Sharing Tools to help you get what you want out of life.

What is Anxiety - based Depersonalization?

Thu, 27 Mar 2025 20:53:26 GMT

One of the least talked about symptoms of anxiety is also one of the most distressing

My patient, Annie* waited weeks to tell me about it. Then, with tears in her eyes and a shaky voice, she revealed that she thought she might be going crazy. "I have this thing that happens where I don't hear what people are saying. I know they are talking but I just zone out and I feel like I'm not real. They're not real. Time kind of seems to stop, but goes too fast, all at the same time."

Assessment revealed that Annie had these experiences during moments of panic due to her intense social anxiety. Depersonalization (feeling detached from one's mind or body) and its related experience, derealization (feeling detached from one's surroundings) are often some of the most disturbing symptoms of Panic Disorder. Many who experience these believe they are losing their minds, and that belief makes anxiety even stronger. In Annie's case, the phenomenon seemed so crazy to her she was afraid to even mention it to me.

Depersonalization and derealization can occur in other mental illnesses, such as Dissociative Disorders and PTSD. It is important to get a good assessment and diagnosis by a trained mental health professional.

However, the feeling Annie expressed is very common in Panic Attacks. These intense bursts of anxiety carry numerous symptoms including increased heartrate, breathlessness, mind racing, and shakiness, to name just a few. It is estimated that 10%-20% of people will experience panic in their lifetime. And for some, derealization is a part of that picture.

There are many tools in the CBT (Cognitive Behavioral Therapy) toolbox, but one of the most important ones is knowledge . Knowing what panic is, and what it isn't, is a key to regaining one's calm. Once the sympathetic nervous (Fight-or-Flight) system is engaged, a number of mental/emotional and physical symptoms are set in motion. These vary by individuals, but can include hyperventilation, increased heartrate, shakiness, even a sensation that the environment is getting too bright. But these are all explainable when you consider that the purpose of this system is to ready you to defend yourself from a threat. The body is primed to run, fight or hide , causing changes in respiration, heartrate, even pupil dilation. The sympathetic nervous system also tends to sharpen focus on these "lifesaving" tasks, while blurring focus on extraneous stimuli. This is likely why Annie couldn't focus on a conversation and felt zoned out.

Knowing this is a physiological protective mechanism, rather than the beginnings of schizophrenia, helped Annie to overcome her anxiety. I hope her story helps to encourage others to reveal this symptom in therapy sooner rather than later, so healing can begin.

*Annie is a pseudonym. Name changed, along with identifying details, to protect patient confidentiality.

OCD Strategies

Fri, 16 Feb 2024 21:15:44 GMT

We Do Not Hang Out With Bullies

In the practice of Cognitive Behavioral Therapy ( CBT ), upsetting moods and negative behaviors are overcome using our thoughts and logic. CBT therapists help clients identify irrational, upsetting core belief s, and then use rational counterthoughts to defeat those beliefs. This strategy has been shown in research to be quite effective; and the reason is obvious - Feelings change, but facts don't. A solid fact is preferable to shaky emotional ground any day.

Yet, in the treatment of OCD , the strategy can backfire. OCD is brutal. Obsessions seek to make you rethink everything; doubting your beliefs, perceptions, or emotions (as in Relationship OCD ), your actions (Safety and Contamination OCD), and even your morals and self-identity ( Harm OCD, Homosexuality OCD ). So, MORE thinking, even seemingly rational thinking, does not equate to LESS ruminating. We find that, typically, it's unhelpful to try to reason with your intrusive thoughts.

However, CBT has been found to be, in general, the most effective psychotherapy for anxieties. So, what to do? It's not a matter of a different therapeutic modality, but rather a different strategy. One of the strategies is this: We do not hang out with bullies.

You remember the bully from school. They call your name, demean you, undermine your confidence. Bullies notice where their victim’s weaknesses lie, and attack where they’re vulnerable. There’s the verbal harassment, the continual taunting. And the threats – there’s always an implication, overt or covert, that if you don’t comply, things will get worse.

But as we all know, giving in to a bully does not engender kindness in return, but rather, more bullying. When the victim acquiesces, the bully may back down for a moment, only to return the next day with more taunts, more demands.

The same is true for the “bully” that is your OCD thoughts. These thoughts are not helpful things to consider in order to improve your life. This bully will only serve to make you fearful, intimidated, and immobilized. OCD holds out a promise of freedom and peace; while in reality, compulsions deliver only momentary relief followed by more obsessive thoughts, and increasingly intense compulsive urges. In therapy, our strategy shifts from examining thought content details to determining the pattern these thoughts take, and to learn to recognize that pattern for the bully it is.

For example, a common anxious thought might be fear of failing an exam. In non-OCD patients, psychologists might help the patient remind herself of the amount of preparation she did, her history of being a successful student, or the fact that one grade does not make or break a semester. These cognitive interventions refocus the mind on the facts, or the “most likely” scenario, as opposed to the worst-case scenario.

But in OCD, the strategy is completely different. An OCD patient faces an exam, and that’s where the mental bullying begins:

“You better wear your lucky sweater – and where is it, by the way?” the bully might ask.

“Have you really studied enough?”

“better check with your professor about that question again”

And so on.

So the OCD bully’s victim feels compelled to engage in superstitions. Or she may engage in repeated checking behaviors, such as asking the professor and her classmates unending clarifying questions. These may provide momentary reassurance, while long-term setting the student up for increased anxiety, and decreased confidence in her own abilities.

Therapeutically, the goal is NOT to reason with the fear. The goal is to help the patient see that these thoughts follow the same M.O. as previous OCD-driven thoughts, and to refuse to entertain the OCD-driven demands.

Just as you would not endeavor to build your life around what a 7 ^th grade bully said about you, you don't build your life around the mental and behavioral hoops OCD is trying to make you jump through. You learn to listen past the content of the thoughts, recognizing the pattern and realizing you don't need to engage. (Remember how engaging the 7 ^th grade bully just emboldened them?) Instead, you see the bully coming and shut the door. There’s no reason to hear what he has to say.

This takes practice and work in therapy, of course. But this strategy prevents OCD sufferers from expending effort on futile missions. Once this strategy is adopted, we can proceed to other parts of the treatment, such as Exposure and Response Prevention ( ERP ).

OCD treatment is not easy; but, in some ways it is simple:

1. Recognize the bully.

2. Do not give him your lunch money

Mindfulness for Non-Meditators

Mon, 29 May 2023 20:40:48 GMT

Try these easy exercises to train your brain to refocus on the here-and-now

Mindfulness has garnered increasing attention in clinical research as a factor in maintaining relaxation, improving focus and productivity, and enjoying good relationships. Certainly, most of my anxious patients struggle with racing thoughts and an inability to focus on the here-and-now. The antidote is living in the present, a skill that is in short supply with many of us in this high-tech world.

Often, meditation is seen as the gateway to mindfulness. However, many of us (myself included!) don’t like or want to meditate. Fortunately, there are other efficient and effective ways to build this skill. The bonus is, these skills and techniques enhance other areas of life, too, such as relationship-building and gratitude, making life more enjoyable. Here are my top suggestions:

1. Breathe – Slow, deliberate breathing, with very slow (5-10 second) exhales, are an excellent way to return your thoughts to the present. You can zero in on the sensation of air entering and exiting your lungs, or on relaxing a tense muscle group, such as upper back/shoulders, with each exhale. I recommend people practice this daily until they are skilled at it – see my blog post on wait-time breathing .

2. Nature Awareness - Spend time in nature for 5 minutes while maintaining focus on one of your 5 senses. If you are walking, for example, you can focus on sounds, including how many different bird songs you can hear, the sound of your feet on the sidewalk, the wind, your breathing, etc. On a different day, sit outside and notice the colors, shapes, foreground, background, etc. well enough that you could draw a picture of it later. Visually orient to where you are in relation to the sun.

3. Mindful Meal - Eat a meal or snack slowly and mindfully, without distractions (no TV, phone, conversation). Enjoy every bite. Pay attention to the flavors, textures, aromas. Be able to describe it to someone who has never eaten it.

4. Body Scan - sit or lie down in a comfortable, quiet place and mentally scan your whole body, noticing any tension, sensations, pains, etc. Start at the top of your head and work your way to your toes. Observe without comment whatever your body is telling you. Are you holding tension in your neck? Is your stomach growling? Do your new shoes hurt your feet? Has your heart rate been speeding up? Tuning in to bodily cues and changes can help you in many ways, such as catching anxiety before it becomes a panic attack, or knowing when you need to take a break and walk around to boost your concentration during a long study session.

5. Need State Check-in – Stress is compounded when we use the wrong coping strategies due to a misperceived or misidentified need state. A classic example is the dieter who overeats when lonely, or a nail-biter who is bored. Similar to a body scan, set aside a quiet moment daily to ask yourself what your body, mind or soul might be needing. Are you sleepy, restless, thirsty? Are you feeling confused, irritated, lonely? A need state check-in may help you realize you need to walk away from a work problem that you’ve been ruminating over. A realization that you are overstimulated can get you to slow down, eliminate excess noise in your environment, silence your phone, or schedule some alone time. Prayer time can help refocus you on the bigger picture. Acknowledging loneliness helps you seeks out encouragement from a friend.

6. Relational Mindfulness – During an everyday conversation with someone, take 5 minutes to focus very intentionally on what they are saying. Look into his/her eyes. Consider how they look today (distracted? well-dressed? energetic?) and reflect on what they are likely feeling. Repeat some of it back to them to make sure you are staying focused and accepting their statements at face value, rather than adding your own mental editorializing. This daily mindfulness exercise can work wonders in a relationship, especially with a spouse.

Mindfulness takes a little patience to develop, but the process is not hard or time-consuming. During any mindful exercise, you will, of course, drift away and start thinking about other, non-here-and-now things. Be aware of this, catch yourself and bring yourself back to the present. This, too, is part of the development of the skill.

To get the most of these exercises, choose one and practice it at least once daily for a week . Next, choose another and try that one for a week. Note your observations – which were your favorites? Which were the hardest to master? At the end of this, you will have improved your here-and-now focus skills, and likely found some new coping strategies.

Can't Get it Out of Your Head

Thu, 02 Mar 2023 20:24:04 GMT

The Truth About Obsessive Thoughts

What is an obsessive thought? My husband wakes up some mornings with annoying pop songs playing in his mind. Though he groans about how Carrie Underwood or Abba have hijacked his brain, this is quite minor compared to what many of my clients deal with on a daily basis.

Obsessions are recurring thoughts that a person finds difficult or impossible to control. Unlike a catchy pop tune, these are typically doubts, worries, or horrible imaginings that cause significant anguish in those they plague. Sometimes they are related to traumatic memories, as in PTSD, but a person can have obsessions without ever having experienced a traumatic event.

I have heard many obsessions in my professional career, often revealed sheepishly by the client. Most sufferers think their thought is the weirdest, most mentally-ill-sounding thought I will have ever heard, and they fear my response. Their fears are needless. I have heard everything from worry that one will abuse their own child, to overconcern that a person’s loved ones aren’t safe. I have had clients who worry about hearing a certain word, some who suffer prolonged overthinking about how they behaved in a social situation, and clients who obsess that they ran over something on the way to work. (The Anxiety and Depression Association of America has more here .)

What is important is that obsessive thoughts are treatable. They are part of anxiety and are manageable, once sufferers understand a little about how the anxious brain functions. Then, thought-based and action-based strategies are quite effective in managing and defeating obsessions. Medications can be helpful during this process as well.

Feeding Your Brain

Thu, 28 Jul 2022 18:47:44 GMT

Natural, Research-Based Recommendations from Nutritional Psychiatry

Did you know Nutritional Psychiatry is a thing? Apparently it is. Increasingly, research is examining the relationship between food and mental difficulties such as anxiety and depression; and the results are fascinating. For example, this study showed a 36% reduced risk of depression simply from eating a Mediterranean-style diet. By swapping out the simple-carbs, processed foods, and vegetable oils typical of the Standard American Diet (they don’t call it SAD for nothing!), you can quickly integrate these foods into your diet, helping your brain to feel great again.

In his recent book, Eat to Beat Depression and Anxiety: Nourish Your Way to Better Mental Health in Six Weeks , Dr Drew Ramsey cites research demonstrating the ability of a change in diet to alleviate mood disorders . Some of the results are stunning - including reductions in depression and anxiety on par or better than medication. His book is not a diet per se, but delves into 7 food categories that our brains need to function well.

Several nutritional strategies emerge from the data – all connecting dots showing that what’s good for the body is good for the brain. Some research theorizes that inflammation is a cause of many mental illnesses; thus anti inflammatory foods are the focus. Others point to the gut-brain connection, including well-known data that serotonin is manufactured in the gut ; thus a focus on improving the quality of gut microbiota through such things as fermented foods. Underscoring all the results are indications that necessary brain nutrients, such as magnesium, folate, and Omega 3 fatty acids, are prerequisites to well-being, and key to the effectiveness of any other interventions, such as antidepressants. There are even dietary recommendations from research showing you can eat to encourage growth of new brain cells.

So why not just take vitamins? Dr Ramsey believes there is no true substitute for consuming vitamins through real food, in the manner in which the body was designed. Many have over-relied on their daily vitamin to fill in nutritional gaps that can never be made up when the diet is poor.

Three brain-beneficial foods that you can start incorporating today include leafy greens , rainbow fruits and vegetables , and seafood .

True story – my brother in law is by no means a health nerd, but he is a big believer in a bowl of leafy greens when he is feeling low. He feels a definite sense of well being and calmness/clarity of thought immediately after consuming these veggies – and it turns out, research shows he is correct! Leafy greens, such as kale, spinach, arugula, romaine, collard greens, etc. are nutrient dense, satiating, hydrating, and packed with fiber, phytonutrients, and naturally-occurring vitamins and minerals. Folate, for example, found abundantly in leafy greens, is essential in making neurotransmitters such as serotonin and dopamine . Dr Ramsey recommends 3 cups of leafy greens daily, meaning they should be a part of most of your meals. Think beyond salad by incorporating kale or spinach in your breakfast smoothie, pesto with your lunch pasta, or sautéed greens with dinner.

Nutritional psychiatry recommendations include ½ cup per meal of a variety of “rainbow” produce . Variety makes your plate more appealing and can ignite your culinary creativity; however, the beauty is not only skin deep. The varied colors in fruits and vegetables are indicative of the plants’ differing antioxidant nutrients – the Vitamin A found in orange carrots and sweet potatoes, the lycopene found in red tomatoes and strawberries, etc. Antioxidants reduce inflammation and help prevent cellular damage due to oxidation.

Seafood is one of the few places one can obtain Omega 3 fatty acids which have important nerve growth properties and inflammation-reducing effects. And while fish and shellfish may seem challenging to cook, in reality they are no more difficult than any other protein. Think creatively – such as fish tacos, salmon burgers, or adding shrimp to a simple salad or pasta dish. Aim for 2-3 servings of seafood per week.

Once you integrate these nutritional strategies, you can move on to some of the other nutritional psychiatry ideas, such as including nuts, beans, and seeds, enjoying eggs several times a week, or (my personal favorite) eating dark chocolate !

If the idea of a natural solution to improving mental functioning appeals to you, I highly recommend Dr. Ramsey's book .

The Three-Minute Organizer

Tue, 19 Apr 2022 15:46:02 GMT

Spring Cleaning for Your To-Do Lists

One of the dirty little secrets of adulthood is that the to-do list is never done. Despite your best efforts, there's always a bill left to pay, or an oil change that's overdue. It's a fact that is frustrating to most and especially unnerving to those perfectionists out there. Here are two tips, using Cognitive Behavioral therapy strategies, to help ease that anxiety.

First, try this "3-minute organizing" tip - Write out your list of tasks. Then, go back through your list and mark each item with E , P , or F :
E stands for Essential . Essential tasks must be completed, usually today. These are the non-negotiables.
P stands for Preferable . You'd really like to get these done, but no one will die or be left at school if they don't happen right this minute.
F items are Frivolous . Sorry ladies, mani-pedis get this label.

Categorizing your list this way brings focus, and your list will likely feel a bit shorter, too. I find that many people are overwhelmed because they see all of the day's tasks as do-or-die, and thus become immobilized. Once you have your tasks categorized, you can dive right in with the most important, "Essential" items first, and build your time around that. (You may find you are motivated to get more of your list done, in order to work your way toward that mani-pedi!)

Secondly, take a moment to glance back at your list at the end of the day, and give yourself encouragement for what you accomplished. Not only did you get some things done, but you prioritized correctly. Don't underestimate what prioritization means. While it may mean some tasks were left for tomorrow, it also means you spent your time wisely.

The three-minute organizer naturally puts into practice a discerning spirit, allowing you to act upon your most important values and P- or F- list those activities that aren't crucial in your life. For example, maybe all the dishes didn't get done, but you were there for an important event in your child's life. Maybe the oil change will wait another day or five, but the card you bought for your anniversary tomorrow will remind your wife of how important she is to you.

Give yourself three minutes to organize , and give yourself credit at the end of the day for a job well done! There are tasks that will have to wait for tomorrow, but your peace of mind can rest easier tonight.

Orange, Yellow, Red... and Blue?

Tue, 05 Oct 2021 20:50:48 GMT

Its October! How are you feeling?

October is Depression Awareness Month. As such, I hope to highlight the lesser known issue of seasonal depression so that you can protect yourself and your loved ones. Although Seasonal Affective Disorder, or SAD, affects 6-13% of the US population , many people still have not heard of it.

Yet many report depression, or a worsening of existing depression, as the days get shorter and there is less intensity to sunlight. By January, it is common for me and my colleagues to have practices full of individuals with this sub-type of depression. Like depression, SAD encompasses low mood, feelings of guilt, low energy, difficulty concentrating, and loss of pleasure in activities.

But unlike depression, SAD symptoms begin in fall and remit in spring. Sufferers report decreased energy and oversleeping. Weight gain often occurs, thanks to an increase in cravings, particularly for carbohydrates . It's as if our brains are in hibernation mode!

A common misconception about SAD is that some people just don't like the winter. SAD is not about preferences for sunny days and beach vacations. There seems to be neurochemical drivers behind seasonal depression, and many psychiatrists treat it with the same antidepressant drugs used for depression.

The reason for these neurochemical changes is unclear. We know that low levels of sunlight can increase melatonin production and cause changes in circadian rhythms, likely accounting for increased sleep, and decreased energy.

For this reason, treatment for SAD has focused on medication, CBT (Cognitive Behavioral Therapy), and light therapy. Light therapy utilizes exposure to very bright artificial light (10,000 lux) for 20-60 min a day, preferably in the morning.

Interestingly, SAD has been linked to low vitamin D levels, notes this study from UGA . In addition to being detrimental to physical health, low vitamin D levels can affect mental health, since vitamin D (the "sunshine vitamin") is involved in the synthesis of dopamine and serotonin, two neurotransmitters linked to depression .

Thus, vitamin D may be an effective treatment. This study concluded that "early detection and vitamin D supplementation can be a simple, convenient, and cost-effective treatment strategy for improving symptoms and mental health outcomes associated with major depression."

If you suffer from seasonal depression, its a good idea to get your vitamin D levels checked . Labs can be safely and inexpensively ordered without a doctor's visit through various online platforms, such as Ulta Labs , Walk-in-Labs , or others. Ask your doctor before beginning any supplementation, and be aware that vitamin D dosing is highly individualized. Your ideal dose can only be determined by rechecking labs periodically to determine if your dose brought your levels in range.

By the way, if you want more on why this issue is near to my heart personally, click here .

Therapeutic Journaling

Thu, 20 May 2021 14:32:01 GMT

Tips for getting the most out of your sessions

Therapy is a valuable journey to those courageous enough to embark on it. A safe, confidential place to process emotion, and sort through ideas, along with a supportive, objective listener creates a rich experience in which your life can grow and change.

However, if you are going to put in the time, effort and finances, you will get more out of therapy with some targeted journaling. Think of your therapy journal as the scrapbook of a deeply personal journey. Whether it is a physical book or electronic file, please be sure to keep your journal in a private place. Then follow the tips below.

Bon Voyage! Record your starting point

I typically give clients objective assessments of some type - a mood survey, social anxiety checklist, etc. This yields a snapshot of current symptoms and problem areas, and becomes the baseline for goals. Your therapy journal should include some objective data about why you sought help, and what you are hoping to accomplish. Adding detail ("I have become so socially isolated I only leave the house once or twice a week") is important, so paint a picture of your starting point. Later, these initial notes provide a great way to compare how far you've come.

Itinerary - Your Session Agenda

Research shows that sessions that begin with an agenda accomplish more. Your agenda is a brief "to-do list" for that day's therapy session. One or two words per topic you want to discuss will suffice, such as: 1. Dad's visit, 2. upcoming presentation, 3. confusing text Tell your therapist at the outset of session what these agenda items are before you start. This helps you and your therapist stay on track with what is most important to you.

Insta Post - Give it some detail and color!

In between sessions, record any time you experience a strong emotion (such as a panic attack), notice a thinking error (such as personalizing, catastrophizing, or all-or-nothing thinking), or have trouble coming up with a logical counter-thought. Bring these to session to process and collaborate. You will begin making connections between concepts discussed in session and your own experience of your thoughts and behaviors. Make a note of those connections! They form the basis of re-training your brain to think more logically, and free yourself from anxiety or self-defeating thinking.

Snapshots - Hold on to the significant moments

There are the lightbulb, AHA! moments in therapy that seem so significant you will never forget them. However, people forget! In a dark moment of depression, it would be helpful to look back at those lightbulb moment notes and remember when your therapist pointed out that you had to continually reach out to your close friends, even when you didn't feel like it, to turn a corner. Or the significance of realizing that your panic attack was the fear of fear, rather than the fear of a clear and present danger.

Bottom line - write down the bottom line! Chronicle the significant learnings from each session, the takeaways that you want to hold on to. Especially if you take copious notes, it helps to color-code or bold those important thoughts in a specific way, so you can find them later when your head is less clear.

Has journaling enhanced your therapy experience? Or were there details you wished you'd documented? I'd love to hear from you in the comments section below (for confidentiality reasons, please do not give your full name or identifying information).

What's Driving You?

Tue, 13 Oct 2020 16:32:59 GMT

Emotions versus Logic - Who Wins?

We all have a memory that we'd like to erase - a time when we reacted instead of acted. A time when we allowed our emotions to reign over us and regretted the outcome. Maybe it was that angry outburst. Maybe, it was a harsh email rant we cannot take back. Maybe it was bursting into tears in front of your boss. Why is it that, so often, emotions drive us?

One reason worth recognizing is that we are quite an emotion-driven culture . Anger, sadness and revenge are often cited as legitimate reasons for poor self-control. Culturally, shutting down your conscience and going with your gut has become not only understandable, it is downright expected, glorified, and even idealized. Suffered a bad breakup? It's reasonable you would slash his tires and take a baseball bat to his headlights. Heck, we might even make a clever country song about it.

But how well does this serve us? It feels good to be angry. Often, it helps us mask very real, very painful emotions that are just under the surface; feelings like hurt, rejection, confusion, or guilt and shame. But anger just leads to more anger, as any mature person has realized. Or as the saying goes: "Holding on to anger is like swallowing poison and expecting the other person to suffer the consequences."

And, it feels good to have a good cry, too. It is certainly something I recommend (and practice myself!) when grieving or facing a gut-wrenching decision, for example. But, we are in control of what happens next. Our God-given , highly sophisticated frontal cortex is able to take all information into account - emotions as well as facts - and then anticipate outcomes and choose our next actions based on conscience and logic. In other words, we don't have to go with our gut. We can let reason be in the driver's seat.

Does this mean we are to act as though we don't have feelings? Not at all. But, feelings are only one piece of information. When you consider the transitory nature of feelings, it's easy to see why feelings are usually NOT the most important piece of information when it comes to making decisions that will have effects in the long term. And the research-backed benefits of self-control include de-cluttered thinking as well as higher levels of success in life than those who follow their emotional whims.

We can use our amazing reasoning ability to override our emotions. It is not easy, but it is something that gets easier with practice. Practice by placing your rationality deliberately in the driver's seat more often, exerting self-control over everything from whether to buy that pair of shoes you don't need, to tolerating an annoying but harmless habit in your spouse .

The bottom line? Let your reason take suggestions from emotions; but, always let reason have the final say.

Prioritizing Social Connection in a Pandemic

Tue, 18 Aug 2020 18:45:04 GMT

Many of us feel the strain and loneliness of isolation right now. We've seen months of sheltering in place, cancelled trips to see family and friends, and lack of social opportunities as schools, restaurants, businesses, even concerts and festivals shut down.

But many of my clients have mixed feelings about the shutdowns. Some secretly rejoice to hear they will be stuck inside. Such is the effect of Agoraphobia or Social Anxiety Disorder. When socializing is awkward, it feels safer to avoid it. Yet, the more we avoid it, the more awkward and out of practice we become. Despite the external limitations, it is crucial to stay engaged.

Becoming socially “rusty” is not the only reason to find ways to get out there, however. You are probably not surprised to hear that social isolation can lead to depression and feelings of hopelessness. What many do not know is there are concerning health and cognitive declines linked to isolation. In short, interpersonal connection keeps us emotionally, as well as physically and intellectually, healthy.

So, how can we stay connected during a pandemic? Creative solutions abound: Zoom parties, neighborhood homeschool groups, tailgate dinners with friends, virtual family reunions. “Quaranteams” have become a thing – getting together with a friends who have the same precautionary tendencies that you do. Or buy a National or State Park year pass and make it a goal to visit all you can for your buck. Just ask Google for creative social ideas; find something that fits your level of health risk -- as well as challenges you just beyond your social comfort level.

The important thing is, prioritize getting out and make it happen. For agoraphobics, just taking a drive is far preferable than having your anxiety revert to pre-COVID levels.

Sleep Solutions

Thu, 24 Oct 2019 17:16:30 GMT

Insomnia is being treated in new ways.

I recently attended continuing education on the treatment of insomnia; namely, CBTi or Cognitive Behavioral Therapy for Insomnia. Interesting information is available that I want to pass on to you. Please read on.

"Sleep Drive" is a thing. Much of the new research centers around the concept of "sleep drive." Sleep drive is like appetite or sex drive - there are conditions that make it wax and wane. The higher one's sleep drive, the more likely they will fall asleep easily, stay asleep, and achieve restful, deep-stage sleep. What increases sleep drive is daily activity, exposure to sunlight (preferably in the morning), and lack of sleep. What decreases sleep drive is leading a sedentary lifestyle, light exposure at night (especially from screens), and use of caffeine and other stimulants.

Keep consistent bedtimes? As it turns out, the idea of keeping a consistent bedtime may work for those who never have sleep issues, but can completely backfire for those who have insomnia. A better strategy is to keep consistent wake times. Going to bed only when you are sleepy helps re-associate bed with sleep. Waking up at the same time every morning, even on the weekends, helps to reset the body's clock and improve sleep drive.

"An occasional glass of wine, or the Ambien my doctor prescribed, helps me get my sleep." This is a commonly held myth that needs to die! Alcohol and sedatives absolutely make us feels sleepy. But, they result in sleep that lacks the deep wave states necessary to give us truly restorative, restful sleep.

Psychologists are treating insomnia with effective, drug-free interventions . CBTi incorporates the empirically-proven elements of CBT with recent research to promote restful sleep and reset normal sleep-wake cycles. As in CBT, irrational thoughts and negative self-talk are targeted, and behaviors that help to prime the body for sleep are employed and practiced until they become habits. Typically, the therapist conducts a thorough sleep assessment, which requires recording specific data for several nights or weeks. A functional analysis helps determine the effects and consequences of an individual's patterns. Concurrent mental issues and illnesses are explored/ruled out.

After the assessment phase, a plan is customized to the patient. CBTi plans can include use of sleep hygiene (such as making sure the bedroom is dark and quiet) and stimulus control (such as avoiding doing work/homework in bed). Sleep Restriction or Sleep Compression is usually employed, whereby the patient's time in bed is carefully controlled and monitored to begin to optimize sleep efficiency, and to re-associate sleep with bedtime and to reset circadian rhythms.

The Core of Self Care

Mon, 25 Mar 2019 17:58:47 GMT

You wouldn't run your car on empty. Here's what you need to fire on all cylinders.

Taking care of yourself is not about one activity or action. It is not a box checked by a once-a-year vacation; it cannot be accomplished by a monthly manicure. Self care, much like a daily multivitamin , consists of numerous elements in greater or lesser quantities that your body, mind and spirit use to regenerate. How much of each nutrient you require is as personal as you. Therefore, self care is an intentional practice that keeps you running at your best.

Self care is also not optional. How well you care for yourself directly affects how well you can do everything else in your life – from your performance at work, to loving others, to physical recovery from illness . You wouldn't think of running your car without gas. You would not be surprised if your house fell apart after years of neglecting its maintenance. Similarly, humans require recharging, upkeep, restoration, and spiritual and emotional "fuel."

There are many elements of self care, and each person differs in how important any particular element will be to them. For example, extroverts will need more community and social time to recharge; introverts will need more alone time. The following list is a guide to get you thinking about what you need in order to adequately recharge, i.e., what your daily “self care multivitamin” needs to contain, as well as some ideas for incorporating this type of self care into your life.

Physical Fitness We all have needs for moving our bodies. Some individuals have very high needs for activity and will notice feeling irritable or restless if they don't get out and move regularly. Cardiovascular exercise, Strength training, balance and flexibility, yoga and walking are all ways to fill this need.

Physical Restoration/Maintenance Think of this category as your body's home maintenance list. Sleep, rest, and down time are in short supply in most modern lives. This also includes regular checkups and seeing the dentist, chiropractor, or eye doctor. Other ways to restore and maintain may include fasting, time in the sun, massage, haircuts, etc.

Social Connection If there is a category that I see most people deficient in, it is this one. Humans are social beings; and even if you are an introvert, you need some time that connects you with others in meaningful ways every few days, and at least one close friend in whom you can confide. Host others in your home, schedule regular guy's weekends, have a once-a-month standing GNO. For those of us who claim we are "too busy," I recommend combining self care goals - meet up with a friend for a workout or walk, carpool to work, call a good friend on your commute, etc.

Nutrition Nutrition is the fuel for your physical body and brain runs on. While our bodies are amazingly resilient and can function on fast food and sugary sodas for awhile, to function optimally we need fresh fruits and vegetables, quality proteins, and healthy fats. Some of us (I am one!) notice immediate negative effects of poor nutrition - including decreased concentration, gastrointestinal issues, poor sleep, etc. Vitamins and proper hydration are important as well.

Spirituality Whether you are a Christian or a staunch atheist, there is no getting around the fact that humans are spiritual as well as physical beings. For Christians, you need prayer, worship, Bible reading, and fellowship time. For others, meditation, solitude, journaling, reflection, and time in nature are recommended.

Boundaries Healthy lines of demarcation between your roles is essential to self care. Intentionally limiting how much one's work (often in the form of calls, emails, DMs, etc.) infringes on home life is especially important to those who work from home. Other important boundaries to think about are those between family/friends, school/home, volunteer time /personal time, etc. Some need thoughtful personal rules about how they set boundaries around their use of social media.

Creativity Building, cooking, and writing are good creative outlets for some, while crafts/art, music, dance are preferred for others.

Family Family time is a key part of self care - to feel connected to those we are closest to is important. So many are living distant from their extended families now that this is difficult. While calls and Facetime can bridge the gaps, there is no substitute for spending quality time with your kids, hanging out with your siblings, or making time to see extended family.

Social Outreach Research consistently shows that helping others improves self esteem and self efficacy and can even decrease depressive symptoms. Volunteering, joining political causes, or giving of one's time or resources to a charity are some ways to meet this need. However, social outreach does not have to be formal or organized - spending time with an elderly neighbor, doing yardwork for a shut-in, or offering free babysitting to a needy family are great options too.

Productivity Yes, self care is not all about bubble baths and pedicures - humans need to feel productive to be truly happy. Work fills an achievement need for most of us, but schoolwork, chores, errands, and organizing/decluttering are other ideas.

Learning/Challenge If you can't remember the last time you felt driven to learn more about a topic or excited to start a new hobby, it's time to take on a new challenge. This can be as simple as a book you've wanted to read, or as involved as learning a new language or training for a marathon. YouTube abounds with information to get you started on just about every DIY project there is. Your local library, Parks and Rec center, and universities have lots of options for classes, groups, and hobbies, too.

Play/Fun/Adventure While most parents would never dream of depriving their children of play, they get little to none themselves. Why do we stop considering fun essential in adulthood? I am a big fan of having adventure, challenge, and play outlets as regular parts of an adult life. Hiking, camping, indoor rock climbing, exploring, travel/travel planning can fill this need for some. Others need quieter pursuits like games or puzzles. Pets can provide an endless source of fun and play too, as can children; both are inherently more creative and fun-seeking than those of us stuck in the rut of "adulting."

In summary, I hope this list gives you some ideas on how to begin caring for yourself and recharging. Of course, it makes sense to combine areas of needs as much as possible. For example, joining a tennis team could fill needs for Physical Fitness, Social Connection, Learning/Challenge, and Play/Fun. By making self care an important ingredient, not an optional afterthought, in your life, I am confident you will see the benefits to your mood, decreased stress, improved productivity, and closer relationships.

Loneliness

Sun, 20 Jan 2019 17:35:02 GMT

Connecting in our over connected world

My office is a space I endeavor to make peaceful, welcoming, and non-judgemental. It is a place where there is always a box of Kleenex (or two!) at the ready. Not surprisingly, there are myriad of emotions expressed in a therapist's office. What may be surprising is which of these feelings is most common. In my office, the most common emotion I hear about is loneliness.

It seems odd to me that in a world in which we are more connected than ever, we are lonelier than ever. Research confirms that individuals of all ages, across cultures and countries, are experiencing higher rates of loneliness than ever before. Feeling alone is not an insignificant problem. There is good evidence to link social isolation to not only emotional but also health concerns, including premature death.

In the tech age, when we are lonely, we reach out, usually electronically. But researchers have found that people who use multiple social media platforms actually report more symptoms of depression and anxiety. Social media shows us the "highlight reels" of others' lives, and we mistakenly believe everyone else is more fulfilled, more connected, and having more symptoms of depression and anxiety. Social media shows us the "highlight reels" of others' lives, and we mistakenly believe everyone else is more fulfilled, more connected, and having more fun.

From Scientific American :

...more than one-third of Americans over the age of 45 report feeling lonely, with prevalence especially high among those under 25 and over 65 years old. “We live in the most technologically connected age in the history of civilization,” writes the former U.S. Surgeon General, Vivek H. Murthy, “yet rates of loneliness have doubled since the 1980s.”

So, how can we connect? I believe with any problem we must start with a good assessment.

First, ask yourself: "When do you feel lonely?" For some, it is obviously when they come home to an empty apartment, or when they face another day isolated in a cubicle. They are suffering from a lack of interaction in their lives. For others, though, there is a tendency to feel alone when they are with roommates, coworkers, or even loved ones. They may feel their colleagues, their acquaintances, or their spouses don't quite "get" them. They are suffering from a lack of closeness or intimacy in their current relationships. These two problems require two different approaches.

A lack of interaction requires that you get out there. Encourage yourself to start small. Don't expect to make a best friend today, just make a connection. Talk to someone in your class, or someone in the elevator. Smile at others, look for opportunities to connect. Challenge yourself to look beyond differences. Often we only reach out to those who are similar in age, interests, stage of life, economic status, etc. And be careful not to assume that others don't want to talk - most people welcome friendliness, but many people have their own insecurities and fears of reaching out first. In fact, if the above research is true, 3 or 4 out of 10 people you see around you are lonely too!

Make a commitment to yourself to try a new group or activity. We make important connections with others when we pursue our interests and values. Check out meetup.com where you can find everything from dinner clubs, to kayakers, to board game enthusiasts. Or type your location into VolunteerMatch.org , where you can link up to ways to help others in your community, based on your passions.

The approach is different if you are suffering from a lack of closeness or intimacy in your current relationships. To combat loneliness, you will have to take it upon yourself to move those relationships forward. Do this with positive words, not by complaining about the other person's lack of availability. This week, make it a point to tell three people how they are important to you. Be specific and give an example, such as "You always make things fun - I remember when we were stuck waiting on that bus in college and you had the whole crowd laughing." Remember, Closeness is something that we can foster in relationships - we don't have to wait for it to just happen.

Secondly, tell a spouse, friend, or family member that you value and desire their time. Again, avoid complaining - just state this in a positive way. Instead of "we never talk anymore," say, "Hey Sis, I just called to chat - I miss our long talks and wonder if you have any time to hang out this week?"

One last note of caution: Be judicious in your use of devices and social media. These tools can be great for linking you to meetup groups or reconnecting with old friends; but, they should be a means to an end, not the end itself. Commenting on an Instagram post is not a substitute for a real relationship!

Gratitude

Thu, 25 Jan 2018 20:38:34 GMT

How Gratitude Boosts Your Attitude

We all want to be happier, healthier, and more optimistic. We all want better relationships. But we tend to believe those things will result from external or situational changes.

Not so, says research compiled by Harvard Mental Health . The studies looked at the effects of giving thanks, in the form of writing thank-you notes, listing things one was grateful for, or expressing gratitude to a partner. You can read a brief summary of the fascinating studies here , but in general, the research suggests that gratitude:

- gets your employees to work harder for you
- improves communication in relationships
- increases personal happiness
- leads to optimism
- may get you exercising more
- is correlated with fewer doctor's visits

Who wouldn't want all of that! Yes, please!!

So how can you harness all the good that gratitude can bring? Here are a few simple ideas:

Start simple. Make it a daily habit to review in your mind three things you are grateful for. First thing in the morning, just before bed, or on your drive to work, list 3 basic things you are glad about that day. The smaller the better - realizing that central heat, clean clothes, or the ability to think clearly are not available to everyone helps us re-sensitize to all we take for granted.

Train your brain to think gratefully. Take the following Mom's list as an example. She took daily chores and annoyances and stretched herself to come up with gratitude for what each represents.

Say it out loud . Tell others what you are grateful for. Say it on social media. Encourage coworkers, friends, and family by regularly telling them what you appreciate in them.

Extra Credit! If you want to really kick it up a notch, try going a whole day with no complaining. You may quickly realize how much you focus on the negative rather than the positive - and stretch yourself to see all the good around you.

Resolve to Form a Habit

Thu, 28 Dec 2017 22:41:58 GMT

Already having trouble keeping your Resolutions?

It's not your fault!

Resolutions, such as "eating healthy," are nearly doomed to fail. That's why I generally dislike them.

Don't get me wrong, I love it when people take the first steps toward change! It's an exciting time! I just want you to make goals that work for you. Unfortunately, I often hear resolutions stated in ways that make change less attainable. Vague goals ensure vague outcomes. It is like tying your shoes together at the starting line of the race! Instead, make your goal to change a habit and it's like giving yourself a head start.

Here's how you do it:

Any new personal goal should be specific, measurable, and achievable.

Instead of "I'd like to eat better this year," be specific : "I'd like to eat more vegetables."

Make it measurable : "I'd like to eat the recommended minimum five vegetables every day."

And here's the key part: Make it achievable by thinking of a way you can turn it into a habit. How about: "I will eat a vegetable at every meal and snack." "I will keep veggies, and no sugary snacks, at my desk." "Each morning, I will plan how I will get my five veggies that day, and I will record on my desk calendar at the end of the day how close I came to my goal." The more specific, the better!

Forming the new habit is key. The more you visualize yourself executing your plan, the closer you are to achieving it.

Happy New Habit!

Emotion Phobia

Thu, 12 Oct 2017 17:25:47 GMT

How avoiding feelings is robbing you of your life

Most of us know feelings are important, that they have a place and a purpose. However, we all have emotions that make us feel uncomfortable. Certainly, my practice is built on helping people gain cognitive control when facing the overwhelming emotions brought on by such disorders as panic attacks or OCD.

Yet, more and more in my practice I notice the irrational fear of emotions. Sometimes during the course of therapy it becomes evident that a client has the hope that they will never feel anxious again, or that their grief will be gone. They fear the emotions of others too, and avoid, for example, the friend who is going through a divorce. They often become experts at concealing their emotions and present an always-sunny demeanor to the world to mask (to others as well as themselves) what they are truly feeling. Any emotion can be uncomfortable, and so their focus becomes avoiding them. They typically believe others cannot handle emotions either and go through excessive lengths to keep their loved ones, especially their children, from experiencing normal ups and downs. Though it is not an actual clinical term, I have come to think of this as Emotion Phobia.

As with any phobia, avoidance is a hallmark. Avoidance both momentarily makes one feel relieved, while long-term it exacerbates the problem. Confusion in life can result as a person becomes more and more distant from what they truly believe, feel angry about, or need. Relationships suffer, as people find it difficult to be close to someone who alienates their feelings.

But it is coping with and coexisting with our emotions that is the goal, not the elimination of emotions. Fear, loneliness, anger, and frustration are all a part of life and each has purpose.

A recent article by Harvard Mental Health looked at studies of those who accept, versus deny or denigrate, their emotions. Not surprisingly, those who were able to acknowledge their own bad feelings were more psychologically healthy in the long run.

My advice to Emotion Phobics: Begin to retrain your brain to recognize that emotions are simply bits of information . They add to your understanding and should be considered, not feared. They are as important to us in choosing a spouse, a house, or a career as many other logical, practical considerations. Emotions should not rule us, but they should not be relegated to the trash bin, either.

Exercise, or Abuse?

Tue, 22 Aug 2017 19:46:11 GMT

Harness your brain power to get the most out of your workouts

I see you at my gym. Yes, you. I know what you are up to. I might have done it once or twice myself.

You exercise hard, doing things you hate. You exercise because you are supposed to. You’ve got to lose weight. You’ve got to flatten your abs. You’ve got to get more fit. But mostly, really, truth be told, you exercise because you are punishing yourself.

Be honest. It’s punitive. You exercise to make up for that weekend binge, that unplanned cookie at work yesterday, that extra 10 pounds you have to lose. And, you tell yourself you will atone for your nutritional sins by pounding harder on the treadmill. And, you hate the treadmill.

The worst part about punitive exercise is that it will eventually have exactly the opposite effect you are hoping for. Hoping to lose weight, you engage in tiring, draining, unpleasant exercise, which leaves you feeling increasingly negative about exercising. Your physical efforts mentally defeat you.

However, you can use your brain to improve your body! Exercise is supposed to be satisfying, like a drink of water when we are thirsty. Humans are supposed to move, not abuse themselves. Non-punitive exercise releases neurotransmitters that improve mood, such as serotonin. Interestingly, a good serotonin balance not only combats depression and anxiety, it can decrease the desire to overeat .

Three suggestions can help you stop the punitive exercise and start feeling and looking your best:

First, choose exercise you like : walk, bike ride, hike, swim. A round of golf, or a strength training class. Pick something that you feel good doing, or at least don’t feel bad doing.

Second, give yourself credit for exercise every time you do it. Just a little encouraging self-talk, like “I’m proud of myself for taking the time to walk,” or “I feel so much better once I get a little activity,” or “I am getting stronger!”

And lastly, for exercise to be helpful, it has to become a habit . Plan for exercise in your daily schedule. I recommend new exercisers commit to only 5 minutes a day of exercise until it becomes habit.

Does 5 minutes sound silly? Consider that a year’s worth of 5 minutes a day exercise would amount to more than 30 hours of exercise! That’s enough to burn about 3 pounds of fat —without even trying; without feeling terrible; without a big time commitment; or even a gym membership.

And, I might add, without punishing yourself. A five minute walk in fresh air feels good. Doesn’t seem like such a difficult habit to start now, does it? After a few weeks, it might even make you want to do 10 minutes. Just to be extra nice to yourself!

Pulling Your Hair Out

Wed, 14 Jun 2017 18:55:15 GMT

Learn about this rarely discussed problem

It's not a problem many people talk about. Even among my clients, who know they have a confidential relationship with me, there's much shame and reluctance to admit this behavior.

The problem is called Trichotillomania (trick-oh-till-oh-may-nee-uh). This disorder is closely related to Obsessive Compulsive Disorder (OCD ) and involves pulling out of one’s own hair, eyelashes, or eyebrows. Trichotillomania (or Trich, for short), along with the related disorder termed Excoriation (skin-picking), typically emerge during childhood, are estimated to affect 2 to 4% of the college population, and often continue into adulthood.

Problems that arise from trichotillomania and excoriation include bald patches, loss of eyebrows or eyelashes, and sores. However, more serious conditions can occur, including infections from repeated picking, and digestive issues from consuming hair. The psychological consequences are no less severe – including shame, self-consciousness, and embarrassment. Social isolation often results as the person tries to hide the bald patches or unsightly blemishes.

So why don’t they just stop? What many do not understand is that the urge to pull or pick is experienced as an irresistible compulsion. Making matters more difficult, the actions of pulling or picking have a soothing, relaxing, or even pleasurable quality to those with this disorder. This is what makes the disorder so agonizing to live with and difficult to treat.

However, there is treatment for Trichotillomania. Medication can be helpful. Cognitive Behavioral Therapy teaches patients to develop motivation and use rewards. Patients learn to tolerate the distress associated with resisting urges to pull until resisting becomes easier. Patients also learn to face their social fears and fight their tendency to isolate themselves. While recurrences are not uncommon, most sufferers can gain some control over the disorder, as well as gaining more confidence and decreasing the shame they feel. The Anxiety and Depression Association of America has more on this and other difficulties.

The Right Way to Brighten a Day

Thu, 11 May 2017 20:29:12 GMT

Avoid these common pitfalls to lift a friend's spirits

Often I get questions about how to help someone who is depressed. Clinical depression is a condition that requires a host of interventions, including medical, behavioral, and psychological tools. However, for the common blues, don't feel helpless - there is much you can do to lift the mood of your friend, spouse, and yes, even your teenager!

Unfortunately, most of us are not very good at dealing with other's moods. Maybe you don't know what to say . Many shy away from those who are down, assuming they might make the mood worse. Many people hold an irrational belief in "emotional contagion" - the idea that talking about emotions makes them somehow spread. Some are at a loss for dealing with their own emotions, thus feel completely like fish out of water when friends have a tough time. If any of these describe you, read on to find easy-to-remember tips for being a help to someone else.

1. Go There. Ask questions! Most people skip this simple step. When a friend is sad, we often rush to "fix" it. The emotionally savvy friend, however, will figure out what exactly is wrong first. There is no way you can know the fix before you know the problem. Ask lots of questions and get your friend talking. What are they feeling, and why? What started this mood? What are any associated fears? Your goal is to truly understand his or her feelings before you do anything else. Oftentimes just allowing the person to vent is very therapeutic. So, take the risk: Go there!

This may sound like a minor, insignificant act, yet it is anything but. Interestingly, numerous studies on therapeutic effectiveness used lay counselors to serve as the "placebo" therapy, while experienced psychologists ran the "real" therapy sessions. Many of those studies found patients feeling significantly better just after being heard by the professionals and non-professionals alike. Since the beginning of my career, I have been struck by how many people have no one who truly listens to them. Much processing can be done just by the act of putting emotions into words while sitting with another human being.

2. Get It Once you know what a person is feeling, reflect that feeling. Let him or her know that you get it. Put the emotion into words, especially if they are having trouble and cannot. For example: "You're angry at your boyfriend, but you also feel hurt. And now you are regretting trusting him." Offer empathy and compassion. Show that you understand the feeling. Even if you don't agree with his or her assessment of the situation, find a part of it you can relate to. It is truly helpful for a person who is down to feel as though someone else cares enough to "get" them.

3. Give Once you are sure that you understand, and you are sure your friend understands that you are on his or her side, then and only then would I advise offering encouragement, advice, or any of the typical optimism-inducing attempts that we usually rush to make first. This is also when you can offer to take her out to coffee, or meet him for a run later. Some people truly will want alone time, and that is OK too. If you were a good listener in Step 1, you will probably have picked up on what your friend most needs in order to bounce back.

So remember - Go there, Get It, Give . In that order. You will not only build a person up, you will be building up your relationship.

And, never underestimate the power of a willing ear !

Playing it Safe

Wed, 12 Apr 2017 18:03:05 GMT

How avoiding stress can make social fears grow

"I just don't want to look like an idiot" my client Kate* said. She sat before me, eyes filling with tears. Kate was clearly anxious just thinking about taking on the "experiment" I was suggesting.

Of all the anxieties that I work with, social anxiety may be the most common. We all have some degree of concern about the way in which we will be perceived. We want to be accepted. No one wants to find themselves out on that social limb.

But social phobics deal with the anxiety by playing it safe . Kate, for example, was deathly afraid of making a mistake in front of coworkers. Whether tripping while walking through the breakroom, making a clerical error, or simply misspeaking in a staff meeting, she had an immobilizing fear of being embarrassed. So, Kate kept to herself at work. She was largely silent in meetings. She reviewed in her mind what she would say before saying it, and went over conversations in her mind at night.

These behaviors were an attempt to make herself more comfortable. Unfortunately, in the long run, this type of phobic avoidance or "safety-blanket" behavior actually increases anxiety. The belief that saying something silly leads to being completely ostracized is an irrational fear. If an irrational fear is never challenged, the fear will grow unchecked. In other words, playing it safe makes the anxiety worse .

Whether the fear is misspeaking, or giving a presentation, or meeting new people, research shows that the key to helping a socially anxious client is directly challenging and disputing negative social expectations and fears.

One of the most effective ways of directly challenging and disputing negative social expectations and fears is using social "experiments" where the fears are directly tested. This may entail having Kate ask for help on an easy assignment or deliberately misspeaking in front of a coworker. The experiment includes predicting ahead of time what will happen and debriefing actual outcomes afterwards. Social myths are debunked and false narratives are challenged. This results in a change in future expectations and behaviors.

Outcomes of these experiments are often very surprising to the social phobic. Kate may see that when she misspoke no one seemed to notice, or a mistake at work actually makes her coworkers seem more helpful and understanding. She may begin to realize that not only are mistakes not catastrophic, they may be neutral or even somewhat positive experiences overall.

But, safety-seeking behaviors can be tricky to sniff out. Many social phobics don't even realize that they engage in them . The key is to find and replace those behavioral and physical safety blankets with true self-confidence.

Consider the following questions:

Do you fill each conversational silence to make certain no awkward pauses occur?
Do you only mingle with others when you have had a "stress-reducing" glass of wine?
Do you only ask someone out by text to avoid face-to-face rejection?
Do you plan out what you will say in great detail?
Do you beat yourself up after conversations for saying something "dumb" or "awkward"?
Do you shy away from making new aquaintances?

These are all indicators you are using safety-seeking behaviors that can put you in danger of having social fears mushroom out of control.

Taking social risks is frightening when you have been playing it safe. Therapy can help. By using targeted, systematic steps, you will eventually increase your self-confidence instead of merely relying on your safety blankets.

*Kate is not my client's real name. Identifying information and therapy details are changed to protect client confidentiality.

Have you been coached?

Wed, 01 Mar 2017 18:01:42 GMT

Take a tip from good coaches to shape your own behavior

There's someone who needs your attention. Someone values your approval more than anyone in the world. Someone has not heard anything positive from you in a while.

Before you dial your mother, wait! It's you!

You need to be your own best coach. It may sound silly, but giving yourself positive feedback and encouragement is an important skill in being successful. This is a skill that contributes to success in sports, in business, in school, in relationships, and anytime you are trying to change a habit. Yet, this simple skill is often neglected.

Think about it. How do good coaches shape behavior? Do they grumble and groan, call the athlete a ”total idiot,” and give praise only when he or she hits a home run? Of course not! Good coaches find a way to point out mistakes non-judgmentally, and capitalize on strengths. Their positive words help the athlete believe they can achieve more. Good coaches use a few key words to describe a piece of technique (such as “elbows up!”), and then reinforce correct execution with positive, immediate reinforcement (“Yes!!”) when the behavior occurs. Then, a coach will move on to adding the next small part of the technique.

Does this mean you become conceited, overly boastful, or tell yourself everything you do is great? Of course not. Constructive feedback acknowledges your strengths without discounting your weaknesses and encourages you in areas you need to improve. This is the basis for healthy self-esteem – a realistic appraisal of oneself.

So, take the next week to practice being your own coach. Talk to yourself in an encouraging way . Use specific feedback and targeted encouragement, such as "good job being assertive", or "I'm really glad I said 'no' to that cookie!" Try to keep your self-talk concise, motivating, and immediate. I'm convinced you will experience improved mood, boosted confidence, and faster habit change just by paying attention to the attitude with which you address yourself.

Make Serotonin While the Sun Shines

Mon, 26 Sep 2016 21:36:48 GMT

As the days get shorter, but the warmth of summer remains, the sun reminds me how grateful I am to live in the South. I wasn't always able to enjoy it.

Twenty years ago, I was in northern Indiana, just finishing up my internship and beginning my Post-Doc Residency. If you've never lived through a northern winter, imagine the coldest, snomaggeddon-ish days we have ever had -- lasting about 5 months. Yeah.

For a southerner, it was quite a shock. This time of year, the days were getting short and we were already having frosts! Though I try to see the benefit and the lesson in everything, my brief time as a northerner was a tough one. I just wanted to get back to the warmth. Wintertime meant leaving my apartment in the morning in the dark, returning after work in the dark.

And then a friend and fellow intern said, "I think God put me here so that I could learn what depression really is like." I certainly did get to experience a bit of Seasonal Affective Disorder (SAD), myself. I came to have a new appreciation for what my clients experience. It is why I cherish the sunny days and strongly encourage my clients to get out and get some sun when you can.

Sunlight has a balancing effect on mood and sleep cycles. Its role in Vitamin D production is well-documented, but only in recent years has medicine fully realized Vitamin D's importance as a key brain hormone. Vitamin D is crucial for the production of serotonin - the mood molecule that helps calm and focus us, and improve willpower. Low levels of Vitamin D and serotonin can lead to neuropsychiatric disorders, including depression and insomnia. Mercola reports that an estimated 30-50% of people have a Vitamin D deficiency, which is staggering when you think how easily this can be remedied.

There are Vitamin D supplements and food sources, but the best source is natural. Sunlight is best; and it is plentiful and free! Spending your days indoors under fluorescents, staring at artificial light screens is not healthy. If time is short (and for whom is it not?), plan your daily sunlight dose with something else you needed to do anyway, like exercise, lunching al fresco, or even taking calls while standing outside. Of course, stop short of burning.

You won't regret making serotonin while the sun shines!

Jonesin' for Joe

Wed, 24 Aug 2016 17:59:31 GMT

Why caffeine and anxiety don't mix

Most of my clients have anxiety and stress. And, a good many of my clients consume caffeine on a daily basis when they first come in to therapy. Now, I tend to believe anxiety has multiple causes, and one of my jobs is to help clients figure out what those are. However, there is much research to suggest that caffeine is at least part of that equation. Consumption of caffeine increases stress, decreases restful sleep, and may cause a host of other health problems.

Confusing? It is. There are so many news reports lately of how good caffeine is for you. And, of course, we want to believe those reports because we love our daily cup of joe. We love the taste of it, the ritual of it. We love talking to our friends over it in boutique coffee shops. And, we really love the cream and sugar that we put into it!

However, despite many glowing reports on the virtues of caffeine, caffeine is a drug. It's effects are dose-dependent, and it affects different individuals indifferent ways . Those who don't have anxiety may not experience the heightened sense of jitters, increased heartrate, and racing thoughts that many of my anxiety clients do. But for anxiety sufferers, those effects can set off panic attacks, increase worries, and make you rethink your morning ritual.

Even so, it can be hard to think about going without your coffee.

Confession time: I’ll admit I became a caffaholic in graduate school. I rationalized my habit as necessary for getting me through my tough academic training and work schedule. After graduating, I tried to quit coffee several times. It was tough - headaches, fatigue, and latte cravings. Three days into going cold turkey, I can remember literally thinking “I don’t think life is worth living without coffee!” How’s that for an irrational self-statement??

However, for me the rehab was worth it when I understood the caffeine-cortisol connection. Research links caffeine consumption to increases in key metabolic hormones, including cortisol . Cortisol, produced by the adrenal glands, is linked to our fight-or-flight system function, and increases blood pressure, anxiety, restlessness, and makes for poor quality sleep.

If you have anxiety, I recommend going caffeine-free. Give it a try and see how you feel after a few weeks detoxed from caffeine. But don’t go cold turkey. It's best to gradually decrease your caffeine consumption over 1 to 2 weeks.

Have you found a link between caffeine and your anxiety level? I’d love to hear your comments below!

Teens, Sleep, and Mental Health

Tue, 02 Aug 2016 18:53:35 GMT

New research shows students are dangerously deficient in sleep

If you are a student, read this: There's a simple thing you can do to reduce your risk of anxiety and depression:
GET MORE SLEEP.

How much is enough? Nine hours a night seems to be key . Research shows that adequate sleep is correlated to lower levels of anxiety and depression in all ages. But, in young adults the still-developing brain needs more time to rest and grow. Longitudinal studies suggest that as sleep suffers over time, the odds of experiencing depression and anxiety rise.

Think you get enough already? The odds are, you don't. New research finds that a paltry 5 percent of high school seniors get the recommended 9 hours of sleep per night -- That's 5 percent! The biggest sleep-robbers I see in students are over-scheduling, increasing academic demands, and of course, social time and electronics.

I encourage several sleep-promoting strategies:

Set regular sleep times and stick to them as much as possible. Playing catch-up on the weekends doesn't work!
Limit artificial light (especially screens) 1-2 hours before bedtime.
Get some natural light each day, especially morning sunlight.
Recognize the value of sleep, and its increase in your productivity, so you will prioritize it. That extra hour you spend sleeping tonight will make you think quicker, remember better, and make you more resilient to stress tomorrow.
Rethink busy schedules, and consider "downsizing" your extracurriculars to those that really matter to you.

If that sounds extreme, imagine suffering from anxiety or a depressive episode that could have been avoided. Mental disorders can rob you of time, relationships, health, and academic gain.

Do your brain a favor and get your rest!

The Myth of Moderation

Mon, 25 Jul 2016 17:36:49 GMT

I love the idea of moderation, and it works well in many areas of my life. But if you, like me, have ever bought into the idea that you could "just eat one chocolate every once in a while", only to find yourself halfway through the box during a midnight kitchen raid, read on!

I'm not a fan of the one-size-fits-all conventional wisdom that says "everything is fine in moderation." While it sounds reasonable at first, in many cases it leads us down the wrong road, armed with all the right rationalizations.

What's wrong with moderation? Well, nothing if you are eating only healthy food, follow all the keys to a good relationship, have no addictions, and know exactly how much sun you can get before you burn. For the rest of us mortals, there's a catch.

Most of us know an alcoholic cannot, by definition, moderate alcohol. I think most of us would laugh if someone suggested there is such thing as "moderate" heroin use. Its easier to see where others need to take a hard line. But the reality is, most of us have something, if not several somethings, that we find irresistible .

Maybe it is a true addiction, where you cannot stop yourself from overspending even though the credit cards are maxed out, or drinking when you have already had enough. It can be a relationship in which you return to a person or situation that you know is unhealthy. Or, you may pig out on nachos when you already know you have a heart condition. In these types of situations, deciding to moderate is a decision to fail. It is a decision to keep doing that which is unhealthy for you.

These vices range from annoying to life-destroying, but they share one commonality: they all involve lying to yourself . And that I am NEVER a fan of!

So ask yourself this question: what indulgence do I feel I could not live without? What is that substance, food, activity, or person that is unhealthy for me, but that I do not ever completely give up? Only you, being completely honest with yourself, can answer that. And the answer to this question is the part of your life that needs cleansing, not moderating!

Just a Homebody

Thu, 07 Jul 2016 17:15:36 GMT

Hanging out in your comfort zone can be a sign of a problem.

Do you know someone who doesn't get out much? A self-described "homebody"?

There's nothing wrong with loving your home, of course, but, for some this is a serious issue. Many introverts are actually socially uncomfortable, nervous about being away from home, and panicky when they are out of their comfort zone.

They may dread long drives, or crowds; and simple tasks like buying groceries, sitting in traffic, or waiting in line makes them very edgy. They may feel tense or "trapped" in meetings, movies, restaurants, even in church.

These anxieties can be debilitating. What often starts as a feeling of “just not wanting to go out” can lead to a person becoming more and more uncomfortable when away from home, more and more concerned about having panic attacks or getting sick while out. Eventually, a person may feel unable to leave the house, and unable to work, socialize, travel, or complete chores or errands.

Therapy is very effective for this type of anxiety. A good Cognitive-Behavioral therapist can help shed light on why some get edgy in crowds, on trips, or in social situations. There are specific strategies to becoming more socially confident and comfortable when venturing out. Therapists help clients gradually face their fears to promote lasting change, without dependence on medications or lengthy therapy.

For more information, including some self-help tips, see the Anxiety and Depression Association of America's post here.

(original blog post date 4/18/14)

Make Dieting More Satisfying

Wed, 01 Jun 2016 21:48:54 GMT

Five Simple Steps

Is it possible to: Make dieting satisfying?

Maybe that swimsuit you want to wear is imploring you to diet. Or maybe your doctor has been encouraging you to "eat healthy." But while the nutritious diet is wonderfully beneficial to your body and ultimately your mental health, being happy with a salad when you're craving fries isn't easy. Ultimately that sense of "deprivation" can derail the best intentions.

I use "deprivation" in quotes because the thought that healthy eating deprives you is irrational. Unless you're not eating enough calories, eating healthy actually provides your body more of the things it needs and less of what it doesn't. But if you are saying to yourself you are deprived, you will feel unhappy and resentful about dieting, setting yourself up for failure.

How do you make yourself reach for the kale chips instead of the potato chips?

While healthy eating is more physically satisfying, we fail at it because we don't make it more psychologically satisfying.

Satisfy your eyes. A chef once told me, "we eat with our eyes first." Take the time to add color to your salads, to arrange everything attractively on a plate, to set the dinner table. Avoiding monochromatic meals (mashed potato, creamy gravy and fried chicken aren't good for you anyway) helps you think in terms of the variety of vegetables that will give your body a wealth of antioxidants. While you're at it, make sure you don't start eating until everything is on your plate. Nibbling half of your dinner before you even get to the table makes for sad-looking portions!
Stop and give thanks. I love the ritual of the prayer before a meal. Stop and thank God for the abundance that you have. If you are a nonbeliever, stop and thank the chef, the gardener, or the thousands of people along the supply chain of our food. Take a second to be amazed at the different foods in front of you, and speculate about where they might all have come from. We are really so blessed to have such an abundance and variety of food available to us!
Savor every bite. Really taste what you are eating. Get all your senses involved - don't just smell and taste your food but notice textures, colors, even the crunchy sound of those fresh sugar snap peas.
Practice mindful eating . At a hospital where I worked, we successfully used the technique of distraction with anorexic patients at mealtimes. That's because distraction gets one to eat more without even realizing it! So, when dieting, turn off the TV. Put down your electronic devices. You can only savor every bite if you're not doing four other things at once.
Remind yourself of the benefits . Think about the fact that what you are eating is satisfying your whole body instead of just your taste buds. Imagine how avocado is providing your brain with healthy fat/fuel, how the proteins in your chicken are building muscle made sore by yesterday's workout, how the vitamin C in those peppers is going to boost your immunity so you don't get the cold everyone else is suffering.

Try these 5 tips for just 3 days, and see how it changes your mealtimes. I'm betting you'll be eating less while enjoying food more!

Feel free to add in the comments section any thoughts or techniques that have helped you stay on track with your diet. I'd love to hear from you!

Bubble Bath for Superman

Tue, 19 Apr 2016 18:11:22 GMT

Why are all the stress management suggestions written for women?

He’s typically the breadwinner and decision maker for his family. He’s called upon for everything from being the “heavy” in discipline, to doing the heavy lifting on home maintenance. The pressures men face are unique, challenging, and yet too often overlooked. Stress affects men both emotionally and physically, causing issues like anxiety, high blood pressure and sleep problems. So, while she goes out for a girls night, what does the average guy do to de-stress?

Don’t “John Wayne” it! I have male clients who would never dream of taking antidepressant medications, but who also don’t take the time to make lifestyle adjustments for emotional balance. Something’s got to give! I recommend trying out several ways to unwind, then choosing one to do weekly. Think of this as your medicine. I have three general suggestions:

1. Draw boundaries around your work. Sure, the modern workday is longer than it used to be, but does it always have to be? Checking email at 10pm is more often a habit than a necessity. Develop rules around your work life, and have distinct clock-in/clock-out times whenever possible. This is even more important for men who work from home.

2. Think active relaxation. While women find stress relief in a bubble bath, a long chat over coffee, or journaling about their feelings, most men recoil at these suggestions. True, I do have some male clients who will attend hot yoga, meditate, or consider getting a manicure. But they are not the majority.

Men tend to be more active in their problem-solving approach, and their response to stress should reflect this. Think projects, outdoors, or exercise over vegging out on the sofa. A long walk with the dog, a round of golf, or woodworking are good choices.

In my practice, I sometimes encourage men to think back to activities they enjoyed as a boy, as that can spur ideas. Did they make up games, explore the woods, tinker with cars? Did they like loud groups or prefer quieter pursuits, like fishing, drawing, or reading murder mysteries? Of course, as adults these might need to be modified to fit into a busy lifestyle, such as listening to recorded books on a long commute, or pairing interests with Dad duties (coaching baseball, teaching your child to fish/camp). For more ideas, check out a previous blog I wrote on Addressing Your Fun Deficiency .

Don’t rule out volunteering – most of us feel tremendously rewarded after doing something to help those in need, and more able to put our own concerns into perspective. I also recommend combining friend time with something you had to do anyway. Meet a buddy at the greenway for a run, or ride together to a conference.

3. Watch out for coping strategies that come with side effects! Many quick-and-easy ways to unwind actually cause more stress in the long run. More TV and more screentime leads to isolation and a sedentary lifestyle. That evening drink to unwind is actually a depressant – and even though you think it helps you fall asleep, studies show alcohol actually decreases the quality of your sleep , making you feel less restored in the morning.

Demand more out of your coping skills - they should decrease your stress now, and have positive side effects, like weight loss, better relationships, and a feeling of calm confidence over your busy world.

What to Give Your Valentine - A Psychologist's Recommendation

Thu, 11 Feb 2016 00:00:00 GMT

How will you express your love on Valentine's Day?

There are lots of opinions out there on how to express your love on Valentine's Day. Cards, flowers, chocolates, jewelry, a night out... I'm not knocking any of them (especially not chocolate!), but if you really want your beloved to know you care, put down your wallet and read this blog first.

After nearly two decades of helping couples in therapy, I heard nearly every spouse easily itemize all the things they do for their significant other to show they care about them. Doing his laundry, offering encouragement after her hard day, going hiking together, rubbing his sore shoulder, cooking her favorite dinner, a hug, a kiss, a surprise gift. What most people have trouble getting right is what makes their mate feel most loved . Sound like the same thing? It isn't!

Gary Chapman wrote an excellent, brief book called "The Five Love Languages." In this classic couples therapy book, he describes the different ways people like to feel loved. Some like gifts; some like words. Some need physical touch to feel loved. Others need actions, however small, like picking up the dry cleaning. Lastly, for some, love is best communicated through time spent together.

So here's a question for the one you love. Ask: " When do you most feel loved by me?"

Get ready - the answer may surprise you! And your challenge will be: Show love in that way. It may not necessarily be in your way; but show love in that way and as often as you can.

For a person who likes quality time, it may seem strange to have a spouse who feels most loved with gifts. Don't make the mistake of becoming judgmental about these differences, insisting that your way of showing love should be enough. As Chapman points out, there is no right or wrong "Love Language." Getting closer to your mate is a matter of knowing and respecting those differences.

And, I believe, it might lead you to find the perfect Valentine's Day gift as well.

Please add your comments below. Remember: In order to protect your privacy, please use a pseudonym instead of your real name.

My Best Holiday Survival Tip

Wed, 02 Dec 2015 20:46:31 GMT

Increase your enjoyment by one simple thought adjustment.

As I sit here in my office, my favorite Christmas CD is playing in the waiting room. It fills me up better than a plate of warm snickerdoodles. It really does! I hope all of you reading this are finding some simple joys this season.

Of course, I know many are filled with pain instead. The holidays can bring up family dynamics, financial concerns, and grieving loved ones whose places at the Christmas dinner table are palpably empty.

I want to share with you my best tip for happily surviving the holidays. Because, the good news is, much of our pain and turmoil is avoidable!

First, be on the lookout for the thoughts of dread . They sound like this:

I hope little Jimmy doesn't throw a tantrum about his presents like last year.

Will Aunt Carol get drunk and embarrass us again?

I'll never be able to spend enough time with this side of the family without making that side of the family feel slighted.

I don't want to miss Dad this year; maybe I won't think about the fact that he is gone.

I just want everything to be perfect for the party/dinner/gift-giving/etc.

Next, apply my best tip to the dreaded thoughts: Adjust your expectations! If little Jimmy is never happy, odds are he won't be happy. If Aunt Carol has been alcoholic for years, she will probably get drunk. If family tends to compete with each other for your time, you will probably disappoint some, or several, family members. If you are grieving, it is normal and it can be expected that you will be sad during the holidays. And, that is OK - you can deal with all those things and still have some joy, too.

Last but not least, all will NOT be perfect. It never is. Perfection is not a quality of human beings. So give yourself a gift this year and really strive to let go of perfection as a goal, in yourself, as well as in others.

Expectations and goals that are realistic are the key to a happy holiday. They take the pressure off you and your loved ones and might just allow you to enjoy the simple peace and comfort that you can find around you right now.

Trouble Saying No

Fri, 27 Nov 2015 18:59:06 GMT

Are you kind to everyone but yourself?

Do these sound familiar?

~ I often avoid speaking up.

~ I usually don't express my true feelings.

~ I avoid conflict at all costs.

~ I have a hard time saying "No."

I work with a number of people who have boundary issues. They find it difficult to limit their time with others, have trouble saying no, and often feel their lives are out of their control.

What’s their biggest obstacle to saying “no”? In my opinion, it is their belief that it would make them a bad person. People pleasers see themselves as good people, as someone who doesn’t want to hurt anyone’s feelings. Human rights are important to them. They would never dream of disregarding others.

However, that is precisely what they are doing to themselves. They disregard their need for personal time, their anger, or their needs for conflict resolution, and they believe this is somehow the kinder thing to do.

As my pastor once said, “Avoidance of conflict is not peace. The avoidance of conflict is false harmony.”

If you have trouble saying no, here’s a challenge for you: Practice saying no in three small ways this week. Say no to the other student who asks to copy your homework. Say no to taking another volunteer duty on top of your full schedule. Say no to a friend who wants to meet when you had scheduled another event. Remind yourself that you count, too.

Stress Management 101 - Calling All Control Freaks

Mon, 12 Oct 2015 00:00:00 GMT

Week 4

This week I am calling on all control freaks!

I have a friend who's a self-described control freak. I must admit, when she says, "I just like to be in control," I think "who doesn't?" If I am being honest, I don't really like surprises.

Control is a feeling that many of us are drawn to. It helps us know what to expect. It makes us feel we have mastery over environment. We exert control to try to feel calmer, confident, and free from stress.

However, as you might've guessed, there's a healthy and unhealthy way to exert control . We are all familiar with the control freak who tries to direct everyone's behavior, who has to choose the movie, who has to choose the restaurant, who cannot tolerate traffic, who has to have the last word, who has to be the one to break up first.

These are not the easiest people to have relationships with. And, they are actually less in control than they believe. In fact, the irony of being a control freak is that exerting constant control over your world makes you less and less able to tolerate changes. Surprise occurrences make you feel increasingly flustered, angry, stressed... basically, out of control!

An easy way to assess whether your desire for control is healthy or unhealthy is to ask yourself: "Do I want to control my environment or do I want to control myself?" Only one of these leads to true peace.

Striving to make your environment exactly what you want always leads to disappointment. Striving to be able to handle your environment no matter what gives yourself a huge sense of control.

This Week’s Challenge : Look back at your notes from Week 1 on when you are most stressed. Find a situation/environment in which you have little or no control, such as traffic, a grouchy coworker, a distasteful task. Now, practice exerting daily control over your internal reaction during those times, rather that controlling or wishing you could control, the external. For example, find a podcast/audiobook to enjoy during your commute. Imagine a bubble or calm boundary around yourself when your grouchy coworker starts up, and refuse to take on that person’s attitude. Give yourself positive credit for tackling your distasteful to-do list, ticking off each item as you go in a small celebration. Lastly, learn the power of saying, "Oh, well" when things aren’t as you would like them to be.

This Blog is part of a multi-series piece called Stress Management 101. See the Blog section for previous entries.

I'd like to hear from you! Feel free to add your comments below. Remember, in order to protect your privacy, I recommend using a pseudonym instead of your real name.

Stress Management 101 - Week 3 - Address Your Fun Deficiency

Wed, 23 Sep 2015 17:36:04 GMT

Do you need more recess?

Welcome back to class! So far, you should be getting a better idea of your sources of stress, your coping skills (positive and negative), and have had a week to practice a key relaxation skill. If you didn't start with us, find my original post HERE and jump on in! You can start class anytime!

This week's lesson is on PLAY . That's right. PLAY! We all need it, and most adults don't get enough of it.

When was the last time you did something that would be classified as play? I am amazed at the number of parents who are committed to getting their children to engage in sports practice, play dates, and time outside, yet do not get that for themselves.

For our purposes, we will define play as an activity done for amusement/enjoyment, ideally in connection with others, the outcome of which we have no concern. That means that play, by definition, is aimless - so, your cutthroat tennis match will NOT qualify for this week's assignment, but playing hide and seek with your toddler does!

The purpose of play is enjoyment, bonding with others, humor, and/or creativity. Decreases in stress levels and cortisol occur in play, along with an increase in endorphins.

Play does not have to be 18 holes of golf, or competitive kickball (although if that's your thing, go for it!). To fit play into your day, it should be short and simple.

THIS WEEK'S ASSIGNMENT : Look back at your notes on what time of day you are most likely to do something to try to unwind. Now, find a way to fit 10-15 minutes of play into that time instead. Jot down what you did and your mood afterward (remember to use the 1-10 scale of most relaxed to most stressed). Ideas include:

At work : Start a game of trash can basketball, paper football, or (if the boss is out) desk chair races. See who can doodle the best caricature (be nice!), or make the best paper airplane.

At home : Play in the sprinkler, turn up the tunes and dance, play with your child/dog (let him/her decide what), climb a tree, explore a creek bed. Ride a bike. Toss water balloons at your teenager. Play a quick game of cards. Turn the breakfast nook into a makeshift ping pong table

Anywhere: Group text movie lines/song lyrics and see how long your friends can keep the next line coming. Sing out loud with the radio (you know you want to). Visit a park. Swing on a swing. Sketch something.

This is your chance to get creative! For more ideas, see the following websites on play and emotional health , and adult playtime .

EXTRA CREDIT : Make all your play NON-ELECTRONIC this week. Apps and gaming are very clever, but they don't engage our level of creativity or connection in the same way.

Please add your comments below. Remember: In order to protect your privacy, please use a pseudonym instead of your real name.

Stress Management 101 - Week 2 - Breathe!

Wed, 16 Sep 2015 15:01:53 GMT

Turn your Wait Time into Relaxation Time

Welcome back to class! Last week, I encouraged you to understand your stress better by doing some simple recordings using a 1-10 scale. If you didn't start with us, find my original post HERE - you can start class anytime!

When you look back at your stresses, I'm betting some of them happen when you are stuck in traffic, waiting, or anytime the clock is not your friend. Just for this week I want you to use your wait time to try a simple coping strategy.

Breathe.

That's right, breathe. Yes, I know, you breathe everyday and yet you are still stressed. This is a different kind of breathing. I want you to focus on a deep, slow inhale, and a slow, controlled exhale. Strive for 8-10 seconds in, 8-10 seconds out. Do it now, watching the second hand of a clock or watch, for a 2 minute period.

Doesn't that feel a little bit better?

What you just did is called relaxation breathing. Breathing in this manner slows our thoughts and physiology and tells the fight-or-flight mechanism to stand down. It also provides a brief mental distraction, one that is often enough to derail negative thoughts. Relaxation breathing has been around for decades and is a proven way to fight stress. However, as I tell my patients, it is a skill, not an aspirin. That means you must practice it in calm moments to become proficient at it (i.e., before you can successfully use it for the pre-public speaking jitters).

THIS WEEK’S Challenge : Every time you are waiting , practice your relaxation breathing. In line, in traffic, before class, during commercials, while the coffee brews… for this week, wait time = breathing time . Don’t forget to keep notes on what your experiences are as you practice these exercises. It can be especially helpful to record your stress level on a scale of 1-10 before and after you practice breathing.

I'd like to hear from you. Feel free to add your comments below. Remember, in order to protect your privacy, please use a pseudonym instead of your real name.

Stress Management 101

Wed, 09 Sep 2015 18:58:55 GMT

How well do you know your enemy?

Class is in session!

If you need some personalized, creative ideas for reducing your stress (and who doesn't?), tune in for the next few weeks. I will be challenging you to learn your best personal coping skills.

My hope is for you to learn more about yourself and to incorporate some daily fun, stress-busting exercises to help you make your life a little more peaceful and rejuvenating and your work or school time more productive.

Everyone has stress, and we all know its effects can be brutal on our health, our mood, and our relationships. That's why we should all have 5 or 6 Go-To Stress Reducers we can use on a short term, daily basis. If your best way to feel better at the end of a long day is to grab chocolate or pour yourself a drink, think again! I'm here to challenge you to get more creative and learn that effective coping skills are NOT mind-altering or fat- producing substances!

This Week's Assignment will prepare you for an important science experiment: Collecting data on how stress affects YOU! That means I am challenging YOU to do 4 things:

Take intervention measures. Get yourself a small notebook, or set aside a place in your phone/tablet to make notes. In it you will record your observations and eventually formulate an outcome summary of the stress in your life. At the end of this process, you will have a list of stress reducers that you know work well for you personally. You will likely also have some good theories on what stresses you most and what your unhealthy coping skills are trying to tell you.
Make 4 columns, as follows:
- DAY
- TIME
- STRESS (1-10)
- INCIDENT (WHO, WHAT, WHERE, THOUGHTS, FEELINGS, SELF-TALK)
Everyday, record in your notebook or phone when it is that you are most stressed. What time of day is it? You may think you are well aware of this; but, take the time to really notice and record both your stressed and relaxed tendencies during the day. Is it first thing in the morning? Is it at the end of a long workday? Signs to look for include crankiness, difficulty concentrating, feeling flustered, depressed, keyed-up or fidgety, just to name a few. Notice what you are doing and feeling. What you are saying to yourself? Remember to record your observations. Also, notice when you are most calm. Who are those with you? What are you doing? What is your internal self-talk? Write this down. Using a scale of 1-10 (1 is most relaxed, 10 is most stressed), assign a numerical value for each instance you recorded. Good job! You are well on your way to formulating the outcome summary of the stress in your life!
On a separate page, make 4 more columns, as follows:

DAY
TIME
COPING STRATEGY
OUTCOME (STRESS LEVEL 1-10)

On this page, you will note your current go-to stress reducers – both positive and negative. Do you reach for a cup of coffee/glass of wine? Do you talk to a friend or tend to get quiet? Do you rush or multitask in an effort to “get ahead”? Write these out in your notebook. Record how well each actually reduces your stress. Remember, use the 1-10 scale described above.

*EXTRA CREDIT assignment : Email me at jlatiolais@bellsouth.net for a brief mood survey, then complete and date it. We'll complete it again at the end of Stress Management 101 for a comparison.

Please add your comments below. Remember: In order to protect your privacy, please use a pseudonym instead of your real name.

How do you compare?

Tue, 01 Sep 2015 18:46:00 GMT

Keeping a mental score takes your eyes off the ball.

Are you feeling beat by comparisons? It's completely socially normal that we gauge our success relative to others. After all, we are social beings! It's important for us to be part of the group, not just because we want to be popular or have the most "Likes" on Facebook, but because we truly need each other for our survival.

A taxing habit. It's important to realize that few habits give us more anguish than the hundreds of comparisons we make daily. Do we earn less or have less fun than our friends? Do we wish we were more popular at school? Do we look fatter than other people at the gym?

Even when we find ourselves better off than others by comparison, the feeling of pride doesn't last. There's always someone who can run faster, earn more, or tell better jokes to the opposite sex. The reality is that keeping mental score takes our eyes off a more important goal.

So what's the antidote to comparison?

I believe it starts with a good understanding of who YOU are. Good self-esteem means an accurate self-appraisal, including all your strengths and weaknesses. What are your sources of pride? And where do you want to grow? Develop your own internal measuring stick, and check back in with yourself frequently to see how you are doing. Maybe you' ll notice an improved focus at work, but maybe you have been less present with your friends. Where are you in your spiritual journey? How is your health relative to a year ago?

These are the comparisons that lead to growth, not anguish; a recognition of strengths, not feelings of inadequacy; happiness, not jealousy!

Here's a challenge for you : Think of three ways that you tend to compare yourself to others. Now, what would you like to focus on internally instead?

Please add your comments below. Remember: In order to protect your privacy, please use a pseudonym instead of your real name.

Comments:
1. Judy M said on 3/19/15 - 04:26PM
3 ways I compare myself to others...appearance, quick mental reactions, living the way we've been taught through our religion. How do I stack up? On a scale of 1-10 I would say I am about a 6. Not horrible, but lots of room to improve. My appearance, I am working on with your help and guidance. Quick menta reactions, well I'm afraid that is a skill I will never be able to achieve. I find myself trying to fake a reaction a lot so no one will know I usually don't know what is being discussed. Dumb, I know, but that is how I deal with deafness and heavy duty drugs that I've taken for so much of my life. Ah, the wicked side effects of modern day medicine! Religious effect on my everyday life...I always feel I want to do better in this area. Not guilty because I don't, but I wish I could follow the Ten Commandments much more thoroughly than I do. I've come to the conclusion there is a lot of space to fill there! You hear "spread the word of God". I don't do that because I feel religion, whether you believe in God or not, is a very private and personal thing, and I refuse to push my beliefs onto others. Yet I need to stand up to myself and ask if I am living my life the way I believe. I don't, which kind of makes me a hypocrite, don't you think?
2. Jo said on 3/20/15 - 10:55AM
I have my two lists and already I feel better about myself. I realized how petty I was. This blog made be return to your last blog. It is tied together. Thank you, Dr. J. It is good to work on "self."
3. Dr Latiolais said on 3/20/15 - 01:50PM
Judy - I don't think it makes you a hypocrite. I think it makes you a human! We are never perfect, only striving. Thanks for your comments. Remember to treat yourself with kindness!

The Best Reason to Exercise

Wed, 26 Aug 2015 22:47:58 GMT

What benefits more, your abs or your attitude?

So, what body part benefits most from your daily workout?

Is it your abs? Legs? Rearview?

It's your brain!

That's right. The best result you leave the gym with is rarely the one people think about. But study after study is demonstrating that the part of your body best served by exercise is your brain. Yes, exercise results in increased blood flow to the brain, and therefore increased mental acuity. Cognitive flexibility is enhanced. Regular exercise greatly reduces the risk for Alzheimer's disease.

Research on elderly show has even shown growth in the brain's memory center with increased aerobic exercise. Memory decline reversed.

All these benefits come with side effects, however! The side effects can include elevated mood, a feeling of accomplishment, and a positive outlook with which to start your day. Oh, and your heart, lungs, and waistline might be better off too.

I encourage everyone to incorporate exercise into their daily lives. This doesn't mean you have to start running marathons. Simply make a habit to exercise five minutes a day, every day. Don't ask yourself if you have time to work out today. Tell yourself you are getting your five minutes, and then find where you can get them. If you go to the gym, run in your neighborhood, meet a friend for a hike, great! If all you have time for is 5 minutes of walking up and down the stairs on your break at work, then that's great too. As long as you form the habit, you are beginning to do wonders for your brain. And, your brain will reward you with increased focus and memory. You will meet your challenges today with a bit more flexibility and a better outlook!

Please add your comments below. Remember: In order to protect your privacy, please use a pseudonym instead of your real name.

Could it be a Panic Attack??

Wed, 19 Aug 2015 19:48:44 GMT

My doctor says I'm fine. So why do I feel...?

My doctor says I am fine.

So, why do I feel...

shaky
heart racing
tingling in the arms or shoulders
short of breath
nervous
hot/sweating for no reason
stomach upset/nausea
bowel upset/diarrhea
dizzy
trouble concentrating
feeling detached from reality

If you experience four or more of these symptoms, you may be having a panic attack.

Panic attacks usually come in distinct periods or waves, lasting several minutes to an hour or more. They are extremely uncomfortable and troublesome, and often create a persistent worry that leads to more panic attacks.

The good news?

Panic can be overcome! Anxiety is common to one in four Americans; but, with a knowledgeable professional's help, you can learn to outsmart, and finally quiet, these agonizing feelings.

Dr. Latiolais specializes in the treatment of panic attacks with Cognitive Behavioral Therapy "CBT." Her approach is simple:

Learn all you can about anxiety and the fight-or-flight mechanism.
Learn what you have been doing right to rid yourself of panic. More importantly, learn the well-intentioned things you have been doing that actually make your panic worse. Finally, learn the simple concepts you need to arm yourself with the ability to defeat your attacks!
Get your thoughts working for you, instead of against you. Learn how to use reason-based “counterthoughts” and self-coaching to effectively combat your doubts and fears.

Dr. Latiolais’ goal in treating panic is to give you the understanding, concepts, and tools you need to defeat your panic, now and in the future. This is without dependence on medications or lengthy therapy. Treatment for Panic is usually short term. Once you know a few basic techniques and how to apply them, you will be feeling like your old self again!

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Tuning In To That Little Voice

Fri, 07 Aug 2015 19:55:18 GMT

What you say to yourself matters

One of the most researched and most effective modalities of psychological treatment is CBT, or Cognitive Behavioral Therapy. CBT focuses on changing thoughts as well as behaviors in order to get control of your feelings.

CBT's most basic premise is that thoughts don't "just happen.” There is an activating event or situation that triggers a thought and the thought precedes emotion. These thoughts are unnoticeable to many of us, but crucial to understanding why we get so emotionally stirred.

So much of my work with clients focuses on utilizing CBT, and to do so, we have to identify what the client is saying to themselves. What is the internal self-talk? Is it self-deprecating? Overly optimistic? Does it contain unrealistic expectations, whether of themselves or of others?

So how do you tune into that little voice? Often times, the easiest way to identify a cognitive distortion is to track it backward from a strong emotion. You notice intense embarrassment or a feeling of humiliation after dealing with a coworker. Track back the activating event (She asked what time I came in to work) and you might identify a thought that came after that (She thinks I am a slacker).

Once we know what you are saying to yourself, we can identify the faulty thoughts and devise rational alternatives. For more on CBT with Anxiety click here ; for CBT with Depression click here ; and for CBT with weight management issues click here and here .

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Am I OCD?

Thu, 06 Aug 2015 00:49:41 GMT

Obsessive Compulsive Disorder is no joking matter.

It has become commonplace to hear people joke that they are "OCD." They usually follow this by itemizing how neatly they keep their sock drawer, or how "yucky" they find raw chicken. I can assure you that those who are truly OCD are very unlikely to joke about it.

Obsessive Compulsive Disorder is a progressive, debilitating illness. Left untreated, it can become completely immobilizing. Those with OCD spend an hour or more a day on behaviors they feel compelled to do, though they know the behavior is unnecessary. Unable to reassure himself, the OCD sufferer is constantly plagued by thoughts that he cannot get out of his mind. Often, associated problems develop, such as strained relationships or alcohol abuse.

OCD can take the classic forms of obsessive neatness or overconcern about germs. However, there are many ways this disorder manifests, including obsessions with order, symmetry, perfection, and counting of items; and behaviors such as ritualistic touching, cleaning, organizing, checking, and hoarding.

If this sounds like you, there is help. Psychotropic medication combined with Cognitive Behavioral Therapy (CBT) is the treatment protocol that has been found to be the most effective. A particular type of Cognitive Behavioral Therapy is Exposure and Response Prevention (ERP) which appears to be the most successful for OCD. ERP involves gradually and systematically helping patients confront their obsessive thoughts, refrain from their compulsive behaviors, and learn the essential skill of self-reassurance.

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Are you fragile?

Thu, 06 Aug 2015 00:34:58 GMT

Anxiety is a fascinating problem.

One of its aspects that continually amazes is anxiety's contradictory nature. In my practice, I have dealt with patients who have been fearful of driving, public speaking, meeting new people, minor illness, common germs, bridges, blood, dogs, and even the sound of certain words. At the same time, my patients have been highly competent parents, accomplished students, hard-working executives, experienced emergency personnel, etc.

Conclusion? Even very strong, very capable people can think they are fragile in the face of something they fear. These same people can be immobilized by fear, begin treating themselves as incapable, and soon find they shrink from everyday challenges. My task is to help them see that despite how fragile they feel, the reality is often something quite the opposite.

Don't let fear make you believe you are fragile. Every time you treat yourself as incapable, you shrink from challenges that would prove you otherwise. On the other hand, every time you face a fear, you gain confidence. When you remember how many real life difficulties you have faced, a fear or phobia is small. In short, only when you challenge yourself to leave your security blanket at home do you have the chance to find that you didn't really need it.

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What do happy people have that I don't?

Tue, 28 Jul 2015 05:01:18 GMT

Everyone wants to be happy.

Everyone wants to be happy. It is such a strong driving force and yet an elusive state and concept. I just returned from a conference on the habits of happy people and wanted to share some of what I learned -- key factors that distinguish happy people from the general population of folks.

One of the most striking observations at the conference is that humans are generally pretty inaccurate at predicting what will make them happy! Ask the average person what would make them happy, and frequent answers focus on the “if onlys” – if only I had more money, if only I were young again, if only I found the right person and started a family. Yet, Dr. Ronald Seigel, a researcher in this field, points out that those who have children and those who are wealthy do not report higher levels of happiness than the average person. And, despite our tendency to overvalue youth, research on happiness and aging demonstrates that older people generally report more happy moments in their lives that younger people do.

So what do happy people have that the rest of us want?

The answer is… nothing! Focusing on a “have” misses the whole point. What research has found is that happiness is not associated with people who have more. Happiness is associated with people who enjoy more. Those who display gratitude, and who remain positive and hopeful despite life circumstances, demonstrated the most overall happiness. Happy people are more resilient when life hands them hardships. They are able to remain calm, to regulate their emotions, and to have hope when things are tough.

Another surprise: Think you need more “me” time to be happy? Wrong! Happy people are more likely to be engaged in activities that help others. They also tend to be engaged in jobs, relationships, and outside interests that closely align with their personal values.

So I’d like to hear from you. Does this description of happiness match what you see in your own life? What are the qualities of the happiest people you know? Do they have the most or do they make the most of what they have? Comment here. For the protection of your confidentiality, you do not need to leave your real name. Even Initials or just a first name in the "Name" field of the comment form is sufficient.

Please add your comments below. Remember: In order to protect your privacy, please use a pseudonym instead of your real name.

COMMENTS:

1. tremelle campbell said on 2/26/15 - 02:31PM
I like this blog. But does'nt it take a lot of energy to be happy and want to be around people? I wonder sometimes if being unhappy and depressed is a disease of energy production. What came first, the depression/unhappiness or fatigue. in any case,having more 'me' time is not the answer.
2. Dr Latiolais said on 2/26/15 - 03:46PM
Agreed - One of the symptoms of depression is low energy. As such, depressed people rarely "feel like" doing many of the things that would make them feel better. As hard as it is, I encourage them to do it anyway. Don't wait to "feel like" going to the movies, exercising, visiting a friend, or volunteering. Get going and do it - undoubtedly you will feel better afterwards than if you sat around the house.
3. Not Tony said on 2/26/15 - 05:20PM
The following quote is usually attributed to Abraham Lincoln: “I have noticed that most people in this world are about as happy as they have made up their minds to be.” I think there is a lot of truth in this. In many ways, happiness is a decision. Also, the happy people that I know are happy 'from the inside.' It is clear that, while they usually have plenty of friends, they are very good friends with themselves, encourage themselves and enjoy their own company.
4. tremelle campbell said on 2/26/15 - 05:27PM
Yes. someone said that very thing to me recently. I was just doing some research on depression, and came across the different types. One disorder that really caught my attention, was melancholia. I saw some art work that dated back as far as the 1600's that was titled 'melancholia'. But the information wasn't clear as to this being a type of depression or a disorder in its self. Was just wondering which it was. One last question, and it may sound like a conspiracy type question. In your experience in the field of phycology, do think, to a degree, that people are convinced they are depressed by the medias in order to sell drugs? There was an experiment in a small country in Europe, where the controllers advertised pain meds for back pain. The conclusion was, people began to have more back pain than ever before. I didn't get this off the net, heard it on a talk show years ago. Thanks.
5. Dr Latiolais said on 2/27/15 - 11:08AM
Not Tony - I love that quote! Thanks! Tremelle - Yes, there is a disorder called Dysthymia or Dysthymic Disorder, that is a type of low-grade depression that lasts for years rather than months. In regards to your question about the pharmaceutical industry - Many advances in our field have enabled us to diagnose and treat problems that people used to just have to suffer with. However, there have certainly been "bandwagon" diagnoses through the years and "bandwagon" drugs, and a tendency on the part of pharma, health professionals, and consumers to overpathologize. However, I have been even more amazed by the public's tendency to be seduced by the idea that taking a pill will solve all. Medications can be quite helpful, but we also know that 70% of all mental and physical illness is due to personal habits and lifestyle.
6. JudiphJ said on 2/28/15 - 10:46AM
One point in this discussion really hits home with me. Happiness is what you let it be and I think the happiest people are the ones with a positive attitude and they are able to find pleasure in whatever they are doing. If you enjoy life, wouldn't it follow that enjoyment brings happiness? No drug is going to make you appreciate the little things that can make your day! You need to be open to ideas, gestures,and words from others, as well as yourself….words of encouragement!
7. JoM said on 2/28/15 - 05:16PM
Thank you for this one. When I remember gratitude, to be grateful for all I have, I feel happy! Like an old friend use to say: "Have a good day if you decide to."
8. D Bear said on 3/19/15 - 12:59PM
This particular blog subject speaks to me. Adjusting to a new life in a new place and leaving my home of 45 years was difficult. I have to add that I still haven't completely recovered from being homesick. For anyone else to whom this boy speaks, I recommend reading "Who Moved My Cheese. The following site provides a summary of the book. business-book-summary.blogspot.com

Is positive always best?

Tue, 28 Jul 2015 04:31:18 GMT

We all stereotype, and I get that. But, one sterotype about psychologist that I particularly dislike is the one that we tell everyone to "think positive."

Why does this bother me so much? After all, I am, at heart, an optimist! I do tend to see the good in people, the beneficial possibilities in a bad situation. But do I believe that if my clients just think positively they will feel better? No. Because positive is NOT always best!

Let me explain. I firmly believe in the tenets of cognitive therapy, and one of the most crucial tenets is that irrational ideas are typically the cause of our distressing feelings and behavior. In other words, it is not the breakup of a relationship, but rather irrational thoughts, like “I am unlovable,” that lead to loneliness, hopelessness, and depression.

However, does it makes sense to replace that irrational thought with the thought, “I’m awesome and anyone would be glad to date me"? As you can see, the “positive” thought is equally irrational!

Consider another example. Let’s say a woman believes “all men are pigs." It's easy to see the emotional and behavioral consequences she might suffer, all on the basis of that thought. She will likely be a bitter, angry person, may be anxious or angry around men, and her relationships with male coworkers, friends, or potential dates will suffer. She won’t notice the nice guy at work or the southern gentleman holding the door open for her. Or, if she notices them, she’ll believe they have a “hidden agenda." And that’s just the emotional and behavioral consequences for her. Just imagine the consequences for the men around her!

However, is it reasonable for her to believe “all men are great guys"? This positive, but irrational thought could leave her vulnerable and easily manipulated by a small, but dangerous, percentage of men.

How does this work in real life? Often I ask clients (most of whom are worriers) to replace their worst-case-scenario thoughts with the question, “What’s most likely?” It’s unlikely you are unlovable or the world’s most perfect date. It’s most likely that there’s some people who will be attracted to you and some people who won’t. Same for our male-basher example – All men are not “pigs” (actually, no man is a pig!), and there are lots of good guys in the world. But not every guy is a good guy. What’s most likely is that all people have positive and negative qualities and no group of people can logically be categorized one way.

So the next time you are having trouble thinking positively, just remember you only need to think “most likely." After all, it’s easier for your brain to believe and hang on to something that’s inherently true!

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