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by Lindsay Simon, LMFT & Clinical Director

 

The uncertainty and general threat surrounding coronavirus are causing anxiety and fear. I’d like to share with you some information about and strategies for dealing with these primal emotions.

First, it will be helpful if we define and differentiate between anxiety and fear. Anxiety is future-oriented thinking based on imagined worst-case scenarios (“What if” thinking, also known as catastrophic thinking or “future-tripping”). Fear is worry about a situation that is happening in the here and now and for which there is evidence.

The human brain is an amazing organ that has helped us survive and evolve for millions of years. Our brains have an amazing ability to anticipate and avoid or reduce the impact of future dangers based on past and current circumstances. When the anticipatory processes of the brain match the severity of threat and danger, this is a helpful, adaptive feature. However, when there is a lot of uncertainty about a novel situation, and a lack of data to assess the actual danger level (as is the situation we are all in with the coronavirus) the brain will still try to evaluate the potential threat in an attempt to avoid a negative outcome.

Without enough information to go on, the brain fills in the blanks, which can create on one extreme unhelpful and irrational anxiety, hysteria, and panic. On the other extreme, we can ignore facts and real threats that are supported by evidence, leading to potentially risky and harmful choices that could put oneself or others at risk. Ideally, we want to be somewhere in the middle, thinking that is based on evidence, data and reality while doing what we can to keep ourselves and others safe.

Here is an example of the difference:

Anxiety: “What if we don’t go back to work and I end up homeless and living on the streets”

Fear: “This is scary to not know when we will be able to go back to work.”

Living in a state of anxiety releases stress hormones like cortisol and adrenaline, and when these are flowing our immune system’s effectiveness is reduced. When our body senses a threat it de-prioritizes fighting off infections. So remaining anxious increases your risk of getting sick and staying sick for longer. Once we have stress hormones flowing in our body, with increased heart rate and anxious chest breathing, this gives our brain feedback that there is an actual threat so our mind will start to race and look for more threats. If there are no immediate threats, our brain will then look for future threats and more “what if” thinking will happen, which will release more stress hormones. This creates an anxiety feedback loop. When in this state, the part of our brain that makes rational decisions and problem solves is no longer working, so we are more likely to make decisions that are rash, defensive, attacking, and unhelpful. If you are able to think fear thoughts (realistic and rational thoughts based on evidence) rather than anxious thoughts, then it is easier to do the next step of acceptance, letting go, and refocusing on what is in your control.

Let’s explore more of what CAN be done:

1. Practice compassion and validation for yourself and others: validate yourself and others that this really is a scary time of uncertainty. There are a lot of unknowns and that can be scary. Validation can help reduce anxiety in yourself and others as long as it stays with validating emotions, events, situations that there is evidence for, and not made up scenarios.

2. Radical Acceptance: this is the concept of radically accepting things as they are rather than wishing they were different. Much of human suffering comes from wishing things are different than they are. We can generate internal peace by accepting things that are out of our control, and refocusing on what is IN our control. Try writing on the left side of a piece of paper “IN my control” and on the right side “OUT of my control” and create a list related to your current worries. Your behaviors, reactions, and thoughts are in your control, and other peoples’ behaviors, thoughts, emotions, reactions, the news, and all events outside of you are out of your control. For all the things that are out of our control, we want to practice radical acceptance. When anxious ask yourself, is this in my control or out of my control? Re-focus your mental and physical energy to the things you can control. For those things that are out of our control, radical acceptance looks like acknowledging the situation without judging the situation or criticizing yourself or others. Radical acceptance might sound like “It’s no use fighting the past,” “The future is out of my control and worrying about it won’t change the outcome and is a waste of time and energy,” or “It’s frustrating that I have to work from home, but I accept that is how it has to be right now to keep myself and others safe.”

3. Practice relaxation and mindfulness strategies: future tripping leads to anxiety.
Instead focus on the here and now. One way to get in touch with and pay attention to the present is to connect with your 5 senses. You can also practice calm belly breathing techniques and guided relaxations or meditations. I suggest using youtube and typing in “guided calm breathing” and “guided relaxation.” Use this time to improve your relaxation and mindfulness skills.

4. Exercise. You might not be able to do your usual activities like going to classes, the gym, or the ski hill, but you can go for walks or do at home exercises. An example of at home exercise is Fiton which is a free exercise app you can do from home with no equipment and you can connect with your friends to share your workouts.

5. Challenge irrational, unhelpful “what if” thinking (called catastrophic thinking or future tripping) to come up with more helpful, rational thinking. Ask yourself, What is the evidence for this?, What is the actual chance of this happening?, What might be the best case scenario?, Will any amount of worry change the outcome?, and What would I tell a friend to make them feel better if they said this to me?

6. Acknowledge and label anxiety as it comes up as a fear of uncertainty, not reality. You can even thank your brain for doing its job of trying to protect you, and let it know you got this and it’s going to be ok. Even if you don’t know that, remember that thinking calming thoughts increases your immune system functioning and your decision making skills, so it’s worth practicing.

7. Practice gratitude. Neurons that fire together wire together, so our habitual thinking
creates pathways that our brain will unconsciously repeat. If we focus on appreciating
what we have in the here and now, we can start to create positive thinking pathways that lead to less stress and more physical and emotional health and happiness. You can start a gratitude journal where each evening you write down 3 things that happened that you are grateful for and WHY you are grateful for them (this last part is essential to get the full neurochemical benefits of a gratitude journal).

8. Avoid/limit the news. If we watch and focus on negative things, we will wire our brain towards negativity. Most news is exaggerated and full of invalid information with the goal of getting viewers hooked. You can have a supportive friend tell you if something major happens instead, or give yourself 5-10 minutes a day to check in on the status of things.

9. Take advantage of the gift of time. (If you’re lucky enough to have it.) We often complain about not having enough time to work on self care, self reflection, reading, continuing education. Use this gift of time to take an online course, read that book you’ve been meaning to read, or start planning a vacation.

10. Stay connected with friends and family. Use technology to stay connected during this time, and maybe teach someone who needs these tools how to use them!

11. Engage in counseling. If you feel you need support from a licensed professional therapist with anxiety, depression, stress, or relationship problems that are arising or exacerbated during this difficult time, we offer tele-therapy and online counseling services, using highly effective evidence-based practices such as CBT, DBT, Solution-Focused Therapy and The Gottman Method Couples Therapy.

 

If you’re like the vast majority of people, you have a behavior that you’d like to change, maybe nail biting, smoking, or getting more exercise. Most people think making a change is linked to willpower and the strength of one’s character. The reality is, sometimes all it takes is changing the way we THINK about our behaviors to actually change them.

I’ll be using my own example of quitting smoking, which happened about 10 years ago. My reasons for quitting smoking were multifold, but mainly I wanted to have better health. I tried white-knuckling it (using pure willpower) several times and it didn’t work. I’d heard that it takes on average 8-14 attempts to quit smoking, and that most smokers don’t stop until their 40s or 50s, so I wanted to take a different approach. Below are tips and tricks that are associated with long term success. These tools helped me immensely in my own behavior change. 

Tip 1: Tracking your behavior.
Tracking your behavior gives you increased awareness and greater responsibility for making new choices. Keeping a record will also help you to find out what events trigger the action. Start with writing down (on your cell phone, notebook, a piece of paper – whatever works!) every time you do the behavior for one week. This will give you a baseline of how often you indulge in the habit you want to change. As time passes, you will be able to see your progress. By keeping track, I noticed particular patterns, such as smoking when I first woke up, when I was driving, when I first got home and after meals. I ended up with an average of a certain number of cigarettes per day. I made a plan for the next week to reduce the number of cigarettes I smoked by half.

Tip 2: Find and focus on your motivation
What is your goal and why do you want to do this? Take time to reflect and ask yourself at least 5 “why” questions, to fully explore why you want to change your behavior

For example:

1. Why do you want to stop smoking: to get healthy
2. Why do you want to get healthy: so I can live longer and in less pain
3. Why do you want to live longer: so I can help more people and watch my kids grow up
4. Why is it important that you watch your kids grow up and help people: because I want to leave a positive legacy behind
5. Why is it important that you leave a positive legacy: because I want to live a meaningful life and feel like I have a purpose on this planet

You can use the results of your journaling exercise to create a mantra. For me, it was “Get Healthy! Breathe!” Every day I would re-read those words and this helped me to maintain my motivation and focus. 

Tip 3: Environmental Control
When we have temptations in our immediate environment, we are more likely to slip into old ways. If I didn’t have cigarettes with me, then I was less likely to smoke. Of course I could always run by a store and get some, but not having them immediately accessible allowed me to be more mindful, give me time to interrupt my urge and decision to buy more cigarettes, and/or use my distraction techniques. 

Take inventory of your home environment and set yourself up for success by getting rid of things that will trigger the behavior you’re removing. If you’re working to increase or add a behavior, such as going for a run in the morning, get your running shoes and outfit ready before you go to bed at night.

Tip 4: It is easier to add a behavior, than to take it away
If you want to reduce a behavior, find something that you can replace it with. If you are adding or increasing a behavior, pair it with something you already do. For example, if you want to practice mindfulness each day, try pairing it with brushing your teeth. Each day after you brush your teeth, do your mindfulness practice. 

I made plans to cope during the times I would normally want to smoke. Instead of immediately smoking when I got home, I would distract myself with putting my things away (instead of just dumping it on a chair), playing with my pets, etc. While driving, I would chew gum or mints. I brushed my teeth right after dinner so I would be less tempted to smoke. 

Tip 5: Accountability
It can be hard to make changes – so having someone to help you stay accountable, while building you up and helping you problem solve, can be invaluable for a behavior change. I bet you have a friend who also has a behavior they’d like to change. Even if the behavior is different from yours, you can still help each other! I had accountability with a classmate who was working on procrastination. We helped each other by checking in each week and sharing what we noticed about our experience. 

Tip 6: Reward yourself
Come up with a plan to reward yourself for accomplishing your behavior! You’ve earned it! Make sure that it’s something special and that it is aligned with your goals. For example, rewarding yourself for sticking to your workout goals for the week could be taking a new class that you’ve wanted to try or buying some new workout gear. When I was able to stick to or below my goal, I rewarded myself with a piece of dark chocolate before bed (from a sleep hygiene perspective I do not recommend this as chocolate has caffeine, but you get the point). If I didn’t meet my goal, I would do ten pushups or situps.

I hope you find these tools helpful in working towards your behavior change goals. It’s been 10 years since I kicked the habit of smoking, and while it was difficult, using these strategies I was able to effect a lasting change in my life. 

If you’re working hard and still struggling or feeling stuck, we have therapists on staff who are ready to support you. You may also want to check out our SMART Recovery meeting, which meets every Tuesday at 6:00pm. SMART Recovery is open to anyone working on quitting or decreasing any addictive behavior, whether it’s phone addiction, gambling, or substance related. We offer SMART Recovery by donation and all are welcome! 

For more support: 

https://www.healthline.com/health-news/quitting-smoking-expect-failure-before-you-succeed#1

https://medium.com/lifeomic/10-science-backed-tips-to-making-a-health-behavior-change-that-sticks-8655c3bbde50

https://www.apa.org/helpcenter/lifestyle-changes

Karen Joaquin LMFT, 82969 | I am a California Licensed Marriage and Family Therapist, LMFT and a Licensed Advanced Alcohol and Drug Counselor with the California Consortium of Addiction Programs and Professionals. I obtained my MA degree in Counseling Psychology at University of San Francisco and have 9 years of providing individual, family and group therapy in the Bay Area and South Lake Tahoe. I have worked with mostly adolescents and adults, with extensive experience with co-occurring disorders and those involved in the justice system. In addition, I have experience in a variety of work environments including crisis services, county, school, group home and field-based services. I will work collaboratively with other providers such as Primary Care Physicians, Psychiatrists and other clinicians for a comprehensive approach. I primarily use a Cognitive-Behavioral approach, incorporating strategies from Dialectical Behavior Therapy, Solutions-Focused treatment, and humanistic strategies. I believe that by forming a cooperative relationship, I can work together with my clients to form a fresh understanding of their experiences, allowing for change to occur.

Written by Lindsay Simon, Clinical Director & Owner

Decades of research has shown that one of the most important factors in humans feeling happy and fulfilled in life is having healthy relationships.  The healthiness of our relationships is extremely important, thus learning and practicing formulas of communication that lead to improved relationships can be one of the best investments you ever make. In this article, I’ll give a step by step review of one of the most effective formulas that leads to relationships filled with more love, respect, compassion, emotional safety and connection.

It might sound demeaning to learn how to give yourself a time out as an adult, but bear with me, if you try it you will see the massive benefit of this interpersonal effectiveness skill.

It’s important to understand the basics of the brain.  The brain is made up of three layers: the brain stem at the bottom, the limbic system (aka the “emotional brain”), and the neocortex (aka the “thinking brain”).  These layers of brain were developed over the last 2 million years with the oldest part of the brain being the brainstem and the newest part of the brain, the neocortex.  The brainstem develops in utero until about age 2, the limbic system develops from in utero until about age 8, and the neocortex develops from about age 8 until about 24 for women and up to 30 years old for men.  The brainstem is in charge of unconscious survival drives like hunger, thirst, safety, keeping your heart beating, breathing, lust, rage and fear.  The limbic system is where your primary emotions originate, your attachment drives to care for babies, fall in love, and in combination with the brainstem, it generates the “fight or flight” reaction.  These more primal brain sytems are much older and more powerful than the neocortex when they are triggered.  The neocortex is where executive functioning occurs, which includes planning, decision making, negotiation, problem solving, time management, language, and healthy respectful communication.  The problem is, when we are feeling threatened (whether a real threat or a perceived threat- meaning whether it is a lion chasing you or your fear of embarrassment or of losing your job if you show up late to a meeting), then our old brain systems take over and we are no longer in a place where healthy communication can occur.  When this happens we feel it: our heart rate goes up, body tenses, and we may start to have much more negative thoughts, black and white or all or nothing thinking, or worst case scenario thoughts. In its extreme, thoughts of suicide can arise.

Once your limbic system has hijacked the brain, the neocortex is no longer in control and is “off-line.” In this state, our ability to think rationally, negotiate and communicate effectively has gone out the window.  At this point in time the Adult Time Out is your best option. What is an adult time out? It is giving yourself the time needed to get your neocortex back online. Only when the neocortex is in the driver’s seat can you have healthy communication with your partner, loved one, or co-worker.

As you go through the rest of this article, I suggest having a place to write or type your personalized steps to an adult time out.

Step 1: Recognize that you need a time out. Write down what you experience when your neocortex has been hijacked by the limbic system. If this is hard to identify, think of the last time you started feeling intense anxiety and having negative thoughts. Write down what you experienced both physically in your body and in your mind.  What did you think, what did you feel, and what did you physically experience. What are the symptoms you will experience that let you know you need to take action to get your thinking brain back in control?  At what level of anger on a 1-10 scale should you use an adult time out?

Now you know the symptoms to look for when you need an adult time out.

Step 2: Announce the time out. This is one of the most important steps and the most often forgotten.  If you are upset with someone and leave the room without saying anything (even if you know in your head that the purpose is to come back and find a healthy resolution) then it is considered a form of emotional abuse. Think of the last time you were really upset with someone and imagine that without saying anything they just walked out. How would that feel?  It would likely feel horrible, that’s because leaving without saying anything is a Power and Control move (even if unintentional) and is emotionally harmful to the other person. So pick something that feels comfortable for you to say, such as “I need to cool down,” “I need a break,” or “I need a time out.”  The key is to talk to your partner ahead of time so you have a plan.  If you are in a new situation (a new co-worker for example) you can say, “I need to take a break and will come back to this later after I have time to think about it.”

Also, it is important that whoever initiates the timeout is responsible for reengaging after the agreed upon amount of time.

Write down what sounds like a good fit for you to say when you need a time out.

Step 3: Leave I don’t care where you go, just get out of that space.  Of course, if you are in a situation where this would leave a child, dependent or elderly person in danger do not do this. Instead, try to find a way to use your calming skills while making sure they are safe and cared for.  This might be a conversation ahead of time with your spouse on how you can work together to support each other’s new emotion regulation skills. Ideally, if you can go outside or to a calm space that is best.

Write down ideas of where you can go in different situations (work, home, home with and without kids) when you might need a timeout.

NOTE, DO NOT: drive, drink, or do drugs – all of these exacerbate the situation and increase the risk of harm to yourself and others.

Step 4: Calm down In order to  clam down, it is crucial that you do NOT THINK ABOUT THE SITUATION.  Your only task is to calm your body down, meaning get your heart rate down.  Use distraction skills and self soothing.  If you try to think about the situation before you are fully calm, you will only come up with solutions you will later regret. This is when your limbic system is still in control, so all your solutions will be extreme and survival based.  To calm down, try: going for a walk or any other kind of exercise (bi-pedal movement has been shown to rapidly decrease stress hormones), play a video game, read a book, watch a tv show, listen to a guided meditation, do a Sudoko puzzle, listen to music, play music, write music, practice belly breathing, call a friend and ask how they are doing (do not talk about your problem at this stage- or if you do at all say you don’t want to talk about it), watch Youtube videos you’ve been wanting to watch that are distracting, take a shower, play with your pet, etc. I think you get the point.  Get your mind off the upsetting situation to give your body time to stop producing stress hormones so your neocortex can get back to full functioning.

Write down a list of what might work for you in different situations (ex: work, home, relative’s house)

Step 5: Reflect and think about what just happened. Now that you are calm, sit down and journal about what happened.  It is key to write this out; putting things down on paper helps us to process and clarify our thoughts and feelings.  Here is a format to help you:

•  Situation: write down the facts to the situation as if you were a fly on the wall watching it, no inferences or opinions, just the facts of what happened (example “I walked in the house and she stated “Did you pick up the milk”, NOT I walked in and she started nagging me right off the bat, FACTS only)
• Feelings: what did you feel, both physical and emotional.  Physical sensations can include increased heart rate, tightness in chest, clenched fists. Emotions are one word answers: sad, hurt, angry, frustrated, upset, inadequate
• Thoughts: examine the thoughts that were going through your head, as if you were a cartoon and there were a bubble above your head that read what the words in your brain were saying, write these down. Example “she always nags me” is a thought – an unhelpful thought that led to the negative emotional experience.  I list emotions above thoughts because those are easier to recognize, but the reality is that often thoughts precede emotions unless it is a learned emotional response to a situation such as jumping every time you hear a loud noise if you have been in a combat. (for extra credit you can Google search cognitive distortions and label the thoughts as well)
• Urges: what were the urges you had? These are the negative automatic urges of fight or flight that come from the old brain systems. Just because we have them doesn’t make them real or valid, they are just urges and we get to choose the meaning we give to them.
• Actions: write down what actions you actually took (hopefully a time out!)
• Think about what outcome you would like that would help resolve the negative feelings around this issue. What is it that you specifically want to ask of your partner/co-worker?

Step 6: Most Important Step!!!! Final Step!!! You MUST go back and talk about the issue and resolve it. A recommended amount of time for a time out is 1 hour. If the emotional upset was more minor, then a 20 minute time out might work. Timeouts should never be 24 hours, as this can trigger abandonment and your partner might not trust the process. The key to this working is you go back and resolve the conflict.  You can start by using the “I statements” formula.

1. When ______________________ happened, (fill in with the facts of the situation)
2. I felt _______________________ (fill in with what emotion(s) you felt, one word answers only, NO “I feel like” or “I feel that”, which automatically turns it into a thought, not a feeling) For beginners starting with I feel ______ when_________ can be more helpful. Try it out, it will be messy and awkward at first as all new things are, but keep at it!
3. Then check in with your partner. If they are able to reflect the basic message back in their own words that you are wanting to get across then go onto the next step. If they misinterpreted what you said then try again until they understand and you are on the same page.
4. Because ___________________________________ (this is where you put your thoughts, interpretations, beliefs, and fears in)
5. So what I think would help now and/or in the future is _____________________

Here’s a full example:

I felt frustrated when I came home and the first thing you said to me was “Did you pick up the milk”

What did you hear me say? Partner reflects it back accurately

Because it makes me feel unappreciated and disconnected from you and defensive right when I see you

What I think would help is if in the future we greet each other with hugs, kisses and a warm hello before asking about whether tasks got done or not.  I think it might also help if when I do remember to get stuff there is appreciation shown.  I know I can work on that too. 

I encourage anyone looking to improve their relationships and quality of life to keep working on themselves and seek the experience and knowledge of a professional if you feel stuck on your own. Communication skills are just one of many areas of improvement that a skilled therapist can help you with. The actions we choose define who we are, not our thoughts.  And with work and practice, you can change your response to conflicts to be more positive and loving.

Attention all MediCare recipients!

Effective immediately, A Balanced Life, Inc. is now an official MediCare provider for Mental Health Services. Please call our office at (530) 544-1748 or your MediCare coordinator for more information.