by Kambria Kennedy-Dominguez
We just wrapped up our very first art therapy series at Flourish, and it was a great success. We found the physical and emotional expression of painting images, shapes, and colors on canvas to be a soothing exercise. Painting, drawing, and creating are ways to do something with emotional experience. Counseling is often about defining what you feel. And often clients ponder this question out loud, "so I know what I feel, what do I do with it?" Most often I answer, "accept". You don't need to do anything with the feelings, except acknowledge and accept.
What you do is better based on what you value, not on what you feel.
Still, sometimes we need some kind of release, expression, resolution, and way to cope with the myriad of emotions that most of us feel every day. Anger, sadness, worry, regret, indifference, fear...to name only a few....are difficult to sit with. So if we can take a walk or a run, go a yoga class, snuggle with our partner or our pet, read a good book, take a warm bath, or paint a picture, these activities may help us endure and sit with the feelings.
Because of the success of the first art therapy 5 week series, we are offering it again, and hope to make it a staple of our services at Flourish. During the series, participants will learn how to use art as a relaxation exercise, how to incorporate meditation into the creative process, and how to build self-compassion. Part of our mission is to help others find what healing practices work for them, whatever that happens to be! Check out all of our groups here.
Alcohol is everywhere in our culture. Drinking is often viewed as an integral part of socializing and even doing business with others. It's relied upon as an anxiety reducer and a social lubricant. It's no surprise then that it's easy to over-indulge and create unhealthy habits with drinking. April is Alcohol Awareness Month, so a good time to reflect about your own alcohol intake and how it's affecting your health and daily life. Below are a few resources to help.
This PDF is their list of national organizations that provide support for addiction recovery.
Bright and early a few days ago, I had the fantastic opportunity to teach a workshop about yoga to counselors from across our state at the Texas Counseling Association annual conference in Dallas. It was a great time! I shared a presentation, then led the group through a yoga practice so they could experience it for themselves. We ended our morning circling up for discussion.
In the session, we talked about the ancient roots and philosophy of yoga, the different types of yoga classes found in many communities today, and how specific approaches have been developed to use yoga for trauma recovery and mental health. You can learn more about all of these ideas in the complete Powerpoint presentation.
Here are a few key slides that may be very helpful when considering starting a yoga practice. First, a description of some of the terms used to describe types of classes.
Then some findings of researchers. There's a lot of data that points to the benefits of yoga.
But yoga is not to be used without caution. Here's my advice for choosing the right yoga class:
What to know before you go:
Here's to finding the best yoga experience to reap the benefits of this ancient practice!
Let's give anxiety some consideration today. You've likely experienced it over and over. You may have heard about certain types of anxiety like phobias and panic attacks, or diagnoses like Generalized Anxiety Disorder or Panic Disorder. There are lots of levels and experiences of anxiety, and sometimes even different definitions of anxiety from person to person. Anxiety is essentially worrying, feeling afraid, overthinking, and sometime panicking.
The common thread is that anxiety exists and is real for all of us, because it stems from an innate human emotion...Fear.
The DSM 5 (the manual we look at to classify symptoms and diagnose) draws a distinction between fear and anxiety like this:
The autonomic nervous system, referenced above, pays a particularly important role in anxiety, and has two distinct parts. It revs us up (courtesy of the sympathetic system), then stabilizes us (thanks to the parasympathetic system), when there is a perceived threat in our environment. Imagine a bear chasing you...your heart rate increases, breathing rate increases, blood flows to limbs, pupils dilate, digestion slows, muscles tense. Sometimes tunnel vision and hearing loss occur, as well as relaxation of the bladder and colon. This very physical response to danger has a purpose. Muscles tense to ready themselves for action, blood flows to limbs to enable us to move quickly away from danger. Then, the nervous system slows and reverses this response once danger has passed, initiating relaxation. Our breathing and heart rate slow down, our muscles relax, our body comes back to homeostasis.
Both humans and animals alike experience this stress response cycle. Animals and humans differ, however, in the ability to reason, classify, predict, and analyze. We humans can thank our bigger brains and cerebral cortex for that. An animal might encounter that same bear, have a fight or flight response, be able to escape from danger, then quickly stabilize and move on. The cerebral nature of our human brains don't allow us to move on in the same way. We would likely have persistent fear or worry after an episode like that. We may feel afraid of bears, the place it happened, what we did right before it happened, that we may not protect ourselves from it happening again, or that it will happen to someone else. You can see how the human mind's ability to analyze gets us in a pickle here.
We can get stuck with our fear in the "on" position, even in response to more innocuous stimuli like work or school demands, relationships, financial issues, health concerns, parenting, and other aspects of daily life. Our reasoning and predicting minds create future scenarios to worry about, and sometimes with good reason. If you lost a job in the past because you were late, you may be well served to worry about being late in the future. So in this way, anxiety is a helpful and useful tool that reminds us to pay attention to something specific like not being late to work. However, as we know, anxiety can become problematic when it immobilizes us in everyday life, keeps us from making decisions, disengages us in things we'd like to do, or impedes relationships.
Here's how I describe the anxiety continuum. Remember, fear and anxiety are related to paying attention to our environments and paying attention is a good thing.
It may be helpful to outline the different types of anxiety disorders listed in the DSM 5.
In counseling, there are many approaches to working with anxiety. I've found three approaches most helpful:
For more information on how we incorporate these approaches into therapy, please contact us! We are happy to help you learn more about how counseling can work to manage fear and anxiety.
By Kambria Kennedy-Dominguez
What "sobering up" means to you depends on your situation. Sometimes it means decreasing the frequency or quantity of use. Called "harm reduction" in treatment terms, many people naturally do this when they notice a problem with drugs and alcohol but are unsure of its severity. For example, if you find that you binge drink (more than 4 drinks at a time for women and more than 5 for men) when you're out with friends at bars, you might decide to ask your friends to meet you at a movie instead of a bar. Shifting the environment in which problematic behaviors occur is a way to reduce harm. Likewise, you may try to limit the amount you are drinking or using, or you may make deals with yourself not to use at certain times of day or in certain places. All of these methods of control are common once a problematic pattern is recognized. Whether these methods of control work or not depends on your individual circumstances. Here's a guideline for the safe consumption of alcohol, by the way. Great graphic from the CDC.
Harm reduction is controversial, because many treatment professionals and many of those in recovery believe complete abstinence is the only way to sobriety. They might say that attempting to reduce harm only keeps you in the dangerous cycle of addiction, as you try to negotiate the problem away. There are reasonable arguments in favor of abstinence as the best strategy and it does indeed seem to work best for many. Taking a harm reduction versus abstinence approach is a very personal decision, one that I help clients make based on their own experiences.
Depending on the severity of the addiction and on the substances or substance combinations being used, withdrawal may with abstinence. Withdrawal symptoms range from mild to severe and vary depending on the drug. The process of withdrawal under medical supervision is called detoxification, and is the safest way to discontinue use of a drug when withdrawal is present, particularly with alcohol, opiates (heroin or prescription pain killers) and anti-anxiety drugs (like Xanax and Klonopin). After detox, many continue to residential treatment for 30 days or more, and some choose to move into sober living environments after residential care. These are each options along the way to sobriety, and most everyone's journey looks different depending on what they need.
Once a more sober life is established, you have entered "recovery." Below is the three part plan that I use with counseling clients to help sustain recovery.
Using coping skills that work
A critical part of therapy for anyone, whether addiction is present or not, is learning to identify and use coping skills that work. What do you do when you feel stressed out at the end of a busy day? What do you do when you fight with your spouse? What do you do when you come up short on your monthly bills? What do you do when your boss yells at you? These are just some examples of possible triggers (see above) that may lead to cravings to use if there are not more adaptive coping skills in place. Some examples of coping skills are exercise, art, reading, talking to trusted friends, 12 step groups like AA, support groups, meditation, spending time with pets, making music, listening to music, walking, drinking tea, taking a warm bath, having a massage, giving yourself a massage, learning a new skill, taking up a new hobby....the list is limitless really. The question to ask yourself is how can I soothe myself in a way that doesn't create harm?
Recovery is possible and it's happening for many people every single day. There are a ton of resources available to help and lots of evidence that positive change is within reach. If you are struggling with addiction or wanting to know more, please don't hesitate to reach out.
by Megan Kennedy
The mental health community is buzzing with talk about stigma. As a social work student, my mental health classrooms were filled with dialogue about the ongoing consequences of shaming individuals with mental health problems. As a professional, the effects of stigma are often detailed in the stories and everyday lives of my clients, and as an individual with a lengthy history of anxiety, I have personally felt the effects of stigma and witnessed stigma through others close to me. Considering roughly 18.6% of adults and 13.1% of children (ages 8-15) suffer from diagnosable mental health problems, chances are you have too. Most of us agree that stigma is harmful, but where does it come from and what can we do about it?
Researchers report two distinct types of mental health stigma - social stigma and self- stigma. Social stigma results from prejudice attitudes and discriminatory actions that target individuals with mental health issues due to the assignment of psychiatric labels. Self-stigma, on the other hand, is characterized by one’s internalization of perceptions of discrimination.
A number of factors contribute to stigma. Historically, individuals with mental health concerns have been treated differently, rejected and abused. Dr. Graham Davey, a British professor of Psychology, notes that this kind of treatment stems from mistaken views that mental health problems steer people to act in more violent or unpredictable ways than those without such problems, or somehow people with mental health concerns are abnormal or different. However, none of these views have any basis in fact. Dr. Davey also includes the medical model as an unintentional source of stigmatizing beliefs, as this model usually signifies diagnoses and diagnoses implies a label to a “patient.” Such labels are often associated with undesirable attributes, which perpetuate the idea that individuals with mental illness and/or diagnostic labels should be viewed with concern.
It’s no surprise that the most blatant perpetuation of mental illness stigma is at the hands of the media, as media portrayals often reinforce stigma with images of violence and homicide associated with mental health problems. Discussions concerning mass shootings and mental illness almost go hand in hand these days. Moreover, words used to represent mental illness are so common in our present-day vocabularies they almost always pass without comment or judgment. Psycho. Nut-job. Crazy. Insane. He’s lost his mind. She has some serious OCD. The list continues.
For some, the nastiest consequences of stigma aren’t social injustices but the effect stigma has on help seeking behavior of those affected by mental health problems. The Scattergood Foundation reports a mere 30% to 40% of people with mental health problems seek treatment in the U.S., and up to 70% of adults and youth worldwide do not receive services for mental and behavioral health problems. Public health researchers attribute stigma as a major causative factor driving these alarmingly low rates of treatment. Moreover, stigma hurts treatment outcomes and hinders effective recovery from mental health problems.
The good news is, there are many simple actions we can all take to help challenge mental illness stigma which include:
Sleep is so important that almost every single diagnosis in the Diagnostic and Statistical Manual for Mental Health Disorders (or DSM) has a disrupted sleep component to it. That's why I ask every client about sleep on the initial paperwork when entering counseling. I have conversations about sleep so frequently in counseling sessions, I decided I needed to gain more information and new ways to explain what happens while we are sleeping. There happened to be a great article about this topic in the November issue Counseling Today, a periodical published by the American Counseling Association.
It turns out there are two critical periods to your sleep cycle. The Stage 3 NREM phase is crucial for physical health. Your immune system and cells regenerate. It's called recovery sleep. The system in the brain which creates the stress response (the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system) is powered down. We spend the most time in this kind of sleep and it seems to be akin to recharging our batteries.
The Stage 4 REM sleep phase enhances our emotional health, allowing us to keep our feelings in check so that we can function in our day. Emotional memories are encoded during this phase and are separated from the actual emotional response, allowing us to retrieve these memories from a distance and not get so overwhelmed in them again, as if they were happening all over. People with trauma histories have a particularly disrupted Stages 3 NREM and 4 REM cycles, resulting in the inability to process memories and deactivate the stress response.
See the below graphic for more details about all the stages of sleep.
For more on sleep hygiene and an excellent sleep diary, visit the National Sleep Foundation. You can improve your sleep by avoiding caffeine, alcohol, and heavy meals in 2-3 hours leading up to bedtime. It also helps to have a bedtime ritual at the same time every day, engaging in an activity like reading, relaxation exercises, gentle stretches or drinking herbal tea in the hour before bedtime. And exercise in the early afternoon seems to have a positive effect on sleep quality.
Here's to a restful night's sleep!
Kambria Kennedy-Dominguez, Counselor and yoga teacher specializing in mental health, substance abuse and wellness.