TALKING TO YOURSELF?

One of the most destructive habits I help clients reduce is what we shrinks call "negative self-talk". Negative self-talk causes stress and self-defeating behaviors. Our thoughts are very powerful. Over time, if we repeatedly tell ourselves we are a failure, or an idiot, or unlovable, we actually change our brain chemistry! Therefore, negative self-talk can affect how we see ourselves and the world, and can ruin our moods and harm our health.

Here are some examples:
"Other people can do this. What's my problem?"
"I can't believe this is happening to me."
"I am such an idiot"
"I'm useless."
"I'm a failure".

Sound familiar?  Very often the quality of our self-talk has been influenced by our family, friends, teachers, bosses and the media. Start to notice when you bully yourself with negative self-talk. 

Here are some ways to stop the self-sabotage: 

1. Notice when you insult yourself.
(Look for phrases such as such as "I don't", "I can't", or "I'll never".)
2. Visualize a stoplight, and gently and silently tell yourself "stop".
3. Replace the insult with a realistic or positive comment.

Example: Negative self-talk- "I will never get a good job." 

REPLACE this with a more REALISTIC or POSITIVE comment:
"Right now I am frustrated with my job situation, AND I am taking several steps to improve my prospects."

Changing your inner dialogue will probably feel awkward; even positive change feels uncomfortable at the beginning. Keep working at it, you deserve the better moods and good health that result from reducing negative self-talk.

Please let me know how you do!

Healing Through Advocacy

If you are feeling overwhelmed by feelings of anger, pain, confusion and despair due to the tragic events at Sandy Hook Elementary School, you are in good company. This week most of the people I encountered in my personal life and in my private practice were feeling highly stressed, sad and helpless. As a psychotherapist from Newtown, CT, I am trying to stay strong by working through my own grief so that I can support others through this profoundly painful time.

Healing from trauma takes time, and varies tremendously from person to person.  Factors such as an individual's genetics; thinking style; home, school, community and work environments; and past traumas all shape the healing process.  Cultural traditions and beliefs, and spiritual or religious faith also play a role in the recovery process.

One wonderful way to counteract despair and speed healing is to foster positive change. Many of you have already helped in ways such as donating to funds for the victims' families and signing a national sympathy card. Another way you can take action is to speak out against assault weapons and high-capacity ammunition magazines.

Instructions are detailed below, courtesy of  Josh Sugarman, Executive Director of the Violence Policy Center.  Josh is a fellow graduate of the Newtown High School class of 1978, and I am proud to call him my friend.

"To my Newtown Friends:
As some of you may know, I've spent most of my professional life working to stop gun violence as founder and executive director of the Violence Policy Center in Washington, DC.

And while I know all too well that gun violence can happen anywhere, that such a horrific event occurred in Newtown is almost beyond comprehension. To see young lives destroyed and the anguish of friends and family is beyond heartbreaking. 

Over the past few days, I've talked to fellow classmates and friends from Newtown and the common question has been, what can we do? Right now, one of the immediate actions you can take is to contact the White House, your Member of Congress, and your U.S. Senators and let them know that you're from Newtown and that you demand action. This may not sound like much, and it's only the first step, but it will make a real difference. I've included contact information below. 
--White House Comments: 202-456-1111

President Obama has said that he will support an assault weapons ban. Call and thank him and urge him to follow through on his promise. 
--U.S. Capitol Switchboard at 202-224-3121 

Call the U.S. Capitol switchboard and ask to speak with your Member of Congress and U.S. Senators. Tell them you support a ban on assault weapons and high-capacity ammunition magazines. 

Please follow the Violence Policy Center, on the web, Facebook, and Twitter, and share this information with everyone you know."

I will be writing more soon on healing from trauma. In the meantime, remember that a little extra patience and small acts of kindness will ease your suffering and that of those around you.

Thinking of you,
Laura

Let the Sunshine In

As a clinical social worker, I have observed firsthand the effects that vitamin D levels can have on mood.  The shorter days of Winter are tough on many people. Vitamin D- which our bodies make when exposed to the sun, is crucial for making hundreds of enzymes and protein and interacting with more than 2,000 genes vital for health and fighting disease- is in limited supply.  Vitamin D deficiency has been linked to chronic modern diseases such as heart disease, diabetes, cancer, osteoporosis, and depression. 

Several studies suggests that Vitamin D deficiency and depression are linked, and that increasing Vitamin D levels can help. We do not know whether low levels of vitamin D cause depression, worsen it, or are a symptom of the underlying depression. One study included  adult women with depression, all of whom were taking antidepressants. The women were also being treated for Type 2 Diabetes or an underactive thyroid gland. All were deficient in vitamin D, with levels under 21 ng/mL. Levels below 21 ng/mL are considered vitamin D deficient.  The women received vitamin D therapy for eight to 12 weeks. After treatment, their levels increased to 32 to 38 ng/mL. The women also reported improvements in symptoms of depression following vitamin D therapy. One woman's depression score changed from indicating a major depression to mild depression.  

I believe that many doctors and mental health professionals have had similar experiences with patients. I have had three clients who presented with major depression, tested below 10ng/ml in vitamin D, and after 10 weeks of receiving vitamin D supplements and weekly therapy, experienced a remission in their depression. Of course we can't measure how much improvement was caused by the increase in Vitamin D, and how much was caused by therapy.  My stance regarding treatment is to  use every helpful, healthy tool available to combat depression.

In addition to the clients who have suffered from major depression and had their Vitamin D levels tested, I have had many clients who have described and exhibited increased symptoms of depression in the late Fall and Winter. Seasonal Affective Disorder (SAD) is real, can be debilitating, and is prevalent when vitamin D stores are low.  In one study, eight subjects with SAD received 100,000 I.U. of vitamin D daily and all experienced a significant lessening of their depression as measured by the Hamilton Depression Inventory. Vitamin D blood levels improved by 74% in all eight subjects.  Vitamin D may be an important treatment for SAD. More, larger studies will be necessary to confirm these findings.

Vitamin D is called the sunshine vitamin because our bodies produce it when exposed to sunlight. Sunlight is an excellent source of vitamin D.  A person sitting outside in a bathing suit in New York City gets more vitamin D in 20 minutes than from drinking 200 glasses of milk.  Many experts suggest getting 10 to 15 minutes of sunshine sans sunscreen three times weekly.  Talk to your doctor about the pros and cons of sun exposure for you. 

Vitamin D is also added to milk and other foods, and is available in small amounts in fatty fish like tuna, salmon, and mackerel; beef liver, cheese, and egg yolks. It can be hard to get as much as we need from our diets, which is why supplements are often needed. Many, but not all, doctors include Vitamin D levels in their standard battery of blood tests when patients come in for a physical. Make sure you check with your doc if you are depressed, and request a blood test for Vitamin D levels. Your health depends on it.

Teens, Therapy and Privacy

Nervous about coming to therapy? 


Of course you are! That is a healthy and very common reaction. Why? You feel alone and vulnerable, and to top it off you are going to talk to a complete stranger about your personal life! You are entrusting the therapist with information that you may not have shared with your closest family members or friends.

Never fear;  therapists have a code of ethics which states that we must keep your private information to ourselves. There are only a few situations in which a therapist is obligated, by law, to break confidentiality:

1. You present a danger to self or others. If the therapist thinks you might hurt yourself or someone else, they need to tell your parent(s) and possibly others.

2. You are the victim of emotional, sexual or physical abuse or neglect.
In this case, the therapist may need to report the information you share to people who work to protect children. However, most therapists will tell you that they feel they need to do this to keep you safe before they make a call or file a report. In Connecticut, I  need to file a report with a state agency called the Department of Children and Families, and a social worker would then look into the situation, gather information, and make every effort to make sure you are protected from future abuse.

In the vast majority of experiences with clients, there is no need to break confidentiality. However, if it is essential to break confidentiality, I discuss my reasoning and next steps with clients before I do so.

Most of the time teens are understandably worried about less serious issues getting back to their parents- like relationship or school problems-  that they are not comfortable sharing with them.  Here's the good news: in many cases therapists do a great job of working with teens to help them decide if, when, and how to share sensitive information with parents. Two aspects of my work I find very rewarding are helping teens learn more helpful ways of thinking about problems, and teaching new approaches to talking to parents.

If you are working with a therapist or school counselor, you should and can check with them about confidentiality. Let them know what information you are not comfortable sharing with teachers, parents, or others.

If you have any questions or concerns about therapy and confidentiality, please ask, and I will be happy to answer them for you.

Be well,
Laura

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-

Laura

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,

Laura

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.