Category Archives: Sleep

Set-Ups, Near Occasions & Solution-Focused Brief Therapy

Haven’t we all had times we felt set up for failure?

Near occasions. Think of them as set-ups. Human beings are spectacularly good at setting ourselves up, for good choices and for the not-so-good, too.

We Catholics refer to near-occasions of sin – the people, places, things and behaviors that we might see as “set ups” for us to make poor choices. There’s nothing inherently “bad” about gathering at a bar and grill with friends, but if you are trying hard to maintain your recovery as an alcoholic, it is a “near occasion.” It’s a set-up to make good choices even tougher. Likewise, the trip to the mall to “just walk around” when you’re trying to work your way out of debt. Why set yourself up for failure?

In the same way, there are what may be called “near occasions of Grace,” the people, places, things and behaviors that increase our odds of making good choices. The friends who are uplifting and don’t gossip; the entertainment that doesn’t feed envy or anger; the activities that make the rest of the day better. We “set up” the likelihood of good choices, too.

Solution Focused Brief Therapy (SFBT) similarly looks at people, places, things and behaviors. You may be thinking, well, duh, what sort of therapy does NOT focus on solutions? Different forms of therapy have different emphases in terms of finding solutions. For example, psychodynamic therapy emphasizes developing insight that leads to new choices; behavior modification focuses on step-by-step actions to guide the client towards reaching goals. In SFBT, there is a particular emphasis on the clues (factors that set up outcomes) in people’s lives and using these clues and the client’s strengths to develop solutions. In many ways, it is looking for near occasions of the goals the client has for therapy. When has the goal in question already happened, or part of it happened?  What was going on then? What was happening right before that? What were you doing? What were others doing? As a team, we investigate the near occasions of success so the client can use the clues to develop solutions that make sense for that client’s life.

Just as a quick example, let’s consider the person who realizes that getting the morning off on the right foot tends to lead to a better day, all-around. We look at examples of those “better days.” What did happen in the morning? What happened the day before that might have contributed to that morning? There are usually plenty of clues and examples of times when the person has been successful in doing things that either led to a “better day” or set the stage to some degree.  Some clues might be eating a reasonably healthy dinner, getting to bed “on time” and not using the phone or other screened device, getting up on time and getting out of bed right away instead of starting the phone-scroll. The person identifies the factors and then we look at how to increase the incidence or likelihood of those recurring. Breaking it down further, let’s take the dilemma of the phone next to the bed and its appeal as a way to deal with insomnia, or its interference with just getting out of bed on time. “I can’t leave it in the kitchen. It’s my alarm clock,” people will assert. Yes, I understand- and I understand that I bought a little travel alarm clock – a couple of AA batteries that have thus far worked for years – that wakes me reliably every morning whether there’s a power outage or not, and I do not have my phone over there, flashing lights and buzzing every time an artist friend posts a painting. It seems many other artists are night owls. The solution, if what is wanted is actually a reliable alarm clock function, can be had for less than fifteen dollars.  If the phone is off in another room, you’ll have to get out of bed to get to it. And by then you will probably have done something besides scroll – brushed your teeth or started the coffee or fed the dog. You will be vertical, approximately on time, and therefore have “set up” a more likely success story about getting into your day “on time.” The phone by the bed is a “near occasion” of extra time awake during the night, more time in bed, and then being rushed, grumpy and unprepared for the day. Nothing is inherently bad about the phone – but it might be part of a “set up.”

We all have “near occasions” – of sin, grace, good choices, bad choices. The negative ones have less power when we know what they are, and the good ones can exert their power when we focus on them.

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!

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.  

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.

7 Things to do When Life Is Crazy

Sometimes, life just goes horribly sidewise.  This week, like most weeks, I spent time with people who have lost their homes to natural disasters, lost their job, had loved ones die, and sometimes are grappling with multiple serious problems.  The world seems crazy, you can feel like you’re going mad, and it is oh-so-easy to slide into attempts to numb the pain that are ultimately harmful.

It’s easy to advise people on what NOT to do – don’t drink alcohol. Don’t use drugs. Don’t eat a lot of junk food. Don’t let yourself scroll through social media and/or your newsfeed for extended periods of times. It’s easier, though, to “do” than to “not do.”  Anyone who has tried to break a bad habit knows that; it’s easier to “eat an apple” than to “not smoke/drink/eat a bag of cheesy poofs the size of a pillow.”

So, here are seven things to do – and keep doing – when life is crazy

  1. Say grace. Say grace when you get to sit at a table and say grace – together – when you eating a granola bar in the shade after another few hours of trying to make sense of the debris that used to be your home.  Say grace when you are out on a hike, just about out of water, and have miles to go. G.K. Chesterton famously noted he said grace when he sat down to write, to draw, etc.  A moment of gratitude shifts the focus from the mud to the mountaintop.
  2. Put the social media/news scrolling down and, instead, watch something that will make you laugh, preferably either an episode of a sitcom or a funny movie. Why? These require sustained attention, will bring a focus on characters who have ups and downs, and have the potential to make you laugh. Laughter releases dopamine – that feel-good chemistry that helps you heal.  Make it better and share that humor break with someone else. Sharing laughter with the person you love helps that sense of connection that seems strained, or even lost, when life has gone crazy.
  3. Eat food that is good for you. Ongoing extreme stress causes havoc in your body, including your brain, and getting decent nutrition is essential to your well-being, now and later.  I did the price comparison:  a precooked chicken, a bag of salad, some fruit and a little something else healthy, for example, feeds two or four people far cheaper than most or all fast food. Your brain will thank you.
  4. Listen to music that is soothing: piano or guitar, instrumental jazz, classical, baroque:  as tempting as it may be to listen to “angry” music because you feel so angry about what’s become of your life, that will only reinforce your distress.  Let peace soak into you, however slowly it may come.
  5. Check in with other people every day. Reach out to someone to see how s/he is doing. It helps us get out of our own heads, our experiences, and feel less alone.
  6. Get outside, preferably in the morning, for natural light exposure. You don’t need to bake in the sun; just get out there. Take a walk if you can.  Early natural light helps the brain regulate the sleep/wake cycle, setting you up for a healthy rhythm of melatonin production over the course of the day.
  7. Ask God to show you where He is at work in the events of your life, because when life goes crazy, the fog can make God’s loving presence hard to detect. Ask for the grace to notice the helping hands, the kind words, the moments of clarity.

I’m sorry if life has gone crazy. It is scary, and lonely, and disorienting when disaster strikes. If you find that you are sinking, reach out for help:  call your local helpline (in Pinellas County, FL the number is 1-888-431-1998, for the new Care About Me program that helps match those in crisis with an appropriate mental health provider).  Call a friend, a family member, or, if you are feeling unsafe and considering suicide or plan to harm yourself or others, go seek immediate help via 911 or go to an emergency service location.  When life has gone crazy, it is natural to feel frightened, confused and even helpless, but remember that none of us were designed to “handle it all.” We are, in fact, designed so that our strengths are distributed so that each has something to offer but none has every gift and ability.  Please reach out for help if you feel you are sinking.

An Alcohol Dilemma

Alcohol can be a touchy subject. Addictions, generally, are frequently considered to be only something other addicts, including those in recovery, can help with.  Someone like me, who never drank regularly and now, since surgery a few years ago that included a bad anesthesia reaction, can’t drink any alcohol except, oddly, 3 or 4 ounces of Guinness on a couple of holidays each year, is automatically considered ineligible to be helpful. Despite my ineligible status, in a previous post, I included the life lesson that, for many, alcohol is not a friend.

This assertion flies in the face of much research, perhaps most famously Blue Zones data, which includes moderate alcohol use as a generally positive factor for long life. On the other hand, avoiding alcohol is well-supported by substantial research in the medical field.  Shake or stir in my non-drinker status and, well, it seems like I am a fun-killing fuddy-duddy looking for an excuse to ruin my clients’ good time.

What are the benefits of alcohol? Much research has focused in particular on resveratrol and relaxation.  There ways to get antioxidants and relaxation that don’t carry the risks of cancer, liver and brain damage, and some of the regrettable behaviors that alcohol can carry along. This might be a worthwhile topic of discussion with your healthcare provider. Eating grapes, prayer and meditation, physical activity and laughing might hit all the right keys on this.

If you are misusing alcohol – relying on it to “unwind” after the day, to “help you sleep” (it doesn’t, actually), or to get through social situations (there are ways to deal with social anxiety that don’t interfere with functioning) – please seek help. Other signs your relationship with alcohol is unhealthy? Using more than the recommended amount – 1 serving max per day for females, 2 for males. Feeling anxious if you run out, or worrying you will run out. If you worried more about stocking up with booze than water, batteries and nonperishable food for the past two hurricanes, that’s a bad sign, too. Any binge drinking is a danger sign. Binge drinking raises your blood alcohol to .08 in two hours or less, usually four or five single drinks. Any changes in your functioning at home, work, or socially are likewise danger signs. Pretending that these signs don’t apply to you is itself a sign.

Where to go for help?  Go to an AA meeting. Call a therapist. Call 866-210-1303, or 211, or another helpline. See your physician. Tell someone you trust you’re ready to make a change. Just take that first bold step towards help. There are good people eager to help you change the course of your life for the better, preferably before it becomes unmanageable.  

Why Ask Me That? Third in a series on questions in the therapy room

Someone who is struggling with anxiety just wants to feel better. It’s understandable; anxiety feels awful. The physical symptoms, so often hovering just below full-blown fight-or-flight; a mind that won’t rest, a brain that hops from topic to topic like a rabbit in a vegetable garden. Add to this the fear that so many people have when they come to therapy:  will the therapist tell me I’m crazy?

No; no, I won’t tell you that, but I am probably going to annoy you with a lot of questions that may seem to be irrelevant to your suffering. My paperwork asks about your history, decade by decade; your losses; job satisfaction; health issues; your alcohol and drug use; your prescribed medications; your exercise and sleep patterns. I ask about screen time, social memberships, supportive relationships. I ask a lot of questions, and I can tell who thinks those questions are irrelevant by who leaves them unanswered, handing me incomplete paperwork and acting surprised when I follow up on the many blank places.

All these questions are important, and here’s a short discussion on just a few aspects and the explanation.

Your sleep patterns, and any difficulties, can both contribute to, and be worsened by, anxiety, stress and depression. If you need more, or better sleep (and most people do), figuring some ways to improve your quality and quantity of sleep can help across many categories of your life: focus, memory, energy, stress level, and mood. When these improve, relationships can often improve, as you might expect when you can pay attention and be less cranky.

If you have major health conditions that are not properly managed, these may contribute to problems with sleep, anxiety, or mood. For example, poorly managed diabetes, besides being physically very dangerous, impacts focus and mood. I would refer you to your physician to see if there are problems that require medical attention.

Social isolation is a recipe for loneliness and depression. Social media use tends to make this worse – something that seems weirdly contradictory. Lonely people eventually withdraw, and this creates more loneliness, isolation and possibly anxiety and depression. We need to explore ways to enter back into activities with others.  From my guidance counselor days: children who are isolated suffer. If you ask a child if s/he has friends, and then ask him/her to name those friends, and there is a flash of hesitation, you know you are dealing with a child suffering social isolation. Just so, adults who cannot identify some supportive relationships and what is good about those relationships is an adult who is emotionally isolated.

I ask questions that make sense to me; if they don’t make sense to you, please ask why I’m asking. Thanks!

Why Ask Me That? Part 1 of a Series on Questions in the Therapy Room

“It’s a lot of paperwork.” 

Yes, I agree, it is. And all that information is helpful and useful for me in what I presume is a shared project: making positive change in some aspect – or many aspects – of that client’s life. 

The number of people who simply skip sections, as if they were optional, or not relevant, is significant. This gives the opportunity to have some conversations about those questions, and their relevance.

For example:

If someone routinely shortchanges their sleep, health problems will develop. In the short term, irritability (which tends to mess up personal and work relationships), less efficient short-term memory (ditto), distractibility (ditto) and impulsivity (mega-ditto) are possible contributors to whatever the primary complaint may be.  So maybe we should address that, too!

If you are extremely extroverted and are working remotely and living alone, you have created a perfect petri dish for restlessness, depression, and dissatisfaction. Those are psychological and emotional factors that create problems across domains. Deliberately arranging adequate real interactions with others will be essential to meeting that basic need.

If you don’t have five or six people who you can identify as part of your social support system, such as friends, family, a mentoring colleague, etc., there may be a heightened risk for depression and anxiety.  That doesn’t mean you confide personal problems with all those folks; you might have someone who provides support and encouragement in career-related areas, some people you can pray with, people who you play sports or exercise with and enjoy lighter conversations.

There are no questions on my paperwork that are not rooted in helping the client and me have a grounded understanding of the client’s strengths, struggles, and emotional resources for making positive change. Just ask me.