Tag Archives: mindfulness

Anxiety as a Warrior

I teach my teen and kid clients about the purpose of Anxiety. The amygdala is a part of the brain that sets anxiety in motion. It’s actually an Ancient Warrior trying to protect you. Sometimes it becomes overly protective and gives you a turbo boost. This is fuel that is meant to keep you strong, fast, and powerful in case you need to take action. Sometimes you need it, and sometimes just in case. We can work together on that ‘just in case’ part. 

How to be more introverted

You read that correctly. While traditionally Western culture has minimized the importance of introversion, most people have a mix of extroverted and introverted tendencies. We have a lot to learn from introverts when it comes to mental health.

1. Reboot
Don’t confuse being an introvert with being shy. An introvert acquires psychological energy or a “reset” after expending energy, by time spent alone.

2. Create
Nurture your individual creativity: Art, music, poetry, writing. Somehow, we lost track of the fact that the arts are important to our cognitive and social growth. When kids play they like to pile blocks, mold a sandcastle, fingerpaint, make a fort, build a treehouse, bake cookies with lots of sprinkles, draw on the walls. We derive an inherent joy in creating that rarely gets built into our adult schedules.

3. Enjoy solitary tasks
We live in an easily bored society. From an early age, learning to master the arts of self-engagement and self-soothing is invaluable. For example, I encourage parents and children to work together to put together a small backpack of goodies to take with them wherever they go; books, sketchpad, favorite pens and pencils, coloring materials, a small stuffed animal or action figure, word finds, squeaky toys for stress, and so many other possibilities. Being able to entertain yourself requires practice. And it’s great for your brain.

4. Practice mindfulness
Have you ever driven past your own exit or street? Mindfulness is the opposite of auto pilot, and it requires practice. Notice what is around you. I have teens practice walking into the kitchen (or any room) and observe/notice five things. Use all of your senses when you’re eating something delicious; when you’re washing the dishes, when you’re making a bed.

5. Reflect
Contemplate the mysteries of existence; the universe, quantum physics, nature, why your companion animal does what they do. The natural curiosity we had as children can be nurtured and stirred at any age.

6. Day-dream
One of my teen clients has an elaborate imaginary life, a running story with nuanced characters, dialogue, and interactions. Others I work with mentally design their dream house, sketch designs or patterns, collect a bucket list of things to do, solve problems. One young person I know has come up with an art theme spread across 12 different works/mediums of art to show how social media impacts the self-esteem of girls.

In a loud and bustling world, we have a lot to learn from introverts. See also Quiet.

What I Learned

I was recently interviewed for a piece on mental health for VerywellMind about things I have learned from the pandemic.

The question was:
As both one who is living through this and helping others live through this, what are the lessons that most come to mind for you?

Seven things I learned from the Pandemic
1. There was no ‘Normal.’
We say, I wish we could return to normal, I miss the old days. When will things go back?
The old days weren’t so great. We have seen businesses go under, people who were barely getting by already go over the precipice, huge upticks in mental health and substance abuse problems, how separated and isolated people feel, and how difficult it is to ask for and receive support. I believe The greatest lesson of these times is the absolute necessity for a paradigm shift. The concept of a paradigm shift, originally based in physics, refers to a major change in the worldview, concepts, and practices of how something works or is accomplished. Recently, people have sometimes referred to it in employment terms as the Pivot.  Why return to a supposed normal that never worked, completely fell apart under duress, neglected the vulnerable, and is certainly not equipped to address any future challenges?

2. Nothing is more important than connection.
People have deeply hungered for love, touch, intimacy, and affection during these difficult times. It is an essential part of being human. Those who felt most isolated suffered the most challenges to their mental health. I recently wrote a piece about loneliness as a marker of danger to mental and physical health. A recent study equated deep-rooted loneliness as the equivalent of smoking chronically, with regard to the impact on longevity and wellness.

It’s literally a killer.

3. Mindfulness matters.
Groundhog Day happens. Over and over again, I have heard people say they have lost track of time. ’It feels like it’s going by so slowly, and yet so quickly’. Each day can feel the same. Learning mindfulness strategies anchors our perception of reality. We cannot live in a blur, and it’s very easy to succumb to that. Before we know it, it’s September 2021. Also see this helpful post on a mindfulness practice.

4. Pain cannot be avoided.
We can numb our feelings of fear, resentment, anxiety, grief, and terrifying uncertainty. They are still there. How to cope without being overwhelmed requires numerous strategies. I was sent a photograph from a recent trash recycling day in DC, where house after house was lined up with dozens of empty bottles; liquor, wine, beer, soft drinks. Our pain is honorable and a marker of experience. It’s not going to go away just because we want to anesthetize.

5. Looking after your health is absolutely essential.
Health care that is consistent in the middle of chaos is one of the hardest things to do. When you’re just trying to juggle bills, care for children and family, deal with virtual learning, work from home, metabolize constant health alerts and daily fears, confront financial hardship and job changes, and combat isolation and ennui, survival needs take over. Self-care often goes on the back burner. And yet, it is the absolute foundation.

6. It takes community.
In previous work, I have referred to the pandemic as the ultimate #compassionproject. In short, thinking about ourselves and our immediate circle has never worked, is not working now, and will not work in the future. Only if we pull together with our amazing range of strengths, talents, skills, and vulnerabilities, are we going to make it through.

7. Creativity can thrive under fire
I have seen innovation, creativity, flexing, and hustle like never before. In line with number six, above, I have seen projects large and small making the world a better place. Resolve, Love, and Hardwork are unbeatable.

On adding mindfulness to treatment

For the past two decades, I have combined my passion for practicing mindfulness and eastern philosophy, with my love for neuroscience and clinical psychology. The ancient and the research; they are compatible.

This is a frequent question posed to me that I deeply honor.

Them: My partner and I are studying Buddhist teachings to help us with anxiety and depression. What can you tell us to help us relieve our suffering?

Me: I believe that attempting to alleviate suffering on an individual basis or just with a partner only partially works. Because it emphasizes attachment to self (ego). To connect with the suffering of the universe, the understanding that all beings suffer, is actually more helpful over time for healing.

I primarily specialize in depression, anxiety, grief, transition, and lack of connection to the moment (ADHD). I encourage my patients to meditate, of course. There is a strong body of neuropsychological research that indicates that meditation changes neural pathways associated with depression and anxiety. I meditate with child clients in my office or my garden outside my office. We ring the gong at the end. Their faces are solemn and joyful.  For more info see Neuropsychology of Meditation.

While most Western practitioners think of Buddhist teachings and practice as primarily sitting meditation (zazen), there is much more in actual practice that is pragmatic. Buddhism is about the every day.

The emphasis is connection, which is highly different than attachment.

I strongly encourage the following adjunct therapies:

  • volunteering and community service
  • tending a garden and green babies
  • caring for fur babies
  • eating foods that honor the earth, animals, and the bounty available to us
  • going through your home and giving away possessions that you don’t need
  • reading poetry and of course Buddhist writings, hopefully a primary source, every morning
  • doing a walking meditation every day
  • teaching non-violence and loving kindness through practical matters such as social justice. Buddhism is not esoteric; it is societal.
  • most importantly finding your Sangha, in your community or even virtually.

Practicing these, and other activities, without attachment, and with a desire to understand and connect with the knowledge that the world is suffering, actually starts to lessen our own.

My work emphasizes the practice of such steps on a daily basis. I have termed it #stonesacrosstheriver. Adding these things to other empirically validated treatment methods is potent.

Walking as Mindfulness

Mindfulness in everyday life is a big topic in my work with patients. Most of the time walking is utilitarian: we go from point A to B. Our mind is focused on our destination, what we aim to do when we get there, or various other concerns. Even when out for a stroll in the park or nature, we can find our attention captured by thoughts, engrossed in conversation, or lost in planning. How often do we miss hearing the birdsong, or seeing a tree in bloom, because we are absorbed in something else?

When we can learn to walk with full awareness (mindfulness), ambulation can become a force for soothing and training our minds to dwell more completely in the present. In fact, mindful walking confers a pretty wide range of benefits, including decreasing symptoms of anxiety, depression, and ADHD:

  • It strengthens concentration and focus.
  • It can help release worries or concerns about the past and future.
  • It can facilitate creativity and new ideas.
  • Mindful walking can calm difficult emotions; it lifts mood and calms anxiety.
  • It increases mindfulness and all of its positive effects.
  • Walking is great for physical health and digestion.
  • You can do it anywhere.

There are many ways to walk. This is a walking mindfulness that I teach patients, but walking has infinite possibilities.

First, walk while keeping your eyes still and watching the view change as shapes and objects shift in and out of your line of vision.

Next, focus just on the soles of your feet, aware of different sensations there as the surface changes.

Then, focus on sounds. Those of your own footsteps, as well as the changing sounds in the world around you as you move.

Lastly, focus on smells and tastes in the air, and how they change depending on where you are.

If desired, you can add a personal mantra as you step. Mine is: No One to Be.

See also Stones Across the River, or Mindfulness as Practice.

Ways to Stop a Panic Attack

I’ve heard numerous comments recently that people are having trouble breathing, racing heartbeat, and deep fearfulness. Even without symptoms that we fear are from virus, these are very significant in their level of distress. Panic attacks are sudden, intense surges of fear, panic, or anxiety. They are overwhelming, and they have physical as well as emotional symptoms. Often people end up at the emergency room or going to their primary doctor because the experience can be very frightening. I am urging my patients to stay at home, or contact their therapist, rather than trying to go to the hospital.

Many people with panic attacks may have difficulty breathing, sweat profusely, tremble, and feel their hearts pounding. Some people will also experience chest pain and a feeling of detachment from reality or themselves during a panic attack, so they make think they’re having a heart attack. Others have reported feeling like they are having a stroke. Other patients have told me of feeling electric currents in their body. Panic attacks can be very scary and may hit you quickly. People can often start feeling that they might have a panic attack and it makes them even more afraid. Anxiety is contagion.

Here are strategies you can use to try to stop a panic attack when you’re having one or when you feel one coming on:

1. Use deep breathing
While hyperventilating is a symptom of panic attacks that can increase fear, deep breathing can reduce symptoms of panic during an attack. If you’re able to control your breathing, you’re less likely to experience the hyperventilating that can make other symptoms and the panic attack itself actually worse. Focus on taking deep breaths in and out through your mouth, feeling the air slowly fill your chest and belly and then slowly leave them again. Breathe in for a count of four, hold for a second, and then breathe out for a count of four. Repeat.

2. Recognize that you’re having a panic attack
By recognizing that you’re having a panic attack instead of a heart attack, you can remind yourself that this is temporary, it will pass, and that you’re OK. Take away the fear that you may be dying or that impending doom is looming, both symptoms of panic attacks. This can allow you to focus on other techniques to reduce your symptoms. I have people create self-statement index cards to remind themselves that they survived panic in the past and they will get through this.

3. Close your eyes
Some panic attacks come from triggers that overwhelm you. If you’re in an environment with a lot of stimuli, this can feed your panic attack. Stimuli includes TV news, social media, and being around other stressed out people. To reduce the stimuli, close your eyes during your panic attack. This can block out any extra stimuli and make it easier to focus on your breathing.

4. Practice mindfulness
Mindfulness can help ground you in the reality of what’s around you. Since panic attacks can cause a feeling of detachment or separation from reality, this can combat your panic attack as it’s approaching or actually happening. Focus on the physical sensations you are familiar with, like digging your feet into the ground, or feeling the texture of your jeans on your hands. These specific sensations ground you firmly in reality and give you something objective to focus on. Some people have to go outside, and get some fresh air or walk around.

5. Find a focus object
Some people find it helpful to find a single object to focus all of their attention on during a panic attack. Pick one object in clear sight and consciously note everything about it possible. For example, you may notice how the hand on the clock jerks when it ticks, and that it’s slightly lopsided. Describe the patterns, color, shapes, and size of the object to yourself. Sometimes, I recommend finding a picture frame and counting the corners while you do your breath work. No matter where you are, there are objects on the wall that you can use to focus your gaze and your breath. Focus all of your energy on this object, and help your panic symptoms subside.

6. Use muscle relaxation techniques
Much like deep breathing, muscle relaxation techniques can help stop your panic attack in its tracks by controlling your body’s response as much as possible. Consciously relax one muscle at a time, starting with something simple like the fingers in your hand, and move your way up through your body. Muscle relaxation techniques will be most effective when you’ve practiced them beforehand. Progressive muscle relaxation or PMR is an important behavioral strategy that can be learned and practiced.

7. Picture your happy place
What’s the most relaxing place in the world that you can think of? A sunny beach with gently rolling waves? A cabin in the mountains? For me, it’s running on the beach with my dogs, breaking bread with my best friends, sitting by a bonfire or fire pit. Picture yourself there, and try to focus on the details as much as possible. Imagine digging your toes into the warm sand, or smelling the sharp scent of pine trees. This place should be quiet, calm, and relaxing. One client told me that he pictures himself in his mother’s very large clothes closet, because everything in it has her scent, and it soothes him.

8. Engage in light exercise
Endorphins keep the blood pumping in exactly the right away. It can help flood our body with endorphins, which can improve our mood. Because you’re stressed, choose light exercise that’s gentle on the body, like walking or stretching. The exception to this is if you’re hyperventilating or struggling to breathe. Do what you can to catch your breath first.

9. Keep lavender and sage on hand
Lavender is known for being soothing and stress-relieving. It can help your body relax. If you know you’re prone to panic attacks, keep on hand and put some on your forearms when you experience a panic attack. Breathe in the scent. You can also try drinking lavender or chamomile tea. Both are relaxing and soothing. Smudging using sage or Palo Santo can be very healing and calming. Nutmeg, in tiny amount helps promote sleep. Note: Lavender should not be combined with benzodiazepines. This combination can cause intense drowsiness.

10. Repeat a mantra internally
Repeating a mantra internally can be relaxing and reassuring, and it can give you something to grasp onto during a panic attack. Whether it’s simply “This too shall pass,” or a mantra that speaks to you personally, repeat it on loop in your head until you feel the panic attack start to subside.

11. Take benzodiazepines
Benzodiazepines may help treat panic attacks if you take one as soon as you feel an attack coming on. While other approaches to the treatment of panic may be preferential, the field of psychiatry has acknowledged that there is a handful of people who will neither respond fully (or at all in some cases) to the other approaches listed in above, and as such, will be dependent on pharmacological approaches to therapy. There is no shame in seeing your primary care doctor or psychiatrist, if you continue to struggle. Because benzodiazepines are a prescription medication, you’ll likely need a panic disorder diagnosis in order to have the medication on hand. They should only be used sparingly and in cases of extreme need.

12. Have an emotional coach buddy.
Somebody that you can call during a hard time who will literally talk you down. It’s like a sponsor for your emotions.

The Psychology of Houseplants

Plants are a metaphor for our lives.

The average person spends more than 85 percent of their time indoors, maybe more so now because of COVID-19. So it’s no surprise that quarantine has made plant parents of a lot of us. But the human connection with plants is ageless; countless studies have analyzed the mental health benefits of keeping indoor foliage.

People have been keeping potted plants as far back as ancient Egypt, Babylon, and Rome. Wealthy Victorians embraced houseplants as a way to brighten the dull, dreary English winters. In the 1970s, the decade of the world’s first Earth Day, there was an indoor foliage boom. There are many mental health advantages to having plants in your home and office spaces that have been documented across psychology studies.

Houseplants give you a taste of nature.
Houseplants are an easy way to bring the outside in and reap the restorative benefits of being in nature, even when you can’t be outside.  A Japanese study that explores Shinrin-yoku (‘forest bathing’) found that spending time around nature lowers stress levels, reduces blood pressure and has an overall relaxing effect on the body. Forest bathing is simply being in nature, connecting with it through our senses of sight, hearing, taste, smell and touch.

Tending to plants models self-care.
Caring for a plant, giving it water and sunlight, cutting it back when needed, repotting to a better space, the simple consistent habits required for plants to thrive, lay the foundation of doing these things for yourself.

Plants improve executive functioning.
Caring for plants creates a positive feedback loop, in which you are taking on a measured responsibility, following through, and witnessing the effects. Tangible evidence of what can happen when we are consistent, do what needs to be done, and adapt to our environmental needs. Plants teach us the outcome is worth the effort and that we are constantly growing and evolving. The sequential aspect of plant care is good for our mental functioning.

Plants can boost your creativity.
Plants are good for brain storming and creativity. A Texas A&M University, department of psychology, study found that having indoor plants in the workplace greatly improved idea generation, creative problem-solving, and boosted sustained effort.

Plants can make you more productive.
A 2014 study in the Journal of Experimental Psychology found that the presence of plants in the workplace led to increased productivity, energy, and higher levels of concentration. Maintaining plants actually appears to stimulate your brain and increase your attention span.

Plants reduce feelings of anxiety.
Exposure to indoor plants has positive effects on mental health. When we’re in the presence of indoor plants, the activity of our sympathetic nervous system, which is the fight-or-flight portion of our nervous system, decreases. Indoor plants promote a sense of relaxation, comfort, and calm.

Plants promote mindfulness.
Most people with anxiety worry about the future. They may be mentally living in the future, worried about what’s going to happen next, or what could go wrong. Mindfulness brings emotions and feelings to the present. Taking the time to tend to plants can be considered a mindfulness activity.

The primacy and recency effect

In neuropsychology experiments, research participants were asked to douse their hands in ice water for extended periods. Psychologist Dr. Daniel Kahneman called the experiment results the Peak-End rule – that our perceptions about an experience are determined by how it feels at its most intense, and how it feels at the end. The actual duration is irrelevant. It appears we don’t rationally calculate each moment of pleasure or pain using some kind of mental ledger. Instead, our memories filter how we feel about the things we’ve done and experienced, and our memories are defined more by the moments that seem most characteristic – the start, peaks, and the finish – than by how we actually felt most of the time during the experience. The theory has been applied to both positive and negative experiences, including relationships.

Mental Health and Empathy

Who are Highly Empathic People?

Neuropsychology research has shown us that we are wired for empathy—that we literally have brain circuits devoted to trying to understand how another person is feeling and to “feel with” them.

Highly Empathic People (HEPs) are highly sensitive individuals, who have a keen ability to sense what people around them are thinking and feeling. Psychologists may use the term empathic to describe a person who experiences a great deal of empathy, often to the point of taking on the pain of others at their own expense.

There are many benefits of being highly empathic. On the bright side, empathic folks tend to be excellent friends. They are superb listeners. They consistently show up for friends in times of need. They are big-hearted and generous. They also tend to be highly intuitive and emotionally intelligent.

However, some of the very qualities that make them such fantastic friends can be hard on the empaths themselves. Because they may literally feel what others are going through, they can become overwhelmed by painful emotions, such as anxiety or anger. Empaths have a tendency to take on the problems of others as their own. It is often difficult for them to set boundaries for themselves and say no, even when too much is being asked of them.

It is common for empaths to feel drained after spending a lot of time around people. Empaths can present as introverts, because they require a certain amount of alone time in order to recharge. A fascinating study from 2011 suggests there may be a link between highly empathic individuals and ‘symptoms’ of social anxiety. Crowds can feel particularly overwhelming to HEP, who are often extremely sensitive to certain noises, smells, and incessant chatter or small chatter. They often feel their best when they are surrounded by animals, quiet, plants, or nature.

Types of empathy may include:
Cognitive Empathy
Cognitive empathy refers to thinking processes called perspective taking. Perspective taking is an essential part of the definition of empathy. It means that you think about a situation from a different viewpoint than your own. To do this, you have to imagine what the situation is like from someone else’s perspective. Rather than thinking about how you might feel in that situation, you picture what it would be like if you were the other person, with their beliefs, emotional health, relationships, and personal history. In short, you see things from their perspective.

The brilliant writer, George Orwell, most known for Animal Farm and 1984, worked for several years as a colonial police officer in British colonized Burma. In the 1920s, after his colonial stint, Orwell returned to England determined to discover what life was like for those living on the social margins. “I wanted to submerge myself, to get right down among the oppressed,” he wrote. He lived on the streets of East London with homeless individuals over the next year. The result, recorded in his book “Down and Out in Paris and London”, was a radical change in his beliefs, priorities, and relationships. He not only realized that homeless people are not “drunken vagabonds or scoundrels”—Orwell developed new friendships, shifted his views on inequality, and produced exemplary literary material. He eloquently wrote that ‘empathy doesn’t just make you good, it’s good for you, too’.

Emotional Empathy
Emotional empathy, also called affective empathy, is a subjective experience in which you pick up the emotions of others and feel them yourself. For example, if they show their sadness, you feel sad, too, even though you may not feel have felt sad before. You share in their feelings.

This may include:
Recognizing suffering
Understanding that everyone suffers
Feeling for the person who is suffering
Allowing yourself to feel the uncomfortable feelings that result
Doing or wanting to do something to alleviate their distress
How to rejuvenate if you’re a Highly Empathic Person (Recovery Acts)
Give journaling a try

If you’re feeling overwhelmed with emotion, it can help to get it out in some way. There are lots of different options. Dr. James Pennebaker is a clinical psychologist who has shown that putting pen to paper for at least 10 minutes a day, without editing, actually reduces depression and stress. Just writing whatever’s on your mind, can not only be a release, but can also reconnect you with your own emotions, and help you not feel so full of everything. To get into the habit, perhaps start by writing a few lines every evening or morning to process the day.

Start a mindfulness practice
While mindfulness has often been associated with meditation or breath work, there are many other strategies that can be used in this practice. For example, we all have to take out the trash. Taking out the trash mindfully can mean you are mentally removing the detritus of the week, or letting go of ballast. You can walk mindfully, cook, eat a meal, do a tea ritual, garden, or massage your dog or cat. Mindfulness is just paying attention to all of the intricate steps in any given activity.

Try visualization techniques
Visualization is a great strategy, because you can use it as a tool anywhere you go. One that I teach is called ‘the relaxation place,’ in which we use our individualized images of soothing to make makes this so powerful.

Other visualizations you could try include picturing yourself in a protective bubble, imagining other people’s emotions as water that flows over you, or even seeing their emotions as a balloon and letting that balloon go.

Be in nature regularly
Nature has a wonderfully grounding effect, helping you to clear your mind and feel closer to the earth. If you can, aim to get outside often and seek out green areas. Taking time to notice the leaves on a tree, or clouds in the sky, can help you anchor yourself in the moment and feel more connected to yourself and your emotions. Nature includes your green babies, your companion animals, your favorite tree on your street, everything around you.

Plan ahead for emotion overload
Being prepared can help to avoid unexpected emotion overload. If you know you’re going to be in a draining situation, make sure you give yourself plenty of time and rest the next day to get back to baseline.

Practice release mantras
Dr. Judith Orloff, a physician who teaches other doctors how to be more empathic, has taught what I call ‘release exercises’ in my practice. For example, at the end of the day when feeling full from the energy or hurts of others, she suggests chanting ‘ send it back, send it back, send it back.’ There are many release exercises, and like mindfulness and visualization tools, they are highly individual.

Therapy, in whatever form that fits you
In addition to talk therapy, art therapy, movement therapy, expressive therapy, spiritual counseling, life coaching, and more, are all very helpful for highly empathic individuals to maintain their vibration without damage.

Embolden Psychology
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Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

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