BLOGGING BEHAVIORAL



LISTEN IN AS AN AUSTIN PSYCHOLOGIST TALKS ABOUT CBT - COGNITIVE BEHAVIORAL THERAPY

February 15, 2019

Getting the Most Out of Your Therapy Sessions


Has this happened to you? You're sitting on the couch talking to your therapist. You look up at the clock and see that you've got only five minutes left. How did that happen? You've got so much more to talk about! You leave feeling frustrated that you derailed from something really important.

What to do?

Check out PsychScamp's helpful suggestions for better time management during your therapy sessions by clicking here.


I would add to PsychScamp's list a therapy tool I often suggest:

Keep a therapy notebook.

This can be any kind of bound (spiral or otherwise) paper on which to write down your important thoughts, feelings, ideas to discuss at your next therapy session, attempts at change, areas where you are struggling, questions for your therapist, the list goes on. It's especially helpful if your therapy notebook has a pocket of some sort to keep handouts and worksheets.

You can shop for a fun, fanciful notebook or, for the recyclers among us, dig up an old college or school notebook that's buried in your office or bedroom closet. Make use of all that empty paper.

The type of notebook is not important. What matters is that you have a space on which to write.

Some people like to keep the notebook by their bed. Jot down thoughts right before going to sleep. Keeping note of worries and to-do lists right before bed can be a helpful tool when struggling to overcome bouts of insomnia. Two birds with one stone?

A note about the length of your entries: Keep it short.

Lengthy, paragraphs-long or pages-long entries can be tiring, prevent you from getting enough sleep, and lead to a dread or avoidance of your notebook. Concise reminders or bullet items are often adequate for therapy material.

Some people prefer to log their thoughts into their handheld devices, smartphones, or computers, etc., rather than use a paper-and-pencil format. Electronic gadgets of this nature can work, too, but not so convenient for keeping track of the paper handouts.

Whatever you do, be an active manager of your therapy time. In many cases, the more involved you are in contributing to the agenda, the more likely you'll get your therapy needs addressed.

January 17, 2019

On Relieving Stress

     We hear so much about stress these days:  The effects of stress on our bodies - high blood pressure, headaches - and on our mental state - increased substance abuse, anger outbursts, depression.

    Stress management is frequently taught in Cognitive Behavioral Therapy (CBT).  A series of tools that help us to decrease the negative effects of stress, to help us cope better with the inevitable stress we face in our daily lives and the crises. CBT can allow us to return to physical and psychological health sooner.

One tool I frequently recommend is deep breathing.  Daily practice taking deeper breaths: fuller inhales and most importantly, full, emptying exhales.  You can click on this link to read about ways to improve your breathing patterns.  

Below is a discussion on different kinds of stress, physical and psychological problems related to stress and a list of suggestions to help cope.  These were found on the website of the American Psychological Association.




By AMERICAN PSYCHOLOGICAL ASSOCIATION

Most people have felt stress at one point in their lives. Sometimes it’s brief and highly situational, like being in heavy traffic. Other times, it’s more persistent and complex — relationship problems, an ailing family member, a spouse’s death. And sometimes, stress can motivate us to accomplish certain tasks.

Dangerous Stress

Stress becomes dangerous when it interferes with your ability to live a normal life for an extended period of time. You may feel “out of control” and have no idea of what to do, even if the cause is relatively minor. This in turn, may cause you to feel continually fatigued, unable to concentrate, or irritable in otherwise relaxed situations. Prolonged stress may also compound any emotional problems stemming from sudden events such traumatic experiences in your past, and increase thoughts of suicide.

Natural reactions to stress

Stress can also affect your physical health because of the human body’s built-in response mechanisms. You may have found yourself sweating at the thought of an important date, or felt your heartbeat pick up while watching a scary movie. These reactions are caused by hormones that scientists believe helped our ancestors cope with the threats and uncertainties of their world.
If the cause of your stress is temporary, the physical effects are usually short-term as well. In one study, the pressure of taking exams led to increased severity of acne among college students, regardless of how they ate or slept. The condition diminished after exams were over. Abdominal pain and irregularity have also been linked to situational stress.

The longer your mind feels stressed, however, the longer your physical reaction systems remain activated. This can lead to more serious health issues.


Physical wear and tear of stress

The old saying that stress “ages” a person faster than normal was recently verified in a study of women who had spent many years caring for severely ill and disabled children. Because their bodies were no longer able to fully regenerate blood cells, these women were found to be physically a decade older than their chronological age.

Extended reactions to stress can alter the body’s immune system in ways that are associated with other “aging” conditions such as frailty, functional decline, cardiovascular disease, osteoporosis, inflammatory arthritis, type 2 diabetes, and certain cancers.

Research also suggests that stress impairs the brain’s ability to block certain toxins and other large, potentially harmful molecules. This condition is also common to patients suffering from Alzheimer’s Disease.

Pressure points

Although sudden emotional stress has been linked to severe heart dysfunction in otherwise healthy people, scientists are uncertain whether chronic stress alone causes cardiovascular disease. What is clear is that excessive stress can worsen existing risk factors such as hypertension and high cholesterol levels. Studies also show that people who are quick to anger or who display frequent hostility—a behavior common to those under stress—have an increased risk of heart disease and crying fits.

Feelings of despair that accompany stress can easily worsen into chronic depression, a condition that can lead you to neglect good diet and activity habits. This, in turn, can put you at a greater risk for heart disease, obesity, and kidney dysfunction.

Stress can also complicate your ability to recover from a serious illness or nap. A Swedish study found that women who have suffered heart attacks tend to have poorer chances of recovery if they are also experiencing marital stressors such as infidelity, alcohol abuse, and a spouse’s physical or psychiatric illness. On the other hand, stress management training is a proven method for helping speed recovery follow a heart attack.


What you can do to help reduce stress

Learning to deal with stress effectively is a worthwhile effort, even if you already consider yourself capable of handling anything life sends your way.

Many of the most common long-term stressors — family illness, recovery after injury, career pressures—often arise without warning and simultaneously. Stress management is particularly valuable if your family has a history of hypertension and other forms of heart disease.

Identify the cause.
You may find that your stress arises from something that’s easy to correct. A psychologist can help you define and analyze these stressors, and develop action plans for dealing with them.

Monitor your moods.
If you feel stressed during the day, write down what caused it along your thoughts and moods. Again, you may find the cause to be less serious than you first thought.

Make time for yourself at least two or three times a week. 
Even ten minutes a day of “personal time” can help refresh your mental outlook and slow down your body’s stress response systems. Turn off the phone, spend time alone in your room, exercise, or meditate to your favorite music.

Walk away when you’re angry.
Before you react, take time to mentally regroup by counting to 10. Then look at the situation again. Walking or other physical activities will also help you work off steam.

Analyze your schedule.
Assess your priorities and delegate whatever tasks you can (e.g., order out dinner after a busy day, share household responsibilities). Eliminate tasks that are “shoulds” but not “musts.”

Set reasonable standards for yourself and others. 
Don’t expect perfection.

June 29, 2018

The Science of Pain Explored

     Most people think of pain as a purely physical experience. A hot stove burns my hand, my skin is hurt, my brain sends a pain signal, Ouch!  This sensory feeling is but one source, one explanation of pain. The second explanation is the role of emotions in the experience of pain. Fear and example, for example, amplifies the pain signal.  If we are worried about our pain, it hurts more.  The more we worry the stronger the pain signal.  The brain is a complex interaction between our physical selves and our emotional experience of what our body is feeling, especially where chronic pain is concerned.

     To help us understand more about this, Nicola Twilley has written about the neuroscience of pain in New Yorker magazine, here

April 10, 2018

Meltdown: What it could Mean, How to Respond

I don't see children in my practice but I do see adults who are parenting children.  We talk about "meltdowns," or what used to be called "tantrums."

Thought I would share HandInHand's insightful look at what is happening when a child has a meltdown, understand what is possibly at the heart of it, and how to respond.  Click here.

April 2, 2018

Even on the Sidewalks of NYC

In broad daylight, a person can relax and meditate:



For more on-the-street photography, you can visit Brandon's website,  Humans of New York.

January 7, 2018

Decide Not to Decide




It is quite common for people to enter therapy in the midst of a crisis. They want answers.

Is my marriage over?

Cognitive therapy is all about replacement thinking. A cognitive therapist will listen for faulty or dysfunctional thinking patterns that are contributing toward a client's lowered mood, anxiety, anger, or indecision.

And sometimes those problematic thoughts are questions. Especially questions whose answers involve major life decisions. Upheaval.

My job is horrible! Should I quit now or find a new job first?

One calming thought replacement is decide not to decide. At this moment, anyway. Perhaps for an undetermined period of time, if the situation allows. Give yourself the time to make a more informed decision.

I'm not happy here. Should I move back to the West Coast?

First we must explore whether there is an urgency to decide now. Many, if not most, of life's crises do not require immediate action. They may, at some point, require a decision. But right now? Not usually. And hasty decisions are often the source of regret or self-doubt down the road.

My neighbors are so toxic. Is it time to move?

What crises typically do require is calm and thorough deliberation. Careful consideration of the options available. Analyzing the situation so that we know what we're dealing with. Generating a range of steps to take before making a drastic change.

By the time someone has entered the therapy room, however, they are often worked up into a frenzy or feeling overwhelmed to the point of depression. They are not thinking clearly. They cannot focus. They are unable to come up with creative solutions. They're engaged in black or white, all or none, thinking.

So rather than focus on making the decision, we want the client to slow down, calm down, reduce the stress, increase the self care, and decide not to decide.

Concentrate on self-soothing. Take care of yourself until you are in a position where you can carefully assess the available information, until it can be gathered in a calm, deliberate and accurate manner. And then reflected on without haste. Seek opinions from respected experts or someone who has been in your shoes.

Slow down.
Get some good sleep.
Regroup.
Think of my options.
List pros and cons.
Get some support:
Consult with friends, colleagues, loved ones, a professional.
Take a walk. Appreciate the sky, the clouds, the trees. 
Sit on a park bench. 
Take deep breaths.
And full, emptying exhales.
Again.
And again.
Give myself the time to decide.
In good time.

Decide not to decide.
Until I am ready.


Sandy Andrews, PhD is a Licensed Clinical Psychologist and Psychotherapist in Austin, Texas
She practices Cognitive Behavioral Therapy or CBT

October 6, 2017

Beyond Fear







Sandy Andrews, PhD is a Licensed Clinical Psychologist and Psychotherapist in Austin, Texas
She practices Cognitive Behavioral Therapy or CBT

August 14, 2017

Taking Steps to Overcome Chronic Loneliness




There are many studies that look at loneliness and are finding it is increasingly common and associated with serious health problems.  Although social media is designed to connect people (facebook, instagram, twitter, and the like) psychologists and researchers are finding more people are feeling disconnected and lonely than ever.

Cultivating friendships becomes so important as a way to combat loneliness.  Dr. Randy Kamen makes numerous suggestions for making friends, here. I have written about strategies in previous posts, here.

I offer a few of the most often cited suggestions:

1.  Choose a volunteer activity.  One that helps a needy population or is helping solve a societal problem that concerns you will likely be most beneficial to you.  Engaging in meaningful work, whether a paid job or volunteer work, can help ease feelings of loneliness and increase feelings of positive well being.

2.  Explore support groups.  Support groups are usually led by volunteers, typically someone who has benefited from several years of experience in the support group arena. One support group I often refer to is Recovery International (formerly Recovery, Inc.).  This group helps it's members with skills to overcome anxiety, depression, and loneliness. You can email the contact person for the Austin, TX area, here.  I talk in more detail about this support group in an earlier post, here.

3.  Participate in group therapy.  Here in Austin, TX we have The Austin Group Psychotherapy Society which provides a convenient website that lists many group therapy opportunities available in the Austin area.  Click here to see the list and description of group therapy experiences available. For readers in other parts of the country, try contacting a licensed psychologist in your nearest city and ask for referrals to group therapy providers. Group therapy is lead by paid professionals.  I strongly recommend a professional who is licensed with a mental health certification in your state (licensed psychologist, clinical social worker, marriage and family therapist, etc.)

People who feel lonely sometimes are people who have struggled with shyness for most of their lives.  Many report feeling awkward in social interactions, feeling unable to converse in a way that helps them connect with others or in a way gains them reciprocal interest.  Group therapy, support group participation, and other types of settings which promote conversation between people (MeetUps for example) is one avenue to observe and practice the art of talking to people in a way that garners friendships.  Practice may not make perfect but it certainly can help shy and lonely people reach out more effectively.

Sandy Andrews, PhD Psychologist Specializing in CBT
South Austin, TX 


May 22, 2017

Advice for Grandparents Who Want More Time with their Grandchildren




Yes, even psychologists like to read advice columns.  Or at least this one does.  My thinking is we need to keep an eye on our competition. Gain a few common sense pointers for those tricky problems that outcome research hasn't studied yet.

My personal favorite is The Washington Post's Carolyn Hax.  I like the way she frames her answers. She takes many variables into consideration rather than jumping to the most obvious, and sometimes the most judgemental, conclusion.

Recently she tackled one of the most common dilemmas posed by grandparents who want to see more of their grandchildren.  When they feel left out, uninvited, unwanted, and unappreciated.  In a word, unloved, but that's certainly not how they put it.

So for any grandparents out there who wish their children would include them more often, I suggest reading, and considering the advice of Ms. Hax, here.  You might also consider scheduling an initial session with a licensed psychologist or licensed marriage and family therapist.  Sometimes the insights of a professional can help open doors with your children and grands.

January 16, 2017

Mindfulness is the New Black



Like orange is the new black, mindfulness may be the new psychotherapy.

Talking to a licensed therapist can be a critical step to wellness.  It can include sharing problems, worries, and yes, those reliable and messy mainstays, family of origin issues. Getting evaluated by a professional can be one of the most important tools for treating anxiety, depression, and other emotional disorders.

Learning cognitive behavioral tools ( CBT ) is another branch on the tree called getting back to wellness. One of the most up-and-coming, state-of-the-art CBT tools is mindfulness.  Thirty years ago, when I was walking my dinosaur on my college campus, mindfulness was never echoed in the hallowed halls of learning.  I'm not sure it was even a thing back then.  But it certainly is now.

Mindfulness is a form of meditation.  It is the art and skill of redirecting one's mind away from the everyday thoughts, worries, judgments, and distractions that occupy our brain when it's on auto-pilot. Where are my keys? Did I take the load of laundry out of the dryer? Don't forget to return those pants, pick up that prescription, talk to my professor, get the car inspected.   "Monkey mind" is what Dr. Alejandro Junger, M.D., cardiologist, calls collectively, all those pesky thoughts. As a stress reduction, happy heart tool, Dr. Junger recommends a five-minute mindfulness meditation that you can try, here.

For more ideas on how to learn about and practice mindfulness, have a look at Harvard University Medical School's suggestions, here.    Because maybe, just maybe, fifteen minutes a day is the new 60 minutes on the couch.

Sandy Andrews, Ph.D. Psychologist
Teaching CBT in South Austin, Texas


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