Tag Archives: Stress Management

Depression on Easter Sunday

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“Ask Ellen Anmuth Psychotherapist” is a series dedicated to readers’ questions on topics such as depression, anxiety, anger, relationships, communication, conflict resolution, grief/ loss/bereavement, genetic counseling, medical problems, and stress management.  Today’s blog is focused on depression associated with holidays.

Amy from Maine writes: “Dear Ellen Anmuth, Psychotherapist: Today is Easter Sunday, and I am feeling very depressed. I moved to Maine last October from San Diego. My family and life-long friends live in Southern California. This is the first Easter in a new place. I have been feeling depressed all week, and today was a very hard day. Please help.”

Ellen Anmuth, Psychotherapist writes: Dear Amy: Relocation to a new place can be a very difficult adjustment. When I read that you moved from Southern California in October of last year to Maine, that means that you experienced a very cold and challenging winter season. In addition, the sun sets earlier in Maine than Southern California. People who change their locations may have a condition called Seasonal Affective Disorder, related to reduced sunlight exposure.

Depression can be triggered by other factors, as well, such as a holiday spent away from family and friends. Was this your first Easter Sunday spent without these familiar faces?  Was Easter Sunday usually a day of spiritual and emotional comfort?

Finally, relocating your home involves loss and adjustment. Some people focus only on the positive aspects of a move, and try to keep up a happy face, in spite of feelings of sadness and loss. Attempting to deny the feelings of loss can create more feelings of depression. There is an expression, ‘what we resist, persists’. By talking about feelings of loss, we become more empowered to cope with the challenges. Speaking with a Licensed Mental Health professional can also be of help. Easter Sunday, Thanksgiving, Christmas, birthdays, and anniversaries of deaths can all trigger depression. Creating a support group of friends during holiday times can help to avert severe depression. It took much courage for you to relocate across the country. Sometimes it takes equal courage to reach out for help and support during the difficult times. It is wonderful that you were able to write this email. If you continue to seek local support within your community, you will find the transition to Maine easier to adapt to.

 

Feeling Upset? 3 Quick Tips for Getting Happier

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This blog answers emails from readers. Today’s email comes from Jennifer in Kansas City.

Jenifer asks:Dear Ellen Anmuth, Psychotherapist: I find myself feeling upset lately. Do you have any advice? Thanks very much.

Ellen Anmuth, MS, MSW, LCSW, Psychotherapist replies:

Dear Jennifer: Your question is universal. “Getting Upset” is a common phenomenon. By “upset”, do you mean  that you feel angry, sad, or afraid? Do you experience behavioral changes, such as sleep disturbances, over-eating, not eating enough, yelling at other people, using drugs or alcohol? Here are 3 tips for dealing with “feeling upset”.

Tip #1: Look inward, and try to name your feelings. By “Upset”, do you mean that you feel sad, angry, afraid, or all  3? Sometimes, when people feel angry, it could be that they are feeling sad, and are not allowing those feelings to be acknowledged. Similarly, people can feel sad, when they are denying feelings of anger. There is an expression, “what we resist, persists”. One way to manage “upset feelings” is to isolate the feelings, and connect with them. By allowing our true feelings to be expressed, we gain some control over them.

Tip # 2: Notice what events may have occurred in your life in the past year. Did someone you love get ill, or die? Have you had a relationship breakup? Are you having financial problems? Is your health changing? Some of us try to cope with sadness or loss by minimizing these events. It is better to acknowledge the events, and work the feelings of loss through with a friend or a licensed psychotherapist.

Tip #3: Look back to your family of origin history and your childhood. In adulthood, seemingly benign events may trigger unresolved issues of childhood. For example, if you had a very controlling mother or father, a boss at work may trigger some unresolved feelings from years ago. Feelings of helplessness or powerlessness in the workplace could result in depression, anxiety or anger.

Hopefully, exploring these three areas will help turn the general concept of “feeling upset” into a situation in which you can more clearly define and describe the real issues that need to be addressed. This leads to a feeling of control and well-being when a breakthrough in understanding and coping can be achieved.

Music Therapy: 3 Keys for Creating Calm in Stressful Times

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The term “Music Therapy” may bring up the image of a professionally trained  “Music Therapist” interacting with a child, adolescent or adult in a hospital, rehabilitation facility or office, in order to help them deal with stress. These applications are well known and very helpful.

I recall how impressed I became with the field of Music Therapy when I worked at Miami Children’s Hospital years ago. A Music Therapist was involved in a research study, in which two groups of children were given two different experiences during surgery. One group of children had surgery with head phones and music, and another group of children had surgery without head phones and no music. The results: The group of children who had music during the surgery asked for less pain medicine after surgery!

It was wonderful for the effects of music to be quantified in this way. I had also heard of a research project involving plants, although I cannot verify this study. I was told that one group of plants were exposed to classical music, another group of plants were exposed to New York City street noise, a third group of plants were exposed to rock music, and the last group of plants had complete silence. The results: The plants exposed to classical music grew the most and were the healthiest! I think the worst result were the plants exposed to New York City street noise.

The purpose of this article is to inspire readers to embrace a simple practice of listening to inspiring music….whatever it is for you…..in a conscious and therapeutic manner, in order to create feelings of calm in the midst of challenging moments.

For example, if you are going through a hard time (such as a health issue causing you fear), a relationship issue (such as a death or a divorce), financial problems or any life challenge, taking a “mini music vacation” can change your mood and improve your health, even for a brief period of time. For example, people who meditate can lower their blood pressure. Listening to music can be a meditation.

You can select music that creates a feeling of calm when stressed,  or happy and upbeat music if you feel down or depressed. It is always important to honor all emotions, rather than deny or repress them.

3 KEYS TO CREATING “A MUSIC THERAPY” STRATEGY:

1) Write out a list of songs that have special meaning to you, and which are associated with happy times.

2) Keep these musical selections handy so that you can listen “in the moment”.

3) If you are not in a situation where listening to music is possible, have a “play list” in your head. Imagine that your mind is a metaphoric radio, and you can “hit a button” and recall a song, including the lyrics and melody. If you are able to recall the tune and/or lyrics during times of stress, just play the song in your head! This is a technique similar to self hypnosis or guided imagery, In fact, as you sing the song to yourself, you could also imagine sights, sounds, aromas and feelings of a time in which you felt peaceful or happy.

While a few moments of “music therapy” cannot completely fix serious and complicated emotional problems, the music will provide a “mini-vacation” so that you will rest, re-group, and have more coping skills to handle life’s challenges.

If you are experiencing severe anxiety or depression, it is best to see a licensed mental health provider.

 

Ask Ellen Anmuth, Psychotherapist: Coping With A Cancer Diagnosis

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Ask Ellen Anmuth, Psychotherapist

Ask Ellen Anmuth, Psychotherapist

A cancer diagnosis can be terrifying. The journey can begin with a swollen lymph node, a breast lump discovered while showering, or a visit to the doctor, where the words “we need to get this biopsied” reverberate in you head in stunned panic.

This blog series answers email questions from readers. Robin from Westchester, NY writes:

Dear Ellen Anmuth, Psychotherapist: I had a mammogram a month ago, and was called back for another scan, because they found something that concerned them. Yesterday, I went back for a repeat scan, and they found some abnormality…not sure, but I think they said something about calcification. I set up a biopsy for next week, and I am really afraid that this may be cancer. Please help me.

Ellen Anmuth, Psychotherapist: Dear Robin….It is normal to feel anxiety when told that you need a biopsy. The fear of cancer looms heavy when told that we need to do a biopsy, which is an invasive procedure. Let’s outline some approaches:

1) You live in Westchester, NY which is very close to New York City, with some of the best Medical Schools and Universtiy Medical Centers in the world. Many people like to take their mammogram scans to a University Medical Center, and get a second opinion. You may even want to get another mammogram at the medical center in New York City, and get a second opinion from a specialist in this area. Often times, the University Hospitals are aware of the current research, and if you find a world renowned expert in the diagnosis of breast cancer, you may feel more comfortable. It would be a shame to undergo a biopsy if an expert has an opinion different from  your community doctor. Of course, you can always get a third opinion if the first 2 doctors disagree.

2) Let’s look at some emotional coping skills. First, a cancer diagnosis is no longer is a death sentence. There are many approaches to breast cancer, and treatments are improving all the time. Even in a serious cancer diagnosis, there have been people who have defied the odds, and survived. Dr. Bernie Siegel wrote a book called “Love, Medicine and Miracles” in which he documented cancer patients who told their doctor that they were not going to die, and survived. Remember….the journey of a possible cancer diagnosis is a challenging one, and yet if you are open to support, the journey can be easier. The hospital social work services department can refer you to cancer support groups and licensed mental health providers who can help.

One approach emotionally is to “stay in the moment” and notice if you are visualizing a disaster scenarios. If you start to imagine death and pain, stop and ask yourself if there is fact to support your catastrophic images, or just your fear. Yes, fear is understandable, but try to manage the tendency to imagine the worst. Think back on your family of origin coping skills. Did your parents have a pessimistic tendency, always jumping to the worst possible conclusion? Or, did they tend to be optimists or realists? Reflecting on some automatic patterns you may have learned can be helpful. Finally, some people like to seek religious and/or spiritual support, and find comfort by doing so. Remember that current crises can bring up some repressed memories of past unresolved issues. A licensed mental health professional can be of help with coping with the wide array of issues that emerge when faced with a possible cancer diagnosis.

Ask Ellen Anmuth, Psychotherapist: Coping With Financial and Health Stress

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This article series addresses questions from emails. Today’s topic is “Coping With Financial and Health Stress”.

Anthony from Brooklyn, New York writes: Dear Ellen Anmuth, Psychotherapist: I am a waiter, and have to share an apartment with another guy, because I cannot afford a rental on my own. I am 21 years old, and wish I could afford my own place. I would like to go to school at night, to get a BA in Criminology, but I do not know how I could afford it. Any ideas how to cope with this stress and worry? I am having trouble sleeping.

Ellen Anmuth, Psychotherapist: Anthony, I can understand how financial stress can affect your life. However, the positive that I read in your email is that you have a desire to go to school to study Criminology. Have you identified a school that you would like to attend? In the New York City area, there are likely many colleges that offer that training. Perhaps you could contact the Admissions Office, and inquire about any student advisory services that may be able to help. In addition, there are usually financial aid departments, who may know of scholarships to help you get through school.

Regarding your sleep problems, anxiety and depression can cause sleep disturbances. If you contact the Social Services Department of any local hospital, they will be able to provide a list of agencies that offer counseling at a sliding scale to help you learn to manage the stress more effectively. I know many people who have had jobs and have also gone to school at night. As a waiter, perhaps you could attend day classes, and wait tables at night? If you are creative and flexible, you can create a schedule that works well for you. Keep the vision of your goal, and that will help you through the stressful moments. Also, if you contact Police Departments, they may have ideas of how you might find scholarships for your education.

Beverly in Colorado writes:  Dear Ellen Anmuth, Psychotherapist: I am trying to cope with an elderly mother who is declining. She is 72 years old, and is dealing with a new diagnosis of Leukemia. I am fearful of the course of this illness, and how I might cope with this, and be of help to her.

Ellen Anmuth, Psychotherapist:  Beverly, there is a national organization called “The Leukemia and Lymphoma Society”, and their website is LLS.org.  They provide information regarding  Leukemia and other blood cancers. Experts are available by phone who you could speak with to learn more about this disease. They also know about  community resources  to help you cope better with the stress of this illness in your family.  Good luck with this challenging issue. Make sure that if you are a caregiver of your Mom, you also find time to take care of yourself.

Ellen Anmuth, Psychotherapist: Find A Child’s Joy in Adulthood

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 How can we, as adults, feel the joy of children more often?

Yesterday, I was in a few different stores, and I noticed children beaming at me and smiling. These kids were likely under 5 years old. One child was actually walking backward quickly, trying to keep up with the large stride of his mother, grinning ear to ear while “speed- walking backward”.

Another child, in a food store, seemed to have a sling on her arm. From a distance, I glanced and perceived that she had hurt herself. As I got closer to her (at Whole Foods Market, produce department), I smiled and asked, “How did you hurt yourself?” She beamed back with a big smile, and said, “I am not hurt, I am just pretending”.  Then I noticed that her “sling” around her arm was actually a plastic bag from the produce department that she fabricated as a pretend sling.

She skipped away with her siblings and mom, having played “doctor” in that moment, creatively taking a prop, using a plastic bag that could hold apples or bananas, turning it into a joyful game in the moment.

Yes…joy in the moment. Do you recall a time when a moment could be joyful, in the most mundane of circumstances?

Today I need to drive about 20 miles north. It is sunny and beautiful, and I live a mile from the ocean. Rather than drive quickly up the highway, I plan to bring lots of my favorite music CD’s, and take a slow and beautiful ride up “A1A”, the scenic drive by the water. Yes, that will bring me lots of joy in each moment. The drive will take twice as long, and bring me much more joy in the moment.

ACTION QUESTION: What can you do each day to minimize your world of adult worries, live in the moment, feel more peace and celebrate simple joys?

Ask Ellen Anmuth, Psychotherapist: Reduce Stress in College

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“Ask Ellen Anmuth, Psychotherapist”  is a series of blog entries by Ellen Anmuth MS, MSW, LCSW,  a Licensed Clinical Social Worker. Select emails will be answered which may appeal to a broad audience.

This blog does not replace mental health counseling services, and I strongly recommend seeking the help of local licensed mental health providers when indicated. The Social Work Services Department of most hospitals can be a helpful referral source, especially if financial need is an issue.

This article will deal with two different topics from Sharon in Texas and  Don in California.

Sharon S. from Texas: “I find myself seeking approval from my family. They tend to be very controlling and critical, and I am afraid to make a decision that they may not approve of”.

Ellen Anmuth MS, MSW, LCSW: Sharon, I see that you are 20 years old, and living at home while attending community college. This can be a difficult period of life for you, in terms of a concept called, “separation-individuation”. You are in a period of life that some therapists call “The Young Adult Transition”. There are certain developmental tasks in each period of adult life, and stress can result when our inner compass differs from parents’ views.  Do you have friends you can relate to, and who share your values? What type of things do your parents disapprove of?  Are you engaging in any dangerous activity that would support their concern, or do you feel that their controlling behavior is related to treating you like a teenager, rather than a young adult? Sometimes, if parents have a difficult time adjusting to an adult child’s need for separation and individuation, conflict can emerge. Perhaps there might be counseling services through the community college, where you may be able to meet with a licensed therapist in person, to better evaluate the situation and guide you through your options and coping strategies.

Don M. from California: “I am pre-med, and so anxious about my tests that I can’t concentrate to study, and my grades are suffering. Do you have any ideas how I can study when I have so much anxiety about failing?”

Ellen Anmuth MS,MSW, LCSW:  Don, this is a question that so many others have asked me. I have an Education degree, and was an Assistant Professor of Family Medicine, teaching  medical students and doctors about psychology and education. I developed a technique to help people deal with test anxiety that was blocking their concentration. Try this: Take a sheet of paper, and make two columns: 1) The advantages of holding onto the feeling of anxiety, and 2) The disadvantages of holding onto the feeling of anxiety.  Fill out both columns quickly, writing the first things that come to mind. You will see a pattern, which will reveal information that may provide some insight. You may find that there is no logical “advantage” of holding onto the feeling of anxiety! That realization helps us to compartmentalize it away, at least temporarily, in order to concentrate.

Another useful technique is to make a “contract” with yourself, that every day, from 8pm-10pm you will study the course material that worries you the most. Do an “imagery exercise”: Imagine putting the feeling of anxiety in a box that you can put away (metaphorically speaking). You may imagine putting a box with your anxiety on a shelf in your closet, where you can close the door, so that with your anxiety “away” for the few hours, you can focus on the subject matter. After 2 hours, if you want to find that box, open it up, and experience the feeling of anxiety again, you can. You have that control. However, after 2 hours of focused study, you may find that the anxiety can stay in the closed box, and that you feel more confident and relaxed!  In fact, you may decide to throw that black box with anxiety out into the trash, rather than keep it on your closet shelf. This is a guided imagery exercise, which may be helpful. With incremental hours of successful concentration, you will feel more in control, and more confident about passing your tests.

Emotions: When we “Feel” Them, we Can “Heal” Them

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What could be the first step in managing emotions?

There are many approaches to handling our feelings more effectively. What could be the first, most logical step? The answer may appear elementary, but it is as follows:  Notice what you are feeling in any given moment!

This seems simple, yet the popular culture seems to send a message that it is not OK to feel. When was the last time someone said, “How are you?”, and you said, “Fine”, when you may have been feeling anger, sadness, fear or some other emotion? The tendency to deny, repress or avoid emotions is widespread.

Anger, sadness, fear, guilt, shame, hopelessness, and the myriad of other feelings that we experience can overwhelm us, in my opinion, because we have not been taught how to effectively manage them.

When you feel emotions, do you reach for a drink, or open the refrigerator when not really hungry? If you are angry or irritable, do you find that you might interact with someone else with more impatience or hostility?

In 1985, I took a course on how to manage feelings. We were instructed to observe our feelings, and attempt to bring them up, rather than try to avoid them. One technique we were taught was to drive our cars without turning on the radio. (Back then, there were no cell phones or other devices to distract.)

That is not so easy! Try to drive your car in silence, and notice when you have an urge to turn on the radio. Does that happen after you have an unpleasant emotion or thought?

Managing emotions is a complex process, and yet, avoiding the tendency to deny them is the first step. Yes, the first step to healing feelings is to, in fact, FEEL THEM.

Action Tips:

1) Keep a log or journal or your emotions, and what usually happens before you have the feeling.

2) Notice what you do after you connect with the unpleasant feeling. Do you reach for food, alcohol, or drugs?

3) Have a conversation with friends and family, and if they are receptive, have a discussion about recommended methods to manage emotions in a healthy way.

Update–March 2014…..For those readers who first read this entry last year, have you kept a log of your emotions related to events in your life? An “event” could be an “internal event” or an “external event”. What do I mean by that? An external event is something that happens within your environment, such as a person speaking to you in a harsh manner, finding out about a death in the family, etc. On the other hand, an internal event is something that happens within you, such as a thought, feeling, memory, flashback, or some other experience within yourself. It may be helpful to begin to better discern when an “internal event” causes another “internal event”. For example, if you suddenly have a flashback of an unpleasant experience, you may find yourself having an internal dialogue that is self critical. Then you may feel sadness or guilt. How do you turn around this escalating spiral of negativity? Often, this happens unconsciously. Practice being more aware, by asking yourself, “What am I feeling now?”, or “What am I thinking now?” From this type of inner awareness, you may be able to manage your emotions more effectively.— Ellen Anmuth, MS, MSW, LCSW, Licensed Psychotherapist, Genetic Counselor, and Founder of “The Language Of Solutions” Self Improvement and Wellness Programs.

 

 

“The Secret of Talking is Listening”: A Hollywood Line, or Good Advice?

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The Secret of Talking is Listening“The Secret of Talking is Listening”. This is a quote from the film with Matt Damon and Scarlett Johannson called “We Bought a Zoo”.

Flipping through TV channels today, I heard this line in the middle of this movie. I was intrigued with a film writer’s idea of effective communication.

Is this good advice?  Sure…listening is always important. However, this film line fails to encompass the broader complexities of effective communication, conflict resolution or healthy relationships.

The film writer, I suspect, is using semantic shorthand to correlate the notion of of “talking” with “communication”. However, listening is only one aspect of effective communication.

Other “secrets” of good communication are patience, managing emotions, clarifying misunderstandings, using solution focused, objective language, being aware of tone of voice and non-verbal behavior, such as eye rolls and sighs that convey disgust, and the use of techniques such as “paraphrase” and “reflection of feeling”, just to touch the surface of some strategies and  elements of healthy and effective interpersonal communication.

Yes, a Hollywood film writer seemed to have collapsed a highly complex series of interpersonal transactions into a sound bite, “The Secret of Talking is Listening”.  “Listening” is simply one essential and fundamental aspect of increasing the probability that an interpersonal communication event will leave both parties feeling satisfied.

Perhaps it is not a figure of speech for the film writer to write: The Secret of Talking is Listening”. Have effective communication skills and techniques been kept a “secret”?  Have school systems in elementary school and secondary school given our children enough classes in this subject of effective communication, conflict resolution, managing emotions, managing anger, and using solution-focused communication?

I believe it is time to stop keeping these skills and techniques a “secret”, and have public school systems, colleges and adult education courses teach the basics of interpersonal communication and conflict resolution, anger management, and staying connected even when communication conflict gives us the feeling that we want to either run away or attack.

ACTION STRATEGIES:

1) Notice how you respond when you feel misunderstood or hurt during a conversation. Do you tend to use attack language, or do you detach, not telling the other person why you are upset?

2) How do you listen? What are the elements of effective listening skills?

3) Do you know how to use techniques such as “Paraphrase” and “Reflection of Feeling” during interpersonal communication?

4) If you feel that effective communication skills and techniques have been kept “secret” from you, take steps to learn new skills and techniques to apply during a moment of interpersonal communication difficulty or breakdown. This could improve your personal relationships, professional relationships, your stress reduction plan and your overall health.

 

Emotions, Defense Mechanisms and Discernment: An Inquiry into the Complexity of Communication

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What are Defense Mechanisms, and what do they have to do with emotions, effective communication and healthy relationships?

Defense mechanisms are, by definition, unconscious processes. Yikes!! If they are unconscious, how do we deal with them?

Let’s start with the easy part.

We think of “Emotions” as being the feelings we have, such as anger, sadness, fear, joy, happiness, guilt, shame…the list is quite extensive.

The notion of “Defense Mechanisms” is a more difficult concept to grasp. When I was in graduate school studying to be a psychotherapist, we studied many theories. One school of thought was that there are unconscious processes called Defense Mechanisms that would automatically be clicked into gear when we were faced with a threatening or upsetting life event.

These DM’s (Defense Mechanisms) serve to protect us when we are under stress, but when over-used, they can be a problem. For example, if you hear about a friend or family member who has suddenly died, the first reaction may be a DM called “Denial”, and a person says, “No, it cannot be true”. At first, the denial gives a buffer of time for the trauma to be integrated.

If time goes by, and a person is still in denial about the death of a loved one, it becomes an unhealthy pattern of avoidance.

Some people consider “denial” to be a form of dissociation from one’s own feelings. For example, in a relationship, if someone feels threatened or upset, they may begin to go into denial, and not be aware of appropriate feelings of anger or hurt.

The tendency to detach when in a relationship conflict is understandable, in the context of the conceptual framework discussed in this article.

Tips to deal with the Defense Mechanism of Denial:

  1. Be open to the words and emotions of the person you are in a relationship with, even if it feels difficult.
  2. Ask yourself, “What am I feeling now”? Take a deep breath in, and ask yourself again, “What am I feeling now?”, and see if a different feeling comes into your awareness.
  3. Begin to keep a journal of trigger events, feelings and behavior, and you may be able to see a pattern. This can help to allow unconscious, automatic patterns to become more in the conscious realm of control.