Category Archives: Counseling

Today’s Tip: KNOW SUICIDE RISK FACTORS

According to the National Institute of Mental Health, depression, other mental disorders, and substance-abuse disorders are risk factors for suicide. Studies show the best way to prevent suicide may be through early recognition and treatment of depression and substance abuse. If you or someone you know feels depressed and hopeless, seek help through your employee assistance program, physician or mental health professional.
Source: National Institute of Mental Health

Sleep Hygiene

Insomnia is a common issue so I wanted to give you a tip sheet on good sleep hygiene.

Sleep hygiene is a combination of your behaviors and environment surrounding sleep.

Lack of quality sleep affects your mood. It also lowers your pain threshold, increases your blood pressure, and interferes with your memory. It harms your immune system, elevating your chances of getting sick. It diminishes your ability to concentrate, and makes you more impulsive. It can also cause weight gain.

How to improve the quality of your sleep?

Here is a summary of 14 suggestions given in Fix Your Sleep Hygiene by Dr Korb.

1. Go to bed at the same time every day.

The reason for going to sleep at the same time is that your brain releases melatonin about 30 minutes before it thinks you want to go to sleep. If it doesn’t know when you’re gonna go to sleep it can’t do that.

2. Avoid bright lights after the sun goes down.

The melatonin that prepares you for sleep is inhibited by bright light so when it’s getting close to bed time turn off most of the lights in your house .

3. During the day stay in a brightly lit environment.

The melatonin cycle is part of a hormonal package collectively called circadian rhythms, controlled by a region of the brain known as the suprachiasmatic nucleus of the hypothalaums , which projects to the pineal gland to release various hormones. These rhythms are synchronized by bright lights during the day. So take a few minutes to go walking in the sunshine. This has the added benefit of boosting your serotonin, which may be why it helps sleep, as melatonin is derived from serotonin.

4. Sleep for 8 hours straight.

Your brain needs to cycle through various stages of sleep (Stages 1 to 4 and then REM sleep). Each cycle takes about 90 minutes, so in about 8 hours you get the appropriate number of cycles. If you wake up in the middle of a cycle you don’t feel rested. Your brain needs to know how much time it has to get everything done it needs to. In general the older you are the less sleep you need. In college you need about 8 hours and 24 minutes (approximately). When you start drawing Social Security you might only need 7.

5.  Use your bed/bedroom for sleeping, not doing work.

That way your brain associates your bed only with sleep, and it will induce sleepiness like Pavlovian conditioning.

6. Make your environment comfortable.

Sleep requires down-regulation of the sympathetic nervous system, which is harder if you’re uncomfortable. If your room is too cold, or too hot, or too noisy, or too smelly, then do something about it. If it’s something you can’t change, then just accept it.

7. Don’t take naps.

Taking a nap will often make it difficult to fall asleep at your bedtime. If you must nap, keep your nap between 20-30 min. This may surprise you, but if you actually consistently get quality sleep, you won’t even feel the need to take a nap.

8. Create a routine for preparing for sleep.

Do it every night. This helps you separate yourself from the hectic nature of the rest of your day. It prepares your brain for sleep.  A bedtime ritual might be brush your teeth, wash your face, go to the bathroom, and then read for a few minutes. These should be non-stressful activities. If you have a really hard time falling asleep, then include some meditation as part of your routine.

9. If you find you’re stressing over all the things you have to do, then write them down.

Your prefrontal cortex is responsible for keeping all these things in your working memory, and worrying about forgetting them is stressful. That stress inhibits sleep. Write it down so you don’t need to keep your prefrontal cortex working overtime.

10. Just chill.

Just relax, and lie still in a comfortable position. If after 20 minutes or so you’re still not asleep, then go to another room. Do something relaxing for a little bit (no more than 20 minutes), then try again.

11. Avoid caffeine near bed time. Duh.

12. Don’t eat a large meal less than 3 hours before bedtime. 

Indigestion can interfere with sleep, and acid reflux is more common once you’re horizontal.

13. Don’t use alcohol as a regular sleep aid.

While it may help you fall asleep, it disrupts the patterns of brain activity while you’re asleep. That means your sleep is not as restful as it could be.

14. Exercise.

Exercise is pretty much good for everything. Make physical activity a regular part of your life. The exact role of exercise in improving sleep though is not well understood. It may be due to increased levels of the neuropeptide orexin, which is essential for appropriate sleep regulation. It may also be due to the effects of exercise synchronizing circadian rhythms, or stress reduction, or some combination of several factors. Regardless of the reason though, it is clear that aerobic exercise helps improve sleep. Exercising too close to bedtime may make it difficult to fall asleep though, so try to do it a few hours before.

MASLOW’S HIERARCHY OF NEEDS

Maslow  was a Humanistic psychologist who was best known for creating Maslow’s hierarchy of needs, a theory of psychological health predicated on fulfilling innate human needs in priority, culminating in self-actualization.

According to Maslow, an individual is ready to act upon the growth needs if and only if the deficiency needs are met.

DEFICIENCY NEEDS

 1) Physiological: hunger, thirst, bodily comforts, etc.;

2) Safety/security: out of danger;

3) Belonginess and Love: affiliate with others, be accepted; and

4) Esteem: to achieve, be competent, gain approval and recognition.

Self-actualized people are characterized by characteristics such as incorporating an ongoing freshness of appreciation of life, a concern about personal growth and the ability to have peak experiences.

GROWTH NEEDS

5) Cognitive: to know, to understand, and explore;

6) Aesthetic: symmetry, order, and beauty;

7) Self-actualization: to find self-fulfillment and realize one’s potential; and

8) Self-transcendence: to connect to something beyond the self or to help others find self-fulfillment and realize their potential.

An interpretation of Maslow’s hierarchy of needs, represented as a pyramid with the more basic needs at the bottom (Image from wikipedia – http://en.wikipedia.org/wiki/Abraham_Maslow)

ALCOHOL: HOW MUCH IS TOO MUCH?

April is “Alcohol Awareness Month.”

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), some warning signs of alcohol abuse include: 

  • Drinking alone when angry or sad
  • Being late to work due to drinking
  • Forgetting what you did while drinking
  • Often having a hangover after drinking

If you suspect that you might have a drinking problem, or you know someone who abuses alcohol, check to see if your resources for treatment such as SAMHSA’s treatment facility locator at http://findtreatment.samhsa.gov/, employee assistance program (EAP) provided by your employer, and feel free to contact us.

Source: Substance Abuse and Mental Health Services Administration, HealthStart

Some Other Tips for Easing Up on Yourself

Timing:

If you and your spouse tend to fight when you discuss things at night—perhaps you’re tired, or distracted, or maybe it’s just habit—try changing the times when you talk about important matters so these talks don’t turn into arguments.

 

Avoidance:

If your child’s chaotic room makes you furious every time you walk by it, shut the door. Don’t make yourself look at what infuriates you. Don’t say, “well, my child should clean up the room so I won’t have to be angry!” That’s not the point. The point is to keep yourself calm.

 

Finding alternatives:

If your daily commute through traffic leaves you in a state of rage and frustration, give yourself a project—learn or map out a different route, one that’s less congested or more scenic. Or find another alternative, such as a bus or commuter train.

Do You Need Counseling?

If you feel that your anger is really out of control, if it is having an impact on your relationships and on important parts of your life, you might consider counseling to learn how to handle it better.

What About Assertiveness Training?

It’s true that angry people need to learn to become assertive (rather than aggressive), but most books and courses on developing assertiveness are aimed at people who don’t feel enough anger. These people are more passive and acquiescent than the average person; they tend to let others walk all over them. That isn’t something that most angry people do. Still, these books can contain some useful tactics to use in frustrating situations.

Remember, you can’t eliminate anger—and it wouldn’t be a good idea if you could. In spite of all your efforts, things will happen that will cause you anger; and sometimes it will be justifiable anger. Life will be filled with frustration, pain, loss, and the unpredictable actions of others. You can’t change that; but you can change the way you let such events affect you. Controlling your angry responses can keep them from making you even more unhappy in the long run.

Strategies To Keep Anger At Bay

Relaxation

Simple relaxation tools, such as deep breathing and relaxing imagery, can help calm down angry feelings. There are books and courses that can teach you relaxation techniques, and once you learn the techniques, you can call upon them in any situation. If you are involved in a relationship where both partners are hot-tempered, it might be a good idea for both of you to learn these techniques.

Some simple steps you can try:

  • Breathe deeply, from your diaphragm; breathing from your chest won’t relax you. Picture your breath coming up from your “gut.”
  • Slowly repeat a calm word or phrase such as “relax,” “take it easy.” Repeat it to yourself while breathing deeply.
  • Use imagery; visualize a relaxing experience, from either your memory or your imagination.
  • Nonstrenuous, slow yoga-like exercises can relax your muscles and make you feel much calmer.

Practice these techniques daily. Learn to use them automatically when you’re in a tense situation. See our other posts regarding relaxation and stress management.

 

Change the way you think.

Simply put, this means changing the way you think. Angry people tend to curse, swear, or speak in highly colorful terms that reflect their inner thoughts. When you’re angry, your thinking can get very exaggerated and overly dramatic. Try replacing these thoughts with more rational ones.

For instance, instead of telling yourself, “oh, it’s awful, it’s terrible, everything’s ruined,” tell yourself, “it’s frustrating, and it’s understandable that I’m upset about it, but it’s not the end of the world and getting angry is not going to fix it anyhow.”

Be careful of words like “never” or “always” when talking about yourself or someone else. “This !&*%@ machine never works,” or “you’re always forgetting things” are not just inaccurate, they also serve to make you feel that your anger is justified and that there’s no way to solve the problem. They also alienate and humiliate people who might otherwise be willing to work with you on a solution.

Remind yourself that getting angry is not going to fix anything, that it won’t make you feel better (and may actually make you feel worse).

Logic defeats anger, because anger, even when it’s justified, can quickly become irrational. So use cold hard logic on yourself. Remind yourself that the world is “not out to get you,” you’re just experiencing some of the rough spots of daily life. Do this each time you feel anger getting the best of you, and it’ll help you get a more balanced perspective. Angry people tend to demand things: fairness, appreciation, agreement, willingness to do things their way. Everyone wants these things, and we are all hurt and disappointed when we don’t get them, but angry people demand them, and when their demands aren’t met, their disappointment becomes anger. As part of their cognitive restructuring, angry people need to become aware of their demanding nature and translate their expectations into desires. In other words, saying, “I would like” something is healthier than saying, “I demand” or “I must have” something. When you’re unable to get what you want, you will experience the normal reactions—frustration, disappointment, hurt—but not anger. Some angry people use this anger as a way to avoid feeling hurt, but that doesn’t mean the hurt goes away.

 

Problem Solving

Sometimes, our anger and frustration are caused by very real and inescapable problems in our lives. Not all anger is misplaced, and often it’s a healthy, natural response to these difficulties. There is also a cultural belief that every problem has a solution, and it adds to our frustration to find out that this isn’t always the case. The best attitude to bring to such a situation, then, is not to focus on finding the solution, but rather on how you handle and face the problem.

Make a plan, and check your progress along the way. Resolve to give it your best, but also not to punish yourself if an answer doesn’t come right away. If you can approach it with your best intentions and efforts and make a serious attempt to face it head-on, you will be less likely to lose patience and fall into all-or-nothing thinking, even if the problem does not get solved right away.

 

Better Communication

Angry people tend to jump to conclusions, and some of those conclusions can be very inaccurate. The first thing to do if you’re in a heated discussion is slow down and think through your responses. Don’t say the first thing that comes into your head, but slow down and think carefully about what you want to say. At the same time, listen carefully to what the other person is saying and take your time before answering.

It’s natural to get defensive when you’re criticized, but don’t fight back. Instead, listen to what’s underlying the words: the message that this person might feel neglected and unloved. It may take a lot of patient questioning on your part, and it may require some breathing space, but don’t let your anger—or a partner’s—let a discussion spin out of control. Keeping your cool can keep the situation from becoming a disastrous one.

 

Using Humor

“Silly humor” can help defuse rage in a number of ways. For one thing, it can help you get a more balanced perspective. When you get angry and call someone a name or refer to them in some imaginative phrase, stop and picture what that word would literally look like. If you’re at work and you think of a coworker as a “dirtbag” or a “single-cell life form,” for example, picture a large bag full of dirt (or an amoeba) sitting at your colleague’s desk, talking on the phone, going to meetings. Do this whenever a name comes into your head about another person. If you can, draw a picture of what the actual thing might look like. This will take a lot of the edge off your fury; and humor can always be relied on to help unknot a tense situation.

The underlying message of highly angry people is “things oughta go my way!” Angry people tend to feel that they are morally right, that any blocking or changing of their plans is an unbearable indignity and that they should NOT have to suffer this way.

There are two cautions in using humor. First, don’t try to just “laugh off” your problems; rather, use humor to help yourself face them more constructively. Second, don’t give in to harsh, sarcastic humor; that’s just another form of unhealthy anger expression.

 

Changing Your Environment

Sometimes it’s our immediate surroundings that give us cause for irritation and fury. Problems and responsibilities can weigh on you and make you feel angry at the “trap” you seem to have fallen into and all the people and things that form that trap.

Give yourself a break. Make sure you have some “personal time” scheduled for times of the day that you know are particularly stressful. One example is the working mother who has a standing rule that when she comes home from work, for the first 15 minutes “nobody talks to Mom unless the house is on fire.” After this brief quiet time, she feels better prepared to handle demands from her kids without blowing up at them.

What is Anger?

The Nature of Anger Anger is “an emotional state that varies in intensity from mild irritation to intense fury and rage.” Like other emotions, it is accompanied by physiological and biological changes; when you get angry, your heart rate and blood pressure go up, as do the levels of your energy hormones, adrenaline, and noradrenaline.

Anger can be caused by both external and internal events. You could be angry at a specific person (Such as a coworker or supervisor) or event (a traffic jam, a canceled flight), or your anger could be caused by worrying or brooding about your personal problems. Memories of traumatic or enraging events can also trigger angry feelings.

Expressing Anger The instinctive, natural way to express anger is to respond aggressively. Anger is a natural, adaptive response to threats; it inspires powerful, often aggressive, feelings and behaviors, which allow us to fight and to defend ourselves when we are attacked. A certain amount of anger, therefore, is necessary to our survival.

On the other hand, we can’t physically lash out at every person or object that irritates or annoys us; laws, social norms, and common sense place limits on how far our anger can take us.

People use a variety of processes to deal with their angry feelings. The three main approaches are expressing, suppressing, and calming.

  • Expressing your angry feelings in an assertive—not aggressive—manner is the healthiest way to express anger. To do this, you have to learn how to make clear what your needs are, and how to get them met, without hurting others. Being assertive doesn’t mean being pushy or demanding; it means being respectful of yourself and others.
  • Anger can be suppressed, and then converted or redirected. This happens when you hold in your anger, stop thinking about it, and focus on something positive. The aim is to inhibit or suppress your anger and convert it into more constructive behavior. The danger in this type of response is that if it isn’t allowed outward expression, your anger can turn inward—on yourself. Anger turned inward may cause hypertension, high blood pressure, or depression.

Unexpressed anger can create other problems. It can lead to pathological expressions of anger, such as passive-aggressive behavior (getting back at people indirectly, without telling them why, rather than confronting them head-on) or a personality that seems perpetually cynical and hostile. People who are constantly putting others down, criticizing everything, and making cynical comments haven’t learned how to constructively express their anger. Not surprisingly, they aren’t likely to have many successful relationships.

  • Finally, you can calm down inside. This means not just controlling your outward behavior, but also controlling your internal responses, taking steps to lower your heart rate, calm yourself down, and let the feelings subside.

Anger Management Overview

The goal of anger management is to reduce both your emotional feelings and the physiological arousal that anger causes. You can’t get rid of, or avoid, the things or the people that enrage you, nor can you change them, but you can learn to control your reactions.

We all know what anger is, and we’ve all felt it: whether as a fleeting annoyance or as full-fledged rage. Anger is a completely normal, usually healthy, human emotion. But when it gets out of control and turns destructive, it can lead to problems—problems at work, in your personal relationships, and in the overall quality of your life. And it can make you feel as though you’re at the mercy of an unpredictable and powerful emotion.

Over the next few posts we will discuss what is anger, strategies to keep anger at bay and some other tips for easing up on yourself.

Cognitive Behavioral Therapy – Cognitive Journaling Using the ABC Model

Cognitive Behavioral Therapy (CBT) has many different interventions including Cognitive Journaling using the “ABC Model ” or a variation of the model where we include the letter “D” for Disputing.

Disputing is just an alternative belief that would lead to healthier consequences.

Please look at our previous posts for a brief overview of CBT and a brief explanation of the “ABC Model”.

Below is an outline on the basic elements in Cognitive Journaling.

Activating Event

1. The situation. Briefly describe the situation that led to your unpleasant feelings. This will help you remember it later if you want to review your notes.

2. Initial thought. What thought first crossed your mind? This was probably a subconscious or automatic thought that you have had before.

Beliefs

1. Negative thinking. Identify the negative thinking behind your initial thought. Choose one or more from the list of common types of negative thinking.

2. Source of negative belief. Can you trace your thinking back to a situation or person? Is there a deep belief or fear driving your thinking? Search your heart.

 Consequence

1. Consider the consequences. What are the short-term and long-term consequences if you continue to think like this? Look at the physical, psychological, professional, and emotional consequences.

Disputing

1. Challenge your thinking. Look at the evidence both for and against your thinking. Have you been in a similar situation before? What did you learn from it? What strengths do you bring to this situation? Make sure you see the whole picture.

2. Alternative thinking. The previous steps of the thought record helped you understand your thinking and lower your defenses. Now that you’ve considered the facts, write down a healthier way of thinking.

3. Positive belief and affirmation. Write down a statement that reflects your healthier beliefs. Find something that you can repeat to yourself.

4. Action plan. What action can you take to support your new thinking?

5. Improvement. Do you feel slightly better or more optimistic? This step reinforces the idea that if you change your thinking, you will change your mood. Gradually over time, your thinking and life will begin to improve.

Example of how a Cognitive Journal worksheet may look like:

Cognitive Journal

Cognitive Journal PIC

This thought record template is a variation of a public service provided by www.CognitiveTherapyGuide.org. It can be printed without restrictions. For a more complete guide to cognitive therapy refer to the book “I Want to Change My Life” by Dr. Steven M. Melemis. This handout may complement the work you do with your doctor or therapist, but should only be used in combination with professional guidance.

Cognitive Behavioral Therapy – The ABC Model

Cognitive Behavioral Therapy may be explained using the ABC Model or a variation of the model where we include the letter “D” for Disputing.. This model teach us that our beliefs/thoughts leads to how we feel and what we do.

Activating Event – the actual event and the client’s immediate interpretations of the event

Beliefs about the event – this evaluation can be rational or irrational.

Consequences – how you feel and what you do or other thoughts

Disputing – alternative belief that would lead to healthier consequences.

ABCD

Please look for our next post on how to do a Cognitive Journal using the ABC Model.