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

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Decisions…Difficult but Important to Choose and Own

Our current times continue to present challenges in many ways for all of us.  From the smaller decisions of what to purchase at a grocery store and how to do so: online, via delivery, or in-person; whether we’ll follow the guidance to wear masks; to the no-brainers of breathing in and out each day, and to the largest decisions about when to retire and other big life changes.  We can say that some of these decisions are easy, whereas on others we will not reach agreement with everyone.  As Eleanor Roosevelt said “In the long run, we shape our lives, and we shape ourselves.  The process never ends until we die.  And the choices we make are ultimately our own responsibility”.  There are crucial decisions being made by governors and legislators right now related to COVID-19, the economy and businesses, as well as protecting individuals.  At this time, we are also called upon to make our own choices, and decision-making is often challenging and stressful.

Part of this stress is brought on by hearing multiple conflicting ideas about how to open a country back up, what is too soon, what is too long, how much individual health and lives should be considered versus the economy, and whose guidance should be followed in these areas.  I believe, as Eleanor Roosevelt and others have said, that we are responsible to determine what is in our own or our loved ones’ best interest.  Some of the decisions our leaders make we need to assess and determine what to follow and when, such as the recent ones, and ones to come, about reopening.  So, I thought it was time to review a few basics on decision making.    

First, get yourself in a quiet place, without distractions, and relax yourself.  Hard to do in a Covid-19 world, but perhaps these steps will be taken over a period of a day or two, and that’s fine.  This might be doing some meditation, prayer, deep breathing or yoga, or other ideas you might have.  It’s important to have our brain available, and when we are relaxed, we have more capacity to use our full brain without it being impacted by a fight, flight, or freeze change in brain reaction. 

Second, once you’ve done the above, write down what the decision is that you’re trying to make.  Tie it down to one decision, after all we can’t make more than one decision at a time.  Writing it down helps you to focus.

Third, do the research you need to do.  For decisions about work, going out of the house, deciding whether to go to salons or restaurants, or even just whether to grocery shop versus using pick-up services, I’ve found some sources of information and am providing those here.  These links provide various views so you can consider what the pros and cons are.  But seek out your own sources as well.

1.  CDC suggestions/plan on how to reopen

•  CDC guidance documents on various topics relative to COVID-19. 

• WHO ideas on reopening workplaces

• Arizona Department of Health Services dashboard with statistics of what is occurring in each county in AZ.

• Arizona Department of Health Services blog by Dr. Cara Christ

• Governor Ducey’s page with the current status of things as they change. 

• Governor Andrew Cuomo’s guidelines for reopening New York**

•  Governor Newsome’s plan for reopening California**

**I’m providing several Governors’ plans as it will allow you to see what they are considering and that may help you in making your own decisions.

After reviewing the facts and areas to consider from the above or other information you have, the fourth step is to write down your pros and cons on choosing to take various steps, i.e.:  go out to dinner vs. picking up dinner or having it delivered, going to the hair or nail salon, working in these environments and offices, and the others you’ll be faced with in the next week to months.  Then if it is clear to you what you will do, be clear with yourself how you reached the decision.  We can only make the best decision we can on any one day and with the information available to us.  You’ll want to reassure yourself later why you made a decision if later you question it.  If it is not clear, consider talking it through with your spouse, a significant other, close friend, person you respect, or trusted other.  And then follow the above once your decision is made. 

The fifth step, that will seem familiar to all who have studied science – from junior high forward, is to re-evaluate and make sure the decision still makes sense as you go.  Feel free to change your mind if that makes sense to you later.  For example, as many have suggested from a lot of entities and as we’ve seen in other countries, the numbers are going to go up as we reopen, so you may choose to change your decision if they are going up very rapidly, or begin going back down.

I ran across this in looking for a poem on choice and decision-making.  And in the end, I loved the simplicity of it:

Source credit: quotesgram.com

Having peace during these times is challenging – but remember that with following all the guidelines we already know from so many sources, continue to:

1.  Wash your hands often, with soap and water, for at least 20 seconds.
2.  Wear a mask in public.
3.  Cover your nose with a Kleenex if sneezing anywhere.
4.  Cover your mouth with a Kleenex if coughing.
5.  Socially distance keeping 6’ between you and the other person/people.
6.  Clean and disinfect touched surfaces regularly and throughout the day.
7.  Do not touch your face or wash your hands after you do.

All of these get tiring to hear about at times – but they will be essential for a long time to come.   And they can provide you with peace within that you are doing all you can to protect yourself and others. 

Finally, remember to take time to relax, enjoy your family around you, reach out to friends in socially distant methods, pray, meditate, and use the tools we and others have provided. 

See our website for general resources.

We also have COVID-19 specific resources as well as blogs on ideas in managing these stressors.

You deserve to take care of yourself, and I encourage you to make your own decisions, and take care in all the ways you need to do so during these challenging days.  We’ll be back to the regular blog again on Sunday, but I wanted you to have these thoughts earlier as things are changing rapidly. 

Take care,

Dr. Beth

Covid-19 and Brain Conditions

We keep hearing the experts talk about the dangers of Coronavirus especially involving those with preexisting conditions or “comorbidities”. But does that include a brain or neurological condition? There is so much information that’s been written that it can be difficult to sift through. We’ve compiled some good resources from trusted websites just for you. In general, the answer is no, your risk is not greater due to your condition and the current CDC guidelines should be your first steps. Following that, there are a few other things we’re suggesting to take a few additional precautions. We’ve created the graphic above which can be downloaded here. Once downloaded, each of the links are clickable so you can use it as your single page go to for lots of information.

The takeaway? 

1. MS:  Be sure to really focus on stress reduction as both a preventative of exacerbations of your condition and warding off COVID-19.  If you do get sick, treatments appear to be the same as the general public. Be sure to follow your neurologist’s recommendations and closely follow the CDC guidelines on distance, wearing a mask, and staying in due to your lowered immune system. Additionally, it’s a good idea to have 3 months of medication on hand. https://multiplesclerosisnewstoday.com/faqs/2020/03/02/faqs-about-coronavirus-and-ms
2. Parkinson’s:  Since this patient is also usually over age 60, be careful to follow all CDC guidelines and stay in.  See the following link for a letter the Parkinson’s Foundation Association recommends keeping with you:  https://www.parkinson.org/sites/default/files/Hospitalization%20During%20COVID-19%20Letter.pdf  Take a look at some other ideas at: https://www.parkinson.org/blog/tips/Coronavirus. There is also webinar and audio content available at: https://www.michaeljfox.org/news/coronavirus-and-michael-j-fox-foundation
3. Migraine:  Be very careful of your known triggers to prevent worsening.  Monitor and minimize your stress levels, practicing good self-care.  Have enough of your meds on hand for 3 months.
4. Seizures:  If you have been consistently free of seizures with medication for 6 months or more, there is no current indication of a correlation.  But do have a 3 month supply and take it as prescribed.  And, as always, manage your stress and worry to the best of your ability.
5. ABI – TBI :   Good news, there is no known higher risk for those with a brain injury. But you do need to manage all symptoms such as seizures and migraines– see above for details.  If your ABI is stroke related – keep taking the medications you were put on, following your neurologist’s advice and stay in touch especially if you are having more seizures, headaches, etc.  https://www.stroke.org/en/about-us/coronavirus-covid-19-resources  Watch diet, self-care, balance and keep up your exercises for this safely, manage stress, and have any medications on hand preferably for 3 months.  Follow all CDC guidelines for safety for COVID-19.  See https://www.biausa.org/brain-injury/community/covid-19-resources and https://news.shepherd.org/qa-coronavirus-disease-2019-covid-19/ For other information on traumatic brain injury and COVID-19. 

Links for everyone: 
To maintain this self isolating, we will all do better with managed stress, good quality and amount of sleep, and maintaining relationships with friends and loved ones using technology. For some suggestions, take a look at the links below!

1.  Down Dog – https://www.downdogapp.com/ free until May 1^st to all; free to teachers, students, and healthcare to 7/1
2.  Music to calm and relax:  https://advancedbrain.com/shop/music-to-relax/ easy download as well.
3. Headspace:  https://www.headspace.com/covid-19
4. Browse our recent blogs
5. 5 quick tips:  https://www.npr.org/sections/health-shots/2020/03/03/811656226/pandemic-panic-these-5-tips-can-help-you-regain-your-calm
6. The resources page of our website (we try to keep this updated with news, shopping tips, and some fun!)  https://www.thewholenessinstitute.com/covid-19-resources.html

 I hope you have a safe and healthy April. Please reach out if you need additional support, this is a stressful time for most. I’m here if you need me.

Take care,    Dr. Beth

COVID-19, Control, & Compassion: Choosing Our Attitudes and Being Compassionate

We can’t control our world, our family’s lives, even our own life right now, can we?  We can’t know when or where the Coronavirus will hit.  We can’t know if we’ll get it, or our neighbor, or our best friend, or our coworker.  We can’t know if we’ll come through this time financially whole or if the financial condition of the country and world will collapse. And this is scaring many of those I see or those I read about in the news or that I hear from on Facebook or other social media accounts.  And I get it – there is much uncertainty.  This morning, though, I wondered to myself – but can we ever?  Can we truly ever have power and control over all that happens to us?  All that we experience, think, and feel?  All that we so often trudge through life trying to control.  Our boss?  Our job? Our health? Our financial condition?  Or is it possible, just possible, it’s an illusion of control?  And that the truth we are living right now – that we cannot control the spread of COVID-19 more than following the suggestions of medical professionals and mandates of our government is the reality we live each and every day? 

Dr. Viktor Frankl was a psychiatrist who was put in a prisoner camp in Germany during the time of Adolph Hitler.  A man of Jewish faith and lineage, he was in the group abhorrently victimized and often killed by those under Hitler.  And from him came some of the most profound writing in the area of existential psychology – or the psychology of meaning and experience of life.  He survived the camp, a feat beyond my imagination, and stated, “When we are no longer able to change a situation, we are challenged to change ourselves”.  Ah – here is the kernel of hope we do have, we can always change ourselves, our reactions. He went on to elaborate: “Everything can be taken from a man [person] but one thing:  the last human freedoms – to choose one’s attitude in any given set of circumstances, to choose one’s way”.  And this is how he survived the experience in Auschwitz.  And helped many others to do so – to choose their attitude to keep trying, one step, one day at a time; and to assist others by noticing them, handing them a crust of their dried bread, or a sip of the tiny bit of water they were given. 

A choice – we, too have choices.  Are we going to share with others compassion and love and a safe place to share what isolation is like?  Or what living at home 24 hours with children and/or spouse is like?  Either can be very challenging.  Are we going to be supportive of the grocery store clerks and employees – or grumble that we didn’t find what we wanted?  It’s a choice, isn’t it?  I will say I can sometimes be tired and grumble when someone doesn’t acknowledge what I’m experiencing – but how would they?  We’re each unique and experiencing this time differently.  So, I need to back up and possibly share it and ask for understanding or at least respect for my experience and apologize for the grumble. 

Kristen Neff talks about self-compassion, and Viktor Frankl about compassion towards others.  But Neff makes an excellent point – if we don’t have it and show it to ourselves first, how will we ever share it with others?  So, as we are facing days that are long, with limited control but room for personal choice in attitude, perhaps a little self-compassion would be a good first step.  Especially through this next week when many who are Jewish cannot celebrate Passover as they are accustomed to and Christians cannot celebrate Easter as they are.  We will need to choose attitude and show compassion. 

Kristen Neff discusses this from a place of self-compassion, Brene Brown from a place of shame and working to change that and let go of that, and Viktor Frankl from a place of making a choice in our experiences about our attitude.  All three, interestingly, have similarities in what to do.

1. Notice what you’re feeling.  Be with it in the moment.  Be present and mindful so that you are aware and do not act out, hopefully, towards another.  So, for example, when I am feeling lonely facing Easter without the family and traditions we usually share, I need to sit with that.  Feel the pain, the disappointment, the loneliness. 
2. Being kind to yourself in language is also important.  Rather than the voice that might say, “Oh grow up, it’s one holiday.  You’re fine.  At least you’re not in the hospital and dying of Covid-19”; we need to instead say, “I’m having a hard time. This is something I haven’t experienced so it feels new and lonely.  And it’s a change – I struggle with change in family tradition.  So, I need to be even kinder in planning and deciding how and what I will do Easter Sunday”. 
3. Name the feeling and share it with some safe person in my life.  It might be in prayer.  It might be in text to my best friend.  It might be a call to a family member to connect at least that way and share and listen to what they are experiencing as we face the next 7 days.  (This is unique to Brene Brown’s idea of coming out of the shame spiral by facing it and sharing it.)
4. Decide how with what attitude to face the next 7 days and what choices are available.  For example, reaching out to others is something Viktor Frankl recommends as we reach out in love.  Not in guilt or caretaking or shame.  But as he says, “Love is the ultimate and the highest goal to which [we] can aspire”.  This means both the love in self-compassion above, but also the love in reaching out.  Perhaps something special to do with the children over the coming weekend.  Perhaps sending cards of love to family we cannot see. Maybe planning our own special day of ritual and celebration and sharing it in love for the other(s) we might be with – even if that is ourselves.  Nurturing the sense of self-compassion, and care. 

So how will you face your own attitudes this week?  How will you remain mindful of what you are experiencing?  What change can you commit to?  What are the steps you might take to show yourself and others compassion?  I would encourage you to write them down.  Post them, put them in front of you, and lovingly remind yourself of them each day. 

Warmly and with compassion,

Dr. Beth

PS:  Want to learn more about these 3 theorists and clinicians?  I suggest the following books:

Daring Greatly:  How the Courage to be Vulnerable Transforms the Way We Live, Love, Parent, and Lead by Brene Brown

Man’s Search for Meaning by Viktor Frankl

Self-Compassion:  The Proven Power of Being Kind to Yourself by Kristen Neff

Hope, Love, Faith

Featured Post

Last weekend I spent a lot of time coloring and processing what was happening within.  This weekend I have spent a great deal of time in reading and prayer.  And both weekends I have sought out time with friends or family – through FaceTime, Zoom, or other mediums in order to feel connected.  One thing I believe we are all learning is that much as we are all individually having to handle this crisis given the need for social distancing; we are also in this together – with the entire world.  I keep replaying in my mind a song from the 60’s … “what the world needs now, is love, sweet love, it’s the only thing that there’s just too little of…what the world needs now, is love sweet love, no not just for some, but for everyone.”  (You can listen to it at https://www.youtube.com/watch?v=YUaxVQPohlU).   

And so, we look for love and connections through our faith communities, our friends, our families, and even our pets.  Pope Francis really touched me this weekend when he spoke and said simply, yet powerfully, “We are all on the same boat, all of us fragile and disoriented, but at the same time important and needed, all of us called to row together, each of us in need of comforting the other … [we] have realized that we cannot go on thinking of ourselves, but only together can we do this.”  This made me begin to think about how I share my hope and love.  And I do have hope for our futures.  It will not be the same future we imagined 30 days ago perhaps; but it can be one that is even more connected with each other, working toward common goals.  I’ve seen small examples of games in the neighborhood like putting a teddy bear in the window for children to find on a walk with their parents during a break in studying at home.  Or neighborhood children (and adults) who have left messages in colored chalk for others walking by.  I loved running across one while walking Finley the other night – just a reminder of not being a solo in the neighborhood, but part of a bigger whole.  Or the neighbors offering to do grocery runs or other errands if someone cannot get out to do their own at this time.   And yet … reminding everyone to stay in as much as possible.  There is hope in the fact that we are reaching out to one another in love … through chalk, teddy bears, or 15-minute errands. 

I’ve found this weekend I also want to express myself in different ways – by returning to some artwork — not to express my emotions, but to enjoy the freedom of creation, the hope in creating something that didn’t exist.  I read a brief article somewhere this morning that said people are reaching out to plant more gardens (it mentioned similar to victory gardens around World Wars I and II).  And we are in a war for our lives and a cure, are we not?  Many are looking at creating something no matter what level of talent they may have.  I would encourage you to reach out and try something this week.  Perhaps a crayon drawing.  Or plant some herbs or flowers if you have the materials or can get them via pick up at one of the local stores like Ace, Home Depot, Walmart, or Lowe’s.  Color a mandala (Go to this link for some free ones to print https://printmandala.com/) or do some paint by number on an app like Happy Color.  One favorite I had as a child and only takes a piece of paper and crayons or markers is to scribble lines and curves all over a blank piece of paper, and then color the spaces in forming a picture among the shapes.  Or, color all of the shapes in, then color over it in black, and lightly scrape off the black letting colored shapes show through the black.  Have children?  In addition to the above projects that would also work for them, check out Highlights at https://www.highlights.com/parents/crafts/31-kids-crafts.  And remember Pinterest always has 100’s of ideas. 

Scribble Art Sample

Pope Francis speaks of our vulnerability, a favorite topic of Brene Brown as well.  She had her first new podcast recently, and spoke about FFT’s, Frightening (or another F word) First Times.  So many are wondering how does one get through a frightening time like a pandemic?  And Brene said, honestly, none of us knows – it’s our first time, we are all vulnerable and exposed in walking through this time.  Pope Francis said, “The storm exposes our vulnerability and uncovers those false and superfluous certainties around which we have constructed our daily schedules”.  A student of mine asked me this week if I’d ever survived a pandemic.  As well as sending her a history lesson 😊 I also spoke of the fact we are vulnerable, we are all in the same boat of one day at a time, and reaching out for support from friends, faith communities, and therapists or other care providers during our time of fear and vulnerability; and to our physicians and hospitals if we do become ill.  But allowing oneself to be vulnerable with another – share your fear, allow another to cry or be with their feelings, offer your hope and strength when you have it, be present fully in the moment by text, video chat, letter, email, phone call – will allow you to also move forward “choos[ing] what matters” (Pope Francis).

And so hope, and love, come through faith, connection, vulnerability, giving, and risk in trying new things.  We will not find hope if we hide in a corner.  As frightened as a person may be, the only answer is to come out into the light.  Be vulnerable with another and connect.  Risk doing so and expressing yourself honestly, perhaps for the first time; but at the least for the first time during a pandemic.  Give to others through any way that comes to you to do so.  And walk in your faith, whatever it may be, and take it just one step at a time, one day at a time, through these darker times.  Regardless of your faith, I would encourage you to reach up for strength and hope, reach out in love, and reach in to find one thing to be grateful for each day.  If we each do our best, just our best as we are able to do today, we will make it through this time together.   

Take care of yourself,

Dr. Beth

Caring for Yourself in Times of Fear and Illness

This week has been a stressful one for many people.  The combination of the coronavirus, the stock market, the grey skies and rain, school and college closures, and the world news each day has been very hard.  But . . . in all of this, did you catch any of the good news?  It’s a bit hard to find, I learned, as I went to locate some for you to try to balance the week.  I did finally find a couple of pieces: 

            The La La Land Kindness Café in Dallas has hired 9 foster kids who aged out of the foster care system and were having trouble locating jobs.

            How about the House and the President agreeing, within just a couple of days, to relief legislation for victims of the coronavirus? 

            The Dow started a rebound today – that’s very good news for most!

            All of the fast action employers and schools/universities are taking to protect their employees and students – it seems unprecedented to me, although it may not be.  From Amazon in Washington to ASU to Ford to many others many are limiting exposure by providing employees with laptops and having them work and study virtually.  

All of these are truly ideas that are very positive news – and get covered in the anxiety so many are feeling, and the care for family that is often at the root of this.  Just tonight I learned one of my sisters-in-law may have been exposed to it, and her father likely has it.  Yet of the 16 members of my family nearby, she is the only one, which is good news thus far. (Edit 3/15/20: Good news! Her father’s test results reflected negative results.) See how we can flip it?  In psychology it’s called reframing the bad or difficult situations by looking at life a bit differently, without denying the hard does exist as well.

We sent out notices about Covid-19 procedures for our office this week.  Now it’s time to also offer some concrete help along with the above reframe tool.  The American Psychological Association and the National Association for the Mentally Ill are the two sources I’m using for the ideas that follow.  I wanted you to have some resources to print or click for the coming weeks.  What I know from 911 and other events is that when we are faced with being bombarded on social media and news media with information that is difficult, we tend to seek out more information and stay focused on the difficult situation.  This merely drives fear and anxiety up further.  We do need to know what we can do to try to protect ourselves; but once we know, i.e.:  wash hands to count of 20, do not shake hands and stay a further distance from others, and isolating someone with clear symptoms including fever, cough, and shortness of breath, we need to also look at how we care for our family and selves in a way that minimizes the fear and focuses on good things in life.  And, in the situation we have right now, we also need to know how we can cope with isolation whether from working at home, not going out for social events, not being able to travel to family or friends on trips we have had to cancel, or other reasons.  And we must have a method to deal with the uncertainty, fear, loneliness, depression, resentment, and challenges we face trying to secure things we may need.  So, here goes!

1.  Make sure you have some games to play that are age appropriate for you and your family, and especially if you have children.  If isolated, the family will need ways to entertain themselves, laugh, enjoy each other’s company, and get through the days together.  We know that closeness breeds irritation, so have some things that can break up the days and draw you together, not apart.
2. Have a plan with your doctor.  My physician sent out a text announcement to all of his patients tonight just letting us know he’s there, where to go for trustworthy medical information on the virus, and what to do if we are having symptoms.  Reach out to your pediatrician, cardiologist, pulmonologist, or primary care to know ahead what to do and how their office is managing this.
3. Use the tools that help your mental health on a regular basis.  So…do:
4. Keep up your physical activity – there are some great YouTubes on how to do yoga, walk along with you to keep your steps up (I like Leslie Sansome’s https://www.youtube.com/watch?v=m9yI2LGZRE0), and many others depending on what you prefer to do.
5. Make sure you have enough medication or supplements like Rescue Remedy, Vitamin C and B, and other things around to keep you feeling better and less anxious. 
6. Stay on a schedule.  We can get very loosey-goosey when at home too long or too much.  So make sure you keep an agenda to normalize your life and not fall into the doldrums too much.
7. Make sure you can connect with Messenger, FaceTime, and the others available.  It helps for you to actually see friends, not just text.  We’re learning that the more texting that is done, the lonelier people are becoming.  So, in this time of increased stress – reach out even more and if you can’t touch one another, at least see one another.  I know someone who was separated from a loved one for quite some time, and they would watch a favorite show while connected on Facetime.  Another dad who was away who would play checkers with his children.  Get creative in your connection!
8. I know you get tired of it – but remember to breathe when anxious.  Or start a mindfulness app during this time.  The website has a number of these on the Links page, and this is a great time to learn to do it and practice.
9. Listen to music that uplifts you – for me that might be one thing – but what is it for you?  Listen!  Music does a lot to impact our moods.
10.  Keep some numbers available if you need to reach out to a warm line, i.e.:  you’re not suicidal but you are feeling isolated and need to connect.  See SAMSHA’s line for disasters at 1-800-985-5990 or locally at 602-347-1100.  And remember AA, Al-Anon, and many other groups have online and phone meetings.  Take care of your sobriety as well! 
11.  Pay attention to your spiritual practices.  I love labyrinths and downloaded the Mount Mojo Labyrinth Journey app to my cell phone quite some time ago.  I can walk it by finger on the phone even if I have only 5 minutes and can’t get to one locally.  Or, call a friend to pray.  Watch a Joel O’Steen, Beth Moore, or even your own pastor or rabbi may have something online to watch or even just listen to. 
12. Humor, humor, humor!  You have to laugh!  I go to Bob Newhart videos, Carol Burnett, or Tim Conway as well as Friends and Frazier.  My mom loved SpongeBob Square Pants (I did not ever figure that one out!)  How about funny movies often free on Amazon Prime, Netflix, and other places you may have membership. 

All of these are tools – now you just need to use them.  As I said in my letter to current clients, I’m here and I am available.  Feel free to call and schedule an in-person or video therapy session.  The teletherapy appointment is on an encrypted service that meets HIPAA standards, we don’t use FaceTime or other things that might seem easier – but don’t offer the privacy.  So, if you can’t come – we’ll walk you through how to set it up. 

May you find these ideas helpful – and know there is a hand to reach out to.  And keep reaching out to friends as well.  Do you have other ideas?  Let us know and we can share those on our Facebook page. The disasters end.  The illnesses come to an end in such large proportions.  The blue skies come out again.  Something my mama told me growing up is that “it’s always darkest before the dawn”.  Obvious, right?  But it kind of normalizes problems and difficult times.  And reassures us – that “Joy will come in the morning!” (Psalms 30:5).  And so it will!

Take good care of yourself!

Dr. Beth

Yoga and Your Brain

Yoga. It can feel like an intimidating word for the uninitiated, can’t it? Visions of perfectly chiseled bodies in spandex holding positions that look impossibly difficult. But yoga is so much more than that. I’ll leave it to the countless experts who explain that the physical movements of yoga are only a tiny part of the whole practice (google will lead you to lots of resources if you’re interested). But the physical piece which ties into the mental component and so many other benefits is a great way to move forward and “deepen” your healing.

After an accident or an acquired brain injury the sheer volume of appointments of follow up care can feel like a full-time job. But yoga is a practice that can be added at any time in the recovery process and shows great promise at helping those who have sustained a brain injury with balance, balance confidence, range of motion, pain control, strength and mobility. Studies have shown the practice to improve balance by 36%, balance confidence by 39%, lower extremity strength by 100%, and endurance by 105%. Those statistics speak volumes for the benefits of such a gentle exercise and practice. In addition, it can be helpful to so many who suffer from anxiety related to post-traumatic stress disorder after an injury or even a car accident without injuries. One study done at two centers involving a Canadian location and Brigham and Women’s Hospital in conjunction with Harvard University found a 10% reduction in PTSD anxiety symptoms following only an 8-session program of Kundalini Yoga.  Another study through Boston University and the Trauma Center found significant reduction in PTSD symptoms after 5 weeks of yoga, and individuals held an improvement for at least another 5 weeks.  So, it seems that we should be thinking about yoga much more frequently in the field of PTSD and brain injury!

There are studios throughout the country which offer yoga classes geared toward those with brain injury through the Love Your Brain Foundation and rehab centers. You can find some resources online at https://www.loveyourbrain.com/yoga though if you do a search right now you’ll find that in AZ, classes are not yet available (check back soon as a provider training is happening in April and is already full—so we should see some offerings coming!) The other place to check is the outpatient rehabilitation program through your local TBI hospital. In the Phoenix area, Barrow has some yoga classes with details found here. Although they have no specific yoga offerings at this time, Ability 360 is also a great resource for those with brain injuries and changes. A recent search of google for trauma and yoga in Phoenix brought up several studios with classes specifically for traumatic stress or PTSD. So, there appear to be some options, but take caution with these studios, doing homework to ensure their credentials are what you’re looking for and are the best choice for you.

These in-person classes are a great resource and whenever possible, I do recommend that people attend with an instructor present. That hands on advice and adjustment to a position can be very beneficial, but if it can be intimidating to try something new, can’t it? A big barrier to entry for an untried activity is the lack of understanding what the cultural norms are, what’s to be expected, and not wanting to look foolish doing something for the first time. Rest assured, the classes that are geared towards beginners, and specifically for those with brain injury, are not going to include the difficult poses that you see highlighted in yoga articles or images. Everyone in the class will enter with about the same level of expertise, that’s why there are classes for a variety of different audiences. Also, there are modifications that can be made to make this gentle stretching available to anyone, in any condition. If you’d like to see what a class may include, or would like to try something at home without an audience, there are some videos of classes for brain injury you can try at your own risk (check with your physician first to be sure you’re ready for these). Love Your Brain says it best, and I agree with their statement, “I cannot assume responsibility for any exercise and/or subsequent injury you may incur, “Yoga is for everyone. However, when online, it is up to you to assess whether you are ready for the class you have chosen. The techniques and suggestions presented here are not intended to substitute for medical advice. LoveYourBrain assumes no responsibility for injuries experienced while practicing these techniques.” And we cannot assume any responsibility for injuries experienced either through their program or others. That’s why it’s best to check with your doctor or physical therapist first. Classes online are an option for you to try if you cannot find anything available near you and once cleared by your medical health provider. Take a look at https://www.loveyourbrain.com/yoga-videos for some classes geared toward healing from a brain injury.

As we move through 2020 and we continue to explore our word for the year, deepening, I hope you’ll give some of the ideas I propose a try or use these suggestions to look for ways to incorporate new ideas into your life. I will be offering a workshop for you and your partner or spouse in April that will discuss the changes brain injury has on your work and home life. For more information, click here, and together let’s incorporate strategies to help you heal to be the very best you can be.

Unfolding: From Shame to Praise

I’ve been sitting here looking at a blank piece of paper, interspersed with time searching for ideas of what to write about for this blog released to be released on Ash Wednesday, the first day of Lent for Christians.  I’ve had a few thoughts pass through my head:

• The childhood years of eggs and noodles for Friday dinner and tuna fish for lunch – no meat on Fridays was required. 
• Grade school years of giving up chocolate, candy, cookies, or something else and putting a penny in the missions’ box to collect money for those in need.
• Junior year religion class when we were challenged to show love to someone each day instead of forgoing a favorite treat (a la Fr. Martin’s blog last year – Be Kind at https://www.americamagazine.org/faith/2019/03/01/fr-james-martin-sj-be-kind-lent
• Looking out the window this morning and wondering at the cloudy sky and my cold feet while considering how to make this day into something growth-inspired.  This afternoon revealed a bright blue sky, clean and shiny leaves from yesterday’s rain, and beautiful pink and purple flowering shrubs. And this evening it is followed by dark clouds.  Such a metaphor of life – constant evolution.
• Finley’s facial expression, as I showed in an Instagram post and below – full of joy and expectation.  Which brought me to thoughts of C.S. Lewis via a blog by Dawn Klinge where she talks about  Lewis’s view of joy.  (You can check it out here https://www.dawnklinge.com/abovethewaves/7-thoughts-on-joy-from-cs-lewis).
  • 
• Searching and finding a book recommended for Lenten journeys by one of my favorite authors related to growth spiritually, Sue Monk Kidd.  She recommended Gifts from Within, written by a group in Texas at Brigid’s Place.  Interestingly, this is also tied back to my ancestral motherland of Ireland. 

What is the common thread in all the musings I’ve had?  I believe it to be there is no perfect way through Lent, or preparation for Easter or Passover.  In reality, no perfect way to reach and experience joy, resurrected hope, true presence in our own lives of and with God.  But it does take preparation, time, energy, and choices daily. 

So, whether it is by 1) sacrifice, i.e.: fasting or giving up something; or giving something like love and kindness; or 2) reading the thoughts of others as shared in Gifts from Within; or 3) reading for my Jewish friends Kurshan in her first person article in The New York Jewish Week, “Preparing for Passover Physically and Spiritually” that reminds us that the history of Passover “begins with shame and ends with praise”  (see https://jewishweek.timesofisrael.com/preparing-for-passover-physically-and-spiritually/); or 4) stretching and committing to really look at something around you (or within) each day like the change in the day from dreary to spring-like to stormy; or 5) watching the joy around you that comes from hope and expectation – they all count.  Each one can take you farther along your spiritual path.  And your psychological healing.  And isn’t this really unfolding – opening up to more of what you want to be, hope to be, are within; but perhaps are unaware of because of something blocking you?  Moving from shame to joy.  So, start thinking – has one of the above ideas struck you as one to use?  I’m using the book recommended by Sue Monk Kidd and a daily thought prompt from another group.  One person I know is using a specific book with a goal of reading the complete book by Easter.  Another person is writing her prayers daily.  And another is just working on breathing – with reminders to himself in his calendar to work on decreasing his anxiety. 

Pema Chodron said, “Nothing goes away until it teaches us what we need to know”.  Carolyn Myss said it a bit differently, “Always go with the choice that scares you the most, because that’s the one that is going to help you grow”.  Lent and preparation for Passover are times for such growth for all.  So…choose wisely this year.

Take care,

Dr. Beth   

“Silence the mind to hear the whisper.”

I was at a meeting recently with a guest speaker, the topic unknown to me prior to attending. On my way, music on in the car, I found myself turning it down so I could let my mind wander, mulling over a few of life’s stressors. Due to some scheduling changes, I was going to be walking into the meeting just before the speaker began, not having my typical time to say hello to everyone and chat before the meeting. I sat down just before she was introduced, and among the first couple of sentences about her, she was quoted, “Silence the mind to hear the whisper.” It felt like such a timely topic for me, a divine intervention of sorts, putting the reminder directly into my stream of consciousness that I had been subconsciously working towards on my drive. The use of such a simple yet powerful sentence by way of introduction –our speaker caught the attention of all of us in the room. The concept of quieting the mind has been around for a long time and while meditation is something I practice routinely, there is always room for learning, improving, changing the practice for oneself and so, I listened, and I learned.

Mindfulness is a topic I’ve been wanting to write to all of you about for some time. The word of the year for the practice is “deepening”, as I’ve shared before. We are working towards that with greater and different offerings from the practice based on the feedback from you, wanting to offer services that are relevant and meaningful to each of you. But also, deepening is creeping into my subconscious and my own life. I want to embrace this time of evaluation and growth and would like to share some reminders with you on how to be a better steward of your mental focus and energy.

Online you’ll find a wealth of meditation resources, several apps you can download with a click, a few of which I’ve even featured under the links tab of my website and in previous blogs. But. Did you know that taking a walk can serve as a meditative experience? Taking a bike ride, being outside, a scenic drive, gardening, laying in the sun or the shade of a tree, a round of golf, going to the batting cage, going to the practice green or driving range are all activities that can promote mindfulness and meditation. It doesn’t take sitting in a pretzel shaped position on a rubber mat to qualify as meditation. It can take place wherever you feel moved to practice as long as it’s in an environment in which you feel you can relax and unwind. The idea is not the act of stillness, it’s about quieting the noise of the demands of life and taking moments of quiet.

Beginning isn’t as hard as you may make it out to be. Set low expectations for yourself, planning to spend 3-5 minutes at your first attempt–you’ll increase your level of focus and lengthen the duration with routine practice. Begin in the space of your choosing, allowing any thoughts that enter your mind to simply move past your attention as if they were a billboard you pass on a highway. Notice the thought and allow it to move on. Practice breathing exercises. Deep inhales, lungs full, holding the breath and a slow, deliberate exhale. There are exercises that guide you to count your way through breathing and those can be helpful but generally, if you exhale for longer than you inhale you are lowering your blood pressure. These breathing exercises alone are a way to calm yourself and even can be used to drift off to sleep.

A drive that previously may have brought stress due to traffic I’m now looking forward to. The forced time alone in the car is a good time for me to quiet my mind. To listen for the whisper—of intuition and my higher power which is such a help to me in times of growth. “Be patient with yourself. Self-growth is tender; it’s holy ground. There’s no greater investment.” – Stephen Covey. As a part of mindfulness and deepening, let these ideas be a start for you. I’ll be sharing more on this topic in blog posts to come as well as in an upcoming workshop. Stay tuned!

PS: Looking for a great way to open relationship discussions and mindfully listen to loved ones? These would be a great way to start: https://www.shopsundaypaper.com/Sunday-Paper-Table-Topics-p/tabletopic.htm

2020: Goals and Goofing Off

I was thinking about the new year and recall recently hearing someone say, instead of resolutions that we often set ourselves up to break, think of the beginning of the year as a time to set one goal. And, while it feels like a blank slate and a good time to start something, I also wondered if we take a moment to pause and renew, would we all be more likely to hold to the new goals we’re trying to form? We go through the holiday season and it’s a blur. How often do we look back and wonder where 30, 60, 90 days or more have gone? We are so busy with the hustle of preparing that starts in October, maybe earlier, that when the new year comes it’s no surprise we’re all feeling ready for a new leaf. But is there room to be more mindful about how we go about all of these new practices? Instead of starting January at the gym doing more than our bodies have in weeks/months/years and going home sore, energy depleted, and looking into a refrigerator stocked in an optimistic moment with all the foods we “should” be eating is it any wonder that by the end of that week or the end of January we already feel we’re failing at what we set out to do? Here’s an idea it’s not too late to start on, the timetable is your own. Let’s bring in this new year with intention and balance.

Happy January, welcome new year, new decade! I’m going to choose my activities and set goals that are achievable, because I don’t need guilt over self-imposed ideas that make me feel a failure. And I’m going to learn to play, alone, with friends, and with my family.  Join me? Here are a few things to get you started but remember this is not an inclusive list, just inspiration:

• Meal plan and prep on weekends. It sounds simplistic and it is, but this is the way to get the foods I want in the house. This is not the start of a strict diet; this is making healthier choices than I made during the holiday rush.
• Create set work hours. It’s easy to allow myself to let my work spill into my evenings during times I don’t have plans or distraction, but everyone needs down time to recharge each day. It’s not a luxury, it’s what enhances productivity during the day and if I don’t consciously make this choice, I will let myself stay at my computer longer than I should.
• Read, listen to audiobooks, listen to podcasts, or watch TV. Getting myself enmeshed in a good book is an escape nearly like a vacation. And for all the bad TV out there, there’s plenty of good to watch as well.
• Pray or meditate. Quiet time for consideration and reflection is soul enriching and an amazing stress reducer that has been shown many times over to reduce blood pressure and improve brain health.
• Move my body. This doesn’t mean I have to join a spin class or train for a marathon (though if those things lift you up, wonderful!) this just means a walk with my dog, or yoga at home or in a studio, a bike ride on the greenway. Again, stress reducing, heart and brain healthy, blood pressure reducing, and an aid in depression and anxiety management. 
• Schedule physicals or check-ups. Annual exams are important to be sure any changes in blood work, blood pressure, vision, mammograms or PSA checks, etc. can be addressed before a possible issue becomes advanced.
• Call and schedule time for coffee with a friend.  Often, we do not give our friendships the time they need, and we don’t benefit from the recharge that time will give us.  (And moms – I just read today that in order to be the healthiest mom possible you need two girlfriend outings a week.  Two!  So perhaps start with one and work it slowly up to two.)
• Make an activity list with your family.  Have everyone list what is fun for them.  And then use this to plan your vacations, time together, and year. 

Remember, not every minute of the day is meant to be about productivity.  It’s also meant to include time for relationships, recharging our batteries, learning, and balancing our lives.  So, this year, rather than adding a list of 5 must-do’s to your daily schedule, how about taking care of you – in any of the above ways or another way you might want to embrace and enjoy.  Brene Brown reminds us that “adults goof off”, they play, and defined this as spending time doing things that are not productive but are fun.  Several of the ideas above are not “productive”, but they may be fun for you.  So, my challenge is – go have some fun this year.  Play. Meditate. Spend time with friends.  Read a novel that pulls you in.  After that – perhaps get back to the one or two goals for your year.  But don’t take the “fun” time off your calendar to get the goal met. Instead, balance both in your time.  And have a great 2020!