Coping with COVID-19

Note: Dr Unger is now offering Phone or Video sessions instead of office visits. Dr Unger has been using phone or secure video (i.e. telehealth) for therapeutic sessions since 2001. Contact her through your normal channels if you are an existing client to get instructions to set up phone or video options.  California residents only please.

Are You Overly Anxious?

If you have a history of anxiety, specifically around health issues this article is for you. Of’ course exercise, yoga and meditation through apps can help but, with all the dreadful news and social media posts surrounding coronavirus, we need to put some things into perspective and find ways to come together emotionally.

“Social Distancing” is Really Physical Distancing

It is totally normal to have some fear response to COVID-19 since it has been declared a global pandemic and humans have neither “herd knowledge” nor “herd immunity” since it is a new virus. When we are confronted with an unknown threat like this our initial response is to be fearful.

Some fear (or “concern”) is rational if the threat is real. However, turning our fear irrationally into willful ignorance, xenophobia, hoarding, or panic solves no problems. In fact, it creates more problems for the community than it solves. For example, face masks are in short supply for health workers because of panic buying by the public.

The internet is wonderful; the internet is terrible! While the internet can be a wonderful source of factual information, it can also contribute to fear and panic because there is both innocent as well as intentional spreading of incorrect or malicious information, as well as people trying to profit off of the fear and panic.

Check your sources! Only trust news outlets known for objective reporting. Do not trust social media unless you know the source is objective and not politically motivated! Avoid extremist and conspiracy theory based sources!

The US Center for Disease Control (CDC) {https://www.cdc.gov/coronavirus/2019-ncov/index.html} says to stay home if you are sick, keep up your sanitation (especially hand washing) and exercise proper social (i.e. physical) distances (6’ and only fist or elbow bump if necessary). This will help prevent the spread of the virus.

COVID-19 has a longer incubation period during which people can still unknowingly infect others as well as a high infectivity rate; the virus also attacks the lungs directly in advanced cases. These are some of the main “problems” with this virus compared to the common flu (which has a short 2-3 day incubation and lower infectivity). COVID-19 therefore can be spread to many others by people who are unaware they are infected.

The virus appears to be spread mainly by coughing which spreads droplets and some aerosolized particles (much smaller particles which last a little longer in the air, but not indefinitely, and travel a bit farther). It appears to last on various surfaces from a few hours to a few days. Therefore, cough into your sleeve and clean any surfaces you or others may have touched, keep your hands away from your face and well sanitized.

Elderly with underlying health issues are most susceptible.  Younger people may have “mild” cases (ranging from typical mild flu-like symptoms to just short of needing a respirators in a hospital), but are still infectious.

Thus the need for a community based response of avoiding interpersonal contact as much as possible.

Coping Skills

We all react to stressful situations differently but, if you know you are easily anxiety prone, keep your logical and coping mechanisms “on” at all times. This includes keeping to a routine, focusing on learning something new, bonding emotionally with those close to you or even something simple like cleaning out and reorganizing a messy space in your home. These actions can turn an anxious mind into a hopeful one.

If we don’t have hope it is probably because our social, economic, and local support systems are not strong enough. If they are not, this emergent time may be the time to make them stronger.

Here are some symptoms of fear that are not obvious:
• Perseverating on negative thoughts or ideas
• Changes in sleep or eating patterns
• Difficulty concentrating
• Worsening of chronic health problems
• Increased use of alcohol, tobacco, or other drugs.

Here are some tools to help ease your worries:
• Avoid excessive exposure to media coverage of COVID-19 and only listen a few times a day to reliable sources to get factual updates. Avoid highly political or extremist or alarmist sources.
• Take care of your body. Take deep breaths, stretch or use apps to help you stay in a peaceful place. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep and avoid alcohol and drugs.
• Make time to unwind and remind yourself that strong feelings will fade with time. Try to do some other activities you enjoy to take your attention off the negative.
• Connect with others at home especially if you are family quarantining. Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships (but physical distance).
• Maintain a sense of hope and positive thinking. Society has survived pandemics in the past such as the terrible 1918 influenza, SARS, Bird Flu, etc!
• Most importantly, if you are self-isolating with a roommate, partner or spouse use your sensibilities and adopt a civility rule. This means to accept that may be some topics are off limits and we use what San Miguel taught about the four agreements: speak your words with kindness, impeccably and truthfully, no assuming or judging, and of course put your best foot forward. Use your own sense of what you is the right and kind thing to do now. It is easy to get caught up in “Herd Mentality” whether it is to run out and buy a product or to ignore warnings based on fact. Bring up neutral topics with those you are living with and try to put a halt on correcting others or being right. Keep telling yourself we are all in this together and are all taking a hit now.
• Seek professional help (mental health, help lines, etc.) to help get yourself focused and calm mentally if the above doesn’t work.

Conclusion

This is a time for all of us to act as a community and take care of one another emotionally. Stress will just make you more vulnerable to illness. There are many trusted online sources, apps and skilled counselors out there to walk you through this. It is all a matter of reaching out and being open and flexible to possibilities (which you can control) rather than overfocused on calamities (which you can’t control). If everyone did just that we would be better equipped to handle the worst of anything out there.

We will all face this rough patch … but this will pass.

About

Arlene Unger, PhD is a Dana Point CA based Clinical Psychologist in private practice. Her approach is to use Cognitive Behavioral Therapy along with Mindfulness and Acceptance Commitment Therapies.

She is the author of numerous articles (https://drarleneunger.com/resources/) on the practical applications of mindfulness.

She now concentrates her practice on Telehealth. She works with numerous platforms including Telemynde, Betterhelp and Talkspace and accepts most forms of insurance.

Online Therapy is Growing!

Online Therapy is Growing!

I have been interested in online therapy for many years but it’s been a slow slog to gain acceptance for this modality. However, recently I’ve been accepted by two newer services (BetterHelp and Talkspace)–that cover millions of patients each–following very strict credentialing and training processes. They offer several different approaches from txt to video.

See my Appointments page for more information, and if you are a California resident, check out BetterHelp and Talkspace, or the other services listed below:

BetterHelp

Talkspace

Breakthrough

Ask The Internet Therapist

eTherapi

Virtual Therapy Connect

Mindful Patience

Everything in life takes time! For example, how many times have you rushed to just wait? Or you get stuck behind a car going too slow. Or your newborn has a messy diaper just as you are ready to leave the house? Or the service rep puts you on hold for 15 minutes?

As you are waiting, you start feeling your blood boil and before you know it you are snapping at everyone. Losing your patience just brought you an onslaught of interpersonal problems as well as physical stress.

Have you ever noticed how impatient people tend have fewer friends? Impatience makes us sound like “know it alls,” act impulsively and treat others with insensitivity.

Those who show patience are mindfully aware of themselves (see references for more information on mindfulness), their surroundings and their situation. They are typically sought after, trusted, promoted and viewed as more likeable by others. Consider asking your close friends and family about their impressions of you when you are calm versus when you are angry or irritated.

How to develop Mindful Patience

We can better modify our impatience when we know more about our wound-up behaviors from someone else’s perspective. Rather than taking their feedback personally, try to accept it and, in little ways, pay mindful attention to your physical signs and behaviors.

Some of us can’t tell when we are being impatient because we are so caught up in our own reactivity. Most likely when you are inpatient you display shortness of breath, tenseness, restlessness, irritability, and anxiousness. You are probably not aware that your mouth seems dry, your fists are clenched, and your expression would freeze water.

Think for a moment about a time when you felt that feeling of impatience building inside you. What set your impatience off? Was it the traffic, temperature, hunger, thirst, fatigue, being questioned or something else that put you in an impatience spiral? What did you recall seeing, feeling and hearing back then? Try to jot down a few notes and you’ll see the roots of your impatience emerge. Understanding your triggers and reactions can lead you toward resolution.

Practicing patience doesn’t mean ridding yourself of all anxieties, but rather catching yourself before your impatient attitude gets the better of you.

Here are some soothing, mindful strategies that could turn an impatient frame of mind into a calm one:

  • ·         Catch a few slow, deep, cleansing breaths to slow down your blood flow and lower your blood pressure.
  • ·         Try relaxing from head to toe to loosen the tension in your skeletal muscular especially in your neck. Tense and release your muscle groups, one at a time, from head to toe.
  • ·         Imagine yourself taking a mindful pause as you stay consciously alert to your bodily cues.
  • ·         See your next step as a chance to contemplate. Why not choose to do the opposite of rushing. For instance, move deliberately slower and act thoughtfully and calmly.
  • ·         Late? Change your attention from what you are going to lose to what you can gain from the extra time. Take advantage of the opportunity that is in front of you.
  • ·         Encourage yourself to mindfully listen and try to put yourself in the other’s shoes.
  • ·         Take another mindful moment to talk yourself out of simply reacting by focusing on what you can gain from keeping your composure.
  • ·         Rehearse what you want to say by using a peaceful tone.
  • ·         Tactfully mention your lateness as you gently relate to the circumstances at hand.
  • ·         Experience the benefits of an unjumbled mind and the relief in your body.

If you find yourself unable to manage your reactivity using this mindful sequence, consider counseling, anger reduction classes, yoga or meditation.

References

See other blogs here for background and discussions of mindfulness applied to everyday life problems.

Dr Unger’s books on mindfulness: “Calm,” “Courage,” “Sleep,” and “Happy” are available through Barnes & Noble. “How to be Content” and “How to Make Space” will be available in the US on Amazon in late July 2018.

Colier, Nicole The Power of Off: The Mindful Way to Stay Sane in A Virtual World. Amazon.

Lucado, Max, Anxious for Nothing. Google Play.

https://www.psychologytoday.com/blog/emotional-freedom/201209/the-power-patience

Sisko, Alden, Ultimate Guide to Developing Patience. Barnes & Noble.

Avoid Going Numb

If all your limbs suddenly went numb it would totally freak you out. But when we can’t feel our feelings, it could be sign that we are emotionally in deep trouble.  Emotional numbness has been associated with acute stress, trauma, anxiety and depression.  Some common numbing agents include the internet, excessive work, over sleeping, and TV.  More dangerous forms of numbing escapism are associated with alcohol, pills and sugar. Unfortunately, none of these give us permanent relief from the painful feelings we wish to avoid.

Shame and inadequacy are common emotional culprits that most people would rather ignore.  It would be great if we could just stamp out these unwanted feelings and just keep our pleasurable ones, but the emotional center of our brain doesn’t work that way.  When we turn off the brightness in one feeling, the lights go out in all the rest.  Emotional numbing hurts us more than helps us.  We may momentarily get rid of our insecurities, but we also lose out on fun and freedom.

The key is to stop robbing yourself of the moment, self-awareness and the ability to move forward.  Here are some steps to get the most out of your negative feelings.

Know your triggers

You are your own best researcher and problem solver.  All it takes is making the decision to notice, rather than ignore, the patterns that keep you stuck.

Deal with discomfort

Remember the saying “what hurts can only make you stronger.” Try sticking with accountability and moving away from avoidance when it comes to looking inside yourself.

Let go of victimization

We all stumble in the face of adversity. By embracing, rather than wallowing in your pain, you can create and witness positive change.

Rejoice in staying mindful

Accept that your condition is temporary, just like most things in life. Judging just inflames your hurt and forces you to numb.  Instead, seek new horizons by giving yourself permission to simply, and passively, feel whatever comes up.  All feelings are finite.  Once you allow yourself to feel and accept your feelings, you can learn to let them go.

Facing your emotions that you trying to numb can help you identify where they are coming from.  Once you know the source of your pain, the healing process can begin.

References

https://www.7cups.com › Q & A › Managing Emotions

https://www.psychologytoday.com/blog/…/stop-numbing-out-and-awaken-your-life

http://www.thejdnation.com/what-is-numbing/

“Calm” and “Sleep” books now available at Barnes & Noble

My two books on “Calm” and “Sleep” are now available at Barnes & Noble, in store and online (click on titles below).

These books (the first two of a planned series) contain 50 simple cognitive behavior (CBT), emotional brain training (EBT) and mindfulness/visualizations/relaxation (MBSR) exercises to help readers learn coping skills. Each book focuses on a particular topic and is beautifully printed with rich illustrations and exercises.

They also make an excellent and thoughtful gift!

Calm: 50 Mindfulness Exercises to De-Stress

We can’t escape stress and, in fact, some stress can be helpful to us (“Fight or Flight”).

Humans are equipped to cope with small amount of stress. It can serve as a motivator, keep us focused on our priorities, or help us to detect danger. Misery replaces growth when we are bombarded by stress and can’t escape it. Unrelenting stress deprives our bodies of the homeostatic experience we need and crave.

Many of us are in search tranquility and calm, but this is hard to find when so many are combating stress related illnesses. According to the American Psychological Association (APA) the impact of stress on the USA population has substantially risen in the last decade.  The toll stress has taken on people’s live has contributed to 77% health and 73% psychological problems.  Compulsive eating, alcohol/tobacco abuse, and drug addiction are too often used to curb stress but they only compound the problem.

Rather than turning toward nonproductive methods of coping, this book offers ways to unleash our mind and bodies from the negative cycle of stress.

Fortunately, our brain, bodies and beliefs can be trained through daily practice to embrace peace while protecting us from harmful stressors.

Sleep: 50 Mindfulness Exercises for a Restful Night’s Sleep

One of the most troubling behaviors that effect one out of every 3 people is sleeplessness. So why do we need sleep? First it occupies so much of our 24 hours each day! According to the National Sleep Foundation our bodies need sleep for restoration and rejuvenation. Similar to nutrition, sleep helps our body repair itself on many levels. Sleep has been touted as a necessary luxury, but research shows that we need sleep to function both mentally and physically at our peak levels.

We do know is that our sleep can improve with treatment. Medication does help, but, in most cases, sleep sufferers do better with psychotherapeutic strategies and suffer fewer (or no) side-effects.

Sports and neurological research points out that mental imagery can have a positive impact on our mental health.

The next two books in the series “Happy” and “Courage” are currently in press.

Office Clients Note: I have a small supply of the “Calm” and “Sleep” books as well as my book  “Presence of Mind – Mindful Affirmations” available in my office just for office clients.

Mindfulness and Finding Life Balance – Part 8 – Compulsions

Conquering Compulsions Mindfully

Compulsiveness affects millions. It gives us a false sense of being content, but ultimately supports our avoidance or escape from a bigger problem or emotional pain. Compulsive behavior is a huge challenge because while it reduces tension, it can lead us to more temptation. Its repetitive nature keeps interfering with our healthy habits.

According to Licensed Psychotherapist Gloria Arenson compulsive behaviors may include shopping, hoarding, eating, gambling or obsessive-compulsive thoughts. She believes we suffer from a compulsion when we are no longer able to control when we begin or stop the behavior. She states that we can become trapped in a repetitive whirlwind of irrational thoughts and rituals.

Some researchers view compulsiveness as outlet so that we never have to confront our real problem. Our addiction to compulsive behavior keeps us stuck. It may lead us toward repeated feelings of guilt and shame.

Compulsive behaviors are typically the result of stress, and eliminating those stresses with the help of the Emotional Freedom Technique (EFT) developed by Gary Craig or Acceptance Tuning In and Meeting Needs Tools (AMT) developed at BYU may help eliminate the behaviors.

As a Licensed Psychologist I have observed how bad feelings about ourselves may make us keep these rituals as dark secrets and lead us more acting out. If we stop buying into the belief that we are worthless, or bad, just because we have compulsions, we can begin to unravel the cycle.

Regardless, there are no immediate solutions to compulsiveness but knowing that we can’t always singularly overcome our dependence and physical urges can move us toward recovery. Compulsions may, in the moment, help us cope with our stress or unmet needs, but it is a poor substitute for not being productive, proactive and prosocial.

Nonetheless recovery is possible but it will take patience and time.

The Role of Mindfulness in Conquering Compulsions

The cornerstone of mindfulness is that things have a natural progression and we cannot force things along as much as we want.

Acceptance is an important component of mindfulness. So accepting that your compulsion is essentially numbing and distracting you from experiencing upsetting feelings is a critical first step in letting go of its hold on your life.

Compulsive behaviors may only temporarily fill, or distract, us from an unmet need, but it usually leaves us feeling worse. Ultimately, compulsions disconnect us from ourselves and others. Awareness of our inner-most feelings and thoughts is another essential component of mindfulness. Thus, being aware of our negative as well as our positive emotions is another critical step to destructing the rut compulsions gets us in.

Feelings of shame and isolation are very common with compulsive behavior because of the indulgent aspect of the behavior. Shame based behaviors may lead us to a declining sense of control, very low self-esteem and discouraging relationships. When we are in the throes of a compulsive cycle, we need to constantly increase our compulsive cycle to deal with our shame, emotional letdown and secretiveness.

Concealing our compulsions can further deepen our attraction to them and bring about “real self.” Sharing our “real self” is an important feature of mindfulness. It may be impossible to even consider the idea of sharing our compulsive rituals with someone who cares about us or who may help, but this may actually prevent us from acting out again. Thus, that’s why joining an anonymous group can be adjunctively very beneficial.

Those that struggle with compulsions know how powerful and menacing they can be. Most who struggle have tried repeated to restrict themselves by telling themselves they just to more will power or to white-knuckle it. The mindful person knows that they need input and help from others and stops making the assumption that they are just too broken to get fixed.

Here are some helpful mindful tools to break down the denial and assumption making associated with compulsive behaviors:

  • BREATHE & RELAX … rather than let yourself get sweep in by compulsive behavior cycles
  • TUNE IN … rather than let yourself check out of your feelings
  • OPENLY ACKNOWLEDGE … that you are being tempted and pulled into acting out again
  • CONSIDER YOUR CHOICES … before you act out try asking yourself what else can I be doing to relieve my stress or boredom right now?
  • STOP JUDGING YOURSELF IF YOU ACT OUT OR RELAPSE. You are not bad or perverted just self-neglectful.

Stress, restlessness, poor self-confidence, and fatigue can all undermine our attempts to gain self-control.

Forgiveness, setting limits, relying on others as well as making a plan have helped suffers. If you can’t make head way with any of the above, please know that professional help is either a thumb click or phone call away.

References

www.byui.edu/counseling-center/self-help/ocd
www.amazon.com/Gloria-Arenson/e/B001IGONWQ
eft-help.com/intro/EFThistory.htm
www.amazon.com/Freedom-Obsessive-Compulsive-Disorder-Personalized/dp/042519955X

Mindfulness and Finding Life Balance – Part 7 – Relocation

A Mindful Approach to Child Relocation Culture Shock

I have lived and worked abroad as a young adult on two different occasions.  It was a frustrating and overwhelming experience since I did not know the languages well enough to communicate.  As much as it was exciting to leave behind everything that was familiar in my USA community, I realized pretty quickly that I missed the comforts of my home.  There were a lot of mixed emotions that went along with my being in a strange, new place for the first time.

Looking back, it would have helped me immensely if I had a parent to pave the way for me.

Today as a Psychologist, I apply three key principles of Mindfulness when working with military families who have to move to strange and unfamiliar lands. I have found the Mindful concepts of Exploration, Listening, and Innocent Embrace apply to helping children and teens acclimate to different cultures.

Mindful Exploration refers to seeking out information without any preconceived agenda.  I refer to the initial phase of acclimation as the Jubilation Phase.  This is when everything that is different is met with excitement and curiosity. During this phase virtually everything—including the way people talk, eat, and work—sparks a delightful interest because it is so new.

To move children/adolescents through this phase, it is important to take advantage of your child’s inquisitive nature and to Mindfully help them explore their new surroundings.  This exploration might include visiting a local town, taking public transportation, or seeing artifacts at a museum.

The next phase of acclimation is referred to as the Uncertain Phase.  Whatever was exciting and new is now looked at with skepticism and/or criticism.  You might hear a comment like “that is sooo boring”.  Here your child might be not sure they are happy, or secure, in this new and different place.  In effect they may be letting you know that they are terribly homesick.

Mindful Listening is understanding without judging, and here, it’s important that parents do not panic, moralize or bring up how excited their child was just a month ago.  Instead, they should try to encourage communication and reflect back their understanding. Mindfully listening to what your child may think is now “boring” can definitely ease their stress.

Once your child feels heard and not judged, you can slowly begin to get them involved in physical activities offered in the new community they now live in.  Here the concept of Innocent Embracement comes in handy. Innocent Embrace means being open to and/or engaging in the possibilities that surround us. For instance, it might be a fencing class if they are in Scotland, or a cooking class if in France, and so forth.

The latter (food) is actually a great way to encourage your children to not only want to try, but to actually prepare the local foods right in their new home. It’s also a way to help your child feel more connected to the place he or she is now living in.

Belonging is the last phase of acclimation and Innocent Embracement can assist with this transition. This is the time your child may want you to initiate play dates or meet ups with children of the new culture. Parents can help their children by embracing these friendships rather than being suspicious of them.  Getting your child involved in foreign language classes or camps can foster their sense of belonging and help them develop a sense of home abroad.

Children and adolescents adjust much faster than adults, but need help in navigating through the extreme cultural differences, especially at the beginning.  In order to minimize a child’s culture shock it’s important to help them through each phase of adjustment.

There is no set time when your child will begin and end a phase, but the strategies mentioned above can help move things along for you and your children.

Reference

Third Culture Kids: Growing Up Among Worlds, Revised Edition by David C. Pollock and Ruth E. Van Reken

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