The Importance of Boundaries

by Annabelle Parr

Do you ever feel like you can’t say no?  Do you believe that you are responsible for the emotions of others?  Do you take others’ opinions and needs into account before your own?  Do you find yourself unsure of what you want or need (Eddins, 2015)?  If so, you are certainly not alone.  However, your feelings, thoughts, and needs matter.  By setting some boundaries in your life, you can begin to treat your needs as important.

Boundaries and Anxiety

Image source: https://blogs.goarch.org/blog/-/blogs/boundaries-healthy-limits-or-barriers-to-relationships-

For people who struggle with anxiety, learning how to create healthy boundaries can be a helpful tool.  Though sometimes people cope with anxiety by creating unnecessary boundaries or avoiding situations that serve as triggers, other times anxiety is experienced as a result of unclear lines between self and other.  When you don’t protect your sense of self, it is easy to feel overwhelmed and take on responsibility for everything and everyone (Eddins, 2015).  This can lead to feelings of guilt and anxiety.  It is not hard for a vicious cycle to ensue, where a lack of boundaries leads to anxiety, and where anxiety leads to a feeling that you cannot set clear and effective limits.

What Are Boundaries

Image source: http://quotesgram.com/img/quotes-about-healthy-boundaries/1HBuCAOAF6/

So what exactly are boundaries?  Boundaries help us to define who we are.  They orient us in our relationships, and signify to us and to others where “I end and you begin” (Eddins, 2015).  Boundaries can apply to any area of our lives, and can range from material boundaries to physical, mental, or emotional boundaries to sexual or spiritual boundaries (Lancer, 2015).  Boundaries are very personal, and there is not a right or wrong answer regarding to how to set ones that work for you.  They are based on your beliefs, values, opinions, and needs (“12 Signs,” 2015).

Boundaries as an Act of Love

A common misconception for people who struggle in this area is that setting boundaries is selfish.  However, self-care is not selfish.  Have you ever flown on an airplane, and heard the stewardess tell the passengers in case of an emergency to put their own oxygen mask on before helping others with theirs?  This “oxygen-mask” rule is a profound metaphor for the idea that we cannot take care of others if we have neglected to take care of ourselves first. 

Image source:  http://www.thedynamicturnaround.com/healthyboundaries.htm

Setting boundaries for ourselves and giving ourselves permission to articulate our needs is an act of self-love (Strgar, 2010).  And in the wise words of Brené Brown, “we can only love others as much as we love ourselves” (2010).  Furthermore, when we set clear limits in our lives, we are better able to be compassionate towards others.  Brown (2010) states that “the heart of compassion is really acceptance,” and when we lack boundaries, we are not accepting our own needs and we may have a difficult time accepting others if we feel they are taking advantage of us. 

So contrary to this idea that boundaries are selfish, they actually help us love ourselves and others better.

How Therapy Can Help

You are the only one who has the ability to set boundaries in your life.  However, therapy can be helpful in navigating this challenging task.  Therapy offers a place where you can explore your values, your feelings, and your relationships.  Your therapist can help support you in the process of determining where you need to establish stronger boundaries or areas in which you might benefit from more flexibility.

Therapy can also be a good place to experience a relationship with very clear boundaries.  Dr. Irvin D. Yalom (2002) describes “therapy as a dress rehearsal for life,” meaning that it is a safe place to encounter challenging aspects of life and relationships before you face them outside of the therapy room.  An important goal of therapy is to take what you have learned and apply it to the rest of your life, but it can be helpful to practice new skills in a safe space first.

Don’t Forget to Be Kind To Yourself

One final thing to note is that boundaries are learned (Lancer, 2015).  If you are not used to setting clear limits in your life, know that it is a skill that takes practice.  The best way to start learning this skill is to cultivate self-awareness and practice asserting yourself (Lancer, 2015).  Remember, it is important to give yourself grace and to seek support throughout this process.  If you feel like you could benefit from some professional support in developing boundaries in your life…

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

12 Signs you lack healthy boundaries (and why you need them). (2015).  Harley Therapy Counselling Blog. Retrieved from http://www.harleytherapy.co.uk/counselling/healthy-boundaries.htm

Brown, B. (2010). The gifts of imperfection: Let go of who you think you’re supposed to be and embrace who you are.  Center City, MN: Hazelden Publishing.

Eddins, R. (2015). Keeping Good Boundaries & Getting Your Needs Met. Psych Central. Retrieved from http://psychcentral.com/lib/keeping-good-boundaries-getting-your-needs-met/

Lancer, D. (2015). What are personal boundaries? How do I get some?. Psych Central. Retrieved from http://psychcentral.com/lib/what-are-personal-boundaries-how-do-i-get-some/

Stgar, W. (2010). The importance of boundaries. The Huffington Post. Retrieved from http://www.huffingtonpost.com/wendy-strgar/working-boundaries_b_717339.html

Yalom, I. D. (2002).  The gift of therapy: An open letter to a new generation of therapists and their patients. New York, NY: HarperCollins Publishers.

Hoarding

by Jan E. Estrellado, Ph.D.

Most of us know someone who has difficulty throwing things away or cannot seem to stop him or herself from buying things at bargain prices, even when he or she doesn’t need them.  Extreme versions of these behaviors (i.e. “clinical hoarding”) affect up to 5% of the U.S. population (Samuels et al., 2008). What might cause an individual to let these situations get out of hand?  And what can that person or a loved one do to help that person change?

What is Hoarding Behavior?

According to the International OCD Foundation (https://iocdf.org/), hoarding consists of three related issues: (1) collecting too many items; (2) difficulty getting rid of items; (3) problems with organization.  Hoarding behavior can result in significantly limited living or work space, strained relationships with others, and in extreme cases, unsanitary or hazardous living conditions.

A person with hoarding behavior may experience severe distress when attempting to get rid of items.  That person may feel he or she need these things or that he or she will eventually use them.  Even if the person’s belongings are of little material value or use, the person feels unable or unwilling to get rid of the items. 

Hoarding behavior negatively impacts relationships.  If one person in a household hoards, others living in the home may resent and/or blame that person for the status of their living conditions.  While it may seem like an “easy solution,” (i.e., “Just throw those things away!”) this is a much more complex process for the person who has difficulty letting go of material things. 

Why Do People Hoard?

A person’s beliefs about his or her posessions, as well as the meaning he or she attributes to them, are core parts of why a person hoards (Steketee et al., 2003).  A person may be extremely sentimental about his or her items and feel as if losing the item is “like losing a friend.”  The individual may feel exceptionally protective over his or her belongings and become very defensive or territorial when another person suggests he or she get rid of them.  

Source URL: http://www.dcputnamconsulting.com/hoarding-keepdonatedump/

Wheaton et al. (2010) discuss the difficulty some individuals have with tolerating distressing emotions related to hoarding.  The actions a person takes or does not take in order to minimize upsetting feelings is called avoidance.  For example, a person who feels upset when trying to give or throw something away might avoid those feelings by saving the item.  By keeping the item, the person can also avoid feelings of loss that might result from not having the item.  An individual who hoards might also feel a “high” when acquiring new items, so he or she continues to obtain new items, even if the item is not needed.

Getting Help for Hoarding

Seeking mental health treatment for hoarding behavior might be particularly difficult.  By the time the individual shows up at his or her therapist’s door, it is possible he or she has been hoarding for years.  Treatment might not have been the person’s first choice, but was perhaps at the strong encouragement of a concerned family member or friend.

Source URL:  http://hoardercleanuplosangeles.com/?p=59

Cognitive-behavioral therapy (CBT) is the treatment of choice to address hoarding behavior.  In a recent review of the scientific literature on hoarding treatment, Tolin and colleagues (2015) found that those who received CBT for hoarding had significant reductions in symptoms, especially with regards to a core feature of hoarding behavior, difficulty discarding.  A hoarding-specific version of CBT combines a number of different elements, including resolving the person’s ambivalence towards his or her hoarding behavior, and using exposure therapy to help the person directly confront his or her discomfort regarding discarding items (Tolin, Frost, Steketee, & Murdoff, 2015).

Another significant finding from the same study (Tolin et al., 2015) is that greater improvements with discarding symptoms were associated with greater number of therapy sessions conducted in the person’s home.  In-home sessions are more effective than office sessions because the therapist can be there with the client to help build new discarding and acquiring skills.

CSAM is here to help

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for hoarding, anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

International OCD Foundation.  https://hoarding.iocdf.org/

Samuels, J. F., Bienvenu, O. J., Grados, M. A., Cullen, B., Riddle, M. A., & Liang, K. Y. (2008). Prevalence and correlates of hoarding behavior in a community-based sample. Behaviour and Research Therapy, 46, 836 – 844.

Steketee, G., Frost, R. O., & Kyrios, M. (2003). Cognitive aspects of compulsive hoarding. Cognitive Therapy and Research, 27, 463–479.

Tolin, D. F., Frost, R. O., Steketee, G., & Muroff, J. (2015). Cognitive behavioral therapy for hoarding disorder: A meta‐analysis. Depression And Anxiety, 32(3), 158-166. doi:10.1002/da.22327

How Anxiety Affects Couples

by Jan E. Estrellado, Ph.D.

Most of CSAM’s blogs focus on the experience of having a mental health condition, such as anxiety, depression, or PTSD.  This blog is a little different because it focuses on the impact of a mental health condition, anxiety, on couples.  What is it like to care for, live with, and support someone with anxiety?  What kind of strain might this cause in a relationship and what can couples do to sustain each other and their relationship?

Loving Someone with Anxiety

Partners or spouses of individuals with anxiety might experience feelings of helplessness.  When anxious loved ones feel intense fear (i.e., scared of having a panic attack or becoming severely preoccupied with worried thoughts) or avoid certain situations (i.e., not wanting to drive on the freeway or refusing to leave the home), partners may not feel there is much they can do to help reassure or calm them down.  When a partner does attempt to help ease his or her loved one’s suffering, those attempts (i.e., reassuring, problem-solving) may be rejected by the anxious individual.  This can be extremely hurtful and can lead to other intense feelings described below.  In addition, partners may try to help by offering to drive for the anxious partner, agreeing to skip a social event, or allowing the anxious partner to engage in compulsions so that he or she gets relief.  While these efforts are meant to be helpful, the avoidance partners are enabling actually contributes to and maintains the anxiety-related problems.   

Image source:  http://www.recovering-couples.org/

The emotions that partners of anxious individuals can experience range and vary greatly.  They may feel anger and frustration that the anxiety inhibits their lives, and because their partner’s anxiety is outside of their control.  It is difficult to accept that a loved one may continue to feel anxious, regardless of the actions of the partner.  If a partner’s anger remains unresolved over a long period of time, this can turn into resentment, minimization, or blame.  Partners may feel overlooked or overshadowed by their loved one’s anxiety, perhaps feeling like their needs can’t be met when calming their partner down feels the most urgent.

Being the Anxious Partner in the Relationship

Image source:  http://www.dralexandrasolomon.com/common-fights/

The partner who experiences extreme worry can easily feel guilt, shame, and embarrassment at their lack of ability to manage anxious feelings.  They may also feel misunderstood and alone.  These negative feelings, if not addressed or acknowledged effectively, might actually contribute to further anxiety.  If an anxious person feels his or her partner is getting frustrated, that person might shut down, withdraw from the relationship, or engage in unhelpful coping behaviors, such as smoking cigarettes or shopping excessively. When worry and stress take up a lot of space in a relationship, the anxious individual often feels responsible for his or her partner’s feelings of frustration, hurt, or helplessness.  These feelings of guilt or embarrassment compound the individual’s pre-existing feelings of worry, increasing the suffering of that person. 

It may be difficult for the anxious partner to know what he or she needs.  Perhaps he or she is too ashamed to ask for support when so much help has already been requested of the partner.  When a person experiences intense fear in the moment, it can be challenging to know what is helpful and perhaps even more challenging to communicate those needs effectively.  Intense fear, by nature, prevents a person from thinking logically or rationally and it can be tough to know how to reign one’s self in during those moments.

Sustaining the Relationship

What can a partner of an anxious individual do to help make the relationship work?  One crucial element is for the partner to make sure that he or she is able to maintain his or her own health and wellness.  A partner can feel guilty for taking care of himself or herself, especially knowing that his or her loved one may be suffering.  However, if both partners are suffering, especially over a long period of time, the relationship is no longer sustainable.  A partner might need to seek this support outside of the relationship.  Examples of support outside the relationship include trusted friends, family members, health providers, faith leaders, co-workers, and therapists.

Image source:  http://claudialistens.me/couples/

In addition, a person may want to communicate his or her needs to the anxious partner, even if it is difficult.  If only one person’s needs are being met or paid attention to consistently, the relationship feels one-sided—another predictor of an unsustainable situation.  Asking for one’s needs to be met can also include discussing feelings and reactions to the partner’s anxiety.   While communicating feelings in an authentic, yet caring way, can be challenging, both partners might experience some relief and a greater connection, and the likelihood of resentment decreases.

An anxious individual may not want to wait until he or she experiences intense fear to know what help the partner can provide.  Rather, identify wants and needs during more calm or grounded moments.  When an anxious person knows what works, it is easier to engage his or her partner in a collaborative manner.  Having a “game plan” can ease some of the intensity of fear in the moment. 

Finally, as we say in Acceptance and Commitment Therapy, anxiety can have a place in the relationship, but it shouldn’t be “driving the bus.”  When anxiety appears to be controlling the direction of the relationship despite the couple’s best efforts, it’s time for one or both individuals in the relationship to seek outside support.

CSAM is here to help

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

Trauma and the Brain

by Jan E. Estrellado, Ph.D.

image source: 

http://www.forbes.com/sites/toddessig/2015/12/02/post-traumatic-stress-disorder-ptsd-is-more-than-a-bad-story/#31ac76b313ad

Responses to trauma can be found in both the mind and the body.  In the mind, people can experience unwanted, intrusive thoughts that remind them of the traumatic event.  They may feel misunderstood, isolated, and irritated with others around them.  Their beliefs about the world might change from a sense of safety and stability to one of unpredictability and danger.

In the body, people can feel “on edge,” like something bad is about to happen.  They may feel more anxious than usual, with symptoms of an increased heart rate, sweatiness, hyperventilating, difficulty focusing, or even a panic attack.  This is more likely to be true when they are exposed to an internal or external cue reminding them of the traumatic event, but for others, it can feel like it comes out of nowhere.

Trauma Response in the Brain

For an individual with PTSD, much of the response to trauma can be found by understanding what is happening in the brain. 

When something might be dangerous or threatening, it first goes to the thalamus, which is responsible for receiving sensory input (what you see, smell, taste, touch, and hear).  From the thalamus, it can go in one of two directions.  In the first direction, the “more sensible” direction, the sensory cortex accurately appraises the event as non-threatening and the hippocampus (responsible for memories), confirms or modifies this response.  This direction, while slower than the second direction, is often more capable of accurately assessing true threat.

Image source: 

http://www.helpguide.org/articles/ptsd-trauma/ptsd-in-the-family.htm

In the second, “less sensible” direction, the thalamus sends signals to the amygdala (the emotion and fear center of the brain), which then goes to the hypothalamus, where action is taken to get relief.  This direction is often seen as tapping into the “fight or flight” response to fear.  While this direction is quicker and engages our survival mechanisms, it can also get us into trouble if our response is bigger than the situation calls for.

For individuals with PTSD, their brains often go in the second direction.  Their amygdala is on “over-drive” and cannot help them evaluate what is a true threat and what is not. 

Re-Training Your Brain

If your brain is trained to fire its amygdala at will, what can you do about it?  Enter the pre-frontal cortex.  This part of the brain is responsible for planning, strategizing, executing, reasoning, and decision-making.  At CSAM, we often encourage our patients with PTSD to engage their pre-frontal cortex in various ways: deep breathing, mindfulness practice, even coloring!  Any grounding activity that helps you stay in the present moment will help you engage your pre-frontal cortex.  These are effective short-term strategies for helping to manage an individual’s immediate PTSD-related anxiety.

Longer-term strategies include Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), and Acceptance and Commitment Therapy (ACT).  These interventions have strong support in the scientific literature showing their effectiveness to manage PTSD.  In CPT and PE, patients “re-train their brains” to reduce their reactivity to distressing cues, often related to the traumatic event.  They continually re-write or re-tell the story of their traumatic event until they make new meaning of the trauma, learn that the trauma memories are not dangerous and discover that they can handle the upsetting responses that come with remembering the traumatic event.  In Acceptance and Commitment Therapy, patients practice mindfulness in order to understand what distressing thoughts they have when they recall the traumatic event.  They develop a willingness to engage with the memories and feelings of the traumatic event, so that they are “freed up” to live a life based on their values and what’s important to them.

CSAM is here to help

If you or someone you love might benefit from CPT, PE, or ACT following a traumatic experience, or if you would like more information about our other therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

U.S. Department of Veteran Affairs (2015).  How common is PTSD?.  Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp

Anxiety and Chronic Illness

by Jan E. Estrellado, Ph.D.

Chronic illness affects half of all adults (117 million) in the United States (Center for Disease Control, 2012). These conditions can include chronic pain, fibromyalgia, arthritis, heart disease, HIV, and cancer. While the types of conditions vary broadly, stress and anxiety are common experiences for individuals with long-term illnesses.  

The Stress of Having a Chronic Illness

Image source: https://massage.elitecme.com/blog/chronic-illness-massage-therapy/

Anxiety may result in part from the unpredictable nature of a chronic illness.  For example, a person with chronic pain will likely have some days when he or she can go for long walks and some days when getting out of bed is too challenging.  The tough part is not knowing when the bad days come.  The anticipation and fear of the pain, even more than the pain itself, is a better predictor of long-term functioning  (Turk, 2002). 

Because the experience of a chronic condition is specific to each individual, it can be difficult to feel connected to others.  Isolation is common, which can both disrupt relationships and intensify negative thinking (“No one understands what I’m going through,” “I have to take care of this on my own,” “I don’t want to burden my family,” etc.).  When those negative thoughts start to spin out of control, especially without the support of others, one’s ability to manage anxiety lessens.

For a child with chronic illness, fear and anxiety can be especially common.  The unpredictability of a chronic illness can shape how he or she views the world as an adult.  Knowing that caregivers cannot control discomfort or pain may be particularly terrifying for a young person.  A child may internalize the uncertainty of what life will look like with a chronic illness (“Will I still be able to go school,” “What will my friends think,” “Will I have to take medications forever,” etc.).

Managing Anxiety Related to Chronic Illness

Each person chooses how to manage his or her chronic illness in the best way possible with the resources they have.  An important step in managing anxiety related to chronic illness is to ask one’s self about the benefits, as well as the costs, of those choices.  For example, someone with heart disease may feel that by eating whatever he wants, he is in control of his life and that his condition does not exist.  But the stress of feeling ashamed or of disappointing others also takes its toll.  Being open and honest with one’s self about the pros and cons of choices is a crucial step to managing stress.  When a person can have this conversation with one's self, he or she might be more willing to ask if this choice supports the type of person he or she want to be.

Image source: http://www.huffingtonpost.com/2011/06/30/chronic-pain-13-americans_n_887749.htm

Another way to help manage anxiety about a chronic condition is to be as present as possible, even when it is difficult.  Calling attention to your thoughts, feelings, and bodily sensations in a non-judgmental way is the practice of mindfulness.  This can be especially difficult when what you think, feel, or experience is intense pain or discomfort.  However, a review of research showed that mindfulness-based practices can improve patient outcomes not just for chronic illness management, but also for depression and anxiety (Grossman, Niemann, Schmidt, & Wallach, 2004). 

If you have a family member with chronic illness, your support is very important.  A research review on the relationship between family support and chronic illness found that patients responded most positively when their families emphasized self-reliance and personal achievement, family cohesion, and responding attentively to symptoms (Rosland, Heisler, & Piette, 2012).  Continuing to reach out to your family member with a long-term condition can make a huge difference in their management of their illness. 

Living with a chronic illness is by no means easy.  Living well with a chronic illness, however, is possible.  With the right support and coping skills, individuals with chronic conditions can take concrete steps on the path of living with, but not being ruled by, long-term illness. 

CSAM is here to help

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or a chronic medical illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Center for Disease Control (2012).  Chronic diseases: the leading causes of death and disability in the United States.  Retrieved from http://www.cdc.gov/chronicdisease/overview/.

Grossman, P., Niemann, L., Schmidt, S., & Walach, H. (2004).  Mindfulness-based stress reduction and health benefits: a meta-analysis.  Journal of Psychosomatic Research 57(1): 35-43.

Rosland, A.M., Heisler, M., & Piette, J.D. (2012).   The impact of family behaviors and communication patterns on chronic illness outcomes: a systematic review.  Journal of Behavioral Medicine 35(2): 221-39.  doi: 10.1007/s10865-011-9354-4.

Turk, D.C. (2002).  A diathesis-stress model of chronic pain and disability following traumatic injury.  Pain Research & Management, 7(1): 9-20.

Pursuing Values over Resolutions in the New Year

by Jan E. Estrellado, Ph.D.

2016 has arrived!  As we say good-bye to 2015, it’s time to look forward to setting intentions for the new year.  Knowing that resolutions don’t always work out, what if we tried basing those intentions on our values rather than on our goals?

Image source: http://allisonpataki.com/set-new-years-resolutions-january/

The Problem with Resolutions

It seems that while many people make resolutions every year, only a few are able to maintain those changes.  According to the Statistic Brain Research Institute (2015), 45% of people in the U.S. make resolutions, but only 8% of people successfully achieve them.  In 2015, the top three resolutions for the new year were losing weight, getting organized, and spending less/saving more.

Why might it be so hard for us to accomplish the resolutions we set so hopefully at the beginning of each year?  And perhaps more importantly, how do we deal with and recover from the guilt, anxiety, stress, and embarrassment that often come when we fail to meet these goals?

For some helpful answers, we might look to Acceptance and Commitment Therapy (ACT), an evidence-based intervention that, in the words of Happiness Trap author Russ Harris (2008), “helps people create a rich and meaningful life, while effectively handling the pain and stress that life inevitably brings.” 

According to ACT (pronounced as one word), it is the struggle with “what’s wrong” in our lives that causes much of our suffering.  We’ve all been there: the slice of chocolate cake we couldn’t resist, the day we chose to stay home instead of going to the gym, or spending more than we wanted to eating out.  It is normal to feel ashamed, guilty, or frustrated with ourselves, often accompanied by thoughts of self-judgment and doubt (i.e., I have no self-control, I was doomed to fail from the start, etc.).  It is so easy to spend time and energy beating ourselves up for what we should have done, that we end up in a worse place than when we started.  How many of us have eaten that second slice of chocolate cake to soothe our guilt about eating the first one? 

Values-Based Living

Image source: http://www.sanitygurus.com/relaxation/

In contrast to resolutions, values are never finished.  Think of values as the direction you are headed in (“westward”) versus a destination west of you (“Hawai’i”).  One can continue on in that direction indefinitely and it will never be done.  It is a series of choices we make over and over again to carve out a path in the direction of that value. 

What might values-based living look like as an alternative to New Year’s resolutions?  Let’s take the #1 resolution of 2015: losing weight.  Why might losing weight be important to you? Do you want to feel good in your body, to invest in your physical health, to live longer for your family or to model healthy behaviors to your children?  Clarifying why we choose a goal might be more important than the goal itself.  For example, if I want to live long enough to see my kids grow up, my choices might focus more on being active with my kids and less on counting calories.  I may or may not lose weight, but keeping my choices and behaviors aligned with my greater value moves me toward the person I would like to be.

Acting in service of our values does not mean that the path will be easy or comfortable.  In fact, choosing our values means that we also choose the pain that will inevitably come.  Living from our values means we accept that painful and unwanted outcomes sometimes happen. Staying the values-based course as the painful stuff happens is what gives us meaning and purpose.

Are you willing to give values a try this year?

CSAM is here to help

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or a chronic medical illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Statistics Brain Research Institute (2015).  New years resolution statistics.  Retrieved from http://www.statisticbrain.com/new-years-resolution-statistics/

Harris, R. (2008).  What is acceptance and commitment therapy?  Retrieved from   http://www.thehappinesstrap.com/about_act