Changing Lives

Can Mindfulness Help My Anxiety?

2009-11-30T10:17:00.009-05:00

Being mindful is about being aware of what's happening around us and inside us in any given moment. We all have thoughts about the future, the past, perhaps 17,000 thoughts in any given day. But those of us who live with anxiety can get stuck in a particular thought. We end up looping around, fixating on a particular thought such as "What if my train crashes on my way to work?" or "Will I lose my job today?" We focus on this thought until our mind convinces us something serious WILL happen. This is called catastrophizing. It can become a habit.

Mindfulness is about noticing automatic behaviors, simply noting them, not judging or analyzing them, just learning to be aware of them. Mindfulness is about experiencing the anxiety and then moving past it. It is about befriending it although this may sound counterintuitive.

The biological pathways of anxiety are becoming increasingly understood by researchers. Therapists like myself are using this knowledge in developing treatment protocols. These are based on the patient's particular life circumstances and state of discomfort. From a mindfulness perspective, avoidance and maladaptive habits are what our brains have learned to do and programmed into our bodies. It's about the brain, not a personal defect. A mindfulness approach is about what is happening in the present moment so it is positive and accepting. It can include meditation but it does not require it. It is awareness OF, rather than thinking ABOUT.

Those thousands of thoughts are like clouds passing above us. They come and go. They are temporary like our feelings and sometimes our body sensations. But they do repeat because our experiences have conditioned our reactions. Our hippocampus near the base of the brain stores emotional memory so that scary or traumatic memories can trigger alarm even when we merely think about possible danger. The evolutionary process has also shaped our neuralphysiological reactions. But the quick action we needed on the savanna to escape a predator can easily lead to road rage or anger at ourselves or others if we're always on automatic pilot.

Mindfulness is about acceptance. It is about noticing and separating the facts of experience from the conclusions our mind makes afterwards. Jerry, one of my patients, experiences frequent paranoic thoughts. He noticed when they popped up, learned to talk back to them for a brief moment, and then took deep breaths letting the thoughts go off in a white cloud. He would get up, and observe what the person next to him was doing. A reality check. Usually they would be absorbed in the words on the screen, not looking at him at all. All of us have triggers which stir up our emotions. Jerry grew up in a household with very anxious parents who carefully observed his actions trying to keep him safe.

We do not always identify our triggers, or schemas. During the first few therapy sessions we examine and identify these schemas, enmeshed strands of intense emotions, body sensations, thoughts, and/or feelings usually formed in childhood. Three of the most common I see at work are negativity, being hypercritical, and "there's something wrong with me". Mindfulness can help us see them, feel them, and then LET THEM GO. Therapy is yes, about change, but we probably want to change our behaviors and reactions, not our basic natures. Understanding and deconstructing our schemas is a part of the process. Mindfulness may sound easy but it requires practice and noticing and learning to let go.

Practicing self-compassion is another form of mindfulness. The early research in this area show that practicing it can reduce the impact of a negative event. It can also help us regulate our emotions. Self-compassion also relates positively to life satisfaction and emotional intelligence. We can also learn and practice this in therapy sessions if appropriate.

For more information, consult Christopher Germer, The Mindful Path to Self-compassion.

What Can You Expect from Couples Counseling?

2009-11-01T16:15:00.004-05:00

When two individuals make a marriage or "live-together" commitment, they bring with it their individual expectations, values, past wounds, and life memories. Sometimes they have children and financial debts to add to the complex mix. Couples often have different communication and conflict resolutions styles. Love grows and flourishes in the initial romance period but it can die on the vine if not watered by attention and positive affection.

When angry talk, emotional coldness, and continual carping and negativity start to dominate the relationship, it's time to find a couples counselor.

Couples counseling is about getting in touch with past wounds, talking honestly about unmet expectations, discovering individual triggers for angry outburst and observing the intimacy dance that happens with all couples. It is also about revisiting the joys felt during the initial stages of falling in love.

Couples fall in love for a reason. But then life intervenes. All too often a small fault grows larger and sets the stage for frustration. Human beings are usually optimistic in thinking they can change the annoying habits in their partner. But change happens from within and cannot be forced.

I begin the work with an initial couples session where each person sets forth the issues which are causing the friction as each perceives it. We agree about some initial goals and set up individual sessions, either one or two, with each of the partners. The purpose is to learn about past history and experiences. What did each partner learn about love and conflict resolution growing up? About expectations? About gender roles? Sex?

Then we all meet again to discuss individual strengths, vulnerabilities, share ideas on communication style and learned habits. For example, do the individuals differ in terms of conflict resolution? Hang on to grudges? Avoid sexual intimacy? Have unmet expectations? Has there been an affair? If there are kids, how do the adults find their own time?

The last step is deciding whether to go ahead with therapy. I ask for a 8-12 session good faith effort! These can be every week or every other week. And yes, there's usually a takeaway activity to be tried. The time frame varies with each couple depending on how entrenched they are in behaviors, how aware they are of their triggers, how present and mindful they are about their actions. Change happens with small steps.

We know what habits and patterns make marriages work. These are readily available in popular self-help literature. But we can't understand the emotional underpinnings without bringing them into the light. We can live on the surface on automatic drive. Gaining awareness of unconscious emotional underpinnings is crucial to a happy tension-free relationship.

In a recent case, Monica and Harry (names changed) were able to forge a successful, loving relationship once each of them came to see how their individual relationships with an emotionally abusive father (Harry) and a cold, standoffish mother (Monica) were still at play in their couples relationship.

Successfully and joyfully living with another person can't happen when individuals live on automatic pilot.

For more information, see The Mindful Couple: How Acceptance and Mindfulness Can Lead You to the Love You Want, by Robyn Walser and Darrah Westrup.

Acceptance Commitment Therapy (ACT): An Effective Approach

2008-08-31T15:00:00.011-04:00

When a new client comes to my office, her/his first question is: "What type of therapy do you do?" followed by a second: "How long will it take?" Answering the second is easier.It depends on previous experiences in therapy, changes wanted, defense mechanisms at play, and how removed someone is from feelings and sensations. The answer to the first varies with the client just as my therapeutic response differs for each client.I work collaboratively with each person to develop personal goals and an effective way of working together. I do not have — and never expect to have — a one-style-fits-all approach.

Over the past year I have seen the efficacy of combining cognitive behavioral therapy (CBT) with acceptance, commitment, take-action therapy, called ACT. Because ACT, sometimes called the third wave of CBT, is not as well known, here is a brief explication of the approach that I find increasingly effective.

We are all shaped by our past experiences.Some of us have mothers or fathers who left us at an early age. Others may have been taunted, verbally or physically mistreated, or grown up in a divisive household affected by alcoholism, mental illness, or anger avoidance. Or we may feel we grew up unscathed by anything unusual. But we all have memories stored in portions of the brain. These can be automatically triggered which activates our "flight or fight" response releasing cortisol causing us to feel continually "stressed out", depressed, and/or anxious. Current research into the workings of the brain has shown how these automatic thoughts can cause physical illness and also cellular changes in the brain. Struggling to rid ourselves of the memories or voices usually makes the battle worse and maintains the stress.

Here is where acceptance comes in. By accepting these as part of us but not reacting to them, we can diffuse our triggers and deactivate the autonomic responses. We can allow them to come and go, but ignore them. You can learn to drive your metaphorical bus ahead allowing annoying passengers to go along for the ride. You can choose or COMMIT yourself to proceeding in your direction not theirs. It sounds simple and it can be depending on how much you can learn to be mindful of where you are in any given moment. Is your mind causing an automatic response to a situation? Is your mind creating the reality or is your experience creating it? Can you become an observer of your thoughts without getting entangled in them?

The Acceptance part of ACT helps you reframe your current situation. What will you believe: your mind or your experience? It is very present oriented and mindfulness based. Awareness of your senses is critical and some of us gallop through life paying little attention to what we truly see and experience in the moment. We fuse what our mind tells us with our feelings for and about ourselves. The voice in your mind, which may sound like your father's, tells you "you're incompetent", but your experience, if you really observed it and were mindful of it, will tell you that your work colleagues see you as completely competent.

I see my role as helping clients deconstruct past patterns, gain insight into triggers, learn to stay in the present, commit to acting on their values, and most importantly to become an observer of themselves and their thoughts.

For most of us, our current mainstream culture traps us into taking our own thoughts literally even though they are not based in our actual experience. We may suffer deeply and feel abandoned when an adult relationship falters or feel as though we are miserable failures at what we do professionally. So we THINK the answer is to keep searching for someone new or for that perfect job. But our mind keeps "looping around" telling us "you can't do it". But what does our actual experience tell us? Doesn't the answer lie within each of us as we continue our journey into feeling whole and alive? Going to therapy can help you gain insight into your past experiences and give you hope that you can live in the present moment without framing everything through the filters of your past.

For a deeper understanding of ACT, consult The Worry Trap: How to Free Yourself from Worry and Anxiety Using ACT. New Harbinger, 2007. Get this book on Amazon. See also www.contextualpsychology.org/treatment. Steven Hayes, PdD, University of Nevada, the originator of ACT, posts research studies and maintains the site.

See also Emotional Alchemy: How the Mind Can Heal the Heart, Random House (2002) for information on common emotional/thought patterns or schemas. Get this book from Amazon.com

How to Know When You or Your Child Needs a Therapist

2007-02-07T10:17:00.001-05:00

How do you know when you or your child needs a therapist?

For children, the key is when they are out of synch with their developmental stage. "No, I won't!" tantrums may be developmentally appropriate for a child of 2 or 3 but not for a 5 or 6 year old. Usually by age 4 or 5, a child is able to tell a parent what she/he wants and to accept that wants are not always instantly satisfied. They are able to separate from parents or caregivers without undue crying or clinging. Developmentally by this age, children are secure in the fact that their parents return at the end of the day. So if your child cannot separate without experiencing an emotional meltdown, you might want to schedule some family and/or parenting sessions to talk about or play out the feelings and situations. It's important for your child not to feel there's something wrong with him/her (or in fact with a parent). Unless there's a serious mental illness in play, you can explain it as a "communication issue" or "there's too much anger and/or tension when our family interacts with each other." Or "You don't seem to believe me when I tell you every day that I'm coming back." A possible way to approach scheduling a visit is by saying, "Let's talk to someone who knows more about kids' fears than I do."

Other signs for children are lack of interaction with peers such as a child who never wants to go on play dates or go to birthday parties. School behaviors can be a sign that some early intervention is needed. Some children are overly anxious, hyper-vigilant, or convinced they can't succeed. At school, they may continually say "I can't do this" or bang or slap their heads in frustration. All of these can be raised and talked about and/or played out with puppets or small figures in a child-oriented therapist.

Parenting books, attending parenting classes, and reading your child books about feelings and how others handle different situations can help. But an experienced, child-oriented therapist can help enlarge a child's feelings vocabulary, practice problem-solving skills, or help uncover fears or feelings of not being heard. Family sessions and individual play therapy sessions can help a child gain confidence in meeting a new friend for the first time. Role play is just one possible way to work on the issue of shyness or anxiety in social situations.

Early intervention is a better approach than waiting until a problem has become embedded in a child's mind, damaged her/her all-important self-esteem, and turned into childhood depression. A child who is always unfocused and/or loses track of tasks, is not able to track words in learning to read, is never able to settle down and/or comfort himself/herself, and begins to have educational problems in school should be assessed for a possible learning disability or Attention Deficit Disorder. A child does not have to be hyper to have ADD.

Signs for adults which suggest a need for therapy might include panic attacks, anger and irritability, rapid mood swings which interfere with job performance and forming or maintaining emotional connections with others. Eating disorders and alcohol or drug abuse are often used to mask underlying feelings of inadequacy and unresolved emotional wounds from the past. Sometimes adults want help in changing unhealthy patterns of behavior, moderating anger when reacting to a teenager's behavior, or feeling "turned off" to a partner. Self-help books abound in every bookstore and library but these are not always interactive enough to promote deep change. Or you have consulted all you can find in your local library and you feel things still are not right with yourself and/or your family. In this case, therapy is an appropriate course of action.

After determining that a therapist is needed, finding one is the next step. Consult your local Mental Health Association, Psychology Today, and/or your insurance company's web site. All of these have lists and/or individual profiles which allow you to find out something about the background, methodology, and location of the individual therapist. If the match of styles and available times do not seem right for you, go back to your list and keep trying. The schedules of good therapists fill up quickly. If time does not work, ask them for a referral. Your primary care physician might also be able to give you a referral. Seeing a professional does not have to mean a long, drawn-out series of counseling sessions. If you decide what you want to change before consulting a therapist, work can proceed in a more focused manner. Adults and/or families can often get relief after just a few sessions. If there is a serious mental health issue such as depression, PTSD, or the possibility of a learning disability such as Attention Deficit Disorder, successful treatment can take longer. Everyone has different needs and experiences which have shaped their current attitudes and behaviors.

The Sand Tray

2006-06-08T22:07:00.002-04:00

Working in sand is not just for kids. True, children of all ages like arranging small figures in the sand. But so do adults.

For children, playing is what they do. Expressing feelings is not easy for them. They do not have the verbal expertise and developmental sophistication to participate in the more traditional "talk" therapy. Sometimes they do not even know the words. But by working in the sand tray, children are using figures to tell their stories. "Playing out" their experiences and feelings is natural. It is also a self-healing process for them. Sand tray allows the therapist to enter the child's world, instead of asking the child to "come up" to where the adult stands.

Adults can also use the sand tray to make their own miniature worlds. In life and therapy, adults can get stuck on a painful issue. Using sand tray figures can free them from their self-consciousness or anxieties. It is an emotionally safe place to uncover conflicts or resolve serious issues without the restrain of self-censorship.

One client was struggling to find her inner voice and stand up to the abusive men in her life. Without thinking about what she was doing, she chose a small child as the focal point of her world. Other figures represented playmates and her mother. She had a shadowy figure in the corner. She spent time rearranging the figures and burying the shadowy one, in her case her abusive father. At the end of the process, she came to a deeper understanding of her inner feelings which she had often found hard to express to anyone, including herself.

Children use sand tray work to play out their interpersonal conflicts, either to move the figures themselves or to direct the therapist to move the characters. They can feel safe because the figures can act out, express the pain for them. This is especially useful for children who have been traumatized.

A seven-year-old girl, adopted at birth, was having trouble separating from home to go to school. This was upsetting the whole household because she felt sick often and thus "forced" either one parent or the other to stay home from work. In the sand tray, she created villages engulfed by tidal waves. She recreated these over and over. The child had never been near a tidal wave nor been swimming in an ocean. It was a way of working out her unspoken anxiety of being left or perhaps not finding her parents again. After several sessions of continued disasters, the little girl and her miniature friends built a huge wall which successfully kept out the tidal waves. Along with therapy, the parents were urged to read stories about adoptive families. They told "What if" stories about a mythical, mischievous girl who wondered if being naughty would cause her parents to send her back to her birth country. After more sand trays, the little girl made peaceful villages and the going-to-school tears and stomach aches ended. Sand tray work helped the girl resolve her fears about being left. They were too scary to express openly or tell her parents.

Self-expression and self-exploration are crucial to successful therapeutic outcomes. Sand tray enhances this process. For children, the figures speak for them.

Hypnosis and Change

2006-05-11T11:24:00.001-04:00

Hypnosis does not involve a swinging watch. That's for stage magicians, not therapists. Instead, therapeutic hypnosis is the practice of letting go, of relaxing deep into yourself, of accessing old feelings that have been walled away. It is being used increasingly to help relieve anxiety and depression. It's about reclaiming inner, buried resources.

For example, with hypnosis, Jennifer (not her real name) was able to visualize her graduation from college and get in touch with her feelings of pride and accomplishment. She remembered the beaming faces of her parents as they congratulated the first in their family to earn a college degree. She had forgotten these feelings and was fixated on her self-doubt. Now, with hypnosis, she could call up these feeling when she got mired down worrying about the criticism she received at work. This was the major goal of our work together; easing her anxiety and giving her tools for the future. She learned and practiced therapeutic hypnosis in our work together. She was then able to "go inside" on her own, whenever her anxiety was starting to grow.

Tom was overwhelmed by financial woes and concerns about his physical health. He thought he could never plow through his depression. But after working for several weeks in therapy on self-esteem, he was able to break down his cloud of self-doubt into smaller and more manageable pieces. Guided imagery and therapeutic hypnosis proved valuable for him as well. Under hypnosis, he first saw his financial worries as a huge bear eager to pounce on him. By suspending his conscious worry of "I'll never make it" and going deep into his memory bank, he recalled his feeling of power, of "being at the top of my game" when he first became a teacher. He saw that he was good at it. He helped his students break up work into separate pieces. He could do that for himself. Gradually, he was able to call up his old feelings of strength and turn the huge bear into a small, friendly one. His transformation took time, but less time with hypnosis than with regular talk therapy.

All of us have pass experiences which our conscious mind has closed down. Although some are painful, others are examples of feeling super competent or successful. Our conscious mind, when mired in a depressed or anxious state of mind, may shut down the times we felt competent. Guided hypnosis can unlock these experiences. They can be anchored in your mind so that you can call on them in current situations. Hypnosis can also break harmful habits such as smoking and/or alcohol abuse.

Hovering Helicopter Parents Don't Make Resilient Kids

2005-10-10T16:50:00.002-04:00

Are you one of those parents who "hovers" over your child every time they complain or present a problem? When they come home from school, do you want to jump in and fix their problems? Call up a kid's parents who was mean to them? Or call up the teacher who "lost" your child's homework and made them do it again?

Children need to learn how to solve problems. Solving problems helps them feel competent and learn self-efficacy—one of the basic personal skills needed to be successful in life. Suppose your child comes home from school and says: "Mom/Dad, my teacher hates me." Your first response should be to say, "I hear you're really angry." Don't be afraid to use a feeling word. This shows that you empathize with them. Then ask them "What was it like in the classroom? What were the other kids doing when you felt that? What were you doing when you felt she disliked you?" Get your child to think about what happened. Then ask them: "What do you think will happen tomorrow? Will you act differently?" Provide them the opportunity to come up with the solution. If you immediately call the teacher—or the principal—your child will probably feel that he/she is disempowered. It will encourage them to come running whenever things go wrong. There will always be events in a child's life when they truly need help in a situation. But if you jump in as a "hovering solution-provider", you're doing your child a disservice.