Category Archives: anxiety

What are they thinking?

What are they thinking, we wonder. It’s a question we toss about in conversation. It frequently comes up with someone is doing something that seems self-destructive, or bizarre, or just unexpected.  For psychotherapists, like myself, a lot of people seem to believe we have a secret insight into what some particular person is thinking. Of course, I don’t. I have theories, sometimes, based on study and thirty-plus years of experience in mental health and sixty-plus years of experience being human, most of that as a voracious reader. But even with all that, I am often stymied and stumped as to what someone is thinking.

I recently dropped off art for a show and met another artist. We were introduced, we shook hands. He is a tall man with big, baseball mitt-sized hands. At least, compared to mine. And my small hands are twisted up and deformed with arthritis, with many joints completely failed, such that my ability to hold a brush or a pastel stick is pretty much a miracle. What was this man, a visual artist whose attention to detail is apparent in his work, thinking when he squeezed my hand as if I were a big man with whom he was about to enter an arm-wrestling contest? I don’t know, but what comes to mind is unkind. So, I try to assure myself it was a moment of oblivion.

We have many people in our neighborhood who walk their dogs and assiduously clean up after them. There is one person (I hope and pray it is only one because it is almost unbearable to think there are more) who very carefully picks up after their dog with proper little dark plastic bags, knots the bags carefully … and then leaves them behind. On the sidewalk, on someone’s driveway and once on the table at the end of our driveway where we had set out the abundant crop from our starfruit tree to give away. What was this person thinking as they left their little present next to the box of starfruit and the big sign announcing, Free Fruit? I hope I never figure it out. My husband, who is better-hearted person than I am, suggested that perhaps it was dark and they thought they were just adding to the trash pile. Hmmm.

What are they thinking when … we all wonder. And I am sure people wonder it about me. Certainly, my little adventures such as hiking up and down canyon walls and white-water rafting when I don’t even know how to swim generate some of that. Then there are the times when I nervously blurt out something stupid, awkward but well-intended when a friend shares difficult news, such as a scary health diagnosis. Being a professional is not a vaccine against that. And perhaps about you, too, sometimes, inspire people to wonder, what were they thinking? Reminding myself of this helps me give a little grace to other people’s weirdness or inconsideration, because I definitely have my moments of being weird, inconsiderate or just plain oblivious.  And at those times, no doubt someone is wondering, “My gosh, what is she thinking…?”

Quitter’s Day Part 2

So … a week since the second Friday of January, what is sometimes called “Quitter’s Day,” for the frequent demise of New Year’s Resolutions. If you’ve given up, or fallen off track, every moment is potentially a new start.

Perhaps you need something a little more manageable: a small step instead of a massive change. Here’s a second suggestion, building on last week’s short post, for a small but potentially life-changing experiment. If you’re not already doing this, get outside in natural light early in the day – as soon after sunrise as you can manage, and, if it’s feasible, again at day’s end. Follow the sunset session with softer lighting indoors; night is not the time for blindingly bright lights. By getting early daylight, end-of-day light and softer, warmer indoor lighting, you will set your brain up for a more natural, sleep-friendly chemistry. With some sources citing 40% of adults having insomnia or other sleep problems, experimenting with the benefits of the right light at the right times could be well worth it!

Quitter’s Day – part 1

On New Year’s Day morning, Fr. Mike noted in his homily to those of us at early Mass that the second Friday in January is known as “Quitter’s Day,” because by then 80% of people would have quit their New Year’s Resolutions.

Perhaps you find yourself in the 80%. If so, may I suggest considering one or more short experiments – trying on a change, for a week or two – and assessing its usefulness for you. These are simple but not easy.

If making such changes were “easy,” we’d be a country overflowing with clear-thinking, peaceful, energetic, well-rested and generous-hearted people. Based on my 15-minute daily ration of news, that seems to not quite be the case.

Starting with the most basic – the marker of life at birth – breathing, which turns out to be something that we so easily can get wrong. If you are in good health and your medical provider doesn’t object, you might experiment with a practice of better breathing. This can be as simple as practicing slow, deep breathing for a few moments three times a day and then as needed when you want to calm yourself.  Breathe comfortably, slowly and deeply, so that the belly expands, rather than a quick, panting breath. Breathing out through the nose can help. “Slow” doesn’t mean make yourself dizzy or lightheaded; it means comfortable and relaxed. This kind of breathing impacts the nervous system in the abdomen and signals the brain to slow down its fight-or-flight, anxious mode.

It’s an experiment that you might try early in the morning, again when you shift gears between day and evening, and at bedtime.  You can find plenty of tutorials online with demos on relaxation breathing. If you have any medical conditions, of course, be sure that this is safe for you by consulting your healthcare provider.

Some people find this very useful as part of changing between activities, such as stopping work for lunch or at day’s end; before a stressful activity such as a presentation or dealing with a negative person; and when preparing for rest at night.

Thanks for reading!

Believe that there is more to you

It is a sad and common theme.

A person is struggling: with an addiction, or obsessions and compulsions, or moral injury, or the impact of trauma, and has come to a place where the sense of self has been entirely subsumed by the problem and its pain.

The definition of self becomes “the addiction,” or “the monster who did (whatever has led to moral injury)” or “the mental disorder diagnosis.”

And, of course, as a therapist, I believe it is critical to address mental health troubles with the best of the science we have, with the particular approaches suited, as discerned ongoing, with the specific needs of that client.

But I also believe that a parallel need is extant and urgent: the need for this person, who is suffering, to come back to an awareness of self as a deeply beloved child of God. Not generically loved, like we may say that we “love” some food or activity or type of animal – but particular, personal, and intense.  Women who, like me, have been blessed to give birth will recall that wild wave of emotion that engulfs us when we meet that little person face-to-face after the peculiar intimacy of pregnancy. It makes us irrationally jealous of everyone and anyone; what mother doesn’t remember resenting the nurses and physicians who separated us from the baby long enough to do the general assessments and necessary care? Well, that is a reflection God’s love for each person.

If a person who is suffering is willing to enter into, and do, the hard work of therapy, which will include lifestyle changes and “homework,” and also becomes open to reconsidering his or her existence as a deeply loved person, someone who is more than the addiction, or bad choices, or terrifying memories, or intrusive thoughts and painful compulsions, then true and deep healing can happen.  This is what I would wish for every person struggling with emotional wounds.

Riding the Rapids

We recently spent a few days hiking up mountains, camping and white-water rafting in Wyoming and Montana, because isn’t that what people who are afraid of heights (me) and can’t swim (yeah, me, again) do for fun? And it was fun. It’s good to push out of the comfort zone.

Most parents and the other adults who care for and work with children are quite serious about helping them get out of their supposed comfort zones and into a healthier lifestyle. Recently, I was speaking to a group of adults about the topic, “Raising Mentally Healthy Children.” We spent our time focused on what we can do.

One problem that arises in these conversations – whether in a group, one-on-one, or with a family, is that making time for change seems impossible. The days are packed, and nothing on the schedule seems negotiable. Yet, in reality, what’s not negotiable is what humans need to be healthy and thriving.

What most kids need, and what we need, too, is more appropriately divvied-up time. For example, children and teens benefit from a solid two hours or more of physical activity every day. They need time outdoors, in nature, for their immune systems, Vitamin D, circadian rhythms and even their eyesight development. The near-and-far variation in focus that being outdoors elicits promotes healthy eyesight in young children; kids are supposed to go from crouching down to study a beetle to peering across the field to see if that’s a hawk in the tree and then taking off running to make sure. Optimally, they’re outside for at least two or so hours every day – more on weekends.

Kids need enough sleep – probably 9 or 10 hours a night, with an absence of screens. Recent research links high levels of artificial light at night (ALAN) with increased rates of cancer due to disruption of the circadian rhythm. An immediate risk with insufficient sleep is the attention system. Sleep-deprived people are irritable, inattentive, forgetful, disorganized and generally not fun to be around. Sleep-deprived drivers test as impaired, much like those with alcohol and/or drugs in their system. Think about inexperienced and sleep-deprived teenagers driving to and from school and work, often in the dark.

Kids, and we adults, need unstructured time. Most of the adults present had a creative hobby or two, and we all agreed that it takes time to shift gears into that hobby. It’s hard to walk in the door after work and immediately pick up a paintbrush, or guitar, or journal, or woodworking tools, and be in flow. The segue into creativity requires a sort of almost boring downtime – something many adults and children avoid compulsively through electronics. 

I can’t tell people what sacrifices have to be made for their family to have a healthier life. It varies from family to family, and it is never easy. It might be simple or quite complex, but it is never easy. However – after the white-water part, when you aren’t on nature’s roller coaster, there are always some smooth, easy times ahead. Thank you to all the parents who go for it – who strive to be sure their children to have the range of experiences they need to grow up resilient, curious and confident.

Hard Changes

Most of us have some changes to make. And most changes are not so easy. That’s why people postpone them, or poke at the edges, or just pretend the problem will go away by itself. Sometimes people convince themselves there isn’t even a problem, really; that it just depends how you look at it. Maybe so. But maybe there’s something that needs changing.

Let’s say you have a teenage child, or a child approaching the teens. S/he is cranky, sullen, uncooperative with chores, sulks during family meals and resists being on time for school and other appointments. S/he wants to spend time alone, in the bedroom, with electronics. The child is depressed and/or anxious and/or obsessive and/or perpetually angry. You know the situation will change, one way or the other. Everything changes. If you do nothing, you are gambling that your child will continue down this road and somehow, at 18 or 19 or 20, wake up, shake themselves off like a wet Golden Retriever and come out of their bedroom, smile and say, “Wow! How could I have been so wrong?!”

Yeah, I doubt it, too.

If you have this situation and need to take it on, it can be hard to know where to start. Here’s a suggestion: if the situation is not a crisis, then the most practical first step may be to start with yourself.

You will have to change. Perhaps you have to start the change process by being sure that all the adults in the house are on the same page in your expectations. Perhaps you need to get yourself on the right path.

You go first. You get enough fresh air, and time in nature, and sleep, and healthy nutrition, and balanced physical activity. You strive to do interesting and challenging things in what little free time you have. You will, quite naturally and incidentally, spend less passive screen time. You’ll be leading from strength rather than being a target for adolescents’ favorite criticism: that we adults are hypocrites. You’ll be in a much better stance to steer positive changes for your tween or teen.  

It’s Just an Experiment

You know how it is. You want to make a change. Something needs to change. Maybe the kitchen needs organizing, or you need to sleep better, or be less stressed…whatever it may be. You want to get it “right.” And that’s where the freeze happens. “Right.  It has to be right.”

But what if there’s no way to know what is right for you without experimenting?

For all the chatter the past few years about science, and following science, there seems to be a misunderstanding of what science is. Science is more of a verb that a noun. It has more in common with, Hey, let’s try THIS and see what happens, than with learning a few things and deciding that’s it – that’s all there is to know.  You can see the difference in real time when SpaceX runs another experiment with the super heavy and the personnel there are excited about how much they’re learning and thus able to improve, while some people in the press call it a “failure.”  No, “failure” would be not doing or, having done, failing to study and learn. That’s failure.

At an individual level, let’s say you decide to take guitar lessons. You have no idea how to do anything with a guitar, but it’s been a long-time dream. Unless you are younger than five, you surely wouldn’t pick up the guitar, strum at it, and wonder why you didn’t sound like Carlos or Angus or Eric or Brian or whomever. You would have to spend many hours, experiment after experiment, building and reinforcing the new neural connections and fine motor skills that lead to the ability to play guitar. You would not call the outcome after the first, or tenth, or thirtieth, lesson a “failure,” properly, unless you gave up in impatient disgust and stuck the guitar in the closet, where it will peek at you through the clothes hanging in front of it and reproach your surrender until you sigh and try again or give the guitar away.

If you are looking at making a change, and feeling stuck, reframe what you are doing as experimenting.  Move the coffee mugs to that cabinet, over there, closer to the coffee maker, and see how you like it.  Buy a battery-operated alarm clock and leave your phone in the kitchen overnight for a few weeks and see what happens. Try turning screens off during meals, or leaving the audio off in the car, for a month or so.

Start the experiment, and then pay attention. That’s a critical part of an experiment. What happens in the absence of the old behavior? What seems better? What’s harder? What is your theory on why it’s better or worse? Can you build another little experiment – not a long-term commitment – on this one? It’s an experiment, for goodness’ sake, not a marriage.  That is science, and that is a way to get unstuck, make changes and work around any lurking perfectionism.

Not another horrible day

A different day, another awful situation. 

A child, or teen, or young adult has been struggling with emotional turmoil and is tumbling into danger. They confide in a friend, or maybe a few friends.

They may have “met” someone in an online chat and now this person is their “boyfriend” or “girlfriend,” and they are planning to run way to meet this person.

Perhaps the young person has been “sexting” with someone they know personally, or “met” online, and now are being threatened with “sextortion,” that the images of them will be spread around, unless they meet some demand. This has recently led to many teen and young adult suicides.

Perhaps the young person shares that they are a victim of abuse.

Or, perhaps they stumbled upon, or were led to, the terrible misinformation that hurting oneself is a useful way to cope with painful feelings. The young person proceeds to experiment with self-harm, and posts online about it.

So-called friends hear the plan, listen to the horrible stories, or see the images of scratches, cuts or burns, and fail to turn to an adult for guidance.

Every parent I’ve ever spoken to is under the impression that their child would, of course, come to them if a friend were in grave danger. And sometimes that is true, but an awful lot of the time – in almost any of these kinds of incidents I’ve ever encountered in clinical practice or consulted on, as it happens – that was not the case. The case was, almost every time, that other young people knew about the plan to run away, or the abuse, or the self-harm, and did not seek the guidance of an adult.

Sometimes these “friends” have an unflagging alliance, suddenly, to keeping promises (unlike the promises they have made to you, dear parent, about everything from cleaning their room to homework being done well to treating your automobile with respect). Sometimes they believe they are better equipped to help than an adult would be, although they cannot arrest an abuser, drive someone to the emergency room or help them connect with a mental health professional for counseling, and their capacity to manage extreme distress is probably not much better than the troubled friend’s skills. Sometimes they dread social disapproval for breaking the rule that you keep adults out of it, whether the “it” is someone self-harming, or sharing that they are a victim of abuse, or are planning to run away from home to meet up with the “boyfriend” they “met” online.

I urge you to have frequent, open conversations about these topics with your young people. Make them age appropriate; be calm and encouraging. If you are too stressed out, you may be misread as “angry.” Remember that adolescents go through a stage where their brain interprets almost every non-happy facial expression as “angry.” If that happens, the conversation will probably be a complete failure.

Be calm, be matter-of-fact, and be sincere. Ask questions, too:

How do the people you know handle things like a friend telling them this kind of stuff?

If this was your friend, what would you do?

If it were (fill in the blank for some close friend or family member), what would you want their friends to do in this type of situation?

Why do you think people are reluctant to ask adults for help with this?

What would make an adult seem safe to go to with this problem?

Don’t lecture; have the conversation. It may be a conversation that occurs for a few minutes at a time over an extended period. That’s okay; sometimes a few sentence and letting it simmer is what’s necessary.  

You may, without knowing it, be setting the groundwork to save a life.

Loneliness can kill you…part 3

This is the third of three posts. This one focuses on the art of conversation:  being better at conversation will help you overcome loneliness.  As noted in part 2 of this series, a lot of people struggle with reflection and/or asking questions that elicit a deeper conversation.

So, here are two strategies to help with these.

Reflection:  reflection has to do with being able to identify how someone else feels, and mirror that back to them with your expression and your words.  Laughing when someone tells you something sad (it happens, trust me) is not good. Identifying all negative emotions as some form of “mad” or “angry” is not helpful, either.  Sometimes, when you are watching a show, put it on mute and try to verbalize the emotions that characters are experiencing. Then go back and watch with the sound on. See how you did. Experiment with mimicking their facial expressions and see what feelings you experience; the imitated expression can trigger a shadow of the other person’s emotion via our mirror neurons.  If your emotional vocabulary is lacking, do an online search for Dr. Gloria Wilcox’ “The Feeling Wheel” for a research-based set of some of the many emotion words.

Asking questions:  there are plenty of sources for “conversation starters.” I have used Gary Chapman’s conversation starter cards for couples and for families with clients, as well as a discount store’s set of conversation starters for couples, families, and general-use conversation. Basically, at this writing, for about $1.25, you can get about 100 sample conversation starters. Here’s how to practice by yourself: pull a random card, look at the question, make up an answer someone might give, and see how many questions you can come up with related to that answer.

Random example:

Who was your favorite teacher?

And, here are just a few of the many possible questions to take the conversation further:

  1. What was special about this teacher?
  2. What is one of your favorite memories about being in that teacher’s class?
  3. Did other students feel the same way? Why or why not?
  4. How did having this teacher help you out in future classes with other, not-so-great teachers?
  5. If you could meet this teacher now, what would you want to say?
  6. Have you had any opportunities to help others the way this teacher helped you? What was that like for you?
  7. If you were going to encapsulate what you learned from this teacher as a “life lesson,” what would it be? How has that lesson reverberated for you since those days?
  8. Did you ever have a teacher who was sort of the evil opposite of this teacher? Who helped you get through that school year?

Practice making up questions. You won’t be peppering people with multiple questions; the goal isn’t to overwhelm people with an endless interrogation. The idea is to develop confidence that you can invite someone to have a richer conversation by asking a thoughtful question or two, and have the kind of dialogue that helps heal the loneliness that you, and perhaps they, are experiencing.

Because loneliness can kill you.

Stress…And a Lesson From Cognitive Behavioral Therapy for Insomnia

Cognitive Behavioral Therapy for Insomnia (CBTi) helps people with insomnia via examining and, where appropriate, helping them change their behaviors and thoughts surrounding the issue of sleep.  One important factor we explore are called “Sleep Safety Behaviors.” These are habits which people believe are helpful for sleep.  Some sleep safety behaviors are in fact very helpful, such as avoiding screens for a couple of hours before bedtime, using soft, warm light sources in the evening, and avoiding upsetting discussions before bedtime. Other sleep safety behaviors are counter-productive, but if a person is convinced that they are helpful the anxiety around giving them up ends up disrupting the process of falling or staying asleep. The objective is to have positive habits around sleep, not unhelpful sleep safety behaviors. It is not as easy or obvious as it might sound.

For example, many people use alcohol as a type of sleep safety behavior. They believe it helps them relax and unwind, and seem to either not know, or disregard, that it actually is a sleep disruptor. Alcohol-fueled sleep usually involves waking up in the middle of the night as the effects of alcohol wear off. It also disrupts the quality of sleep. However, the person convinced that they “need” a drink to sleep may become so anxious about going without the drink that they have difficulty falling asleep, which they attribute (wrongly) to the absence of alcohol.

In the same way, don’t most people have some sort of “stress safety behaviors” to cope with stressful situations or extended times of stress? Some are helpful and constructive, and others are terribly unhelpful and even destructive.  Some are fairly neutral until taken to excess; an ounce or so of chocolate as a snack is one thing; a pound is another. Odds are, you know someone who clings to a stress safety behavior even though it is clear as day that it is unhelpful and even harmful. You may have encountered the futility of trying to convince the person that the extra drinks, the avoidance, the angry outbursts to vent over and over, merely get in the way.

Imagine a person for whom life has delivered a set of one-two punches – illness, a hurricane or two, unexpected car repairs. There are all sorts of paperwork and bills to tackle, and after a long day of work it is all too much. He takes an evening off to binge watch a favorite series, and then, the next day, everything is one more day behind, one more day piled up, and even more overwhelming – too much to be tackled, again, after a long and wearying day. Surely there is a half a season or so of something that will distract from the looming piles of paper.

Perhaps the person doesn’t binge-watch. Perhaps she enjoys a glass of wine, or two, or three, or, heck, why leave only one glass in the bottle? She adds poor sleep and the three days it takes for the full effect of alcohol to leave the brain to the problems still piling up on the table. Perhaps he gets caught up in a vortex of videos about things he cannot afford – certainly not at this moment – and adds envy and resentment to the problems at hand.

Odds are, too, you know people who have some good “stress safety behaviors.” Those habits reinforce resilience. You might notice some people seem to surf through the ups and downs of stressful times without falling apart or adding to the trouble at hand. If you are that someone, that’s wonderful; stick with it. If you know some people like that, but are not one yourself, perhaps you might give some positive stress safety behaviors a try.

If I were making an official list of Stress Safety Behaviors (which I am not at the moment), I’d probably include these:

Sleep: getting regular and adequate sleep – not feast or famine approaches to the weekly rotation, where you pretend you can “get by” on four hours during the workweek and really make it all up to your brain with a long sleep on Saturday.

Move regularly and adequately. Exercise, appropriate to your overall health and physician’s guidance, is essential. The machine needs regular movement to function properly.

Limit exposure to negative influences. Don’t feed your envy, your insecurities, or your bad habits.

Minimize exposure to media and people that encourage you to compare yourself to other people.  Do you think it’s a coincidence that so many magazines and websites feature articles about improving oneself – and a surfeit of advertisements for products that will, in theory, improve those things?

Treat Sabbath time seriously. Set aside one day each week for renewal. Pray, rest, read, enjoy time with family and friends, play, create.

Journal. There are lots of ways to journal. There’s the quick “5 things you’re grateful for” at bedtime journal. There are prayer journals and journals that are brief paragraphs on the events of the day. Maybe it’s that annoying journal assignment your therapist gave you. The act of writing – more than just “thinking about it” – brings more of your brain into the process. This way, for example, you benefit more from noticing good moments during the day, recollecting them in the evening, writing them down, and seeing your words on the page.

Positive stress safety behaviors are simple, common sense…but they can appear to be just one more thing to keep you from getting things done. If you think, for example, that a short walk is just a waste of time, that you’d be better off using those fifteen minutes for the big mess at hand, well, that might be true if that were, in fact, what would happen. But if the thing that would actually happen was a big sigh or a venting of angry frustration and the welcome distraction of a text message from a friend – well, then, the short walk to breathe deeply, move quickly and focus yourself for action might be less of a time-waster than it seemed.

If you’ve taken a look at the task manager window on your computer, you know there are dozens of programs running even though you may be only engaged in one. Start clicking on random programs to turn them off and watch the warnings pop up that this will interfere with the proper functioning of the computer. It’s the same with these sleep and stress safety behaviors. The people who do these things do them consistently, even when things are smooth and rolling along just fine.  These habits operate like a background program, always running. They keep the system working properly but without a big fuss. Turn off, or pause, those background programs and the system stops working properly, or perhaps just shuts down entirely.

Even good programs need updates. Taking that weekly break gives you a chance to notice if you need to make changes to the routine. Ignoring necessary updates usually makes the whole system a bit glitchy.