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

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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

Travel-Related Anxiety

Image source: http://www.oncallinternational.com/blog/holiday-air-travel-survival-guide/

Many people travel during the holiday season to visit friends and family.  For those struggling with anxiety, traveling by personal car, airplane, bus or train, can be triggering and stressful.  The expectation to visit loved ones living afar can cause pressure and conflict within relationships and families when someone feels they cannot travel.

Types of Travel Phobias

According to the U.S. Department of Transportation (2001), 91% of holiday travel is via personal car.  Car-related fears can stem from either being the passenger or from being the driver (Neuman, 2012).  Anxious passengers may feel like they are not in control, while anxious drivers may feel like they may lose control of their vehicles due to panic attack or an accident (Neuman, 2012).   Fear of having a panic attack while driving is a common concern.  People cope with these fears by limiting how far they drive, how often they are in the car, and by only being in the driver’s (or passenger’s) seat.  This can have a debilitating effect on one’s ability to work, socialize, and get outside the house. 

The fear of flying can come in various forms, including fear of having a panic attack while on a plane, fear of crashing, and claustrophobia (Seif, n.d.).  There are multiple aspects of flying that might trigger anxiety, including long lines at the airport, being far away from home, extended waits on the runway, or turbulence (Seif, n.d.). 

People who have difficulty riding on trains or on buses often have fears that they will be involved in an accident, that they will have a panic attacks while on the bus or train, or that they will feel trapped and unable to escape or get help. 

Treatment of Travel Phobias

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Travel-related phobias can be successfully treated using exposure therapy.  Exposure therapy is an evidence-based treatment, meaning it has strong support within the scientific research literature showing the effectiveness of the treatment to manage these types of anxiety.  Exposure therapy is a type of cognitive behavioral therapy that includes the repetitive practice of engaging with the feared or triggering situation, within the safety of the therapeutic environment and with the guidance of a trained mental health professional.  

Social Anxiety

For people with social anxiety, traveling during the holidays can be doubly hard.  Traveling often means having to interact with others, especially if going by plane, train, or bus.  In addition, the pressure of socializing with others after arriving at your destination can be daunting. 

The treatment for social anxiety often includes exposure therapy.  Individuals receiving exposure therapy practice being in their feared social situations.  The goals in exposure therapy for social anxiety are to develop skills to manage uncomfortable and stressful feelings and to act in accordance with their desired social goals.

CSAM is here to help

CSAM can help you or someone you love by providing exposure therapy for travel-related and/or social anxiety, cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback.  CSAM also helps treat other conditions related to anxiety, depression, stress, or a chronic medical illness.  If you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Neuman, F.N. (2012).  Driving Phobia: An Ideal Treatment.  https://www.psychologytoday.com/blog/fighting-fear/201207/driving-phobia-ideal-treatment

Seif, M.N. (n.d.).  How can I overcome my fear of flying?  http://www.adaa.org/living-with-anxiety/ask-and-learn/ask-expert/how-can-i-overcome-my-fear-of-flying

U.S. Department of Transportation (2001).  U.S. Holiday Travel.  http://www.rita.dot.gov/bts/sites/rita.dot.gov.bts/files/publications/america_on_the_go/us_holiday_travel/html/table_01.html

Oct. 11 - 17 is OCD Awareness Week

What is OCD? 

Image source:  http://www.jamesaltucher.com/2012/02/how-to-increase-your-productivity-500/

Have you ever found yourself obsessively worrying about whether you locked your door, turned off your stove, washed your hands well enough, or contaminated or harmed someone else?  While it is normal to have concerns in particular situations, individuals afflicted with obsessive compulsive disorder (OCD) experience intrusive, unwanted, distressing thoughts and images that they can’t stop from coming into their minds.  In order to cope with the anxiety that is experienced as a result of these obsessions, individuals with OCD often develop behavioral rituals, known as compulsions, such as hand-washing, cleaning, checking, and counting.  The compulsions tend to give individuals a feeling of temporary relief from their anxiety.  As a result, this relief reinforces the individual to continue performing the rituals.  OCD thoughts and rituals can dominate several hours of a person’s day, interfering with work, school, family, and social activities.  If left untreated, OCD can worsen over time.

Who Gets OCD?

It is estimated that 1 in 100, or approximately two to three million adults, are currently living with OCD in the United States.  An additional 500,000 children and teens in the U.S. are also estimated to suffer from OCD.  The exact causes of OCD remain unknown and are thought to be a complex combination of genetics, biology, and environment.  Research has indicated that OCD may be triggered in those who are vulnerable (e.g., have a genetic predisposition) by stressful life events, such as a devastating loss or a significant life change.  However, research has also suggested that some individuals are more prone to OCD than others.  There are specific brain areas that seem to have subtle differences when compared to brain images of those who do not have symptoms of OCD.  This may influence one’s ability to cope with stressful situations, as well as one’s likelihood for developing OCD.  OCD affects men, women, and children from all races and backgrounds equally. 

What is the Most Effective Treatment?

One of the most effective treatments for OCD is cognitive behavioral therapy (CBT), or specifically, Exposure and Response Prevention (ERP).  CBT/ERP is a present-centered, skill-based treatment that focuses on systematically reducing obsessions and compulsions and the anxiety associated with them.  Certain medications are also beneficial for treating OCD.

When Should I Seek Treatment?

If you or a loved one is experiencing any of the symptoms mentioned and these symptoms are taking up more than an hour per day and/or are interfering with normal functioning, you may want to consider contacting a mental health professional who specializes in Cognitive Behavioral Therapy or medication management for anxiety disorders and OCD. 

If you have questions and would like to speak with a professional at The Center for Stress and Anxiety Management, click here.

References

Farrell, L.J. (2011). Treatment outcome in adult OCD: Predictors and processes of change. Asia Pacific Journal of Counselling and Psychotherapy, 2(1), 82-97.

Anxiety Disorders Association of America: www.adaa.org.

Older Adults Afflicted with Depression, Stress and Anxiety

Image source:  http://www.tricitypsychology.com/older-adults-remember-the-good-times/

As the baby boomer generation ages, many more begin to experience the physical and mental challenges that inevitably accompany the aging process. The prevalence of mental illness has been found to increase with age. Research indicates that 20 percent of the American population over 55-years-old is afflicted by at least one mental disorder (APA, 2012). Furthermore, nearly 70 percent of those in long-term care facilities display psychological and behavioral challenges (APA, 2012). However, less than three percent of individuals in late adulthood have reported that they seek psychological treatment. Thus, there are likely many individuals within this population who have never sought treatment who could truly benefit from it.

A high co-occurrence rate has been identified between physical health problems and mental health problems. Unfortunately, many physicians fail to notice their patients’ anxiety and depression (Alexopoulos, 2005). As a result, an appropriate diagnosis may be overlooked and associated symptoms may be left untreated.

 Suicide Risk

 Older adults have the highest risk of suicide when compared to all other age groups (Connell, Chin, Cunningham, & Lawlor, 2004). In fact, they are two times more likely to commit suicide in comparison to the general population. Both social factors, such as isolation, and the prevalence of psychological disorders, highly impact the rate of suicide within this population (Alexopoulos, 2005). Thus, if the symptoms of mental disorders are unnoticed and left untreated, they may lead to fatal consequences. Research has shown that approximately 75 percent of older adults who have committed suicide have met with their doctor within the last month (APA, 2012). Thus, it is necessary for everyone, including physicians, to be aware of this high risk age group, so that proper precautions can be taken to prevent suicide and improve overall mental health care.

Potential Signs of Depression in Older Adults

 Here is a list of possible signs of depression in older adults according to the National Alliance on Mental Illness (NAMI, 2013, para. 3): 

• Memory problems
• Confusion
• Social withdrawal
• Loss of appetite
• Weight loss
• Vague complaints of pain
• Inability to sleep
• Irritability
• Delusions (fixed false beliefs)
• Hallucinations
• Persistent and vague complaints
• Help-seeking
• Moving in a more slow manner
• Demanding behavior

 Treatment

 While the prevalence of mental health problems is higher in older adults, the good news is that there are evidence-based treatments that can help. Cognitive behavioral therapy (CBT) has been demonstrated to be effective in relieving the symptoms associated with stress, anxiety, and depressive symptoms. In fact, structured therapies, such as CBT, have been found to be as “effective as antidepressants for moderate depression and may be more effective in reducing recurrence” (Ell, 2006, para. 12).

 If you know anyone who suffers from symptoms of depression, anxiety, or stress, please encourage them to seek professional support. If you are in the San Diego area and would like to speak to a professional at CSAM who specializes in CBT for older adult stress, mood, and anxiety problems, please contact us.

References

 Alexopoulos, G. S. (2005, June). Depression in the elderly. Lancet, 365(9475), 1961-1970. Retrieved from http://web.ebscohost.com

 American Psychological Association. (2012). Growing mental and behavioral health concerns facing older Americans. Retrieved from http://www.apa.org/about/gr/issues/aging/growing-concerns.aspx

 Connell, H. O., Chin, A. V., Cunningham, C., & Lawlor, B. A. (2004, October 16). Recent developments: Suicide in older people. BMJ, 329(7471), 895-899. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC523116/

 Ell, K. (2006, July). Depression care for the elderly: Reducing barriers to evidence based practice. Home Health Care Serve Q, 25(1-2), 115-148.

 NAMI. (2013). National Alliance on Mental Illness. Retrieved from http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=7515

"Mommy, My Tummy Hurts": Anxiety and Kids

by Jan Estrellado, M.A.

No one wants to think about children struggling with anxiety.  However, anxiety disorders are the most common psychiatric disorder in teens and tend to start around the age of 6 (Merikangas et al., 2010). 

Image source:  http://www.indusladies.com/parenting/10-tips-to-help-your-child-overcome-her-pre-examination-stress/

What does anxiety look like in children and adolescents?  Does it differ from adults?  To find out these answers, one can look to the research and to mental health clinicians with experience in these areas.  

How Common is Anxiety in Kids?

Anxiety disorders are the most common psychiatric disorder of 13 to 18 year olds (40.2%; Merikangas et al., 2010).  Of the teens with anxiety disorders, 8.3% are severely impaired by their anxiety disorder.  However, 80% of kids with an anxiety disorder do not receive treatment.  Interestingly, kids tend to develop anxiety disorders at the age of 6 (versus age 11 for ADHD and age 13 for mood disorders, like depression).  

Why might it be that the most common psychiatric disorder in young people goes largely untreated?  One reason may be that parents, caregivers, and teachers may not know some common signs of anxiety in kids.

What Does Anxiety Look Like in Kids?

All kids feel anxious at one time or another, as stress is a normal part of life.  In addition, many kids with shy personalities may tend to feel more nervous in general than their peers.  So how does a parent know when their child’s anxiety becomes a problem?

When stress starts to get in the way of life’s activities, like withdrawing from friends, avoiding school, having trouble sleeping, experiencing difficulty being away from parents, or lashing out at loved ones, then unmanaged stress can damage the child or teen’s physical and mental health.  Kids who suffer from anxiety tend to see their fears as catastrophic (Miller, 2012), which can be puzzling and confusing to some parents.  Children may get extremely upset when parents or caregivers prepare to leave and may cling very tightly to their parents.  

Anxiety in children may look different than in adults because kids may lack skills to express their fears and stressors.  They may experience symptoms that take place in the body, also known as somatic symptoms.  In young children with anxiety disorders, the most common somatic symptoms are restlessness (74%), stomachaches (70%), blushing (51%), palpitations (48%), muscle tension (45%), sweating (45%), and trembling/shaking (43%) (Ginsburg, Riddle, & Davies, 2006).  Children who experience these somatic symptoms are more likely to have severe anxiety and higher levels of impairment.

What can parents and caregivers do?

Image source: http://www.intentionallife.me/slowmotion/

Parents often know if their child is facing high levels of anxiety because they observe the child to be more anxious than his or her peers (Miller, 2012).  In addition, the child’s anxiety gets in the way of everyday functioning, such as school, sleepovers, and swim class. Parents, teachers, and significant caregivers play important roles in a child’s ability to manage anxiety successfully.

“The best advice I have for parents is to remain calm and focus on self-care. ”

— Dr. Starr MacKinnon, CSAM psychologist

Parents whose children present with these symptoms may feel their child is being manipulative or lying in order to get out of school or other activities.  Learning more about your child’s fears, what management strategies you can teach your child, and how you can be supportive are successful keys to helping kids overcome their anxiety.  CSAM’s own child/teen specialist, Dr. Starr MacKinnon shares that it’s important for parents to take care of themselves: “The best advice I have for parents is to remain calm and focus on self-care. The truth is, your children will predominantly learn from the model you provide them and are less impacted by your words.  Children and adolescents are sponges and they will often grow up and engage in the same self-talk, behaviors, and coping that you do. So the more that you can take care of yourself and be the person you want your children to be, the better it will be for all of you.”

There are additional strategies parents and caregivers can use when helping kids cope with anxiety (Miller, 2012):

• Explain to the child that his or her feelings of worry or dread are caused by a condition called anxiety.
• Help the child notice the connection between anxiety and shallow, rapid breathing. Teach the child how to breathe slowly and into the belly.
• Encourage the child to replace anxious “red light” thoughts (“that dog will bite me”) with more helpful and realistic “green light” thoughts (“most dogs don’t bite kids”).”

Another way that Miller encourages parents to support children is through gradual learning and patience.  If a child has intense fears about making a speech in front of his or her class, consider having the child read it in front of one parent first, then the family, followed by a few close friends, and so on, until the child feels confident enough to speak in front of a larger group.

If a child’s anxiety symptoms persist despite their caregivers’ best efforts, seeking professional help is recommended.  Mental health professionals who specialize in anxiety treatment with kids can help train the children to develop coping strategies to manage anxiety, but can also coach caregivers to reinforce these strategies while the child is in school and at home.  

Help is Here!

Parents and caregivers are the most important factor influencing whether kids develop effective coping skills to manage anxiety.  The Center for Stress and Anxiety Management is here to help.  Starr MacKinnon, PhD, is a licensed psychologist with a specialty interest in working with children and teens with anxiety disorders.  Dr. MacKinnon shared what she enjoys about working with kids and teens: “I love working with children and teens because often they are more flexible and open to self-exploration and growth…I love helping kids and adolescents to gain insight into who they want to become so that the barriers to living that life can be addressed."

Click here to speak with Dr. MacKinnon or another professional at the Center for Stress and Anxiety Management.  

References:

Ginsburg, G. S., Riddle, M. A., & Davies, M. (2006). Somatic Symptoms in Children and Adolescents With Anxiety Disorders. Journal Of The American Academy Of Child & Adolescent Psychiatry, 45(10), 1179-1187. doi:10.1097/01.chi.0000231974.43966.6e

Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., & ... Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). Journal Of The American Academy Of Child & Adolescent Psychiatry, 49(10), 980-989. doi:10.1016/j.jaac.2010.05.017

Miller, L. (2012).  Early screening for anxiety disorders in children helps prevent mental health concerns: UBC study [Press release].  Retrieved from http://news.ubc.ca/2012/04/16/early-screening-for-anxiety-disorders-in-children-helps-prevent-mental-health-concerns-ubc-study/