced by Michael Quick of QuickOne Media
Ann McIntosh is also listed on the following Web site directories:
Psychology Today | YellowPages.com | Eating Disorder Referral and Information Service

Stress Relief Tips

Forest PathStress, an unavoidable hazard of modern life, can overwhelm us with feelings of having little or no control over our own lives. It produces hormones no less powerful than those triggered by the “fight or flight” reaction to a sudden attack by a dangerous animal or another human being. Unlike external physical threats to our safety, instead of being resolved by immediate action, modern-day stress can be unrelenting . . . if we let it.

Having a Life Coach can help you along the way. One antidote to stress is to create an emotional distraction: doing something pleasurable, fun, relaxing or even neutral. The following are proven effective lifestyle tactics to reduce the negative effects of stress:

  1. A good night’s sleep – Seven to eight hours of rest is optimum, and the quality of our sleep is directly improved by creating a dark, very cool, and quiet bedroom.
  2. Nutrition – Eat as cleanly as possible, emphasizing protein, fresh fruits, and vegetables and decreasing processed, packaged foods. Markedly reduce simple sugar in the diet, too much of which creates anxiety and exacerbates stress.
  3. Exercise a minimum of 20 minutes per day – Speed up your heart rate to the point of breaking a sweat if it’s physically safe for you to do so and alternately increase your speed with a slower pace. Take a walk in the early morning without sunglasses, even if only for a few minutes, to get sunshine on your retinas. Don’t stare at the sun. The angle of the rising sun is what makes the difference.
  4. Silently recite prayers and other phrases used in your religious, spiritual, or philosophical practice – Use relaxation CD’s such as “Your Present: A Half-Hour of Peace” by Susie Mantel.
  5. Reduce or eliminate listening to radio talk shows and reading/listening to the news for at least a week until you feel better.
  6. Choose soothing music.
  7. Watch movies that you enjoy or documentaries of interest but avoid disturbing or gruesome subject matter.
  8. Become very conscious of being stuck at the keyboard when it’s time for bed, or when you have time for a quick walk or actually talk with a friend.
  9. Cease texting as a mode of discussing anything of significant personal importance, and never text while driving. Far too much valuable human information is lost with abbreviated electronic communication, such as body language, eye contact, and the subtleties of voice. It’s the instant gratification we crave which in and of itself is stress inducing.
  10. Two well-researched, effective daily tactics for dealing with stress are: listen to a relaxation CD such as “Your Present: A Half Hour of Peace” by Suzie Mantell; and sit quietly with your palms up in your lap, eyes open or closed, breathe in deeply through your nose with your diaphragm while keeping your shoulders and chest still and then exhale through your mouth. On every third breath, hold your breath for a beat or two and then release.

For Your Austin Counseling Convenience

For more information, please call (512) 306-9992, or send an email to ann@annmcintoshcounseling.com. All inquiries are held in strict confidence. Please understand that no counseling will be provided via the Internet or e-mail. Working with you in person is the best way to help you achieve your goals.

Daytime and selected early-evening sessions are available, Tuesday through Thursday 10:00am to 6:30pm. You may choose from three types of sessions: individual, couples, and family. Please feel free to ask about other possibilities to fit your lifestyle and needs.

Ann McIntosh, MA, LCSW, Counseling and Psychotherapy

4407 Bee Cave Road
Building 5, Suite 513
Austin, Texas 78746

512-306-9992


Video produced by Michael Quick of QuickOne Media
Ann McIntosh is also listed on the following Web site directories:
Psychology Today | YellowPages.com | Eating Disorder Referral and Information Service

Sitting is Deadly

Recent research cautions that too much time sitting down is unhealthy. As reported by NBC News on July 9, 2012:

“The study adds to a growing body of evidence suggesting that sitting itself is deadly. While previous studies have looked at the health risks to the individual, the new study examines the risk of sitting for the whole population, said study researcher Peter Katzmarzyk, of the Pennington Biomedical Research Center in Baton Rouge, La. The research ‘elevates sedentary behavior as an important risk factor, similar to smoking and obesity,’ Katzmarzyk said.

“Other studies have found our culture of sitting may be responsible for about 173,000 cases of cancer each year.

“Because U.S. adults spend, on average, between 4.5 and five hours a day sitting down, a significant shift in the population’s behavior would be needed to have an effect on life expectancy, Katzmarzyk said. This might be achieved through changes at the workplace, such as the use of standing desks, and by watching less TV…”

Waterfalls-mountainsTo help combat the work necessity of sitting more than 3 hours per day, resolve to get up and move around every 30 to 45 minutes. Better yet, go outdoors.

Think about ways you can increase your physical activity throughout the day. For example, make several trips up and down stairs instead of using the elevator, or park at the far end of the lot, or walk to your remote mailbox and decrease time spent watching TV.

For Your Austin Counseling Convenience

For more information, please call (512) 306-9992, or send an email to ann@annmcintoshcounseling.com. All inquiries are held in strict confidence. Please understand that no counseling will be provided via the Internet or e-mail. Working with you in person is the best way to help you achieve your goals.

Daytime and selected early-evening sessions are available, Tuesday through Thursday 10:00am to 6:30pm. You may choose from three types of sessions: individual, couples, and family. Please feel free to ask about other possibilities to fit your lifestyle and needs.

Ann McIntosh, MA, LCSW, Counseling and Psychotherapy

4407 Bee Cave Road
Building 5, Suite 513
Austin, Texas 78746

512-306-9992


Video produced by Michael Quick of QuickOne Media
Ann McIntosh is also listed on the following Web site directories:
Psychology Today | YellowPages.com | Eating Disorder Referral and Information Service

Weight Loss and Healthy Lifestyle

Interest vs. Commitment

Clearly you have the desire to change how you feed yourself because you’re reading this essay.

The difficult part, however, is recognizing the important difference between interest and commitment as relates to successful long-term behavioral modification.

Behavior that you are interested in changing will be easy to address only so long as it’s convenient. Commitment to change, on the other hand, requires employing the new behavior regardless of how you feel, and doing mental battle with ingrained, well-honed excuses because you will not be deterred from doing what is healthiest for you.

Sometimes on-going emotional problems such as stress, anxiety, depression, or persistent relationship issues need to be addressed before beginning to deal with unhealthy eating habits. The only answer is to be honest with yourself and proactively seek the help you need.

Get Emotional Support

6542182You are the leader in your efforts to improve your health, and your weight is an indicator or parameter of good health. That doesn’t mean you have to do everything alone. Seek support when needed from your partner, family and friends, and be very cautious of people who try to lure you back into old, unhealthy behaviors.

People you know, respect, and admire and who are already doing the behaviors you want to consistently employ will be your most valuable allies. They will understand and applaud your efforts, and a wonderful by-product of choosing healthy behaviors is that you will automatically increase your self-esteem as a result of their support.

Steady As You Go

You would not be here if your ancestors weren’t able to lay down body fat. We humans are very talented in that way, so our bodies are genetically prone to easily accumulate pounds and resist our efforts to shed them.

Weight loss is healthiest and the most attainable when we think in terms of 1/2 to 2 pounds of fat per week. That’s about all the human body begrudgingly will give up without also decreasing lean muscle tissue and reducing your metabolism, which in turn makes it harder to achieve the weight-loss results you want. This insidious side-effect is the ultimate downfall of any weight loss diet, and it’s the reason diets in and of themselves don’t work. They are isolated events and contrary to the normal, healthy way of eating for the human body.

12351353Planning, embracing curiosity about feelings and thoughts you experience connected with the decisions you make, and observing and celebrating your improved behaviors best contribute to your success. Think in terms of choosing healthy behaviors rather than outcome goals such as clothing sizes, a predetermined weight, or a specific date to accomplish your objectives.

Exercising regularly and limiting portion sizes are process goals, and they focus your attention on objectives that are immediately obtainable. Changing your thinking is the key to weight loss. Make sure that your process goals are realistic, specific and measurable. Deciding you’ll walk for 30 minutes a day, five days a week if possible in the early morning sunlight, for example, rather than saying to yourself that you’ll simply walk more.

Select Healthier Foods

Start by selecting foods in their natural form: fresh vegetables and fruits in a rainbow of colors, protein, and healthy fats. Markedly reduce or temporarily eliminate treat food: pies, cakes, cookies, puddings, ice cream, packaged, processed foods, and the white foods. Keep away from artificial sweeteners (they only make you want to eat more) and no-fat items.

Humans need fat—the good kind—canola, olive, and coconut. Shop the outside aisles of the grocery store and don’t buy anything with an ingredient that sounds like a chemistry term. Adhering to a new eating style will be best accomplished by a devotion to your health.

Increase Physical Activity

37277301Get out in the early morning sunshine if possible, for at least a 30-minute walk. Research tells us that the sunshine on your retinas while it is still at the early morning angle helps raise our mood. Enjoy yourself, notice your surroundings and appreciate nature. It’s an evolved thing to do. For the very overweight and obese, it’s important that you do this cautiously so as not to injure or put too much stress on your knees and hips. Resolve to get as much walking as possible (without joint pain) and increase your exercise as you reduce weight.

Exercising helps burn more calories, but you get even more benefits: reduction in stress, and the sense of accomplishment in progressing toward a new, healthier lifestyle. Think in terms of how you can move more by using the stairs or parking so as to increase the distance you have to walk to your destination.

Make Lifestyle Adjustments

Unfortunately, it’s not enough to incorporate these changes for only a few weeks or even several months. The longer and more consistently you persist in healthier behaviors, the greater the possibility you will leave poor functioning behind. Practice makes us consistent.

And yes, we’re talking about that dreaded word: discipline. Start by acquiring an attitude of discipline. Look around you. What does your living space look like? Would you like a neighbor to drop in? Is there chaos all around, dishes in the sink from days ago, a less than inviting bathroom, and a disheveled bedroom and sheets that haven’t been changed for how long?

How about your car? Would you offer to take your office group or classmates to the restaurant? Are you often late for work or for appointments? Chaos breeds chaos. To gain control, behaviors must change. Lifestyle changes start with taking an honest look at your eating habits and daily routines one step at a time.

36368723After assessing your personal challenges to weight loss, work out a strategy to gradually change behaviors and attitudes that have sabotaged past efforts. Start with curiosity. Embrace your thinking and figure out how that thinking is helpful or destructive. The secret to being curious is accepting where you are now, which helps you plan how you’ll deal with various challenges that get in the way of your health.

Occasional setbacks are also dealt with by being curious. Notice how you felt just before you didn’t do what you said you wanted to do. Was there a negative feeling involved? Stay in the present with yourself and resolve to choose your behavior starting with your very next action. You’ll feel more positive immediately and experience renewed encouragement to behave in the ways you desire.

For Your Austin Counseling Convenience

For more information, please call (512) 306-9992, or send an email to ann@annmcintoshcounseling.com. All inquiries are held in strict confidence. Please understand that no counseling will be provided via the Internet or e-mail. Working with you in person is the best way to help you achieve your goals.

Daytime and selected early-evening sessions are available, Tuesday through Thursday 10:00am to 6:30pm. You may choose from three types of sessions: individual, couples, and family. Please feel free to ask about other possibilities to fit your lifestyle and needs.

Ann McIntosh, MA, LCSW, Counseling and Psychotherapy

4407 Bee Cave Road
Building 5, Suite 513
Austin, Texas 78746

512-306-9992


Video produced by Michael Quick of QuickOne Media
Ann McIntosh is also listed on the following Web site directories:
Psychology Today | YellowPages.com | Eating Disorder Referral and Information Service

Mental Health Parity Act

The Mental Health Parity Act provides for greater equality in health insurance. If you are employed by an organization with 50 or more employees, this information should be very important to you.

Final regulations for the Mental Health Parity Act went into effect on April 5, 2010 and apply to health plan years that began on or after July 1, 2010.

To recap the new law, the Mental Health Parity Act does not require health plans to cover treatment for substance abuse or mental illness, but does require that plans which do include such benefits treat these conditions on par with other illnesses.

The rules explicitly state that parity applies across the board. This means that group health plans may not impose higher deductibles or caps on hospital room stays for mental health or substance abuse treatment. Nor can they impose more stringent preauthorization requirements for such treatment.

The rules specify that if a group health plan provides coverage for substance abuse and/or mental health services in any one or more of the following six categories, it must be on par with the medical and surgical benefits offered in that category.

  • Inpatient in-network
  • Inpatient out-of-network
  • Outpatient in-network
  • Outpatient out-of-network
  • Emergency care
  • Prescription drugs

The Mental Health Parity Act applies to both public and private group plans with 50 or more employees. It also applies to Medicaid managed-care plans, but does not cover Medicaid.

The Bottom Line

Your employer should review their plan documents to ensure that they comply with the new interim final rules. To the extent that plans decide now to drop their mental health or substance use disorder coverage, Summaries of Material Reduction must be provided, and revisions will need to be made to the Summary Plan Descriptions, benefit booklets, and other benefit communications.