Category Archives: behavior therapy

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

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

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

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

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

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

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

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

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

“It’s a lot of paperwork.” 

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

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

For example:

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

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

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

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

What’s in your backpack?

I was speaking with someone reluctant to make any sort of commitment to a small change in the routine. Things were not going well for my friend, and the future seemed murky. With no clear picture of “where the journey is heading,” taking any first step seemed imprudent, my partner in conversation asserted; it would be better to wait until the “where” is sorted out in life before making a concerted effort in any direction.

One reasonable response to that is, there is no “standing still” in life: attempting to stand still just means things around you will change while you pretend you can hold your position.  See how that works for you standing in the ocean. Maybe that seems trite; the whole “you never step into the same river twice” trope that is, as it happens, absolutely true.

Another way of looking at my friend’s dilemma is this: no matter where my journey is going, some items always go in the backpack. I may not always need the water purification straws, or the sleeping bag rated for freezing weather, but I always need underwear and socks. I always need a spare pair of contact lenses and sunscreen. I always need a small Bible. I always need chocolate and my thyroid medicine. Even without knowing where, or when, I’m going, some things can go into the backpack.

No matter where your life journey is taking you, wouldn’t it be helpful to have a better quality of sleep? More physical energy?  A firmer sense of what your values are, and why, and what the implications are for daily life? A little less messiness in the closet or refrigerator or your car? Less weird clutter and mysterious crumpled papers in that one drawer? Some better thinking habits, whether it’s taking on a phobia or developing your capacity for focused attention?

Even if you’re feeling really stuck – a lot of pressures, an unhappy job situation, the first year or so into significant grief – perhaps there is one small thing you can do first– something you can “put into the backpack” – without a clear picture of where you hope to be heading. And, as you’re putting those essentials into your pack, perhaps the mystery of the next few steps on the journey will begin to come into focus.

Happy trails –

Life-Changing Hacks

Confession: I really dislike the term “hack.” It sounds awful, like a data breach somewhere, drenching the dark web with the personal info of thousands of people. It also used to mean someone whose work was poorly done and usually rushed, or the work itself. Somehow it became slang for “something you can do to make things easier/simpler/better.”

So be it, then.  In the spirit of openness (in which I score extremely high in personality tests), here are seven “hacks” for a happier life:

  1. Spend at least 15 minutes a day sitting in silence. For me, it is prayer time. This is a powerful early-day practice. If you are religious, this is a good time to sit with Scripture, a devotional book if you use one, and a small notebook in which to write a brief response as part of your prayer. For some people of faith, opening with a short Scripture reading and sitting silently in a contemplative mode of prayer is better.

If you are not religious, use it as quiet meditation time, focusing on breathing in a way that feeds relaxation and focus.

Why it works:  The research on the benefits of such a meditative practice is robust: brain health, heart health, reduced depression and anxiety symptoms. For people of faith, it becomes an opportunity to listen and reflect on God’s presence in their lives and how they are called to live. Taking a few moments to formulate your thoughts and write to God can help anchor you into the experience. The act of writing – words of gratitude, questions, fears – helps with focus and invites you to be in dialogue.

  • Go on a news fast.  If something horrible that actually requires your attention happens or is imminent, like a hurricane or other disaster, you’ll find out about it. Otherwise, just skip the news for a week, or two, or more. Then titrate your dosage:  15 minutes a day, checking into two or three varied sources.

Why it works:  repeated exposure to what are often the same events, or people discussing those events, has the neurological effect of repeated distressing experiences and amplifies your stress level. By quickly reading, rather than watching and listening, you will be better able to glean information without being overly stimulated emotionally.

  • Once a week, avoid all electronics except:
    • Live interaction with loved ones at a distance
    • Shared experiences with family or friends such as watching a movie together, which you can then discuss over a meal.

Why it works:  you will necessarily be spending more time in the real world, either resting, being creative, or otherwise having your life rather than passively observing others’ lives.

  • Go outdoors every day, preferably in the morning.

Why it works:  Morning daylight helps with brain chemistry; it contributes to a better mood and improved sleep by getting your melatonin system set properly.  It is also a good time of day to get your beneficial Vitamin D exposure (check with your physician) and to take in the benefits of exposure to nature: the sky, the sights, sounds and smells of plants, the sight and sounds of animals.

  • Clean up your diet.  Experiment with giving up highly processed junk foods. If you are a “one toe in the water” type, pick one change at a time and stick with it. Add a small change a week. If you are a “cannonball into the pool” type, go all in: get rid of the chips, the fast foods, the super-sweetened snacks.  See how you feel after a couple of weeks, after the worst of the withdrawal has passed and your tastebuds start to recover.

Why it works:  junk food is addictive, hijacking your dopamine system; it leads to erratic moods both because of the direct up and down of dopamine and the very complex relationship between the gut and the brain. The research here is abundant and easy to find; simply put, you’ll feel better. Your energy level should be more stable, helping you feel more energetic and, without that brain/body overstimulation from processed snacks in the evening, you may even sleep better, which leads to number 6:

  • Be religious about sleep.  If you are a 7-hour-a-night person, get those 7 hours; if you are a 9-hour person, get the 9.  Since you will be consuming less electronic media you should be able to squeeze out the time.

Why it works:  Sleep is essential. It is when your brain, and the rest of your body, does a lot of its clean-up and repair work. Your brain uses sleep to sort out information, store memories, and do important work such as using your new, improved, healthier diet to rebuild your stress-and-junk-damaged hippocampi, amygdala, etc.  Try to go to bed and get up at around the same time every day. If you are skeptical, then be scientific about it: do this as a four-week experiment and then assess the outcome.

  • Be committed to a daily exercise routine appropriate to your health requirements.  Your physician can give you info on recommended guidelines and any limitations or considerations you need to bear in mind.  There is no one routine for everyone, but unless you are on doctor’s orders to remain resting and sedentary, there is something you could do in this area. You may have to start slow; you may have to scale back because you are burning out; you may need to add variety so you are addressing cardiovascular health, strength, flexibility and balance.

Why it works:  Well, look at the data!  We are engineered to move, not to sit for hours.  Regular exercise is good for physical and mental health, can help with social well-being for those who exercise with or around others, afford time in nature, and help with sleep and digestion. 

So, there you go.  Seven simple hacks for a happier life.  Most of them cost nothing; even healthier eating could start with a money-saving switch of water in lieu of sugar- or artificially-sweetened prepared beverages. So – all simple, all potentially free. Since it doesn’t cost anything – what’s the harm in giving it a one-month trial run?  If one month of free, simple changes could mean more well-being in multiple areas of life, that seems like a great bargain – cheaper than coming to therapy and paying me, or someone else, to tell you the same thing.

I could tell you, but you’re not going to like it: Anxious Youth

As you know, this column isn’t intended as psychotherapy or professional advice. It’s information and entertainment, and, I hope, the spark for some conversation with someone who can help with a problem. The problem here is anxiety in all its forms.

According to the Anxiety and Depression Association of America, about 31.9% of youth have some sort of anxiety disorder.  This would include diagnoses such as generalized anxiety, separation anxiety, panic disorder, and trauma disorders. It’s hard to believe this is accurate; if it is, then as a culture, things have gone horribly wrong. 

We know a lot about what works, and what doesn’t work for anxiety.  Isolation, the vortex of doom the internet can be, the misguided or malevolent support of random strangers online, endless social networking, and a sedentary, sleep-starved, junk-fed existence don’t work.  Overscheduling doesn’t work. Avoidance doesn’t work. Irresponsibility doesn’t work. So do the opposite.

Get off the devices except for schoolwork.

Get enough sleep. Go to bed at a set time, get up at a set time. Every day, even weekends.

Cut down on activities.

Read real books. Learn about other people’s interior lives via good fiction (that’s a primary reason that we read classic literature in school; to understand more about how other people think, feel, and respond to life’s events). Then talk about them. That means parents should read them, too.

Get physical activity.  A healthy young person needs at least two hours of activity a day, and ought to be standing, moving around, and active a big chunk of the rest of the time.  

Learn useful skills.  For example, everything it will take to manage one’s own money, car and home.

Socialize in person, often while doing something purposeful (whether that’s a sport, volunteering, or other activity).

Spend a lot of time in nature. If it can’t happen just about every day, plan a four- or five-hour chunk on the weekend.

Have chores and responsibilities for young people.  No, “school is not their job” and therefore nothing else is to be done around the house. How are they going to learn necessary life skills? Plus, who wants a spouse or roommate who thinks going to work covers them for any contribution to home and family life?

Learn mindfulness meditation skills, to slow down the stress response and “step back” from anxiety-provoking thoughts. This facilitates the cognitive restructuring of cognitive-behavioral therapy, in which new ways of thinking and behaving are identified and rehearsed.

…and try cognitive behavioral therapy (CBT), preferably with at least one parent learning, too, to be coach and to help the parent. Anxious parents tend to teach their children fear-fueled ways of thinking and behaving, and anxious parents are apt to facilitate avoidance.  Avoidance is like jet fuel for anxiety. Find a licensed mental health professional who will work with you as a family to teach the skills. Keep in mind that CBT will work much better if the other parts of life are in healthy, working order – proper sleep, nutrition, exercise, etc.

To expand on an earlier point: parents, often your anxiety feeds your child’s anxiety. If you are behaving as if the world is a terrible, dangerous place, do not be surprised if your child responds the same way.  Making changes together to have a healthier, less anxious lifestyle will help the whole family.

I could tell you: Bryce Canyon Therapy

I could tell you, but you’re not going to like it…there’s no way to defeat fear without going through it

I am afraid of heights.

Not, “Eew, a little squeamish standing on the observation deck at the Empire State Building” afraid of heights. I mean, heart-pounding, sweaty-handed angst when faced with the open stairs in your typical outdoor, three-story-ish observation tower. I come by it honestly; I apparently took a few hard tumbles down long flights of stairs as a toddler. Hence the reality that “falling can and does happen, and it’s bad,” is hardwired in.

The thing of it is, avoidance works perfectly if by works you mean, never feel that afraid. It also means missing out on things, standing around at the bottom of things feeling slightly foolish when everyone else goes up and looks out over scenic vistas that I will see as a thumbprint on their cell phone screens.  The only way to reduce it, or at least have the experience that fear will not be what kills me, is to go through it.

Enter our long-planned, long-saved for vacation earlier this year to Utah, where we joined a small group tour hiking and camping and taking in five of the national parks: Arches, Bryce Canyon, Capital Reef, Canyon Lands and Zion.  The first day, we set up camp nearby and drove over to Bryce Canyon to see the canyon at sunset and see the trail we would take on the next morning just past sunrise – a narrow path down the cliff walls, through the varying terrain of the bottom, and back up the narrow path along the cliff walls.  I spent half the night in turmoil, crying with fear, and woke up knowing if I did not do that hike, I would regret it for the rest of my life. Meanwhile, of course, my amygdala were trying to convince me that the rest of my life would be short because I would certainly fall off a cliff and die.

I did hike the trail, sometimes in tears, sometimes trying to melt into the cliff face away from the edge (sorry, everyone who had to pass me; I disobeyed the rules of foot traffic on that).  By the end of vacation, I was navigating through elevations with much less fear. I am not a fan of heights, and probably never will be, but I know I can feel afraid and still do reasonable things.

Sharing this tale with friends, one shared that he, too, is afraid of heights and that’s why he decided to apply to and go through jump school in the military (as in, jump out of perfectly good airplanes). He didn’t expect it to cure his fear of heights – it didn’t – but it did do what he hoped, which was convince him he could handle scary things, something he wanted in his pocket before being deployed to war.

The purpose of this rambling set of tales is to illustrate what’s happening when we therapists annoyingly insist people face their fears, even one small step at a time, if the fear is keeping them from doing the normal, necessary things of life and/or barring them from their goals. Whether it’s elevators, public speaking, or driving over bridges, only taking the small, often agonizing steps forward works. Thinking about it, waiting until you’re magically not afraid, or postponing only convince your emotional, instinctive brain parts that the situation in question merits that level of fear. In other words, avoidance doesn’t reduce fear, it increases it. Every time I started up an observation tower, freaked out and sat down on the steps and then crept back down before reaching the top, I didn’t accomplish anything except making my fear worse.

So when, as the therapist, I encourage you to plan out, with me, and begin taking small steps towards conquering the fears that block you from living as enthusiastically as you’d like, I am not being mean or insensitive. I am not failing to understand how gut-wrenching fear can be. I get it. Really. As in fear-sweat drenched, heart-pounding, climbing that narrow path in and out of Bryce Canyon on a hot day getting it.