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.

More Tips for Coping with Stress

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.

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   

Fake It Til You Make It: The Power of Body Language

Nervous about an upcoming job interview? Wanting to invite a new friend for coffee but feeling too shy to do so? This video of Harvard researcher and social psychologist, Dr. Amy Cuddy, is a bit long but well worth watching.  Based on research findings, Dr. Cuddy offers a few short and simple exercises designed to help boost confidence in school, work and social settings.  These are examples of behavioral tools recommended frequently in CBT psychologist offices.

-Sandy Andrews, Ph.D.

CBT Cognitive Behavioral Psychologist 

Austin, TX

See the Stars

When it gets dark enough, you can see the stars.

Charles A. Beard

It may come as a surprise to few that many people present for therapy during the darkest of times.  New patients may feel powerless to change their circumstances, hopeless to overcome their problems.  We clinicians like to point out that, through therapy, people often gain the tools necessary to first cope and then to feel stronger, maybe stronger than ever, and then ultimately to overcome the difficult obstacles they face.   

It can help to believe that dark points in our lives may be fulcrum moments, the very point at which we gain the help we need to make substantial life changes.  To find the power within ourselves to take action and change.   

It would be foolish to suggest that we should look forward to low moods and hardship.  But it is worthy to suggest that when they arrive we can learn to accept them  as temporary turning points.  Maybe even necessary turning points.  To embrace the potential adversity presents.  As an end to stagnation.  The pivotal shift we need to grow.   Stronger.  To learn. To succeed.  To  flourish. 

As this quote suggests, we can learn to look beyond the clouds.  Look into that darkness.  Look for the stars.  We might just find incredible, life fulfilling opportunity.  

finding friends

In my last post, I talked about being new in a city and the struggle to find friends.

Years ago, I read a research study dealing with social support. It found that the variable most predictive of a friendship developing between any two people was, simply, time spent together. Not common interests, like I guessed. Not same background or religion. Not age. Not level of education.

Greater length of time spent in each other's company was the factor most associated with friendship bonding. Either long periods of time in one space (think weekend workshop or jury duty) or repetitive intervals across time (weekly art class). Time that allows for talking and getting to know each well enough to break down the barriers and move to a point where calling each other for a get together feels acceptable. Safe. And eventually easy.

I wish it were faster. I wish we could attend a party, walk up to someone new and say, "Hi. I overheard your conversation and you seem like someone I could be friends with." But this rarely happens. It might have been this easy in kindergarten. The older we get, though, the longer it usually takes. We grown ups are a leery lot.

Place of employment is a common venue for making friends. We can see the "time spent together" factor at work here. Many of my clients in this friendless predicament report the social scenerio at their jobs is lacking They might have made slight inroads or none. "Everyone is married." Or, "They're all older than me." Or, "They all do the bar hopping scene. I don't like bars." When friends don't arise in the work place, it can lead to looking around and wondering, "Now what?"

Well, here's one idea for the now what. Remember this one goal: Put yourself into situations where you are likely to see the same people again and again.

Visiting a museum one afternoon is not going to cut it. Signing up for a book club where the same people will be meeting week after week might.

What kind of situations? Start with an interest. A hobby. A creative outlet. An athletic pursuit.

What do I like to do? What am I interested in doing that I've never done before? What have I long wanted to try but haven't made the time to do so? Gardening? Creative writing? Volley ball? Woodworking?

Thumb through the newspaper in the local/metro or life section. Check out informal classes or adult education available at nearby colleges. Read over the available class schedules as a way of getting ideas or jogging your memory: photography, landscaping, stained glass, salsa or country western dance, yoga, walking tours, home improvement, bridge, dominoes.

Look for events that meet repeatedly, once/week or every other, where it seems likely you'll see the same faces on a repeat basis. A one-time seminar on a Saturday is better than sitting home and meeting no one. But a class or support group that meets regularly is a better bet for getting in the time needed to develop a friendship.

Some venues encourage interacting, such as team sports, creative writing classes, support groups, walking clubs. Others are more of a solitary pursuit. Avoid the latter. We want to optimize our recreation and volunteer time. Go where the opportunity for getting to know others is made easy.

The beauty of my plan is this: Even if your pursuit doesn't result in friends, let's say you're not interested in anyone who shows up, you are spending time doing something entertaining, challenging, and fun. You might be learning something.

Another benefit? You become more interesting this way. So when you do meet someone who has friendship potential, you're more likely to have something to offer. To be found friendship worthy.

So starting with something you're interested in is one friendship finding avenue. I'll have more to offer in a later post or two.

Feeling Friendless

Lonely Walk Home

by Michael Pickett

Living in a large, popular city, I see quite a few people coping with transition. One of the common requests for an initial appointment will go something like, "I'm new in town," or "I've lived here about a year now," followed by their complaint, typically something to do with depression or anxiety.

Many clients, particularly those beyond their mid-20's, are shocked, at a loss, or somewhat ashamed when they realize they are struggling in the friendship department.

Maybe they were used to making friends easily. Or they remember that reaching out to make friends never was easy but they somehow stumbled into a group of chums.

And now they find themselves feeling friendless. They start to feel the panic rise. How do I do this? Where do I start? What's wrong with me that I haven't found friends yet?

At some point in therapy, it becomes apparent to me that they are struggling to establish friends. It might take us awhile to reach the stage where we decide the client needs to target socializing. It's seldom a problem area people feel comfortable bringing up. People feel awkward admitting their lack of affiliation. The worry about the stigma of appearing friendless. The fear of being judged as a social dud.  

In therapy we explore the client's friendship history. How did they make friends in the past? Did it feel easy or was it a struggle? What types of friendships did they enjoy? Close confidantes or more distant acquaintances? Feel a part of a close knit group or often like an outsider looking in?

We often talk about the ease of making friends in high school and college, in particular. Life surrounded by hundreds or thousands of same-age, similarly situated peers. Mostly single, working part-time jobs, flexible schedules, with a variety of clubs and avenues available to study, exercise and socialize. To make friends. Dorm life is a friendship building tool at the ready. Close to campus apartment living is another. Potential friends all around, within arms reach, even.

Sometimes friends come in a bundle. A sports team. A choir group. A work team. Or we start to date someone and they have a big group of friends. Gradually they become our friends, too. Though not always easily. This wriggling into and feeling accepted by a pre-existing set of friends can feel awkward for many. Especially when those friendships go back to their days in the nursery. It's a situation ripe for feeling odd-person-out.

Which brings me to relationship break-ups and divorce. These are transitions where friendships are often lost. Partners exit and take their friends with them. You see this in a large group of couples. After the break up, maintaining friendships with those remaining in the couples club is a logistical nightmare. Seeing and hearing about The Ex can be too painful. Too close a reminder of what is lost. Learning about their new dating interests. Ouch.

Sometimes the friends appear to take sides. Or they don't know what to do and in their uncertainty, fail to reach out. This can really hurt the person left behind. Loss on top of loss can leave someone with profound self doubt, feeling sad and lonely.

It is well documented in the research literature that socializing on a regular basis is associated with positive physical health and emotional wellbeing. Feeling connected and cared about, laughing and going places together, keeping busy, exercising together, having someone to confide in: These are all benefits of friendships. It is no wonder, then, that finding oneself in a suddenly-friendless situation is associated with the onset or exacerbation of depression, anxiety, or a number of psychological conditions.

So how does one go about finding friends, exactly? Stay tuned. In my next post we'll talk about the goal of meeting new people and making friends.

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