November 25, 2015

Deep Breathing: Lower Abdominal Breaths

Breathing Fire by Carmen R. Sonnes

CBT psychologists recommend behavioral tools to manage anxiety, panic, stress, anger, and fear is deep breathing exercises. Many people with anxiety disorders and anger management issues, for example, breathe in a shallow manner, known as "upper chest breathing." This type of shallow breathing is unintentional and largely goes unnoticed until something triggers the anxiety/fear/anger mechanism. At this point, a "tightness" in the chest might be felt. Others describe this as "pressure" or feeling as though a heavy "weight" is on their chest; classic signs that now is the time to engage in some deep breathing exercises.

Begin by lying flat on your back on a firm surface. A padded, carpeted floor is an excellent location.
You may also sit up straight in a chair, if that is more comfortable.  If sitting, be sure your lower back is fully supported, your feet are flat on the floor and your knees are level or at a slight decline.

You can also practice this exercise standing upright. All sorts of choices for all sorts of situations you may find yourself in. For example, I like to do deep breathing exercises while standing in long checkout lines. Gives me something to do besides glare at the slow check writers in front of me.

Lower Abdominal Breathing:
Place your hand on your stomach area.
Breathe as you normally would and notice whether your hand and stomach rise and fall, or your chest rises and falls, as you breathe.
When you are breathing properly, your chest will stay still while your stomach will rise slightly as you inhale. When you breathe out, or exhale, your chest will continue to stay still while your stomach lowers slightly.
To learn to breathe correctly, begin by slowly inhaling through your nose on the count of six while gently allowing your stomach to lift or raise your hand.
Hold the breath for a count of four.
Slowly exhale through your mouth for a count of eight, fully exhaling until all air is gone, while gently pushing down on your stomach.  Now for a round of comfortable, natural breaths. Focus on the feeling of relief you get during these natural, easy, recovery breaths. 

Repeat this cycle of 6-4-8 second breaths, with recovery breaths in between, for a good five minutes.

It is quite normal to feel slightly dizzy or light-headed, especially as a beginner. If the deep breathing causes you to begin panicking, only do it for as long as you are able. Increase the length of time each day until you can do the exercise for at least five minutes twice per day. If you continue to practice breathing this way, you may begin doing it more naturally throughout the day.

An additional benefit will be that once you are familiar with the exercise, you may do it while experiencing anxiety or at the beginning of a panic attack, and you may feel relief. The more you practice the deep breathing throughout the day, the more effective you will be at heading off anxiety and panic symptoms.

Slow, emptying exhales tend to be the most therapeutic for some. Really concentrate on exhaling fully. You might experiment with exhaling to the point of emptying your lungs. You want to feel a slight discomfort and then take a relaxing, relieving, natural inhale. Concentrate on the feeling of relief that you are now able to breathe in a comfortable, natural, unforced way. Alternate several natural breaths in between the deep breathing exercises.

Resist feeling frustrated with yourself or giving up if you are struggling to do this exercise correctly. It takes practice. Give yourself time. Do not give up.

Do not be afraid of the exercise causing panic. Remember: you are in control and can stop at any time. Take it as slowly as needed.

Sandy Andrews, PhD  is a Clinical Psychologist / Therapist who provides CBT in Austin, Texas  

October 29, 2015

Is Stress Hurting You? Or What You Think About Stress?

One area of expertise common to most CBT psychologists is stress management.  A new study sheds light on one cognitive aspect of stress.  Standford University psychologist Kelly McGonigal suggests that what we believe about stress, and how we respond to stress, predicts how harmful it is to our health  Signs of stress, such as elevated heart rate, sweating, muscle tension, and throat constriction is a sign of our body's strength, our body's way of mounting a defense against the worrisome event, our body's campaign to succeed in the face of something scary.  When we are taught to see stress as a good thing?  The risk of harm caused by stress goes way down, perhaps disappears.

So the next time you're studying for that test and are freaking out because you waited too long?  Feel that adrenaline pumping through your body and believe that it's there to help you study better, remember more, and ultimately pass the class.

Watch Dr. McGonigal talk about letting stress be our friend, HERE.

Sandy Andrews, PhD is a Clinical Psychologist and Psychotherapist who practices CBT in Austin, Texas
depression anxiety dysfunctional  relationships toxic relationships divorce stress lonely making friends help therapy therapist 

October 20, 2015

Recovery International: A Cognitive Tools Support Group

This a repost from two years ago.  As a cognitive behavioral psychologist, I continue to believe in the potential effectiveness of this support group for people with anxiety, depression and other disorders.

There's a little known but excellent support group resource available here in Austin, Texas and in hundreds of cities nationwide. Historically it was known by the name, Recovery, Inc.  But more recently, thanks to its expanding influence, it now goes by Recovery International.  

Recovery International was started many years ago by a physician, Dr. Abraham Low, who himself was working to recover from his own bout with depression.  The name "Recovery" is misleading (which may explain the relative obscurity of the support group). Recovery is a term that most people, including myself, associate with substance abuse recovery. But Recovery International. is a self-help support group designed to assist people struggling with anxiety and depression. It can also help people with a variety of different psychological and emotional difficulties. For a list of the many struggles Recovery International can offer assistance with, click here. People who have alcohol and drug abuse issues can be helped, too, so long as their substance abuse is under control.

But the name isn't so important. What matters is the group's core focus: teaching and helping group members persistently use cognitive skills to reduce symptoms.

I've had a few patients attend these groups. I have been consistently impressed with the quality of the skills taught there. I often refer my clients to the group in the hopes they will use it as a place to practice the cognitive skills learned in my individual therapy sessions, learn new skills above and beyond what our sessions have covered, and gain social support. I also refer individuals who are not attending therapy but would like some free-of-charge group support.

Recovery International, in short, teaches people tools to help cope better with situations that provoke unpleasant feelings and emotions. They call these tools "Recovery Language."

One typical example: Many people experience significant anxiety walking into a support group for the very first time. Anxiety that, for so many, is anticipated ahead of time to such an extent that they fail to go to the group at all. Typical thoughts are, "I won't know anyone and I'll feel stupid." "I won't know what to say." "I'll be too nervous to talk and then I'll look ridiculous." "What if I walk into the room and everyone stares at me?"

The anxiety, fed by these negative, fear inducing thoughts, can mount until one feels overwhelmed and stays home, or stays in the car and drives away.  Recovery language might encourage you to "spot" and replace these negative thoughts with more realistic and empowering ones, such as:

"These thoughts are distressing, not dangerous."

"It is perfectly average for someone to feel nervous when walking into a new group."

"I can do this. I am capable."

"I will move my muscles and start heading inside."

"Bear the discomfort and comfort will come."

I've had a few patients attend only one meeting. Their complaint was that they didn't quite "get it." As I understand the group format, members use Recovery Language and new people feel a bit lost and confused. My advice to patients is this: Plan to attend at least three groups. See if some of the initial confusion, which again is average (a recovery term) lessens over time. See if you don't start to feel a little more comfortable. Find out how you can learn the Recovery Language for yourself. You will likely be encouraged to buy a book but it isn't essential.

So take the first step. Move your muscles to use the following link to find the support group closest to you.  Two groups per week are currently offered in the Austin area:  South Austin on Thursday evenings at 6:30pm and Northwest Austin on Wednesday nights, 7:30pm.  But I advise you to double check before heading their way.

Sandy Andrews, PhD  is a Clinical Psychologist / Therapist who provides CBT in Austin, Texas   

October 3, 2015

Vitamin C May Prevent CRPS Chronic Pain Syndrome

Sharing a chronic pain resource, Princess in the Tower, while educating myself on Complex Regional Pain Syndrome, formerly known as Reflex Sympathetic Dystrophy (RSD),.

Thought I'd share an informative post talking about this really difficult pain syndrome, ranked as one of the most painful medical conditions known in the scientific literature.  CRPS symptoms include "burning pain, increased sensitivity to all stimuli, and sensations of pain in response to normally non-painful stimuli including: light touch, a breeze, sound, vibration, bright lights and more." (Birklein et al., 2000; Wasner et al., 2003).

It is believed CRPS is more likely to occur following an injury that accompanies severe emotional trauma, such as rape or assault.

According to the post, research recommends that, to prevent an injury from developing into CRPS, take 1000mg/day Vitamin C every day following a sprain or strain.

Sandy Andrews, PhD is a Clinical Psychologist and Psychotherapist who practices CBT in Austin, Texas

August 31, 2015

Stay Faithful: A Cognitive Strategy

When an individual or a couple presents for therapy because of infidelity, the unfaithful partner often says they weren't "looking" to have an affair, that the unfaithful partner felt content in the relationship. The cheating partner sometimes reports that a chance meeting or newly assigned co-worker is what sparked the affair.  So what to do when you find yourself attracted to a forbidden someone?

Telling yourself to "stop thinking about" the romantic interest doesn't work.  Conventional wisdom tells us this and a 2008 study* confirms it.  Instead, researchers recommend that you think about the love you feel for your partner instead.  Think of a time you felt close and connected to your partner.  In the experiment, loving thoughts and memories of your current partner decreased thoughts of another person. Interestingly, thinking sexual thoughts about your current partner wasn’t nearly as effective.

 *Gonzaga, G., Haselton, M. G., Smurda, J., Davies, M. S., & Poore, J. C. (2008). Love, desire, and the suppression of thoughts of romantic alternatives. Evolution and Human Behavior, 29, 119-126.

Sandy Andrews, PhD  is a Clinical Psychologist / Therapist who provides CBT in Austin, Texas  

July 31, 2015

Social Anxiety and Alcohol Abuse

I just listened to NPR's Fresh Air interview with Sarah Hepola, author of the memoir titled,  Blackout: Remembering the Things I Drank to Forget. If you drink to be a more bold, brash, funnier, or sexier you, in other words, to quell social anxiety, then this could be a listen that helps you swerve off of the road to addiction (or a read that helps, but I haven't read the book yet so I can't recommend it).  Important fact:  Blackout refers to memory lapses due to excessive drinking.  It does not mean passed out or unconscious.  If your friend tells you how funny you were last night but you don't remember?  You might have experienced a blackout. Unhealthy, yes.  Dangerous? Could be.

Click here to listen to Fresh Air's Terry Gross interview the author.

--Sandy Andrews, PhD 
Clinical Psychologist
Austin, TX 

July 20, 2015

Cubicle Got You Down?

Want to be happier at your job?  Here is one way:  Ask your boss if you can install a tub in your cubicle.  After she finishes laughing at, and/or firing you, return to your cubicle, sit in your office chair, and imagine you are taking a bubble bath.  A long, relaxing, soaker bath with scented bath oil and fluffy white bubbles and a glass of your favorite beverage at your side.  And while you're imagining this bath?  Breathe...  Breathe...  Breathe...  Slow, quiet inhales and exhales.  Feeling your chest expand, your shoulders rise, your nose take in the subtle current of air.  After two minutes of this relaxing bubble bath of your mind?  Return to work.  

According to researcher and educator, Shawn Achor?  After doing two minutes of breathing meditation, your productivity will go up.  You will feel less stressed, more focused, and experience greater optimism.
Most of us work somewhere in the vicinity of 40 hours per week.  That is a lot of our lifetime spent working.  For many, that's a lot of time spent hating one's job, feeling trapped, dreading the rest of the work week, feeling hopeless.  

Do you have fifteen minutes to watch a video that will help inspire you toward feeling better about your job? Can you take fifteen minutes, or  less than one-tenth of one percent of your work week to steer yourself out of the work-week-blues?  Sure you can. You owe it to your physical wellbeing and future happiness to do so.  

Besides being entertained by Achor's delicious humor, listening to his TED Talk will help you  learn that job success is largely determined by:  

1. optimism levels
2. social support
3. ability to see stress as a challenge, not as a threat

You will learn that, happiness isn't determined by what you do, what you have, or where you are.  Rather, "Ninety percent of your long term happiness is predicted ... by how your brain processes the world."  Happiness, in other words,  is determined by how you think about what you have and where you are.  

So even if you're stuck in a tiny cubicle, you can think your way into a more productive, more challenging, more successful mindset.  And mindset is, according to research Achor discusses, seventy-five percent of the happiness equation.  

Watch the video and you will also learn that, "being positive in the present - turns on the learning centers of the brain."  You have the opportunity to be better at what you do, learn more, and impress your boss with your willingness to go the distance.  

Watch Achor's TED Talk, here.  

--Sandy Andrews, PhD 
Clinical Psychologist
Austin, TX 

July 14, 2015

Happy Is As Happy Does

We're all in search of happiness and nothing makes this more certain than a search of recent research in the field of psychology.  Lots of studies looking for ways to increase our feelings of happy.

A Washington Post journalist spoke to Shawn Achor, a Harvard trained expert on positive psychology.  Achor recommends several exercises to increase feelings of wellbeing, including.

(1) Gratitude.  Spend two minutes every day thinking of three new things you appreciate, enjoy, or are thankful for.
(2) Positivity. Spend two minutes every day recalling a positive experience from your day.  Recollect every detail you can think of and let yourself feel the pleasant feelings associated with each detail.  This can be as simple as observing a beautiful flower or seeing a dog chase a frisbee.
(3) Exercise.  Fifteen minutes a day of high energy physical movement.  Get your heart rate up AND your feelings of happiness.
(4) Breathe.  Here's the magic time again, two minutes.  Push away from your keyboard, silence your phone, turn off the tv, sit under a tree, lay beneath a ceiling fan.  For two minutes, just listen to your breathing.  That's it.  Just listen and stay focused on the sound of the air moving in and our.
(5) Kindness.  Each day send an email or text someone a message telling them how much you appreciate something about them or something they have done.  According to Achor, this is one of the most powerful happy-getters.

You can read the Washington Post article and interview in full, here.

--Sandy Andrews, PhD 
Clinical Psychologist
Austin, TX 

May 31, 2015

Just Do It - Use the One Minute Rule

And speaking of doing it now rather than procrastinating, here's a quick and helpful pointer. It's called the one-minute rule and it's courtesy of Gretchen Rubin of The Happiness Project.

I mean, who doesn't love reading, or in this case watching a video clip, about a one-minute-solution?

In this world of looking for unrealistic, so-called quick solutions, isn't it wonderful to find a one-minute-rule that might actually do some real good? Maybe help boost our organization?

And maybe even a blog post that takes one minute to read? (Give or take.) Grammar check: does the period go inside or outside the parentheses? And yes, I do have an MLA Handbook on the shelf behind me. And no, I will not reach up to grab it and risk an allergic reaction to the dust that will surely find it's way into my nostrils.

In the words of Gretchen, outer order contributes to inner calm.

--Sandy Andrews, PhD 
Clinical Psychologist
Austin, TX 

May 25, 2015

Stress and Your Work Station

Stress on the job can refer to a toxic supervisor, duties that you really dislike, hours that work against your body's natural rhythm, and other complicated factors that aren't solved by a simple fix.  CBT psychologists recommend that you consider changing posture as a way to improve coping with work demands.  How you sit at your desk might be adjusted to greatly decrease your physical stress, to free yourself from a frequent cause of back neck and shoulder pain.  Take a look at this video to get an idea of ways to improve your posture in the work place or at your home computer station.

--Sandy Andrews, PhD 
Clinical Psychologist w/ expertise in CBT
Austin, TX 

May 18, 2015

Meditation Basics

Meditation is the new black.  CBT psychologists are finding that meditation is good for decreasing anxiety and stress, boosting the immune system, falling asleep, healthier management of physical illnesses, improving memory, all sorts of benefits.

Try this guided meditation to go beyond the basics, here.

--Sandy Andrews, PhD 
Clinical Psychologist
Austin, TX 

April 27, 2015

love junkie

Frequently heard in psychologist offices is some version of the question, "Why am I attracted to losers?"  Losers being a euphemism for hurtful, selfish, deceptive, cheating or otherwise, all-around unloving, abusive partners.

In Love Junkie: A Memoir, Rachel Resnick gives us a powerful, brave, and well written memoir of her pattern of this very kind of relationship.  She tells of partners who have insulted her, degraded her, belittled her, called her names (Spencer yelling, "Hey Tits!" from the kitchen at a dinner party), cheated on her, kept important secrets from her, or coerced her into sexually objectionable behaviors.

Resnick tells about her painful childhood experiences with emotionally abusive and neglecting parents, much in the way someone has flashbacks in the midst of experiencing or recalling unpleasant relationship events. Some people might not like the back and forth between her adult and child experiences.  I found it compelling and consistent with the way many people convey their stories in therapy.

While I don't agree that people are loser-magnets or specifically attracted to losers per se, I do agree there are plenty of unhealthy people to be culled in the dating world.   Love junkies, to borrow Resnick's term, want loving mates as much as anyone but are willing to stay with unhealthy partners longer.  In some cases, years longer.  It may well be that one of the reasons people stay in abusive relationships is that the love-hurt-love-hurt connection is familiar, having been learned from hurtful, neglectful or somehow, emotionally, physically or sexually, abusive parents, caregivers, and or peers (the junior high years can be brutal).

Picture the love junkie encountering a hurtful behavior, early on, from someone they are dating.  Instead of saying, "Hey, that hurt!  If he does that again, I'm out of here!"  they say, like Resnick did, "Hey, that hurt! He must not love me very much.  I need to work harder to get him to love me more." Repeated and sustained abusive relationships may be an attempt to finally triumph this time around; to earn the love of the unloving other.

This need to work harder often gets channeled into sexual desire.  Hurt, in many instances, triggers doubling the effort to be pleasing.  What better way for a woman to be pleasing than to be sexually alluring and adventurous with her partner? Especially in our society with its plethora of media messages which define women as sex-objects.

Resnick talks of her tendency to blame herself and of her shame for being weak.  Love Junkie is loaded with a multitude of specific thoughts that keep her coming back for more: thoughts that interfere with leaving the men who repeatedly and blatantly hurt her and thoughts that fuel her increasing desire.  Resnick's intimate disclosures, I believe, offer therapeutic value, both for therapists who want to more fully understand their clients cognitive distortions and for individuals who feel alienated and ashamed, who fear they alone think in such a disturbed way.  

Resnick's book, in my opinion, is a tremendous contribution to the memoir literature.  It is a valuable resource for insights into some of the specific and very intimate thoughts, feelings and triggers that lead a person to remain in harms way.  I have already suggested it to people who find themselves in repeated hurtful relationships, to people who don't understand why they can't seem to end relationships once hurtful behaviors recur and to people who incorrectly view themselves as attracted to abusive partners.  In short, Love Junkie can illustrate the simple fact that "you are not alone" and that there is a road to recovery.

--Sandy Andrews, PhD 
Clinical Psychologist and CBT expert
Austin, TX 

April 14, 2015


Anxiety? Stress got you wired?  Looking for a fun form of relaxation?  Try Medikittentation.  

January 12, 2015

Ready, Set, Sleep!

I may stand corrected.  Which would make me and a lot of clients happy.  And sleepy.  As a cognitive behavioral psychologist (CBT) I typically teach a 6-4-8 breathing exercise as a stress relief technique and as a sleep aid,.  This involves a 6-second inhale, 4-second hold, and 8-second exhale (or 8-4-10, depending on the individual's starting point).

But in this post  by Alina Gonzalez entitled, How I Learned To Fall Asleep In Under 1 Minute, she advocates using Dr. Andrew Weil's breathing technique which she calls the "4-7-8 Trick."  You can go to Dr. Weil's website to see him demonstrate, here.

So I plan to take the 4-7-8 versus 6-4-8 breathing challenge.  And I invite readers to do the same. Leave me a comment and let me know which breathing exercise calmed, relaxed, and helped you get to sleep the most quickly.

Ready, Set, Sleep!

And a big shout out to my sister for 
bringing my attention to the article Under 1 Minute blog post. 

--Sandy Andrews, Ph.D.
Cognitive Behavioral Psychologist 
Austin, Texas