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.

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• National Institutes of Health

Check whether your drinking is healthy or excessive. This link will take you to their easy-to-read web page about alcohol use.

• National Council on Alcoholism and Drug Dependence

This PDF is their list of national organizations that provide support for addiction recovery.

• Centers for Disease Control

This PDF is the best infographic to illustrate the lines between moderate and excessive drinking. 

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:

1. ​Know what type of class you are best suited for, and seek that out. Know the class descriptions above and search for those in your community. If you can't find a class, try yogaglo.com for online streaming.
2. If you are a trauma survivor, be especially selective about your yoga class. Choose a class that is "trauma-sensitive" if you are just beginning to process your traumatic experiences. Know that some teachers provide "physical assists" or adjustments that involve them touching you. If you do not want to be touched, communicate that to your teacher prior to class.
3. Hot yoga (100 degrees +) can be counter-productive if you are overwhelmed by heat or have medical conditions. You should have an established practice of good hydration before you attend hot yoga classes. As an alternative, many vinyasa classes offer a warm room (85 degrees +).
4. Look for teachers that offer modifications of difficult poses and encourage acceptance of your body as it is today.
   

What to know before you go:

1. ​Yoga is usually practiced barefoot.
2. It's best to practice on a mostly empty stomach. You will be more comfortable with heat, vigorous sequencing, or twisting if you haven't just eaten a meal.
3. Some studios will have mats to borrow, or you can bring your own. For sweaty classes, a towel placed over your mat keeps you from slipping. You can use a towel from home, or there are special ones made to go on top of yoga mats.
4. Most studios have a place for your belongings outside of the yoga room. They are usually secured by the teacher locking the outside door before class begins.
5. Studios have differing policies about talking inside the yoga room. Some observe silence and others welcome chatting before class.​

​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.

• ​Generalized Anxiety Disorder. This is a general worry that underlies experience and gets in the way of daily functioning. It may be hard to pinpoint exactly what you are worried about, or it may seem like you're worried about everything. You may feel tense quite a lot and find your mind racing, jumping to conclusions, and thinking of the worst case scenarios. 
  • ​Fear is is generalized to everything.
• Social Anxiety Disorder. This is anxiety specific to social situations. You may worry about what others are thinking of you, that you'll embarrass yourself, that others will reject you, and avoid social situations in which you are likely to have to interact. 
  • ​Fear is about social interaction.
• Specific phobia. This is anxiety specific to a particular object, activity, or situation. Common phobias are of heights, flying, insects, blood, animals. You may feel intense immediate anxiety when seeing or thinking about your phobia, and actively avoid it.
  • Fear is related to something very specific.
• Panic Disorder. This occurs when panic attacks perpetuate themselves through anticipation of another attack. Panic attacks can occur with other anxiety disorders, depression, post traumatic stress disorder, and many other mental health conditions. Panic attacks are episodes of terror that occur for no apparent reason, in which one may feel shaky, sweaty, racing or irregular heartbeat, difficulty breathing, the sensation of choking, chills or hot flushes, and/or nausea. (Remember the fear response to the bear described above...a panic attack is almost just like that, minus the actual danger). Most panic attacks involve a fear of passing out, fear of going crazy, and/or fear of dying. Merely having a panic attack doesn't warrant a Panic Disorder diagnosis, however.  Panic Disorder emerges when the anticipation of more attacks and the avoidance of places or situations that may cause another attack interferes with everyday life. 
  • Fear is of having another panic attack. 
• Agoraphobia. This occurs when there is a persistent fear of public places or situations, including using public transportation, being in either open or enclosed spaces, standing in line or being in a crowd, or being outside of home alone.  Usually thoughts accompanying this fear are "I can't get out of here" or "no one will help me."
  • Fear of a particular situation, usually in public. 
• Substance or Medication Induced Anxiety Disorder. This occurs when anxiety is attributable to the effects of a specific drug, legal or illegal. 
  • Fear occurs as a side effect of a drug.

The body's natural ability to balance itself in response to stress is powerful. Just knowing that the nervous system is able to balance chronic anxiety is the first step. Then, learning and practicing tools that enhance our body's natural ability to balance, will help us move beyond fear and anxiety that might be crippling us. 

In counseling, there are many approaches to working with anxiety. I've found three approaches most helpful:

1. awareness of the breath
2. mindful meditation
3. awareness of habitual, unrealistic or unhelpful thought patterns.

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

Getting Sober

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.
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The good news is, there are many simple actions we can all take to help challenge mental illness stigma which include:

• Be respectful. Use courteous and considerate language. Avoid using from derogatory language and correct people when you hear the use of such words and phrases. As mention earlier, unintentional yet derogatory words such as “crazy” or “insane” aid in the maintenance of stigma. I know I’m guilty of this one.    
• Talk about mental wellbeing and mental illness. Educate yourself and teach others when opportunities arise.
• Get to know people who have experienced mental health problems.
• Offer support to those who are experiencing mental health problems.
• Speak up about your own experiences. The more concealed mental illness remains, the more people continue to believe that it is shameful and should be hidden.

Stigma is personal. Stigma isn’t some kind of frivolous abstraction experienced by a highly sensitive and sparse few. It’s a social injustice that shames countless individuals with mental health concerns and damages them tremendously in the process. The consequences are deep and extensive. Public endorsement of prejudicial attitudes and discriminatory behavior towards individuals with mental health problems embrace stigma, and the social effects of this include exclusion and isolation, poor quality of life, a lack of social support and low self esteem. Adopting and internalizing the stigma of mental illness and targeting stereotypical, harmful attitudes towards one’s self leave people believing they are helpless and undeserving.  

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!