Sunday, September 18, 2011

Anxiety or Imposter?

We all experience some degree of anxiety in our lifetime. It can range from mild and time-limited, such as nervousness before a test, to debilitating and pervasive, such as struggling daily to leave home. Anxiety is one of the top reasons people seek therapy. Fortunately, therapists have made great strides in the past two decades in our knowledge of how anxiety affects the brain and the body, and how to treat it effectively.

I have worked with clients who came to therapy with different experiences of anxiety: panic attacks, being scared to be alone, being afraid of bridges, and living in fear of throwing up in public. Other clients suffer horribly from frequently being in a general state of high anxiety. 

Anxiety can make us miserable

What is heartening is that with a combination of relaxation techniques, cognitive strategies, and exposure therapy, most of my clients got better within a few months. Sometimes, however, these strategies have not helped clients. Several times the client and I have identified that their anxiety was actually a decoy.

This may sound strange, but anxiety is actually easier for some of us to experience than our emotions. Most of the time, when treatments for anxiety are ineffective, it becomes apparent that clients are struggling deeply with grief, a painful decision, or depression. Once the client and I agree that there is more going on than anxiety, we can get to work on strategies to help them face the underlying issues. It requires work, but clients report a decrease in anxiety within a few weeks of beginning to recognize and experience their emotions. 

If you suffer from anxiety and have struggled to feel better,  try to identify if you have been avoiding a difficult emotion or decision. If you think this is a possibility, spend 15 minutes at a set time every day for a week allowing yourself to "feel" that emotion or discomfort. Hopefully you will begin to feel better. If not, you may benefit from a few visits with a therapist or counselor. Don't let anxiety, real or imposter, keep you from enjoying life.

Please let me know if you suffer from anxiety, and what techniques help you feel better by commenting on this blog post.

Be well-

Saturday, May 7, 2011

Superwoman Syndrome

All too often women, especially mothers, use the three dirtiest words in the English language: "should, could, and would".  This type of thinking is an energy-draining, unproductive trap that is important to avoid.

You are likely carrying a very heavy load of responsibilities, which makes it impossible to do anything perfectly. In addition to taking care of yourself, chances are good that you are also caring for several others: a partner, children, an aging parent, a pet, your home, and a business. There is not enough time in the week to perform all of these roles well. It is easy to slide into a negative thought process and focus on what you “should” have done differently- beating yourself up rather than acknowledging the many things you are doing well.

This type of thinking is common in perfectionists. It contributes to exhaustion, high stress levels, and low self-esteem, which can in turn contribute to depression and anxiety.  It is really important to observe your tendency to be self-critical, and work to change your negative thought processes.

Change your thought patterns and behavior for the better:
   Repeat until you believe: "The best thing I can do for everyone is take care of myself." in addition to getting enough sleep, eating well, and exercise, schedule doctor and dentist appointments for yourself religiously.
   Prioritize and be realistic. Studies show we usually under-estimate how long everyday tasks will take. Block out time on your calendar for everything from grocery shopping to running errands to exercise. With practice, this technique may help you break the cycle of always feeling behind and/or running late.
   Think about or write down what you HAVE accomplished.
   Ask for help. It may be painful at first, but you will be doing everyone a favor if children and your  partner become more self-sufficient and you become less stressed.
   Evaluate and adjust relationships. Which friendships are truly genuine and reciprocal? Which ones feel like obligations and are draining?
   Are you being penny-wise and pound-foolish? Unless you really enjoy pulling weeds, your time investment in your job or business will likely eventually reap more money than the going rate for yard work will cost you.
   Review decisions. Some decisions are wonderful in theory but do not stand the test of time. Volunteer commitments, children's activities, certain social obligations, and household rules can and should be re-evaluated and adjusted frequently.

Women are twice as likely to become depressed as men, and are particularly vulnerable after giving birth and during the years around menopause. If you notice your are engaging in an unhealthy habit such as over or under-eating, drinking to excess, abuse of prescription or street drugs, isolating yourself from others, or engaging in an inappropriate relationship, seek help.

You deserve to enjoy some peace of mind and free time long before retirement or your children are grown. It is time to put the Superwoman myth to rest.

Be well,

Sunday, March 13, 2011

Making Sense of a Mental-Health Diagnosis

Receiving a diagnosis from a mental health provider can be confusing and overwhelming. Recently, several clients and I have had conversations about their diagnoses.
The first thing I did was help each client put his diagnosis into perspective. Most of the time, clients are mentally healthy human beings who have been worn down by an accumulation of bad circumstances and/or bad habits. Usually a diagnosis does not mean you are mentally ill or crazy.

Diagnoses are required by insurance companies in the U.S. for clients to receive some reimbursement for the cost of treatment. Many of us in the mental health field believe diagnoses are at best somewhat helpful, and at worst severely limiting labels used to placate insurance companies.  The criteria used in our profession’s guide, the Diagnostic and Statistical Manual of Mental Disorders (DSM), are imperfect and often over-lap, and therefore should be used with caution. However, a diagnosis can help direct you and your therapist to a style of therapy that has been proven to treat your symptoms.

It is the therapist’s job to explain a diagnosis in a manner that you can understand, and to work with you to create a treatment plan that you are comfortable with. For example, Interpersonal Therapy and Narrative (Writing) Therapy have both been shown to help with symptoms of Post Traumatic Stress. Clients who are shy and enjoy writing are likely to choose Narrative Therapy, and will likely respond better to this treatment.

What to do when you receive a diagnosis

             Ask your therapist good questions
*Why did they assign this particular diagnosis to you?
* What are the best types of therapy to help with your symptoms?
   Are there studies that back this up?
            * How long does the therapist estimate treatment will take?
            * Are there other treatments for your diagnosis besides therapy?

Hearing the diagnosis  “Adjustment Disorder”, “ADHD”, or  “PTSD” is disconcerting. However, an open dialogue with a good therapist can turn an uncomfortable moment into an opportunity. Be assertive, ask questions, and partner with your clinician in your treatment.  Good luck. It is hard work, but feeling better is well worth the effort.

Tuesday, February 1, 2011

You Can Break Bad Habits

The stress created by the shaky economy, bad weather, and political unrest worldwide are causing many of us to either increase, or go back to, bad habits. We all have bad habits. I often find clients really beat themselves up over them. Don’t! It is not helpful. A kinder and more effective strategy for getting rid of a bad habit is to actively replace it with a new, helpful habit.
      1. Identify a positive habit and behavior you would like to adopt. (for example, drinking more water)
      2. Recognize the sensory impulse(s) you experience in your body or other stimuli that occur just before you usually act on the negative habit. (You are having a drink with friends and crave a cigarette.)
      3. Instead of acting on the negative impulse (lighting up), use your conscious attention to re-focus your thoughts and behaviors on the new and positive habit you identified in Step 1. (Ask for a glass of water with a slice of lemon.)
      4. Substitute the new behavior that is congruent with the positive habit you want to form for the behaviors of the negative habit. (Slowly sip the water.)
5. Continue Steps 4 and 5 for at least 9 weeks. You will be using the triggers from your old habit to begin the new habit.

Drinking water is a good substitute behavior
       How long will it be painful to change from the new habit to the old one? About 9 weeks. What is important is that you stick to your new routine every day for the first couple of weeks. Use willpower to repeat the behavior so that the new, positive habit will get ingrained. Sooner than you think, you will no longer need to think about doing the behavior. It will become automatic. 
The bad news: you will slip up. No change of behavior progresses steadily. Usually it is an experience of two steps forward, one step back. The good news: If you are kind to yourself and don't give up, you can make your desired change. 
Good luck!
Be well,
Excerpted from an article in Positive Psychology News Daily, by Emily van Sonnenberg
 The 12 Bad Habits That Hold Good People Back: Overcoming the Behavior Patterns That Keep You From Getting Ahead

Thursday, January 27, 2011

Surviving Snow-Fatigue, or Snow Derangement Syndrome

With the huge amounts of snow, cold and grey skies we have had this Winter, many of us are feeling desperate for warmth and sunshine. Unless you have the good fortune to be able to flee to a tropical hideaway, it's a good idea to shake up your routine. 
  • Humor is healing. Seek out a funny friend or a favorite comedy.
  • If you have children, remember that you are not responsible for entertaining them. Challenge them to come up with new games and to entertain themselves. A great book full of old school, inexpensive activities is "The Orange Mama Laid", by Kirsten Denny. (Available on Amazon)
  • Get outside on sunny days. Even better, leave your sunscreen off for 15 minutes to maximize absorption of Vitamin D.
  • If you exercise, try a new sport or class to create some novelty for your body and brain.
  • Plan your real or imagined spring garden. Consider starting seedlings indoors in March. Visualizing a bountiful garden and planning for fresh food will lift your spirits.
  • Do a good deed. Even small acts like offering a smile to a cranky neighbor or letting someone into traffic have been scientifically proven to reduce stress and create a feeling of well-being.
  • Check your caffeine intake. We often unconsciously increase our caffeine consumption during the Winter to keep the cold at bay. If this is the case for you, gradually bring it back down to no more than two to three cups a day. More than that can cause irritability and interfere with sleep.
  • More hours indoors can lead to more hot Toddys and wine by the fire. If you are prone to the blues, limit your alcohol intake as much as possible- it's a depressant, and it interferes with sleep. 
  • Low folic acid levels are associated with depression. A good source of folic acid is found in leafy green veggies. If they aren't your top food choice, chop them and add them to soups and stews for the last five to ten minutes of cooking. This works well with swiss chard and spinach.
  • Even my snow-loving Golden Retriever, Ginger, is struggling this Winter!
  • You've heard it before, but I would be remiss if I did not mention Omega 3 fatty acids, which play a crucial role in overall health. However, Omega 3's are found in greater concentrations in the brain than in other parts of the body, and have been shown to alleviate depression. Omega-3s can be found in fatty fish like wild salmon, sardines, Atlantic mackerel, and in lower quantities in ground flaxseeds, walnuts and omega-3 fortified eggs. Ground flaxseeds can be substituted for small portions of flour or pancake mix without sacrificing taste. Kirkland Signature Natural Fish Oil Concentrate with Omega-3 Fatty Acids - 400 Softgels
Making all these changes would be daunting. Try choosing a few that appeal to you, and monitor your mood, health and overall level of functioning for the next few weeks. Hopefully you will see some positive results. If your low mood persists, you may be suffering from Seasonal Affective Disorder (SAD) or depression, and should consider getting a professional opinion from a licensed therapist. 

Saturday, January 22, 2011

Medicine, Therapy, or Both?

Twice yesterday clients asked good questions about medication, therapy, and how they relate to each other.

A new client, "Mr. X"*,  was prescribed an anti-depressant by his doctor for ongoing depression due to his wife's death several years ago.  He asked my opinion about anti-depressants. He was reluctant to take an anti-depressant, feeling that he should be able to "get over it" on his own.  Like many wise individuals, my client is concerned about his health, and does not want to ingest anything that could harm him. Although like all medications, anti-depressants can cause side-effects, for most people the benefits far outweigh the side effects. Furthermore, we live in an era when there are a number of effective medications for depression, and if the first medication you try leaves you with undesirable side effects, there is a good chance that the next one your doctor prescribes will not.

What I have observed is that for some clients, anti-depressants are a temporary bridge between depression and a return to being "yourself".  Many people who are depressed are bothered by cloudy thinking and/or circular, repetitive thoughts. In such a state, clients are not always able to use therapy to it's full potential. However, anti-depressants help many people return to their normal, logical thought process. When clients can think clearly, they are able to use techniques that they learn in therapy and apply them to their outside life. Once a client feels that they are functioning and feeling better, it is often possible to gradually discontinue anti-depressants. Contrary to what some believe, anti-depressants are not addictive, but discontinuation absolutely needs to be monitored by a qualified physician.
"Bridge the Gap" between medicine and therapy

At this point you may be wondering if I am in the back pocket of a pharmaceutical firm. Absolutely not. I cannot prescribe medication. In fact, I always work with a client on natural stress reducing and mood boosting techniques before making a referral for a medication evaluation.  However, in some situations, the ongoing stress of a death, job loss, or family problems can wear people down to the point where their brain chemistry needs stronger support- ie-medication.

Many well-done independent studies have been done to research what the best treatment is for depression. The results are consistent: many people get better from therapy, many people get better from anti-depressants, but the most effective, quickest way to feel better is through a COMBINATION of medication and therapy. 

Regardless of what "Mr. X" decides regarding medication, I look forward to working with him to help him find his unique path to healing.

Be well,

 *Details changed to protect client's anonymity.

Sunday, January 2, 2011

Work-Life Balance

Happy New Year! Months ago I was interviewed for an article on Work-Life Balance. Published recently, it may help you start the New Year in a more relaxed way.

An excerpt:
How to create happy memories
• Take three. A three-pronged approach to relaxation can vastly improve your quality of life. Daily, weekly, and seasonal "vacations" should be incorporated into your schedule. Give yourself permission not to do laundry, pay bills, work, chauffeur children, or do any activity that feels like a chore.
• Pared-back Parenting. That's already been discussed, though some parents might feel guilty if their focus isn't "all children, all the time." But that's the wrong attitude. psychotherapist Laura Van Riper says. Still not sure about the value of paring back? Studies have shown that children who were over-scheduled when growing up had poorer decision-making and coping skills when first faced with free time in college or when living independently.
• Simplify. Henry David Thoreau advocated the simple life, and modern therapists agree. "One of the best ways to simplify is to make a list of the five aspects of life you most value, written in descending order. Then you can gradually go about adding enjoyable activities that support your values, and paring back on commitments that do not support them," says Van Riper. "If it's not your passion, too, meet your commitment and then gracefully make your exit. This may free up one night a week or a month to spend with your partner, a friend, or a good book."
• Unplug. If you are one of the many who has trouble disconnecting from technology, force yourself to disconnect for a set time frame every night. You will be better rested, and probably feel more creative and effective in the morning.
• Face the music. One of the least discussed but most important ways to free up precious energy is to take care of lingering interpersonal conflicts as soon as possible. Many people, especially women, ruminate over relationship problems, and get paralyzed trying to sort them out. Try addressing disagreements and uncomfortable situations as soon as possible. It takes some practice to find the right balance of directness, diplomacy and compromise, but will be well worth it. You'll be surprised by how well this style of problem solving can free up energy.
-- Adapted from a list by Laura Van Riper, MSW