Auto Accident Brings Stress Management to Forefront

Just two weeks ago, I received a phone call at night from my son, away at college, who had just been in an auto accident. That experience brings the subject of stress management straight to the forefront. Here was a real threat. He could have been permanently injured or killed by this accident. It was sudden and completely out of one’s control. It compounded upon previous stressors we had already been managing. I needed to rally and to cope.

In the face of a sudden, serious threat, the body’s fight-or-flight response initiates. The activating hormone, adrenaline, and the stress hormone, cortisol, are released into the physical system. During an imminent threat, this is the exact and appropriate change needed. A person becomes more alert and energized, the heart beats faster, respirations increase, muscles tighten, and all of the body’s resources are mobilized. Bodily functions which are not essential to the moment are dampened, such as digestion, rest, and repair.

For my son, the fight-or-flight response was quite helpful. He was able to pull himself out of the car through a broken window, climb a steep embankment, travel by foot seeking help, cope with being wet and freezing cold, keep his wits together to obtain items he needed such as a room key and access to a phone as his were lost in the accident, and was able to communicate with police, tow companies, and myself. I was at home experiencing the fight-or-flight response which mainly served to help my alertness and problem solving in communicating with my son. I also mobilized the next day to contact insurance companies and traveled to my son to ensure he got medical attention and practical matters were accomplished.

A few days after this intense moment, my son and I both felt the after effects of the fight-or-flight response. During the emergency, our immune systems were dampened, digestive functions were delayed, rest and recovery functions were set aside. My son came down with a sore throat. I came down with a severe intestinal flu. He reported exhaustion, headache, muscular aches and pains.

Unfortunately, the stress from the accident doesn’t go away quickly, it continues. Now my son was behind in his school work and he had additional new work as well as exams. I had numerous phone calls and tasks related to various insurances, phone service replacement, auto replacement, financial issues and increased requirements for problem solving.

The question arose:

How do we keep going without falling apart?

A recent article in Psychology Today discusses the connections between exposure to stress and lack of supportive environments to the triggering of mental illness in those with predisposing factors. It also notes research connecting cortisol to changes in the neurotransmitter, dopamine. This is one of the neurotransmitters involved in mood disorders such as depression. The presence of cortisol is also related to weight gain. Research continues to support the need to effectively manage stress in order to maintain health.

http://www.psychologytoday.com/blog/the-athletes-way/201301/cortisol-why-the-stress-hormone-is-public-enemy-no-1

There were several stress management techniques which I employed during this time.

Modeling: I thought of my parents who were always there for me. They steadily and persistently managed life stresses. I could feel the presence of their support during this time even though they have both been passed away for several years. They were an example to me and I would do the same for my son. I would persist and manage the situation. My son also demonstrated that he would persist, possibly influenced by my being an example to him.

Cognition: My thought processes were very important during this time. I was very aware of aspects of stress management. I consciously gave myself permission to take the steps needed to manage stress. I also managed my thinking, catching and altering negative and defeating thoughts. I advised my son to not get upset about future worries which had not come to pass.

Time Management Choices: I prioritized tasks. Things like laundry and basic house cleaning were neglected. Medical and financial matters were the main focus. I took a day and traveled to my son to get him medically assessed and to take care of practical matters. I took a two hour lunch one day and spent the time making phone calls and completing paperwork.

Communication: I informed my co-workers who then made accommodations for me and altered their expectations of my work load. The physician who examined my son wrote a letter asking the school and professors to take into account my son’s situation. My son e-mailed his professors and all of them extended the deadlines for assignments.

Limits/Boundaries: I said no to some activities and postponed others. I said no to friends and family for the time being. I also delegated some aspects to my son as was possible.

Exercise: I continued a mild to moderate exercise routine. Though I am a runner, I only felt like walking on the treadmill. That was ok. I still went to the gym, did the treadmill, and lifted some weights. I started doing some Pilates exercises at home. Exercise helps to expel the lingering cortisol, the stress hormone, which remains in the body. It also makes use of any adrenaline which is still being released. The following article discusses cortisol and exercise and nutrition.

http://www.inc.com/minda-zetlin/two-easy-changes-that-will-stress-proof-your-brain.html

Rest/Sleep/Relaxation: My needs for sleep increased and I allowed myself the downtime. I slept on the couch during the news. I went to bed early. I kept a schedule and a routine. I like to stretch for relaxation. Some people implement mindfulness or meditation techniques. Some listen to music. The main thing is to allow yourself time to rest. Do something which counteracts the stress response and turns it off.

Two weeks from the accident, my son and I seem to be recovering. Chronic stress takes a toll on people physically, emotionally, and mentally. Be aware of the real need for stress management, make it a priority, and give yourself permission to take care of your own health.

Nine Ways to Stay Out of Destructive Relationship Triangles

                                                   Me with the cast of Capone's Dinner and Show in Orlando, FL

Relationship triangles are the template for romantic dramas, especially those of daytime TV. Multiple hidden relationships involving betrayal and revenge fuel the interest of the audience. Mark finds that his current girlfriend is pregnant and she dreams of love and marriage with him. He is ambivalent, and in fact, has just returned from visiting his previous wife in an attempt to reconcile. She has rebuffed him. In the meantime, his very first wife is just out of prison and is maneuvering to attack him legally for custody of their young daughter. He has done all he can to keep her far away and out of his daughter’s life. The little girl’s loyalties shift depending on who is talking to her, and for some reason, she is angry with her father. The man’s current girlfriend tries to make alliances with both of the ex-wives, supposedly to best help him care for the daughter, but these alliances could easily turn against him if he were to decide he doesn’t want to be with her after all. Each person involved is bound to get hurt. We know something terrible is looming, and we watch expectantly. This is entertaining when it is on TV. It is destructive in real life.

In real life, it is best to stay out of relationship triangles. It is healthiest for individuals to have direct relationships without interference from a third actor.

It is possible for a person to have a good relationship with one individual even though that same person had a terrible relationship with another. If a positive relationship can exist, it should be given the opportunity. This is most obvious when it involves parents with children. While a parent may mess up their adult relationship with the other parent, that same person can develop a good relationship with their child. And the child deserves the right to experience a positive relationship with each parent, if possible. (If abuse is a factor, appropriate precautions need to be in place to protect children.)

This point became clear to me one day when I was attending a workshop. A man in his 60s told the group that he had always considered his father to be a good, wonderful man. When his father passed away, this man was talking about his dad’s attributes when other family members began to disagree with him. Evidently, all of the other members of the man’s family considered the father to be mean, spiteful, argumentative, and other hurtful characteristics that the man in our group had not experienced his father to be. He was shocked and surprised, but he was also grateful that he had been able to have a good relationship with his father. The other family members had not interfered with his developing this relationship.

In a relationship triangle, aspects of one relationship pair influence the interactions of each person in another relationship. This could be in the form of power alliances or in the form of misdirected emotion. For example, if one’s relationship with another is shaky, in other words, it might not hold up under stress, the partners in that relationship might find a common enemy in another person. This helps to bond them together while setting the other as an outcast and focus of their joint attacks. In another example, it may be that one person carries anger at a significant individual, but cannot express that anger directly for fear of losing that important person. The anger gets expressed elsewhere, directed at a person who doesn’t necessarily deserve that anger, or that intensity of anger. An example is when one cannot directly address anger or frustration with a manager and comes home to be grouchy and irritable with family members.

The approach to take with relationship triangles is to try to stay out of them. Do not draw others into your issues and stay out of others’ issues. Each individual needs to manage their own situations directly.

Develop assertive communication skills which give you the ability to be direct in your interactions.

If you are angry with someone, go to them directly to try to solve it.

If you are having a strong emotion or significant event, tell others so that they know what the real issue is and it does not get expressed indirectly.

Do not draw someone else in to be your ally against the person with whom you are having issue.

Do not keep secrets. The act of holding a secret creates an alliance between the secret keepers. This creates a closer bond between them and a lesser bond between each and the one left out of the secret.

Discuss problems and issues without blaming.

Trust that individuals have the ability to handle their own situations and that it is healthy for them to develop this ability for themselves.

Also, trust that others have the strength to handle the truth and that they would prefer to be in an honest relationship with you.

Start Communication Off Right with the Word 'I'

Taking care of oneself includes speaking up when something is amiss. It means you do not just stay quiet and tolerate or put up with behaviors from others which are bothering you. Reasons people tend to not speak up include: fear of the other person’s reaction, not wanting to be rude, not believing they have the right to say anything, not wanting to hurt someone else’s feelings, fear of it turning into an argument, fear of retribution or a negative outcome, and more.

Learning how to initiate a conversation about a problem issue with less inflammatory words can go a long way in promoting problem solving rather than conflict. When making a statement about what is bothering them, many people resort to statements which begin with the word, ‘you.’ For example, “You never listen to me!” or “You make me so angry!” The problem with starting a statement with ‘you’ is that it is accusatory and it quickly results in the receiving person becoming defensive. Immediately, they are less open to listening and more into supporting their own position. Sentences starting with ‘you’ are fighting words.

If you really want to bring up a problem to have it worked through and resolved with the important people in your life, you need to bring it up in a manner which is more egalitarian, which presents it as a shared problem to resolve, our problem.

A simple change is to replace ‘you’ with ‘I’ at the beginning of a statement.

Starting a statement with ‘I’ sends the message that you recognize you are presenting your point of view, your feelings, reactions, perspective, and that there could be a different perspective. It allows for the possibility that there could be a misunderstanding. It allows for discussion.

There is a formula for creating useful ‘I’ statements:

I (think/feel) ____________ when you (do some behavior), and I would like you to (do something different.)

Using this formula also helps to focus the discussion on a particular specific problem rather than some vague, blanket accusation about the other’s character.

For example, the above statement of “You never listen to me!” becomes “I feel ignored when you text while I am talking; I wish you would stop and give me your full attention.” The statement, “You make me so angry!” becomes “I am getting too angry, I need a moment to calm down.” In both ‘I’ statements, the speaker takes some responsibility for their own feelings and perspective. Both leave room for further discussion of each person’s point-of-view on the matter.

Common pitfalls:

People say “I feel” and then follow it with their thoughts on the matter. Saying “I feel” does not make it all ok if you still state judgments and accusations. 

The wrong way: “I feel you are a selfish pig!”

The right way, “I feel discounted.” “I think it is rude when people talk over others. I think it means they don’t value the other person.”

Also, it is not necessary to completely eliminate the word ‘you’ from the statement. The important thing is to not start the statement with ‘You.’ When describing the problem behavior, the word ‘you’ may still be used. For example, “I get upset when you leave your underwear on the floor.”

Using ‘I’ statements doesn’t mean you are ‘right’ and others have to comply with your directions for their behavior. Remember, you are entitled to your own feelings, but people don’t always have to behave according to your directions. Using ‘I’ statements is a tool for open discussion; it is not a tool for controlling others.

Changing to ‘I’ statements doesn’t guarantee conflict free communication, it just gives improved communication a chance. There are many variables involved in successful communication, such as timing, stress levels, personality, values and beliefs, to name a few.

If you want to be part of the solution, try implementing a change to using ‘I’ statements.

Six Key Approaches to Treating Depression Including The Brain Simplified

Depression: helplessness, hopelessness, sadness, feeling overwhelmed, trouble concentrating, sleeping all of the time or not being able to sleep, overeating or complete loss of appetite, significant weight gain or weight loss, irritability and easy to anger, isolating and lack of interest in usual activities. It may include suicidal thinking and/or attempts, but not always.

How the depressed brain functions:

Brain cells (neurons) communicate by sending electrical signals down long extensions (axons). Brain cells are not connected to each other. When the electrical signal reaches the end of the axon, it releases chemicals into the space between that axon and the next brain cell. These chemicals, called neurotransmitters, cross the space and attach to specific sites on the next cell’s receptors. In this manner, messages are passed on between brain cells. Once the message has been sent, the chemical neurotransmitters are sucked back up by the sending brain cell, a process called re-uptake. In depression, the amount of available chemical neurotransmitters is very low. Brain cells do not communicate effectively and the person’s overall functioning is compromised.

How do you treat depression?

First, get a physical including lab work to rule out any underlying health issues such as deficient vitamin D levels or thyroid dysfunction.

Anti-Depressant Medications: Most of the anti-depressant medications used today function by slowing down the re-uptake process and help to keep neurotransmitters present in the space between cells longer so that signals are sent more effectively between brain cells. The neurotransmitters targeted by medication tend to be serotonin, dopamine, and norepinephrine. 

Selective serotonin reuptake inhibitors (SSRIs) include Celexa, Lexapro, Prozac, Zoloft, amongst others.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) include Cymbalta and Effexor, for example.
Norepinephrine and dopamine reuptake inhibitors (NDRIs) are represented by only one medication, Wellbutrin.

By the way, many recreational drugs attach to the receptor sites in the brain which are meant for the neurotransmitters. Cocaine, for example, attaches to dopamine receptor sites. If the brain thinks there is more neurotransmitter available than needed, which would be the case if another chemical is filling the receptor sites, then the brain stops producing that neurotransmitter – hence withdrawal and depression when a person stops using drugs.

Counseling: People suffering from depression benefit greatly from counseling. The type of counseling most effective for depression as demonstrated by research is Cognitive Behavioral Therapy (CBT). A more modern version being used now is called Dialectical Behavioral Therapy (DBT). Both of these therapies have a person look at their patterns of thinking and work to change negative and extreme patterns to more constructive thinking which helps to improve mood and outlook. A focusing technique called Mindfulness is currently incorporated into these approaches. Mindfulness helps a person to not be influenced so much by past experiences or worries about future outcomes and helps a person to more fully experience the present moment. A key component of mindfulness is the elimination of negative self-assessment and judgment.
Issues of anxiety are also effectively treated by these therapeutic methods. Depression and anxiety frequently co-exist.
(Finding a counselor that you like and feel comfortable talking with can be just as effective no matter what therapeutic approach they employ.)

Multiple research studies over many years have shown that therapy plus medication results in more improvement than either therapy or medication alone.

Sleep: In depression, sleep is generally disrupted. The person may have trouble falling asleep, may awaken in the night and not be able to go back to sleep, or wakes early in the morning and can’t get any more sleep. Ongoing sleep disruption takes a toll on a person’s mood, functioning, and health. A person should not remain in bed trying to go back to sleep if it has not come in about half-an-hour. Our brains are creatures of association. If you lie in bed thinking and ruminating for hours, your brain comes to associate bed with thinking. It determines that lying in bed is your time and place for thinking. Get up out of bed and leave the bedroom if possible. Keep the lights low and activities quiet and mellow, even boring, and follow these guidelines:

Keep a schedule. Go to bed at the same time each night and get up at the same time every day.

Have a bedtime routine such as: dress for bed, brush teeth, organize items for the next day, read for a little while.

Turn off all electronics an hour before bed. Lights from electronics disrupt sleep cycles. Cover any lights that must stay on, such as clock lights. Have a dark room. Keep things a little cooler as well at nighttime. Do not sleep to the TV. Again, the brain makes associations, you might not be able to sleep without a TV, or you might wake up at certain times because the brain thinks it is TV watching time. You do not get the benefits of all of the brain’s sleep cycles with a TV on.

Do not get hooked on sleeping aid medications. These also disrupt the natural sleep cycles and you do not get truly deep, restorative sleep. Melatonin is produced naturally by the brain just before nightfall and signals the brain and body to relax for sleep. You can get melatonin over the counter and take it an hour or two before your regular bedtime. Talk with your physician about the effects of long-term use.

Learn and practice relaxation techniques such as progressive muscle relaxation, deep breathing, or meditation as part of your bedtime routine.

Exercise: Exercise earlier in the day and not close to bed time. Aerobic exercise, which gets your heart pumping, has been shown to increase levels of serotonin and dopamine in the brain. Find an activity you like to do. Walking gets you out into the fresh air and sunshine. A recent study has found that being out in the morning sunlight improves mood.

Socialize: Human beings are meant to affiliate with other human beings. Positive interactions with others can lift a depressed mood. It can be as simple as a pleasant ‘hello’ in passing or witnessing joking or teasing which happens naturally in many interactions. If a person is inclined, volunteer work can help improve one’s own outlook. Loving a pet fits under this category, as well.

Work to solve problems: High stress situations and ongoing life problems contribute to depression. Treating the symptoms of depression can help put one in a better state to approach and solve life problems. Seek out information and educate yourself on the issue, explore options, seek assistance, start taking steps to solve, improve, or change the situation.

Many of these approaches you can do on your own or with others and you can seek assistance from professionals for an objective view of your situation. 

Camping Demonstrates Personal Growth

I went camping last weekend. I am not the same person I used to be. Several aspects of this camping trip make that very clear to me.

Organizing and packing: I do it all and I am very good at it. Several times this weekend as an item was needed I said, “I have that!” This is in contrast to my ex-husband giving up on me by our second camping trip partly because I did not contribute to organizing, packing or meal planning due to not knowing how to do it. I have the ability now because after the divorce, I wanted to take my two sons camping and I studied up on products and read books in my own manner of learning and careful preparation. Do not ask me to wing it.

Hiking: This trip, I hiked up a snow covered trail and over streams by traversing rocks and wet logs until I came to a back-country high mountain lake. Years ago, I was non-athletic and needed to be guided through walking along a slanted trail and downhill. This weekend’s hike was not without consternation, but I dealt with it with the confidence I have developed. My feet slipped over the snow. I jolted and caught my balance and repeatedly felt I might fall. I anticipated getting hurt. As I stepped on a log to cross a stream, it moved and I did slip down into the water. My shoes and socks were now soaked for the rest of the hike. I acquired a large bruise on my inner calf. These risky situations would have paralyzed me in the past.

I still don’t like those thoughts and fears. I wished I had brought my sturdy hiking boots rather than running shoes and I am considering purchasing a walking stick for hiking situations. (I had been told it was a groomed, moderate path. I didn’t think of snow.) Rather than catastrophizing, now I tell myself such things as “So what if my feet are wet. I am wearing my wicking socks. I shouldn’t get a blister and they will dry quickly.” I also had confidence in my conditioning. I am a runner. I earned the right to proclaim that about myself. “I am a runner!” Years ago, with trepidation, I took up fitness walking. Now, I am on ten years of running. I have overcome plantar fasciitis, bunions, and am managing asthma. On this hike, my muscles and lungs were strong and I knew I had endurance. I noticed my own preference: I will stick with running for regular exercise. I prefer solid more predictable paths. (I relish forming my own opinions on what is best for me.)

Camp Cooking: This trip, I tried Dutch-Oven cooking for the first time. Chocolate cake was my debut! My brother-in-law who has known me since I was a pre-teen exclaimed, “I can’t believe you went out and bought a Dutch-Oven! I can’t believe you are even trying this!” There you have it. Being willing to try something new, to take a risk, to go out of my way to pursue something out of my regular experience is far from how I used to be. I prepared the charcoal briquettes which used to be the man’s job. I forgot the cooking oil. I decided I could substitute melted butter. It wasn’t finished cooking at the time the recipe had indicated. I had to make decisions about additional cooking time and on-or-off the coals. “Maybe the oil cooks hotter than butter and that changed the cooking time,” I wondered. My camp-mates were impressed with the resulting Chocolate Delight Cake. In my own mind I downplayed it as I tend to do, “What is the big deal?” I realize the big deal is they know how far I have come!

Reasonable and Mindful Rather than Positive

I run a group for adolescents in which I teach about distorted thinking. The first thing I tell them is that we all do it. Our brains take in thousands of pieces of information per second and the brain must identify, sort, classify, and decide what to do with this information. The brain takes short-cuts to do this efficiently. Most of the time, this works very well, and we are able to function. Sometimes, however, these short cuts, or ways of classifying, lead to mistakes in thinking. I let them know that I have been a therapist for over twenty years, teaching about distorted thinking, and I still do it myself. I tell the adolescents that you are not going to get rid of it. The goal is to learn about the different types and recognize when you are thinking in distorted ways and to change it so that your thinking is at least not making a situation worse than it needs to be. I educate that whatever mood you are feeling, distorted thinking increases it. Distorted thinking increases anger, depression or sadness, anxiety and worry. By catching one’s distorted thoughts and changing them, strong emotions can be managed. Then I ask the adolescents, “So what do you do with distorted thoughts, how do you change them?” And somebody always says, “Think positive thoughts!”

I tell them that if they are able to do so, finding something positive about a situation is helpful and switching to positive thinking can improve your mood. But then I say, “But this world isn’t all rainbows and butterflies. Horrible, awful things do happen and no matter how you look at some things, you can’t change it to a positive.” This gets their attention. In an instant, skeptical, bored, disdainful teens show a little respect and interest. Keep in mind, some of the teens in my groups have experienced terrible abuse that the average person doesn’t want to believe takes place. All of the teens in my groups are there because they have lost control of their emotional reactions and have landed in my treatment center. I tell them that the goal is to notice distorted thinking as it happens and to change it to more reasonable thinking, to put it into better perspective. Then I begin to teach them about cognitive distortions. See my blog post:
http://www.psychsage.com/2014/02/halt-calamity.html

I was very pleased as I attended a PESI workshop this month, “Cognitive Behavioral Therapy and Mindfulness: An Integrative Evidence-Based Approach,” presented by Daniel J. Moran, Ph.D. He echoed almost exactly what I have been saying in my adolescent group about adjusting thinking to be more reasonable. He of course taught some basic concepts of CBT such that there is an activating event followed by a person’s beliefs about that event followed by the consequent emotions which results in actions or behaviors. He then explained Rational Emotive Behavioral Therapy in which irrational beliefs are disputed or challenged. Extreme emotions are then transformed into more adaptive emotions even though they could still be negative emotions. He then moved into discussing how the technique of mindfulness can be incorporated with cognitive behavioral therapies and he specifically discussed Acceptance and Commitment Therapy.

I had been aware of the usefulness of mindfulness as being focused on the present moment experiencing it without the distraction of or distortion by thoughts of the past or the future. Moran pointed out that one does not have to have the emotional reaction which follows a thought and one can choose whether or not to react. Based on this, he recommended using mindfulness to notice one’s internal thoughts without the emotional reaction. He presented that simply being mindful of one’s cognitive distortions can reduce their ability to bring about an automatic powerful emotional response. It is important to notice the thoughts without judgment. “There is one of those thoughts.” Getting some distance from it reduces its emotional power. The person can then decide whether to act on the thought or not. Just because you think it does not mean you have to do it.

Gaining some control over emotional reactions requires being mindful of one’s thoughts, noticing them without judgment and even with some detachment. Practicing mindfulness during daily activities can develop the ability to use mindfulness to manage distorted thinking and to manage emotional reactions.

Boundaries Protect: Five Tactics for Setting Boundaries

“I can’t say, ‘No.’ I don’t want to make them mad at me!” This person is struggling with setting a boundary. The person doesn’t want to go along with someone’s request, but is more concerned with the other’s feelings than how agreeing to the request makes the person themselves feel. Now, it is good to be thoughtful and helpful and to care about others’ needs. The problem comes when an individual always compromises and ignores or subverts one’s own needs and feelings. The problem is being out of balance and skewed in favor of the other too much. People do have the right to care about themselves, to protect themselves.

Boundaries are the limits we put into place to protect ourselves from being harmed by others. They are rules which guide people such that they don’t harm each other. People with healthy boundaries respect the boundaries of other people, even if the other people do not know to enforce those boundaries themselves. Harm comes about in situations where people with poor boundaries interact. A common scenario is the combination of a person who doesn’t respect others’ boundaries taking advantage of someone who isn’t good at recognizing and enforcing their own boundaries. Some people care so little of others’ boundaries that they cross them even when they are clearly expressed, for example, a thief steals even with signs saying ‘Shoplifters will be prosecuted.’ The crossing of boundaries can happen on a continuum from simply, without malice, not recognizing that a boundary exists to quite knowingly pressing through boundaries.

Pia Mellody, in her book, “Facing Codependence,” gives an excellent explanation of the various combinations of intact and non-intact boundaries. She also explains how boundaries are learned. In general, we learn boundaries as children from our parents who both teach us and demonstrate by their own behavior, how we should be in this world. A child who grows up with parents with poor boundaries, for example, a child who is being sexually molested, is not taught appropriate boundaries, has its own inherent boundaries crossed by a more powerful adult, and doesn’t learn what appropriate boundaries are or even that they can have their own boundaries. This child grows up having difficulty even knowing how to gauge appropriate boundaries. People generally do grow up having learned boundaries, and vary in their abilities to enforce boundaries in different situations with different people. For example, a person may be very good at holding boundaries with acquaintances but doesn’t maintain boundaries and gives in easily to Mother’s demands.

Most of us struggle to sort out boundaries in complex situations. It is overly simplistic to think we can simply say, “No,” in any situation which makes us uncomfortable. For example, at work, people cannot simply refuse to do aspects of a job they don’t like doing. However, when job duties are compounded so much that they practically cannot be completed in the allotted time and this continues indefinitely such that it is causing burnout in the employee, this would be the time for the employee to recognize limits and boundaries and speak to the employer about making changes. (Labor laws exist to protect employees from abuse.) In personal relationships, people must compromise and take into account each other’s feelings and needs, but when does one person’s compromising become unhealthy self-deprivation or another’s lack of compromise become selfishness rather than healthy self-care.

There are five tactics which help in setting boundaries:

Recognize your own feelings. The first step in setting appropriate boundaries is honoring your own feelings. Do not deny or ignore any feelings. Some feelings have gained a bad reputation as being “bad” feelings or “weak” feelings. In fact, all feelings are guides and should be noticed. Feeling nervous or uncomfortable may be an instinct telling you something isn’t right. Anger and frustration can be signals that you need to enforce a boundary or ask for changes to be made. Sadness could mean you are not taking care of your own needs.

Know your preferences. Sometimes people do not enforce boundaries because they do not know their own opinion! When a person doesn’t know what they like or what they want, they open the door for others to do the choosing for them. If you can’t make a decision, someone else will make it for you. When you leave all of the choices and decisions up to someone else, over time, you lose yourself. Some find they “don’t even know who I am.” Notice your own likes and dislikes, have a favorite color, know what vegetables you like and don’t like, have an opinion on what movie to see.

Be reasonable, give yourself guidelines. Decide what you are willing to live with and when it is time to speak up. For example, you might choose to speak up when something has annoyed you at least three times. If it only happens once, you don’t say anything, you just tolerate it. If it happens repeatedly, three times in our example, you determine this is worth speaking up about and asking for change. Practice assertive communication. Or you might have values be your guidelines. You might decide that you will not live with someone who breaks your trust or who isn’t loyal. Know your own values.

Practice honesty. Be honest with yourself. Be honest with others. Many of us have been taught to lie in the practice of being polite. We have been taught it is polite to always appear happy. It is polite to not be a bother to others. When someone asks you how your day was, it is ok to reply, “Some good, some bad,” rather than the standard, non-informative, “It was fine.” Or we have learned to lie by omission. We do not want to burden others with our own experiences, so we don’t tell. But the reality is we are not having true, real relationships with others, if we do not share our own experience. We lose ourselves and our ability to have boundaries when we don’t express our honest experience.

Learn to say, “No.” Many people shudder in fear and trepidation at the thought of actually saying “No” to any request. But we become over-committed and then over-stressed when we are not able to set limits on our time and energy we have available to give to others. We harm ourselves, and others take advantage when we are not able to set a firm limit. Abusers are attracted to those who don’t recognize their own right to hold a limit. The December 2013 issue of Psychology Today magazine has an article by Judith Sills, PhD titled, “The Power of No.” She provides guidelines on how to begin the practice of effectively, kindly, assertively saying “No.”

http://www.psychologytoday.com/articles/201310/the-power-no

Maintaining boundaries is a way to protect ourselves from interpersonal harm. It is also how we stay connected to our own identity. Boundaries help us to maintain the “self.” To be human is to be in relationship with other humans. Learning to have boundaries in relationships with other people contributes to healthier, more equal relationships for all involved.

Speak Up Without Causing Destruction: Communication Styles and Assertiveness

Hello Friends and Colleagues. I have not posted for several weeks because I came down very sick with a fever and other changing symptoms. My energy is back and I have just a lingering cough. I am ready to provide you with the post I had promised you on communication styles.

There are three main communication styles and one sub-style:

First is the Non-Assertive or Passive Style of communication. A person who expresses themselves with this style tends to ignore and to not express their own rights, needs, and desires. They are indirect, inhibited, and self-denying. This person tends to feel hurt and to be anxious and can build up resentments. The behaviors they display include: permitting others to infringe on their own rights, avoiding unpleasant, risky situations and conflict, and not speaking up or stating their own opinions. They allow others to choose for them. A person with the passive communication style tends to not achieve their own desired goals. A stereotype associated with this style is the “Doormat” or the “Pushover.”

Next is the Aggressive Style. A person who expresses themselves aggressively tends to express their own rights, needs and desires but, unfortunately, they do this at the expense of others. They are emotionally honest, direct, and expressive, but in a hurtful manner. They are self-enhancing. They tend to anger and resentment. The behaviors they display include: having inappropriate outbursts or overreactions, putting others down, getting even or getting revenge. They tend to justify their blow-ups. They choose for others and they achieve their desired goals with indifference for others and even by hurting others. The stereotype associated with this style is that of people “walking on eggshells” around the aggressive person.

A sub-style is the Passive-Aggressive Style. A person with this style is predominantly passive most of the time. This person feels anger and resentment due to their passivity. Some express this anger in a sneaky manner by being outwardly passive but behind the scenes getting revenge. The person may spread rumors, undermine another’s efforts, cause property damage, or even manipulate relationships. Others will be generally passive and build up such anger and resentment over time until they have an aggressive outburst or angry explosion. Usually, they dislike this angry outburst, feel guilty and ashamed, and return to being generally passive. The stereotype could be “Backstabber” or “Ticking Time Bomb.”

Finally, there is the Assertive Style. This is the ideal to which we strive. The definition provided by Alberti and Emmons in their book, “Your Perfect Right,” is:

Assertive behavior promotes equality in human relationships, enabling us to act in our own best interests, to stand up for ourselves without undue anxiety, to express honest feelings comfortably, to exercise personal rights without denying the rights of others.

A person with an Assertive Style expresses their own rights, needs, and desires while respecting others. They are emotionally honest, direct, and expressive in a respectful manner. They are self-enhancing and they work through their emotions in a constructive manner. They feel good about themselves. The behaviors they display include: valuing self and others, being self-confident, communicating effectively, choosing for themselves, and being more equal and honest in relationships. This person achieves their desired goals without harming others.

Some key aspects to improved assertiveness include: developing self-knowledge or self-awareness, improving effective communication skills, developing strong boundaries, and managing emotions. These will all be topics of future posts.

Do you have any experiences with these communication styles you would like to share and any knowledge you have gained related to this topic? 

Knowing, Protecting, and Expressing Identity

I think therefore I am - Descartes. But who am I? How do we know who we really are (identity) and how do we honor that unique person?

Without a sense of identity, people flounder. They can have difficulty in relationships with others and trouble maintaining stability in life. Poor sense of identity is an underlying cause of many maladaptive behaviors and much mental anguish.

Identity is a sense of one’s unique self which is separate from others and is in relation to others. It includes what we believe, our preferences, values, passions, unique talents and attributes, and the groups with which we associate.

Closely connected with identity is self-esteem which is an evaluation of one’s own worth.  It includes the amount of confidence in self based on experience and on successful achievement.

Our identity develops from our genetic composition and from the beliefs and values taught to us by caregivers. Then it is honed by our own experiences and assessments, is influenced by society and culture, and is adjusted in response to feedback from others and to our experience of outcomes.

We honor our unique identity by developing healthy boundaries (the limits we set) and by having an assertive approach to interpersonal interactions.

A couple of useful books on boundaries are: 

1. Boundaries, Where You End and I Begin by Anne Katherine, and
2. Facing Codependence by Pia Mellody.

An assertive approach to interacting with others serves to: express our true selves honestly, protects the self, gets one’s needs met, and allows one to have safety in relationship with others.

In my next post, I will discuss several styles of interpersonal interaction, including the assertive style.

Readers, do you have anything you would add, especially any references to good books on these topics?

Feel the Fear and Do It Anyway

I first read, “Feel the Fear and Do It Anyway” (1987) by Susan Jeffers, as a college student. A few key points have remained with me throughout life, even without specifically going back to the text for a reference.

The title itself has often been a mantra in the back of my mind. In situations where I want to take a beneficial course of action, but I am nervous about my ability or the actual outcome, I tell myself, “Feel the fear and do it anyway.” It helps me to have the energy and confidence to take action.

In explaining how to get past fear to make a decision, Jeffers points out that at each step, we make a choice. Then, we find out how that turns out. If we do not like how it turns out, we make another choice. There is always another choice to be made. This seems obvious when stated, but we can tend to operate as if a particular decision is all there is. We tell ourselves we have to get it right. In actuality, we cannot know all aspects or know for certain the outcome of our choices. It is more important to know we can make further choices and that we are capable of managing what comes of our choices. I believe my grandmother used to say, “What come, what may.” Jeffers states, “Every time you encounter something that forces you to ‘handle it,’ your self-esteem is raised considerably. You learn to trust that you will survive, no matter what happens. And in this way, your fears are diminished immeasurably.” (Chapter 7, p. 117.)

In chapter eight, a life grid is presented which shows the importance of diversifying the number and type of people or activities which we value. I have used this grid to help get this concept across to my clients. For example, some people put all of their focus and energy into a relationship with another person. Nothing else in life is of much significance. In this instance, the grid is a single large box filled completely with RELATIONSHIP. If that relationship ends, the box goes blank, demonstrating what the person has of importance in their life – nothing. This puts the person into crisis. Instead, if a person develops several areas of value, several areas in which they invest their energy and focus, then they have an actual grid of several squares, each representing a different area of importance in their life: school, work, friends, relationship, hobby, spirituality, health. In this situation, if one area of importance slips or struggles, there are still several other areas which remain important and bring value into the person’s life. The multiple areas of value buffer and support the person while struggling in the one area. Their entire life does not go into crisis.

In an article related to this topic, “How to Make Yourself Do It When You Just Don’t Want To,” Halvorson lists as reason number one for procrastinating “being afraid you will screw it up.” While Jeffers emphasizes developing confidence in one’s ability to handle any outcome, Halvorson encourages thinking of the possible negative outcomes of non-action as a motivator to go ahead and do the thing you are nervous about doing. She also discusses a couple of other reasons for procrastination and specific ways to address them. http://www.psychologytoday.com/blog/the-science-success/201402/how-make-yourself-do-it-when-you-just-dont-want

Jeffers’ book is helpful to people who know they could make changes and improve their experience of life, but who stay frozen by their own fears.

Ten Attitudes Helpful for Personal Growth

Develop these ten attitudes that support creating a better life and quality relationships:

Valuing Lifelong Learning – You want to know more about self, about human nature, about science, about new discoveries.

Curiosity – Children learn and grow naturally, with enthusiasm and enjoyment, through curiosity. Adults can continue to cultivate an attitude of curiosity.

Hope – You have hope for positive changes and outcomes.

Desire to Become the Best One Can Be – This is not just for the Army. There is more than just surviving, getting by. You may find fulfillment in striving for self-actualization, becoming one’s best version of self.

Open-Minded – We grow by becoming aware of new approaches, ways of thinking, new information.

Saying ‘Yes’ to New Opportunities and Challenges – You have a willingness to try, to go along.

Believing One Deserves Improved Circumstances – Value yourself to be just as worthy as others. Don’t just settle.

Willingness to Work – You are able to see aspects of self that can be improved upon. You are willing to expend effort for personal gain.

Desire for Quality Life Experiences – You understand that life is, indeed, short. You want to fill life with good experiences and positive relationships.

Desire to Contribute One’s Unique Talents to Humanity – Self-improvement is a positive contribution to others, to friends and family, and to society.

Is there a quality or two on this list that you want to focus on? Are there some qualities that you already find helpful? Is there a quality you would add to this list?

Halt the Calamity

Cognitive Distortions, Thinking Errors, and Distorted Thinking: We all do it. I have been a licensed therapist for 20 years teaching this subject to others and I still do it. Our human brains are wired to work in these ways. The brain takes in multitudes of information per second. Then, it has to identify, sort, classify, and make sense of the incoming information and make decisions about it. It takes short-cuts to make this process fast and efficient. Most of the time, the short-cut method works very well and is necessary for our quick thinking minds. But those short-cuts can also cause misperceptions. They can trip us up. We can’t always trust that because we think it, we are correct in our thinking.

It is important to know about cognitive distortions, because when we think in these ways, whatever emotion we are having is increased. If we are angry and engage in distorted thinking, it causes us to be angrier. If we are depressed, we feel worse. If we are anxious and worried about something, our cognitive distortions increase the anxiety. We want to be able to recognize our own distorted thinking so that we don’t make our experience of a situation worse than it needs to be.

Distorted thinking is not something you are going to completely eliminate. The goal is to learn what cognitive distortions are, be able to recognize them when they come in to your thinking, and then adjust your thinking to be more realistic. Now, there is a lot of talk about positive thinking, and it is a valuable endeavor. But I like to point out that life is not all rainbows and butterflies. Sometimes bad things happen and we can’t say anything positive about it. Sometimes things happen that are horrendous. So cognitive distortions need to be changed, but they don’t always have to be changed to a positive thought. Cognitive distortions simply need to be put back into reasonable perspective.

I am going to discuss ten of the cognitive distortions presented by David Burns in his book, “Feeling Good,” (1980) and suggest how to counter them with something more realistic:

All-or-Nothing, Either/Or, Black-and-White Thinking: The person thinks in extremes and does not see other possibilities or variables. The person thinks, “It is either this or that.” For example, “They either love me or hate me, “I am either good or bad,” I am either a success or a failure” The person may have perfectionistic tendencies such that when they earn an 80% on a test, they conclude that they are a failure. In fact, they did well on 80%, which is not failing.
Change it to: There are a number of possibilities which exist on a continuum. Give credit to that which falls in-between the extremes.

Overgeneralization: The person takes a single event and sees it as an ongoing constant. The person thinks, “This always happens.” For example, “You never listen to me,” “You always do that,” “I always screw up,” “You never finish anything you start.” Words like ‘always’ and ‘never’ are clues that one is making an overgeneralization.
Change it to: Observe only the present situation, such as “Right now, you don’t seem to be listening.”

Negative Mental Filter: The person gives more attention to negative events or negative variables and does not notice positives or dismisses positives as not as important as the negative. For example, a person in a good mood looks out a window at a blue sky with a single cloud and thinks, “It is going to be a beautiful day! The sky is mostly sunny and blue!” A person in a low mood uses Negative Mental Filter, looks out a window at a blue sky with a single cloud and thinks, “This is going to be a miserable day. See that cloud. It is going to cloud up and rain.”
Change it to: Notice what is going well or what is right along with the negative. The positive holds as much weight as the negative. This is the time for changing negative thinking to positive thinking. Remind yourself to direct your attention to the positive aspects of a situation.

Related article:

http://www.learning-mind.com/5-mistakes-our-brain-makes-every-day/

Magnification or Minimization: The person thinks of a problem as much worse than it is or, on the other hand, doesn’t give enough significance to a real problem. With minimization, the person thinks or says, “It doesn’t really matter” or “It is no big deal.” With magnification, the person catastrophizes, and reacts as if a moderate problem is of life or death significance. For example, a woman over-reacts to having broken her nail or having a bad-hair-day. A man slips or makes a mistake while making a repair and throws his tools and the object being repaired around the room.
Change it to: “I can get through this. With some patience and practice, it will get done.”

Should Statements:  The person thinks in terms of moral rules applied to oneself and to others. The person mentally whips themselves to take action. For example, thinking “I should do this or that,” “I had better do such-and-such,” “I need to do this.” Or the person looks at the past and thinks, “I should have done such-and-such.” The person applies judgment to other people on how they should behave. For example, “That person should apologize to me, and until they do, I am not going to speak to them.”
Change it to: When motivating oneself, say “I want to get this done before the next thing.” Changing ‘should’ or ‘have to’ into ‘want’ is more positive and helps a person feel more in control instead of driven. When it comes to other people, keep in mind that they do not have to live according to rules in your mind. There are a number of ways to approach most situations.

Labeling: The person observes a single behavior and applies a general label. In other words, the person engages in name-calling, usually of a negative nature such as: stupid, clumsy, lazy.
Change it to: Discuss only the behavior in that moment. Remember that people are complex and we only see snippets of their entire personality in a moment.

Emotional Reasoning: The person has a feeling and believes that is proof that something is true. The person makes decisions and takes action based on feeling, not factual evidence. For example, a person feels they are going to make a fool of themselves and they feel an interview will go badly, so they choose to not go to the interview at all.
Change it to: Just because you feel something doesn’t make it true. Feelings are not facts.

Personalization: The person takes on full responsibility for things that are outside of their control. For example, a parent attributes their child’s misbehavior entirely to their own failure as a parent when other variables could be involved such as the child’s inherent temperament or hyperactivity. Another example would be a spouse blaming themselves for their partner’s alcoholic overindulgences.
Change it to: Be aware that all people are responsible for their own behavior. Take responsibility only for that which you control, that is, your own choices and actions.

Comparison Game: The person compares him/herself to someone who seemingly has more or better belongings or attributes.
Change it to: Know that each situation is unique and most comparisons are not equal or fair. It is reasonable to strive for something. It is not reasonable to put oneself down because of not having what another has. Notice one’s own worthwhile qualities and work to improve and to grow from where one is at that point in time. A positive form of the comparison game is to compare one’s own situation to those less fortunate and to then be grateful for the blessings one does have.

Jumping to Conclusions: The person takes minimal information and assumes full knowledge. In Mind-Reading, the person sees an expression on another’s face or observes body language or actions and assumes they know what another is thinking. The person does not check with the other for accurate clarification. In Fortune-Telling, the person assumes a negative outcome to a future event.
Change it to: Don’t assume. Ask if you are correct in your thinking. Communicate.

If you want to work on your own cognitive distortions, pick one or two and keep track for a few days of each time you think in those ways. Just keeping track of them will lead to you reducing your use of them. Then, practice changing your typical ways of distorted thinking into something more realistic for the particular situation at hand. It is most useful during a time of high emotion to notice cognitive distortions and change them so that they do not contribute to the intense emotion. Keeping a journal is a good method for catching distorted thinking and taking time to put it into better perspective.

Can you share a time when your own thinking errors made a situation worse than it needed to be?

Review of Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward by Prochaska, Norcross, and DiClemente (2010)

“Changing for Good” assures that true change is possible. It explains that there are certain stages and certain steps to take in each stage. Many people are unsuccessful in their attempts at change because they skip important initial stages or they use the wrong strategies for the stage they are in. The authors assert, “The key to success is the appropriately timed use of a variety of coping skills.” (Kindle location 135-136.) Through educating the reader on the processes followed by “successful self-changers”, the book increases the likelihood that change attempts are effective.

The book has a conversational style. A caring guide explains important points while empathizing with the struggles at each stage. At the same time, the author refers back to the extensive research of the team and outcomes which support their assertions. Common defenses, excuses, and behaviors which contribute to maintaining the problem behavior are confronted in a manner that is palatable to the reader who might be employing those very self-defeating actions. The serious difficulty in making lasting change is not glossed over; it is made quite clear.

Hope is given. This is the text which introduces the concepts of slips and relapses. It teaches that these are a normal part of the change process. It also encourages the reader that one does not have to fall back to start all over at the pre-contemplation stage. With education and perspective, one can begin again at one of the later stages such as preparation or action.

The book is written to support people who are trying to change on their own. Near the end, however, it notes that if one has tried repeatedly without success, it would benefit to seek professional help. I was disappointed that when different helping professionals were identified, there was a specific caution made against those who call themselves counselors. The point was that some call themselves counselors who do not have legitimate training. The caution should have advised that one look for those with appropriate credentials such as master’s degrees and state licensure. Since I am a master’s level Licensed Clinical Professional Counselor in my home state and a Licensed Mental Health Counselor in the next state over, I want people to understand the credibility of licensure.

In the end, “Changing for Good” makes it clear that making lasting change is a difficult process that one must make a commitment to continue working at over a long period of time, such as over years. It states, “Clinical research indicates that only about 20 percent of the population permanently conquers long-standing problems on the first try.” (Kindle location 3120.) The person seeking to change a problem behavior is advised to examine what stage of change they are in and to follow the processes outlined in the book to help the person to move from one stage to the next with the best preparation. Overall, it is an easy to read, educational, and supportive self-help book.

Blinded by My Own Mind Games

As a therapist working in a hospital psychiatric setting, there are certain tricks I frequently see employed by people to protect themselves from the pain of facing problems. If a problem situation is too intense or overwhelming, especially in the beginning, it is adaptive for the mind to employ these protections. Over time, the person addresses different aspects a little at a time in a manageable manner. However, people can protect themselves so well that they never acknowledge a problem exists. In order to be in control of one’s life choices and personal actions, one must recognize problems, tolerate emotional distress, and take conscious action. The following eight defenses are common. If a person works to reduce reliance on these defenses and instead faces facts, then progress can be made in solving or eliminating the source of stress or emotional pain. The person takes back the right to make conscious personal choices about their own life direction.

Denial

The person does not believe there is a problem. There is a complete lack of awareness. Common statements include: “I don’t know what you are talking about,” “That didn’t happen!” “I don’t get angry” “I didn’t say that.”

Minimization

The person admits to something but assesses it to be within the normal range or of no consequence. Common statements: “It’s no big deal,” “I don’t know what they are getting so upset about,” “It’s not a problem for me,” “I drink sometimes like anyone else,” “Everybody gets angry, sometimes I get a little annoyed.”

Avoidance, Dodging, Shifting

The person brings up a completely different issue or brings attention to something else of no connection to the topic. Sometimes it elicits concern from others which takes away from the problem to be discussed. Examples: “My tooth has been hurting; I need to make a dental appointment.” “Oh, look, I have a stain on my shirt (or it is unraveling, etc.)” “What is for dinner? I am starving!”

Intellectualization

The person over-analyzes and uses logical justification to explain away the problem. The person remains so logical and analytical that they do not experience the emotions associated with a problem. It is the experience of emotion that could spur the person to action. Instead, the person remains mired in over-thinking and contemplating. “I wonder why I do that. It could be because I haven’t slept well, or I have a lot of work on my mind. But it makes sense; anyone under the same circumstance would do the same.” Or the person does a lot of describing or telling the events of a situation but cannot talk about their emotional responses.

Blaming or Projection

When someone is trying to talk to the person about a problem, the person responds with angry blaming and accusations about the other’s actions. Common statements: “You don’t listen to me,” “You don’t care about me, this is about you getting what you want,” “You always point out what’s wrong with me” “You care about so-and-so more than me.” These accusations put the other on defensive which leads to them trying to explain themselves and to reassure the individual. This takes away from discussing the problem that originally needed to be discussed. With projection, the person accuses others of the very characteristics or issues that are within them which they deny.

Victim Stance

When people try to confront a person about a problem, the person reacts as if those doing the confronting are being mean or cruel. The problem cannot be discussed because the person reacts with such hurt. The person might label themselves in a negative manner or generalize that life is not fair to them. They have bad luck and they do not make the connection between negative outcomes and their own choices and behaviors. The person might assert that they are incapable or ineffective. This elicits sympathy from others and attempts to talk the person out of their negative assessments.

Anger or Displacement

A person uses anger to keep others away, to make it too uncomfortable to bring up any issues. In displacement, a person takes out their anger on a safe object rather than directing it at the true cause of their anger. For example, a teen boy is failing in school and is on probation and he frequently argues with his mother who continues to love him. Or there is the stereotype: man has bad day at work, comes home and yells at child, then child kicks the dog.

Passive Aggression

The person does not confront a problem directly. They might be agreeable but not follow through. Examples: Instead of talking directly to someone to resolve a conflict, the person gossips and complains to others about the other person. Or the person agrees to do some task which is asked of them, but they forget to do it.

What can you do? Allow yourself to become open to other’s observations. Don’t reject others’ complaints about you or their presentation of a problem. Tell yourself and them that you will consider what they are saying. Then do it. Stop thinking about what is wrong with the other person and take a look at your own actions and reactions. We all play some part in every situation. What is the part you are playing? What positive outcome would you like to see happen? Consider what choices and actions you have control over and what changes you could make to positively affect the situation. Also, take a good look at how things really are. Allow yourself to feel your own feelings of fear, anger, hurt, disappointment. But don’t get stuck in them. Use them to determine that something isn’t right and you don’t want it to continue. Use your feelings to propel you into taking action to resolve, remedy, or alter negative circumstances. Practice constructive problem solving and assertive communication. Identify some change you can make or some action you can take or even a change in your thinking. Take some control back and quit just tolerating the status quo. I hope you have positive results!