Senior Isolation and Loneliness Part 2

Last time we looked at Senior isolation, loneliness and depression for our loved ones who are living on their own, or maybe even with you. But, what about those in assisted living? How can they feel isolated when there are other people around them? How can they feel lonely when they are almost never alone? Loneliness among the elderly is not merely a lack of companionship; it’s the absence of meaningful connections that once defined their daily lives. If they don’t feel truly connected to or supported by the people around them, being with them may not provide enough fulfillment to combat loneliness. They may no longer have the relationships that once meant so much to them.

It’s difficult to watch a loved one navigate the waters of loneliness and depression. And loneliness and depression in seniors has some health risks associated with it, including heart disease and stroke. And for those with heart failure, the risk of emergency room visits, or hospitalization increases. So, what can we do to help the people we love deal with these feelings. Keeping a senior active and engaged might seem challenging, especially if you live far away or if your loved one is living with health, cognitive, or mobility limitations. So, what can we do to help? Try some of the following:

• Call them: use the phone, Zoom, or a video phone call.
  Regular contact with loved ones, even phone calls, FaceTime, or Zoom, can help an older adult maintain social connections. If your loved one struggles with technology, a professional caregiver can help with set-up and troubleshooting to get them going.
• Help them feel needed and valued.
  Depression in the elderly sometimes stems from feeling unwanted or not valued. Ask for input or assistance from your loved one — even if they live far away. They will thrive and appreciate the opportunity to assist.
• Participate in favorite activities.
  Find activities you both enjoy, and plan times together to do them. Stay connected through regular visits, weekend dinners, baking cookies, card games, evening walks, or grandchildren’s sporting events. These activities can go a long way toward preventing isolation and depression.
• Create opportunities for companionship.
  Encourage your older loved one to safely engage in activities with community groups, religious organizations, and senior centers to provide opportunities to meet new friends and socialize. If they are in assisted living, they may have planned activities there in which your loved one can participate. If they are living alone, hiring a companion can sometimes help.

But what if this loneliness becomes something more: depression. Depression can be a vicious circle for those who already feel lonely; causing a low mood or lack of motivation which makes it very difficult for them to spend time with others. When they withdraw from others, the feelings of loneliness can increase. This can in turn deepen depression. And the lack of interaction with others may cause other health issues such as: Alzheimer’s, dementia, or other cognitive health problems. Watch for the signs of depression: feelings of hopelessness, loss of interest in activities, changes in sleep or appetite, and thoughts of suicide.

If you suspect your loved one is suffering from depression, talk with them. Let them know they are not alone. If the depression is serious, suggest they see a doctor for medication, or that they speak with a therapist. Offer to go with them to the doctor if they are afraid to go alone. Support them as they take the steps to improve their lives.

Senior Isolation and Loneliness

Following up on my last blog about the Winter Blues, I would like to address a special population directly, those who often suffer from depression the most. So, this is for anyone over the age of 60, and from one of your peers – me. I don’t particularly care for the term “elderly” so I am going to instead use senior, a term I can better identify with. There is an issue that is growing in our population, Isolation, loneliness and depression. This is a silent struggle that often goes unnoticed. Many seniors find themselves grappling with a profound sense of solitude and depression.

Aging is a natural part of life’s journey, and with it comes a myriad of changes – physical, emotional, and social. As we enter our senior years, and throughout the 40 years that make it up (60-100+), the social landscape can transform into unfamiliar terrain, and multiple times at that. Children grow up, friends move away, and the once-familiar faces may become distant memories. In this process, we can find ourselves standing on the precipice of isolation, peering into a void that threatens to engulf our sense of purpose and belonging. Loneliness is not merely a lack of companionship; it’s the absence of meaningful connections that once defined our daily lives. Social interactions that were once abundant may dwindle, leaving behind a void that cannot be easily filled.

Anyone living alone, and at any age, can face these feelings. Whether retired or working, we need to face loneliness head on. And please, if you haven’t retired yet, plan, plan, plan for it as loneliness and depression are more likely. I recall my mother struggling with meaning in her mid-60’s. It was then that she added several activities to her life: hospital volunteer; Eucharistic home-bound ministry at her church; and her ladies stretching, exercising, and friendship group. These activities carried her through her late 70’s; adding meaning, friendships, and reducing her loneliness.

If loneliness is there, but also depression, making changes may only be part of what needs to happen to get back into a good place. Feeling down occasionally, lonely, anxious, sad, or “empty” is normal. However, if these feelings persist for weeks or months, it could signify a more serious depression. Here are some signs of depression to watch for in yourself or another:

• Feelings of hopelessness, guilt, worthlessness, or helplessness,
• Irritability, restlessness, or having trouble sitting still,
• Loss of interest in previously enjoyable activities,
• Decreased energy or fatigue,
• Moving or talking more slowly,
• Difficulty with concentration, memory, or decision-making,
• Changes in sleep habits, such as trouble falling asleep, waking up too early, or sleeping too much,
• Changes in appetite
• Thoughts of death or suicide, or suicide attempts.

If you are facing depression, or stuck in loneliness and isolation pre-depression, please remember you are not alone. Sometimes it means reaching out to an old friend. Or, finding a new friend group or two as my mother found. Maybe taking a class in something you’ve been interested in will help. But if those things don’t help, or you checked off more than two of the first 9 symptoms above, or just the 10^th, talk with your doctor as well as someone close to you.

If you know a senior who seems to be struggling and is not getting help, offer to listen and encourage them to go to their doctor. Sometimes more than a change is needed to resolve the issue. Only by addressing it with their doctor will they be able to get the medication needed to help them. And having your support may be what they need to take that step.

Both of my parents often said in their 80’s that “getting older is not for sissies.” And they are right. But dad also had his humor until the end. He celebrated every holiday, birthday, and family get-together as a special event, golfed every week – 3 times, played poker with his buddies monthly, and went to a support meeting at least twice a week. He lived. My mother lived. I watched a birthday special for Dick Van Dyke’s 98^th birthday this month. His message was to keep moving …” get your living done first, and have the nerve to try something. Failure’s OK. “

So, take a risk: call the doctor; call a friend, sign up for a class; join a book group; move closer to friends or family; go to a Bible study; play poker with your buddies; learn to garden at your pace whether pots, raised bed, or in the ground; and keep moving. Finley is one of my biggest joys as my pup. Getting a dog or cat for a pet reduces depression and improves health. But take a risk…You may have to learn new ways to live at 68 or 75 or 83, as life and our bodies change. Remember my dad’s face … and keep smiling, keep getting out, and revise your activities and life as needed. As Betty White said: “Don’t try to be young. Stay interested in stuff.”

Winter Blues

The holidays are over. Lights taken down, decorations packed away, candles blown out. Maybe you’re more aware of the brevity of our days, the darkness or grayness of the weather and short days, or the loneliness as all of the activity has ended and you’re back at work full-time. While some of this is very normal and natural, if feelings of depression, isolation, anxiety or simply “feeling down” are intense or last for more than two weeks can be a symptom of a more serious problem–depression.

Frequently the holidays bring to the surface long avoided feelings of loneliness, discouragement, or dissatisfaction with family relationships. You may find you feel disconnected from others, that you don’t count, or that no one cares for you. Often food, music, and work are used to push away those feelings. But in bed, late at night, you’re aware of the feelings again. And with no holiday to look forward to, it’s even harder to keep going.

It is important to determine whether the blues are temporary or are a symptom of depression. If it’s been more than 10-14 days, it’s time to consider emotional reasons for depression. If they are deep and/or began in November, you might also need to consider whether you have seasonal affective disorder (SAD).

Generally, the holiday blues will resolve with no extra effort within a few weeks. While you may feel sad, tired, or distressed, you are able to handle everyday activities and responsibilities. Spring may become your goal as you deal with rain or spring break is the vacation coming up. You are moving forward.

Depression is more intense than the “blues”. First, the hope in the vacation or spring or some other experience is not present. Depression is interfering with your daily life. What used to be enjoyable may now feel like a burden. In fact, getting out of bed in the morning may be more than you can handle some days.

Other warning signs are:

• Feelings of emptiness, guilt, hopelessness, or despair,
• Lack of energy–even after eight hours of sleep,
• Changes in eating and sleeping patterns,
• Feeling irritable and overwhelmed—life’s responsibilities feel crushing,
• You can’t concentrate or follow through on plans, or
• Memory isn’t as crisp as usual.

The good news is that depression IS treatable. Up to 80% of those who finally seek help are helped. If you have a doctor, nurse practitioner, therapist, or psychiatrist you trust, go, and talk with them about what is going on. Often, we believe we must keep a stiff upper lip and not ask for help for depression. It may be considered a sign of weakness to ask. But the fact is depression is not helped by just ‘thinking positively”. Professional intervention is often necessary, and treatment for depression may be multi-faceted.

First, see a therapist for a complete evaluation. For years studies have indicated that therapy along with anti-depressants is more effective than anti-depressants alone. Naturopaths and others also have good luck with herbal remedies many times. Then, increase physical activity as exercise allows the body to produce more endorphins which increases mood. Minimize the amount of sugar and flour you eat as these foods increase depression. Finally, get adequate but not excessive rest–six to nine hours per night. If this sounds like too much, choose one to try for the next week. If you don’t have success, then call one of the professionals I mentioned above. If you don’t know someone, ask a friend for a referral. You might also try the following:

• Partnering with a friend can be very helpful during these times. Connect with a friend to hold each other accountable to do one thing you’ve avoided. Build on that success.
• -Listen to your heart. Do you need time with a friend, a funny movie, or a day with a child?
• -Often depression is anger turned inward. Consider forgiving yourself.
• -Take care of your physical needs. Set reasonable goals and develop a way to achieve them.
• -Plan an outing for March when it’s warmer and brighter. Or, consider your spring garden and what you will do with that as it warms up.

Hold onto hope. As C.S. Lewis said, “You are never too told to set another goal or to dream a new dream.” It may feel impossible today, but if you reach out to another, accept help, and don’t stop believing, you will find a clearer day ahead.

The Coming Dawn: Paradox of Expectations

It’s been said that the morning comes with expectations and the evening ends with experiences. Have you ever been asked to go on a hike, and wanted to go, but expected the view in the desert to be brown and very hot, and not terribly exciting?  But the hike sounded wonderful?   

As you keep walking the hot, dry desert there are various twists and turns, and you learn new lessons about the desert and what it is like, what you are capable of hiking.  And then there is turn, perhaps around the small mountain to the right, where you will see a whole new view that opens, like this:

The difference reminds me of how my expectations often are short-sighted and only about now.  It can lead to an experience that seems “unfair” or somehow wrong.  As an example, when I got Finley, my one-year-old Australian shepherd, a year ago, I very much enjoyed much of the love the companionship and fun I wanted.  There also were many days of housebreaking and teaching him to walk on a leash and playing with him when I was exhausted.  On one particularly difficult day, he chose to go and dig up a sprinkler line and come in full of mud (and joy) in the middle of an appointment I had with a client.  Not a happy dog-mama at that moment!  But today, all I need to do is call him when I see him out in the yard and suspect he is digging and he runs right in and comes to me.  And it is rare for him to do it.  So I ended up with a well-behaved dog (most of the time) and I’ve learned more patience, but the middle was not always fun and I wasn’t necessarily anticipating some of how I grew in this first year.  😊

Henri Nouwen spoke about this as the paradox of expectation in his writings.  He wrote of many paradoxes, but in this one we may be expecting something wonderful, and yet receive pain, growth, or challenges in the middle, and the gift comes through that experience.  In being open to this potential growth or gifting we can make it through some very painful days more easily.  As Nouwen aid, “those who believe in tomorrow can better live today…those who expect joy to come out of sadness can discover the beginnings of a new life” (Henri Nouwen Society, March 12, 2019 Daily Meditation).  Finley did grow up – and is much better behaved as a one-year-old than he was 9 months ago.  And when I could remember he would mature and grow out of things I had much happier days. 

I have a couple of friends going through very difficult cancer treatments right now.  And you know I see clients who are often going through hard, hard times.  We are all stressed this year by Covid-19 and the changes it has brought to our lives.  When I turn to the expectation paradox, I get through these experiences so much more easily as I truly do believe good will eventually triumph in health, recovery will follow the sickness of chemotherapy, and when a loved one is near the end I truly do believe my loved one will again have a new life.  I also believe that somehow a new normal in living with Covid-19 will come that allows better treatment or vaccine that will allow more contact and connection with others physically as well as through the virtual sources we often use now. 

Am I being a Pollyanna?  Well, I don’t think so.  What I’ve learned over years is that if I expect that eventually things will work out, whatever happens in the middle is just the middle.  It doesn’t mean I don’t grieve if I lose someone in death.  It doesn’t mean I enjoy it when a doctor has a concern.  And it doesn’t mean that I want to offer shallow compassion.  But I do want to help you, and others, to remember this is but one day in our lives, not all of it.  A Jewish proverb I have read is “He that can’t endure will not live to see the good”.   And aren’t we really talking about the essence of hope as expressed on a save to my Pinterest board, “H.O.P.E.:  Hold On Pain Eases”.  So, what to do in the middle?  One part is dealing with what is in the middle.  If there are treatments we must undergo, we do it.  A little over a year ago I needed to have a biopsy in out-patient surgery.  To not address that would have been very unhelpful.  It would have been closing my eyes and ignoring the situation.  That’s not what I’m talking about.  Instead, it was scheduled, and most fortunately, I was able to find out everything was fine quickly.  For others, it’s going through very difficult treatments.  Either way – we come out the other end – pain does, indeed, ease. 

Another thing I recommend includes self-care methods I’ve written about frequently.  But what about just looking for positive things happening in our world right now?  We tend to over-focus on the election, Covid-19, and other concerns that are valid, but when overly focused upon lead to depression and anxiety and constant unrest within.  We cannot ignore those concerns, but we also need to take time to notice what we are grateful for and what is positive around us.  Angie found several things, and I’ll mention three here:

Take a look at “Cook Like a Firefighter”, an event ongoing through October 17 at https://egivesmart.com/events/ibl/.  Quite a few Arizona fire departments are participating in a fundraiser for burn victims.  You’ll find recipes you can make at home and each department has a separate link to a video to watch them prepare the dish!

A baby gets to hear his mother’s voice for the first time and let me tell you, it is adorable and reminds me of the miracles in medical science! https://abcnews.go.com/WNT/year-hears-mothers-voice-time-reaction-precious/story?id=73083089

Finally, a story for both dog and cat lovers alike, a local rescue group brings together an unlikely family: https://www.abc15.com/news/state/rescued-dog-who-lost-her-puppies-adopts-trio-of-orphaned-kittens

Where to find such stories and information when you just need a breath of fresh air?  Check out https://www.goodnewsnetwork.org .  This allows us to also alter some of our expectations by reminding us that, as my grandma used to tell me, “It’s always darkest before the dawn” – and dawn will eventually arrive no matter how bad it feels or is today. 

May you each remember the paradox of expectation and focus on the joy that will come, the healing, the peace.  As Nouwen says, your heart will be full of joy again.  We are wishing each of you some time of lightness, peace, and rest so you may take on the next challenges to come your way with a renewed spirit.

Take care,

Dr. Beth & Angie

Beth Sikora, PhD and Angie Read, B.S.

Loneliness. Solitude. Alone.

Such words often stir feelings deep in our souls and hearts.  As humans we tend to avoid such feelings and experiences.  And yet we have had to often face all three more deeply this year than others.  What do they mean?  Are they the same?  How are they different?  Sometimes we find we want to just brush over the words and feelings that pop up and run to find someone and be busy.  Yet some philosophies, spirituality and philosophy among them, encourage solitude at times.  And in solitude we are alone.   

Depending on the definition, loneliness is either physical isolation or the feeling of sadness over not having people around.  Or, from a philosophical and psychological perspective, it is a feeling of having insufficient relationships or accessibility to others to meet the needs a person has at that time.  It may simply be a need for companionship and with Covid-19 we cannot always get together as we’d like because it competes with need to stay at home more.  

Solitude is defined as the less painful part of not having people available – being alone and enjoying that and finding comfort or relief in the silence, or as Paul Tillich defined it, “the glory of being alone”.   

Alone is simply having no one else present.  It’s a state of being, but not related to feelings.   

Introverts often relish times of solitude and use them to recharge their batteries.  I’m partially introverted, and a quiet evening alone is sheer enjoyment for me.  I am in solitude, not feeling loneliness.  However, an extrovert who recharges with others may face alone time after a busy day as painful and lonely.  That person doesn’t have the others around to recharge with and thus the felt experience of solitude is very different.   

I read a book by a philosopher and psychologist from the 1950’s, Clark Moustakas, that was entitled “Loneliness”.  It was interesting as I read reviews of it on Amazon today – readers talk about it as not being the self-help book of the 2000’s, but rather a warm, inviting book, that asks us to look at what we are experiencing in the way of solitude versus loneliness and helping us to individually tackle the existential loneliness we are feeling at times.  I truly believe the experience of loneliness is not unique to us – but rather something we all experience at times, and based on the situation of it, may feel like solitude is pleasurable or loneliness which is painful.   

I was speaking with a friend who had cancer years ago, and one of the things she mentioned to me was that while she had family and sisters who were there to support her every step, and friends who were available and caring, the essence of her experience was a very lonely one.  She had to go under the radiation with only herself.  And eventually, she had to face her own death in some lonely ways.  Yet she also had times of solitude when she experienced spiritual growth and connection.  During Covid-19 many people are feeling lonely and depressed – others feeling solitude – and both can be in times they are alone or with others.  But it is loneliness that leads to depression.   

Depression is a reaction to longer term loneliness for some, and can leave a person feeling isolated, hopeless, and abandoned.  On a rational level, we may know that we are not abandoned at all, and yet the isolation is hurtful.  I can only imagine how isolating life is for many in senior care facilities or hospitals during this time.  The time we most need connection and love and touch is the very time we are quarantining and not connecting or touching.  And if a person has a limited memory, as many elderly do in senior care facilities, then that must feel like true abandonment.  Thankfully iPads and other devices have allowed some connection for many; but, this is still not the touch and presence that can bring us out of loneliness.  And unfortunately for many living alone and for others isolated in their living without time with friends, this is leading to higher levels of depression that has led to even higher levels of suicide than the past.  This month is National Suicide Awareness month and it’s so important we remain aware that we can turn loneliness to more of an experience of solitude – for growth spiritually and otherwise that can become more positive rather than the intensely painful loneliness that underlies the suicide increases.   

So how does a person make this shift?  Here are a few ideas from multiple sources of both spiritual and psychological literature.  Moustakas would encourage us to look within for what loneliness means to us, and how solitude might help us move out to a more healthy place.  He believed that it comes through introspection and not just trying to change the environment.  So asking yourself questions – what does it mean to you to not have people around as much?  What do you believe that means about you?  How did you come to have that belief?  What are your spiritual beliefs about loneliness?  Is there a way to walk into the loneliness and see what you might learn about yourself?  How is loneliness helpful in your life right now?  What is there for you to learn from it?  Start anywhere in these questions and begin journaling about your own experiences and internal feelings.  I would encourage you to move on to see where this goes and, if you can, look for Moustakas’ book (it’s hard to find but worth it) and take the journey he offers through it.  One of the gifts of loneliness is shifting to solitude through which we find meaning or purpose in this time.  In writing through exercises such as the above I do believe you’ll make your way through the desolation of loneliness to the peace of solitude.  

If depression has you, then first deal with the depression.  If it is significant and/or you have thoughts of self-harm at all – then you need to reach out for help now.  Not later.  There is a suicide hot-line at 1-800-273-8255 that is available 24 hours a day.  If you don’t feel suicidal but the depression is strong, then reach out to your family doctor, gynecologist, therapist, or spiritual director/priest/rabbi and get some help for it.  Only after this is resolved will you be able to move into the above ideas from Moustakas.  

Don’t ignore the spiritual work you may be called to during this time that can soothe the loneliness.  Starting a new practice can be helpful at times when we feel dark around us rather than the light of solitude. At other times hunkering down in a tried and true path is more comfortable.  Regardless, consider which feels right to you and perhaps try walking a handheld or land-based labyrinth, focus on a daily reading, take a mindful walk in the park, reread a special spiritual book or passage in the Bible or your faith’s tradition and take comfort in the words.   

In addition to the personal work, I would also encourage you to consider who else might be available.  Call a friend and ask to do it face-to-face on WhatsApp or Facetime or Zoom or some other modality.  Visual connection helps over only auditory and much more so than text.  I also encourage walks – get out and move and at least see others in your neighborhood as it will give you a mild sense of connection to your community in a safe way.  Other ideas to reaffirm connection can be joining an online class or service where there are regular Zoom or other meetings and you have the opportunity to interact with everyone; planning a weekend camping with a friend or a time at a cabin with friend or family member; volunteering where you feel safe such as walking a dog at a shelter- walking outdoors and cuddling with an animal might meet two needs in one; get a pet after considering what you can handle long-term, it may not be a dog or cat but perhaps a hamster or bird to keep you company.  You get the idea.   

Loneliness is a frequent feeling experienced recently, and may underlie the fatigue many are feeling in following pandemic safety.  There are ways through it, as I’ve shared.  John O’Donohue also writes about solitude and loneliness. May his words bring you encouragement, comfort, and increased solitude over pain.   

With care and best wishes for growth and comfort to your heart,  

Dr. Beth 

Dr. Beth Sikora, PhD, LPC, NCC 

Making Decisions: A Time of Challenge but All Shall Be Well

It seems there isn’t a week that goes by that doesn’t demand we make decisions about our safety and health as well as that of our families’, elections, finances, how to better show respect for each other, and what to do about school for our children.  While that is always the case in some way, 2020 has certainly brought all of these issues to a much higher frequency and intensity than we’ve had to deal with in the past.  It’s hardly a surprise, then, that both anxiety and depression are rising at a very high speed and being predicted to be the next pandemic we’ll have to address.  In fact, the Arizona Republic today reported that a warm line that is for those struggling with those feelings has gone from an average of 850 to 1500-2000 calls a week since mid-March.  So, with an awareness of how much stress is on individuals with decisions right now and the anxiety and depression increase I’m including a Part 1 and Part 2 to this blog.  The first is on decision making, and the second on anxiety and depression. 

Part 1:  Decision Making   

Weighty decisions can be difficult to make when the options are clear or there are good arguments to be made for either side. And right now, that is proving especially true. It’s tough to know the right thing to do, isn’t it? Mask wearing. Elections. Going back to school or a workplace. How do you make decisions when there are so many unknowns, and the options are not the best? There was a clip on Good Morning America this past week from a pediatrician who was sharing her advice on making decisions. Her focus was on safety of students returning to school but my takeaway was something that could be expanded to broader decisions: there is no “right” decision.  A person just has to make the best decision for his or her family with the information available at the time  and move on. So, let’s take it back to the basics, and start with the decision-making process itself.

1. Identify the decision: Clearly define the nature of the decision you must make.

2. Gather relevant information: Collect some pertinent information from trusted sources. Some information is internal: you’ll seek it through a process of self-assessment. Other information is external: you’ll find it online, from other people, and from other sources.

3. Identify the alternatives: As you collect information, you will probably identify several possible paths of action, or alternatives. You can also use your imagination and additional information to construct new alternatives. In this step, you will list all possible and desirable alternatives.

4. Weigh the evidence: Draw on your information and emotions to imagine what it would be like if you carried out each of the alternatives to the end. As you go through this difficult internal process, you’ll begin to favor certain alternatives: those that seem to have a higher potential for reaching your goal.

5. Choose from alternatives: Once you have weighed all the evidence, you are ready to select the alternative that seems to be best one for you. You may even choose a combination of alternatives. Your choice in Step 5 may very likely be the same or similar to the alternative you placed at the top of your list at the end of Step 4.

6. Take action: You’re now ready to take some positive action by beginning to implement the alternative you chose in Step 5.

7. Review your decision & its consequences: In this final step, consider the results of your decision and evaluate whether or not it has resolved the need you identified. If the decision has not met the identified need, you may want to repeat certain steps of the process to make a new decision. For example, you might want to gather more detailed or somewhat different information or explore additional alternatives.

This process may be one you already intuitively use, but if you feel you’re more of a gut reaction person, write down the direction you want to take based on your instinct and then try using the process described above. Do you arrive at the same conclusion? Is there a way to blend both conclusions that feels like a well-informed answer for you? Remember that even in times of uncertainty, we can each only do our best. What is right for today may not be what is right for tomorrow, so take some time, consider all options, and trust yourself. We can only make the best decision for today, and with the information we have today.  Know that and try not to question the decision later.  Reassessing later is fine to see if you need to change direction, but it’s again a decision made from the information you have on that day.  The decisions you make will be the right ones for yourselves for today, and that’s the best any of us can expect.

Part 2:  Anxiety and Depression Increasing

Essentially depression is a feeling of hopelessness, sadness, and/or loss of interest in life or activities you would generally enjoy.  It may be situational, i.e.:  related to a current situation in your life; or, clinical, i.e.:  related to a biological change or malfunction from medical, hormonal, genetic, or other reasons over which you may not have control.  Anxiety is a sense of impending doom or reaction to a stressful or situations perceived as dangerous.  The symptoms of each are specific, and you can get more information on anxiety and depression on our website.

Now that you understand it – what do you think?   Are you suffering a bit from it?  I do encourage you to track it for a while to see where you are with it and how it’s trending.  So, get a piece of paper, a notepad in your device, or use a program, and rate it 1 (none at all) to 10 (you could act on suicide today).  If it is 8-10 you need to call your doctor or therapist.  Or, at the bottom are a few crisis lines if you can’t quickly reach someone for help.  Please don’t let your ego or past beliefs get in your way – depression is a high-risk illness – and potentially can be fatal in a small number of cases.  So, get the help you deserve.  How about anxiety?  I would encourage you to again track for a while – what is triggering it?  If it’s decision making – see above.  If it’s getting sick – work on focusing on what you’re already doing to take care of yourself and family.  And if it’s always stuck in your head, ask for help. 

If you are nervous about dealing with both children and work this fall, sit down and speak with your partner or a good friend and work out a plan for your day.  Sometimes using a calendar helps one in organizing the day so you know what the children need to do and where they need to be – whether at school or online for school, work hours, doctor and other appointments, shopping, etc.  And together also brainstorm all the free services or low-cost services you can call on to help save you time – Instant Cart, Door Dash, individual store shop and pick up options, and others.  Also, who can you share with and split the errands or needs?  Perhaps after reviewing your calendar together your spouse or partner can list all the errands for the week, and each agree to handle some of the work.  The same with work around the house.  Often an hour of planning can help save you hours.  And that will mean decreased anxiety and depression.    

Other anxiety and depression prompts can be larger with less tangible solutions.  Things like, will I be laid off?  How will I survive if that happens?  What will happen in the election?  Worry about a parent in an assisted care whom you cannot visit presently.  Or even a lonely feeling of not seeing friends as you have in the past, the isolation many are enduring.  Interestingly the steps are similar to decision making in that we need to first identify what is triggering the feeling.  Next, look for information about that to identify whether you are worrying or anxious about a reality or something that isn’t real at present.  An example might be a fear of being laid off as fear of the economy is in your mind.  Well, check out your company’s financial condition, see what your boss or Human Resources know about potential lay-offs.  They won’t give you concrete assurances, but often you can identify whether things have even been talked about and check the trade periodicals for the same.  Then consider how to make your position and you more valuable to the company and be sure to improve your position through upgrading skills, identifying your successes to more than just yourself, and challenging any negative thoughts that are not grounded in facts.  Even if you are affected by a lay-off by doing these last things you are upgrading your value to other companies.  Then note this on your calendar for 30 days out and reassess.  Each time you want to worry – take yourself back to the calendar and notice you have a “worry date” made for later.  That written task let’s our brain let go of this more easily.  The steps here are:  a) identify the cause of the feelings; b) get information about the reality of the situation; c) determine if there is someone else who can help you gain more information or perspective (often this is a spouse or friend); d) list options you can take to better the situation for you; e) make a date to next evaluate the situation; and f) reassess it on that date. 

Next time I’ll write about loneliness as it is impacting so very many individuals and I believe it is frequently underlying the current depression.  But for now – you have some concrete tools to deal with situational depression and anxiety and decision making.  I also have to encourage you to call on your spiritual resources, support people, creative outlets, and music.  All can improve or worsen our current functioning.  So, consider a step in each of these areas, you may be surprised how much something as simple as listening to music if you haven’t for awhile will help your mood.  Or coloring a mandala.  Or even just doing a walking meditation or online church service.  We’re not made in isolation, folks, we need others to live successfully.  So, use the creations of others (music), the connection spiritually that you have; the friends and close others in your life as well as family; and creation outdoors to bolster you at these times.  And if it is even too much for those resources, see the resources for immediate help if you can’t reach a therapist or physician.  But take care of yourself and reach a therapist or doctor for ongoing care. 

To close I’ll share a prayer that was written during a time of great difficulty 100’s of years ago: 

All shall be well.

And all shall be well.

And all manner of thing shall be well.  (Julian of Norwich)

Be well and take care of yourself,

Dr. Beth

Teen Lifeline:  (for teens) 602-248-8336 or 1-800-248-8336

Maricopa County Suicide and Crisis Hotline:  1-800-631-1314 or 602-222-9444

National Suicide Prevention Line:  1-800-273-8255 and for Spanish:  1-888-628-9454

Crisis Response Network:  602-347-1100

Decision making process excerpts taken from https://www.umassd.edu/fycm/decision-making/process/

An Exercise for a Time of Adversity

I’ve been working on my thoughts for the blog this weekend – one I promised on growth in adversity. And I’ve written it once, had it edited, and am issuing a fully rewritten one now. Obviously, adversity is hard to go through – and challenging in other ways. The meditation that had hit my inbox on Friday that spoke to me about growth in adversity was from Henri Nouwen in “You Are Beloved.”  And what strikes me today in it is the same and yet different after more meditating and doing a finger labyrinth meditation today.  The quote is: 

“The great conversion in our life is to recognize and believe that the many unexpected events are not just disturbing interruptions in our projects [or lives], but the way in which God molds our hearts[.]…Our great temptations are boredom and bitterness. When our good plans are interrupted by poor weather, our well-organized careers by illness or bad luck, our peace of mind by inner turmoil, our hope for peace by a new war, our desire for a stable government by a constant changing of the guards, and our desire for immortality by real death, we are tempted to give in to a paralyzing boredom or to strike back in destructive bitterness. But when we believe that patience can make our expectations grow, then fate can be converted into a vocation, wounds into a call for deeper understanding, and sadness into a birthplace of joy.” [changes mine]

What my labyrinth walk, a talk with a friend this morning, and the above from Nouwen have all pointed me toward is – – release.  Release is necessary to grow in times in adversity.  In fact, it was just in rereading the quote that I realized that the onus was on God and Spirit to mold – not me to change.  And then release of what?  From what?  To what?  Ahhh – there is the rub at times.  From even knowing that. 

What we often want so much during difficult, really adverse life events or times is to KNOW.  Know what we are to do next.  Know why something happened.  Know how to change it.  Know how to prevent it.  Know how to keep life from changing as it has been comfortable for us. And in the last weeks, months, or even days, we each have had to face down varying levels of demons or challenges in our lives.  Think about it for just a moment – what are you facing right now?  Is it illness?  Is it not understanding your partner or spouse?  Is it not knowing what to do next to help someone?  To help yourself?  Is it financial difficulty?  Go ahead, take a few moments to name the situation for yourself. Write it down if you’re open to doing so before you read on.

Now, what is it that you are trying to control in that situation?  For me, often it is outcome.  I want to be able to create a change or gain an insight in order to grow and move.  Or I want to create that space and hold it for another.  But my goal or method is not the answer; often, it is allowing the answer to unfold.  It is … release.  And yet being with someone or sharing the process with someone without knowing is to walk in darkness alongside them knowing that is enough.  As you are aware of what you are trying to control – perhaps a parent from getting Covid or dying from it alone in an ICU; maybe how you will pay the bills in 3 months when the severance runs out or tomorrow when there is no money; maybe how your employer is responding to changes in life recently; or maybe how you are managing your day-to-day life in the midst of a mild or moderate depression.  Give yourself a moment to pause, and again write down whatever outcome you are trying to control.

Next, I’d like you to find an object that reminds you of that issue.  A penny for a financial one; a rock for a stubborn issue you can’t seem to get around or influence; a Bayer Aspirin bottle for a loved one who is ill; these are some ideas to get your mind going.  If you can and choose to do so, take a few minutes to go find it in your home and return to finish reading. Pause here.

Then take the item you have chosen and hold it in your hand. Gently, as the hand is with the birds in the image above. Consider this item as fragile, even if, at first glance it isn’t. Your emotions about the issue this item symbolizes may be fragile, so treat this item with tender care. As you are meditating, look over the item you’re holding and see what feature you might not have noticed previously.  Release what you think you know, and turn it over and look at it with new eyes.  Consider what it has to show you.  I’ve had a very craggy rock Finley brought in the house that I’m using for my exercise in this.  And as I’m looking at it, I’m seeing an eruption in the top of it that is very sharp and discolored and today am aware of that as the focus – not the rock.  It is helping me to see the pain in something from not a heavy place but from the sensitive, hurting place.  What is different about the item in front of you – what hadn’t you noticed about it previously?  What is the message about the situation from that perspective?  Consider spending a few moments writing about that.  You might think about it in these terms if you get stuck on this part. 

I saw the _________________________ as representing _________________.

What I’d never noticed about the ___________ was ___________________________.

I’m aware now that it is possible that ________________________________.

As you finish the above exercise, what is the takeaway for you?  What have you learned by simply looking for the small factor you hadn’t considered or known about or been aware of as clearly?  Does that allow your view of the adversity you experiencing to shift?  And what does that mean to you about moving forward? Take some time to think about this and make some notes about it before moving on. Pause here.

Going back to Henri Nouwen’s writing – adversity, change, growth, understanding, and finally, joy are the stages of movement when moving through adversity and emerging in a new place.  What we must do is release ourselves from having to understand and know — and then, only then, we can begin moving towards the change, growth, understanding and finally joy that comes from that release.  The baby bird in the above picture wasn’t born with the ability to fly, it needed tending to and nurturing until ready to be released from the nest in flight. Only then, after time, after growth, came the release. I hope you can find your way to it through the above exercise too. 

Peace and calm be yours this week.

Take care,

Dr. Beth

Calming an Anxious Mind

Sometimes it can seem as though our minds never turns off. During these times most recently, we may find that we have ruminating thoughts about the state of our world, our nation, our state, our county, and lastly but certainly not least–our households. Trying to maintain a positive attitude at home or with others may be difficult, let alone being fully present with others.

These are concerns facing many today, and part of a larger theme of anxiety I’m hearing about routinely in my practice. Across our nation, we are seeing re-openings of businesses, and with that comes new decisions of what is truly safe to do. I’ve provided resources in past blogs (found here, here, and here) of reliable sources to look for information as well as tools to get you through this time on my website found here.

Today though, let’s talk about the anxiety itself and how to cope with it. There is a graphic circulating online which shows varying stages of acceptance, take a look below:

This is a great illustration of the process of learning to open oneself up again. In some ways, this re-opening feels a bit like the immediate post-911 world to me. There was fear of going out and resuming “normal” life directly after the attacks because we just weren’t sure it was over. Our nation faced significant losses during that time, and we will never be who we were before that event; but, as time marched on we learned to process the experience and with that, we moved forward. We will do the same with Coronavirus/Covid-19. Take a look at the graphic, see where you think you may fall in the bands radiating off of the circle of Covid–do you see that you’ve made some progress? Or are you still practicing some of the behaviors in the darkest zone, the fear zone? Do you see that some of how you are feeling or acting are examples spread across more than one zone? That is a completely reasonable reaction. Likely where most of us are.

The above graphic also reminds me of the stages of grief, in more than one way. Many of us are familiar with this model of grieving developed by Elizabeth Kubler-Ross and I find the stages apply to more than the loss of a loved one. She defined them as, 1. Denial and isolation, 2. Anger, 3. Bargaining, 4. Depression, 5. Acceptance. Some of those examples look familiar to the handling of this Covid era too, don’t they? The initial denial that this could be happening to the people of our world, our nation; the anger at others who may not be taking the news the same way we have chosen to respond; the bargaining–if only we’d done X, then…; and the isolation which can also bring on depression.

My point to all this? We’ve handled grief likely on a personal basis, but also as a nation before. We’ve been fearful of unknown forces. We have come through it, and maybe we don’t look the same as we did before the catastrophe–on a world or national scale or on an interpersonal, familial one such as after the loss of a loved one–but we humans are resilient and even after a time that feels like it could have been the end of the world, we can again find beauty in things. So, let’s talk about how to move forward.

Mindfulness. Merriam Webster defines mindfulness as: 1: the quality or state of being mindful. 2: the practice of maintaining a nonjudgmental state of heightened or complete awareness of one’s thoughts, emotions, or experiences on a moment-to-moment basis also; a state of awareness. It’s a topic I’ve covered on a recent blog found here because I feel strongly mindfulness is one of our most useful tools in healing.

• I came across some wonderful “attitudes for anxiety” in a blog post on Positive Psychology–to read the full post, click here. The 10 attitudes to practice for anxiety are towards the bottom but there are a number of other tools to practice she highlights–it’s worth the read. The one I find most essential is to: 1. Notice what is going on in your body. What are you feeling? Where? Is it the discomfort of reflux? The heart-pounding of panic? The headache or migraine of muscle tension? 2. Just stay with that feeling and feel it for a moment. Really let yourself become aware of what is going on internally. 3. Recognize what your thoughts are that either preceded the physical issue or are still present with the physical sensation. 4. Take a slow deep soothing breath into that part of your body that is in pain, taught, or uncomfortable. Hold it. Then blow it out as fast and hard as you can. Imagine that breath out as the difficult thoughts and feelings – blow them all out of your body. Do this several times and then attend to the area of the body with some self-care, i.e.: massage the muscles, notice the heart pounding may have slowed down with the breaths, or the reflux released just a little and if not take the medication you have for it.
• Learn to meditate. There are countless videos and apps for meditation, some found on our website here, others a mere google search away. But here’s a good one I learned from a nun at an anxiety workshop many years ago. Spend 5 minutes looking into the flame of a candle. A well done video with an introduction to this meditation and a recorded candle’s flame for this process can be found here.
• Deal with only one day at a time – Jon Kabat-Zinn has discussed this on Oprah’s Super Soul Sunday, the clip may be found here. He proposes checking in on yourself. How do you feel this morning? Are you still upset about a fight last night, or worried about an upcoming meeting? What do you want to achieve today? Understanding how you feel before you embark on your day can help you go through your day more mindfully. “Drop in on yourself and rest for a stretch of time,” Kabat-Zinn says. “And then as you go about your daily life, check in. Once an hour, once a minute. Once a day. You decide”.
• Another technique a trusted colleague recently reminded me of when dealing with anxiety about the future and what is okay to do now or in a week about Covid-19 is to look at your watch. What time is it? What day? This is all you can make decisions about and deal with in this situation – use your watch as your reminder. See this blog for more information.

As I’ve written about before, practice good self-care. Not only the physical in good hand washing practices or wearing masks; but also, the mental self-care. Remember to limit your media consumption, be gentle with yourself, and get outside daily. If you’re dealing with OCD, it can be a tough time to manage your symptoms. If your current techniques aren’t working or you’re becoming worse through this, here’s an article written first person by someone who is handling OCD related to our current pandemic. Take a look at her tips, and if they’re new to you consider implementing the ideas. Even if they were routine previously, it may be time to up your game on using them. There are also some basic self-care principles written about here.

The same basic ideas apply to how to best care for your children during this time, but I cannot underscore this point enough, talk to them. Ask questions about how they’re feeling in an age appropriate way. If they’re older, see if they have questions on the state of things related to the illness and the ability to go out in the world or what your emergency preparedness plans would be. Ask them how they’re really doing at this time, and if they’re isolated from their peers–and consider supporting them in some things you previously may not have been as open to such as gaming on a device. In limited doses, it may be a great way for your kids to stay connected to their friends–it’s often a group activity yet can be played from individual houses. Watch for behavior changes in them–and if you’re seeing signs that are worrisome get them help. At this time of tele-therapy, they may be more open to the idea of talking to someone from the comfort of their own space rather than having to go into an office for counseling. If your children are younger, don’t overlook playtime as moments that feelings surface. Role playing with dolls, or even putting names to favorite play cars and trucks may bring out “feelings” the toys may have–but could really be the feelings your child may be dealing with. Remember, just like it can be hard for us as adults to put a name on a feeling or be forthright when we are having a hard time, children feel that too. Play with your kids when you can make time. No moment is too small–from the bathtub to a walk around the neighborhood, remember to take moments to check in on your littler people. Here’s a quick read from Seattle Children’s hospital on helping children and teens cope with anxiety.

I hope this provides some tools to each of you to calm the anxiety you are facing. Remember that this, too, is just a season. It will pass, and even if we have some longer lasting changes to adapt to, as was said by the late great Maya Angelou, “I can be changed by what happens to me. But I refuse to be reduced by it.”

If you need some professional help, know I’m only a phone call away. Get ahold of Angie, my practice manager, and get yourself scheduled. I’m here for you, reach us by phone at 602.508.9190.

Wishing each of you an easy mind today, a restful night tonight, and a more peaceful tomorrow,

Dr. Beth

Deepening: Thoughts to Consider

Deepening…the word for 2020 that we are using at The Wholeness Institute.  Angie and I spent a good deal of time on brainstorming and planning what we want to accomplish in 2020, and deepening resonated with our goals and, hopefully, with yours.  Deepening has many meanings…

            ~To become more profound

            ~To enhance

            ~To strengthen

            ~Powering up

            ~Living more deeply into something – a relationship, spirituality, one’s inner self

            ~Living with purpose

            ~Leaning into experience

            ~Result of transformation.

When I think of it in terms of my counseling practice, I think of it as being present to others as they grow, as they go within themselves more to the discover who they are. Witnessing each person transform parts of him or herself that may no longer fit or has caused pain.  It’s being privileged to be with a person as they are leaning into their gifts, owning them, allowing themselves to become better acquainted and experience life more deeply as well as broadly.  Broadly alone isn’t enough, though, if we want to feel connected with others, with those most special to us, to ourselves.  This isn’t so new, if you go back to the Quakers, the mindfulness writers, those who are Jungian in thought, there are many books and articles written.  We hope that at the end of 2020, the first year of our new decade, you feel that you have received direction or ideas from me that have resulted in deepening your life and experiences more completely. 

Toward that we are restarting, adjusting, and adding some offerings, and welcome you to ask questions, reach out as you are called to deepen in during this year, or share with me how we can help you in your process throughout the year.  We are still working with many of the same populations and with similar issues, but with a slightly revised focus as we walk into 2020.  Rather than just teaching, or counseling, I hope to experience a deepening of my practice, and Angie’s work here, so that you are able to find a deeper sense of who you are and perhaps how things have moved forward in your life. So, we will be working in the next month to begin adjusting things in the following ways:

~ We will offer two blogs a month – one about a change or addition to your knowledge or understanding of what the field of psychology and spirituality are understanding today.  So perhaps an update on how yoga is used; a new treatment method for brain injury or depression; or even just a new idea to try to keep life balanced. The second will offer deeper content such as journaling exercises, ways to make your growth more experiential, and allow you the opportunity to move a tiny or larger step forward.

~As some of you know I have a new puppy – Finley.  We are going to add Instagram back with a focus on Finley’s Corner, lessons he is learning, that we also can learn from.  As an example, a lesson he learned after Christmas family celebrations? We all need rest after a long day. Look for an Instagram link soon!

~More days of retreat and mornings of information.  There are two we are looking at now, in addition to two in conjunction with others we have been invited to or are co-offering.

March 7 – Unfolding to Yourself:  Understanding Self and Spirit

May 16 – Professionals with Brain Injury:  Couples Facing Change

~Watch for the addition of concierge counseling services soon both for brain injury and personal growth clients – with special information pages, some case management built-in for no additional charge, consults with other professionals on your behalf, priority scheduling to meet your schedule, and other tips or help.

~More teletherapy appointments available to you.

So, as you are beginning your new year, here’s a deepening question for you to consider and write about:  What do I need to do to lean into my own life more fully? Write for 10 minutes and stop. Step away from the writing for a few moments.  Reread it and write down one action step to take or new awareness you have.  It might be set a reminder to write tonight before retiring for 10 minutes.  It might be to spend 5 minutes of your walk in silence, not talking with anyone with you, but taking in what you are seeing.  It might be saying a prayer or writing a prayer to your Higher Power tonight at bedtime.  Then go – live your life as it is unfolds today (including football and friends).  Begin each day with this – and just watch your life transform and deepen this year.

With care and encouragement to dare to dive more deeply into who you are,

Dr. Beth

In my own deepening understanding of myself
I find my capacity to serve others is deepened as well.
The better I am at self–care
the more genuinely nurturing of others I am able to be.
– Mary Anne Radmacher

The Grip of Anxiety: How to Find Relief

The room is too hot. I’m worried. I just need to go back to sleep. But I’m so anxious. Is that the sun peeking up already? I feel like I’m a ball of nerves. My pillow needs fluffing, my neck is sore. Should I just get up and try to be productive? But I’m so tired, and my mind won’t stop. Is the air working? It’s really quiet in here. Mind, why won’t you let me sleep? I’ll roll over and see if that helps…. Maybe I should paint my bedroom. But what color? Shhh brain, tomorrow. Let’s sleep tonight.

It can be a battle, can’t it? You enter your bedroom and catch sight of your bed and instead of seeing it as an inviting place you can’t wait to retire to, it looms large in your mind, knowing that with nightfall your worries invade the space that needs peace and rest. Something small can become large in the darkness of night; causing you worry and angst that in the light of day you realize is manageable and not something worth the cycle of sleeplessness.

“My life has been filled with terrible misfortunes, most of which have never happened.”

-Mark Twain

Sleep is one of the biggest areas affected by anxiety, but it can wreak havoc on your whole day, not only because of the exhaustion but other times it takes you by surprise, a simple text, email or phone call is enough to set you spinning. Other times that pit of fear and worry holds you by the hand all day each day. So how to get through it? Read on about a few ways to help regain control of our minds and the way we process perceived trouble or worries.

Breathing. It seems like such an automatic process, that we shouldn’t have to think about it. And we don’t for mere survival, but for optimal health this needs to be step one. But does it really work? Truly, it does, it’s proven. The studies are out there, and they are numerous, a quick google give you plenty of hits, among them is this one if you’d like to read more: https://www.health.harvard.edu/blog/stress-raising-your-blood-pressure-take-a-deep-breath-201602159168 The breathing exercise I most often recommend is by Dr. Andrew Weil called the Relaxing Breath or 4-7-8 breathing. The process is illustrated here, https://www.drweil.com/videos-features/videos/breathing-exercises-4-7-8-breath/. The idea behind this breathing, and others, is to slow down the heart rate, and reset the body. It also stops the panic and anxiety attacks. If you can’t breathe out as long as 7 or 8, start lower and work your way up. Whatever exercise you choose to follow, the idea is—if the exhale is longer than the inhale, the heart rate slows, and your blood pressure lowers. I encourage you to try this and let me know how it works for you.

Meditation. It’s regarded as a big word that packs plenty of punch. Often thought of as too ‘out there’, the practice is simply about quieting the mind. And, in an anxious state, quieting the mind is exactly what we are trying to do. The easiest way to start? An app. There are plenty to choose from for your phone or tablet that will walk you through the techniques. My favorite at the moment is called Insight Timer because it is free. There is a membership you can purchase but there are lots of tools that come with the free usage, including a specific ‘coping with anxiety’ section. This is only one of many, to find a few others too consider, take a look at my website under ‘links’ to see them listed.

These are just two ideas to get you going. Other ideas I strongly encourage as they support brain changes are coloring mandalas, walking a labyrinth, or doing a finger labyrinth. There is a simple app for this called Labyrinth Journey by Mount Mojo.  These allow spirituality to enter your processes as well to calm your anxiety. And for a few outside of the box ideas, these suggestions could be fun, and would be an experience you’re unlikely to forget. Cuddling a cow? Who would have guessed? See: Cow cuddling. Or: Cat cafes. Therapy dogs. Hug therapy. And don’t forget the outdoors and how great it is for the mind: Head out on a hike.

The moral of this story? If you’re feeling anxiety, there ARE ways to help yourself. Try one or more of the ideas above, talk to a friend, family member, or therapist.  If none of these ideas work, including therapy, then know that there are also excellent homeopathics and medications with minimal side effects that do help.

Wishing you a restful night’s sleep and anxiety-free days,

Take care,

Dr. Beth