If you're living with a chronic illness, you're in the right place.

Thursday, September 10, 2015

Chronic Illness and Suicide (repost)

11:21 AM Posted by Stephanie Horgan , ,
As part of World Suicide Prevention Day, we wanted to repost our entry from May 2013 on chronic illness and suicide. This is a tough topic to talk about but one that needs more attention since it is 100% preventable and the 10th leading cause of death for people in the United States. Our hope is that by talking about it, we can be a resource to those who are struggling. Only half of people struggling with major depression reach out for help, but treatment is 80-90% effective! Please share with your friends and loved ones and encourage them to get help. 

Chronic illness is complicated. When one is newly diagnosed, there is a challenge of learning how to explain your illness to others, and learn who to let in on your journey of ups and downs. Here are some of the common reactions we get when we see clients who are newly diagnosed with an illness, trying to navigate a world of stigma and shame. "Why would anyone want to hear about my illness? And what's the point of talking about it- either way I have to deal with it and I don't want pity. I hate burdening my loved ones. What if people change how they think of me? What if people ask embarrassing questions or have judgmental reactions?" 

Honestly, these are all valid concerns! We spend time talking with clients about each of their questions and also encourage them to tell people who are safe, and to only disclose what they are comfortable with. We also know that not everyone benefits from a support group, and that everyone reacts differently to their diagnosis. Some may want to externally process every detail of their illness with many loved ones, some may keep things completely private, and then there are people in the middle. 



One thing we know, regardless of who you tell, is that chronic illness is not easy, and is a lifelong challenge that should not be done alone. An amazing organization is out there called the Great Bowel Movement. Their mission is to help patients embrace their disease, be proud of their experience, and spread awareness throughout their communities. We at Oak Park Behavioral Medicine are proud to know the founders, and are encouraged at just how many people are choosing to wear their "Ask me" shirts in order to diminish the stigma there is about illness, just by starting conversations with people. What a simple, yet incredible idea! 



One person who did not openly talk much about his illness was Internet pioneer and activist Aaron Schwartz, and a Rolling Stone article briefly mentioned his ulcerative colitis and described it as "a condition that would embarrass and plague him for the rest of his life." He was a well-known blogger and did not talk about his illness much, and when he committed suicide this year (despite being part of a well-known lawsuit), it made me stop to think about what role chronic illness has in suicide. Does living with a chronic illness put you at higher risk for suicide? What toll does hiding embarrassing symptoms day after day from others take on someone? I am not implying that everyone needs to blog about their illness, as suicide is much more complicated. But I am suggesting that social support and openness about your illness may help prevent depression and suicidal ideation



Its not something people talk about very often, but its something that needs to have light shed on it. Chronic pain is a known risk factor for suicide. In a recent study, it was found that significant predictors of suicidal ideation was both distress in interpersonal relations and self-perceived burden to others. 

Another study found physical illness constitutes a significant risk factor for suicide, independent of psychiatric and socio-economic factors. This same article states that previous epidemiological studies have indicated an increased suicide risk associated with cancer, diabetes, epilepsy, multiple sclerosis, stroke, myocardial infarction, and allergy. 

So in order to bring awareness to this important issue, we are beginning the discussion. We encourage you to speak up. Dial 911 or a suicide hotline if you are having suicidal thoughts. Reach out if you are struggling. Push through the hopelessness and depression, and let someone know how you feel. Call a loved one if you need help. And when necessary, enlist a professional to guide you along the way. You may be surprised how letting someone into your darkness can be helpful and give you hope. You are not alone. 



Sunday, June 21, 2015

Fear and Phobia Reduction

9:30 PM Posted by Skyler Schuyler , , ,

Fear and phobias are experienced daily. Several studies have shown that the most common fears are arachnophobia (fear of spiders), ophidiophobia (fear of snakes) and acrophobia (fear of heights). While many of us can relate to these top fears, there are hundreds more. Phobias such as aerophobia (fear of flying), astraphobia (fear of thunder/lightening) and agoraphobia (fear of open or crowded spaces) are only a few that people experience based on circumstances. For instance, its does not rain every day and most individuals do not fly daily. Reviewing techniques to reduce fear’s impact, I found a few mnemonics (memory aids) that may be helpful.


The F-E-A-R System used by Dr. Pamela Garcy stands for Focus, Expose, Approach and Rehearse. This acronym first addresses when you experience a state of fear, an individual in distress needs to Focus rather than freak out. Mindfulness skills such as meditation, body scanning and mindful movement allow people to stay in the present. Here-and-now techniques have been shown to be successful with reducing anxiety caused by fear. Exposing yourself to a certain fear, at appropriate times, can help limit the desire to escape from it all. Time is a sensitive for everyone; rushing your exposure to fears is not suggested. Approaching your fear allows you to deal with the phobia rather than avoiding it. Research suggests that Rational Emotive Behavior Therapy (REBT) can be helpful with tolerance and level of comfort. Small steps towards reducing fears add up and tackle the bigger picture at hand. Rehearsal of behavioral skills and fear reduction techniques are needed until the fear no longer exists. Just like a seasoned athlete or musician, it takes practice to learn and continue to fine tune skills.


The second acronym examined is the LMNOP Cycle. Former infantry Marine veteran, Akshay Nanavati, created this memory aid to help others master their own fears as he once did. First, you need to Label the emotion you experienced. Research has shown that just labeling an emotion reduces amygdala activity (part of your brain that processes fear) and increases activity in your prefrontal cortex (part of your brain that is associated with processing emotions). The Meaning of emotions tied to an event can greatly impact a state of fear. Even when you are not experiencing a fear directly, if an emotion is connected with an experience, this connection may can create undesirable consequences. Remind yourself that it’s NOT you, it’s your brain stuck in an old pattern. Sometimes we respond unconsciously based on a memory. Opting for a new meaning associated with an emotion may be challenging to adjust to, but the hope is that you will eventually change undesired behaviors and patterns. Finally, reducing fear requires Purpose and Preemptive Strikes. Research has shown that preemptive strikes such as writing down what AND how you will reduce undesired patterns can help prepare you for future obstacles. You have to train and practice before exposure to phobias occurs in order to reduce unpleasant experiences. 

Taking a closer look at fears and phobias, we know that its effects can paralyze and even destroy an individual’s ability to rationally process the experience at hand. Using quick memory aids such as these acronyms may help limit the impact of your fear. However, individuals whose fears or phobias negatively impact their work or home life often may consider additional assistance through support groups, individual therapy and even hypnotherapy. Whether it’s a quick reminder using memory aids or processing your fears with someone, finding what works best for you is extremely important. Remember: personalities are unique and different which means fear reduction techniques will look different for everyone. 


Wednesday, June 10, 2015

Having Kids with Chronic Illness

9:08 AM Posted by Tiffany Taft , , , ,
Well hello there.  It's been a while since I contributed to our blog.  I went and had another baby last October and let's just say baby brain is really a thing.  While I've been back at work since mid-January, I've really only recently gotten back to what I'd call full mental capacity where I can muster any type of writing creativity.  That's a good 7 months of what I can only refer to is this mild brain fog, where you're able to do what you need to do but adding in anything beyond the core functions of your life, yeah, well, forget that nonsense.


A few weeks ago Steph wrote a post about parents of kids with Chronic illness.  If you haven't read it, you should go check it out.

So today I want to write a few things on having kids when you have a chronic illness.  This comes up with my clients pretty often, whether it's deciding to even have kids to coping once they're around.   But most of what I'll write is more from my personal experience.

If you met me more than 5 years ago, I'd be living the DINK (dual income no kids) life.  I had zero intention of having any children.  My husband was seemingly in the same boat.  I joked that my biological clock was digital because there was absolutely no ticking going on and I was in early 30s.  Part of that, I believe, was having Crohn's disease.  Not because I was really sick, I've been pretty fortunate in that department.  But a big concern I had was passing this lovely disease down to my offspring, even though I know the statistics based on genetic backgrounds (around 7% if only 1 parent has the gene).  That's a 93% chance my kids won't have it.  Those are pretty good odds.  But if I let the "yeah, but..." creep in, it certainly affected my decision making.  However, if you told me I had a 93% chance of winning next week's PowerBall, you know I'd be out buying a ticket.

Tip #1:  Learn about the odds your illness could be passed down.  And if they're overwhelmingly in favor that it won't happen, don't let that deter you from having a child.

Then biology kicked in big time and I went from no ticking to alarms going off in my head.  So we went and had ourselves a daughter.  My first pregnancy was uneventful.  I was taking a TNF biologic medication at the time, so my focus became understanding what, exactly, this drug could do to the baby pre- and post-delivery.  Unfortunately there were ZERO studies on the drug in pregnancy, so I had to go off of anecdotal evidence from my doctor.  I sought a second opinion from a gastroenterologist who knew women's stuff and we came up with a game plan where I took the risk and stopped the medication around week 32 of my pregnancy.

Tip #2:  Learn about your medications and how they may impact pregnancy and, if you decide to breastfeed, how they may impact lactation.  If your doctor doesn't know, get a second opinion.  This should be a joint decision between you and your physician.

I decided to breastfeed so that also affected my decisions about medications, and I opted to stay off of medications until I had a problem.  About 50% of women with Crohn's will flare after pregnancy.  I was fortunate in that I didn't flare but also stayed in med-free remission for 3 years.  We don't exactly know why, but doctors have seen this.  Kind of like the anecdotal evidence for the medications - not much research out there on it but it happens.

Tip #3:  Remember, the worst case scenario probably won't happen.  But if it does, you can handle it.

Then I lost my mind and decided to have a second, and last, baby.  This time I went into pregnancy on no medications and I had what I'd call a minor flare.  My doctor probably would have disagreed with the term "minor" but I've noticed I'm much less of an alarmist, rather walking a fine line of denial and seeking appropriate care.  So I showed up at my doctor's office 6 months pregnant asking her to fix Humpty Dumpty and get me through the last few months of my pregnancy.  I did at least have the courtesy to email her when I got pregnant and keep her posted every month as to how I was doing.  This involved a lot of discussion about what medications to use, for how long, and also alternative treatments to ensure I was getting enough nutrition.

Tip #4:  Feeling part of the treatment team is important regardless, but becomes especially salient when you're pregnant.  Find a doctor who you trust and lets you make decisions based on information they provide you and their recommendations.  No time for the "My Way or the Highway" mentality.

Needless to say, I made it to term and had a healthy baby boy.  Because I'm breastfeeding again, I'm back off of medications and am keeping hold of remission.  Maybe I'll luck out and get another few years out of the deal.  But with chronic illness comes uncertainty, so for now I'm just enjoying each day.

With pregnancy and motherhood comes a lot of emotions, some of which are chalked up to hormonal changes that we experience.  But there's more to it than that.  And I encourage you to listen to your gut about things, and not allow others, including a doctor, to dismiss the psychological aspects of medical decisions should they need to be made either while you're pregnant or after.  For example, stopping breastfeeding can be a very emotional experience if it's before mom or baby are ready.  While this can happen if we need to start a medication that isn't nursing-friendly, it's important to acknowledge that there may be a flood of emotions that comes with that decision.


Tip #5:  Your emotions are important and should never be dismissed, especially under the pretense of being overly hormonal.  Your experience matters and should be taken into account in treatment planning.

It's good to be back.  I hope this blog post makes some sense and is helpful.  If not, I'll just revert back to blaming baby brain.  That's gotta be good for at least a few more months, right?

Best,
Dr. T

Sunday, May 17, 2015

Support Groups: Finding the Right One

5:47 PM Posted by Skyler Schuyler , , , ,
At one point in everyone’s life, there comes a time where having a little extra support would be beneficial. But where do you go for this help? Who do you contact? How do you search for groups in your area with specific interests? I thought it would be useful to provide some insight to what support groups provide, types of groups that exists, how these groups work and how to find local ones in your area. 

Support groups are designed for people who experience stressful life changes. These changes could be impacted by medical or mental health changes, relational or occupational shifts and even personal desires for behavior modification. Within a support group you are encouraged to make connections with other members of your group to help alleviate negative emotions brought on by these stressful life changes. Sometimes your friends and family members will not understand your stressful event. Engaging with individuals who face similar issues provides an opportunity for people to share their life experiences, give advice to hardships and ultimately remind you that you are not alone in your struggle.
Additionally, having extra support outside of your immediate circle (family and friends) provides a safe place to truly open up and discuss emotional difficulties you have had throughout the week. A support group offers assistance for you to use more effective coping strategies and feel less isolated within your circumstance. I do want to point out that support group should not replace medical care. It is a valuable resource to aid you in moments of crisis, but if medical necessity is required, please refer to your physician.  
Looking closer at support groups, it’s important to understand that each one focuses on a common interest. For instance, support groups exist for individuals with medical conditions (cancer, diabetes, heart disease, long-term caregiving, etc.), mental health concerns (depression, anxiety, mood disruptions, substance abuse, etc.) and addictions (alcoholism, narcotic dependency, overeating, sex, etc.). I would also like to stress that support groups are not group therapy. While some support groups are led by licensed professionals, they do not follow group therapy guidelines. Group therapy is formal by design and always has a mental health professional trained to process the group’s area of concern.  
Support groups are often lead by individuals, or lay person, who have experienced your situation in some fashion and would like to provide encouragement to others as they face similar difficulties. Many times, groups are created by nonprofit organizations, community mental health clinics, Anonymous sponsors and advocacy organizations.
These groups not only have different interests at hand, they are available in variety of formats and venues. For instance, they meet in person, over the Internet and even by phone. Support groups are designed to be informative, educational and structured. So don’t be surprised if guest speakers attend your group or extra material is provided to you at the end of a session.
The benefits of support groups include:
·         Feeling less isolated and alone
·         Reduce feelings of judgment
·         Improve coping strategies and communication
·         Increase your sense of control; empower you
·         Reduce your distress
·         Educate you on your circumstance and choices you have
·         Provide practical advice (sometimes treatment options)
·         Even allow you to compare resources and treatment options
Finding a support group in your area is easier than ever. You might want to first begin with suggestions from your current provider. Your doctor, therapist, nurse, social worker or pastor typically have some insight for support groups to fit your needs. If these resources do not work, navigating the Internet is a great option. Using the following sites may be helpful:
http://online.supportgroups.com/
http://www.addictionsandrecovery.org/12-step-groups.htm
http://www.mentalhealthamerica.net/find-support-groups
If you have some time, you might consider contacting local community centers including churches, mosques, synagogues and even libraries to inquire about support groups held at their locations. Organizations devoted to your cause will more than likely have resources for you. Newspapers and telephone books also have listings for support groups. Don’t forget, you can always ask individuals YOU know who have experienced similar stressful life changes. People who know you best can help guide you to the right support group to fit your needs.
Remember: whatever hardship or condition you face, you are not alone. Chances are there are more people than you would expect who are going through similar difficulties in life. It’s your job to reach out and find a group that fits you best. – Don’t be afraid to try different ones out. – Whether it’s in person or over the internet, you CAN find a group that will help you overcome and cope with life’s stressors.


Monday, May 11, 2015

To all the mom of kids with chronic illnesses

12:59 PM Posted by Stephanie Horgan , , ,
I wanted to send out a belated Mother's Day shout-out to all the mothers who support a child with chronic illness. In our practice, we see many different types of clients, many of whom have a physical illness. This can be something acute, temporary, chronic, or terminal. For parents who have to watch their child face an illness, it can be a very trying and scary journey. The entire family unit is affected, and it is important that there is communication and support for each member of the family. Often times the parents will need to have their own therapist so they can manage the stresses that come along with advocating and supporting their child who is suffering.
I came across an encouraging article recently that I wanted to share all the parents who walk this tough road of chronic illness with their children. No parent thinks they willy be watching their child decline physically before them. This is when support is so crucial, and there is a natural grieving process of having to watch your child go through his or her reality, and wishing you could control the outcome. Some days or seasons are easier than others, and sometimes its just good to have friends who can acknowledge the challenges you're facing. Make sure to check out this great line of new greeting cards by Emily McDowell called Empathy Cards for Chronic Illness. They are brilliant and refreshing!

Many parents find comfort in having other friends who have been through something similar, and connect with those parents in a support group or online. I am closing today wishing all the moms out there a healthy, happy year full of parenting bliss. And for the harder, more dismal moments, I wish for many nets of support around you as you go through the day-after-day of chronic illness.  Last but not least, here is a great blog entry about this topic, which includes a wonderful list of resources for parents of kids with chronic illnesses. Please be sure to check out the links!

Sunday, April 26, 2015

Stress: What it Does to Your Body

5:28 PM Posted by Skyler Schuyler , , , ,
As we continue to explore anxiety and the impact stress, I thought this would be an ideal time to discuss some of the physical symptoms that stress can have on your body. Simply put: stress leads to distress – so much so that 77% of Americans experience physical symptoms caused by stress. Distress of your body manifests itself in various ways for each person. For some, it can resemble a headache or migraine, it can upset your digestive tract, increase your blood pressure, reduce sleep and even cause chest pain. Some research has suggested when your body is in distress, it may exacerbate (bring on or worsen) certain illnesses and diseases. Additionally, when people try and use tobacco, alcohol or other drugs (including prescriptions) to relieve stress, the long-term effect may be more harmful than helpful for your body.  

Looking at some basic statistics, 44% of Americans have reported feeling more stressed than they did five years ago; three out of four doctor visits are for stress-related ailments; work stress causes 10% of strokes; the basic cause of 60% of all human illness is caused by stress; more than 40% of people stress eat; 44% lose sleep each night due to stress; and stress increases 40% of heart disease, 25% risk of heart attacks and 50% risk of stroke. 


Examining physical symptoms more closely, the American Psychological Association in 2014 reported these statistics for those who expressed physical manifestations of stress. They included:
  • Fatigue – 51%
  • Headache – 44%
  • Upset stomach – 34%
  • Muscle tension – 30%
  • Change in appetite – 23%
  • Teeth grinding – 17%
  • Change in sex drive – 15%
  • Feeling dizzy – 13%
Psychological symptoms following the distress of physical manifestations included:
  • Irritability or anger – 50%
  • Feeling Nervous – 45%
  • Lack of energy 45%
  • Feeling as though you could cry – 35%
With these numbers being so high, it’s no wonder that 3 out of 4 doctor visits are stress-related! It’s important to understand the impact that stress and anxiety can have on your body. Sometimes, we do not even know that we are stressed or contribute physical ailments to stressful situations in life. Being mindful of your body and the reaction it has to daily events can offer insight of how to manage stress. Please see the previous blog for helpful suggestions/ healthy lifestyle changes to reduce your anxiety and stress.

Also, there is an interesting video available online (via Netflix, YouTube) titled: Stress, Portrait of a Killer. National Geographic takes a look at thirty years of research and examines scientific discoveries through field and lab research to prove stress is not just a state of mind, but measurable and dangerous.


Friday, April 17, 2015

Mental Health Round-up

3:00 PM Posted by Stephanie Horgan , ,
Recently, I've been noticing a lot of articles about mental health online. May is only a few weeks away, and it will be National Mental Health Awareness Month. Here's a round-up of some recent articles I enjoyed and wanted to share about this topic.


Why the World Needs the Mentally Different
This is a blog written by Glennon Doyle Melton, an author and speaker with a history of mental health illness herself. I admire her honesty and humor, and in this post she has a wonderful perspective on what those who are "mentally different" bring to the table. She says, "What we who are mentally different need is respect. We know we need help managing our mental differences, but what we ask for is a shift in your approach to helping us. Instead of coming at us with the desire to change us because we are inconvenient to the world- come at us with the desire to help us because we are important to the world. We want you to see that with a little help, we can be your prophets, healers, clergy, artists, and activists. Help us manage our fire, yes, but don't try to extinguish us."

In Sickness and In Mental Health
This is an audio episode of a program on NPR in New York called Death, Sex & Money. It features the story of a couple who were married for three years, when the wife started experiencing symptoms of bipolar disorder. It chronicles her recovery and inpatient stays, as well as their decision to have a child. I appreciated the honesty of this couple who had no idea this was going to hit them a few years into marriage, and the openness in letting others see what their journey was like.


MLB Teams Nurture Players' Mental Health
Three teams in Major League Baseball hired sports psychologists or mental health coaches. For major league athletics, I am pleasantly surprised at their recognizing of the needs of the players on and off the field. So far the Chicago Cubs, Boston Red Sox, and the Washington Nationals are the teams on the front lines of this new holistic approach.

Last but not least, I'm including a fluff article about Celebrity Quotes that will Change the Way You View Mental Illnesses. It includes a list of various celebrities who have faced mental illness in some way, which I feel will help decrease the stigma for all the people who admire them and think they have it all together. My favorite quote from this article is by John Green, a young adult author. "I take medication daily and have for many years. I also try to exercise a lot, because there's some evidence that exercise lessens the symptoms of anxiety, and I try to use the strategies that I've learned in cognitive behavioral therapy to cope with my illness. But it's a chronic illness and it hasn't, like, gone into remission or anything for me. It's something I live with, something that I've integrated into my life. And we all have to integrate stuff into our lives, whether it's mental illness or physical disability of whatever. There is hope. There is treatment.

Sunday, April 12, 2015

Coping with Anxiety

5:42 PM Posted by Skyler Schuyler , , ,
It’s just past midnight and you find yourself wide awake at night; restless, worried and looking at the clock. There’s a long list of chores to be done at home, but you still need to pick up dinner, get the kids to practice and return a phone call. Your boss informs you several people have called in sick today and now you have the responsibility of three people. – The majority of us have all been there; experiencing the symptoms of anxiety in our own way. But how do you cope with anxiety when it creeps up on you unexpectedly?

Because anxiety develops and presents itself in various ways for everyone, being mindful of its symptoms is the first step to combating anxiety and feelings of stress. Symptoms include excessive worry, sleep problems, irrational fears, muscle tension, chronic indigestion, self-consciousness, panic, flashbacks, compulsive behaviors, excessive sweating and increased heart rate. When you find yourself trying to manage any level of anxiety, it is a good idea to remind yourself of what you can actually change (what’s in your control) and accepting the rest (what’s out of your control).

Also, it can be helpful to take a personal time-out. Having time for personal reflection such as listening to music, meditating and practicing your own relaxation techniques (taking deep breaths, counting slowly to 10) can provide you with an opportunity to take a step back and look at your stress from a different perspective. Eating right and getting enough sleep are easy steps to reduce your anxiety. It may seem easier said than done, but it’s important to eat well-balanced nutritional meals which help boost your energy, limit your amount of alcohol and caffeine and get plenty of rest to revitalize your mind. In addition to eating healthy meals and sleeping more, you should explore different options of daily exercise. Sometimes your body needs to release energy that builds inside you. Excess energy can increase your levels of anxiety and make your symptoms of stress feel much worse.

Sometimes you just have to accept that your best is not always going to be perfect. Challenge yourself to be proud of what you have accomplished and release your desire for perfection. Humor is also a great way to reduce tension. Give yourself a break and try to use laughter as a form of release. While choosing to have a positive attitude can be difficult, it can replace negative thoughts and cognitions you may be experiencing. Finally, if your levels of anxiety allow, try to get involved more. Being active in your community by volunteering or joining clubs can help you build a positive social network and provide you an outlet from your anxiety and stress.


While there are many other coping strategies to reduce tension, anxiety and stress, these are a few ideas that are more basic. – Try and discover what works best for you. In order to reduce undesirable anxiety, you have to learn what your triggers are and talk to someone if your feelings become unmanageable. Remember you are not alone and almost everyone has experienced anxiety in some form another. Hang in there and use those coping skills!

Monday, March 30, 2015

Cognitive Distortion of the Month: Dichotomous Thinking

2:44 PM Posted by Tiffany Taft , , ,
Greetings.  It's been a while since I wrote a blog entry as I had a baby last October and it's kind of amazing how real baby-brain is, which makes writing feel exponentially harder.  Especially when they don't sleep very well.  He's 5 months old now and is being gracious enough to let me sleep in 3-4 hour increments.  So I have that going for me.

Steph kicked off our 2015 blog series on Cognitive Distortions, or as some say "thinking traps" with a nice piece on using a Negative Filter when evaluating our life.  If you haven't read it, go check it out.

For March, the topic is Dichotomous Thinking.  As it implies, dichotomous thinking is only seeing a situation from two potential angles.  It's all or nothing.  Good or bad.  Black or White.  There's not much room for any grey area.  But, if we take a step back we see that life is full of grey areas and it's actually less likely that we're operating in one of the extremes.  So why do we go there?


How do we know when we might be stuck in a dichotomous thinking trap?  There are certain key words to look out for.  The biggest 2 are Always and Never.

In terms of living with a chronic illness, it might be thoughts like:

"I'm always getting sick when I have plans."

"My treatment is never going to work."

"People always give me a hard time about my condition."

"My doctor never listens to me."

Or, we can fall into this trap more generally:

"I didn't get a perfect job review so I'm obviously a total failure."

"I forgot my friend's birthday so I'm obviously a horrible human being."

Thinking this way can cause a lot of stress, not to mention feelings of helplessness or even hopelessness.  Dichotomous thinking is the basis for perfectionism, which I've found is often behind feelings of anxiety and depression because who can ever measure up to perfection?

What are some ways to combat dichotomous thinking?

Like most cognitive-behavioral therapy (CBT) strategies, we start with pausing and evaluating the legitimacy of our thoughts.  I like to ask clients "Would your argument hold up in court?"  Or, "Would your argument hold up to scientific review?"  If the answer is no, then we have to look at why you might still hold on to those thoughts if they aren't valid.  But that's for another blog entry.

Evaluating our thoughts in a rational and logical way pulls us back from overly emotional thinking, which lends itself to cognitive distortions like dichotomous thinking.  Don't get me wrong, we don't want to be too robotic about life. Rather, we can operate in between, in what some in psychology refer to as our "wise minds."  

The next time you're thinking this way, jot down your thoughts on a piece of paper.  Draw a line with your belief at one end.  At the opposite end of the line write down the opposite thought (e.g. you wrote down "I'm never going to get better" then write down "I will get better.")  Next, draw a short line through the middle of the original line and write down a few thoughts that are somewhere in between the 2 extremes to try to get at the middle ground, or grey areas.  

And then ask yourself:

Are situations where your belief isn't happening.  This is good for the always and never thoughts.  

Would everyone see the situation this way?  What are some alternative arguments?

What would I tell my friend if he/she came to me with this belief?

If I thought of the situation in terms of the grey area, how might my feelings or behavior change?

Reining in dichotomous thinking can help us feel less anxious, down, or defeated.  Evaluating these thoughts help us look at our world through a more realistic lens.  This exercise may seem simple and straightforward as you read it, but it takes time and practice to make this a habit that we use in the moment when dichotomous thinking is kicking up intense feelings.  If you struggle with making the adjustments on your own, getting help from a CBT therapist can certainly help.

Best,

Dr. T.

Tuesday, March 24, 2015

Understanding Anger – Part 2

7:44 PM Posted by Skyler Schuyler , , , ,
As we know, anger is a powerful emotion that can endanger your work, relationships and even your health. Managing anger effectively is important not only for self-care, but also within personal relationships. While experiencing anger is normal, coping strategies to reduce internal frustration can look very different for everyone. Looking to the experts in anger management, the following strategies are found to be the most effective when attempting to reduce internal frustration and anger directed outward.  



First, think before you act. It’s easy to get caught up in the moment and to say exactly what’s on your mind. It takes far more practice and skill to take a moment and pause before speaking. Giving yourself and others around you time to gather thoughts can help deescalate frustrating situations. Once you are able to remain calm, it is important to express your frustration in a nonconfrontational manner. Being assertive without offending others can be challenging in itself. Expressing your anger appropriately takes time and practice, but soon you will be able to offer insight to your feelings without hurting or potentially insulting others.

When confronting a frustrating event, using ‘I’ statements can greatly reduce feelings of criticism. If a person feels blame is placed on them, it’s difficult for them to hear what you are saying. Using ‘I’ statements reduces the likelihood of someone becoming defensive in the moment and may give them a chance to listen to the feelings you are trying to express. For instance, “I’m upset when I come home and feel like I have to clean up the house by myself.” It’s also important to evaluate and identify as many possible solutions. When you start to feel anger build inside, ask yourself if what is making you mad could be changed with reframing your thoughts. If you burn dinner, can you make something else instead? If traffic is backed up, can you spend that extra time as self-reflection? If a room is messy, is it possible to shut the door for that day? Creative solutions and reframing frustrating moments can instantly change your outlook for the day.


Using humor is also an effective way to manage stress and reduce frustration. When you can lighten up a mood, tension will diffuse. Humor can help you look any possible unrealistic expectations that are driving your anger in the moment. However, tread lightly with sarcasm. Sarcasm has a tendency to escalate circumstances that already invoke irritability. Remember, forgiveness is powerful. If you hold a grudge towards others, the only person it truly impacts is yourself. Negative feelings you harbor towards others may go unnoticed, leaving you feeling bitter and possibly enraged. If you are able to, and can forgive, you may be surprised at how much both parties can learn from the situation.

Combating anger requires the use of relaxation skills and exercise. With flared tempers, relaxation strategies such as deep-breathing, reciting calming words or phrases, or listening to music can reduce irritability in the moment. The right song or choice of words may look different for each person, so it’s important to figure out what works best for you. This may take some time and practice, but is well worth the effort when you experience success. Movement and exercise can physically help reduce blood pressure, change chemicals released in the body and improve your mood. Try going for a brisk walk, yoga or playing a sport with friends to transfer negative energy and emotions into positive use.

Finally, take time out for yourself and know when to ask for help. It’s challenging in the heat of the moment to take a step back and give yourself space. Some scenarios that make us mad can be worse than others. Recognizing events that require additional space can save you time and energy. However, sometimes, no matter how much you try, you might need a little help. Seeking assistance from anger management counselors, social workers or therapists can help increase your coping strategies.



Anger is powerful, and it can be destructive. Do not let your anger control you. Find the right coping strategies that work for you. This may mean you might have to get creative, but that’s ok. Praise your efforts and remind yourself that anger did not get the best of you – because you made that choice.







Monday, March 2, 2015

Understanding Anger - Part I

7:15 PM Posted by Skyler Schuyler , , , ,
Emotions are powerful responses that are unavoidable. As unique individuals, we express our emotions in various ways depending on the situation and people around us. You may have a friend or know someone who is always happy and cheerful or someone who is cranky and moody.
But what about anger? Do you know someone who expresses anger frequently? Perhaps you find yourself feeling angry more often. Understanding your emotions is the first step to knowing how to appropriately express these feelings.
What is Anger?
According to Dr. Charles Spielberger, anger is “an emotional state that varies in intensity from mild irritation to intense fury and rage.” Exploring the nature of anger, irritability and agitation are accompanied by both physiological and biological changes. For instance, when you experience frustration or agitation, your blood pressure and heart rate increase, energy hormones increase, as well as adrenaline and noradrenaline. – Family fighting during holidays, a delayed flight, wrong food order, argument with a friend, the kids arguing in the back seat – Anger is the result of external or internal (even a combination of the two) events. Either an individual person or an event can stir up irritability.
Why Do We Feel Anger?

It’s normal to question why we experience anger. Leading experts within anger management programs have offered several responses why irritability occurs more often for some. However, several of these reasons are worth taking a moment to consider. For instance, anger occurs because someone wants to harm themselves. Depression can play a big role in anger directed towards oneself. If you feel powerless or isolative, it may represent a desire for self-destruction.
We may experience anger in an effort to achieve control. It has been suggested that anger is used to intimidate or manipulate our circumstances. Fear, irritation and even sadness can drive your intent for control. People will experience anger to feel powerful. Making someone feel small when you’re feeling down can make you feel bigger in comparison. Additionally, the need to fight injustice can fuel anger. While personal morals and feelings of social justice look different for everyone, some people experience outrage at any inequality committed against themselves or others.
As we continue to explore causes and consequences of anger, remember that anger is typically goal-driven. ‘Why’ we experience anger will be different for everyone. Anger can be triggered and leave people feeling worse than the start of their irritability. Regardless of what causes your frustration, what you do with those feelings of agitation counts! Over the next post, I will review some of the best approaches to reduce anger and some practical steps to limit agitation and irritability daily.


Wednesday, February 11, 2015

Cognitive Distortion of the month: Negative Filter

8:42 PM Posted by Stephanie Horgan , ,
In 2014, Dr. Taft and I took turns writing monthly entries on rare diseases, in order to bring more awareness to the psychosocial aspects of living with chronic illness. In 2015, we are going to do a monthly blog entry on various cognitive distortions (although we are off to a late start!). For February, I am writing about the distortion called "negative filter". But first, let's discuss what a cognitive distortion is. It is simply an unhelpful thought pattern that is very common but lead people to feeling stuck in depression or anxiety. Since we are big believers in cognitive behavioral therapy (CBT) here at Oak Park Behavioral Medicine, we wanted to spend some time looking into the various patterns that trip people up. CBT is a theory that looks at three aspects of a person: thoughts, emotions, and behaviors.

A negative filter is when a person views information through a negative lens. The positive aspects of life are disregarded, and the negative aspects are focused on. As you might be able to forsee, this can be particularly depressing when everywhere you look, you see negativity. An example of this distortion is when many things go right at work, but a person gets hung up on the one thing that went wrong during their day. Maybe they overslept, or maybe a meeting didn't go as well as planned, but there were other positive moments throughout the day that got completely overshadowed by this negative event.

Why does this happen, you might ask? Well, we know from research that our brains are wired to react more strongly to negative stimuli than to neutral or positive stimuli. Researchers believe this is an evolutionary behavior that helps us pay attention to the things that may hurt us so that we can survive these threats. Research conducted with married couples has found that the ideal ratio of positive interactions to negative interactions is 5:1. The higher the ratio of positives to negatives, the more stable the marriage tends to be.

When we realize we have this negative filter, what can be done about it? The answer is to simply change our focus and look for positive things, no matter how small they seem. Be intentional about spending a few minutes at the beginning or end of your day to recognize what is going right and what you are thankful for. Then throughout your day, when you find yourself stuck in negative thoughts, take a few deep breaths, and use logic to challenge your thought that you are stuck on. Is it true? Is it helpful? What other perspectives are there? Realizing that you have a the power to change your thoughts and that this can, in turn, change your mood is a main building block of the therapy we do. One particularly helpful suggestion I share with clients is to start a happiness jar, an idea from Elizabeth Gilbert. She is the author of Eat, Pray, Love, and she challenged all her followers to start a daily practice of looking for positives and writing them down. Then find a jar around the house to keep all of these positive slips of paper and read them at the end of each year. The key is to do this as consistently as possible. Do not beat yourself up if you forget. There is nothing too small to be a positive from your day, although some days it may be easier than others to identify things. The overall goal is that you are changing the way your brain is wired, by choosing to look for positives, rather than allowing your negative filter to take over.

Sunday, February 8, 2015

What Does a Healthy Relationship Look Like?

6:58 PM Posted by Skyler Schuyler , , , , ,
Continuing on the topic of relationships, I thought it would be great opportunity to review several journal articles and get the “expert opinions” on what healthy relationships look like. While many articles featured their own spin and interpretation of positive responses in relationships, many concepts remained the same. Let’s explore these traits!

 According to many marriage and family therapists, emotional responsibility is highly valued for a successful relationship. If someone is unable to take responsibility for their own feelings, pressure is placed on their partner to create personal happiness, wellness and security. The problem with making your partner responsible for your emotions is the likelihood you will experience disappointment. When your partner fails to meet your expectations emotionally, people feel “emotionally abandoned.” Take ownership and responsibility of your feelings and do not ignore your feelings. Another trait for healthy relationships involves empathy and compassion. Partners thrive in relationships when their counterpart show kindness and acceptance regarding personal thoughts and experiences. A simple gesture of compassion and empathy goes a long way to improve your loved one’s day.

Healthy relationships have connections. Both parties need to experience warmth and affection as well as humor and fun. Connecting with someone, especially intimately, can be life changing. Memories are created with connections and draw us closer to our loved ones. Be mindful – connections are both give and take – you have to show your partner warmth, affection and even humor in order to receive these feelings yourself. Essentials for the health and longevity of a relationship include trust and support. Your partner needs to know that they can count on you. Significant others should not be threatened by their partner’s success or happiness, it should be shared. Your support in good and bad situations create lasting impressions for your partner.

Difficult for some, partnerships should be enjoyed both together AND apart. Your well-being should not be dependent on one single person. (But do not confuse emotional dependency for emotional responsibility. Someone’s “need” and “want” can look very different.) It is important to explore your personal interests with support and encouragement from your partner. Another common theme is growth from conflicts. People make mistakes and how you learn from them will be visibly noticeable in your relationship. When you experience conflict with your significant other – which everyone does – do your best to listen first and try to understand your partner’s point of view. It’s not always about being right or having to win.

Last, but certainly not least, is chemistry. Partnerships need to have positive stimulation physically, emotionally and intellectually. While people place different values on these sparks or chemistry, the reality remains that couples need a certain amount of each. As you and your partner explore each other’s needs and desires, a deeper loving energy grows, fueling the flame in your relationship.

So what do we take from all this information? Healthy relationships are constantly moving in a forward motion. You have to adapt AND evolve often. When people get stuck on a single notion, gesture or comment, negative emotional responses tend to develop, leading to the end of a relationship. Healthy relationships are not easy, they take a lot of work and BOTH parties are needed for success. So challenge yourself this week and consider these traits of a healthy relationship. Are you engaging in a healthy relationship? Are there areas you can improve yourself? Remember, change starts with you.