Never in most of our lifetimes, has there been quite a virus like this one.  Not since the Spanish Influenza of 1918.  Our minds race, trying to make sense of this new normal, however temporary.  Healthcare workers of all disciplines are scrambling to make sure there are enough supplies and testing materials to distribute to people.  It is a true test of our nature as humans to cope effectively and survive.

Our genetics, brain chemistry, and life events are factors we have little control over.  However, the way we perceive and handle those life events we do have a great deal of control over.  How we think about this crisis, literally causes physiological changes in our brain and body.  By dwelling on a stressful thought, anxiety increases.

Peace, on the other hand, is a natural state of being already within each one of us, just masked by all the stress and tension we take in and focus on.  Looking to the past and towards the future actually raises anxiety.  Mindfulness is the act of keeping our focus on the present moment, paying attention to the here and now, with kindness and curiosity (not with judgment or criticism).  By practicing mindfulness, we learn to “let go” of anxiety and bring ourselves back to a peaceful state.

The following are ways to feel more mindful and peaceful:

• Movement:
  • Relaxed stretching.  Stretching slowly and gently dissipates stress chemicals and increases circulation in the body
  • Yoga.  Combines poses, breathing, and meditation to quiet the mind and increase concentration.
  • Tai Chi.  A Chinese martial art performing softly and gracefully movements with smooth even transitions between them to relax, calm the mind, and relieve tension.

• Progressive Muscle Relaxation.  Consciously tensing then releasing muscle tension from various muscle groups relieves anxiety.  
• Deep breathing.  Brings oxygen to all of your muscle groups to relieve anxiety and clear the mind.  Following the breath, focusing on how it flows in and out of your body.
• Centering yourself.  Focusing attention on the physical center of the body for improved balance and stability.
• Mindful attention to daily activities.  Doing one thing at a time. Using one’s senses to experience the activity.  Focusing on what you are seeing, hearing, feeling, smelling, and tasting.   Bringing your mind and thoughts back to the present when your mind wanders.
• Visualization.  Creating a safe place or situation in your mind relaxes the body and releases anxiety.
• Meditation.  Training one’s brain to let go of anxiety and come back to a peaceful state.  Used as prevention, this helps with staying calm in situations that used to make one anxious.
• Prayer.  Belief in a higher power can help with preventing and managing anxiety.

For more on mindfulness, check out https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/mindfulness-exercises/art-20046356.  

If you are struggling to find ways to be mindful or if stress continues to impact your life, contact me at SHCS.

It’s April.  We continue to hunker down and practice social distancing.  I hope you and your family have been staying well and healthy.  And if you have been ill, I wish you comfort and healing.  For those of you who have faced financial setbacks, grief, and loss for any reasons, my sympathies are with you during this time.  

While COVID19 continues to be prevalent, I am practicing gratefulness for the downtime I am able to enjoy with my family now that we are not running around in different directions to activities.  We have played board games, taken walks or hikes, and read/talk more together.  I genuinely miss hugging my extended family members and spending quality time with friends.  I am more mindful of the little things that are a blessing to me and am reminded of the things in the world that are truly meaningful. 

I am thinking more of the things of the world that are unnecessary and thinking of ways to be more resourceful in the days ahead as we prepare for more disruption.

While increased time together can be a blessing, it may also be more stressful for many families.  For children and adults alike with anxiety, depression, or other mental health needs, feeling confined and around the same people, every day is taxing.  Here are a few ways to pass the time more productively.

• Time apart (quiet time, personal time, breaks).  Everyone needs time to him or herself.  
• Together time (prepare a meal together, eat together, have fun together)
• Get outside and play (walk, hike, garden, etc.)
• Practice mindfulness (pray, count a particular color in a room, eat slowly paying attention to your senses, focus on a particular sound, a sensation in the body, or your own breath)
• Stay Busy (clean a room, work on a project, school work, journal about your day, color, call a friend, etc)
• Find ways to relax (yoga, stretch, bathe, meditate, listen to music, play an instrument, etc)

It may feel like Gilligan’s Island for a while, but remember you are not alone and everyone all over the world is dealing with this.  However, if you and your family need additional support at this time, please contact me at SHCS.  

For the first time in many of our lives, our world has been completely disrupted due to the coronavirus, affecting the lives of billions of people in their work, school, livelihoods, relationships, and health.

Its impact is still underway as scientists learn more about the virus, its symptoms, and how it manifests. Projected data about the virus have increased social distancing measures and brought the needs of our health care workers to the forefront.

Parents have felt extraordinary stress and anxiety due to loss of income, concern about elderly relatives, themselves, or children. Our world is in survival-mode at the grocery stores and pharmacies as families prepare to hunker down for what seems to be many months of unknown solitude.

Grief and loss are forthcoming realities for many families in the days ahead.
Our children also feel this stress, though may show it in different ways. They may talk more, talk less, be more active, or withdrawn. Many have questions or misunderstandings about the virus. In the podcast, The Daily,
children provide their questions and are answered by a virus expert. You can check this link out below.
https://overcast.fm/+LHyeeFXno

Another great resource for explaining the COVID19 response for parents is through the Gil Institute.

Here are some general considerations to help children during this time:

• Reassure children. Allow them to comfort themselves (this is not a time to remove stuffed animals, blankets, or soothing objects).
• Stick to routines as much as possible.
• Encourage daily exercise and physical activity.
• Check-in daily with your child.
• Practice positive coping skills and pleasurable activities.
• Encourage connection with others virtually to maintain social distancing.
• Practice good hygiene.

I have recently moved my practice to Telehealth in order to continue to support clients during this time. Kids are enjoying teleplay, parents are able to check-in about their children, and clients continue to have a connection outside the home for mental health care. Insurance companies are also responding by making this outlet possible for families, and in some instances waiving copays and deductibles so that more can access care. If you or your child require additional care during this time, please contact me at SHCS.

I have been fortunate to have had positive teacher experiences when advocating for my children’s needs at school.  While I have found that most teachers are open and receptive to learning about ADHD and making adjustments to accommodate children with these needs, this remains an area of need.  Here are a list of things that teachers do that an ADHD child appreciates:

• Preferential Seating (away from distractions)
• A consistent place to find daily HW or classroom notes.  Many kids with ADHD miss visual or auditory information due to distractibility or tracking issues.  (Unfortunately, peers are not consistently reliable as a resource.  Many kids with ADHD face more peer rejection than typical kids.)

• Eliminate distractions.  Testing in an environment with fewer people make s huge difference.

• Regular check-ins for organization of materials, reviewing the child’s agenda or schedule.

• Chunking or breaking down of larger assignments.  Kids with ADHD struggle with attention, organization, long-term planning, and time management.  They tend to procrastinate.

• Look, rephrase.  Be clear and specific.  Be patient.  Don’t criticize.  An ADHD child is usually doing the best they can.  Be sure your expectations are reasonable. 

• Be mindful of your own triggers and overreactions.  Yelling, ignoring, sudden or harsh consequences, making comparisons, nagging, negative labeling, and lecturing help the child underachieve.  A defiant child with ADHD may avoid work because it requires sustained mental effort.  This child may also lack emotional intelligence.  The ability to be self-aware, to manage mood, self-motivate, have empathy, and manage relationships is immature. Instead create a calm emotional atmosphere for learning.

• Prepare for changes and transitions.  Kids with ADHD lose track of time and have difficulty understanding directions.  This cannot be fixed with punishment.

• Use of fidgets to improve focus, attention, and to discharge heightened energy.

• Breaks during times of frustration.  Understanding that frustration is very real when work is too hard, too easy, too long, or not stimulating.

• Being understood.    A child with ADHD struggles with daily challenges, bombarding thoughts, and emotions.  A sense of helplessness can occur when overwhelmed.  Negative feedback diminishes self-esteem.  Instead, be calm, firm, and non-controlling.

• Expect setbacks.  Help the child cope with setbacks and making mistakes.  “Let’s figure out to succeed next time.”

• Praise, positive reinforcement, rewards or incentives for their efforts, not outcomes.

• Avoid power struggles.  Free your mind of the need to win.  Pick your battles wisely.  Offer choices.  Use humor. Empower the child.  

Teachers are great role models.  However, they are not immune to feeling drained or overwhelmed by kids having ADHD.  Consult others who are knowledgeable.  Stay proactive and involved.  Contact me at SHCS for more information.

I’ve been working as a therapist with people for over 20 years.  For many years I worked with children having ADHD in a school setting.  Then I became a parent to children having ADHD as well.  So not only have I experienced it first hand as a professional, but live the experience at home as well.

ADHD is a neurodevelopmental disorder affecting millions of children, though more often in boys.  It affects focus, concentration, and task completion.  Often children can appear easily distracted or forgetful. They may have trouble sitting still or may interrupt frequently.  These children may struggle academically, in social settings, and at home.  Some may also have learning disabilities or other mental health conditions in combination with ADHD.

ADHD takes different forms, so it’s important to differentiate.  There are three forms: Inattentive-type, Hyperactive-impulsive type, and Combined type.  Inattentive-type is most common in girls and is identified by a more pronounced difficulty with focusing, finishing tasks, and following directions.  Girls may also day dream and talk a lot more than boys.  Hyperactive-impulsive type is identified by fidgeting, interrupting others when talking, and not being able to wait one’s turn.  Combined type is the most common.  Children with this type have both inattention, hyperactivity, and impulsivity.

Children with ADHD have an immature frontal lobe and less grey matter in the brain as compared to typical peers without ADHD.  This means that the parts of the brain responsible for stopping and thinking, organizing, planning, and regulating emotions, is not as developed.  Children with ADHD may struggle with speech, self-control, decision-making, and muscle control.

There are numerous resources on the web about ADHD to find information about recognizing symptoms, the prevalence of ADHD, how to advocate for your child with ADHD, as well as treatment options.  Here are a few things I have come to learn both professionally and personally that have made me a more informed therapist and parent.

• When in doubt, get your child tested.  A common inventory used by pediatricians is the Vanderbilt.  It is  designed to compare your child’s symptoms at home and in school.  Another option is going through a psychologist, either at your child’s school, or an outside resource specializing in ADHD testing.  Testing is helpful and can provide you and your child with additional recommendations for next steps, such as  school accommodations, a 504 plan, or therapy resources.
• Get informed.  Learn about ADHD…things that work and don’t work.  Attend trainings or workshops.  Read about it.  Join an online forum.  
• Advocate for your child at school.  Teachers are busy.  You are the best expert on your child at home.  Develop a working relationship with your child’s team.  Consider meeting with your team early in the school year, and following up with the team on a regular basis.
• Employ checklists and routines at home.  If your child is not yet independent with routines, start with one-step, check to see it gets done.  If it isn’t getting done, break the task down into smaller steps, and do the task together.  
• Keep it together.  Yelling really doesn’t help.  It escalates you and your child.  Nine times out of 10, the child isn’t trying to make you frustrated when they fail to follow through.  Instead, think about what is the one thing you could do to make this task easier and more successful for my child.  
• Be compassionate towards your child.  Think of your child in a positive light.  There will be hard days.  Check in with yourself often when you feel your buttons are being pressed.
• Consider a good therapist specializing in ADHD.  Therapists have additional clinical experience and resources that can set your child up for success.  Perhaps your child needs a behavior chart or plan at school, or behavioral services that can come to the home or school.  Sometimes families need therapy too to cope with a child having ADHD.
• Medications can help.  Non-pharmacological approaches are a great first step.  But if everything has been tried and your child is not finding success in multiple environments, it’s time to consider medication.  Your doctor will work with you to find the right medicine for your child. Sometimes this can be a bit of trial and error.  Be patient.  Take good data and observe your child.  Communicate regularly with your child’s doctor.  If the medication and therapies are working, grades get better, friendships are healthier, your child appears happier, and homelife is more stable.  

Our journey at home continues and involves all of these aspects.  If you have concerns about your child’s ADHD, or think you have ADHD yourself, or need more information about the therapy process, contact me at SHCS.

I recently left a stable full-time job to embark in private practice.  The amount of decisions and tasks required to get started felt enormous.  There were times my mind was spinning in different directions just thinking about the things I needed to do, how best to keep up, and get ahead.  Painting, getting paneled with insurance companies, moving, learning new systems, working full time, attending trainings…all happened at the same time.  Then, I got a sinus infection.  The consequence of being overworked and run down.  I did it to myself and I knew better!

Stress is a feeling people experience when struggling with life challenges.  From feeling rushed or pressured at work, to financial worries, disorganization, or having too many demands.  It can be a real or imagined, or a threat affecting one’s well-being.  It can be brief, or long-lasting.

Stress can be impacted by reactive thinking and negative thoughts about situations or events.  It is commonly found in those having Type A personalities and those who are chronic worriers. Under stress, workplace environments can become burdensome.  Burnout is common.  Relationships among co-workers and family members often deteriorate.  Illness, cold/flu, are more frequent.  

Signs of stress can include:

• Anger, irritability
• Anxiety and depression
• Muscle tension- headaches, back, neck, or jaw pain
• Stomach, gut, and bowel problems
• Hyperarousal symptoms- increased blood pressure, heart rate, sweaty palms, dizziness, cold hands or feet, shortness of breath, sleep problems, and chest pain

Stress left untreated, that becomes chronic, can significantly damage physical and mental health. Other factors include aversive experiences in childhood (i.e. poverty, abuse, family dysfunction, unemployment, substance abuse, etc) or traumatic experiences later in life.  Chronic stress can also lead to feelings of hopelessness.  

Reducing stress takes lifestyle changes, attitude adjustments, healthy boundaries, attention to self-care, and accountability for our choices.  Ready to manage your stress more productively? Contact me at SHCS.

Relaxation, self-care, soothing your mind and body, thought-changing, mindfulness…

No matter what we face in life, we do have to develop reasonable ways to manage our thoughts, feelings, and behavior.  We cannot control other people, only ourselves.  Whether it’s coping with a difficult personality, facing a fear, or working through traumatic memories, how we learn to handle distress can have lasting changes in our brain and impact those around us.

Coping muscles are the muscles in our brain that we cannot see.  It gives us the ability to move past “hurdles,” see a problem differently, walk away from a heightened situation, and make informed choices.  Getting there though takes work.  Physical activity and relaxation need to be practiced.  This requires time, effort, routine, and consistency built into the day.  How long is required to be effective?  That depends…for mindfulness, only 7 minutes/day for lasting results.  

Next time you are finding it difficult to focus, having racing thoughts, or are feeling overwhelmed, try a few of these mindful techniques to slow yourself down.

• “Clear a Space”- Check in with your mind and body.  Create a safe image in your mind.  Set aside thoughts of the past, present, and future.  Or use a backpack image…leave behind judgement and self-doubt.  Pack courage or inspiration.  Look at the experience with kindness and curiosity.  Focus on clearing a space in your mind.

• “Safe Place Imagery”- Imagine a real or imagined scene your mind using all of your senses.  Focus on the sensation of each sense and provide as much detail as possible.  (Your brain will not know the difference between you being there or merely thinking about it!)

• 7/11 breath- breathing in for seven seconds and exhaling for eleven.  Repeat…

• Take a breath before answering the phone, while you are on hold, replying to a text, or email.

• Breathing Retraining- For early signs of panic.  Hold the breath for 10 seconds.  Breathe in for 3 seconds and out for 3 seconds 10x (about 1 minute).  Repeat both steps until symptoms are gone.

• 4-Square breath- Using your finger as if to trace a square, breath in as you move up, hold for 4 as you move across, breath out as you move down, and hold for 4 as you return to start.  Repeat.

• Figure 8 breath- Using your finger as if to trace a figure 8, inhale for the first half, and exhale for the second half.  Repeat.

• Focus on your footsteps.  Breathe with your steps…in for 4, out for 4.  Gradually slow your pace.

• Focus on a particular sound (single instrument, nature sounds, etc) How far away can you hear it?  What is the next closest sound?  Can you hear anything nearby, your own breath?    

• Yoga poses (try holding a pose that is comfortable to you, like “Mountain Pose” and focus on the stability of the pose, the connection with the floor, the emphasis on posture, and the breath that gives you strength.

The key to any mindful technique is consistency.  Try it first thing in the morning, during lunch, in between work tasks, or at the end of the day before sleeping.  Need support building your coping muscles.  Connect with me at SHCS.

Ever make a decision that you felt made you happy, but might make others mad, and you did it anyway?  Say, send a text, made an accusation, or sent a “prickly ball” to someone just because you wanted a payback?  Ever say hurtful things to someone else without a second thought as to how that person may feel towards you afterward?  Ever not care about the consequences of those actions?  Ever argue with someone because they didn’t have the same viewpoint about a situation you were passionate about?  Ever “spin” the dialogue of another person to fit your own perspective?

Perspective-taking…Did you know no two people think exactly alike or see things the same exact way?  Maybe similarly sometimes, maybe not even close.  It happens all the time with teenagers, folks with autism, personality disorders, divorce situations, and among the many adults I see.  

Sometimes folks are so angry, so passionate, or so unwilling to allow others to have choices, that they are unwilling to see the view of any other lens, just their own.  Or they believe their opinion or viewpoint is the only correct one and become annoyed with others in their lives who challenge those opinions.  Or one person blames the other and fails to see their own contributions to an interaction that goes south.  It happens all the time.  The unfortunate situations are when children model the unhealthy interactions of what they see at home because they do not know anything else or split/side with one parent out of fear of the actions of the other parent.

To be an effective communicator takes work and effort.  It requires support and practice being assertive and making one’s needs known.  Human beings are all important and all have value.  We can all strive to be effective communicators.  

Here are some DBT tips to be more effective in not only in communicating, but also understanding the viewpoint of someone else.

• Set up a goal for the interaction with the person you want to talk to 
• Ask yourself what you want from the interaction and how you want to feel afterward?
• Describe the situation you want to be addressed.
• Express your emotions clearly.  Use I statements…. “I feel…”
• Request what it is you want from the interaction
• What does the other person need to hear in order to listen to you?
• Stay mindful of your goal for the interaction
• Act confidently (use a calm, neutral firm tone; eye-contact, etc)
• Be willing to negotiate or compromise;  Or “Turn the tables” by saying, “what do you think we should do about this?”

If the relationship is important to you consider being:

• Gentle
• (act) interested
• Validate feelings
• Be easy-going (use humor if possible)
• Stick to your values
• Don’t apologize for having an opinion, even if it’s different
• Above all, don’t argue, judge, criticize, make threats, or resort to intimidation tactics- this just adds fuel to the fire and will lead to problems.

Lastly, accept that if you are afraid to make your needs known or if you are the most effective person in the room, the environment may make it difficult to be effective.  It may not be an interaction that gets better.  You get to decide then whether working it out or moving on is the next step.  

Putting ourselves in someone else’s shoes gives us a way to learn and understand the thoughts or actions of others.  It helps us to develop empathy and compassion.  Need support navigating relationships in your life?  Contact me at SHCS.

I know of a child who regularly has meltdowns when asked to do something he or she does not want to do.  Instead of using words, the child escalates to the point of disrupting property, slams doors, yells, and makes poor statements about his or herself.  The child’s coping skill….going to sleep.  Is it effective?  Maybe.  Can it be generalized to other settings?  Unlikely.  You can’t go to sleep at school if things aren’t going your way or when a teacher asks you to follow directions. “Use your coping skills,” I hear from others, time and time again.  Not only have I said these very words to my own kids, but to clients, too.

What are coping skills anyway?  According to UCLA, coping skills/strategies are “the behaviors, thoughts, and emotions that one uses to adjust to the changes that occur in life.  Some are more effective than others depending on the stressful situation and the person employing them.”  How one copes can be good for you or not so good for you.  

For example, if you think to yourself, “I’ve got to take a break before I lose it” then go for a run, this can be good for you.  Running releases endorphins drives out stored up muscle tension, and can benefit your body physically and mentally.   The pros are that you are coping in a healthy way and are not giving into the distress you feel.  On the other hand, if a person thinks that nothing will ever get better and he or she needs to release the pain, self-harming behavior, such as cutting, may occur.  This, too, can also release endorphins, yet can leave permanent scarring, resulting in hospitalization, or even death.   Both sets of coping skills can become habits.

What I do know is that coping strategies require practice to become a habit.  Timing is important too.  Being aware of what causes stress, anxiety or frustration is also important.  We call these triggers, the things that “set us off.”  Ignoring the signs and waiting too long before using a coping strategy can worsen the experience.

When the intensity of one’s thoughts and emotions become too big, tantrums happen, or the individual may give into distress by self-harming.  Sometimes the escalation is so quick that there isn’t time to intervene, such as in ADHD or autism, where thoughts become stuck or inflexible, quickly leading to the behavior.  (It’s also important to note that in children with these conditions, the frontal lobe of the brain, responsible for self-regulation and executive functioning, is still immature, making it harder to access coping skills.)

Healthy coping skills can include:

• exercise, 
• writing in a journal
• drawing/coloring
• listening to music
• playing an instrument
• taking a shower/bath
• playing with a pet
• spending time outdoors in nature
• organizing or cleaning activities

In regards to DBT (dialectical behavior therapy), coping skills can include mindful distractions and ways to soothe yourself.  They can improve the moment when you can’t make things better right away.  They can help you make more informed decisions so that you are not giving into distress.  For kids, parents/teacher/counselors can model and teach expected responses and practice calming skills with kids to assist them in the learning of new habits and behaviors.  

Being a musician, music is meaningful to me.  I sing, strum guitar, and play the piano for self-expression and to self-soothe.  If I don’t do it, I miss it.  It’s a release that I’ve come to require in my life for my own self-care.  In addition, I walk my dog daily.  It’s a time to think quietly and focus on my steps, a mindful moment.  These have become habits and routines that have made my life more balanced.  

If you are having trouble learning coping skills or would like to improve on the ones you have, contact me at SHCS!

I’ve been afraid of bees since the age of 12.  Why? A sting from a wasp, of course, six of them down my right arm, when a wasp got caught in my shirt sleeve while I was jumping rope.  While my memory of the sting is the root of my fear, the likelihood of another sting is fairly rare.  Even so, I spent many summers eating indoors to avoid stinging insects.  I’ve even run away from bees I felt were flying after me at the beach.  I’ve managed to read about bees, watch them in a live hive indoors behind glass, talked back to my fear, and practiced breathing techniques to slow my responses down.  I can now eat outside most of the time, though I’m not always comfortable doing so.

Fear…it’s gripping.  Most dread it.  It is a feeling induced by perceived danger or threat, which causes a change in the brain and the body, ultimately resulting in fleeing, hiding, or freezing behavior.  Fear can be caused by a traumatic event or it can be caused by a false alarm, such as an irrational fear, called a phobia, or a stuck thought, as in OCD.   Fear can sometimes be so intense it can interfere with daily activities.

Tips for managing fear include:

• Naming it 
• Rating the intensity of the fear
• Talking back to it
• Making a plan to confront it by breaking it down into smaller more manageable steps
• Practicing breathing, relaxing the mind and body, and exercising (to get the anxious energy out)
• Creating a positive image of handling the fear
• Gradually facing it using the small steps described earlier.

Playing/singing upbeat songs about overcoming obstacles can be motivating and empowering, too!  Using cheerleading statements, drumming, and songwriting can create new pathways for reducing fear.  Listening to relaxing music and practicing mindfulness can also reduce our responses to fear.  Need some motivation?  Try it at SHCS!