Worry Boxes

In my practice I have come across a rise in anxious patients.  I can speculate on the changes in our world that seem to be causing this rise in anxiety and, unfortunately, none of them seem to be going away any time soon.  Since anxiety seems to be a pervasive problem that is here to stay, I have been working with my patients to develop tool boxes of techniques that are helpful in managing both symptoms of anxiety and their underlying causes.  For patients who have anxiety-related sleep difficulties, one tool that I find especially helpful is the Worry Box.

Most patients who have anxiety struggle to fall and/or stay asleep.  This break in the sleep cycle causes sleep deprivation, which has multiple emotional and physical detrimental effects.  Often the reason for a patient’s inability to have sound sleep is their sensation that they are laying in bed running through worries and concerns or to do lists when they should be settling down and falling asleep.  While the eventual goal is to teach patients how to mentally “wipe the slate” so that they can rest peacefully, the worry box is the intermediate step that can help develop this positive life habit. 

The technique is fairly simple.  I ask patients to find a box with a lid.  For some it can be as simple as a shoe box with a slit cut in the top.  For others it has to have more symbolic meaning than that.  For one patient, it had to be a solid wood box with a hinged lid because that “felt solid enough” to hold in the worries.  Just pick the box that’s right for you.  Right before bed, as you are running through the litany of worries or overwhelming lists, write them each down on an individual piece of paper and put the paper in the box.  As you put them into the box use self-talk to tell yourself that you are “putting that worry away for tomorrow”.  In essence, you are symbolically wiping your mind of these concerns knowing that they will be there for you to pick up in the morning should you choose to do so. 

While this is not likely to work the first time you try it, this is something that, with practice, you can do successfully to really improve your sleep.  There is also a modification I often use that works with kids that worry.  In their case, I use a worry doll or stuffed animal.  They get to talk to this worry buddy every night and let their worry buddy handle the weight of their fears and anxieties while the child sleeps soundly.  At the end of months of practice, the worry box can be retired and this can become a mental exercise where you can visualize your worries floating into the box in your head and getting shut up tight for the night.  This is a wonderful metaphoric way to teach yourself how to compartmentalize your worry so your body and mind can get what it truly needs: a good night’s rest!

For other helpful tips for dealing with anxiety you may want to read some of the articles posted here www.betterhelp.com/advice/anxiety

Hitting the Pause Button

While there are many techniques that I employ in my therapy practice, some are favorites that have a lot of applications.  Lately I seem to be talking to a lot of my patients about “hitting the pause button”.  Like many therapists I love using metaphors to help myself and patients visualize techniques.  Hitting the pause button is a visual everyone seems to be able to pull into their imaginations.  When I tell people to hit the pause button, I want them to take a mental pause.  It is a great way to get them to stop or slow down to process things in a different way before reacting.

There are many applications for this technique but I find it especially useful for people who struggle with immediate emotional reactions.  I will always teach this technique to people who need anger management help, but it is also effective for helping to control anxiety response and strong emotional reactions.  The key is if you feel yourself having a strong emotional reaction to, as soon as possible, visualize hitting the pause button. 

While you are paused you do not respond to others, you may even choose to remove yourself from the situation.  The intention is not to avoid the dilemma, but to take a break to allow your emotional response to fade a bit and your rational mind to take over.  This break is supposed to give you time to process what triggered your emotional response, rationally consider what are your options for dealing with this situation, and calmly select which option is going to get you closest to your goal.  You will find that when you are having a strong emotion your reaction is often not the one that will get you closest to your goal, but rather the one that will make you feel an immediate release. 

I like the idea of pausing, but self-imposed timeouts can work as well.  However, such timeouts will not work if you do not pause your self-talk.  Pausing does not mean sitting and obsessing about the situation while you work yourself up further.  It means taking the time to calm yourself in order to respond thoughtfully and appropriately to life’s dilemmas.  While truly pausing and calming yourself may be hard initially, with practice it becomes easier to do.  As you become more effective in employing this tool, you will almost certainly find yourself less embarrassed and regretful about your responses when you take the time to pause.  Often, your first response is not the best one.  Take the time to fully consider your response to stimuli before you act on it.  The results can be profound. 

Finding work-life balance

Often when people begin to feel overwhelmed by their lives it is related to their lack of work-life balance.  One of the drawbacks of our increased reliance on technology in our life is that it has changed our work day.  We no longer go to work, finish our daily tasks, and head home to enjoy our personal life.  We are instead available 24 hours a day, 7 days a week via mobile phone, computer, skype, etc.  It is not uncommon in this day and age for work to significantly encroach on family vacations and holidays.  The question people often ask themselves (and me) is, how can I create more balance in my life given my current circumstances?  I have two quick and easy suggestions to help restore some of that balance.

A lot of people seem to struggle at the end of a long hard day to transition from work to home.  If a day has been particularly tense, or if they have a problem leftover from the day that they need to deal with later, that tension and stress carries over into their first few hours at home.  They will often stress about work the whole way home from the “office” and find themselves unable to engage with family when they do get home.  This is one of the first things to address.  It is possible to feel more balanced if your personal life creates a feeling of connection and well-being.  If work interferes with this quality time, you never connect with loved ones or activities that make your life feel more enriched.  It is time to begin using your travel home more wisely.  This is the time that you should be transitioning mentally from work mode to home mode.  Use this time to shut out work concerns.  Practice some deep cleansing breathing and switch your thoughts to home.  If you have children or a spouse, this is the time to think about what you know about their days so you are ready to ask questions and engage when you get home.  It is also the time to let go of the stress and tension.  You may want to take the time to do a small short guided meditation (if you are not driving) or, if it was a particularly difficult day, to think about the positive things that happened.  It is important to change your mind set before you arrive home.  If you absolutely must take a work phone call or review something on your way home, take a few minutes before you walk through the door to reset, but, no matter what, make the transition.

The other suggestion I have is the creation of “personal time”.  Force yourself to shut off your electronic devices for a certain period of time every evening.  Leave them in another room so you aren’t even tempted to open up your personal social media or games.  It is important to have periods of time when you are awake that you can disconnect and recharge.  People often make the mistake of keeping their phones beside them or in their hands.  It is much harder to ignore a work request that comes through if you are aware that it is there.  Even if it only takes a few minutes to address, it has broken up your personal time and diminished your quality time.  Plus, being attached to your phone can cause frustration with the significant people in your life.  Nobody wants to feel that they don’t have somebody’s full attention when they are interacting.  You will have fewer arguments with significant members of your life if you give them undivided attention for periods of time every day. 

While these habits may seem hard to implement at first, if you put them into effect regularly they will quickly become habits that I am sure you will enjoy.  Plus taking time to recharge will certainly make you more efficient and effective in every aspect of your life.  You are only a few steps away from creating more balance in your overwhelming life.  Take the first step today. 

The power of breathing

Breathing is something that everyone does every day without really thinking.  Therefore, most people don’t recognize the power to control anxiety, relieve stress, stimulate sleepiness or increase focus that can come from controlled breathing.  Diaphragmatic breathing is something that I teach most of my patients.  It is a useful tool that, when practiced, can be called upon automatically at trying and emotional times, but its benefits are far greater than a few applications.

You may be asking what diaphragmatic breathing really is.  It is a type of breathing that fully inflates your diaphragm, thus creating deeper breaths.  The basic idea is that you inhale until your diaphragm is fully inflated and hold your breath for a split second before exhaling completely.  The key is to have your exhalation be twice as long as your inhalation.  In my opinion, the best way to achieve this is to count during your breath cycle.  Everyone has a different lung capacity based on many factors including size, gender, etc.  Therefore, I often suggest starting with an average count and adapting it to what works for your natural breath capacity.  The average inhalation is a count of 6 with a one second hold and an exhalation count of 12. If you are struggling to find a count that works for you, you can even download an application to help you.  For added stress relief benefit you can breathe in through your nose and out through your mouth.

I recommend doing the full cycle ten times and practicing it every morning or night before bed even when you don’t feel as though you need it.  Since bedtime practice helps your body settle and may improve the quality of your sleep, it can be a good option for people who struggle with sleep issues.  Morning practice is good for people who need to work on focusing to get their day started and accomplish tasks.  Practicing regularly, as mentioned above, helps individuals who struggle with panic attacks call on this technique quickly to help minimize panic symptoms.  The counting aspect of this exercise helps to bring your mind to the present and distract you from other factors that may be causing paralyzing fear or unhappiness.

So now it’s time for you to start using something you already know in a new way.  The power of breathing may just amaze you.

Technology: Friend or Foe of Your Mental Health

Technology has been wonderful for our society in so many ways.  We can keep in touch with people all over the world easier.  It has improved our time management by allowing us to do more, faster. It even allows us to benefit from the experience of countless strangers so that we can find the best restaurant, hotel or vacation spot.  In much of the world, nobody ever needs to be lost or  out of communication again. But have you ever considered what ways technology might be harming you?

For those of you that follow the articles on my page, you may have noticed an article that I posted last week discussing the increase in depression due to technology.  We often underestimate the stimulating effects of screen time.  I hear from people that they watch TV before bed because they can just “shut their mind off and be entertained”, but this couldn’t be farther from the truth.  Whether you are consciously aware of it or not, the back lighting and images on the screen stimulate your brain. They interrupt your natural ability to fall asleep and stay asleep if used too close to your bed time because they disrupt your natural sleep rhythm.  Sleep deprivation often causes an inability to regulate your emotions or think positively.  Depression is not a big leap from there.  

Another problem with our use of technology is how isolating it can be.  Despite our ability to keep in contact with everyone around the world, we often don’t feel genuine connection in these interactions.  Electronic communications are often much more superficial interactions as we no longer need to talk to or see other people to communicate with them.  This allows social anxieties to flourish through avoidance of actual, personal interaction.  Social cues are lost in texts and emails because we do not have to read body language or benefit from hearing the tone of voice used by the counter party.  It is easy to assign intention to someone else’s texts or emails even if that isn’t what they were thinking at all.  Not to mention the way social media can make people feel:  who hasn’t had a day where they look at everyone’s happy times on social media and judge their own normal life in negative ways?  Why isn’t my life as exciting as theirs?  Why wasn’t I invited to that event?  Why is their marriage happier? 

I also believe that technology is a large contributor to the increasing number of patients with anxiety that I am seeing in my practice.  It becomes easy to feel overwhelmed when we can never disconnect from work or personal expectations.  Our family time is often interrupted by competing demands which can damage our relationships with the people who want, and deserve, our full attention.  Quick response time has become expected in most industries and this creates pressure to respond immediately to anything you receive. 

The anonymity afforded by technology also makes it easier to say things to someone remotely that we would never say to their face.  We don’t have to watch them cry when we hurt them or be embarrassed when we share things about them.  This cyber bullying is no longer an anomaly.  It is a regular practice, not just for teens but adults too.  In our quest to be the first to disseminate information or photos to the world, we often don’t take the time to think through the ramifications of our actions.

As a therapist I am often tasked to develop ways for someone to combat or manage all of these technological encroachments and the resulting negatives they impose on the framework of their life.  I suggest thinking about picking up a phone or visiting someone in person when you have the time.  You will be surprised at how much more positive the interaction will seem to you and how much more you (and the other person) will get out of it.  It is also necessary to pick times in your day when you can disconnect from your technology and focus on other priorities in your life.  This often requires shutting down your phone, tablet or computer and leaving the room.  Before you give me all the reasons you can’t do that, ask yourself what you might actually be missing? If a crisis occurs, I am sure that those close to you would know how to reach you.  Is there really anything that can’t wait for an hour?  Then think of all that can be gained while you take a break from the electronic world and reconnect with the physical world.  It affords you the opportunity to truly recharge your emotional battery and connect with people in your life who would love to have your undivided attention.  If you still feel unable to disconnect, ask yourself what you might be missing in your life because you are paying too much attention to the technology.  My guess is that you are missing a lot.  

Christian Lous Lange once said that “Technology is a useful servant but a dangerous master.”  This is as true today as ever before.  Spend some time today taking back control over your life from the technology you have become increasingly reliant on.  You might see some remarkable results.