Uncertainty: The Only Certainty In Life

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“If you want to be successful in this field, you’d better learn to love ambiguity.”  A professor said this to her class 12 years ago.  As a student in that class, I can almost hear these words today as clearly as they were spoken over a decade ago.  This has stuck with me because it has proven to be true.

In my job I work closely with people, come to care for them deeply, watch them struggle and triumph.  And then, in the majority of cases, we stop seeing each-other.  This is the natural progression of therapy.  In the cold clinical sense it is meet, assess, treatment plan, intervene and then terminate.  I usually invite (if not outright plea for) follow-up calls, periodic check-ins.  Perhaps naturally, seldom is this invitation accepted.  Here is the ambiguity that my professor identified.  Did this person maintain their progress?  Did that issue ever resolve?  What happened with their spouse?  These questions rarely receive an answer.

But this post is not about me or the ambiguity that therapists encounter.  It is about how we all come to terms with the ambiguities and uncertainties in our own lives.


We Seek Answers

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One important thing to understand about the way that our psyches operate is that we seek answers.  Uncertainty and ambiguity are uncomfortable for us.  We strive to be in a world that we know and understand.  We actively seek this knowledge and most of the time we are able to find and achieve it.  However, there are some circumstances where this knowledge is simply not possible.  When we find ourselves in these circumstances, we have a choice to either continue to search, in vein, for the certainty we crave or to learn to come to terms with not knowing, even though it is uncomfortable for us.


The Allure of On-Again Off-Again Relationships

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Understanding how ambiguity affects our minds, we are able to more fully understand the allure of relationships that do not get a firm and clear ending.  These are the types of relationships that we refer to as on-again off-again.  These couples get together and then break up only to reunite to give it another go.  This cycle may repeat countless times until one or both partners are willing to give an unambiguous ending to the relationship.

Knowing how stagnating this pattern can be, taking a page from Taylor Swift can really help.  She wrote the song “We Are Never Ever Getting Back Together.”  That is a direct, unambiguous signal that this relationship is ending and not going to enter the on-again off-again dynamic.  While it may be more painful to do so, we really do ourselves and others a favor by being direct and clear when a relationship is over.


Two Types…

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There are two “flavors” of ambiguity.  First up is future oriented ambiguity.  This is when we are uncertain about how something will turn out in the future.  This is fertile ground for worry to take seed and grow.  This often takes the form of “what if” thinking.  (This will be addressed below, but see the earlier blog about worry for a more in-depth discussion of this topic.)  The second flavor is past oriented.  This is where we are unsure about something that already happened.  If there is a situation that leaves you pondering why someone treated you the way they did, then you are dealing with this type of ambiguity.  There is a 4-step protocol for dealing with this that I will describe in a later section.


“What If” Thinking

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As mentioned above, this is worry.  We may wonder what if… and then create all sorts of scenarios in our head.  These tend to be worst-case scenarios.  The missing ingredient here usually is our ability to cope.  We tend to over-estimate the likelihood of some terrible fate befalling us and under-estimate our strength and capacity to overcome hardships.  I find myself frequently reminding my clients that they are far more resilient than they give themselves credit for.  You would do well to remind yourself of the same thing.


Four Step Protocol to Handle Past Oriented Ambiguity

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It can be difficult to stop rehashing troubling things that have happened in our past.  We may find ourselves constantly playing over situations from the past and wondering why it happened the way that it did.  If you find yourself doing this, give the following protocol a try:

  • Express your wished for outcome. This is your opportunity to define what you wanted to have happen in an ideal world.
  • Acknowledge the reality of what did happen. You then define how things actually turned out.  This will often highlight the discrepancy between what you wanted and what you got.
  • Acknowledge your feelings about the situation. Are you angry about the way you were treated?  Perhaps sad about the outcome?  If you have a hard time identifying emotions, remember that emotions fall into the four main categories of mad, glad, sad and scared.  Consulting a “feelings chart” may also be helpful.  By expressing these emotions openly and directly, you can begin the process of mourning, if needed, and then move on to the fourth and final step.Image result for feeling chart
  • Let it go. This is not just a song that Elsa sings. Image result for let it goIt is the culmination of the work you have done through the first three steps.  Now that you have acknowledged the gap between what you wanted and what you got and how this makes you feel, you can begin to put it to rest.  Accepting that things cannot be different and you cannot change the past are the main tasks of this final step.


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Let’s Be Clear About Our Conclusions…

I hope that you are now certain in your understanding of why ambiguity is difficult for us and how you can go about working through it.  Oftentimes, simply understanding the nature of what you are struggling with helps you to deal with it better.  In this way, clearing up the ambiguity about ambiguity makes things less ambiguous.  I hope that’s clear.

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Getting Around to Talking About Procrastination: 3 Simple Principles to Stop Delaying and Getting It Done


I have intended to write this post for 3 months now.  My process has been as follows:

Identify the topic – check.

Brainstorm an outline of what I want to say – check.

Stagnate – check.

Stall – check.

Finally get around to actually writing – check.

Granted, other things have come up that demanded my attention.  Some legitimate, some mere distractions, some blatant attempts to not do the thing that had been hanging over my head.  This is the very essence of procrastination.  I put off to tomorrow what could have been done today.  I know better.  I counsel and advise others on how to avoid this pitfall.  I know the short-term benefits of avoiding are not outweighed by the long-term consequences that will follow.  Yet none of these chiding thoughts prodded me into actually writing this post.  Up until this moment as I write, I had not followed my own advice.

I have been on both sides of the procrastination battle; both as a victim to the temptations of delay and as a victor over the siren’s song of postponement.  I can say that being the victor is far more satisfying and rewarding.  Following the three simple principles that follow will help guide you to be victorious over procrastination more often than you fall victim to it.  I know firsthand: it is simple, just not easy.  But it is well worth the effort.


Front Load the Work

We often have a lot of things that need to be done and a lot of things that we could do that would be beneficial, wise, and productive uses of our time.  Some of them are responsibilities and some are things to unwind and relax.  Most likely, the items on the responsibilities lists are the ones that will be put off to some other time.  We prioritize other activities over what should be done.  How this typically plays out is that we will engage in some other (less important) activity, all the while feeling the weight of the thing we are not doing hanging over our heads.  This tends to rob us of some of the enjoyment of what we are doing.  It is likely to be hard to fully enjoy going out with our friends if we know that we really needed to be working on a report that is due the next day.

The fix for this is to “front load” the work.  Do the thing that needs to be done first and then you can fully enjoy the rest of your time, free of the burden of knowing that work awaits you once you are done.  You will feel good about getting the to-do item accomplished and then you can engage in whatever activities that follow with a clear conscience.

If you get into the habit of doing the work first and then playing afterwards, you can achieve a balance to where you are fully productive and fully engaged in fun and fulfilling activities as well.  This balanced approach will help prevent you from feeling burnt out or overwhelmed.


Present Me and Future Me

               The second principle is to remember that future me is not going to be any more motivated, energetic, or capable than present me.  To understand this principle, you must first understand that you hold two versions of yourself in your mind at any given moment.  The first is “Present Me,” which is the you that you are currently experiencing.  Present Me is currently reading these words.  Whatever you are thinking, feeling, and doing in this moment makes up Present Me.  Future Me is the idea of what you are going to be like outside of this moment.  You may be thinking that Future Me is going to cook dinner, or go to that movie you have been wanting to see, or take that vacation you have been dreaming about.  Future me gets to do all sorts of things, both pleasant (like the movie or the vacation) and unpleasant (like chores, pay bills, and get root canals).

Problems with procrastination occur when we start to assign too much stuff to Future Me.  We may begin to think that Future Me is going to develop super-powers of super-human will, motivation, and energy.  Or at least Future Me would need to develop these super-hero abilities in order for them to accomplish all that is being assigned to them.  When there is this rift between what Present Me and Future Me is capable of, we are deep in the waters of procrastination.  And we are likely drowning in those waters.  We need to understand that Future Me is going to feel exactly like Present Me does.  Future Me does not like doing dishes any more than Present Me does.  Future Me does not possess an amazing ability to balance the checkbook any more than Present Me does.

Future Me and Present Me are the same person.  When we understand this, we may be less likely to heap loads of responsibilities onto Future Me.  If you use the first principle of front loading work, Present Me can accomplish some things and then go and have some fun rather than Present Me hogging all of the fun and Future Me getting the raw end of the deal.


Motivation Follows Action

               The final principle deals with how we perceive how we get things done.  When asked, people will often respond that they do something when they feel like doing it.  “I get the inspiration to accomplish something and then I set about doing it.”  Some things will happen in this sequence.  But if we are procrastinating, it is this process that has gone awry.  We are waiting to feel the motivation to do something before we start doing it.  And typically, that motivation just ain’t coming any time soon.  This way of thinking is what I call “action follows motivation.”  You can think of it as motivation being the engine and action being the trailer that is pulled along by the engine.

This simply does not work when we are faced with a procrastination problem.  In this case, we must force ourselves to flip the sequence and realize that motivation will follow our action.  When discussing this, I often think of how I feel when there is a sink full of dishes from dinner.  I don’t really want to do them, but I know that I want them to be done.  If I wait around to feel like doing the dishes, I would probably still be sitting here with a sink full of dirty dishes.  So instead, I start doing them and, after about the second plate, I realize that I am motivated to finish the job.  It feels good to be making progress towards being done with this chore and I am looking forward to when I can go sit down and enjoy some quality time with my family and unwind.  What has happened here is that motivation has followed my action.  And when you think about it, the flipside of that is that being unmotivated follows inaction.  The longer we avoid doing the things we know need to be done, the less motivated we feel.


Procrastinate No More

We will all likely struggle with procrastination from time to time, but now you are armed with these three principles to assist you in combating procrastination.  It may have taken me three months, but I eventually took my own advice, kept these principles in mind and completed this post.  And I feel much better for having done so.  I wish you the same success!

Edited by Shirley Sachs
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The Search for the Positive

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This post is aimed at helping you through struggles.  Not of the external variety such as financial stress or interpersonal problems, but targeting those struggles that reside within our own minds.  This is about the way that we see and interpret the events that are happening around us.  The manifestations of these struggles may be as mild as being in a bad mood or a bit grumpy for a small spell all the way to a full-blown depression that lasts for months on end.  While these endpoints are quite different, the same process underlies both results.

On a surface level, you are likely familiar with what this discusses.  People may have told you to “search for the silver lining”.  Others may have attempted to encourage you by saying that “things are not as bad as they may seem.”  Heck, even Monty Python told you to “Always look on the bright side of life.”  While well intended and on the right track, these suggestions and advice have likely been ineffective in pulling you out of the negative that clouds your thinking when you are feeling down.  Why is this?

Basically, this is prescribing the very thing that is most out of reach to you at that moment.  It’s like telling someone who is lost in the desert and dying of thirst to “just drink some water.”  When this suggestion is presented without appreciating the difficulty it entails, we are likely to reject it out of hand.  This is quite unfortunate, because the wisdom behind the suggestion being offered actually has some value in terms of the behavioral health benefits.  I will attempt to dig beneath the surface of what is being said when someone offers this type of advice and transform it from quickly discarded tropes to something that may be meaningful and helpful.


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The Power of Negative Thoughts

Negative thoughts are like a black hole.  Once you have fallen into its depths, there seems to be no escape.  This happens in part due to how our memory works.  In the interesting book Pieces of Light by Charles Fernyhough, the author describes memory as working to serve the moment.  We may think of memory as a documentary of the past: what has been recorded will be watched and viewed the same way each time.  However, that is not the reality.  Our memory actually changes each time we recall something based on our current mood and the reason we are recalling the memory.  Therefore, when we are in the midst of a negative mindset, we recall and interpret past events from that point of view.  Not only are the things that come to mind more likely to be negative events, but we may even recall positive or neutral events in a negative light.

This is the ultimate form of kicking someone when they are down.  Not only do we have to deal with our current negative state, but now it seems as if your entire life history has been one great story of woe.  It is easy to see how despair may set in if this is what we are experiencing.

It is important to know that this bias happens.  It may not be possible for this knowledge to stop the torrent of negative thoughts, but understanding that your current mindset is not an accurate portrayal of reality may be the life saver thrown to you that can help you survive the turbulent waters in which you are currently drowning.

Another aspect that makes our thoughts so powerful is that they guide our emotions.  According to the cognitive behavioral model (or CBT, the most widely empirically supported form of therapy), our thoughts or interpretations of events are the things that shape how we feel about these events.  We may think that events directly cause our emotions.  You can see this operating when people say things like “I was so sad when that milk spilled” and “I was really happy when I got that raise.”  These ways of reporting our experience make it seem that the event inevitably led to that emotional response.  However, we interpret the things that happen to us.  We tend to leave this step out when we report it, in which case it would sound like “the milk spilt and I thought to myself how much of a waste that was and how now I would not be able to enjoy that glass of milk and that interpretation of events made me sad,” and “I received a raise at work and I thought about how it will be beneficial to my finances and represented a recognition of the hard work I have done and that made me happy.”

The interesting thing is that if we are able to change our interpretation of events, it will cause us to feel differently about the event.  For example, “The milk spilt and I realized that I could just pour myself another glass and therefore I was only mildly annoyed.” and “I received a raise at work but it seems like it was too small given how long I have been at the company and how hard I have been working so I was angry.”

You can see that our thoughts do much in the way of shaping how we feel about the things that happen to us, either for the good or the bad.  This can be an empowering reminder to you when bad things are happening in life.  You can do your part to buffer yourself against the negative impact by paying attention to your thoughts and interpretations of these events.


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Become a Detective

To alter your thinking, or challenge your negative thoughts, you must practice finding ways to see the positive in situations.  This can be quite a challenge, especially if you have already been feeling down or if you are dealing with overtly negative events in life (such as a divorce, death of a loved one, etc.).  However, with dedication and a bit of practice, you can become quite good at finding silver linings in even the darkest of storm clouds.  You may have to challenge yourself to become a detective who doggedly searches for clues.  Again, much of this is about the choice to adopt a positive mindset and then to practice finding the positives.

No matter how dire your circumstance, it is possible to find those things.  In the extremely powerful book,  Man’s Search for Meaning, Victor Frankl shares his story of being in a concentration camp during World War II.  Even in this harshest of worst-case scenarios, he shares how he managed to find even small things to be thankful for.  This terrible life experience served as a way to reinforce to him that the one thing that can never be taken away from an individual is their ability to choose their outlook on life.



Learning to be aware of how you are thinking is another thing that requires commitment and practice.  It is difficult, if not impossible, to change your thoughts if you are not aware of having them.  They often happen so swiftly that it is easy to miss them.  But learning to slow down and reflect on how you are  thinking can begin to show you the ways in which your negative thoughts may be coloring your outlook and reactions to the events you experience.


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Sleep 101: How to Give Yourself the Best Chance at a Good Night’s Sleep

               It’s been a long day.  From the time the alarm went off until this moment, as you lay your head on the pillow, you have been going full steam ahead.  Meeting the demands of your job, your kids, the household chores, the errands, and your social life has taken every last ounce of energy you have.   You expect to fall into the oblivion of sleep the moment your head hits the pillow.  But once you get there, “it” happens.  Your mind starts going, thinking about the things left undone, the things you worry about, the plans you are making.  Now sleep is just about the last thing you can do.  But you know you need to.  You start doing the math.  “Only 6 hours until the alarm goes off.  I have to get to sleep now or tomorrow is going to be a disaster.”  The more pressure you put on falling asleep, the more unlikely it becomes.

               If you can relate to this story, you are not alone.  The sleepless are not just in Seattle; sleep issues are a factor for nearly every client I see in my practice.  Thankfully, there are some very straightforward things that you can do to improve your sleep.  While these guidelines are simple, they are not easy, as many of our bad sleep habits are deeply ingrained.  However, with dedication, you can see some dramatically positive improvements in your sleep within a few weeks.

               First, we need to differentiate between a few types of sleep problems in order to give you the correct recommendations.  If you are having trouble falling asleep (called primary insomnia), all ten of the recommendations that follow will be very helpful for you.  Difficulty falling asleep is usually associated with anxiety and/or poor sleep habits, so addressing these issues will help you overcome the problems you face.  If you are having trouble staying asleep (called maintenance insomnia), the first four of the following recommendations can be helpful.  Difficulty staying asleep is often related to depression and/or sleep disorders (such as sleep apnea) and may require consultation with a doctor who is likely to order a sleep study.  If the first four of the recommendations do not bring relief within a few weeks, I recommend that you schedule an appointment to see your primary care doctor to further assess your sleep problems.

How to Address Sleep Problems

               Your body is designed to initiate sleep, basically like a reflex.  When we are experiencing difficulty with sleep, it is usually because we are doing things that interfere with this reflex.  Creating and maintaining healthy habits that encourage sleep is referred to as sleep hygiene.  The following ten suggestions will help you have healthy sleep hygiene in order to fall asleep in a timely manner and get the good quality sleep you seek.

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1)  Establish consistent sleep and wake times.  Your body has a natural ebb and flow of energy throughout the day and night that is called your circadian rhythm.  When it is functioning correctly, it will help you wake up and become alert in a timely fashion in the morning and get tired and ready for sleep at night.  If you find yourself wide awake and fully alert past the time that you were hoping to be asleep, there is an issue with your circadian rhythm.

               The things that we do that can throw this off are a lack of what are called anchor points.  Anchor points for our circadian rhythms are the following: sleep time, wake time, meal time, and… well… #2 time.  Being as consistent as possible in each of these areas can help stabilize your circadian rhythms.  Meal time and time for bathroom breaks are pretty straightforward, but sleep and wake times can be a bit trickier.  One of the biggest barriers that I see people stumble over is by trying to make too big of a change.  If you currently stay up until 2:00 am but set your goal as being in bed by 10:00 pm, you are likely to be unsuccessful because it is too dramatic of a shift.  The best way to approach this is to start where you are and be consistent with that time.  So, based on the example above, you would aim to be in bed each night at 2:00 am.  This is 7 days a week, even on weekends when you could stay up later.  Remember that consistency is the main key here.  After you have corrected your sleep problems, you may be able to go back to having a different bedtime on weekdays versus weekends, but while you are trying to correct these problems, it needs to be the same bedtime every day of the week.  After a week of getting to bed at 2:00 am, you then move it up by 15 minutes (so 1:45 am in this case) and do that for a week.  Each week you move it up another 15 minutes until your bedtime is at the desired time (10:00 in this example).  I do want to acknowledge that this process takes time, a lot of time.  Using this method, every one hour of earlier or later bedtime takes a month.  Therefore, to go from 2:00 am to 10:00 pm would take 4 months.  While it may be difficult to dedicate this amount of time to this issue, it is what is required to ensure success.

2)  Eating.  Obviously, we need to eat in order to provide our body the nutrition it requires to keep us going.  However, there are some aspects of eating that can interfere with getting good quality sleep.  This mainly has to do with the timing of when we are eating as it relates to our bedtime.  A general rule is to try to allow at least 3 hours between a meal and bedtime.  While having a full belly can induce a sense of drowsiness, this full belly can disrupt our ability to fall and stay asleep.  It is ok to have a bedtime snack (especially things that contain tryptophan, a natural sleep inducer, like milk or turkey) if your hunger would keep you awake.

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3)  Exercise.  Getting moderate to rigorous exercise at some point during the day can be a tremendous help when it comes to sleep at night.  You are more likely to be physically exhausted, which can aid you in falling asleep quickly.  You are also more likely to feel that you productively utilized the day by getting a workout in and are therefore less likely to have your mind start recounting all the “to-do’s” for the next day.  While getting exercise can be helpful, the timing matters here.  Avoiding this exercise in the four hours before your bedtime is recommended.  If you exercise too close to bedtime, you are likely to still be revved up and unable to fully wind down in order to initiate sleep.

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4)  Comfortable sleep environment.  Ensuring that your bedroom environment is conducive to sleep is another area to key in on.  This entails getting a comfortable mattress, pillow and sheets.  While some of these can be pricey, especially the mattress, it will be a wise investment if it helps you overcome your troubles with sleep!  Doing what you can to make the room a comfortable temperature to you is another good move.  If you find yourself waking several times during the night due to discomfort, one of these issues is a likely culprit.  Some other areas to consider are light and sound pollution.  Ideally, having a completely dark and silent environment is recommended, but some people need a night-light or some ambient noise.  For those that use the television to provide both light and sound, there is compelling evidence to suggest that this is more disruptive to your sleep than you may think, even if you think that you are not paying any attention to this stimuli.  Having non-language based sounds such as a fan running or a noise machine is a much better approach.


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5)  Light exposure.  Our circadian rhythm is, in part, controlled by how our optic nerve is stimulated by light.  Artificial light by way of the light bulb is a very recent development for humans, having been around for only about 100 years.  Previously, non-sunlight light was quite dim by comparison, being provided by oil lamps or other fire-based sources.  Therefore, the amount of stimulation our optic nerve receives now is exponentially higher than it had been for the vast preponderance of human history.  Our body and brain developed to initiate sleep when it became dark and this system worked well for generation after generation… until the light bulb, television, smart-phones, and tablets were created which bombard our optic nerves with a near-constant stream of artificial light.  Our body and brain is unable to distinguish this light from actual sunlight, so using these sources of artificial light after sunset can disrupt our natural ability to regulate our sleep.  With this in mind, it is best to limit our exposure to the lights in our house and our usage of light-producing tech devices (such as the television, cell phone and tablets.)  In addition to limiting our use of these things, it is also a good idea to dim our lights (either through the use of a dimmer switch or by switching off certain lights) and decrease the brightness settings on our electronic devices in the two hours before bedtime.


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6)  Caffeine intake.  Caffeine is fairly ubiquitous in our diets.  If you are anything like me, you are likely to be ingesting caffeine often without realizing it or purposefully consuming it.  We may be using it out of routine (our morning cup of coffee) or just because we like the flavor of the food or drink that contains it (chocolate or soda).  While it is omnipresent, it is also a fairly powerful stimulant that can certainly interfere with our ability to sleep.  People are sensitive to caffeine to varying degrees, but if you are having difficulty falling asleep, it is best to consume no caffeine after lunch.  That allows your body plenty of time to process out whatever caffeine you have ingested during the early day.



7)  Body temperature.  Part of what drives our circadian rhythm is our body temperature.  A slight raise in your body temperature is associated with alertness and your body will shift to a slightly lower body temperature when you are getting sleepy.  Knowing this, you can do certain things to manipulate this in your favor.  Taking a hot shower or bath around a half-hour before your bedtime will initially raise your body temperature.  Your body will respond by working to lower your body temperature and therefore help you feel drowsy and ready to fall asleep.  The same principle is at play when you drink a warm beverage (such as tea or warm milk).  However, you would obviously want to pick a non-caffeinated drink if you are going to use this technique, though.


8)  Pre-bedtime activities.  We are creatures of habit.  Keeping this in mind, having a bedtime routine can be a very important thing in order for you to address your sleep difficulties.  It is interesting that we typically recognize the importance of this when it comes to our children.  We have them take a bath, brush their teeth, comb their hair, get into jammies, read them a story, get them a glass of water and then tuck them into bed.  We likely follow this routine each bedtime and any deviation from this routine will evoke an objection from our children.  Basically, with each completed step, we are moving a step closer to the point where they will shut their eyes and (hopefully) fall asleep quickly.  Yet we rarely take this approach with ourselves.  Each night may look different.  Sometimes we will watch TV, other times we may read for a while before bed.  Setting up a predictable, and repeatable routine that we follow each night can help us make the transition from the waking to sleeping phase of our day.  Another issue is to try to only do activities that are tiredness promoting.  If you are watching compelling television shows, reading a gripping book, or engaging in evocative conversations, either in person or via electronic means, these are activities that may promote alertness and interfere with you to falling asleep quickly.


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9)  No clock watching.  When we are having difficulty sleeping, it is common to check the clock to see how long we have been trying to fall asleep and to compute how long it is until we have to wake up to start the day.  This is disruptive in two key ways.  First, engaging the cognitive faculties to do this math requires alertness.  You have to wake up to a degree in order to complete this task and that interferes with the process of falling asleep.  Second, you are likely to feel anxious or stressed as you do this computation, not relaxed.  This is also moving us away from the state of sleep.  If you have difficulty adhering to this suggestion, perhaps moving the clock you check, whether it be an alarm clock or your cellphone, into another part of the room where you can’t see or check it–or out of the room completely in the case of cellphones.  Clients of mine who have done this seemingly radical step have reported to me that it had a tremendous positive effect on their sleep and overall level of stress.


10)  The 15 minute rule.  This suggestion may seem to conflict with the previous one, but we will explore how to synthesize them.  In essence, the idea here is that you limit any time spent in bed trying to fall asleep to no more than 15 minutes.  Here, we define “trying to fall asleep” as having the lights out with your head on your pillow.  It does not include any other time that you may spend in the pre-lights-out rituals that comprise your bedtime routine.  Now, obviously, you do not want to be looking at the clock with every passing minute and trying to keep tabs on how long it has been since you turned the lights out.  That would violate suggestion #9.  Instead, rely on your innate sense of the passing of time.  You are likely to be fairly good at predicting when approximately 15 minutes has passed.  If you are not asleep or feel that you are well on your way to that state, then get up and get out of bed.  Ideally, you will get out of the bedroom and do something else until you feel tired again and ready to give falling asleep another shot.  When selecting your activity to do in the meantime, keep all of the above suggestions in mind.

11)  Deal with bedtime worries appropriately.  Many sleep problems are caused by our minds racing when we lie down to go to sleep.  Unfortunately, given the busy and often over-stuffed nature of our schedules, bedtime is really the first time we have any quiet time in our day.  Therefore, we may be bombarded with a myriad of things we need to remember to do, problems we need to solve, worries we need to worry about.  Sadly, none of these thoughts are conducive to falling asleep.  They are more likely conducive to an ulcer-inducing, near-panic state of mind where sleep is the furthest thing from what is going to happen.

               To deal with this worry-keeps-me-from-sleeping problem, you will want to implement two main strategies.  First, find some other time in the day, preferably at least a half hour before bedtime, to sit down and worry.  Find a quiet spot (even if that means locking yourself in your bathroom) and remove any distractions (that means no phone, TV, books or magazines).  You can then invite the worried thoughts to come in.  I recommend using the worry once and worry well technique described in the earlier blog about worry.

               Second, keep a pad of paper and a pen next to your bed.  If a worried thought pops up while you are trying to fall asleep, jot it down and say to yourself, “I have written this down so I won’t forget to address it tomorrow.”  If the worried thought keeps you up even after you have done this, then you need to follow rule #10: the 15 minute rule.  An important part of this second strategy is that you actually address the worry the following day.  If you fail to do so, you will know this in the back of mind and will not trust the process of writing it down, rendering this strategy ineffective in the future.


Your Relationship with Mr. Sandman

               By following these eleven suggestions, you should be able to change your dysfunctional relationship with Mr. Sandman into a healthy one.  Typically, to correct a sleeping issue, you will need to put forth considerable conscious effort to consistently follow these eleven suggestions for approximately a month. At that time, you will likely to be able to relax your efforts a bit as your body will have adjusted to the new healthy sleep patterns you have established.  However, if you notice that your sleep problems are returning, you will need to get back to consistently following these guidelines.  Good luck and sweet dreams!

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Should I Stay or Should I Go: How to Decide What to Do With An Unfulfilling Job



Chances are, we’ve all been there: dreading to go to work the next day because we just absolutely despise our job.  Perhaps it is due to the work itself: too boring/unchallenging or stressful/overwhelming; perhaps it is due to your co-workers or boss; perhaps it is due to the clientele you deal with.  Whatever the reason, nothing can be more dispiriting and have a stronger impact on your overall well-being than being stuck in a job you hate.  The connection between work stress and negative effects on both mental and physical health is well established, even if all other aspects of your life are fulfilling and healthy.  Hopefully, these suggestions will help you to navigate what to do if you are currently in a negative work situation.  Instead of reading this article word for word (which you’re welcome to do if that is your style), I recommend that you skim through to the sections that apply to you and your particular brand of job dissatisfaction and then read the section on coping efforts.  After doing so, you will hopefully have a clear answer to the question posed by The Clash in their 1982 song “Should I Stay Or Should I Go.”


Why do you hate your job? And What to Do About It

Before we can explore what to do, we need to identify the nature of the problem.  There are 4 basic issues that may be driving your dissatisfaction: the work, co-workers, clientele, or other factors.  Let’s explore each of them in turn.

The work – One possible way that the work you do may itself be at issue is if it is not what you are passionate about. If you are left with a nagging sense that you would rather be doing something else, this likely points to the fact that your present work is unfulfilling.  If this is the case for you, you will need to identify what barriers are keeping you from doing what you would rather do in life.

Perhaps the barrier is that you do not know what you would rather do.  If so, consulting with a career counselor may be beneficial.  They can aid you in discovering your strengths, talents and interests and what possible jobs with which those link up.  Alternatively, you can use online career interest surveys like the one that can be found at: http://www.careerwise.mnscu.edu/careers/clusterSurvey.  Thinking back to subjects you enjoyed in school or aspects of your current job that you enjoy and then brainstorming what careers may incorporate these aspects can also help.  If you still do not know, and your job dissatisfaction is significant enough, a bit of old-fashioned trial and error may be needed.  Volunteering or taking on a part-time job to explore other opportunities may be an option if you are not able to fully commit by quitting a full-time job.  Whether or not you find your eventual landing spot, you will learn something about your interests no matter what the outcome is.

If the barrier is financial in that you cannot afford to leave your well-paying job, this is the trap referred to as the “golden handcuffs.”  One of the first things that would help would be to make a budget.  Track your expenses over the course of a month and then compare that to your income.  At this point, you have a few options:  1) Find a way to decrease your spending in order to offset whatever decrease in salary will be involved with a change of jobs.  2) Figure out how much you would need to make in order to support your current budget and then look for a job that would meet that figure.  3) Do a hybrid of the first two and decrease your spending and then find a job that supports this new budget.  The other thing that may be helpful would be to take an honest assessment of your values.  Do you value the current lifestyle that your job affords more than your well-being?  There is no shame in answering this question affirmatively.  If you do, then staying at your current job is the best option, and you need to find ways to cope with it as best as possible, perhaps by reading other portions of this article.  If you value your well-being more, then making the difficult financial decision of taking a potentially lesser-paying position is the best course of action for you.

Perhaps the issue with your work is that you are unsure of yourself or your abilities.  The first thing to assess is if your doubt is grounded in an actual lack of knowledge or ability.  If this is the case, then view this as an opportunity to learn new things.  Giving yourself reassuring messages along the lines of “I am capable of learning new things even if I may struggle with them at first.  In time I will master these tasks.”  However, if this is purely self-doubt without a basis in reality, then recognizing it as such and not giving it credence is the best approach.

A final barrier with your work may be that you find it unchallenging.  Clock-watching, overwhelming boredom, or excessive daydreaming/being off task may all be indicators that unchallenging work may be the culprit.  If this is the case for you, there are a few specific things you may try.  The first would be requesting a change in your work flow.  If your supervisor is receptive to it, getting assigned new projects or a different type of work could pump a breath of fresh air into your work day.  Alternatively, you could request to be involved with a committee or special project.  If these things are not an option, then it may be time to consider a career change or new job.  Before doing so, assessing what kind of work may be engaging for you is in order.  Just changing jobs for the sake of a change may be effective in the short term but is unlikely to be a long-term fix if you do not address the underlying reason your current work has become stale for you.

Co-workers – If your colleagues are the cause of your dissatisfaction, there are some things to consider when attempting to resolve this issue. If the nature of the conflict is purely a result of personality conflicts, there are two main approaches that may be helpful.  The first would be to limit the amount of contact you have with the problematic coworkers.  While you may have to be subtle and clever in the ways that you do this, the less time you are around the offending person(s), the easier it will be to cope with them when you do have to be around them.  If limiting your contact is not possible, an alternative is to be assertive about the things that upset you.  (See previous blog post for discussion about assertiveness skills.)  Being as clear as possible, while also being respectful, is the approach that is most likely to be successful in these situations.

If the nature of your conflict with your co-workers has to do with the quality of their work, or work ethic, you will want to seriously evaluate what impact their problematic behaviors will actually have on you and/or your work.  If there is a tangible impact, this is a situation that is likely to warrant involving management.  While we may sometimes shy away from this approach due to feeling like a “tattle-tale,” management’s role is in place to resolve these types of issues.  If you choose to go this route, relay your concerns in objective terms:  leave out any interpretations, personal attacks, or exaggerations.  Report the problem and its impact on you in clear terms and get into problem-solving mode.

Clientele – Sometimes the problematic part of our job is the customers. While we would all likely love to have the kind of job where our customers are appreciative of our work, effusive with praise, polite, and respectful, few of us have this luxury.  Some jobs require us to interface with people at difficult times when they are likely to lash out in anger or frustration.  Other jobs simply do not, for whatever reason, evoke the reverence with which we would prefer to be treated.  If this is the situation in which you find yourself, you must evaluate your options.

First and foremost, you should evaluate if you have any options to not interface with the type of customer that vexes you.  Having a discussion with your supervisor about other opportunities within the company may be a start.  Instead of framing it as a negative (i.e. “these people are driving me crazy!”), frame it in terms of your seeking growth opportunities and wanting to learn more about other areas of the business.

If this kind of change is not a possibility, then it is up to you to learn how to better cope with the situation.  This is no easy task, as it can be difficult to deal with people who rub you the wrong way.  In order to figure out the most effective ways to work through this, ask yourself what things have helped you the most in getting through other difficult things in your life.  What approaches do you find most calming and soothing?  What are the ways that you can interject these things into your daily work routine?  Making it a habit to take a small break after dealing with a problematic customer (like going to get a drink from the break-room, or going to the restroom) may be helpful.  Getting up, moving around, and getting away from your work, even if only for a few minutes, will give you the opportunity to take a deep breath and regroup.

Other factors – There are a host of other things that may drive your dissatisfaction. Things like: the commute, your work hours, your pay scale, or something about your physical work environment can all be major contributors to your unhappiness.  For any of these items, the key is to get into a problem-solving frame of mind.  Identify the issues, brainstorm possible solutions, evaluate which solution(s) may be most effective and then enact (or attempt to) those changes.  Asking other trusted friends, family, or co-workers for their input may also be helpful if you feel stuck and unable to brainstorm possible resolutions.  Sometimes engaging in the thought experiment of “What advice would I give to someone else in my situation?” can help break the blockade of ideas in order to begin brainstorming.

Coping efforts

               In addition to the things discussed above, you may consider these adjunctive suggestions to generally cope with the stress of being dissatisfied with your work life.

  • Lifestyle – your career is but one domain of your life. Making efforts to be fulfilled in other areas of life can do much to buffer you from the unhappiness in the work domain.  Maintaining good relationships with friends and family and being actively involved in hobbies and other leisure activities are things that can go a long way in helping.

  • Stress management – As mentioned previously, work is only one domain in life. If we are stressed in other realms, it can have an exponential impact on the work stress we experience.  Making efforts to cope with stress in all domains of life is therefore an important strategy.  See a previous article on coping with stress <HERE>.

  • Focus on the positive – It is easy to get bogged down with all of the negative aspects of work and the stress you are experiencing there. Making efforts to attend to the opposite experiences at work can help mitigate the negative aspects.  In order to do this, try the following: keep a notebook at your work-space where you make an effort to record one funny thing that happened during your work day, one fulfilling thing that occurred, and one nice or heartwarming thing that happened.  Be as consistent as possible and try to record one of each of the three things each day that you work.  It may have to be the smallest thing, but make an effort to identify these things.  Making this effort will help in two ways: one is that it will help remind you that it is not all bad at work.  Second, it helps to limit the time and energy you spend focusing on the negative aspects.


While being in a job that you despise, dislike, don’t care for, or disparage can be discouraging, there are things that you can do to regain a feeling of empowerment and being in control. Feeling helpless and powerless can be extremely demoralizing, so hopefully the suggestions above will help give you some ideas of how to feel that you’re “back in the driver’s seat” in this domain of your life.  If, after your efforts to put these ideas into place, you are still feeling unhappy with your job, perhaps it is time to sing the song that goes: “Take this job and shove it, I ain’t working here no more.”

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Grief & Loss – Understanding and Coping with the Pain

There may be no life experience that is more profoundly painful than the loss of a loved one.  Unfortunately, it is an incident that we all must face at numerous stages in our lives.  Even though these are losses that we must all go through, we often find ourselves ill-equipped to deal with the depth of the suffering that we may experience.

While we will focus mainly on loss in terms of the death of a loved one, it is important to note that the grief and loss response can be triggered by the loss of anything we hold dear.  This could be loss of a valued job, moving away from a neighborhood that we were connected to, or the break-up of a relationship or friendship.

How we grieve

Our experience and process of grief will differ depending on many factors: our culture, our family, our history of other losses, other stresses present at the time of our loss, and our own personal traits.

Our culture plays a huge role in our grief process, as it sets the parameters of what is the expected and “normal” reaction to our loss.  Various religions often have very strict guidelines as to what is to occur following a death.  Ceremonies are prescribed in detail, and there is a degree of certainty in knowing what to expect–and what is expected from us–during the funeral and interment process.  Employers often give a predetermined amount of time off to allow for grieving and we are subsequently expected to return to work and resume a “normal” life.  The people with whom we come into contact are expected to pay their condolences and to offer support.  There is a rough sequence of events that we may expect to ensue, together with fellow mourners.  Typically, this predictability is a helpful thing, as we may be left reeling after our loss, whether sudden or inevitable.  When everything may seem upside down in our life, at least certain events follow an anticipated flow.

Our family is also likely to respond in ways that we can expect.  Some families come together in shows of support by spending time together.  Some families allow for individual family members to have space and privacy to allow them the time to grieve.  Family members are likely to play a crucial role in the sharing of memories and honoring the departed in a manner that is vital to the process of grieving a loss.

Our history of prior loss can also influence our progression through grief.  If we have lost a loved one in the past, we have some expectation of what this process is likely to hold for us.  However, the new loss can also trigger unresolved issues from past losses, thereby compounding the pain we feel.  If this is our first experience with loss, we may feel more confused and uncertain.

The amount and type of other stresses present at the time of our loss also plays a role in how we cope with the experience of grief.  If there is relatively little on our plate at the time of the loss, it may be less complicated for us as we move through our grief process.  However, if there are other major issues occurring at the same time, it may be exponentially more difficult to effectively process our grief.

Lastly, our own personal traits may influence how we grieve.  Some people find great solace in being around others; others prefer solitude to allow time for introspection and processing their feelings.  While specific recommendations will be made as you read further, I do suggest that you find ways to grieve that will honor your own preferences.


How we understand grief

Perhaps the most widely recognized manner of understanding grief is through the groundbreaking work of Elisabeth Kübler-Ross.  You are likely to have heard, if not memorized, the 5 stages of grief that she identified: Denial, Anger, Bargaining, Depression, and Acceptance.  While this framework is excellent in that it validates many key experiences that the bereaved go through, there are some limitations of this model that are important to discuss.

First, the label of “stages” can be misleading.  It suggests that we will progress through each of the five in a linear fashion, even though this was not Kübler-Ross’s intention.  In reality, we may fluctuate between stages, at times regressing back to previous stages.  A more accurate label would be “the 5 components of grief.”  We are never fully through the stages of grief, as it is an ongoing and ever-evolving process.

Second, it is important to note that Kübler-Ross’s work emerged from her experiences working with people who had terminal illnesses.  Her model was based on people coming to terms with their own deaths, not that of a loved one.  This model was used by the bereaved because it had obvious cross-over.  However, if this is the primary method of trying to understand our grief process, this is an important limitation to keep in mind.

Even with these limitations in mind, this model serves as a very good starting point for us to understand the grief process.


How to grieve

The grieving process is basically an instinctual and natural response.  Most of our role in progressing through our grief is to learn not to interrupt this on-going process.  Developing an ability to express our grief is key.  The manner in which we express our grief is up to us as individuals, but I will present some ideas that can be helpful.

  • Social support – whether this be something formal like attending a grief and loss support group (many funeral homes offer these or a listing of local groups) or perhaps something informal, such as meeting with family or friends to discuss how we are feeling about the loss, sharing our experiences with others can be deeply healing. Typically, people who allow us to have our experience without trying to “fix” it are most helpful.  While well-intentioned, those who say things like “you just need to move on,” “we all have difficulties in life,” or “God only gives us what we can handle” are usually not as comforting and helpful as the person may have intended.  Communicating to these people that if they could just hear you out and validate your experience by saying something like “it sounds like this has been very painful for you,” or “it is clear that you loved the person that you lost very much”, this would be much more helpful.  If that person is not able to honor this request, then perhaps they are not the right one with whom to share your grief.  Surrounding yourself with people who offer helpful and comforting interactions during this difficult time can be very important.

  • Soften your body – our instinctual reaction to physical or emotional pain is to clench our muscles. We are also likely to hold our breath or engage in short and shallow rapid breathing.  While this is a common reaction, it is not very productive in helping us move through the pain.  Instead, learning to relax our bodies, particularly the muscles in our core (or belly), allows for the welcoming space to work through the pain that accompanies a loss.  Inhaling deeply and then slowly exhaling also helps to avoid the shallow breathing associated with the clenching response.

  • Journaling – having a place to record your thoughts, feelings, and reactions can be very helpful as you go through the grief process. You are likely to experience a range of emotions, thoughts, and reactions to the events that will transpire.  Journaling helps in two ways: 1) It allows you the space to coherently collect your thoughts.  As you put down onto paper the things that are flowing through your mind, the structure of language and telling your story will help to calm the sometimes chaotic nature of your inner turmoil.  2) It serves as a way to track your progress.  Reading back through previous journal entries will most likely highlight your progress and you will see how you have progressed through the grief process.  Reviewing your thoughts, feelings, and reactions at various points in time will help you see the shifting and evolving nature of your experience and can instill hope that even the most turbulent emotions will fade and change with time.

  • Ceremony – most traditionally we think of the funeral as the most common form of ceremony for grieving. This is usually a major part of how we honor and recognize the grieving process but, depending on your personal feelings, this may be inadequate to honor the loss.  It also only applies to one specific type of loss: death.  It does not address other losses like job loss, death of a loved one by suicide, miscarriages, infertility, loss of property (such as in the case of a house fire), or moving away from family, friends, and community.  These are things that fall under the category of disenfranchised grief, or grief that is not widely recognized by others and/or society.  Typically this adds another layer of difficulty to the person experiencing this type of grief.  It is increasingly important in these cases that the person find ways to validate their loss either with trusted loved ones or at least internally.

  • Clear up unfinished business – Another issue that can complicate grief is when there are unresolved issues in the relationship with the person you have lost. This is most common in cases where sudden death or unanticipated loss occurs.  Clearing up unfinished business is a way to attempt to bring whatever level of closure is possible.  Discussing the unresolved issue with the person you lost by writing a letter and then burning it or putting it out to sea in a bottle may be effective if the person has died.  Sometimes doing something in their honor that would have resolved the issue may be effective.  Your options vary greatly, but ultimately the aim is to feel that you have done something to bring some sense of resolution to the issue.

Maintaining connection

One of the ultimate goals of accepting your loss is finding a way to maintain your connection to the person you have lost.  My first clinical supervisor described this eloquently when he said “when someone dies they do not go away completely, instead they go to a special place in your heart where they live on.”  That has always stuck with me because it seems to hit the nail right on the head.  We need to find ways to come to terms with this.  It may be painful to let go of our ties to the person in the physical realm, but hopefully this pain does not eclipse the ways in which the person lives on within our hearts and minds.

This can look very different depending on the relationship you had with the person you lost as well as your own personal style.  Some people prefer to create a designated area to fill with photos of and mementos from the person.  Others may go to a place that was special for the two of them.  Some will continue to write letters or even talk to the person.  Whatever the specifics look like for you, these acts can be an important part of moving forward now that your loved one is no longer with you.


Good grief

Ultimately, even though it is painful, grief is a healthy process that leads towards healing.  Allowing the space for this process to occur, getting adequate social support, and taking care of yourself (through proper sleep, hygiene, healthy routines and good nutrition) are all keys in allowing for this process to move forward with minimal disruptions.  Experiencing a loss is difficult, but the possibility for a happy and healthy future, including accepting the change in how you relate to the departed, is possible with patience and kindness towards yourself.


Edited by Shirley Sachs

Dedicated to Marie “Gigi” Elward and her family and friends who are coping with her loss.

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Defeat the Worry Beast


We have all, at one time or another, been overpowered by the beast that is worry.  We are bombarded by “what if” thoughts, attacked by nightmarish fantasies about every possible thing that could possibly go wrong.  This may be triggered by hearing an awful story, a stressful situation that has arisen, or just a random thought that comes to us, seemingly from nowhere.  We feel the weight of this worry: physically, emotionally and mentally.  We end up tense and exhausted, anxious and nervous, overwhelmed and fearful.  In short, the worry beast can wreak havoc in our life.

At best, we may attempt to distract or calm ourselves from this onslaught of negativity, but there is a nagging feeling that our efforts have been futile and we will be a victim of these thoughts indefinitely.  It is difficult not to feel despair when this seems to be the case.

However, the good news is that there is a way to defeat the worry beast.  We can learn to work through our worried thoughts to where they are not out of control and creating these negative side-effects.  Before we can get to the specifics of what to do to handle worry, we first must understand a little bit about what worry is.

What is worry?

The Merriam-Webster dictionary definition of worry is “to think about problems or fears: to feel or show fear and concern because you think that something bad has happened or could happen.”  That is a fairly accurate description of worry but what it misses is the depth of discomfort that worry can cause.  Worry  falls under the umbrella of anxiety (it is the core piece of the anxiety disorder Generalized Anxiety Disorder) and, like all anxiety issues, it has a tendency to build upon itself to the point of being overwhelming.

Worry is something that happens in the present moment, but it is something that takes us away from the present and into a fantasy future.  The things that we are worrying about are not happening to us now, in this moment; instead they take place in a future that is playing out in the theater of our mind.  However, our body does not differentiate this and responds physically, as if these worry-based events were happening in reality.  We bear the full weight of the stress of these events, no matter how horrific the worried thoughts may be.  This is an important fact to know because it drives home how important it is to stop these worried thoughts.  If we allow our worried thoughts to run amok, we, in effect, live through a myriad of awful life events.  While we cannot control the terrible things that may happen to us in real life, we can control the ones that only occur in the context of our worried thinking.

Worry tends to be a negative presence in our mind due to two processes: catastrophic thinking and avoidant coping.  Catastrophic thinking is when we project the direst of outcomes onto what we are worrying about.  A worried thought about your child’s poor performance in a class leads to thoughts that they will drop out of school and end up homeless.  A worried thought about a project at work leads to thoughts that we are going to be fired and never be able to find another job.  While these examples may seem extreme, if you struggle with worry they probably have a fairly familiar ring.  Your thoughts go to worst-case scenarios, no matter how far from reality they may be.  Avoidant coping is the second process, and this comes from our best attempts to handle our worry.  Avoidant coping is defined as an attempt to avoid dealing with something that is causing us distress.  In one way, this makes sense.  It is grounded in the principle that if something is causing us pain or discomfort, we shouldn’t do that thing.  While there is a certain logic to this, it does not work when we are dealing with things in the realm of anxiety.  Anxiety tends to grow in the void that our action leaves behind.  The net effect of this is that we end up having to avoid more and more things in order to not get anxious.  In order to break avoidant coping, we need to learn more direct ways to face and work through our worried thoughts.  We will explore this momentarily, but first, let’s work to understand a bit more about worry.

Why do we worry?

So now that we understand thoroughly what worry is, let’s explore why it is there.  There is a school of thought called evolutionary psychology.  It proposes that the ways in which our minds work are based on the same principles as evolution.  Basically, things that help an organism (in this case a person) survive will become prevalent as those who have the trait will be more likely to live long enough to reproduce.  Therefore, any function our mind performs must serve some adaptive function.

I find this framework to be very helpful when trying to understand why seemingly unhealthy processes occur.  It challenges us to identify the ways in which the process in question would be adaptive or useful.  In the case of worry, this is a fairly straightforward explanation.  One of the main functions of our brains is to predict what may be harmful to us.  This clearly gives us an adaptive advantage.  Imagine two of our ancient ancestors: the first one we will name “Gloom.”  Gloom demonstrates the ability to worry; in other words, to predict potentially harmful things in the environment.  Gloom is also predisposed to seeing or anticipating threat where none really exists.  The second of these ancestors we will call ”Sunny.”  Sunny loves life and walks through the world completely carefree.  Sure, Gloom can be a bit skittish and his cave-dwelling buddies may poke fun at him for being a scaredy cat while Sunny has much more fun in life.  However, Gloom is much more likely to accurately assess and avoid dangerous situations even if it is at the cost of missing out on all the fun that Sunny may have due to over-estimating danger in the world.  Meanwhile, Sunny is much more likely to inadvertently do something that results in their untimely death; an untimely death that Gloom avoids and goes on to have multiple children while poor Sunny has none.  Sure, Sunny may live the more fulfilling, albeit considerably shorter, life, but Gloom ends up being the winner in the procreate-as-much-as-possible-to-keep-our-species-alive contest.

Fred-Flintstone-PNG-HD-Imagesflintstone mad

While the process of worry can be an unhealthy thing for modern humans, you can see how it would have given an adaptive advantage to our ancient ancestors.  Understanding this role of worry is a key to understanding how to defeat the worry beast.  Basically, worry is our brain’s attempt to have us foresee possible negative events.  When we attempt to push worried thoughts aside or dismiss them as unreasonable, this does not compute for our brain.  So our brain will thrust the worried thought back into our consciousness.  You may have been on this worry-go-round before.  A worried thought comes up, you suppress it only to have it come up time and time again, despite your repeated efforts to dismiss it.

This is where a process that I call “closing worry loops” kicks in.  We need to resolve the worried thought before attempting to dismiss it from our consciousness.  If we do this properly (I will discuss how in just a moment), our brain will be able to accept that we have adequately assessed the possible danger and can shut off the alarm bells that are clanging.  If a fire alarm goes off, it does not make sense to disconnect the alarm before we have assessed whether there is actually a fire.  We would need to first locate the reason the alarm is going off, and then disconnect the alarm.  The same process holds true with worry.

Anxious vs Proactive worry

It is helpful here to differentiate between two different types of worry.  Proactive worry is a type of worry with which you may not be familiar.  It is where we identify potential negatives and make a plan for how we would react and cope if that eventuality occurs.  It prompts us to make plans, focus on our resiliency, and generate ideas.  Once we have engaged in this type of worry we feel prepared and confident.  There may still be ambiguity as to what will happen, but at least we have some ideas about how we might handle whatever may arise.  Anxious worry is what we typically refer to when we think of worry.  This is a thought about a future negative event that makes us feel anxious.  We focus on unanswered “what ifs” and may jump from one negative outcome to another.  We generate no ideas on how we can handle things and we are left feeling overwhelmed and anxious.  Obviously, the goal is to practice doing more proactive worry and less anxious worry when worried thoughts arise.

Worry Well and Worry Once

One of the best ways to engage in proactive worry and to avoid anxious worry is the process called “worry well and worry once.”

  1. The first step is to identify that you are experiencing a worried thought. What are you worried about?  What is the situation that you fear?

  2. Write down your worry and begin the process of identifying how you would handle the situation. What are the possible outcomes?  How would each one affect you?  What could you do to cope with or prevent each outcome?

  3. What other aspects of this situation are you worried about? Repeat step 2 and each time after it is complete, ask yourself “what else am I worried about with this situation?”  Once you are able to answer that question with “nothing else,” proceed to step 4.

  4. You have now completed the “worry well” part (or closed the worry loop) and if a worried thought about this situation comes up again, say to yourself (either out loud if no one is near you or in your head if someone else is around): “I have already worried about this thoroughly and there is no reason to go over it again. I am as prepared to handle this situation as possible and I can be confident that I will handle it to the best of my ability.”  Repeat this statement as often as needed.  DO NOT re-worry the situation unless you have some new information that drastically changes the situation, for to do so would really be engaging in anxious worry in the guise of worrying well.

In Sum…

Armed with these new tools, you should be able to defeat the worry beast that haunts you.  At this point you should:

  • understand worry and why it exists

  • be able to identify catastrophic thinking and avoidant coping

  • know the difference between anxious and proactive worry

  • know how to worry well and worry once

If you have achieved these things then you should be well equipped to face down the worry beast and grow in confidence that you can defeat it.  It takes some practice to break the worry habit, but these concepts should guide you through that process.

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From My Bookshelf: A Review of the Most Often Recommended Books


Books have tremendous power.  They can move us to feel deep emotion.  They can educate us.  They can allow us to travel back or forward in time.  They can help us address and overcome challenges we may face. There are countless excellent books available that address behavioral health issues.  This post is here to highlight some of the best of those works that I have read.

I am nearly constantly reading books from the field of behavioral health, reading novels only when on vacation.  The bookshelves in my office are full of the titles I have read and there is a special section in my bookshelves where I keep the books that I have found to be particularly enlightening and helpful.  It is from this selection that I culled my “most recommended” titles to review and share with you.  While I probably could have done a write-up on each of these books, I have limited myself to a “Top 10” listing.

In some ways this feels like book report assignments that I had to do in elementary school days.  However, unlike those book reports, I have actually read the books that I will review here! (Apologies to my elementary school teachers).

I give reading recommendations to my clients when I feel that gaining a deeper understanding of the issues they are facing would be beneficial for them.  And honestly, this is most of the time.  I know that I personally find a certain type of relief if I am able to understand what I am experiencing.  For example, even if it is something as simple as the common cold, understanding what my body is doing in an attempt to fight off an infection allows me to be somewhat less disturbed by the symptoms I am experiencing.  It also enables me to make informed decisions about what I can do to alleviate my suffering.  (Such as drinking plenty of fluids, getting adequate Vitamin C, etc.)

The same goes for behavioral health issues.  When we better understand the dynamics of what is happening, we can be less disturbed by them and may use this knowledge to inform our efforts to alleviate our suffering.

I have attempted to pick from a variety of titles that cover a wide range of issues.  So, without further ado, here is my “Top 10 List of Recommended Books” (in no particular order):


#10: Feeling Good by Dr. David Burns


This is perhaps the most popular self-help book ever written, and with good reason.  Dr. David Burns popularized what is now considered the gold standard for treating depression and anxiety: Cognitive Behavioral Therapy (CBT for short).  This book does an excellent job of introducing the reader to CBT and explains how to apply it in order to address depression and anxiety.

CBT is based on the basic idea that the way that we think about or interpret the events in our lives shapes our emotional reactions to these events.  Therefore, if we wish to change the way that we feel, we need to change the way that we thinkFeeling Good also introduces us to the most common types of thoughts that cause negative or unwanted emotions.  These happen so quickly and often outside of our conscious awareness that they are labeled “automatic thoughts.”  Dr. Burns describes each of these and how to identify when they are operating.  He then goes on to describe how to shift these thoughts to where they will generate less negative or unwanted emotions.

My favorite and most referenced portion of this book is a chapter titled “Verbal Judo.”  This chapter addresses how to handle criticism, and brilliantly uses the analogy of the martial art Judo, where you absorb and redirect the energy of your attacker rather than meet force with force.  It is such an artful approach in that it is highly effective and easy to grasp.  I think this chapter alone makes the book a worthwhile read.


#9: The Anxiety and Phobia Workbook by Edmund Bourne


Anxiety is a very common issue in our society.  We are living increasingly demanding and hectic lives that place more demands on us and allow for shrinking amounts of time that we can dedicate to relaxing or rewarding pursuits.  (See my last blog about stress management for more ideas on how to cope with this issue.)  For those of us that suffer from any form of anxiety (panic attacks, worry, post-traumatic stress, agoraphobia, or other phobias), thankfully The Anxiety and Phobia Workbook is available to provide relief.

This book most closely mirrors the treatment that you would receive from a therapist to address anxiety issues.  In my practice, I take a three-pronged approach to treating anxiety: 1) education (what is happening within our bodies and brains and why), 2) coping skills (what can we do to effectively calm ourselves), and 3) lifestyle issues (how does the way we live life impact anxiety).  The Anxiety and Phobia Workbook does an excellent job on touching on all three of these areas.


#8: Quiet: The Power of Introverts in a World That Can’t Stop Talking by Susan Cain


Understanding our innate needs for a balance between social contact and alone time is important.  All of us differ in what that balance will look like.  The field of behavioral health uses the terms introverted and extroverted to describe these different types of personality traits.  People who are high on the trait of extroversion are very social by nature.  They enjoy being with others, thrive in crowds, tend to be gregarious, and are energized after having social contact.  Conversely, people who are high on the trait of introversion prefer small, intimate groups or one on one conversations, appreciate alone and quiet time, and tend to feel depleted after having social contact.

Quiet argues that we, as a society, over-value extroversion and under-value introversion.  We tend to view introversion as something that people should be coaxed out of rather than something that should be cherished.  The author does a tremendous job of encouraging people who are introverted by nature to honor this aspect of themselves and resist social pressure to think of this as a weakness or something to be changed.  She speaks of the unique gifts and strengths of introverted people and encourages our society as a whole to learn to respect and value these.

This is a great book for someone who is introverted and wants to learn more about how to appreciate this aspect of their personality or for a loved one of someone who is introverted and who wants to learn more about this aspect of their loved one’s personality.


#7: The 7 Principles for Making Marriage Work by John Gottman and Nan Silver


Conflicts within our marriage or any committed relationship can have a dramatic impact on our overall satisfaction in life.  Thankfully, The 7 Principles is available to help us learn about how these conflicts operate and what can be done to work through them and minimize the potential destruction they can potentially cause.

Dr. Gottman and Nan Silver explain how they have been studying relationship dynamics by observing couples as they interact and, specifically, fight.  They identify the different things that couples do that lead them to have either healthy and productive conflicts or unhealthy and destructive ones.  Beyond identifying these healthy or unhealthy patterns, they also provide tangible and useful suggestions on how to create more positive interactions between you and your partner.

If you are in a relationship that is creating conflicts, stress, or unhappiness in your life, then this book is a must read.


#6: Buzzed: The Straight Facts About the Most Used and Abused Drugs from Alcohol to Ecstasy by Cynthia Kuhn, Scott Swartzwelder, and Wilkie Wilson


Substance use is something that has various effects on people’s lives.  From those of us who are able to recreationally use various substances with little to no negative consequences, to those of us who struggle with serious addiction issues, Buzzed is a great resource for direct and non-biased information on nearly every drug available.

While we, as a country, have taken many approaches to getting people to be more responsible with their choices around substance use, we often have mixed results.  In the 1980’s and early 1990’s, the “Just Say No” campaign was in full swing.  It focused on helping children learn how to resist and decline opportunities to acquire and use drugs.  The take-home message was that drugs are bad and we shouldn’t do drugs, as famously referenced in South Park:


While this approach arguably had an impact by lowering rates of substance use, from a psychological standpoint, this approach is not a robust and thorough way to approach the addiction issue.  The authors of Buzzed have taken the approach that can be boiled down to: “Just say know.”  They come from the viewpoint that offering clear information about substances, their effects, and possible consequences of use is the best way to allow for people to make informed decisions about the use of these substances.  I believe that this is a much more effective way to approach the issue. as well as being more respectful of a person’s autonomy.

The book can be helpful for people at any age who seek to learn more about these substances, but it is geared towards readers in late adolescence and early adulthood (ages 16-24).  If it were up to me, I would give a copy to every person as they enter their teenage years and have to begin to make decisions about whether or not to use substances and if “Yes,” to what extent.


#5: The Five Love Languages by Gary Chapman


Earlier I listed The 7 Principles for Making Marriage Work which is based on how to identify and correct problematic and destructive patterns that can develop within a long-term relationship.  While The 5 Love Languages is technically another book that deals with relationships, I have included it on my top 10 list because it really has such a drastically different approach to relationship issues.

This book does not deal with conflict in relationships directly, though it can be helpful in addressing them, nonetheless.  Instead, this book explores how love and affection are expressed in a relationship.  The authors present the 5 different ways in which people express and receive love.  It seems that when partners are feeling unloved, unappreciated and undervalued, typically, it is because the partners are not using the same ‘love language.”

Being able to name and identify these different styles of communication is very helpful for couples to understand why partners may be feeling unloved, even when the other partner feels that nothing could be further from the truth.  This book is most helpful when both partners in a relationship read it, as this allows for them to be on the same page, with the same understanding and vocabulary.


#4: Quiet Your Mind and Get to Sleep by Colleen Carney and Rachel Manber


Issues with insomnia are one of the most common issues I see in my practice.  This is no surprise with the amount of stress that most of us face on a daily basis.  Added to stress, the ways in which technology interferes in our natural ability to regulate our sleep makes it almost impossible to avoid having issues with sleep at some point in our lives.

While the subtitle indicates that it is geared towards helping those with mental or physical health issues, I would argue that anybody dealing with sleep issues could benefit from reading this book.  The reason for that is that the book does a wonderful job of educating the reader on how our body regulates and initiates sleep and the things that happen that can disrupt these natural processes.  While mental or physical health issues are common culprits, there are a diverse number of reasons why we can get off track with our sleep.

Once the book covers the educational piece, it gets into specific recommendations for how to address the sleep problems you may be facing.  The suggestions and advice are clinically sound, based on current sleep research.  This is my go-to resource when someone is having a hard time sleeping, and I believe that you will find it helpful and easy to read.


#3: An Unquiet Mind by Kay Redfield Jamison


One of the most troubling and confusing conditions that people can deal with is bipolar disorder.  Not only is it a potentially very serious and complicated condition in and of itself, but the misconceptions of the general public about this disorder greatly add to the difficulties facing someone who suffers from this disorder.

Thankfully, there is the clear and piercing light of An Unquiet Mind to cut through the dark and help us understand this condition.  The author is in a unique position of being able to enlighten readers due to her being both a clinical psychologist and a person who has bipolar disorder.  She bravely shares her personal story of living with this illness while also being able to give clear and concise clinical information about the condition.

This book is helpful for either the individual dealing with bipolar disorder, or the loved ones of such a person.  I commend this author for her efforts in educating the public on this illness in hopes of decreasing the associated stigma, and in encouraging people to get quality care for this condition.


#2: I’m OK – You’re OK by Thomas Harris


This is the oldest book on the list, having been originally published in 1969.  It is a book that explains a rather complicated clinical framework called transactional analysis (TA), which grew out of psychoanalysis (as made famous by Sigmund Freud).  To be completely honest, when I was first exposed to TA in graduate school I was not moved by the theory.  At that time, I did not see how it could be clinically useful due to it being, in my view, a rather antiquated approach.  However, this changed once I read this book.

The author does a wonderful job at describing some complex psychological concepts in an easy-to-understand fashion.  Being rooted in psychoanalytical thought, this book is most helpful in gaining a deeper understanding into our psyche and the subconscious mind.  It can aid the reader in gaining a better understanding of why we react emotionally the way we do.


#1: Parents, Teens and Boundaries: How to Draw the Line by Jane Bluestein


The last book on my top 10 list is one that addresses the area of parenting.  I began my career as a counselor before I had children.  Now that I have two daughters of my own, I find that I counsel issues of parenting differently.  I have a deeper understanding and respect for how challenging the role of a parent can be.  I also read parenting books with a dual awareness.  On the one hand, I read them gauging their clinical utility to either teach me or my clients new perspectives.  On the other hand, I read them gauging how useful they could be to me as a parent.  This is one book that did a great job of checking both boxes.

While, as you can gather from the title, this book is geared towards parents of teenagers, it can be helpful for parents of children of any age.  The process of setting boundaries ideally starts from the moment you gain the privilege and responsibility of being a parent.  In this usage, boundaries means a line or rule of what is acceptable in terms of the behavior of our children.  It is being able to say no and then consistently enforcing that.  If we have said no to a child asking for candy at the store, having good boundaries means that we do not eventually give in to their continued asking, their escalating negativity, or presenting us with a full-blown melt-down tantrum.

By the time our children have become teenagers, their attempts to get us to change our minds or manipulate us have changed in style and sophistication.  After defining in more depth what boundaries are and why they are important, this book does a good job of helping us understand how our teenage children attempt to challenge us and gives concrete strategies for how to maintain your boundaries.  For any parent who is exasperated with their teenagers, this book is a great place to start.

In closing…

I hope that you will utilize any of these titles if they address issues with which you are dealing.  I will continue with my reading and buying bigger bookshelves to accommodate the new titles and will share my reviews of what I have read.  I plan to do an annual book review of the works I have read during the year.  Until then, happy reading to you!


Written April 7, 2016

Edited By: Shirley Sachs

Posted in Book/Movie Reviews | Leave a comment

Stress Management


         Stress:  that ever-present, life-span shortening, ulcer-inducing, pull-out your-hair condition that is part and parcel of our modern lives.  If there is one issue that I talk about with every client, this is it.  Stress has an immediate impact on our well-being and is therefore one of the most vitally important things to learn to manage as well as we possibly can.  This article will help you to learn more about what stress is and how to work towards minimizing its negative impact on our lives and our health.


What is Stress?


         Stress can be a difficult concept to grasp because we tend to overuse the term.  Stress can refer to almost any difficult emotion.  When we apply a term to nearly everything, it basically starts to mean nothing.  We know that stress is uncomfortable, bad, unhealthy, and something we should try to minimize, but what does it actually refer to?

First, often when we use the term “stress,” what we are actually referring to is distress.  Stress manifests itself in a few different forms and some of these are actually healthful and helpful.  Distress is the form that is unhealthful, especially when it is long-term and unremitting.  To simplify, I will use the term “stress” when referring to distress.  According to Kottler & Chen in their textbook on stress titled Stress Management and Prevention: Applications to Daily Life, stress is “a psychological and physiological reaction to a real or perceived threat that requires some action or resolution.”  Let’s break down that definition:

  • Psychological reaction – this refers to the changes in our thinking that occur when we are stressed. Our thoughts may become rapid (racing thoughts), worried (attempting to identify possible negative events by wondering “what if…”), jumbled (for an explanation of this, see the “physiological reaction” section), or fixated (being able to think only about what is stressing us out).
  • Physiological reaction – our bodies have a primitive response to stress that is generally labeled as our fight or flight response. This is a series of changes within our body that prepares us to flee or fight off a predator.  If a lion were to walk into your office,  3 this response would be effective in enabling you to escape or fight off this threat.  However, (unless you work in a zoo) you are highly unlikely to encounter this type of threat on a day-to-day basis.  Your body does not differentiate between the threat of a hungry predator and a looming deadline/overdue bill/household chore (insert your own specific stress trigger here).  Your body and brain are prepared to physically fight off these stress triggers as if they were a lion regarding you as lunch.  Your body undergoes numerous changes that may be uncomfortable and unhealthy, but are adaptive in terms of helping you either put up a fight or flee as quickly possible.  Your brain also undergoes changes that prioritize quick judgments and decisions and de-emphasize more rational thoughts that require more time and effort (hence our thoughts seeming jumbled).  I highly recommend the excellent book Why Zebras Don’t Get Ulcers by Robert Sapolsky which thoroughly explains the stress response while being both informative and funny.  Or you can watch a very crude 3 minute YouTube video that summarizes this work and features its author here.
  • Real or perceived threat – As was just mentioned, your body does not differentiate between threats whether they be a real and present predator or something that we perceive as threatening. It is this factor that makes anxious worry so destructive.  As we ponder the “what if’s,” our body is responding as if those awful thing were really happening.
  • Requires some action or resolution – This tends to be an area that causes many of our problems with stress management. We may go through the first part of the cycle by identifying the threat (real or perceived) and then responding to the threat but we never do anything to close the loop.  We may do something to distract ourselves, the stress may pass, we may even blow off some steam.  However, we need to proactively do something to address the threat that started off this cycle in the first place (more on that in just a bit).

So now that we have a basic understanding of what stress is, let’s explore a bit further the ways in which we may actually manage it.

Inputs and Outputs


         I typically describe stress management by having people imagine a glass container (such as a pitcher).  Imagine that water is being poured into it (this is the incoming stressors) and water being poured out (this is what we are doing to relieve stress, also called coping skills).  If more is being poured in than poured out, the container will overflow.   When this happens, we will feel overwhelmed and very likely irritable.

We will come back to this idea of inputs and outputs (stressors and coping skills) as we talk about how to go about managing stress.  Before moving on to that discussion, one important dynamic bears highlighting.  It is a major trend common to almost all of us that when inputs (or stressors) increase, we tend to decrease outputs.  At times when we have multiple deadlines, a serious illness falls upon a loved one, our kids get into trouble at school, or any other such stressor our efforts at caring for ourselves dramatically decrease.  We say to ourselves something along the lines of: “I just don’t have time to look after myself.  I will get back to it once things settle down a bit.”  Thus, our inputs and outputs look like the following graph:


If you take away only one thing from this article, please let it be that this is the area that will give you the most benefit in managing your stress.  At times when your stress level goes up, so too does your need to initiate coping skills, thus looking more like this:


Using this technique will enable you to persevere through challenging times and not succumb to feeling overwhelmed or overly stressed out.

Signs of Imbalance


When there are more stressors than stress relievers happening in our life, there can be a myriad of negative effects.  Some of these include:

  • Our sleep may be impaired, as with:
    • difficulty falling asleep (also called primary insomnia and may be a sign of anxiety)
    • staying asleep (also called maintenance insomnia and may be a sign of depression)
    • feeling like we are not getting restful sleep
  • Physical Effects
    • Tension – typically in the neck or shoulders
    • Stomach upset – heartburn, indigestion, basically feeling like this:7
  • Anxiety
    • Feeling keyed up or on edge
    • Experiencing panic attacks
    • Having worried thoughts
  • Short-tempered
  • More emotional than usual

The difficult thing about stress management is that sometimes we may not even be consciously aware of being stressed.  If someone were to ask us if we are stressed we might even deny it.  Typically, this is because we are maintaining a high baseline level of stress in our life.  If we constantly run at 90% of our stress capacity but only identify being “stressed” if we reach 100%, it is easy to see how we might deny being stressed while actually we are consistently functioning at a high stress level.  You will recall that earlier we recognized that our stress response (fight or flight) is not designed to run long term and begins to have negative effects when it does.  Ideally, the stress response is turned on when we need it to face an urgent, imminent threat and then it turns off once we have successfully confronted that issue.



Managing Stress


         There are basically two (nonexclusive) approaches to managing your stress: decreasing inputs and increasing outputs.

In terms of decreasing inputs, this involves taking an inventory of the things that are creating stress in your life.  You can take out a sheet of paper and try to list all of these things.  Think of tasks like:

  • Household responsibilities such as chores, caring for children, etc.
  • Community responsibilities such as volunteering, boy/girl scouts, PTA/school involvement, board meetings, etc.
  • Social commitments such as commitments to help friends, attending functions that you perhaps would prefer not to, relationship stresses, etc.
  • Career issues such as job dissatisfaction, interpersonal issues, stressful projects, commuting, etc.


Once you have created as thorough a list as possible, assign a numerical value to each item with 1 being minimally stressful and 5 being extremely stressful.  Tally up your total number.  Now, I recommend that you aim to decrease this number by 10%.  You can accomplish this by tackling a small number of highly rated items or a large number of lowly rated items or some combination thereof.  You may have to get creative in order to figure out how to address these issues.  Can you hire someone to take some of the household responsibilities (like a house cleaner or a landscaper) or delegate some of those responsibilities to other members of the household?  Can you disengage from certain duties within the community or attend fewer functions?  Can you work on saying “no” to requests for help, even if it would be difficult to do so?  Can you work out a telecommuting schedule to address commuting?  Can you look for a different job or delegate certain job responsibilities?

Undertaking these changes is not likely to be overtly easy, so do not get discouraged by encountering resistance (either from others or from yourself).  Your stress level is telling you that you cannot continue to operate as you have been and therefore you need to address these changes or risk having some negative health consequences.  This is not meant to add pressure on you or to make you feel bad about your situation; it is meant to serve as a wake-up call to draw attention to an area of need.  Stress is serious and, as a society, we have a tendency to ignore it by dismissing it as an inevitable part of our lives.  To some degree, this is true, but not if your stress level has risen to that of distress.

In terms of how to increase stress outputs, the key is to turn to things that you find relaxing, rewarding, fun, or supportive.  You should also assess the balance between escape activities – things that allow us to disconnect and be passive recipients, and active enterprises – things that require our active participation in order to receive the benefit.  We typically engage in many escape activities but may not have as many active enterprises.  If this is the case for you, consider incorporating more things in the active mode.  See the graph below for some ideas of things that fall into each of these categories.

Escape Active
Relaxing Taking a bath

Reading a book

Watching TV/movies



Deep breathing

Rewarding Watching children play


Reading to children


Completing tasks that

have been put off

Learning a new hobby

Fun Reading

Watching TV/movies

Attending sports event




Playing recreational



Supportive Go out with friends Attend a support group


The important thing is that you tailor your approach to incorporate those things that are meaningful to you.  Some of these items could become “inputs” to stress if the reward you gain from them is not more significant than the stress of committing to them.  These would be the things that I suggest you cut.  Ideally, you will gain maximum reward with minimal added stress from the events that you are choosing.  The overall objective here is for you to become more purposeful in selecting the events to which you are committing your time.

In Closing…

Stress is an omnipresent and serious issue.  It may be easy to dismiss stress by thinking “everyone has it,” or “I deal with this all the time” but we must recognize that there are significant costs attributable to stress.  In fact, sources show that “job stress is estimated to cost American companies more than $300 billion a year in health costs, absenteeism and poor performance.”  (https://www.uml.edu/ Research/centers/CPH-NEW/stress-at-work/financial-costs.aspx)  While this demonstrates the economic impact of stress to corporations, take a moment to consider the personal burden of being worn-out, stressed-out, sick, tired, and overwhelmed.  It makes sense for us to do everything in our power to confront this and minimize the amount and impact of stress in our day-to-day lives.  While the quote from 1978’s Animal House of “fat, drunk, and stupid is no way to go through life, son” (https://www.youtube.com/watch?v=bK-Dqj4fHmM) typically garners a chuckle, I would tweak this to read “stressed, tired, and overwhelmed is no way to go through life.”

Please accept the challenge of making efforts today to decrease the inputs and increase the outputs of stress.  Every effort made in this area will reap benefits in both the short and long term.

Learning points

         At this point, you should have a clear understanding of the following:

  • What is stress?
  • The purpose of the stress response within our bodies
  • The “fight or flight” response
  • The meaning of inputs and outputs of stress
  • What to do when inputs increase?
  • How to balance inputs and outputs
  • What types of outputs exist?


Good luck and take care of yourself.


Edited by: Shirley Sachs

Written March 11, 2016


Posted in General | 2 Comments

Are You Talking to Me? Tackling Communication Issues (Part 3)

          In the first part of this series on communication, we explored how the words we use can create problems in clearly conveying the messages we intend.  The second part of the series covered how nonverbal and paraverbal factors interact with what we say to augment or change our messages.  This third (and concluding) installment will address the listening side of communication.  The first two parts focused on what we broadcast, but an equally important factor is how we are receiving messages from those with whom we interact.


         When people describe the conflicts they have with their partners (or anyone else for that matter), a common thread is that the conversation escalates.  It may start out as a slight disagreement but soon becomes a full scale, bridge burning, name calling free for all.  While there is much to be said about conflict resolution, that is a subject for another time.  I want to focus here on how we can use listening as a communication tool to attempt to avoid the sparks of conflict from turning into a full blown forest fire.

So often in conflict we only hear the first bit of what our counterpart is saying.  We then hear something that we want to respond to and we begin formulating our own response, counterargument, rebuttal, accusation, or counterattack.  In the time we spend formulating this response, we have effectively checked out from what the other is saying.  Quite often we have missed important information that may have shifted or augmented what we initially were responding to.  This is equivalent to reading half of a sentence and expecting to have a clear picture of what the entire sentence was communicating.  In doing so, we short change ourselves by cutting off our access to the entire picture.  This personal cost is in addition to the frustration that it can cause our partner when they feel misunderstood or unheard in our interactions.

One of the best ways to combat this tendency to quickly formulate a response is to follow the principle of seek first to understand, then be understood.  This originates from the excellent and popular work of Stephen Covey in his bestseller The 7 Habits of Highly Effective PeopleThis principle, as in many suggestions towards healthy habits, is simple but not easy.  We can easily grasp what it means to first understand what our conversation partner is communicating and then to proceed to make our own point, but it can be very challenging to actually do it.  Most of what makes it difficult is the shear habit of not doing it, so making a concerted effort to practice this new style will go a long way.  Practicing two other things will also aid you in working towards being able to follow the principle of seek first to understand and these are active listening and the “did I get that right?” exercise, both of which will be explained in detail in the remainder of this article.

Active Listening


         I recall when I was first exposed to the concept of active listening.  I was towards the end of my undergraduate studies and was taking a course titled “skills of counseling.”  At this point, I had basically made the decision that counseling was the field that I wanted to pursue when I grew up.  So, unlike many of the courses that had come before it, I actually paid attention to the majority of what was taught.  I can recall when the professor announced that the lecture that day would be about listening.  My immediate thought was “Well, this should be a short lesson.  Hear what people say.  Class dismissed.”  Already making plans for what I anticipated to be an unexpected free afternoon, I had no way of knowing how my understanding of listening as a skill would change by the end of this class.

         Part of the mistake that I had made was in confusing listening with hearing.  We hear at all times (unless we are purposefully putting on some noise-cancelling headphones to tune out the world).  It even happens when we are not fully aware of it.  Our brains have the capability to register auditory sensory input without us necessarily having to attend to it.  In English, this means that we can hear things even when we are not really trying to do so.  We may not even be paying attention to what we are hearing (as frequently happened in any history class I took).  We need to differentiate hearing from active listening by defining active listening as hearing, concentrating, understanding, and responding.  Active listening thus is a process whereas hearing is an experience.

         To reiterate, the process of active listening is:

  • Hearing – receiving auditory sensory input that registers for us consciously. We cannot begin to actively listen to someone who is talking in the other room.  We must be able to clearly hear them.
  • Concentrating – attending to what is being said while being free of distractions, both internal and external. External distractions tend to be obvious (our smart phone, interruptions, others’ noises, etc.) while internal distractions are not so apparent (thinking about other things while someone is talking to us, formulating our response, etc.).
  • Understanding – taking the time to process what was said and being sure that we grasp what the other person was trying to communicate.
  • Responding – letting the other person know that we heard and understood what they said. This may also include responding in the manner of statements like “uh-huh” or “I hear what you’re saying” or nonverbal responses like nodding or shaking your head.

In addition to these four components of the process of active listening, we also need to address the role of nonverbal communication in active listening.  You may recall from part two of this series of articles that nonverbal communication encompasses the way that we use our body to “speak.”  We can communicate that we are listening to someone by:

  • 3  Maintaining eye contact – this tells someone that we are paying attention to them.
  • 4  Leaning forward – ok, maybe not that much, Michael Jackson.  A subtle forward lean towards the person talking lets them know that you are interested and engaged with what they are saying.
  • 5  Using encouragers – these are small messages that encourage the other person to keep talking by letting them know that you are following along.  This can be a smile, nodding, saying “uh-huh,” or any other things along those lines.

So now that we know more about active listening and how to do it, let me introduce you to an exercise that will put these skills to use.  I call it the “Did I get that right?” exercise.

“Did I get that right?”


To do this exercise, two people must be on the same page about the protocol in order to successfully complete the task.  Here is how it works:

  • Person A speaks while Person B practices active listening.  Once Person A has completed what they wanted to say, they say “ok, that was it.”
  • Person B now summarizes what they heard by saying “What I heard you say was ___.” Person B should make an effort to put it in their own words rather than simply repeat exactly what was said (though if Person B were able to do so it would demonstrate that they had been listening attentively).  Once Person B has completed their summary they ask Person A “Did I get that right?”  (Ding ding! Now you see where the exercise title comes from)
  • Person A responds with either “yes” or “no.” If “no,” Person A says “What you missed was ___.”  Person B would then have a chance to try again at the “What I heard you say was ___.”  Once Person A is able to answer the “Did I get that right?” question with a “yes” we move on to the next step.
  • Person B gets to respond and present their own input. The same process as above repeats itself with each person now switching roles.  This goes back and forth until the conversation has reached its conclusion.

This exercise might appear to be a bit tedious and it will indeed feel like your conversations take longer than usual when you are using this exercise.  However, it allows you to have a much deeper and clearer conversation because this technique enables each of you to catch and correct any potential miscommunication before they run unchecked and ruin your interaction.

Between this exercise and the other notes on listening presented in this article you should have some solid ideas on how to make a significant effort in going beyond just hearing your partner (either in conversation or in life) and listening to them in a deeper and more significant manner.  The benefits of this effort will be twofold:

First, you will have the benefit of better understanding those with whom you carry on conversations.  You may be surprised at the depths of this new understanding and how shallow your understanding may have been before making a direct effort to really listen to others.  We often think and would maintain that we understand those around us, but if we probe or question this understanding we are likely to find that, without direct effort to really listen, we have but a cursory and superficial understanding of what others are saying.

The second benefit will be that others are more likely to match your efforts to listen.  When someone picks up on the fact that you are taking the time and effort to really attend to what they are saying, they are likely to make this a two-way street and make it reciprocal by attending deeply to you.  Ultimately, it feels really good to be thoroughly heard by another.  When you give this gift to others, you are likely to receive it back in return.

         This series on communication has explored communication including the verbal messages we send (part 1), paraverbal and nonverbal communication (part 2), and listening (part 3).  When all of these areas are addressed and harnessed, we are equipped to communicate as clearly as possible.  This is not to say that misunderstandings or conflicts won’t happen, but we will have the tools to navigate through them and work towards resolutions that allow for us to feel connected and supported by those around us.  As meaningful social connection is one of the cornerstones of good behavioral health, communication tools are some of the most important tools to have in our proverbial toolbox.  I hope this series was helpful to you in either creating or sharpening these tools.


Edited by: Shirley Sachs

Written February 21, 2016

Posted in Relationships | Leave a comment