The Cycle of Anxiety

Anxiety causes us to worry about an event we believe might potentially happen while trying to find ways to cope with the negatives that could follow it. This is done by paying extra attention to possible signs of a potential threat, looking internally to see if you can cope with the threat which results in noticing your anxiety symptoms, believing you cannot handle the situation, and becoming more anxious. The cycle of anxiety starts with anxiety, moves to increased scanning for danger with physical symptoms increasing, seeking a way to escape or avoid the situation, short term relief following avoidance, and a long term increase in physical anxiety symptoms, more worry, less confidence, and an increase in safety behaviors. 

One of the main ways people try to reduce symptoms of anxiety and worry is by avoiding the situation all together, however this only creates more anxiety in the long run. Avoidance causes one to believe that their emotion is dangerous and should be avoided by all means necessary. By acting on these avoidance behaviors, you continue to scan the environment for signals of danger and safety which can result in an increase in anxiety and generalize to other situations. “Safety behaviors” are things such as always having an exit plan for anxiety inducing situations, relying on the security of your phone, or only doing things when people you are close to are involved. Creating and using these safety behaviors causes a dependence on them without learning that our emotions do not equal actual danger. By suppressing the emotion we are actually heightening the emotion and increasing future distress. 

Reversing the cycle of anxiety looks like confronting the feared situations without utilizing safety behaviors, short term slight increase in anxiety with a decrease in physical symptoms and attention scanning, use of coping skills causing anxiety to reduce to a manageable level, and greater belief in one's ability to control their own responses. It’s important to note that fears should be gradually confronted because it will improve confidence with less feelings of being overwhelmed or unsafe. “Graded exposure,” or taking the feared situation step-by-step as opposed to fully head on is recommended. Starting with situations that feel easier to handle and then working your way up to tasks that seem more challenging show better outcomes.

Source: CCI Health

Parenting Styles

There are four different types of parenting styles and each style acts as a guide for a child’s morals, principles, and conduct. Typically, most parents can be categorized into one type of parenting style, however it is possible to have some characteristics from another category. 

The first style, authoritarian parenting, is seen when a parent uses strict rules that are not explained and the child is expected to obey them with no room for negotiations or errors. There tends to be little warmth or positive involvement stemming from the parent to their child in addition to not considering the child’s desires or opinions. Here, there is a lot of anger and displeasure directed towards the child and when the child behaves poorly or does something inadequately harsh punishment is used. Children raised in this parenting style typically are the most well-behaved due to consequences of misbehaving, however they have higher levels of aggression which they have difficulty managing since they were never properly guided. Additionally, children raised in this category usually have poorer self-esteem, rebel against authority figures as they get older, are shy, and have difficulty making decisions. 

The second style, authoritative parenting, revolves around the parent and child having a nurturing, warm, involved and responsive relationship. The parent has guidelines they expect their child to follow and explain why they are being disciplined as a way to support the child instead of punishing them. Parents practicing this style consider a child’s desires, opinions and ideas because they value their input. There is an appropriate level of communication between parent and child with the parent not yielding to child coercion. Parents expect mature, independent, and age-appropriate behaviors due to the standards, communication and enforcements they have set. Generally, this style leads to the healthiest outcomes and children tend to become confident, responsible, and have the ability to self-regulate. Children raised in this style have a better ability to handle negative emotions leading to better social outcomes and emotional health. Children learn they are able to meet their goals independently, have higher self-esteem, and have higher levels of academic achievement.

Permissive parenting is seen when the parent is warm and nurturing, but there are little to no expectations for the child. Here, a parent acts more like a friend as opposed to a parent figure. Parents glorify free expression of impulses and desires while not communicating or enforcing rules. Poor behavior is typically ignored or accepted and in result the parent doesn’t expect maturity. Limited rules can result in unhealthy eating habits, impulsivity, demanding behaviors, selfishness, and a lack of self-regulation. 

The last parenting style, uninvolved parenting, is seen when a child is given absolute freedom because the parent is not involved with the child. A parent will try to avoid their child and/or fail to monitor activities their child is engaging in. Parents here tend to be neglectful and unresponsive while pursuing self-gratification at the expense of their child’s welfare. Although basic needs such as food, water and clothing are usually met, parents remain detached from anything else going on in their child’s life. Discipline is not utilized, there is limited communication, and there are no expectations for the child to meet. Children raised in this parenting style are usually resilient and self-sufficient because they were forced to develop these skills out of necessity. Additionally, children can have difficulties managing their emotions, have less effective coping skills, greater academic challenges, and difficulty maintaining social relationships. 

Source: National Library of Medicine

Phobias

Phobias can be defined as an overwhelming and exhausting fear of an object, place, situation, feeling or animal. Phobias develop when an individual has an unrealistic sensation of danger and can become so severe that the person organizes their life around being able to avoid the root of their anxiety. In America alone there are about 19 million people that have one or more phobias that vary in severity. Typically, phobias are first seen between the ages of 15 and 20, however they can develop in early childhood. Men and women are affected equally, but men tend to seek treatment for their phobias more when compared to women. 

Genetic and environmental factors impact the manifestation of a phobia and certain phobias can be linked to a negative first encounter with the feared object, situation, place, feeling or animal. Phobias are a type of anxiety disorder and symptoms include dizziness, nausea, sweating, heart palpitations, shortness of breath, trembling, and stomach issues. There are a variety of things someone can develop a phobia about, but there are two main categories: specific/simple phobias and complex phobias. Specific or simple phobias are centered around a certain object, animal, situation or activity that often develops during childhood or adolescence and tends to become less severe in adulthood. Examples of specific phobias include animal phobias, environmental phobias, situational phobias such as flying, bodily phobias such as vomit, or sexual phobias such as contracting an STI. 

Complex phobias are typically more debilitating when compared to specific phobias and usually develop during adulthood. These phobias tend to be associated with a deep-rooted fear or anxiety about a situation or circumstance. The two most known complex phobias are agoraphobia and social phobia, or social anxiety disorder. People living with a phobia are usually aware of the problem and may choose to live with it, however there are treatment options available. Simple phobias can be treated by a clinician through self-exposure therapy where the client is gradually exposed to what is causing them fear and anxiety. Treatment for complex phobias include psychotherapy and cognitive behavioral therapy, additionally medications such as antidepressants or beta blockers can help with anxiety.

Source: John Hopkins Medicine, National Health Service

October: National Domestic Violence Awareness Month

October has been assigned National Domestic Violence Awareness Month for the past 34 years and is used as a time to acknowledge survivors and be a voice for victims. Domestic violence is seen in every community regardless of age, socio-economic status, sexual orientation, gender, race, religion, or nationality. This form of abuse has systematic patterns of dominance and control, additionally abusers often use emotional abuse to gain even more control over their victim(s). Progress has been made in reducing reported cases of domestic violence, however there are still more than 10 million abuse victims annually in America alone. 1 in 3 women and 1 in 4 men have experienced physical abuse from an intimate partner resulting in millions living in fear within their own homes. Furthermore, children who are exposed to this violence have a long-lasting negative effect on their well-being, social and academic functioning. 

Domestic violence is an interrelated pattern using a range of abusive behaviors that increase in frequency and intensity over time. The cycle of violence has three phases with phase one beginning with the abuser picking fights, acting possessive, being critical, and drinking or using drugs. During phase one, survivors may begin to feel like they are walking on eggshells, need to appease or calm the abuse, keep children quiet, and feel afraid and anxious. In phase two, abusers begin to restrain their partner, commit verbal, sexual, emotional, and physical abuse, destroy property, and increase control over their victims finances. During this phase, survivors begin to experience fear and shock, try to flee, protect themselves and their children, and call for help. Phase three is seen when abusers ask for forgiveness, promise to change, stop using substances, seek counseling, act affectionate and intimate, and deny abuse. Survivors during phase three may blame themselves, minimize or deny abuse, forgive, feel manipulated, or feel hopeful. This cycle of phases can happen multiple times within an abusive relationship and can take anywhere from hours or years to complete. 

Safety plans are a personalized plan to improve safety while experiencing abuse, preparing to leave an abusive partner, or after leaving an abusive partner. Leaving an abusive relationship is when the survivor is most at risk, so having a safety plan in place can help protect yourself and others in stressful situations. To see examples of safety plans for during an incident, preparing to leave, obtaining a restraining order, being home or outside your home after a separation, and emotional health please visit: https://www.courts.oregon.gov/programs/family/domestic-violence/Documents/DVSafetyPlan.pdf 

National Domestic Violence Hotline: (800) 799-7233

Sources: NCTSN, Doorways VA, National Domestic Violence Hotline

The Power of Gratitude

Gratitude is exhibited when a person has a thankful appreciation for what they receive, whether that is physical or not physical. When we acknowledge the positives in our lives it helps us connect with something larger than ourselves which can be other people, the environment around us, or a higher power. Positive psychology research has found that gratitude is consistently associated with experiencing greater happiness. It helps us to feel positive emotions, recognize good experiences, improve health, cope with adversity, and build stronger relationships. Gratitude can be felt and expressed in multiple ways such as applying it to the past, present, and future.

An example of applying gratitude to the past is remembering positive memories from childhood. In the present, applying gratitude can be seen by not taking things for granted as it happens in real time. Lastly, an example of applying gratitude to the future can be done by having an optimistic attitude. There is a vast amount of research supporting the power of gratitude with one of the studies finding that couples who take time to express gratitude for their partner feel more positive towards their partner and feel more comfortable expressing concerns about the relationship. Another study found that managers who say “thank you” to their employees may notice the employees feel motivated to work harder. A third study found that children and adolescents who wrote and delivered thank-you letters to someone who made a positive impact on their lives made the other person happier. 

Gratitude teaches us to appreciate what we have as opposed to searching for something new in hopes it will make us happier or feel more satisfied. At first, practicing gratitude can feel forced, but our mental state grows stronger the more we intentionally use it. There are many ways to practice gratitude with the first being thanking someone mentally. Thanking someone verbally and/or writing a thank-you note shows an appreciation for how someone has had a positive impact on your life. Keeping a gratitude journal is another option that can become a positive habit for acknowledging the goodness in your life. Counting your blessings, or sitting down to remember a specific number of positives each week, can be very beneficial. For people who are religious, prayer is a powerful tool to express gratitude to a higher being. Lastly, meditation that focuses on the present moment without judgment is another useful way to practice gratitude. 

Source: Harvard Health Publishing 

People-Pleasing

The term “people pleaser” has become more popular in recent years, although it is not a medical diagnosis or something that can be measured. People-pleasing can be defined as when an individual feels an intense urge to please others at their own expense. Typically, people who feel this way do not view their needs or desires as important and place emphasis on the needs and desires of others. An example of this would be a college student helping their friend with an assignment even though they do not have the time and it adds stress to their life. It’s important to note that traits of pleasing people are different from traits such as generosity because it is not being done as a favor, it is being done as an obligation because they feel like they cannot say no. 

For many with people-pleasing tendencies, the urge to please while sacrificing what they need goes back to only feeling loved or useful when continuously doing things for others. This is different from altruism, the desire to help others, because with altruism a limit exists, and that limit does not go beyond sacrificing your own wellbeing. Signs of people-pleasing include finding it hard to say no to requests, taking on extra work you do not have time for, avoiding advocating for their own needs, trying not to disagree with others, and ignoring things they are not happy about. People-pleasers may feel pressured to be positive at all times, anxious at the thought of defending themselves, stressed because of prior commitments, frustration over a lack of alone time, their own needs and wants do not matter when compared to others, and that people take advantage of them. 

People can develop people-pleasing tendencies for a variety of reasons with one of the main reasons being trauma. The term “fight, flight, or freeze” have become well known, however research suggests that there is another trauma response called “fawn,”. Fawn is a severe form of people-pleasing where an individual will try to receive affection and admiration from those they fear in order to survive. An example of this is growing up with an abusive caregiver, but doing everything in your power to make them proud of you. Another common reason these tendencies develop is due to living with a personality disorder, specifically dependent personality disorder (DPD). With DPD, people feel extremely dependent on others for help and approval in multiple aspects of their life. Other causes of people-pleasing include low self-esteem, anxiety, conflict avoidance, culture and socialization, and inequity. 

Because people-pleasing causes one to neglect their own needs, there are risks of doing so. Risks include stress, tiredness, neglect, resentment, relationship problems, loss of identity, role conflict, and harming others. To begin breaking the people-pleasing cycle, start small by committing to meeting one need at a time for yourself. When asked by others for assistance, stall and say you need some time to think instead of automatically saying “yes,”. Another tip would be to set time limits, this can be done by agreeing to help but only for a set amount of time that will not add any unnecessary stress to your life. Time blocking, or intentionally blocking out time in the day for yourself, will help end the cycle. Lastly, rehearse saying “no,” in ways that feel comfortable for you. For some people, rehearsing how they will say “no,” prior to seeing or speaking to someone helps ease any anxiety they may begin to experience. 

Source: Medical News Today

Behavioral Activation for Depression

Behavioral Activation (BA) is a CBT skill that helps us understand how behaviors influence emotions. BA was specifically designed to help address depression in clients due to a symptom of depression being not partaking in activities that bring you enjoyment and feeling like there’s no meaning to life. BA works to reverse the cycle of feeling worse because we are not partaking in activities that bring us joy and instead have us use actions and choices. The CBT skill involves understanding the cycles of depression, monitoring daily activities, identifying goals and values, building motivation through pleasure and mastery, and problem solving barriers to activation. Additionally, it involves reducing avoidance, working as a team to create gradual progress, using between-session assignments, and intentionally scheduling activities. 

Because depression comes from parts of our brain that’s trying to protect us it also isolates us, so continuing to follow the lead of depression results in lower motivation. By activating first, our brain starts to feel better right away and the more we activate the more positive experiences we have. A key pillar of BA is doing things when we don’t want to instead of waiting until we feel better and want to do it. When actively experiencing depression we cannot wait for our brain to give us the motivation to do something. Instead, we need to make the conscious decision to activate, or do the opposite of what depression is wanting you to do that aligns with the values and goals identified, to foster more positive emotions. 

Behaviors such as exercise and meditation can improve our mood right away, however BA wants us to focus on partaking in behaviors that we enjoy and are important to us. In order to feel more consistently engaged and happy in the world, it is best to find goals that are centered around your values, pleasure, and mastery. If you are having difficulty with a problem you feel as though you cannot solve, there are three ways to address it: get the facts, problem solve, or accept what cannot be controlled. One may work better than the other, or utilizing all three may work best, it just depends on the problem at hand. Getting the facts means thinking and understanding the situation, then determining if you need to use problem-solving skills or accept that it’s beyond your control. 

Dealing with low motivation can be a difficult task, however it’s important to remember not to look for our internal emotional state, such as being happy or energized, to cue us to begin a task. Instead, work from the outside-in by acting rather than waiting to feel internally ready. Tips to increase motivation include breaking the activity into smaller pieces, setting realistic goals, using self-compassion, anticipating setbacks, minimizing distractions, changing your environment, and rewarding healthy behavior choices. 

Source: University of Michigan: Medicine

The Brain-Gut Connection

Because the gastrointestinal tract is sensitive to emotions, when we experience things such as anxiety and sadness our gut can begin to trigger symptoms. Our brain has a direct effect on our stomach and intestines and vice versa, so when our gastrointestinal tract is in distress it can either be the cause or result in the production of anxiety, stress, or depression.  Sensations of nausea prior to or during public speaking, having butterflies in your stomach, and having a feeling to go with your gut are examples of the brain-gut connection. Stress or other psychological factors affect movements and contractions of the GI tract.

Stress makes existing pain seem worse, and this is seen in people diagnosed with a GI disorder because they typically perceive pain more intensely than others due to their brain becoming more sensitive to pain signals coming from the GI tract. Studies have found that psychologically based approaches can lead to an improvement in digestive symptoms when compared to only receiving medical treatment. The reason psychological interventions help aid in the treatment of GI disorders is because the brain sends signals to the GI tract via the sympathetic (fight or flight) nervous system and the parasympathetic (rest and digest) nervous system. Ideally, we want there to be a balance of signals between the two because they affect the speed at which food moves through the digestive system. This balance impacts how the GI tract absorbs nutrients, the secretion of digestive juices, and the level of inflammation within the digestive system.

Within the digestive symptom is another nervous system, the enteric nervous system (ENS) which consists of 100 million nerve cells in and outside of the GI tract. The ENS receives messages from the sympathetic and parasympathetic nervous system, although it has the ability to function independently. Additionally, the ENS is connected to immune cells where information about bloating, infection, or insufficient blood flow are sent back to the brain. Due to the strong connection between the brain and gut, research has found that mind-body tools help improve GI symptoms, improve mood, and decrease anxiety. Mind-body tools that promote a healthy brain-gut connection include meditation, mindfulness, breathing exercises, yoga, and gut-directed hypnotherapy. These tools are so effective because they decrease stress within the body which calms the sympathetic nervous system, enhance the parasympathetic nervous system, and decrease inflammation. 

Source: Harvard Health Publishing: Harvard Medical School

September: National Recovery Month

September is an important month because not only is it National Suicide Prevention Month, it is also National Recovery Month. The goal of Recovery Month is to educate Americans on available substance use treatment and mental health services that can help those living with a mental and/or substance use disorder to live a healthy life. This month we celebrate those in recovery in order to reinforce a positive message that our mental health is vital to our overall health. Recovery is possible, treatment is effective, and there are preventions that work to help those struggling with a substance use disorder. 

Talking about addiction and educating the general public allows a better understanding of what it’s like to have a mental and/or substance use disorder. The less we acknowledge addiction in the United States the more shameful and taboo the subject becomes. In reality, addiction is a disease of the brain that requires authentic care and understanding not just from professionals, but society as a whole. In the United States alone, over nine million people 12 years or older misused opioids in the past year. Additionally, over 46 million people 12 years or older, about 16.5% of the population, met the DSM-5 criteria for having a substance use disorder in the past year. Around 29 million people were diagnosed as alcoholics and 24 million people were diagnosed as having a drug use disorder. 

Although there are treatment options available, 94% of those diagnosed with a substance use disorder did not receive treatment in the year 2021. The pattern and progression of substance use disorder starts with experimental or prescription use, occasional use or using prescription medication not as intended, heavy use which then develops into a substance use disorder. Factors influencing the development of a substance use disorder include the effect on your brain chemistry while under the influence, genetics, mental health conditions, access and exposure to substances, and adverse childhood experiences. 

The three main forms of treatment include detoxification, cognitive and behavioral therapies, and medication-assisted therapies. Settings for treatment include outpatient counseling, intensive outpatient treatment, inpatient treatment, and long-term therapeutic communities. Within the realm of psychotherapy are a variety of effective therapies that help to treat those living with a substance use disorder. Cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and assertive community treatment (ACT) are just a few examples of beneficial treatment options. 

Source: Cleveland Clinic, U.S. Department of Health & Human Services, National Association of Addiction Professionals

Mom Guilt

Simply put, “mom guilt” is feelings of guilt and shame mother’s feel when they are not living up to their own expectations or the expectations of others in their role as a parent. Guilt itself is defined by researchers as “a core emotion governing social behavior by promoting compliance with social norms or self-imposed standards.” Because of this, those experiencing mom guilt try to follow the cultural norms of “what a good parent does,” but the voice inside their head tells them they are failing as a parent. Humans have various roles they play in their life such as being a friend, coworker, sibling, parent, and spouse which can cause each role to compete for your time and prioritize one over the other.

When “shoulds” consume our thoughts such as “I shouldn’t be looking forward to my time away from my children,” or “I should be making my kids a home-cooked meal every night and not ordering take out,” it creates internal turmoil. As guilt builds, stress builds and prolonged stress has a negative impact on our physical and mental health. Living with chronic guilt and stress can result in anxiety, increased heart rate, increased blood pressure, and depression. The more guilty and stressed we are feeling will also result in being less effective in the roles we play so it’s important to work through mom guilt. Self-care is one of the top tips to work through mom guilt. One study suggested that feelings of guilt are intensified if we believe our actions are affecting others, so taking time for yourself means not caring for your children, resulting in your choices affecting them. However, when we do not take time for ourselves there can be a buildup of resentment and even more stress making you more irritable, anxious, and angry. It is vital to make self-care a priority, your children will benefit from it. 

Another tip to work through mom guilt is to practice mindful breathing, specifically the five-finger breathing technique to reset your thinking. When doing this, as you breathe in, use one finger to slowly trace the opposite thumb from base to tip. Breathe out as you trace down the other side of your thumb and continue this with each finger. After reaching the bottom of your pinky finger, reverse directions and continue until you reach the base of your thumb. An additional tip is to avoid the comparison game, meaning don’t compare how you are as a parent to your coworker, friend, or social media influencers. Lastly, talk it out! Talking about our concerns allows us to take some of the weight off of our shoulders while acknowledging what we are going through and how it’s impacting us. 

Source: Cleveland Clinic

Health Anxiety

Health anxiety, also called illness anxiety disorder or hypochondriasis, is when you spend an excessive amount of time worrying about if you’re ill and getting ill to the point where it starts to take over your life. This condition is related to obsessive compulsive disorder (OCD) and people may confuse bodily sensations as a serious illness. Symptoms of health anxiety include constantly worrying about your health, frequently checking yourself for signs of an illness, needing constant reassurance from others that you’re not sick, and worrying that a medical test missed something. Additional symptoms include obsessively researching health information, avoiding anything that involves talking about a serious illness such as TV commercials, and acting as if you’re ill. 

This condition can alternate in severity with an increase in age or during stressful times. The excessive anxiety about getting ill causes severe distress that disrupts an individual’s life on a regular basis. Although there is not a clear-cut answer as to the cause of this condition, there are three factors that play a role: beliefs, family and past experiences. The belief that you might have a hard time tolerating uncertainty over unusual bodily sensations can lead to the misinterpretation that all body sensations are serious. Having parents that worry too much about their own health or yours can be a cause. Additionally, having past experiences with a serious illness in childhood can cause fear of physical sensations.  

Risk factors associated with health anxiety include being in a stressful time in your life, the threat of a serious illness that turned out to not be serious, a history of child abuse, serious childhood illness or a parent with a serious illness, personality traits like being a worrier, and excessive health-related internet use. Because this condition has a negative impact on a person’s daily life, complications will arise. Complications include relationship or family problems, work-related performance problems or absences, problems functioning in daily life that could result in a disability, financial problems due to medical bills, and having another mental health disorder. 

Those living with health anxiety have options as to how they can properly handle and treat the condition. Seeking professional advice as soon as possible will help symptoms from getting worse and disrupting your life. Learning to recognize when you’re stressed and how it impacts your body can be done by regularly practicing stress management and relaxation techniques. If you see a professional for health anxiety it’s important to stick with the treatment plan to prevent a relapse or from symptoms getting worse. 

Source: Mayo Clinic, NHS

Cognitive Distortions

Cognitive distortions are unreasonable and illogical thoughts that influence our emotions based on the type of distortion. Although everyone experiences one or more forms of a cognitive distortion, if an individual does not recognize the irrational thought it can become harmful. The first cognitive distortion is overgeneralization which is when individuals make broad interpretations from one or more events. An example of this is thinking “I felt awkward ordering food at the restaurant. I am always so awkward.” The second form of a cognitive distortion is magical thinking which is the belief that acts will influence unrelated events. One example of this would be “I’m an amazing partner, nothing bad should ever happen to me.” 

The third distortion, magnification and minimization, are when people exaggerate or minimize the importance of events. This can be seen when people either minimize their achievements or amplify their mistakes. Within the realm of magnification and minimization is catastrophizing which is seen when individuals only expect the absolute worst outcome of a situation. An example of this might be “My flight got delayed, it’s going to end up being canceled and I’ll be stuck in this airport forever.” Personalization is the fourth cognitive distortion which holds the belief that you are responsible for situations beyond your control. An example of personalization would be “My partner is stressed out, it must be because I don’t do enough for them.” A common distortion most people are familiar with is jumping to conclusions, meaning that an individual is interpreting the meaning of a situation with little to no evidence. Within this distortion are two others: mind reading and fortune telling. Mind reading can be seen when someone is interpreting the thoughts and beliefs of other people without any actual evidence. Fortune telling is the expectation that an event will turn out poorly without any actual evidence. 

Fortune telling is the expectation that an event will turn out poorly without any actual evidence. The sixth distortion, emotional reasoning, is the assumption that emotions reflect how things truly are. An example of this is “I feel like a bad mother so I must be a bad mother.” Disqualifying the positive is when you only recognize the negative aspects of an event while ignoring the positives. One example of this would be a yearly review with your boss and only focusing on the improvements they want you to make and not the positives they pointed out. The last two cognitive distortions are “should” statements and all-or-nothing thinking. “Should statements” are the belief that things can only be one specific way, whereas all-or-nothing thinking is thinking in absolutes like “always,” or “never.” 

Source: Therapist Aid

Solution-Focused Brief Therapy (SFBT)

SFBT was developed to help clients become more future-focused, goal-directed, and focused on solutions rather than focusing on problems the client is experiencing. It is a short-term goal-focused approach that utilizes positive psychology practices which helps clients construct solutions as opposed to problems. Overall, SFBT promotes positive feelings, motivation, achievements, and sustaining desired changes in behavior. The first step in SFBT is to create a description of how the client’s life will be different when the problem is gone or their situation is improved to a point where the client is satisfied. Following this, the client and clinician will search through the client’s lived experiences and behavioral reactions to find the necessary resources needed to create a practical and sustainable solution that the client can quickly implement. 

When creating a solution the clinician will help the client to explore previous “expectations” such as when the client has successfully coped with previous challenges. Both the client and clinician will identify goals that reflect the clients’ desires when developing positive solutions. There are techniques the clinician will use when questioning the client in order to clarify solutions and how they can achieve them. One technique is goal developing questions which includes asking the client to describe their best hope for what will be different after coming to therapy. Another goal developing question is asking what needs to happen after coming to therapy so the client will be able to reflect on therapy being a good idea. 

Pre-session change questions are another SFBT technique where, following the identification of a goal, the therapist will say something along the lines of: “We have learned that sometimes in between making an appointment and coming in, something happens to make things better. Did anything like that happen in your case?”. If the answer is “No,” the therapist will move on, however if they say “Yes,” it hints that the solution-development process has begun. There are many other techniques used in SFBT including looking for previous solutions, looking for exceptions, utilizing present and future-focused questions versus past-oriented focus questions, compliments, asking the client to do more of what is working, and asking miracle questions. 

Source: Institute for Solution-Focused Therapy

Reducing Social Isolation and Loneliness for Elders

Particularly for older adults, loneliness and social isolation have a massive negative effect on health, mental health, and mortality. Because of this, loneliness and social isolation among elders is a major public health concern and the reason for this is because 50% of lonely people are more likely to die prematurely. Both of these health concerns are rarely addressed in health and mental health care settings which has caused them to become the most modifiable risk factors for mortality and morbidity. Outside of all this, social isolation and loneliness among elders must be addressed because one in two people over the age of 60 are at risk of social isolation. 

It is important to note that social isolation does not equal loneliness. A person can become socially isolated, but that doesn’t necessarily mean they are lonely. Loneliness is defined as the sense of feeling alone that causes distress which is associated with having few, if any, social relationships. Risk factors for both concerns include living alone, loss of a loved one, depression, anxiety, dementia, poor health, loss of independence, limited financial resources, and a lack of transportation. Effects of social isolation and loneliness include cardiovascular disease, hypertension, obesity, depression, substance use, suicidal tendencies, cognitive decline, progression of dementia, stroke, and premature death. 

There are four main types of interventions and resources that can be used to help elders that are struggling with either one health concern or both. The first step would be to improve social skills by increasing verbal and non-verbal communication skills. The second is to increase social support, an example of this would be friendly visitors or in-home support services. Thirdly, it’s important to increase social interactions whether it’s social activities or telephone outreach. Lastly, it’s important to change unhelpful thoughts about social situations because some individuals who deal with loneliness have negative thoughts about others and can evaluate social situations in unhelpful ways. 

Source: Suicide Prevention Resource Center

Hypersomnia

Hypersomnia is defined as experiencing extreme daytime sleepiness despite getting the proper amount of sleep. This condition affects the ability to function at work and socially, as well as increasing the likelihood of being involved in an accident. Symptoms of hypersomnia include constant and extreme sleepiness during the day, sleeping ten or more hours daily on a regular basis but still having difficulty staying awake during the day, and decreased energy. Other symptoms include difficulty waking up in the morning or after naps (“sleep drunkenness”), anxiety, irritability, restlessness, slow thinking and speech, memory problems, headaches, loss of appetite, inability to focus, and hallucinations. The condition affects 5% of the population with it being more common in females than males. 

Although the causes of hypersomnia remain unknown and there isn’t a cure, there are many lifestyle changes that can be made to cope with the chronic illness. Going to bed at the same time each night, avoiding caffeinated products within several hours of bedtime, avoiding smoking near bedtime, and avoiding working night shifts can help one cope. When seeking treatment for this condition, the two main options are medications such as Provigil or Sunosi and lifestyle changes such as the ones mentioned above. It’s important to note that anxiety does not cause hypersomnia, however having the condition can cause an individual to experience anxiety. Because the condition can negatively impact your quality of life, it’s important to seek help from a sleep specialist and/or a therapist who can help manage symptoms. 

Source: Cleveland Clinic

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy, or CBT, is a form of psychotherapy that is effective when treating a variety of problems such as depression, anxiety disorders, substance use problems, relationship problems, eating disorders, and severe mental illness. The first core principle of CBT is that psychological problems are based on unhelpful ways of thinking. The second principle states that psychological problems are based on learned patterns of unhelpful behavior. Lastly, CBT states that people suffering from psychological problems can learn more effective strategies to cope which in return will relieve symptoms. 

In order to change thinking patterns, CBT uses strategies such as learning how to recognize one’s cognitive distortions in thinking that create problems, and then reevaluating them in reality. Other additional strategies to change thinking patterns include gaining a better understanding of the behavior and motivation of others, utilizing problem-solving skills to cope with difficult situations, and learning to develop a greater sense of confidence in one’s abilities. When changing behavioral patterns, CBT will have clients face their fears instead of avoiding them, use role play to prepare for potentially problematic interactions, and learn to calm the mind while relaxing the body. 

A psychotherapist and client should work together to develop an understanding of the problem and develop a treatment strategy that will best serve the client. Many times The 3 C’s are implemented into a treatment plan to help correct negative thoughts and thinking patterns. The first C, Catch It, means catch the negative thought. When you intentionally do this you learn to become aware of what you’re thinking and when you have a negative thought. The second C, Check It, asks the client to not be influenced by personal feelings when considering one’s thoughts and consider talking it over with a therapist or someone you’re close to. There are five sub-steps to Check It which include be rational, be specific, think in shades of gray, apply the double-standard technique, and get feedback. The last step in The 3 C’s, Change It, has clients substitute negative thoughts with a positive thought. An example of this would be catching a negative thought such as “My friend canceled our plans because she’s sick, is she secretly mad at me? Maybe she just doesn’t want to see me,” and replacing it with the positive thought “My friend canceled our plans because she’s sick, I hope she feels better soon. Once she is better we can reschedule our movie day.” 

Source: APA, Sharp HealthCare

The Nervous System: A Breakdown

Our nervous system guides everything we do, think, say, feel, process, move, and remember. This system impacts every part of our health including memory, learning, feelings, balance, senses, sleeping, healing, aging, heartbeat, breathing, response to stressors, digestion, and bodily processes such as puberty. Simply put, it is the command center that regulates the body’s systems while allowing you to experience the environment you’re in. Neurons send signals throughout the body that then travel between the brain, skin, organs, glands, and muscles. After experiencing sensations, the nerves send the data to and from the brain. 

There are two main parts of the nervous system which are the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS is the body’s control unit and is composed of the spinal cord, brain stem, and the brain. The PNS is the body’s link to the external world because it sends information from the brain and spinal cord to our organs, arms, legs, fingers, and toes. Within the PNS are two other systems: the somatic nervous system and autonomic nervous system. The somatic nervous system helps to guide our voluntary movements and the autonomic nervous system controls things we do without thinking about them, such as blinking. 

The somatic nervous system has two systems within it: the sensory nervous system (sensory input) and the motor nervous system (motor output). Within the autonomic nervous system there are two systems, the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). The SNS preps the body for action and stress, which we refer to as “fight or flight.” This system arouses us and the body, whereas the PNS calms us and the body while helping conserve energy within ourselves by “resting and digesting.” When the SNS is in control, pupils begin to dilate, heartbeat increases, and muscles tense up due to potential danger. When the PNS is in control, there is reduced heart rate, muscles begin to relax, and there is no need for “fight or flight.” 

A working nervous system is essential to our wellbeing, and a dysregulated nervous system causes numerous problems for an individual. A dysregulated nervous system is when there’s an imbalance between the sympathetic and parasympathetic nervous system. Symptoms include insomnia, migraines, anxiety, chronic pain, GI distress, and/or high or low blood pressure. There are risk factors that can increase dysfunction such as trauma, chronic stress, metabolic disease, and hormonal imbalances. To help balance the nervous system, it’s important to access the vagus nerve through therapies such as breathing techniques and cold water immersion. Additional ways to tone the vagus nerve include exercise, meditation, massages, therapy, yoga, and eliminating stressors. 

Source: Cleveland Clinic, Dr. Ruscio, Byju’s Learning

Emotionally Focused Therapy (EFT)

Emotionally Focused Therapy (EFT) is an approach to psychotherapy using the science of adult attachment, developmental theory of personality, and intimate relationships. This model of psychotherapy emphasizes the importance of emotion and emotional regulation as being the key to individual experiences and relationship interactions. Although EFT is best known for couples intervention, it helps individual clients address depression, anxiety, post traumatic stress, and repair family bonds. 

The goal for couples when utilizing EFT is to expand and re-organize key emotional responses as well as organization of the individual self. The second goal is to create a positive change in partners' interactional positions and patterns. The last goal of EFT with couples is to create a secure bond between those within the relationship. Research has shown that EFT helps couples dealing with depression, anxiety resulting from trauma, medical illnesses, and forgiveness dilemmas. 

For individuals, one of the goals of EFT includes offering corrective experiences that have a positive impact on the self while creating long lasting and stable change. Other goals include providing moments where vulnerability is seen with balance, enabling clients to move into the openness, responsiveness and full engagement that forms secure attachments with others. Lastly, the goal of EFT with individuals is to help clients shape a consistent sense of a competent self that has the ability to handle existential life issues. 

When working with families, EFT has four goals with the first being accessing and expanding the awareness of unacknowledged feelings accompanied by the family’s negative patterns. The second goal is to then reframe family distress and child problems within relation blocks that are reinforcing the distress. Following this, EFT will help to promote awareness to unrecognized caregiving intentions and disowned attachment related needs. Lastly, EFT works to facilitate the sharing of unmet attachment needs as well as effective caregiving responses. 

Source: International Centre for Excellence in Emotionally Focused Therapy

Hypersexuality

 Compulsive sexual behavior, or hypersexuality, is defined as excessive sexual behaviors that are accompanied by social and personal distress. It is also referred to as a sexual addiction and has an intense focus on sexual fantasies with urges that cannot be controlled. The distress is accompanied by problems with one's health, job, relationships, or other aspects of a person's life. The natural unfolding of sexual curiosity at a developmentally appropriate age is damaged because of premature exposure. Typically, hypersexuality is the result of childhood sexual abuse and assault and is seen as the most common trauma response. The sexual behaviors involve different kinds of commonly enjoyable sexual experiences, however when the behaviors become a major focus in one’s life, are difficult to control, and cause personal distress it is likely compulsive sexual behavior. 

There are three major reasons as to why this trauma response occurs with the first being a form of validation. If an individual is only shown attention or “love” during abuse, especially in their formative years, one can learn to believe validation is linked to sex. Secondly, it can be viewed as a way to regain control because engaging in risky sexual behaviors means that the individual has control which reverses the roles by having power over their body. Lastly, chemical dependency impacts hypersexuality because if a person is used to being hypersexualized it can make them want to seek out similar feelings. 

There are many signs and symptoms surrounding compulsive sexual behaviors such as feeling unable to control compulsive sexual urges and an intense preoccupation with sex. Additional signs and symptoms include engaging to either feel pleasure (impulsive) or to escape emotions (compulsive), sexual behaviors leading to negative consequences, trouble maintaining healthy relationships, and intense sexual fantasies, urges, and behaviors that feel beyond your control. When deciding if you should seek professional help, ask yourself: Can I manage these impulses, am I distressed by sexual behaviors, are the behaviors hurting my relationships and causing serious problems, and do I try to hide my sexual behavior? 

Source: Mayo Clinic

Love Bombing

Love bombing is a manipulation technique used to intentionally overwhelm someone with affectionate and loving words, actions, and behaviors. This is done by the manipulator in order to meet their own personal goals by gaining the victim’s trust and affection. The technique is designed to manipulate one into spending all of their time with the manipulator and less time with themselves or others such as family members and friends. Love bombing is frequently used by narcissists in the beginning of a relationship so they are able to shape their partner into a member of their “cast”. This may look like the manipulator constantly reminding you “How good we are together,” when you are suspecting otherwise in an effort to keep you close. This line, “How good we are together,” is frequently used by a love bomber. 

There are nine key signs to look out for in a potential love bomber. The first sign is being lavished with gifts due to the manipulator wanting the victim to believe they owe them something. Non-stop compliments such as “I’ve never met anyone like you,” or “I love everything about you,” being said very early into a new relationship is a red flag that the feelings are not genuine. Healthy relationships develop naturally and gradually, because of this one should not express their undying love after a short amount of time. The third sign is bombarding your phone to the point where one begins to feel increasingly overwhelmed and as if the conversation is one-sided. 

Demanding your undivided attention is used to manipulate the victim into only spending time with the love bomber and feeling guilty when not doing so. True love respects other commitments, ideas, and boundaries. Similarly to non-stop compliments, trying to convince you that you’re soulmates with sayings such as “We were born to be together,” after a short amount of time hints at feelings not being genuine. Additionally, a love bomber may demand commitment by putting pressure on the victim to rush into the relationship while making huge plans for the future. Love bombers will also get upset when their partner tries to create boundaries because it makes it more difficult for them to manipulate you. The last two signs are being overly needy and feeling overwhelmed by the intensity of the relationship with unbalanced feelings. Healthy relationships do not require partners to only spend time with their significant other and relationships should not feel like a constant rollercoaster.