Happy Drynuary?

Empty pint glass

I’ve been seeing a lot of stuff about the trend for people to take the month of January off from consuming alcohol. There’s an interesting term, sober curious about people who want to look at their relationship with alcohol, and NPR just ran a piece on some of the aspects of the whole Drynuary project and what it may bring out for people. Some of the most interesting articles I ran across doing a little preliminary reading included stuff about how annoying people can be doing the whole Drynuary thing– making it more about virtue signaling and basically giving other people a hard time for a month instead of quietly doing their own thing.

Then, of course, there are the various hints that you may have an alcohol use disorder if you think it would be a good idea to take a month off from drinking. Call me a contrarian, but I would like to suggest that it’s just as likely for you to have an alcohol use disorder if you don’t want to take a month off from drinking. Think of it this way– who would you worry about more: a person who thinks it would be a good idea to go dry for a month, or a person who thinks they can’t possibly go dry for a month? Feel welcome to disagree with my point of view.

So we don’t necessarily want to lean too heavily into “maybe I have a problem” signaling, either. How many of us have had periods where we were diligent about going to the gym, avoiding sugar, fried foods, being vegan on Mondays or other self-imposed health improvement projects, only to realize somewhere down the line that we’d fallen off the sugar wagon or the meat wagon and we couldn’t even say exactly when it happened? There have been studies of people’s drinking habits after they did the Drynuary thing; a significant number of people end up drinking noticeably less six or eight months down the line. This suggests that when people re-think their relationship with alcohol by going on hiatus for a month, they decide to drink less and end up drinking less. Not what you’d expect from somebody with a problem; more someone who is just generally taking care of their health.

So, is Drynuary a good idea or a bad idea? I’m definitely with those who say that it’s a bad idea of you’re mainly about virtue signaling and giving other people a hard time for their boozy ways. I can get backup from what some would consider an unlikely source: “Why sit with a long face in places where there is drinking, sighing about the good old days. If it is a happy occasion, try to increase the pleasure of those there; if a business occasion, go and attend to your business enthusiastically. If you are with a person who wants to eat in a bar, by all means go along. Let your friends know they are not to change their habits on your account.” Alcoholics Anonymous, 4th ed. P.102 Yep, that’s right. The A. A. book gives that advice to people who have quit drinking. In other places it is suggested that the non-drinker not be a nag, a killjoy, a wet blanket. And that’s for people who are presumably intending to stop drinking for good, although A. A. is famous for the “One day at a time” slogan. The book also says “. . .not one drinker in a thousand likes to be told anything about alcohol by one who hates it.” (p. 103) And for someone who’s just on hiatus for a month, it would be sort of like badmouthing a lover you’ve broken up with when you’re not sure the split is permanent. So nix on the virtue signaling.

Just FYI, the NIH guidelines for safe drinking are a lot lower than many people think. They define moderate drinking as one drink a day for women and two drinks a day for men, and a drink is twelve ounces of beer at five percent alcohol, five ounces of wine at twelve percent alcohol, or a one and a half ounce shot of spirits at 40% alcohol. I was surprised to learn that in studies of alcohol use only about 70% of Americans say they had a drink of alcohol in the last year. I can’t find a reference to embed, but I remember being at a webinar on traumatic brain injury (TBI) and hearing that something like half of all the civilian TBI is caused by a fall while intoxicated. Everyone has heard of alcohol-related brain damage, but they don’t usually think of it as being the result of falls after drinking. Granted, most of the falls come to people who drink a lot, but if someone just happens to have a couple too many on a Saturday night, that’s a real risk factor– and if you do Drynuary that’s reducing your personal risk by at least one twelfth, right? And presumably throughout the year if you’re one of the people who continue with lower use patterns afterward. So dialing it back can be a successful change strategy. Just check yourself to see what February first looks like.

There’s not a catchy name for it yet, but maybe we need something like Healthuary, where we look at all our behaviors and focus on wellness. There’s Mental Health Month, which is the same as National Physical Fitness and Sports Month (May). I would prefer each to get their own month, but that’s how it is. How about good relationship month? Helping others month? National Eat Your Vegetables Month is June. Don’t wait! Eat your vegetables today. But no virtue signaling please.

Image from https://eatdrinkyorkshire.co.uk/yorkshire-christmas-beer-drought-threat-drivers-hold-strike-ballot-health-safety-issues/empty-pint-glass/

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Prescription: Nature

Everyone knows that time in nature is good for you, but there’s actual research that shows it. A heart surgeon discovered that his patients who went to hospital rooms facing trees healed faster than those that went to rooms on the side of the hospital that faced the parking structure. I’ve been a fan of the healing power of nature all my life, but the article linked at the beginning of this post is peppered with references to different studies that demonstrate how it can lower blood pressure and stress hormones and the effects last for days after the last exposure to it. There are people who theorize that because we evolved to be in nature all day every day of our lives that we naturally (see what I did there) feel better when we get back to our green shoots and roots. Other research shows that the beach or the plains or any natural environment can help; it doesn’t have to be the forest. Every little bit helps, apparently. If you’re in a totally urban environment, get a house plant. Go to the nearest park. If you can’t make the park, look at pictures or nature videos. Doctor’s orders.

photos copyright James Matter 2021

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Food (and Beverage) for Thought

4 'Alcoholic' Beverages with 0% Alcohol

In reports of a recent study researchers found that alcohol consumption increased chances of atrial fibrillation. Although previous studies hinted at this, the study reported in the New York Times was more rigorous in that it had participants wear recording devices that actually measured heart performance and blood alcohol levels. There have been other reports that alcohol consumption is good for heart health, but this one seems to be an important caveat. Does this mean we should all quit drinking immediately? Not exactly. The study involved people who had already reported having a-fib and looked at their alcohol consumption. So if you’ve never had a diagnosis of a-fib you’re not under the gun to lay off the sauce. But a couple of drinks in this study population tripled their chances of having an episode within the next few hours so if you have had the diagnosis it’s quite a wake up call. What’s interesting about this study is that it suggests that moderate alcohol consumption affects the electrical functioning of the heart. Two or three drinks didn’t used to be considered risky, but now there’s clearly a population for which this is the case. We’ve known for a long time that excessive alcohol use is bad for the heart, but this suggests the bar for risk is lower than previously thought. For those who have been intending to cut their consumption already, look at the bright side– it’s a motivator, right? But no recent bad news about chocolate, at least . . .

Image from https://allabout-japan.com/en/article/1888/

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Should I Should?

One problem is that “should” is a scolding word

When I first started studying cognitive therapy, I went down the list of cognitive distortions that David Burns has in his book, Feeling Good. Yes, it was that long ago. The successor book, The Feeling Good Handbook, also has the list of cognitive distortions, a bit modified (if I remember; I’m not looking at the two copies currently), and Dr. Burns has several other titles available– I’m not plugging him, but my experience with the above-cited books has been good. So, most of the cognitive distortions he listed made sense to me. Fortune telling– I make up a story about the future, then get bummed out because it’s a negative story. All or nothing, or black-and-white thinking– I make an absolute statement to myself, then get bummed out about it. Example: I went through a break up and I tell myself, “I’ll never fall in love again.” That can qualify both as fortune telling and all/nothing thinking, so you get the idea. But there was one of the cognitive distortions that I just couldn’t get the hang of, the “should” statement. What’s wrong with that? Isn’t it true that people should mind their manners? Isn’t it true that I should work harder if I want to be successful?

Finally, one day the light went on for me. I realized how incredibly powerful the “S” word really can be. When I say should about something that’s in the past or the future, I’m creating an alternative reality with that one word. “I should have paid that bill on time.” In a parallel universe, I paid that forgotten bill and didn’t get a late charge, and my alternate reality self was a lot happier. At least in the parallel universe that I just created using a single word (In fact, in the parallel universe my alternate self just paid the bill and didn’t think about it one way or another. But we can make up lots of stories). For an example about the future we can use the statement, “I should work harder in order to succeed.” I just created a parallel universe in which I work harder and succeed– and in this world, I imagine a happier self in the parallel universe I just created. Of course, I don’t live in the parallel universe and I never will. Sometimes I’m creating an alternative history, as when I imagine how much happier I would have been if I did something different in the past. What I need to accept is that the future hasn’t happened and the past is over. One I can’t change, the other I can’t do yet.

As much as I find cognitive therapy helpful, I’ve always been uncomfortable with the term “cognitive distortions.” Think about it. Here I am, a therapy client, and I already feel bad. Now some therapist is telling me my problem is my distortions. So I feel worse, no matter how compassionately the message is given. So I looked for an alternative, more positive way to reframe it.

Reframing, of course, is one of the classic moves of modern talk therapy. It’s looking at facts from a different angle. As I’ve often said, therapists are benevolent reframers, while political consultants are evil spin doctors. When a therapy client says, for example, that they fight with their partner, the therapist has the option to reframe it as being able to be open and communicate about differences. An astute observer can see how a political consultant reframes his candidate’s negative remarks about her opponent as “refreshing candor” or “standing up to his attacks.” What a weasel, right? Well, just a reframer with a different agenda.

So how to reframe should statements? Here’s my take: every time I say the word, my powerful imagination creates an alternative reality at one stroke. I’m imagining a self who never forgets an umbrella, always says the right thing, works diligently, etc. I’m a creative genius! This goes along with the obvious fact that humans have always loved made up worlds. We loved myths and folk tales told around the fire thousands of years ago. Today we love movies and novels. We richly reward people who make up the best stories– and we all make up our own, personal stories. Nothing wrong with that, right?

So here’s the only pitfall to it– we make up stories about a parallel reality in which each of us is a superhero, but we fall in love with that world so much that we want to live there. We forget that it’s a made up world, then feel bad because this world is inferior to the one we made up.

The solution to this is a classical cognitive therapy solution– critical thinking. I look at my should statement, my made up world, and I realize that it’s a made up world. Now, I start to rewrite my own script (reframe). I do this with self-compassion– there’s nothing wrong or bad about having a made up world, I just can’t live in it. But it can be a guide to change. I rewrite my self-statement from “I should have remembered my umbrella” to “In a parallel universe, I remembered my umbrella.” One of the things that this implies is that in my current universe, I’m capable of remembering umbrellas. It’s less creative than “In a parallel universe, I have a magic umbrella that follows me around,” but hey– if I’m not Harry Potter, that also means that Voldemort is not out to get me. Even when I reframe, I still have to be on the lookout for making up even more new parallel universes.

There’s another aspect to this which has to do with the future. If I say something like “I should work harder in order to succeed,” I’m essentially scolding or browbeating myself. This was the aspect of should statements that I did get right off the bat– should is a scolding word, a word that makes me an implied failure. When I rewrite my script to say “I want to work harder to succeed” now I’m in charge, and not driven by a scold. I can also say, I have a goal to succeed, or reword it in any way that is more neutral to positive.

I’ve come to realize over time that I will keep on making should statements, no matter how much I try to watch my language. But it’s OK. I’m just creating alternative realities to enjoy and to learn from! I will recognize them for their value, but I won’t try to live in them.

Finger wagging image from https://thechildpsychologyservice.co.uk/advice-strategy/controlling-behaviour/

Landscape photo copyright James Matter 2021

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Venting Negative Feelings– Is It a Good Thing?

Mount St Helens, Volcanic Eruption

At one time, pillow pounding was all the rage (pun noted). But new research suggests that even verbal venting may have a down side.

When I started this blog, I expressed the intention to be focused on new material rather than simply pointing to various things along the way, but I’ve been in a dry spell for new thoughts on various subjects that interest me, and I couldn’t help noticing a great piece on one of my favorite web sites, so without further ado, check it out.

The latest research, for those who didn’t immediately go there, suggests that venting alone doesn’t do the trick for feeling better when dealing with negative emotions. It’s how we vent, who we vent with/to, and how they respond. And venting on social media may make us feel better for the moment, but not in the long run. No giant “aha!” moments there, but interesting. I like the Center for Greater Good because they cite studies. They don’t just promote positive psychology, which sometimes gets a bit mushy, if you know what I mean. They even had an article one time on studies showing the down side of too much happiness!

Image from https://pixabay.com/images/search/volcano%20eruption/

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Thoughts on Zoom Therapy

Well, it’s obvious that there’s been a lot of telehealth going on for the last year, and it has gotten branded, as things do, with the name of one particular provider. Just like Kleenex, a brand of tissue, became a generic for tissues at one point, Zoom has gotten the brand recognition. But there are other platforms, and various practitioners use various platforms. According to one article I read, private practice therapists responding to a question on transitioning to teletherapy for the pandemic had tried up to five different platforms. The reasons for this are varied, but one of them is HIPAA compliance. Once you start transmitting anything to do with clients electronically, the Federal confidentiality standards apply. Zoom by itself is not HIPAA compliant I’ve been told, but I’m not a HIPAA expert and won’t venture into that territory.

What I have thought more about is how well suited telehealth practices are to doing talk therapy. I remember assisting at a telepsychiatry pilot program where the talk therapist would sit in with clients while they were getting psychiatric assessments from a doctor who was at another location. In debriefing with the psychiatrist after the client left one session, I observed that the client had smelled of alcohol; there’s no tele-smella-vision therapy yet, so that’s one thing that’s missing from telehealth sessions.

On the plus side, another practitioner based in San Francisco pointed out that there’s no parking hassle, no getting stuck in traffic. Yet another practitioner pointed out that telehealth provides even greater confidentiality because the client isn’t seen going into and coming out of a mental health provider’s office. We would like to think that the stigma associated with mental health problems has largely dissipated, but not for a lot of people. So there are advantages.

I have to admit that I miss the face to face, two people in a room interaction. One thing that bothers me about telehealth is the same thing that bothers me about seeing baseball on television: your ability to see is sharply limited by the camera. You can’t look around and see other things. I recall a session that happened back in the live old days where my client was sitting and talking very calmly to me, but I observed that her leg was bouncing up and down rapidly– what’s sometimes described as “sewing machine leg.” When I pointed this out, the client became more aware of underlying anxiety and we got to talk about that. So there’s a good bit of body language that gets eliminated– up to and including everything but someone’s facial expression. I think that’s a significant loss. Some camera setups allow you to see more of the person, but then you may lose the ability to focus on a face. In a more dedicated system, I suppose it would be possible to have a feed into a large screen, but most people are doing this with laptops. Also, I have learned to use my own body language as part of the therapy over the years, and this tool is not available to me– or is severely limited– in a telehealth session.

Notice I haven’t particularly commented on the usual problems– connectivity, people’s signals cutting out, router problems within someone’s home or office. For me, they cause a significant loss of quality in the person-to-person interaction. I suppose we can get used to them, but by comparison I’ll just point out that the advent of TV and audio recording didn’t lead to people quitting live music concerts, operas, plays, etc. There’s a richness of experience that you just can’t duplicate by any media platform going. And, as I remember from one work setting, you can’t take your client for a walk on the beach on a telehealth call.

Talk therapy image from: https://healingartssfl.org/talk-therapy-is-extremely-effective-heres-why/

Beach photo copyright James Matter, 2021

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Depression Treatment Without Medication

I frequently get questions about treatment for depression without using medication, or going off medication for depression without relapsing. I’m going to summarize what I know and give my point of view about this.

First and most importantly, nothing said here is treatment or a substitute for treatment. Major Depressive Disorder and related disorders can be life threatening. Prior to Covid-19, suicide was the tenth leading cause of death in the U.S. and for people in younger age groups ranks second. If you are feeling suicidal please contact the national suicide helpline at 800 273 8255 or in the San Francisco Bay Area (number reachable from anywhere, of course, but I want you to know what time zone it is in) 415 781 0500, both available 24 hours a day.

My experience with suicidal clients is that people can and do recover from suicidality and go on to have lives that are fulfilling– something that the person actually wants for themselves. My experience with people who completed suicides is that all of them were missed and grieved by loved ones. I can’t emphasize either of these points too much.

Equally important, if you are on medication do not make medication changes or go off medication without consulting with your prescriber and having a plan.

Here’s a quick list of topics covered:

  • Talk therapies including–
  • Cognitive and Cognitive-Behavioral Therapies
  • Mindfulness and Mindfulness based Cognitive Therapy
  • Interpersonal Therapy
  • Exercise
  • Diet, especially certain nutrients
  • Thoughts on why DIY treatment may fail
  • Light therapy for SAD
  • Electrical stimulation therapies

I will not cover every topic in equal depth.

First, my point of view: medications may be necessary for successful treatment. Don’t reject them out of hand. At the same time, medications alone may be insufficient for successful treatment of depression, don’t reject other forms of therapy and don’t reject a broad based approach to treatment. Your life is not a science experiment; you want to get better. At the same time, medications may not be necessary for treatment but for that to work, you will have to be a lot more proactive in your approach to getting better. All these reasons add up to the main one which is that you should do this with a treatment professional, possibly with both a talk therapist and a psychiatrist, possibly other providers depending on your individual case.

Now let’s talk about non-pharmacological interventions for depression. The most obvious one is talk therapy. There are several types of talk therapy that have been evaluated for depression including Cognitive Behavioral Therapy, (CBT) Mindfulness Based Cognitive Therapy, and Interpersonal Psychotherapy. Interpersonal Psychotherapy is structured for relatively brief treatment and has been widely adapted for use, including by the World Health Organization. It is designed as a time-limited treatment and focuses on interpersonal issues, as the name indicates, and social functioning. It is considered an evidence based treatment and has been shown effective in studies.

There is research that has demonstrated that CBT can be equal to medication in treatment for depression. There are caveats to this– a cognitive therapist may have greater or lesser degrees of skill in providing treatment, whereas the uniformity of the medication is highly likely to be the same at every pharmacy. On the other hand, people who go off medication are more likely to have depression relapses than people treated with cognitive therapy. Probably the best known cognitive therapy book for general consumption is The Feeling Good Handbook by David Burns, MD. My experience with providing cognitive therapy is that although it can seem very simple and obvious to learn about the most common forms of cognitive distortions, it can be surprisingly hard for people to learn to spot them in their own thinking. After all, everything I do turns out badly. That’s not a cognitive distortion, just a fact, right? It can take a relatively protracted conversation with a therapist to discover that one has, perhaps, succeeded at something at one point in life and the statement is an example of all or nothing thinking.

There is also mindfulness based cognitive therapy of depression (MBCT) which has been shown to be helpful. My observation is that depression tends to focus on the past while anxiety is focused on the future. Mindfulness, of course, keeps focus on the present, which means that whatever I’m depressed about (or anxious about), there’s a lot less mental room for it to happen than when I include my entire past and my entire future– If only I had behaved better when I was in first grade! And what about the heat death of the universe billions of years from now… There are reports of people having negative experiences from doing mindfulness so that suggests one should not simply jump into mindfulness for depression without a therapist or meditation teacher. I have introduced clients to basic mindfulness practice with few to no negative effects reported, but that’s clinical experience, not a clinical trial or study.

Regular exercise and a healthful diet can increase a sense of self-efficacy

There have been studies of exercise and depression, and it’s not surprising that there have been positive results. At a presentation I attended, representatives of the UCSF Depression Center were willing to specifically name walking and yoga as two practices shown to relieve depressive symptoms. I have not done a separate web search looking for studies. Interestingly, I had a clinical experience with a client who discounted exercise for depression saying, “It didn’t work. When I stopped walking I got depressed again.” No one has ever been surprised that when they went off medication depression returned, and we should remember that these kinds of interventions are likely to require regular practice to be of greatest effectiveness. I will discuss this more a little later.

A variety of research studies have suggested that diet may have an effect, especially supplementation with folate and omega-3 fatty acids, found in Salmon, walnuts, and other foods. There has been research into the role in vitamin D and its association with depression also. Many people have vitamin D deficiencies– I once asked my primary care doctor if I should be tested for a deficiency and his answer was, “No, everyone’s deficient. Take a supplement.” Another doctor I knew who was a child psychiatrist who did test his patients said that something like 95% were vitamin D deficient, but we are next to the ocean and get a lot of gray days.

Other research suggests that the gut biome has an influence on depression. The UCSF Depression Center is willing to recommend folate and omega-3’s for depression, but nobody is promoting dietary changes as a stand-alone treatment. The thing to be mindful of is that folate is found in leafy greens and is a water soluble vitamin. As such, if you stop eating your vegetables your levels will drop rapidly and any beneficial effect is likely to also drop equally rapidly. Omega-3’s, being more fat-based probably last longer in your system but again, ceasing to consume the foods or supplements will lead to the benefit disappearing. Vitamin D is a fat-soluble vitamin as such probably lasts longer in the system, but nothing lasts forever. The gut biome stuff that I’ve read leads me to think that it’s about getting fiber, but that research is a lot more complex. I’m not trained as a nutritionist and don’t claim special knowledge in this area.

So here’s the thing about diet and exercise from my point of view. Some of the practices have pretty good research support for being specifically helpful with depression. When you look at them from a more general nutrition point of view, getting more leafy green vegetables is clearly a recommended dietary practice, omega-3’s are recommended for a variety of potential health benefits, exercise also is known to have a wide variety of health benefits, so any time we start doing these with a specific goal of helping depression, we’re supporting the general goals of better health and improved self-care. There’s a clear cognitive and behavioral aspect to this– “Look! I’m taking better care of myself! I can effect positive change in my own life!” One label for this is self-efficacy. Another is self-compassion. It’s something that’s under my own control, and when I’ve done it, nobody can take it away from me.

If it’s all that easy, why is depression such a huge health problem? Lots of reasons, obviously. Let me give a brief clinical perspective. One thing is that none of these non-pharmacological interventions has immediate strong effects. Neither do antidepressant medications either, given that most of them take weeks to kick in. A trainer whose lecture I attended once pointed out that people going into detox for alcohol are mostly depressed, and that three weeks off alcohol would lift the depression for most of them– which is also the amount of time it takes for a lot of medications to take effect. So he always recommended what he called “a clinical trial of abstinence for depression” before putting anyone from detox on psych meds. Similarly, changes to diet, exercise, and general lifestyle take time to kick in, so it may be very difficult for someone attempting to self-treat for depression via the diet and exercise route to see progress, leading to a lapse in the lifestyle changes and a relapse to depression.

The other factor is that one of the most problematic symptoms of depression is what was labeled by one of my clients as “that feeling of… I don’t wanna.” If you like more sophisticated language you can call it motivational deficit. This is where feedback from a therapist can help kick start and maintain the change process. Behaviorism works by giving positive reinforcement to successive approximations of the desired behavior. The role of the therapist is to spot the approximation and reinforce it when the client may have discounted it. Client: “I didn’t exercise. All I did was go to the store.” Therapist: How did you get to the store?” Client: “I walked.” Therapist: “So you not only got out of the house and walked to the store, but you also got some groceries. That counts as exercise and self-care.” I knew a client whose discounting was so powerful that they could convince an entire therapy group plus an intern that they had done nothing for themselves when I was able to honestly and factually point out at least three things they had done for themselves that were part of their treatment goals.

Treatment works!

For completeness I am including a couple more non-pharma interventions

There is light therapy for SAD (Seasonal Affective Disorder). I do not have clinical experience with this but have known people socially who lived in the Pacific Northwest and had good experience with it. This takes getting a for real diagnosis by a licensed practitioner and using a specially designed light source, usually in the mornings.

There is also transcranial magnetic stimulation and electroconvulsive therapy along with other brain stimulation therapies. I am including a link to these as they are non-pharmacological in nature, but the last time I read up one still had to fail at getting relief from medication to become eligible. Electroconvulsive therapy is still used in severe treatment-resistant depression. It has bad associations from misapplications and involuntary treatment that happened many years ago, but is no longer in use except on a voluntary basis. None of these are available as DIY projects for obvious reasons.

Photos copyright James Matter 2021

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Don’t Ask Why– There are Better Questions

Someone recently asked me, in effect, “why am I so messed up?” This was the essence of my answer:

A way forward…

Wrong question to ask. Ask yourself the following questions: how do I want to act in the various different circumstances I have in my life? What are the barriers, both internal and external, to behaving the way I want? How do I remove those barriers? Do I need outside help to remove the barriers and if so who do I recruit to help me make the changes I have in mind? What’s the first, easiest tiny baby step I can make that will take me in the direction I want to go? Map out a change plan for yourself, break things down into small steps you can do, and you will become more like who you currently wish you could be.

Take doable steps

In a long career of working with people who had big problems, I have seen so many inspirational lives that I am humbled. People who on the surface look like ordinary folks living unexceptional lives have come from incredible psychological and physical hardships just to have a job, a place to live, food, and a few friends. And don’t forget health care of both the medical and psychological kind. Ultimately, all of them had a plan on how to have a better life. Generically, it was the plan outlined above. For each of us the details will be different– sometimes radically different– but will distill down to the steps in that paragraph.

I have been coming back lately to something that a wise professor taught in my “how to become a therapist” class. Don’t ask why. It’s not an answerable question. It is, however, a transformable question. It can be turned into one or more questions that start with how, where, when, who, what. Let me parse an example. “Why am I so messed up?” Turns into, “When did I start acting messed up?” “What do I mean when I say ‘messed up’?” And importantly, “What would I be like if I was better?” Specifically, “What do I act like and feel like when I’m better?” Also, “How do I get better?” Specifically, “What baby steps that I can do today will help me get better?” See how that works? Notice I’m not promising you will become the person of your dreams. But you will become more like the person you wish you were. And this is the ultra-short version. For a longer, more detailed version, build your own or contact your local behavioral health professional.

Is it the destination, or the start of a new journey?

Images are from Kings Canyon National Park including Sphinx Lakes, footbridge over the South Fork Kings River, and the author’s feet. Photos copyright 2021 James Matter

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Anxiety Management 101

So many people continue to experience anxiety that I have summarized a few of my oft-repeated responses on dealing with it. Many of them also apply to managing negative moods in general.

When in doubt, get professional treatment. Here’s one place to look Behavioral Health Treatment Services Locator for resources in the U.S. Here are some basic tips for managing anxiety:

  • Recognize that a certain level of anxiety is good. Examples— worrying about the weather makes us put on a coat or carry an umbrella, worrying about safe driving makes us wear seat belts and look out for erratic drivers. Worrying about grades makes us study harder. The goal is not to be permanently anxiety-free, but to have appropriate levels of worry about things we can address.
  • Don’t believe everything you think. When we say “I should have…” we mentally create a parallel universe where we made a different decision. Makes for fun science fiction/fantasy movies, but not a happy day. Everything that happens, stays happened. Instead, we can learn from our mistakes and say “next time, I’ll check the weather forecast and carry an umbrella,” not “I should have taken my umbrella.” Or we can even say “I’m always going to carry the umbrella because I hate getting wet.” It can often be not what we think, but how we think it. Shoulda/woulda/coulda thinking is the original “beat yourself up” form of thinking. Stop right now. Don’t say to yourself “I shouldn’t think that way any more.” Just learn to let it go & re-do the thought.
  • Rent your thoughts, or even borrow them. Don’t own them. This is another aspect of not believing everything you think. It’s possible to experience your own internal monologue as dispassionately as you would listen to a podcast or read from a page. How? Mindfulness practice can help. Here’s a lecture from a Buddhist teacher on mindfulness:

  • Learn to relax. There are many relaxation techniques available by looking online. Practice some kind of relaxation technique daily or as needed. It will go better some days, less so some other days. If you listened to the lecture linked above, you will have learned that mindfulness is not a relaxation technique, although many find it to be relaxing. I have a previous post that includes guided imagery/relaxation, which is one of the most widely known and practiced relaxation methods. Weird that we have to learn and practice relaxing, but that’s our world now.
  • Work on living in the now. Mindfulness practice can help with this also. Anxiety/worry is about the future. There are so many ramifications to this that I could write an entire essay about it, but many have been there before me. The DBT formula for this is, “One thing, in the moment, nonjudgmentally” and don’t judge your judgments.
  • Practice self compassion. What would you tell a dear friend going through this? Say it to yourself. There’s also a lot of stuff about this online.
  • Spend time with nature. There are people who suggest that “nature deficit disorder” should be a mental health category. There’s research on how spending time in nature benefits us. If you’re in a nature-deprived urban environment, look for any examples you can find, including the sky, or grass growing through cracks.
  • Get professional treatment. Online advice (including this) is not a substitute for effective assessment and treatment for anxiety disorders and other mental health problems. You may want to become active in advocacy for mental health treatment parity with other health problems as it is often hard to find treatment, unfortunately.

Each of the points raised above is an entire topic, but this is intended, as the title suggests, as a basic starting point. There’s a whole library of books on anxiety treatment/management. Feel welcome to continue the search. It’s definitely possible to feel better.

photos by the author copyright 2021

Posted in anxiety, behavioral health, Distress tolerance, mental health, mindfulness, Uncategorized | Tagged , , | 1 Comment

It Can Be Difficult, I Know– But Relax

I’ve been offline because, quite frankly, I’ve been engaging in as much self-care as needed, and posting here has taken a back seat. But that brings me back to some suggestions that I’ve made many times over the years to other people. One of them is this– taking care of yourself isn’t selfish. If you end up collapsing because you are over-tired and exhausted from caring for others, not only do you become unavailable to care for others, but someone has to care for you. At a time when care givers are pushed to the limit, now’s a good time to not make another case for some professional care giver to handle. If you’re a professional care giver, you need to balance your ability to meet extreme work demands with the ability to show up tomorrow, so while this may work for you, please do whatever it takes above and beyond to take care of yourself.

One of the biggest things that I’ve read about/heard about from people is difficulty handling anxiety, or worry. I realized that there’s an old trick– but still a good one– that I’ve used and guided others in doing many many times. For people who are familiar with DBT, this comes under the heading of taking a mini-vacation.

Get yourself into a comfortable, quiet place. Make sure it is warm enough to sit quietly for half an hour. Close your eyes. Now, think of a safe, beautiful place that you have been in the past or where you wish you could be. If you can’t think of a place from your experience, make one up. Make it someplace warm. Many people enjoy a day at the beach in the summer. Other possibilities could include camping next to a stream with a nice warm campfire, or being in a ski lodge with a big stuffed chair and a warm fire in a fireplace, or soaking in a hot tub– the possibilities are up to you. Now, work on creating as much detail as possible in your mind.

Let’s use the beach example for a moment. Imagine yourself lying on a really high quality beach towel on warm sand. You’ve squiggled and wiggled yourself around until the sand underneath conforms to you nicely. You feel the warm sun beaming down, maybe feel a big straw hat that you have on shading your face. You gently dig your hands into the warm dry sand and think that you have the whole day to just relax. With your eyes closed, you can hear the sound of the waves on the beach, perhaps the voices of children playing somewhere in the distance. Here’s a surprise– someone has a boom box but it’s playing a favorite old song. You think of a line of pelicans gliding low over the water, perhaps smell the salt air, maybe taste a slight aftertaste of the lemonade you just sipped a moment ago. The sky is blue, the ocean may be a blue or a vivid green, with a glassy surface or with whitecaps.

Use your imagination and as many of your senses as you can bring to the imagery. Immerse yourself. On any given time you may want to invite people (real or imagined) to join you in the place you are creating, or you may want to be alone. Always include a detail that allows you to visualize warm hands. This relates to some work that was done on biofeedback many years ago when it was discovered that warming one’s hands was a reliable way to generate a relaxation response. Feeling warm all over is good too, of course, as well as having warm feet and so on. It’s so simple (at one level) and has been around for so long, that numerous comedy sketches have been done about people “going to my happy place.” Well, what can I say? It works, which is why it has become so widely known and so widely parodied. I remember a famous actor talking about how he had become so widely parodied. His response was that it was a kind of honor to be so well known that everyone knew the parody was him. I like that attitude. In this case, I think of what I imagine as a calm, safe place.

It’s so helpful– and easy– to take the mini-vacation. You can make it five minutes or fifteen or half an hour if you want, but usually it doesn’t take too long. Just like in the real world, not every trip to the calm place will be equally calming, but with practice it can become a way to calm yourself, sometimes in a remarkably short time. Feel welcome to create more than one safe, calm place for yourself. If you are blessed with many memories of safe, calm places that you love, feel free to take a brief tour of them over a short period of time as an alternative to the imagery process, stopping to savor the sights, smells, sounds, tactile sensations and even tastes of each.

As always, this is not a substitute, alternative, or replacement for therapy with a qualified behavioral health practitioner.

Photo by the author.

Posted in anxiety, behavioral health, Distress tolerance, Feelings | Tagged , | 3 Comments