Compliments; A Win Win

A recent trip to Trader Joe’s reminded me how important it is to compliment people. In fact, my habit was strengthened that morning. Compliments nearly always makes the receiver feel good and brightens their day. Giving them is particularly helpful for people who have a great deal of social anxiety. The person receiving a compliment usually appreciates the interaction, so a positive experience is much more likely, thereby rewarding the person and lessening their anxiety. Sometimes, it leads to a conversation which is even better.

That morning, I noticed a senior citizen who was wearing an unusually hip jacket. My first thought was, “I would totally wear that.” I considered complimenting her, but I was leaving the store, and it wasn’t easy to make eye contact, so I decided to keep walking.

By the time I put my bags in the trunk and fished out my keys, she was putting her cart away next to my car. I took my second chance for a compliment and said, “I love your jacket.”

Her face lit up like a Christmas tree, and then she moved closer to me and asked, “Can I tell you a story about this coat?”

I was pressed for time, but smiled and said, “Of course.”

“My husband bought this for me in Italy in 1975,” she replied.

“Wow,” I said. “That is a great story and no matter how much he paid for it, it was a bargain because it’s really cool and you’re still able to wear it!”

The woman put her hand over her heart, and as she smiled again said, “You don’t know how much that means to me. You’ve made my day.”

This made my day, too. And it reminded me that even when I’m pressed for time, I can make time to compliment someone. So next time you notice something you like about a person, whether it’s something they are wearing, something they did, or a quality you recognize, compliment them.

Just December: A song about grief at Christmas

Below is a photo. To watch the video scroll down a bit. Please listen to the words.

Effective Treatment for Panic Attacks (Part 3)

-photo by Timothy Dykes on Upsplash

Although your physician and the media may lead you to believe that medication is the best answer, it is not. A meta-analysis (study including several studies) showed that the effect size for cognitive-behavioral therapy is .88; add medication and it reduces the effect to .58. Medication alone has an effect size of only .40.  In fact, benzodiazepines (e.g., Xanax, Klonipin) which bring rapid temporary relief to a panic attack, actually negatively reinforces the fear in the long run.  This often increases the frequency of attacks, causes dependency on the drug, and tolerance such that you might need more and more medication to manage the anxiety.  They can also cause you to be more resistant to the MUCH more  effective cognitive-behavioral therapies that directly treat the panic.  Benzodiazepenes will help decrease the symptoms of a panic attack, but do nothing to treat the cause of panic attacks.  There are also side effects including  drowsiness, poor concentration, incoordination, muscle weakness, dizziness, mental confusion, memory impairment, and even feeling depressed.

For some people panic attacks are a warning signal to motivate you to make a change in your life such as resigning from a job or ending an unhealthy relationship.  Once you make the change, the panic attacks often subside unless you’ve developed a fear of the symptoms. Then, you may still need treatment. But, most people have panic because of the perfect storm of symptoms I described in my last post.

While some people respond very well to SSRI’s (Like Zoloft and Paxil) the best treatment for panic disorder is cognitive-behavioral therapy. The problem is Zoloft and Paxil take 2-4 weeks, sometimes more, before they work and the side-effects may worsen the panic. The great news is that I’ve seen panic attacks cured, that’s right CURED, in a single session. More often it’s a handful of sessions, but still…improvement after one.

There are three cognitive-behavioral strategies that are used to treat panic attacks: 1) interoceptive exposure (IE), 2) mindful acceptance of the symptoms, and catching anxiety early followed by rapid application of a variety of coping strategies.  The latter is more effective for the anxiety attacks driven by worry (see my first post in the panic series).  For true panic attacks, the best treatment, if it works, is mindful acceptance. But the most likely to work is IE.

Fighting anxiety fuels anxiety. When we truly accept the symptoms of the panic, they lessen. See my post on March 23, 2020 that even includes info on how to get your free recording of this strategy!!!

By far the most consistently effective strategy is IE (interoceptive exposure)  It’s based on the fact that the best way to overcome fears is to face them.  Unlike phobias, in which an individual fears situations and things (e.g. crossing bridges, dogs, public speaking) with panic attacks one fears physiological sensations of anxiety such as increased heart rate, difficulty breathing, dizziness, and feelings of unreality, just to name a few.  In interoceptive exposure, the person systematically engages in exercises in order to bring on these sensations.  IE exercises are repeated until desensitization occurs (i.e. the person gets used to them).  These exercises include breathing through a small straw, breathing rapidly, shaking ones head from side to side, and staring at something under fluorescent lights (to bring on feelings of derealization/unreality).  The goal is to eventually feel the physical sensations without feeling the fear. The fear is nearly always lessened in less than 30 min.

It is not recommended that you try IE alone.  Work with an experienced therapist like myself because there is a very systematic and gradual way of approaching the exercises (kind of like putting your feet on the first step of a pool vs jumping into the deep end).  A careful assessment will also determine what the best starting exercise is for you. If you try IE on your own, there is always the concern that you will take on too much, stop prematurely and increase your fear. A trained therapist will be able to ease you into the exercises, know what to do to help you deal with the anxiety if it happens to get too high, and maximize the likelihood that desensitization to the symptoms will occur in the first session.  IE is 88-90% effective in curing panic attacks (ZERO panic attacks at 2 yr follow up) and many of the other 10-12% enjoy greatly reducing the frequency and intensity of panic.

Panic Attacks (Part 2): Causes

While it may feel as though a panic attack comes out of the blue, there is always a trigger.  These triggers can be internal (physical sensations or thoughts) or external (an actual or perceived threat in your environment).  Examples of external triggers include: an argument, a loud noise, hearing bad news, or exposure to a phobic situation.  Internal triggers are thoughts (i.e., worry), physical sensations, and emotions. Panic attacks always include physical changes in your body, and typically there are several. There is always fear (panic) that causes additional physical sensations like tachycardia (rapid heart rate).

Prior to the fear, the physical sensations can be caused by a variety of factors including dehydration, low blood sugar, side-effects to a medication, hormonal changes, caffeine, and even artificial lighting (especially fluorescent lights) and lack of sleep. This time of year heat exposure commonly contributes to panic attacks by causing a variety of symptoms such as weakness, lightheadedness, and nausea.  Heat exhaustion, dehydration, and low blood sugar each contain enough of the same symptoms of a panic attack to qualify as one.

Most of the time someone’s first panic attack is a perfect storm of  “normal” symptoms (e.g. tachycardia, nausea, and lightheadedness are normal when dehydrated) that scare them so much that they panic, causing a spiral of additional symptoms.  I’ve seen countless people who are very relieved when I provide a physical explanation for their first episode, because they are often convinced they have a serious illness. For HIPAA reasons I can’t use a detailed actual example but typically there are at least three factors, and sometimes multiple symptoms, contributing to the first panic attack - like sleep deprivation, dehydration, low blood sugar, preceded by exposure to fluorescent lights (can bring on derealization) setting them over the edge. Psychological stressors often contribute to the first panic attack and some people are genetically prone  to anxiety.

Check in soon for what leads to panic disorder as well as the amazing treatment for panic attack.

-photo by Timothy Dykes on Upsplash

Panic Attacks (Part 1): Panic Attack? or Anxiety Attack?

What IS a Panic Attack?  A panic attack is a sudden increase in intense fear, anxiety, or discomfort that peaks within minutes and includes a minimum of four symptoms.  Most of the symptoms are physical and include tachycardia (rapid heart rate), palpitations, derealization, dizziness, light-headedness, nauseous, numbness or tingly sensations, and difficulty breathing. However, symptoms may include fear of dying, fear of going crazy, or other fears like having a heart attack or being embarrassed. Often the attack feels like it came “out-of-the-blue” but it can occur during a stressful situation like getting a traffic ticket, exposure to a phobia, or having an argument. Most of the time there is a fear of the physical symptoms and often these symptoms trigger the sudden surge. In order to be a true panic attack there must be a sudden surge of anxiety.

What is NOT a Panic Attack? Some people believe they are having a panic attack when they are experiencing intense anxiety stemming from worry. The key difference is that the individual worries their way into a panicked state vs a sudden surge of fear. The anxiety may be equally intense and even include more than four symptoms. However, these “anxiety attacks” don’t typically include a fear of the physical symptoms, unless the person has Illness Anxiety Disorder (formerly known has Hypochondriasis).

Why is it Important to Differentiate Between a Panic Attack and an “Anxiety Attack?” It is very important to differentiate because the treatment is usually radically different. In short, treatment for true panic attacks focuses primarily on systematically facing ones’ fears and understanding the causes of the panic while “anxiety attacks” are treated by addressing worry. In short, worry is addressed by learning to catch it early, nip it in the bud so to speak, and applying a variety of coping strategies like relaxation and cognitive therapy. It isn’t unusual for people to experience both types of attacks. Details to come shortly in future blogs.

What Causes True Panic Attacks? While a chemical imbalance might contribute to panic attacks, contrary to popular belief, it is not responsible for causing panic attacks. Tune in to the Panic Attacks Part 2 soon to learn more about the nature of panic.

Anxiety, Anger, and Frustration about Putin and Ukraine

ALL of these emotions are normal and healthy. If you haven’t felt any of these emotions about the horrors Ukrainian people are facing, you’re unusual.

On the one hand, it can be helpful to cry when seeing the atrocities, yell at Putin when seen on TV, feel anxious about where we might be headed and about your investments. On the other hand, other than donating or raising money, there isn’t much we can do. So striking a healthy balance means letting the emotion flow , then letting it go, repeat. Whether its war, a pandemic, grief, or another painful issue…Visit It, Don’t Live in It. Of course, if you live in Ukraine, have friends and close family in Ukraine, or similar, you will be living in it much more.

By “Visit it, Don’t Live in It” I’m talking about your emotions. Let yourself cry and get angry. Let it out! But once you have expressed these emotions and feel some relief…move on. Recognize that continuing in it for hours isn’t helping anyone, but know these feelings are bound to emerge again with disturbing media coverage or other triggers. I believe that the more we allow these emotions to flow freely occasionally (i.e. visiting it), the easier it is to disengage from them and not live in it. This does mean limiting the media coverage and time spent talking and thinking about it.

Many people believe they should be “stoic” and misunderstand the true meaning of it. The stoics believed that even painful emotions were to be accepted. They were seen as being neither good nor bad, but part of human existence. There is mounting evidence that anxiety and depression are exacerbated when we try to hold in our healthy feelings, reject our feelings, or are self-critical about them.

If you want to do something you can donate, protest, raise money, or find other ways to support the Ukrainian people.

Worry Postponement (Part 2)

Worry Postponement is an effective tool that can be used in two general ways. The first is if you worry chronically about the same things. In this case, designate a 10-20 min time period to think about it each day. During this time, gently remind yourself that worry isn’t helpful and aim to find solutions instead. You’ll still start to worry, but when you do gently remind yourself that you will think about this at your designated “problem-solving” time (e.g., commute home, during your shower) and apply your favorite coping strategy, it will likely be brief. As your worry habit lessens, take weekends off.  You can ween yourself to just 1-2 days/week or may find that you need less and less time for your problem solving time. 

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Another way to utilize worry postponement is when there is something in the future you are worried about. For example, maybe it’s St. Patrick’s Day and you are already worried about a visit with your boyfriend’s, girlfriend’s, or spouse’s parents on 4th of July weekend. Consider when you will start preparing for it. Let’s say that you think it will be about 2 weeks prior. Find the date on the calendar and write on that date “prepare for visit” and then anytime you begin to worry, gently remind yourself that you’ll start preparing on June 20th, for example. Soon you’ll find yourself worrying about this very little. 

Advice About Worry From Scarlett O’Hara? (Part 1)

Even if you haven’t seen Gone With the Wind you’ve probably heard the famous line “Frankly my dear, I don’t give a damn.” But do you know what Scarlett O’Hara said shortly thereafter?… “I can’t think about this now. I’ll go crazy if I do. I’ll think about it tomorrow.” and then she closed the door. If you saw the film, you certainly wouldn’t think of going to Scarlett for advice, but she was spot on in this case. 

Research shows that trying to stop worrying is not only ineffective, it actually makes you  worry more. However, postponing worry can be very helpful. For example, if you are eating dinner and worrying about work you might decide to think about it tomorrow on your commute. If working from home you can think about it when you’re getting ready or during the kids nap. Once you decide you don’t want to worry at any given time: 1) Decide when you want to address your concerns, 2) (optional) Visualize yourself “closing the door” (turning off the computer, closing the car door, closing the front door to the place you work). 3) Use a relaxation strategy and then 4) Follow through at the designated time.  Come back soon for more on this strategy.

Forgive but Remember

One of my least favorite adages is “Forgive and Forget.”  If you believe that you have to forget what a person did to harm you, it can interfere with your ability to forgive them.

Forgive for your well-being rather than for the person who wronged you.  Forgiveness is freeing and usually of greatest benefit to the person forgiving. But forgetting can be hurtful because you leave yourself vulnerable to being hurt again, particularly if you have a relationship with that person. Because the best prediction of future behavior is past behavior, remembering can be a way to protect yourself. 

Say that a friend told a secret that you had made clear was to be kept in confidence and it led to being embarrassed and hurt. It would be healthy to be able to let go of your anger, frustration, and disappointment, but it would be helpful to remember so that you do not trust the person with secrets. 

You might be thinking that you could forgive someone for telling a secret, but not for something more egregious. Mackenzie Phillips, actress on One Day at a Time was the daughter of John Phillips of the Mamas & Papas pop group. He got her into drugs at 11, raped her at 19 and paid to abort a resulting pregnancy. She said she forgave her father on his death bed. In an interview, Oprah commented that it was a wonderful thing she did for her father. Paraphrasing Mackenzie: I didn’t do it for him, I did it for me. It was a huge relief to let that go. 

Anger is a healthy emotion. It is unhealthy to suppress it. When we are angry at someone who has hurt us, it makes it much less likely that we will allow that person to hurt us. However, after a period of time, holding that anger in your heart stops protecting you and begins to hurt you. So forgive, but remember if it helps to protect you. 

Anxiety During the Coronavirus: Part 15, Parenting During the Pandemic

This is guest post written by Barbra Danin, LMFT, ATR who works with children, parents, and families, and is currently practicing in the Philadelphia area. Learn more at www.barbradanin.com 

Photo by Senjuti Kundu on Unsplash

“When my kids become wild and unruly, I use a nice, safe playpen. When they're finished, I climb out.” – Erma Bombeck

 As parents, we are committed to raising our children to become strong, independent, adults. Overnight and without preparation, however, parents’ roles have suddenly shifted, and they have now become their child’s educator, chef, social network, emotional support system, and best friend.  While adjusting to the shock and fear of the current reality, parents find themselves stretched in ways they have never been tested, and they’ve been forced to rethink many of their well-established approaches to parenting.
 
Along with the pressures that parents are encountering, children are faced with their own challenges in dealing with the pandemic, and often express their feelings by acting out or withdrawing and shutting down.

When a child acts out, there is always an underlying feeling they are struggling to express. Help your child understand and verbalize their feelings, and let them know you understand.

Now more than ever, children need their parents’ guidance and support. While it is important to address a child’s undesired behavior, remember that these are unusual times, and that time honored “rules” and expectations need not apply for now. Children are unlikely to be damaged by relaxing certain standards:  (e.g. allowing them to spend more time on devices, especially as a way to connect with peers and relatives, watching more television).  Strict limits and consequences can unduly escalate a child, and rather than setting overly firm limits, parents may decide to pick their battles, and let certain things go.  At the same time, it is vital that parents let children know which behaviors are unacceptable, while they understand that times are difficult.  Reassuring your child that they can handle and manage their feelings in healthy ways is a vital message. 

In order for a parent to be available to their child, it is crucial that they first take care of themselves.

 The following are suggestions to help create a sense of calm and normalcy, in order to help yourself and your child manage and cope with strong feelings:

  1.    Maintain structure

Our daily routine offers predictability and a sense of stability.  

Having a regular time for school, free time, meals, social media, can be helpful in providing a sense of stability.

  2.    Exercise and go outside

 Any outdoor activity is a calming, healthy experience:  taking a walk, bike riding, hiking, bird watching, rock collecting or just enjoying the spring weather can shift your mood.

  3.    Practice self- care

You must take care of yourself in order to be available to your child.  Be sure to carve out time to rest, take a bath, talk to a friend or relative, or anything that nurtures you.

  4.    Stay connected with others

Maintaining social distancing doesn’t mean disconnecting from friends and family.  With technology there are many ways to communicate, and though we all may be using devices more than usual, they are invaluable for us right now.  Children and teens especially need to communicate with their peers and feel a part of their social group.

  5.    Card decks

There are a number of card decks that can give you ideas of activities and coping strategies for your children. A deck that provides both is the Melt Anxiety and Relax Card Deck for Kids: 44 Strategies Using Art, CBT and Mindfulness (Click on the title for more info) that I wrote with Dr. Abel. It also provides 12 tips for parenting children with anxiety.

  6.    Take time for fun

This is a unique opportunity to do things we never find the time for.  Play games with your family (in person and remotely), have a remote party, enjoy meals together, watch a movie.  Allow you and your family to take a break and just enjoy the moment.

 Remind yourself regularly and often that  this will pass, and that one day we may look back at this time with a sense of nostalgia….

 What might Dr. Seuss have said, if he were alive today?

The buildings were big, and people would smile

And travel they did, mile by mile

But sick they became, in numbers it grew

Businesses worried, communities too

Things stopped for a bit, the world slowed its fast roll

The virus had certainly taken its toll

But what they then saw, from slowing things down

Is in fact they now had fewer reasons to frown

Families now gathered, what game shall we play?

Pass me the blue crayon, give mommy the grey.

We’re all home together, so let’s read a book

Afterwards, then, together we’ll cook

The lungs of the planet caught a small break

Less travel meant less pollution to make

People did realize they’d all be OK

They don’t need so much to get through every day

Maybe this virus that caused so much stress

Showed the whole world that more can mean less

• Source unknown - revised by Barbra Danin

Websites with Resources for Parents:

https://childmind.org/article/supporting-kids-during-the-covid-19-crisis/

https://www.npr.org/2020/03/13/814615866/coronavirus-and-parenting-what-you-need-to-know-now

https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/health-crisis-resources/talking-to-children-about-covid-19-(coronavirus)-a-parent-resource

https://www.sciencenews.org/article/coronavirus-pandemic-covid19-how-parents-kids-can-stay-safe-sane

https://www.kxan.com/news/local/austin/parents-balancing-working-from-home-and-taking-care-of-their-children-during-covid-19-outbreak/

https://www.ctvnews.ca/health/coronavirus/help-i-ve-got-kids-what-do-i-do-tips-for-parents-working-from-home-1.4855001

https://www.weforum.org/agenda/2020/03/working-parents-school-closures-coronavirus/

For Teens and Parents of Teens

https://www.buzzfeednews.com/article/rachelysanders/teens-teenagers-at-home-isolation-coronavirus-school

Barbra Danin is a Licensed Marriage & Family Therapist & Clinical Art Therapist and Certified EMDR therapist, treating individuals, couples and families, and is currently conducting therapy sessions via tele therapy.  Barbra works with children, parents, and families, and is currently practicing in the Philadelphia area.
Barbra can be reached at bdanin@barbradanin.com or (314) 477-8585.  Learn more at www.barbradanin.com 

Anxiety During the Coronavirus: Part 14, Help for the Helpers on the Frontlines of COVID-19

Many healthcare workers on the COVID-19 frontlines are overwhelmed and traumatized. In addition to putting your lives on the line, many of you are quarantined from your family and some have insufficient PPE. Many are having to make multiple difficult decisions daily and have see an unprecedented number of people suffer and die; sometimes even colleagues. 

You are amazing! You are also human! So, it is crucial that you express your emotions: cry in the restroom, cry on the way home, go outside for 10 minutes to shed tears or blow off steam. Angry at a co-worker, administrator, or politician? Pay attention to your driving, but imagine they are in the passenger seat and express your feelings. Please see the post Laugh and Cry (Part 3) for the science behind this recommendation and additional help.

Keeping your body relaxed is very important to help with immune function and to survive emotionally.  “How can I possibly relax? I have no time and am way too stressed to relax” are common thoughts on the front lines of COVID-19. Fortunately, relaxation strategies need not take any time at all and can be done without stopping your work activity. Test it out! Because most of you are standing or walking most of the day, stand or walk now while engaging in your favorite strategy simultaneously. Now pretend. Go through the motions of a common work activity while engaging in your strategy. (The exception is you can’t do breathing strategies while talking) Want more strategies? Check out parts 2, 8, and 13 of this series. If you have more time 1, 5 and 11 are also pertinent. Finally, just sighing can activate the parasympathetic nervous system as can taking a single slow diaphragmatic breath. Try them now. For many 56 quick anxiety reducing tips, order The Melt Worry & Relax Card Deck.

It’s easy to get distracted and forget to use your coping strategies. Try to get into the habit of using strategies every time a machine starts beeping, each time you switch rooms, someone calls your name, or when you change tasks. Put up sticky note reminders when possible. Change the wallpaper on your phone or change the ringtone and text-tones. Each time you experience the reminder, engage in your strategy.

No doubt you’re exhausted. Read post 13 and when you experience one of your reminders, ask yourself “do I need all this energy” or “what’s the least amount of energy I can use while doing this procedure? Writing notes? Walking down the hall?” Follow with your favorite word, like soft, loose, or relaxed (See part 8 to find your best word). 

People in helping professions are great at taking care of others, but aren’t nearly as good at taking care of themselves. Now is the time for you to finally ask for what you need, or even want, from others. And take time to self-nurture.

I heard today that people wearing scrubs are being discriminated against out of fear they’re carrying the virus. Some have been mugged or antagonized because they are known to have a job. Please know that the majority of us, not just patients and their families, are very appreciative of your sacrifices.  Know in your heart that having a purpose is a positive predictor of happiness, even though you probably aren’t feeling particularly happy right now. Similarly remember that even when you feel helpless, you are still helping! 

Thank you very much for all the help you are providing, especially if you are putting your life at risk and/or isolating from your family to help! To say THANK YOU I have a gift for you. E-mail me (use the sidebar link) your position and your hospital, firehouse, military branch of service, etc. and I will give you my mindfulness and relaxation digital recordings with the guide absolutely free ($6.99 value). This offer is good until 4/24/2020. 

Dr. Jennifer L. Abel is an expert in worry and the author of three books and two card decks including Resistant Anxiety, Worry, & Panic.

Anxiety During the Coronavirus, Part 13 The Benefit of Loose Muscles

When we experience threat our bodies gear up to try to protect us. It triggers our sympathetic nervous system (SNS) or what is more commonly known as the fight or flight response. Our heart rates and respiration increase along with many other physiological changes, to help us fight and run to minimize harm. This is very helpful when you’re being chased by a bear or warding off a mugger, but for most 21st century stressors, including COVID-19 it does way more harm than good. Because muscles run from head to toe it’s the SNS response that affects the body the most.  In addition to causing muscle discomfort and pain it can cause or contribute to headaches, fatigue, high-blood pressure, insomnia and a whole host of other issues. 

The absolute best antidote to managing your muscle tension and SNS response is progressive relaxation. But, it takes an hour to learn, it is difficult to learn without demonstrating, and requires a big time commitment on a daily basis. So I’m going to give you two quick ways to loosen your muscles. 

Differential Relaxation

Right now use your seat back to rest against and place both feet on the floor. Think of letting go of your muscles and allowing your body to be completely relaxed. Say these words out loud or think them in your mind, pause between each word while noticing what feels the best….loosening…loose…softening…soft…letting go…butter…jello…heavy…light…releasing…released or pick a word of your own that better describes how your muscles feel when most relaxed. 

Now stand…letting go of all tension in your face, hands, arms, shoulder. Using the least amount of tension in the rest of your body. If you’re swaying, great, it’s a sign you’ve let go of a lot of the tension in your legs, if not - think of letting go of 1/2 of the tension in your legs or loosening the legs until you begin to sway. Use the word or words you chose in the previous paragraph. Do the same while walking and throughout your day. 

Tin Man to Scarecrow 

Instead of using Superman to emulate, use the Tin Man as you may strain your muscles if you think of making them like steel. Tightening all the muscles like Tin Man (75%-80% of maximum tightness) for about 8 seconds and then let them go like a Scarecrow for about 30 seconds. Repeat. 

For kids who haven’t seen the Wizard of Oz, ask them to be a spaghetti noodle - first being the uncooked noodle and then the cooked noodle. For anxious kids under 12 check out the Melt Anxiety & Relax Card Deck (click on title) by Barbra Danin and me. One card is the spaghetti noodle idea. Buy the deck for 43 additional tips for kids and 12 tips for caregivers of anxious kids. Teenagers LOVE the Melt Worry & Relax Card Deck (click on title) and many adults love it too. 

Progressive Relaxation Resource

If you want to learn how to do progressive relaxation you can learn it from me for a cost. Just click on the title The Art of Perfecting Muscle Relaxation. At the moment it is 50% off! (Regular price is $59.99, now only $29.99) Psychotherapists, nurses, and some other helping professionals can get 1.5 CEUs. 

Jennifer L. Abel, Ph.D., International Speaker, Author, and Anxiety Expert

Anxiety During the Coronavirus: Part 12, Socializing During Social Distancing

Photo by Alexander Dummer on Unsplash

This is a guest blog by Patrick B. McGrath, Ph.D., Head of Clinical Services, NOCD www.TreatmyOCD.com

Hey, I still like you - just at a distance. 

Social distancing is sure in vogue these days. Keep six feet away and wear a mask and wash your hands and do not get overwhelmed with the ever changing news landscape and on and on and on. 

While social distancing may be good for us in terms of viral transmission, it is surely not that great for us when it comes to the fact that humans are social animal, and we have been asked to go against what just feels natural for us - to be social. So, how do we approach social distancing in a social way? Here are some ideas: 

1. Get out of the house. You can still go for a walk, wave at the neighbors, put funny signs in their yards, or leave fun messages on their sidewalks with chalk. 

2. Have a cookout with the neighbors, with each of you remaining in your respective yards. No need to share food, but you could at least sit on the opposite sides of the fence and chat and enjoy a meal together. 

3. Order a meal and have it sent to a friend as a surprise.

4. Call one person a day to have at least fifteen minutes of social time. 

5. Write a letter once a week to someone - it will make their day to get some mail that is not just bills. 

6. Do a meeting on a social media platform and make it social - not just for work. 

7. If you have supplies in your home for a rainy day project, looks like now might be a great time to do that project and share the daily updates with friends and family and get comments and suggestions from them on-line.

8. One friend of mine has brought her electric piano out on her porch and has been doing outdoor concerts for people in her neighborhood. Know how to play an instrument? Give a free concert. 

9. In Colorado at 8:00 PM there are neighborhoods where everyone goes out and howls like wolves. Organize a fun neighborhood activity like this in your neighborhood. 

10. In Chicago there was a city wide singing of a Bon Jovi song one evening. See if you can organize a city event like this. 

Just because we are not able to be physically together does not mean we cannot be social - we just have to be creative in how we do it. All the best to everyone. 

Patrick B. McGrath, Ph.D.

Head of Clinical Services, NOCD

www.TreatmyOCD.com

Anxiety During the Coronavirus: Part 11, What do You Want?

While I took the above photo and agree with the sentiment, I’m in disagreement with the semantics. We learn so much more when we are advised what to do rather than what to not do. Likewise, we feel better when we think of doing a good thing rather than not doing a bad thing. I remember watching a little boy running at a pool and the father said “Walk” I was so impressed. As a bystander “Walk” felt so much better than hearing him yell “Don’t Run.” Most importantly the child did precisely as he was told immediately and I’m sure he felt better than if his father had yelled “Don’t Run.” 

I’d like for you to notice how you feel as you say these words: 

Don’t Give Up Keep Going Going Strong

Don’t Be Scared Be Brave Being Brave

Stop Being So Negative See the Upside

Don’t Go Out  Exercise, Sit Outside, Wear a mask when out getting essentials

Most of you noticed that the words in the middle or to the right felt better. Not only that, they are more motivating.

As you take on the challenges of the Coronavirus/COVID-19 think about what you want to do. That is, how would you like to behave differently? How do you want to think? Be realistic with how you want to think. Remember that positive thoughts are only helpful if you believe they are true. When you change what you do and how you think you will almost certainly feel better. But it can also be helpful to consider how you want to feel while considering how your actions and perspective will make you feel better. Look for others who are making the best of this situation.  Consider writing about this and revisit your goals for thinking, doing, and feeling better!

Jennifer L. Abel, Ph.D. author of: Active Relaxation, The Anxiety, Worry & Depression Workbook, Melt Worry & Relax Card Deck, and Melt Anxiety & Relax Card Deck for Kids

Anxiety During the Coronavirus: Part 10, Finding Faith in These Times.

This is a guest post by Linda Hermann, M.Ed. LPC with The Marriage and Family Institute (click here for a link to her site)

Maybe you know the story of the Israelites wandering in the dessert for 40 years after they were led out of Egypt?

-So a leader had appeared....his name was Moses (some of you may be envisioning Charlton Heston right now)...he helped them stand up the Pharaoh and to be released from slavery. You think they’d be grateful, right? Well, just like a lot of us in this century, they quickly began to complain. They turned their back on their faith because life was hard in this new place. So God let them wander..... for 40 years... before coming to their Promised Land.

What they didn’t realize, and what we don’t often acknowledge, is
we grow the most in the land between Egypt and the Promised Land.

Faith in something bigger than ourselves can really flourish there....not in spite of, but because we are being tested. And we are certainly being tested now.

This can be a time to renew/refresh that part of yourself, no matter what your spiritual background:

-Many churches have on line services where you can “worship together” from your living room (live and recorded). Easter is coming. Tune in to an online Good Friday or Maundy/Holy Thursday service to remember why you are remembering this time.

-Mitzvahs - Temple Isreal, St Louis, is pairing up youth pen pals with shut in seniors... do something good!- passover starts Wednesday.....this year’s could be an extremely memorable one.

-Passover is a celebration of spring, of birth and rebirth, of a journey from slavery to freedom, and of taking responsibility for yourself, the community, and the world.

- if nature is your sacred space, be sure to take some time to commune with it. Try forest bathing “Just be with trees. No hiking, no counting steps on a Fitbit. You can sit or meander, but the point is to relax rather than accomplish anything” says writer E. Livni.

• -  In recovery? Visit an online 12 step group.

• -  Set up a space in your house for prayer or meditation and commit to 10 minutes a

  day there

• -  Pray for others. Caring about others takes the focus off your fear.

• -  Listen to podcasts, the audio bible, or the Calm app, the Pray app... refreshing your

  spirit on your daily walk

  St. Ignatius Loyola, the founder of the Jesuits, often talked about two forces in our interior lives: one that draws us toward God and the other away from God. Let this be time that draws us into our spirituality, not away from it.

  Yes, we are in the place between Egypt and our promised land....this is your time to not just endure, but to grow.

Anxiety During the Coronavirus: Part 9, Happiness in the Midst of COVID-19

Photo by Stan B on Unsplash

I keep reflecting on something that I learned from the Positive Psychology literature, also known as the Happiness literature: The happiest people are those who have lived through adversity, not those with an adversity free life. This is important because it means that everyone is dealing with adversity right now and I am hopeful that nearly all of us will come out of it being a little better. While it may take time, I believe that many of us will be a little bit happier when it’s over. I could write several paragraphs on the gifts of shattering my femur like having a deeper appreciation for things like friends, showering, driving, and walking. I hope we all have a greater appreciation for hugs, attending sporting events and parties, and dining out, just to name a few. 

About 50% of our happiness is genetic and get this: Only 10% of what determines happiness is our circumstances - income, where you live, age, social status. This includes our stay-at-home order right now!  The good news is 40% is determined by intentional behaviors - things we can control right now. I’ve already given you some of those tools which includes physical activity, your perspective, not only exercises the body, but neurotransmitters and there is evidence that if we vary it we do better.  I’ve been walking almost daily to change my scenery and I go a different route every time to see different homes, trees, decorations etc. 

People who experience FLOW more are happier. To me, flow is being completely mindful, in the moment, while engaging in an activity like cooking, making pottery, playing tennis, gardening, or woodworking. My favorite flow activity is playing the piano. Think about what puts you in flow and do more of it. 

“In general people do really good when things go really bad” Daniel Gilbert, Ph.D. (Stumbling on Happiness). Many people are surprised that they are doing as well with this as they are. The greater point is that we see people stepping up to very good things. We see this in parades for the healthcare workers, birthdays, and those returning from the hospital. People are reaching out to elderly neighbors. Many who are financially stable frequently get carry out to keep their local restaurants afloat and some are giving way better than usual tips to restaurant staff, even at fast food drive thrus. Restaurants are feeding hospital staff for free. Hospital staff are working longer hours and are quarantined from their families. Perhaps the biggest heroes are those who have retired and are going back to help, especially those who have traveled to NY to help out. There’s a saying -  when you’re feeling really down, do something nice for someone else, you’ll both feel better. This is the number one reason I’m writing this blog, to help those struggling through this. I’m doing a few other things too. IF you are doing good things, Thank You!!! If not, consider what you can do to step up! 

Want to learn more about Happiness:

• Watch the documentary Happy (Free on Amazon Prime). 

• Read any number of books on Positive Psychology or Happiness

• Listen to the podcast Happiness Lab by Laurie Santos of Yale or

• Take a Class - You can audit her entire class for free The Science of Well Being (click on the title). Her class Psychology and the Good Life is the most popular class in Yale’s 300 year history with 1/4 of students taking it.  

Want to write a guest blog post or have suggestions for one, e-mail me at abelshrink@gmail.com.

Anxiety During the Coronavirus: Part 8, Using Process Words is Calming

Photo by Jeremy Bishop on Unsplash

One small, but significant, way of being mindful is noticing that what we think affects how we feel. Too often the words we use when we attempt to alleviate tension and anxiety are often words that mean we’re fighting anxiety; therefore, sometimes they have the opposite of the calming effect we intend. A very simple and small change in the words we use can make a big difference in the way we feel and the effectiveness of the strategies we use.

Command, Process, or State?

TRY THIS EXERCISE:

Notice where you feel anxiety in your body now. If you don’t feel much at the moment, think about where you feel it in your body when you feel anxious or worried.

1. Focus on that place or places now.

2. Remember these three words: Relax, Relaxing, Relaxed

3. Soon, I’m going to ask you to close your eyes and say each of these three words aloud Pause in between each word while noticing how you feel.

4. When you’re ready, close your eyes and begin. 

5. Now repeat each of the words in reverse order (Relaxed, Relaxing, Relax) continuing to notice how you feel. 

If you are like most people, you didn’t pick “relax.” Has anyone ever told you to relax and you just want to flip ’em off? Or it just makes you less relaxed? That’s because “relax” is a command. Commands create tension and even anxiety. When trying hard to relax or let go unsuccessfully time after time, many people feel hopeless and depressed. Like when we try not to think about blue monkeys (see Chapter 2), when we try too hard to resist our anxiety, at best, it isn’t helpful and at it usually leaves us frustrated or more anxious. Command words make us try harder than process words do. 

“Relaxing” is a process word. Unlike commands, process words do not create tension. It’s more natural too, because becoming relaxed is not immediate—it is a process. Nothing in nature goes from high to low or fast to stop in an instant. Therefore, process words are much more comfortable. Relaxed is a state of being. It is also not a command, so it is more likely to be helpful than “relax.” If you picked “relax,” it may have only been because it was first in the list, and it may also only have been the most helpful to you because it was first. So choose either “Relaxing” or “Relaxed” for the next exercise.

NOTE: Unfortunately the lack of formatting options on this site doesn’t allow the ease in which the actual worksheet in the book does. Sorry if this is a little confusing.

IF you chose “Relaxing,” you picked a process word proceed here and when you get to the word “STATE” skip to FINDING YOUR BEST WORD. If you liked “Relaxed,” you picked a state word, so skip down to the word STATE.

1. Go back to focusing on the places in your body where you typically feel anxiety.

2. Closing your eyes, say the words below with a pause after each one, noticing which feels best.

• Calming

• Softening

• Releasing

1. Write the word that felt best to you.

2. Repeat the above instructions with the next two sets of three words below.

• Loosening

• Letting go

• Chillin’

• Breathing

• Freeing

• Soothing

STATE

1. Go back to focusing on the places in your body where you typically feel anxiety.

2. Closing your eyes, say the words below with a pause after each one, noticing which feels best.

• Calm

• Soft

• Released

1. Write the word that felt best to you.

2. Repeat the above instructions with the next two sets of three words below.

• Loose

• Peaceful

• Chill (as “I am chill,” not “Chill out”)

• Soothed

• Free

• Tranquil

FINDING YOUR BEST WORD

1. You should now have a list of 3 words. You can add “relaxing” or “relaxed” to that list. Or perhaps you can think or another process or state word that you like.

2. Read the list and remember to pause in between words. Noticing how each word feels.. Narrow your favorites down to two to three. Next, close your eyes and thinking or saying those two to three. Check the best one. You may check more than one if you’d like.

3. In the days to come, instead of telling yourself to relax, chill out, calm down, or breathe, use the word or words above when you feel anxious or tense. If you chose states of being (e.g., loose, tranquil) these words might be of limited effectiveness while you are anxious or frustrated. If they aren’t effective, it may be that they aren’t believable. For example, if you are very anxious, “loose” may seem so incongruent with how you feel that it doesn’t work. Process words may work best in this situation. So, when you are feeling anxious, if the state-of-being word that you chose isn’t working, experiment with the equivalent process word instead (e.g., “loosening” instead of “loose”; “becoming tranquil” instead of “tranquil”).

4. Share this idea with the people who are closest to you, particularly if you find them using command words to try to help you. Encourage them to use process words when they notice that you are worried, anxious, or frustrated. When others use commands, translate them into states of being or process words in your mind. So, if someone tells you to “let it go,” think in your mind “letting go.”

This is an excerpt from my workbook that was edited to make a blog post. For many more exercises and worksheets you can purchase this book by clicking on this title: The Worry, Anxiety, and Depression Workbook: Cognitive–Behavioral and Mindfulness Exercises to Melt Worry, Decrease Anxiety, and Improve Mood

Anxiety During the Coronavirus: Part 7, New Trigger, Same Anxiety

Photo by Mickey O'neil on Unsplash

This is a terrific guest blog by Kathryn Stinson, LPC who specializes in unconventional lives. Check out her website by clicking here: KathrynStinson.com

This pandemic situation we are facing may be new, but the anxieties it triggers are not. 

 I’ve been struck by this over and over for the last two weeks, talking with friends and family. We are not all worried about exactly the same things. For some people, fear of getting sick or dying is the worst part. For some, it’s the thought of losing someone we love or depend on. Some fear the financial fallout. Some fear weeks of  isolation more than anything else. 

None of these worries is unfamiliar. 

Anxiety can be triggered by any stressful situation, and for the most part, it is remarkably predictable. It likes to focus on whatever feels most vulnerable in our lives. It hits on the same familiar themes, over and over again, and chances are, you can recognize those familiar old tapes playing in what anxiety is saying to you now. 

This is good news. Why? Because it means we know what to do!

Everyone who has ever experienced anxiety has some hard-won knowledge about what helps and what hurts. Because anxiety is being magnified, now is the time to magnify the practices that support our psychological immune system in countering it. What do you know about what works for you?

·      Do you know that lack of sleep sets you up for excessive anxiety? Now is the time for good sleep hygiene. 

·      Do you have a mindfulness or yoga practice? Now is the time to start, recommit, or ramp it up. 

·      Do you know that alcohol or caffeine can be triggers for you? Now is the time for setting limits. 

Doctors treating patients are looking at what they already know about viruses and what clues that knowledge might offer about how to deal with this one. We can apply the same wisdom to dealing with anxiety. Coronavirus may be a novel bug, but there is nothing novel about the anxiety it triggers. It’s the same old anxiety, and we know how to keep it from taking over.  Kathryn Stinson, LPC

Kathryn’s point is spot on! If you’d like to learn more skills, tomorrow I will be posting an excerpt from my book or to get dozens of tips, get my workbook or one of my other books. Short attention span? Check out my Melt Worry & Relax Card Deck by clicking on the title! There’s also a deck for kids and their caregivers by Barbra Danin and me: Melt Anxiety & Relax Card Deck for Kids (click on title)

Anxiety During the Coronavirus: Part 6, Target Relationship

This is a guest block by Linda Hermann, M.Ed. LPC with The Marriage and Family Institute (click here for a link to her site) edited by me.

Before all this got really crazy, I thought to myself “a silver lining in all of this is going to be relationships will have the chance to really flourish!”  Now, as the weeks have gone by, I really am seeing that.  Primary relationships and other friendships. 

I have this theory about relationships…..picture the bullseye. Some of “our people” are in the center ring.  They are the ones we can be vulnerable with ….transparent with….  They have been there for us, and we are there for them.  If we are lucky, we have a couple of those.

Moving out a ring, there are those we feel are REALLY good friends.  We can share almost anything with them. They step up during a crisis.  They really have our best interests at heart, want us to succeed and will help us do so. The outer rings represent the movement from close friends to mere acquaintances.   During this time, I am hearing stories of people moving towards center in our rings:

Stories of neighbors helping neighbors. 

Stories of people sending loving texts to friends.

Phone calls from people who don’t usually talk on the phone.

Video conferencing calls between family and friends

Smiling at strangers

Game nights with families

Walks with neighbors they have never walked with before

I challenge you to do one thing every day to move someone from an ‘outer ring’ towards an inner ring!

Having said all that, this can also be a really hard time for relationships, particularly if the relationship was already strained. Close quarters and the stress all around us in the world can take their toll on relationships. To do damage control and remedy problems TRY TO:

• Reach out to others to let off some steam when you’re upset. Don’t keep all that pressure ‘inside” the relationship between the two of you. Remember to speak softly and avoid blaming. 

• Build your relational bank account……do something every day to build up the person in the relationship that is hurting.  Even if you don’t feel like it.  It will pay off for you, them and the relationship. This can be something as simple as making them coffee. Tell them they are attractive to you.  Tell them something you really like about them. Read them something fun out loud.  AND do something together each day…puzzles - card games - walk at sunset - drive through the country - picnic in your front yard !

• Move every day…..30 minutes each day for your mental well being!  (see Jen’s blog #5 for ideas)

And if you feel like you need more….many therapists are seeing people via Telehealth platforms.  Reach out to a professional if you need more help.

Anxiety During The Coronavirus: Part 5 - Depression during COVID-19

Photo by Joshua Rawson-Harris on Unsplash

 STAY ACTIVE

Exercise is one of the most effective anti-depressants. I almost did an entire post encouraging you to keep moving during coronavirus stay-at-home orders because it is also important in managing anxiety and frustration. Most of us are getting significantly less exercise.  Even if you never went to the gym, you’re not walking to and from your car, around an office, or around stores. But if you and your brain are accustomed to going to the gym, a yoga studio, or spinning, the drop in endorphins can be a huge mood changer. Unless you’re actually quarantined, most places are allowing outdoor exercise. I think this is best because we get a break from being in our homes, have the added advantage of enjoying nature, and we get Vitamin D (you get more Vitamin D from the morning sun and supplements are relatively safe too) which improves mood if you’re low. If weather prevents or you are quarantined try these ideas: 

1. Run or walk up and down stairs. 

2. Purchase a video set or a few videos (variety)

3. Consider an online subscription like BeachBody or LesMilles. 

4. Amazon Prime includes some exercise videos free. 

5. Dance - Turn on your favorite tunes and dance in the kitchen or living room. 

6. Similarly - Blast the tunes and do some moves that you remember from classes. 

7. Buy expensive equipment like Peleton, a stair master, stationary bike, rowing machine, etc. 

8. Buy cheap equipment - for $50 or less you can get a mini-trampoline, a peddler, a set of weights, or a step platform. 

9. Go for a hike. 

HAVE KIDS??? They love to “make shapes with their bodies” doing yoga with you.  BeachBody has a workout for kids and rumor has it it’s free temporarily. And you can dance with them to some of their favorite songs. Maybe play hide and seek. 

INJURED? If you can, get in a sauna or steam room. Even a hot bath can increase your heart rate and help you to sweat out toxins. If your legs are injured, work your core and upper body. And of course, there’s a plethora of things you can do to stay active if your upper body is injured.

I dragged my mini-trampoline out of the basement, jump/run on it with weights with music on low to keep me motivated while watching NetFlix. I get some free streaming from my gym and have done one class with LaBlast and one with LesMilles.  I take long walks when weather permits and plan to go biking and maybe hiking. 

MANAGE WORRY

It turns out that more often than not, worry is the cause of depression even if you feel more depressed than anxious. The key feature of generalized anxiety disorder (GAD) is excessive and uncontrollable worry and it usually appears early in life. It puts people at risk for developing more disruptive anxiety disorders like panic and OCD, but it also often winds up leading to depression. You could say that people don’t worry enough about their worry, because they get used to it and don’t realize the havoc it’s causing with more difficult mental health problems. In a recent meta-analysis (study statistically including multiple studies over many years) it was actually found that when cognitive-behavioral therapy is used for GAD, depression improves just as dramatically as when cognitive-behavioral therapy targets depression directly (Cuijpers et al., 2014)! We used only relaxation to treat GAD in one of our studies and depression improved significantly and improved just as much as when they learned cognitive strategies that would expect to help depression even if they got both relaxation and cognitive therapy too (Borkovec et al., 2002). This connection is why I wrote my workbook: The Anxiety, Worry, & Depression Workbook, 65 Worksheets & Tips to Let Go and Feel Better (click on the title to learn more). 

BETTER BUT BELIEVABLE; B3s 

I don’t advocate putting on rose colored glasses because changing your thinking is only going to help if you believe your thoughts. This is why I developed B3s or Better But Believable thoughts. When you’re thinking negatively, think of better thoughts that are believable. So if you are thinking “I hate this stay at home order. I’m so Isolated and I miss my friends and everything I used to do for fun. It’s just awful.” You won’t feel better if you think “I love the stay at home order. It’s great!” Think of what is good about it that you believe is true. Some will feel better and believe these statements for example: I get to spend more time with my pets, I don’t have to deal with traffic and save time I was commuting, I save on gas plus wear and tear on my car, I save time not putting on make up or shaving, I can get up later, I have more time to watch TV. 

Some of my thoughts are: 

1. Things will get better.

2. Even if it’s two months, it’s a very small portion of my life. 

3. I have everything I need.

4. It’s way better than grad school when I worked 100 hours/week stuck inside.

5. It’s great that it’s Spring. I can enjoy the outdoors. 

6. I’ll appreciate socializing more when I can get together with others. 

7. I’m enjoying playing piano more.

8. Thank god for video chat. 

9. Thank god for Netflix.

10. I am cooking more. It’s better for me and I enjoy doing it. 

11. I have a sense of purpose in helping others by writing this BLOG. 

12. I had time to clean out my lazy Susan

13. I’ll have time to do many of my projects around the house I’ve been wanting to do. 

14. Less people will die and be traumatically injured in car wrecks. 

15. It will be safer to ride my bike on the streets. 

16. It will cut down on pollution. 

For more help with depression, get my workbook and check out my answer to How to Help Friends who Are Depressed on the previous BLOG and apply it to yourself.