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When you’re feeling stressed, the parts of your brain that are responsible for keeping you alive go into “high-alert.” These parts sense stress and assume that your life is actually in danger. If you feel stressed, your brain acts the same way, whether your home is on fire or you’re running late to an important event: it sends signals to the rest of your body to prepare for the worst-case-scenario. What results is what’s commonly known as the “fight-or-flight” response, a series of changes within our bodies that help us fight off danger or flee from it.
Lots of things happen inside your body during fight-or-flight, especially inside your chest. You’ll feel a rush of adrenaline (energy and strength) as the heart pumps faster and your muscles tighten. Your lungs will also expand to take in more life-giving air. If there’s no actual danger to fight or flee, though, you’ll probably be left with a very tight chest and a head full of worries.
WHEN IN DOUBT, BREATHE OUT
Just as feeling stressed will tell the body that it’s time to fight or run, feeling safe (from harm) will tell the body that it’s time to relax. One way to return to a more peaceful state is to deliberately exhale the moment we notice we’re in high-alert mode. You might be thinking, “How does that work?”. Well, we spend a lot of time talking about the fight-or-flight response, but did you know that we have a whole system that counterbalances it? It’s often called the “rest-and-digest” response. Breathing is one part of these response systems that we can directly control. Exhalation, especially full exhalation, activates the rest-and-digest response. We can speak to our bodies, from our bodies. We can show our bodies we are safe by simply letting go of the air we were holding in for a fight or run that was never going to happen.
BREATHING EXERCISES FOR FIGHT-OR-FLIGHT MOMENTS
For an advanced technique, place one hand on the lower abdomen, just under the navel. As you breathe in, expand your lower abdomen like a balloon so that your hand moves outward. As you breathe out, flatten the lower abdomen as much as you can.
Long Exhales: After inhaling, exhale slower and longer than usual, to the point where you feel tightness in your stomach. Repeat 3+ times.
Box Breathing: Inhale for 4 seconds, hold the breath for 4 seconds, exhale for 4 seconds, hold the breath for 4 seconds. Repeat 3+ times.
Afterward, check the body and mind: Does your body feel any more relaxed than before? What is your stress level on a scale of 1-10? Is it lower than before? If stress is still high, you may want to repeat the activity or try a different breathing exercise.
If you need support to manage stress and develop practices to intervene when it increases, contact us at Steady NYC.
So, here we are…it’s Fall 2021, and it seems like most therapy is being conducted behind a screen. There’s no doubt that meeting a therapist from our computers, at the click of a few buttons, is a different experience from commuting to their private office and sitting there with them. However, online therapy can be so convenient, and many studies have shown that it is just as effective as therapy done in-person (Barak et al., 2008; Godleski et al., 2012; Kessler et al., 2009; Wagner et al., 2014).
When I first start working with a client online, I let them know all the ways we can make their experience just as impactful as therapy in an office together. It takes some conscious effort, but tiny adjustments add up to create a comfy, private, and connected experience wherein you can feel safe to get the support you need.
Pillows & Privacy: We Set Up the Space.
First, we set up the spaces in our homes to feel cozier, private, and dedicated to therapy.
I ask clients to choose a private space in their home where they can reliably meet with me at our designated time, and then I encourage them to make that space special whenever we meet. How so? We take care of two major priorities in therapy: comfort and privacy. To increase the physical comfort of our designated therapy spaces, we bring in soft and cuddly things (like blankets, pillows, and even pets who don’t distract us) or other comforting tactile objects (like fidget toys and stress balls). I also encourage people to have something soothing to drink during the session. To maximize coziness, we can use relaxing lights, candles, and essential oils to both calm our nerves and signify that therapy has started.
After comfort is increased, it’s time to focus on privacy. To better guarantee that no one else can hear the therapy session, your best bet is to ensure that no one is nearby or your walls muffle sound well. Since those two options are not always available to us, we can use earbuds or headphones to block out the sound of the person on the other end, and we can use fans or white noise machines to muffle all of the sounds from coming from our room (for the best effect, place the muffling machines just outside of your room).
CONNECTED TO MORE THAN JUST THE INTERNET: WE SET UP THE TECH.
Next, we set up the technology to reduce distractions and strain and increase our focus and sense of connection to each other. Before a session, it’s a good idea to ensure our Internet connections are stable and you know how to use the main features of the videoconferencing platform you are using. Chances are that you already have been using the internet for videoconferencing and you know some things that slow it down (like having multiple programs open) and speed it up.
During sessions, it’s best to have the device positioned so that you are looking at your therapist at or around eye-level. This helps us feel more connected and reduces eye, neck, and back strain. While there are many cool laptop risers you can buy, there are also many other creative, sturdy ways to raise the height of a laptop – I speak from experience! We can’t always get eye contact right because of the position of our screens, but we can try. On a related note, it’s helpful to remember that we don’t have to maintain eye contact throughout the session (although it can sometimes feel that way in video meetings). Just like we would in the office, we can take time to gaze at our surroundings and reflect during an online therapy session.
Another note on where we look: Unless it’s helpful for a specific therapy technique, we don’t need to focus on our own video. Sometimes checking ourselves out does more harm than good. I recommend only checking your “Self View” to ensure the other person can see you clearly, and then shifting your focus back to them. If you have options to minimize or hide what you can see of yourself, it is worth experimenting with those.
To further reduce distractions, it’s a good idea to turn off notifications on our device(s) but keep a phone nearby. We can set our phones (and some computers!) to “Do Not Disturb” mode. I cannot tell you how many people’s days I’ve made when I’ve pointed out this feature on the MacBook (it’s in the pop-out menu by the clock, in the “Notifications” tab…You’re welcome!). As for cell phones, I encourage clients to keep them nearby and charged, in case the Internet becomes faulty and we need to get on the phone to keep on talking. This happens rarely, but the transition is usually a smooth one in my experience.
BE A LITTLE SELFISH: WE SET UP OURSELVES.
Perhaps more important than the cozy, private, focused environment we’ve created is the way we as people come into the virtual therapy room. Before and after a session, we can practice routines and habits that allow us to fully absorb the benefits of therapy. Spending a few minutes sitting in our chair and sipping our favorite soothing beverage, writing in a journal, repeating an motivational phrase, or taking a short walk can do wonders. For the person receiving therapy, the transition between life inside the therapy session and outside of it was traditionally experienced as a bit of a ritual, through a commute and a waiting room. That transitional time is precious and best spent being gentle to ourselves. If that’s tough to do, try to at least take a pause between therapy and screen time – your eyes and mind will thank you.
GREETINGS FROM ONLINE THERAPY – YOU’LL LIKE IT HERE
There are ways to treat our physical environments, the technology we use, and ourselves before, during, and after a therapy session to make it just as impactful online as it is in the office. I hope these tips enhance your experience of online therapy, so that you can better enjoy the wonders of mental healthcare and technology all from the comfort and privacy of your (possibly candle-lit and cuddly) remote therapy space.
If you are interested in trying online therapy, contact us at Steady NYC.
We’ll be glad to show you what I mean.
Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human Services, 26(2-4), 109–160. https://doi.org/10.1080/15228830802094429
Godleski, L., Darkins, A., & Peters, J. (2012). Outcomes of 98,609 U.S. Department of Veterans Affairs Patients enrolled in Telemental Health Services, 2006–2010. Psychiatric Services, 63(4), 383–385. https://doi.org/10.1176/appi.ps.201100206
Kessler, D., Lewis, G., Kaur, S., Wiles, N., King, M., Weich, S., Sharp, D. J., Araya, R., Hollinghurst, S., & Peters, T. J. (2009). Therapist-delivered internet psychotherapy for depression in primary care: A randomised controlled trial. The Lancet, 374(9690), 628–634. https://doi.org/10.1016/s0140-6736(09)61257-5
Wagner, B., Horn, A. B., & Maercker, A. (2014). Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial. Journal of Affective Disorders, 152-154, 113–121. https://doi.org/10.1016/j.jad.2013.06.032
A BRIEF LOOK AT THE BENEFITS AND PITFALLS OF ANXIETY AND DEPRESSION AND HOW TO FIND BALANCE BETWEEN THEM.
Most people experience anxiety and depression, and there may be plenty of evidence to support that levels of each are climbing in the United States (Goodwin et al., 2020; Mojtabai et al., 2016). However, there is an important distinction between the anxiety and depression that we naturally experience and what the mental health community calls “Anxiety Disorders” and “Depressive Disorders.”
WAIT – ANXIETY AND DEPRESSION ARE NATURAL?
Anxiety is what we feel when we perceive danger and our bodies become alarmed. It shouts from within us, “Something painful is ABOUT to happen! What can I do to stop it?!” If the danger is real, anxiety can force us into action so that we can avoid the worst of the danger. Anxiety can be necessary to keep us alive.
Depression is a lack of motivation, in response to the painful parts of life. It cries from within us, “Something bad IS happening, and there is nothing I can do to stop it.” When the painful parts of life use up a lot of our energy, depression makes us rest. Actually, what often happens is someone feels a boost in anxiety right before they feel depressed, because the anxiety used up a lot of energy before the person came to the conclusion that there was nothing left for them to do. The rest that we get when we feel depressed can be necessary to keep us alive. The depression also gives us a chance to catch our breath and assess our situation outside of the Go-Go-Go zone – we get to ponder a bit and think about the big picture (i.e., ask ourselves, “What move do I want to make next?”)
THE RISE AND FALL OF ENERGY
The body and all of our organs are meant to alternate between activity and recovery. At any given time, our body has a certain level of energy available to face a difficult situation. As you can see with the roles of anxiety and depression, the rise and fall of this energy level is actually necessary to either avoid danger, stop it in its tracks, or take a time out to learn from a dangerous situation. Because of the importance of extreme moods, we don’t automatically label our anxiety and depression symptoms as mental illness. Sure, we sometimes get up to get knocked back down, but like the rise and fall of our chest when we breathe, the opening and closing of our eyes, and the sunrise and sunset of our days, mood is rhythmic, and we can get back up again.
WHEN RISING AND FALLING DON’T FEEL GOOD
If your mood rhythm becomes imbalanced in such a way that you spend much of your time in high alert and/or down in a rut of hopelessness, you may be suffering from a mood disorder*. Anxiety Disorders and Depressive Disorders entail experiencing both necessary andunnecessary anxiety and depression, to the extent that a person experiences distress in multiple areas of their life (e.g., school, work, chores, relationships, personal hygiene, etc.), on a persistent basis (American Psychiatric Association, 2013). Spending extended periods of time in anxious and depressed states can alter our biological rhythms. This means that anxiety and depression can have detrimental effects on our physical health, too.
ROOT TO RISE
In yoga, we talk about “rooting to rise,” which means feeling stable and balanced in your body’s points of contact with the floor before stretching to take up more space in the room. We root to rise with our moods, too. Finding middle ground between the highest highs and the lowest lows of our mood gives us stability and strength to then flex our mental muscles. In that way, we can experience a range of emotions without getting overwhelmed.
THERE IS HOPE
A therapist can empower you with tools that help the anxious and depressed parts of you better recognize when you are safe. With a more accurate gauge on how safe any situation is, your anxiety and depression will learn to keep coming to your rescue when needed and then take a back seat when they are not. As holistic, trauma-informed therapists, Kathryn, Shelby, Sophia, and myself support every client’s unique situation in a gentle yet highly effective way that is powered by radical compassion. We will guide you through your mood changes with sensitivity, confidentiality, and respect. We will guide you to root and to rise. If you or someone you know would like to learn more about how we can support you in the struggles of anxiety and/or depression, please fill out our contact form, and one of us will be in touch with you within 1 business day.
MAY YOU ROOT TO RISE.
*The terms “disorder” and “illness” can be empowering to some people and disempowering to others. The same can be said for receiving a diagnosis. Some important things to note are 1) there’s no way our complex minds, bodies, and spirits can be summed up by a list of symptoms created by psychiatric researchers, and 2) the better you understand your own patterns, the more you can control your mood rather than letting it control you.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Goodwin, R. D., Weinberger, A. H., Kim, J. H., Wu, M., & Galea, S. (2020). Trends in anxiety among adults in the United States, 2008-2018: Rapid increases among young adults. Journal of psychiatric research, 130, 441–446. https://doi.org/10.1016/j.jpsychires.2020.08.014
Mojtabai, R., Olfson, M., & Han, B. (2016). National Trends in the Prevalence and Treatment of Depression in Adolescents and Young Adults. Pediatrics, 138(6). doi:10.1542/peds.2016-1878
FROM SCARCITY TO ABUNDANCE
This year’s pandemic has brought about many restrictions and losses. As we grapple with these challenges, many of us have also been grappling with the weight of the emotions attached to them. These days, I often hear clients, friends, and family members say that they are struggling to stay hopeful—for a timely COVID-19 vaccine, for a less stressful home life, for a more peaceful planet, etc. The message I hear underneath all of this is our stress is often outweighing our sense of abundance.
A REFLECTION ON OUR FOCUS
Lately, I have been reflecting on the value of shifting one’s primary focus from loss to what we still have, and how to do this effectively. I think it is possible to have space in our hearts that honors—and even longs for—what we have lost, while we open up those same hearts to peace and joy. The more we can appreciate all that is available to us, both within and outside of ourselves, the more we can enjoy our lives.
SHIFTING FROM SCARCITY TO ABUNDANCE
In therapy, I sometimes talk about shifting from a scarcity mindset to an abundance mindset. A scarcity mindset is one that focuses on what we do not have, and an abundance mindset is one that focuses on what we do have. Adopting an abundant mentality does not mean that we have to forget about what we have lost, but it means that we do not anchor our spirits to our losses. Shifting our mindset in this way is an act of self-compassion; it is about recognizing that we are worthy of actively enjoying the life that lays ahead of us.
A SELF-GUIDED ABUNDANCE EXERCISE
Are you ready to push back on your sense of scarcity? Below are my instructions for a self-guided abundance exercise you can try during a stressful moment. Each step of the exercise involves self-guided prompts.
Identify the strongest emotion: “Am I feeling anger, sadness, fear, disgust, or something else?”
Simply get curious, without judging yourself or the emotions as good or bad.
Identify the message behind it: “What message is my [name the emotion] trying to tell me, regardless if it sounds irrational or illogical.”
Feelings aren’t facts, but they have valuable information about my needs.
Identify needs: “What skills, strengths, or qualities would help me get through this?”
Identify mastery resources: “Was there a time in my life when I had the skills, strengths, or qualities I need right now?”
If the answer is ‘yes,’ visualize this memory.
Identify relational resources: “Is there a person from my past or present, or someone I admire, who has the skills, strengths, or qualities I need?”
If the answer is ‘yes,’ visualize them with those features and then imagine the features being transferred to you.
Identify symbolic resources: “Is there a symbol, animal, something in nature, or a material item that can give me what I need right now?”
If the answer is ‘yes,’ visualize gathering what you need from them.
Give yourself what you need: “What words do I need to hear right now?”
Speak these words to yourself.
Check the emotions: “How am I feeling now?”
When you are done, take a moment to acknowledge your abundance of internal resources to navigate difficult moments. Feel free to repeat the exercise again.
A MINDFULNESS PRACTICE TOWARD ABUNDANCE
This exercise (or consideration of the concepts behind it) is a good first step toward a more abundant mindset. We can think of this mindset shift as a mindfulness practice, as our attention will continue to wander toward scarcity and the pain we experience from loss. A mental health professional can support us to honor all of the pain and joy that makes us who we are. If you need support, we welcome you to contact us at Steady NYC.
Loss is a part of life, and—let’s face it—we have lost a lot this year, individually and collectively. What is important to note is it is possible to experience peace—and even joy—despite our losses, with an abundance mindset.
Korn, D. L., & Leeds, A. M. (2002). Preliminary evidence of efficacy for EMDR resource development and installation in the stabilization phase of treatment of complex post-traumatic stress disorder. Journal of Clinical Psychology, 58(12), 1465-1487.
MINDFULNESS DURING A PANDEMIC
Since the novel coronavirus first hit New York City, I’ve been thinking a lot more about mindfulness, both in sessions with my clients and on a personal level.
Practicing mindfulness involves purposely paying attention to the present moment experience, with curiosity instead of judgment. This mental state of focus, curiosity, and nonjudgement makes it possible for us to accept what is – what we can control and what we cannot. Acceptance paves the way for us to concentrate on what we need in any given moment, and it brings us closer to peace. We can practice mindfulness formally through meditation or informally by simply adjusting our mindset during the flow of daily life. Amid the current global health crisis and recent social uprising for racial justice, so many of us are seeking peace within the chaos. Mindfulness seems to be the best way to address the sense of helplessness we are experiencing.
MINDFULNESS IN TODAY’S THERAPY SESSIONS
Many therapy sessions with my clients have included brief meditations, which help us quiet the extra noise in our heads and remember what we want to get out of therapy. In psychotherapy, the focus, curiosity, and non-judgment of mindfulness help us explore our thinking and feeling patterns without criticism. With anxiety and hopelessness on the rise, my clients and I have been mindfully reflecting on whether the stories in our minds are based on fact or fiction. We have also been spending time discussing gratitude despite today’s tragedies and horrors, because mindfulness allows us to accept what is still good in the world.
A THERAPIST WRITES MINDFULLY
One evening last week, I became aware that my mind kept wandering to thoughts of my own social isolation. I noticed that I would think about something that was painful and then quickly try to distract myself with a more uplifting thought. The distraction method only helped temporarily, as my mind continued to focus on my own loneliness and social deprivation. So, I decided to sit down and journal about my social isolation, with curiosity and without judgement. In this way, I was journaling mindfully. After writing and then reading over my writing for about an hour, I felt better: more clarity about what I can and cannot control, more compassion toward the parts of me that were hurting, and more hopeful with my new plans to increase my connection to others.
GET CURIOUS ABOUT GETTING CURIOUS
I encourage you to try on a mindful attitude when you are feeling especially fearful or hopeless one of these days. Maybe you want to take it a step further and try a mindful meditation: find a quiet place to sit for a few minutes, give yourself permission to let go of judgement about yourself, your life, or doing the meditation the right way, and focus with curiosity on a present moment experience – your breath, your body’s sensations, or a peaceful thought of your choice. As your mind wanders from the meditation or mindful way of thinking (and it will, over and over again), congratulate yourself for noticing and, without judgment, gently invite your attention back to your chosen point of focus. See how it feels to focus on the present moment with objectivity. Get curious about getting curious. I wish you many moments of peace.
If you would like to learn more about how to practice mindfulness, we welcome you to contact us at Steady NYC.
WE ARE EVERY AGE WE'VE EVER BEEN
Photo caption: Here’s 6-year-old me, feeling a couple of my parts
I’m sure you’ve heard someone say or said to yourself, “one part of me wants X and another part of me wants Y. I can’t figure out what to do.” Each of us has many different parts. Many of these parts originate at an age from our past.
Some parts of ourselves are unhealed parts from our past – and they can lead to our present-day responses being out of proportion to present-day events. Said another way, these unhealed parts from our past can lead us to overreact to events in our present. In therapy we often refer to these unhealed parts as a “wounded inner child” or an “unmet need.”
The way I see it, we are every age we’ve ever been. Each part has value and is ready to come out when a situation needs them. For example, when I experience rejection or disappointment as an adult, and I have a big reaction, I am able to recognize that my inner toddler feels scared and sad and needs some reassurance. I am aware that, if I give myself the inner hug and gentleness that my toddler needs, she is able to quiet down. As a result of this reassurance I give myself, my emotional response to a challenging situation ends up being more manageable and in better proportion to the situation in the present.
ALL PARTS WANT TO BE HEARD
Most of the time, our younger parts simply want to be heard. The challenge is that most of us are taught to distract ourselves from negative emotions and fight off painful memories. Consequently, we walk around with unhealed wounds. When I take the time to listen to my feelings, and to the parts of me that are feeling hurt, I learn what I need. In this way, I get the information that my adult self needs in order to put self-care into action.
The next time you’re feeling a really strong emotion all of a sudden, try to approach it with curiosity and compassion, by asking yourself these questions:
1. What part of me is feeling this way?
2. How old is this part?
3. What do they need?
GETTING TO KNOW YOUR PARTS
You might be surprised by how eye-opening the answers to these questions can be. The goal here is to get to know our wounded parts and give them the nurturing they did not receive in the past.
When I feel that special mix of fear and sadness, I acknowledge my inner toddler is hurting, and I find a way to give her what she needs. I try to get a hug from a loved one or wrap something soft and cozy around me, and it works wonders. Until we can listen and show compassion to the parts of us that are hurting, they will remain in pain.
BE YOUR OWN SPOKESPERSON
So, go ahead, and listen to your angry inner teenager who comes out when they feel disrespected or your sad inner toddler who wants a hug. Try giving them the time and attention they didn’t get the first time around. Let them know you’re listening now. Then let your adult self be their spokesperson.
Anderson, F.G., Sweezy, M., & Schwartz, R.C. (2017). Internal family systems skills training manual: Trauma-informed treatment for anxiety, depression, PTSD & substance abuse. Eau Claire, Wisconsin: PESI Publishing.
Schwartz, R.C. (1995). Internal family systems therapy. New York, NY: Guilford Press.
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind and body in the healing of trauma. New York, NY: Viking Press.