Blog Archives

3/31/2023

When it feels safe to move on

As a psychotherapist who regularly uses Eye Movement Desensitization and Reprocessing therapy (EMDR) to help people with anxiety, depression, relationship conflict, and trauma, people often ask me why EMDR works.

When you attend an EMDR therapy session, eventually (after preliminary work) we will identify target memories that relate to your current difficulties. For example, from a young age you might have formed the belief that you are ‘unsafe’ or ‘unlovable’, or you might carry around an overwhelming sense of shame or abandonment.

Focusing on a target memory, we will guide your eyes laterally (left and right, rather than vertically, up and down). This process helps to quieten your amygdala (your brain’s alarm system) in relation to that target memory, and the triggering belief or emotion.

Why do we know this works? Because research shows that when we walk or otherwise move forward, and things move past us, this causes our eyes to move laterally, and thus quietens our amygdala. So the lateral eye movements in EMDR replicates the brain’s natural ability to quieten the amygdala.

But that is not all…

When you are triggered, or experience a threat (whether that is in the present, or a distressing memory of a past event), you might fight, flee, or freeze. According to research, the part of your brain that is responsible for the fight response, or “forward confrontation”, is linked to the dopamine reward pathway (and this plays a big part in us experiencing pleasure). Faced with a threat, when we move forward in a safe way, we suppress the amygdala, and we send signals to the dopamine reward centers of our brain to reward us for forward effort.

So in the face of a threat, a sense of forward action will help, and that can be replicated through the use of the lateral eye movements in EMDR - the brain thinks you are moving forward, and this suppresses the fear/alarm system of the amygdala, and it also rewards you through the production of dopamine.

EMDR delivered to the comfort of your home

When the pandemic hit, we were all required to use an online format to deliver EMDR therapy. I use a HIPAA compliant portal to meet you online; we still get to face each other, and use the EMDR protocol effectively, and the only difference is that we face each other on a video screen, rather than sit with each other in an office.

The benefit is that you can benefit from therapy in the comfort of your home, and you can schedule your sessions with more ease (cutting out any travel time). This has worked extremely well with my clients, and therapists have been using this format long before the pandemic.

Here is some research to support the use of EMDR in a virtual setting -

Brown, G. O. S. (2021). Reflections on Providing Virtual Eye Movement Desensitization and Reprocessing Therapy in the Wake of COVID-19: Survival Through Adaptation. In Shared Trauma, Shared Resilience During a Pandemic (pp. 235-248). Springer, Cham
Jones, C., Miguel-Cruz, A., Smith-MacDonald, L., Cruikshank, E., Baghoori, D., Chohan, A. K., ... & Brémault-Phillips, S. (2020). Virtual Trauma-Focused Therapy for Military Members, Veterans, and Public Safety Personnel With Posttraumatic Stress Injury: Systematic Scoping Review. JMIR mHealth and uHealth, 8(9), e22079
Tarquinio, C., Brennstuhl, M. J., Rydberg, J. A., Bassan, F., Peter, L., Tarquinio, C. L., ... & Tarquinio, P. (2020). EMDR in telemental health counseling for healthcare workers caring for COVID-19 patients: a pilot study. Issues in Mental Health Nursing, 1-12.
Bongaerts, et al. (2021). Safety and effectiveness of intensive treatment for complex PTSD delivered via home-based telehealth

I hope you found this as interesting as I did! If you have any questions, get in touch.

Chris Warren-Dickins LLB MA LPC
Explore Transform LLC
Counseling and Psychotherapy in Bergen County, New Jersey
www.exploretransform.com
+1 (201) 779-6917

#EMDR, #FindanEMDRtherapist, #EMDRTherapy, #EMDRTherapist, #TraumaTherapy, #FindATraumaTherapist, #HealingFromTrauma, #FindATherapist, #ridgewood, #BergenCounty, #NewJersey, #teletherapy, #FindACounselor, #Counseling, #Psychotherapy, #psychology, #MentalHealth, #Depression, #Anxiety, #Trauma, #Stress

3/30/2023

Panic attack

Panic attacks are terrifying and debilitating. You cannot breathe, your head spins, your limbs are buzzing with energy, and you are sweating like a pig. At the time you believe that you are going to die, but you don’t. You are sure that you have something physically wrong with you (perhaps your heart or lungs), but the doctors can find no cause for all of this.

Without any explanation for this, you start to do some of the following things -

You avoid things because you are terrified that the panic attacks could come on at any moment,
You become overly dependent on someone for things that you once could do alone,
You become isolated, physically, and emotionally.

Each time you look back and realize that this is your mind playing tricks with you, rather than a serious physical health concern.

But there is hope for change. With a bit of guidance, we can help you to -

Feel the panic less intensely,
Experience panic attacks less frequently,
Regain a sense of control over your life,
Stop avoiding things that you fear might trigger a panic attack, and
Accept the occasional panic attack.

To plan for the next panic attack, here are some things to consider -

Physical health? - Are there any physical reasons why you experienced the symptoms of shortness of breath, a spinning head, or sweatiness. It is worth ruling out any physical health issues, and it is worth reflecting on any substances or stimulants that may contribute to this (caffeine, excess sugar, nicotine, etc).
Psycho-education - After you have ruled out any physical health issues, it can help to understand why you experience a panic attack. Your brain has an alarm system to alert you when things go wrong. You need that alarm system, so your blood can pump faster and get the heck out of there if there is an actual threat. So, in a way, we should be thankful for this alarm system, because without it we would be in trouble. We just need to find ways to reset the alarm, so that it doesn’t keep going off for no reason.
Simple as ABC. Knowledge is power, so you need to track when the panic attacks occur, and why. A simple log called the ABC log can help you record the following -
- A is for Activating Event - For example, you were at the supermarket and you started to panic because you thought people were staring at you, and that made your heart race because you feared you might trip and fall and embarrass yourself, and then your mind started to think about getting COVID because you noticed some people not wearing their masks properly, and then you feared that you were going to pass out in front of everyone, which would be mortifying.
- B is for Beliefs and assumptions - In this example, you assume people are staring at you, and even noticing you in the first place. You are probably also assuming that they are thinking negatively of you. You are also assuming that you are at high risk of COVID, and you are assuming that people will judge you for tripping or passing out.
- C is for Consequences. This is where you would record the behavioral and emotional consequences. For example, you may end up leaving the supermarket and returning home without any of the groceries, and along with the panic and anxiety, you are frustrated at yourself for letting your fear of the supermarket get to you.
I challenge you to a duel. Once you have recorded the when, where and whys of your panic attacks (in the form of your ABC log), I can help you to identify unhelpful thought patterns and challenge your assumptions. For example, I could help you to develop a more compassionate voice instead of that harsh critic who assumes that everyone is judging you. I could also challenge your tendency to catastrophize, and I would do this in two ways -
- Firstly, how likely is it that the ‘catastrophe’ is going to happen? Give it a percentage: Is it ten percent likely, fifty, seventy, or one hundred percent likely?
- Secondly, how bad is that supposed ‘catastrophe’? On a scale of 0-100, how distressing would it be to trip over? It may initially feel like an 80 or 90, but when you compare it with other things that could go wrong (for example, a loved one dying), you may realize that the fear of tripping over is actually a 10 out of 100.
- Only when you stop and realize that this is something that is not very likely to occur, and/or even if it did, isn’t as distressing as other things, you can start to gain perspective. You can then train your body to react more proportionately (and save the heart pumping and sweating for the stuff that is almost certainly happening, and likely to cause a 90 or 100 level of distress).
Calm your body, ease your mind. In previous blogs I have outlined the various ways to calm your body, which in turn will ease your mind, and help you to assess a situation more rationally. Here are just a few examples (with links to the relevant exercises) -
Exposure and positive coping statements. Panic and anxiety are made worse when we avoid what makes us anxious. Gradually, slowly, stop avoiding the things that are triggering your anxiety. For example, if you get anxious around people in a supermarket, you could start by imagining each stage of going to the supermarket. You can develop positive coping statements such as ‘I am strong enough to handle this’, and you can use the above-mentioned body-calming exercises to prepare yourself. Once you have imagined each stage of the event, and you have kept your anxiety levels within a reasonable range, try one stage of the exposure. For example, drive to the supermarket parking lot. Try the next stage and the next, continuing to use your body-calming exercises and positive coping statements, until you have conducted a successful trip to the supermarket with only moderate anxiety.
Stop, Look, and Listen. One of the most helpful things about panic and anxiety is to focus outwards, away from your own bodily sensations. Panic is often fueled when we feel a racing heart or sweaty palms, and then our mind starts to race, and then we focus even more on our thoughts and bodily sensations. Try and take a moment to focus outwards, and even describe everything and everyone you see.
Mind your Mindfulness. I have covered the basic principles of Mindfulness in other articles, but in brief, these include -
- Using present-moment awareness to anchor yourself in the present, not fearing a future unknown. Usually, you would use your breathing, but if you have found that this makes your panic attacks worse, focus on the texture of your clothes or skin as you gently touch your arms and legs. Or focus on the colors and textures of objects around you.
- Non-judgmental acceptance of whatever anxious emotions and thoughts may be arising. Don’t give them fuel by following them; just let them drift away like bubbles.
The Past is Present. Sometimes things that have happened in your past can have an impact on your panic attacks in the present. For example, I once worked with someone who grew up in a household where anger was not tolerated. As a result, this client worked hard to repress their anger at every opportunity. The trouble was that all this repressed energy had to go somewhere, and they ended up having panic attacks instead of assertively communicating their anger. We had to slowly work through this conditioning, and they eventually learned that feeling angry was an acceptable emotion.
Plan for relapse. You aren’t going to manage this perfectly the very first time, so this means you might experience another panic attack. Make plans for this, and reflect on what you learned, rather than making it into a catastrophe. Some people find it helpful to make a list of the above-mentioned strategies and carry that list around with them (either on their phone or on a small card in their pocket). This will be a personalized list of strategies that you have found helpful - there is no one-size fits all. For example, the list might include:
- Positive coping statement: ‘Solid feet set apart, solid mind and solid heart’
- Focus on the colors and textures of your surroundings
- Square breathing (and remembering to pause between sets, and notice that pause)

Panic attacks are scary at the time, but they do not have to rule your life. There are simple tools for you to use and regain control of your life, and if these do not help, there are treatments such as EMDR (Eye Movement Desensitization and Reprocessing therapy) that can help. Either way, you do not have to continue to struggle.

Contact use today.

Chris Warren-Dickins LLB MA LPC
Explore Transform LLC
Counseling and Psychotherapy in Bergen County, New Jersey
www.exploretransform.com
+1 (201) 779-6917

#PanicAttacks, #PanicDisorder, #Anxiety, #Stress, #FindATherapist, #ridgewood, #BergenCounty, #NewJersey, #teletherapy, #FindACounselor, #Counseling, #Psychotherapy, #MentalHealth

3/27/2023

Burnout

More and more people are experiencing burnout. I do not need to point to the contributing factors, you just have to turn on the news, but I do need to point out the significance of burnout to the way your brain functions.

You can recognize burnout via a whole range of symptoms, and these are just some for you to think about: An apathy for the things that you once cared about, a sense of exhaustion, and an overall negative outlook.

Why you should care about burnout
There is a worrying trend amongst some to wear burnout as a badge of honor. They confuse the terms ‘grit and resilience’ with ‘burnout’, and so they shut off the warning signs that tell you that you need to rest. Eventually, you will cause harm to your mind and body, and ultimately this has a negative impact on all the things that you hold dear.

Burnout should be taken more seriously because research shows that it can thin the gray matter of your prefrontal cortex (the part of your brain that is responsible for important functions such as reasoning and decision-making), and it can enlarge the amygdala (the brain’s alarm system). As a result, our alarm system goes into overdrive, sensing threat when there is none, and we are less able to mediate this heightened state with cool, calming reason.

When our amygdala is in overdrive, this activates the sympathetic nervous system, our ‘fight-or-flight’ response, and this can lead to excess production of cortisol (the stress hormone). There is plenty of research to show the health implications for excessive cortisol levels, including increased blood pressure, diabetes, and heart disease.

What you can do
Any attempts to calm the amygdala will help to reduce burnout. This can be tackled on a couple of different fronts – your body, by activating your parasympathetic nervous system (your natural rest and digest state), and your thought process, by challenging the short-circuited thought patterns that lead to these heightened states of stress.

In terms of your parasympathetic nervous system, you can activate this through various different methods, including simple breathing exercises or calming visualizations. I have set out some exercises on this page, so try each and start to repeat (on a daily basis) the ones you enjoy.

In terms of your short-circuited thought patterns, try to watch for assumptions or beliefs that might trigger the amygdala. For example, you have been working late and you see your boss talking to HR. By assuming that they are talking about you, you are personalizing the situations and jumping to conclusions. They could be talking about a whole range of issues other than you. You are also catastrophizing, because even if they are talking about you, you are assuming it will lead to something bad, such as losing your job. You need to calm your mind by looking for evidence against this, such as a recent positive performance review, or the fact that the Great Resignation has left companies currently desperate to keep their employees.

A key component to all of this is to adopt a compassionate tone to your self-talk. Throughout my years as a psychotherapist, I have found this to be one of the most underrated factors in recovery from burnout. When we judge ourselves, we end up feeling even more alienated, and this serves to worsen the symptoms of burnout. The first step to recovery is to recognize how much pressure we have been experiencing, and adopt a kind, compassionate voice, talking to ourselves as if we were talking to a young child. When we can direct compassion inwards, we are in a better position to then direct that compassion outwards, and learn to connect with, and help, other people.

There is no better antidote to the cynicism and apathy that burnout can create than recognizing some sort of good that we have thrown out into this challenging world.

If you need more support with this, contact us today.

Chris Warren-Dickins LLB MA LPC
Explore Transform LLC
Counseling and Psychotherapy in Bergen County, New Jersey
www.exploretransform.com
+1 (201) 779-6917

#Burnout, #anxiety, #stress, #panic, #MentalHealth, #FindATherapist, #ridgewood, #BergenCounty, #NewJersey, #teletherapy, #FindACounselor, #Counseling, #Psychotherapy, #Depression

3/26/2023

You and your nervous system

We need safety. Without feeling safe, our nervous system activates protective responses (we become over-activated or under-activated, we become anxious or shut-down). When these protective responses are activated, it is hard to connect to others, to stay focused on conversations, to become intimate, and to trust others.

It can really help when we understand that our responses, in body and mind, are because we are hard-wired to respond that way. If we cannot sense safety in our environment, it is inevitable that we will try to fight or flee the danger, and if we cannot escape, we will shut-down, so we do not feel the full force of that danger.

What I am explaining has been conceptualized by Dr Stephen Porges as a sympathetic nervous system (fight or flight) and a dorsal vagal response (shut-down). According to Polyvagal Theory (Dr Stephen Porges), depression is a dorsal vagal response, and anxiety is a sympathetic response. Depression is under-activation or hypo-activation, and anxiety is over-activation or hyper-activation.

Only when we sense safety can we connect with others. This makes sense because we are hardly going to have a chat with a friend, make love, or watch a favorite movie if fear that we are in mortal danger. The trouble is, when we have experienced trauma, the slightest smell, sound, touch, or image can activate these protective responses.

When you work with a trauma therapist who uses Polyvagal Theory, they will help you to identify your own nervous system, and when you have been in a shutdown (dorsal vagal) state, when you have been hyperaroused (a sympathetic state), and when you have been in a more connected, ventral vagal state. For example, when you are in the sympathetic state, you might notice that you talk quickly or have racing thoughts, or you feel more angry. In the dorsal vagal state, you might notice that you are sleepy or blank-minded, or your breathing is slow, and in the ventral vagal state, you might feel warm, contented, or peaceful.

Some therapists like the analogy of your nervous system as a ladder; at the top is the ventral vagal state, the most evolved. This is when we feel connected to ourselves and others, and it is only activated when we feel safe. The vagus nerve runs up from the brain down to the abdomen, so breathing and tapping exercises are helpful to activate this nerve. Some have even referred to the vagus nerve as the compassion nerve. At the middle of the ladder is the less evolved sympathetic state of fight or flight, and then at the bottom, the least evolved part, is the shutdown dorsal vagal state.

Once you have identified your differing states, it can be useful to complete the following sentences for each state (whether that is dorsal vagal state, sympathetic state, or ventral vagal state):
When I am in this state, I am….
And
When I am in this state, the world is…

Your trauma therapist will also help you to move out of a shutdown (dorsal vagal) or hyperaroused (sympathetic) state into a more connected, ventral vagal state. For example, they might help you to remember a moment when you felt safe and calm, and they will encourage you to bring this moment back using an image of that memory. If you cannot find such a time, your therapist might help you to create one. Some people even find the visualization of a certain color calming.

Trauma work is not just about the client. The therapist needs to be attuned to your state (whether it is shut-down, activated, or calm), but that therapist also needs to identify their own state. This is why, unlike many other professionals, experienced trauma therapists truly practice what they preach; they do the work and become attuned to their own body and mind by doing many of the things that they might suggest for you to try in therapy. For example, they engage in mindfulness exercises, breathing and grounding exercises, and they engage in their own extensive personal therapy.

I hope you found this useful. Please reach out if you would like to explore this further.

Chris Warren-Dickins LLB MA LPC
Explore Transform LLC
Counseling and Psychotherapy in Bergen County, New Jersey
www.exploretransform.com
+1 (201) 779-6917

#EMDR, #FindanEMDRtherapist, #Polyvagal, #PolyvagalTherapist, #EMDRTherapy, #EMDRTherapist, #TraumaTherapy, #FindATraumaTherapist, #HealingFromTrauma, #FindATherapist, #ridgewood, #BergenCounty, #NewJersey, #teletherapy, #FindACounselor, #Counseling, #Psychotherapy, #MentalHealth, #Depression, #Anxiety, #Trauma, #Stress

3/23/2023

Ever heard of the ‘tyranny of the shoulds’ ?

Ever heard of the ‘tyranny of the shoulds’ ? Psychoanalyst Karen Horney coined the phrase, and it is an unhelpful thought pattern that we can all end up using if we are not careful. We have ideas about how we should (or must) live, and how others should respond to us, and how society as a whole should be. When our expectations do not match reality, and we hold on too tightly to these shoulds, we can end up alienating others because we appear like a petulant child making impossible demands. Alternatively, if we stay silent about how we think things should be, we can end up feeling like we have been taken advantage of, which can leave us feeling devalued. Either way, our depression intensifies.

So what can we do about this?

Flex like a yoga instructor. Studies show that our mental health can improve when we have social contact, so we need other people. Dopamine levels increase (our feel-good chemical), we learn more about ourselves and other people, and we gain more through cooperation. However, what we bring to these interactions may make things better or worse, depending on how tightly we hold onto these expectations. Adopt a more flexible attitude, and really assess: How essential are these 'shoulds' and 'musts', or are they more of a 'nice to have, and I will survive if they don't happen'?
The why, not just the what. Okay, there may be some 'shoulds' and 'musts' that really need to happen. If this is the case, communicate why this is important to you. That takes confidence, so you may need to practice a bit of mindful breathing before you approach this conversation (there are plenty of mindfulness and meditation exercises here), but the more upfront you are about the reasons why these requirements are so important to you, the less you are going to come across as The Controlling One.
Have you communicated your needs clearly enough? I can't tell you how many clients tell me about conflict with people they care about, and when we explore it a little, they realize that they have been making a whole load of assumptions about what the other person is thinking, or what they intended by certain actions or comments. Even if you think that you have communicated your needs clearly, and even if you think you know what is in the other person's mind, check it out with them.
Assertive communication is the bedrock of any sense of self-esteem, and any healthy interaction. Many people fail to grasp what assertive communication really is. It is the opposite of aggressive or manipulative behavior. Examples of assertive communication include: In the face of opposition, offer a clear, calm repetition instead of an apology; keep statements succinct; resist the need to over-explain; practice the skill of saying no.
If we don’t know, how is the other person going to understand? Before we make demands of the other person, perhaps we need to spend a little time on self-awareness. We might not know why something is so important to us, why we cannot bear to see the dishes piled up in the sink, for instance. It would be helpful to take a step back and really understand what is going on. The stress or anxiety, or the pit of dread dragging down the center of our stomach, might be less about the dishes and more about our need for control. Or perhaps we interpret the dishes left as a sign that our partner does not care about us. Is this more about us or the other person? Perhaps a little of both, but until we know about our own processes, we cannot really understand the other person’s, let alone agree a way forward.

I hope you find this helpful. If you need more support, or you have any questions, get in contact.

Chris Warren-Dickins LLB MA LPC
Explore Transform LLC
Counseling and Psychotherapy in Bergen County, New Jersey
www.exploretransform.com
+1 (201) 779-6917

#CBT, #ThoughtPatterns, #EmotionRegulation, #CBTTherapist, #FindACBT Therapist, #FindATherapist, #Ridgewood, #BergenCounty, #NewJersey, #Teletherapy, #FindACounselor, #Counseling, #Psychotherapy, #MentalHealth, #Depression, #Anxiety, #Trauma, #Stress

<<Previous

YOUR CART

When it feels safe to move on

Panic attack

Burnout

You and your nervous system

Ever heard of the ‘tyranny of the shoulds’ ?