By Cate Brandon, Psy.D.
Throughout this very difficult past year, there has been increased focus on the importance of self-care. But who has time? This article contains some simple, effective “bite-sized” ideas for self-care that take only a few minutes so that you can squeeze in your self-care whenever and wherever you can.
Exercise Snacks: While historically, experts recommended prolonged periods of exercise to obtain the full benefits, new research is emerging about the benefits of brief spurts of exercise throughout the day. Even quick bursts of activity of only a few minutes can provide meaningful short-term and long-term benefits for your physical and mental health. Consider setting an alarm to go off every few hours to prompt you to move or perhaps engage in some extra movement every time you get up to go to the bathroom or get a drink. Do a few minutes of jumping jacks, running in place, or jogging up and down a flight of stairs. Just these brief “exercise snacks” can improve your fitness level, blood sugar, blood pressure, mood and memory.
Mindfulness snacks: Mindfulness is an activity designed to ground you in the moment and connect you to your immediate physical and emotional experience. Mindfulness has been shown to improve mood, self-awareness, concentration, ruminative thinking and physical health. However, we don’t all have time every day to find a quiet room and put all of our responsibilities on hold for a long mindfulness exercise. Luckily, mindfulness is an easy activity to incorporate into the things you normally do every day. The simplest way to engage in mindfulness is to focus on your five senses during an activity. You can do this while washing your hands (noticing the smell of the soap, the warmth of the water on your hands, the sound of the running water), pouring your coffee (inhale the scent of the coffee, watch the liquid sloshing in the cup) or even while doing a chore (while dusting or vacuuming, notice the repetitive movement of your body, the change in appearance of the furniture or the carpet as you clean and the smell of the dusting spray or sound of the vacuum cleaner). You can do this while you are cooking as well: inhale the scent of the various ingredients, notice the sound of the wooden spoon tapping the side of the metal bowl or the feel of the dough between your fingers. Engage in mindful eating when you are enjoying a small dessert by slowing down your eating and noticing the smell, texture, taste and appearance of your food. Incorporating mindfulness into your everyday activities allows you to reap the benefits without having to sacrifice your time.
Gratitude Journal: This is a simple exercise that takes only a few minutes, but that an abundance of research has shown to have benefits in many areas, including mood, stress level, sleep, self-esteem, happiness, optimism and even aspects of physical health. By helping to shift your focus to positive things that happened throughout the day, it counteracts the natural human tendency to dismiss or overlook positives and attend more to negative events. Instead of doomscrolling on your phone at bedtime, simply write down three things each night for which you are grateful. This quick activity can make a big difference, and over time, help you to pay more attention to those positive events in the moment as they occur.
Breaks at Work: As many of us are working remotely right now, sitting a desk all day, without the benefits of breaks that naturally occur in the office, such as chatting with a co-worker, having to get up to get materials or walking to the break room to have lunch, we are often sitting in the same location all day. The lack of movement and constant staring at our screens can cause decreased attention, lack of motivation and increased fatigue. Make it a goal to detach from your screen at least every hour, setting an alarm if needed to remind yourself or relying on natural transitions in your work. Use this break productively by doing an exercise snack as described above, munching on a healthy snack while listening to a song or reading an article (somewhere other than your workspace), or even just gazing out the window for five minutes and allowing your mind to wander. Taking these breaks will not only boost your mood, but should also boost your motivation and productivity at work.
It’s okay if right now, you are too overwhelmed with other things in life to make major overhauls to your habits, but sometimes making small changes can have large impacts. These smaller, easier, briefer changes tend to feel more doable and therefore make you more likely to initiate and maintain them. Happy “snacking!”
Surviving the Holidays During a Pandemic
By Cate Brandon, Psy.D.
Holidays are stressful and distressing for many, even in normal times. This year, new stresses, anxieties and uncertainties surround holiday activities and planning. It is necessary to accept that this year will look different and find ways to adapt. Here are some things to consider to help you to enjoy the holiday season in these unique times.
Don’t be afraid to initiate conversations
First and foremost, if you typically celebrate holidays with family or friends, start having conversations soon. Approach these conversations with an open mind. People have varying levels of risk tolerance, personal risk factors and situational factors that can influence their approach to outside interactions. Whether you are more cautious or less cautious than others in your circle, try to accept their positions and perspectives without judgment.
Do not be afraid to be honest about your comfort level and to gently decline invitations that are not consistent with your current risk tolerance and value set. But do not judge or criticise those who make different decisions than you. There are no easy or clear-cut decisions in 2020 and it is important to trust that those you care about are making whatever decisions they think are best for them at this moment in time.
Embrace enjoying the season in a different way
One of the many complaints I hear year after year (and experience myself) is how it is difficult to fit everything in and enjoy the season. People are overcommitted and stretched thin. This year gives us an opportunity to be more selective and participate in the activities we enjoy most. Perhaps that could be going all out with decorating, making some new recipes for a small family meal or having movie nights with the family to enjoy your favorite holiday programs.
Because this year will likely have fewer activities and commitments than usual, take the time to really enjoy the activities that you choose. For example, instead of feeling that you have to rush through a pile of Christmas cards, just scribbling a brief note and your name on each card, perhaps you can take the time to pen a heartfelt message. Instead of rushing the kids back and forth to parties, concerts and extra activities, perhaps you can build an elaborate gingerbread house together, like they have always asked you to do. Maybe you have always wanted to take a winter hike in fresh snow, but have never been able to find the time – this is the year!
It could also be a time to start new traditions. Take a drive around the neighborhood looking at all of the lights, find a charity to donate to as a family or research new dishes to make for Thanksgiving, rather than just cooking the same old thing every year. Check out some books from the library and explore different cultural traditions for some inspiration.
The key is to accept the current situation and the reality that it will limit our ability to participate in many of our usual seasonal activities. We all have a choice this year: rather than getting stuck in feeling depressed or resentful about all the things that are different in a negative way, try to find positive differences that you can appreciate and that can maybe even benefit you!
Find ways to bring joy to others
There is a great deal of research indicating that there are benefits that come from giving to others. This holiday season can provide us with the opportunity to think outside of our circle, as we may have more funds available if we are not spending money on traveling or more time on our hands if we are not preparing a large meal. Dropping some baked goodies off on a neighbor’s porch, sending a gift card for groceries to a friend whose finances have been impacted by the pandemic or volunteering for a food bank can all be ways to help yourself by helping others. Even taking the time to write a handwritten note to someone you know has been struggling this year can make a meaningful impact.
Find different ways to connect
We may all be tired of socializing via Zoom, but for many of us this is the safest way to interact this year. Finding a way to make it unique to your family will make it more special than just looking at each other on a screen. If your family likes to watch movies together, consider doing a watch party. If you like playing family games, consider an online gaming product like jackbox.tv. If the meal is the biggest part of your holiday get-together, maybe consider having each member of the family make a dish and deliver it to each others’ houses (if you live near enough to each other), having everyone find a new recipe to share and have everyone make it at their home (if you live farther apart) or doing a virtual “Nailed It” challenge.
Find joy in the moments
More than ever this year, it is a time for us to find moments of peace, relish simplicity and identify the small things for which we are grateful. While we may miss the hustle and bustle of rushing from one place to another, maybe we can enjoy the slow pace of a holiday just spent with our immediate family, with nowhere to go and the ability to relish in a leisurely meal or taking all morning to unwrap gifts. Perhaps you miss the rush of holiday gatherings, but find tranquility in a frosty winter hike in the woods. Although you may miss seeing family in person, appreciate that instead of having to spend hours packing and weaving your way through crowded airports or traveling in a cramped car, you have time to bake all of the different holiday treats you’ve wanted to try for years but have never been able to – and get the added bonus of the joy of sharing them with neighbors and friends by dropping them off at their door! Instead of the kids holiday concert this year, you can snuggle up on the couch and have a holiday movie marathon.
While this year has had many downsides and losses, to be sure, there are things that we can gain from this experience and focusing on those positives (while still allowing ourselves to be sad, disappointed and even angry about the sacrifices we have had to make) can help prevent this year from being a wash. It has been heartwarming to see communities come together and get creative about how to respond to the crisis presented by the global pandemic – I think of how fun and inspiring it was to see how all of our neighbors found unique candy delivery methods for Halloween so that the kids could still safely go trick-or-treating. This year has taught us about resilience in the face of difficulty and has made many of us realize we can handle more than we think. And this year has also brought us more appreciation for nature, family and friends, as well as a sense of appreciation for all of the things that we were unable to do this year (and hopefully a gratitude for those things that will persist when we are able to do them again in the future).
Whatever you decide to do this year, it must start with an acknowledgement of the grief for the losses we have suffered and sacrifices we have had to make, followed by acceptance of the current situation, and finally by an awareness that these difficulties are not permanent. There is hope for the future that begins with acceptance in the present.
Growing Through Loss
BY KELSEY JAGER, PHD, LPCC-S
Suffering is an unavoidable human experience. To live is to have moments of pain, fear, loss and shame. But with loss comes the opportunity for life enhancing learning experiences. It is through tragedy, death, and other traumas that people are forced to take on new perspectives in life that enhance well-being, empathy, and purpose.
In the chronic illness and disability literature, my specialty area, one theory on loss is in the Meaning-Reconstruction Model (Neimeyer, 2000), which conceptualizes loss as opportunities for growth through re-learning what was once taken for granted. People have a natural inclination to develop meaningful self-narratives, which contribute to a sense of personal significance. In an ideal circumstance, one’s internal perceptions of meaning are validated by one’s social and cultural context. When a loss or divergence unexpectedly occurs, assumptions are threatened or destroyed and thus require rebuilding. Newly constructed meaning is created over time and is unique to each person.
The Meaning-Reconstruction Model has its roots in constructivist assumptions and applies concepts from grief therapy. For example, one constructivist assumption is narrative truth, or that there is no one “true” reality that exists; rather, reality is individually constructed based on the storytelling used to make sense of life. Loss can either validate or invalidate assumptions we have about the experience. Meaning reconstruction offers a contrasting view to the more commonly held belief that living with a disability is a tragedy.
To reconstruct meaning, one must complete three steps (Gillies & Neimeyer, 2006). First, people have to strive to find reasons “why” the loss happened. They are thrown into doubt and turmoil about what brings meaning and purpose to life at this sense-making stage, especially among those with chronic illness. The second step is benefit-finding, or building new narratives that incorporate—or are even build upon—the new circumstances created by the loss itself. The final step is identity change, whereby, in reconstructing meaning in loss, individuals reconstruct themselves.
Counselors have the potential to explore the justification process and facilitate ‘meaning reconstruction’ with their clients. Meaning reconstruction is a process whereby the traumatic circumstance is reinterpreted, or “made sense of,” to establish a positive self-identity in the aftermath of a major personal loss (Neimeyer, 2000). I often see clients faced with a collision between previously held goals and assumptions about life and specific stressful events, such the loss of their identity as a healthy person after a diagnosis such as muscular dystrophy or multiple sclerosis. One’s personal experiences slowly diverge from that of a typical person, a realization that deeply disrupts the life story. To grieve is to make sense of “why” this illness is a part of life, and reinterpret commonly held assumptions about what makes a life worth living. Finding benefits in the circumstance is part of reconstructing a new life story that incorporates the loss with positivity and resonance.
Postmodern approaches are a natural fit for clients coming to therapy for a loss. Logotherapy focuses specifically on the meaning one intends to fulfill in life despite tragic circumstances (Frankl, 1946; Zeligman et al., 2018). Discovering one’s values (e.g., family, love, inner peace, creativity, wealth, authenticity) are an essential part of the meaning making process, as values help individuals make decisions about what to do to actively construct a meaningful life. Narrative therapy also lends itself well to meaning reconstruction because it puts the client in an active position to reflect upon the past and intentionally create the future.
Reconstructing meaning is one way to personally develop after a life-altering event, promoting posttraumatic growth. Otherwise termed “existential growth” or “thriving,” posttraumatic growth is a cognitive process that promotes growth through suffering (Middleton, 2016). Scholars have begun to examine posttraumatic growth for individuals living with various chronic illnesses, such as stomach cancer (Sim et al., 2015), chronic fatigue syndrome (Arroll & Howard, 2013) and HIV/AIDS (Amos, 2015). Standing in opposition to the traditional role of a sick person passively depending on healthcare professionals to manage chronic illness, those who have endured threats to psychological survival are willing and able to manage their own conditions as partners with professionals (Middleton, 2016). It is important for counselors to consider the meaning that can be made from a traumatic experience because to be educated on the growth that can occur because of difficult circumstances might increase positive adjustment for the client.
Amos, I.A., (2015). What is known about the post-traumatic growth expereince among people diagnosed with HIV/AIDS? A systematic review and thematic synthesis of the qualitative literature. Counseling Psychology Review, 30(3), 47-56.
Arroll, M. A., & Howard, A. (2013). The letting go, the building up, [and] the gradual process of rebuilding: identity change and post-traumatic growth in myalgia encephalomyelitis/chronic fatigue syndrome. Psychological Health, 28(3), 302- 318.
Frankl, V. (1946). Man’s search for meaning. Boston, MA: Beacon Press.
Gillies, J., & Neimeyer, R. A. (2006). Loss, grief, and the search for significance: Toward a model of meaning reconstruction in bereavement. Journal of Constructivist Psychology, 19, 31-65.
Middleton, H. (2016). Flourishing and posttraumatic growth. An empirical take on ancient wisdoms. Health Care Analysis, 24, 133-147.
Neimeyer, R. A. (2000). Searching for the meaning of meaning: Grief therapy and the process of reconstruction. Death Studies, 24, 541-558.
Sim, B. Y., Lee, Y. W., Kim, H., & Kim, S. H. (2015). Post-traumatic growth in stomach cancer survivors: Prevalence, correlates and relationship with health-related quality of life. European Journal of Oncology Nursing, 19(3), 230-236.
Zeligman, M., Varney, M., Grad, R. I., & Huffstead, M. (2018). Posttraumatic growth in individuals with chronic illness: The role of social support and meaning making. Journal of Counseling & Development, 96, 53-63.
What do I Need to Know about Telehealth
By Cate Brandon, Psy.D.
During the current health crisis, telehealth is available to allow you to safely meet with your mental health provider. It may be a little different to meet with your therapist online, but many of our patients have found it to be just as effective as meeting in person.
WHAT DO I HAVE TO DO?
When you contact our office to schedule your appointment, our office staff can walk you through the very simple process. You will receive two emails: one with an informed consent to sign and one with instructions for beginning your telehealth session. Logging on is easy! It is not necessary to download anything to your computer. You simply log onto a website and wait for your therapist to begin the session. You can use a computer, smartphone or tablet to talk to your therapist.
WHAT ARE THE RISKS?
The platform our office uses for telehealth is confidential, secure and encrypted. Nothing is recorded. The therapist will be an office with a closed door, just like in an in-person session, so you can be assured the session is confidential. It is recommended that you also ensure your own confidentiality by meeting in a private space. There is always the possibility of technical glitches and disconnection, a potential problem that your therapist will address with you. At this point in time, most insurance companies are covering telehealth appointments. You may feel somewhat awkward or uncomfortable at first, as this is different from how you may have participated in counseling in the past. These feelings are normal, and typically improve over time. Please bring up any questions you have or discomfort you feel with your therapist, who will be happy to help you cope with and work through these feelings.
WHAT ARE THE BENEFITS?
The most obvious benefit is the protection from personal exposure to COVID-19. Our practice has adapted quickly to challenges presented during the pandemic in order to ensure that our patients can continue to receive quality care, while protecting their physical health and doing our part to prevent the spread of the virus. There are also benefits for those who have suddenly found themselves with children at home and without childcare options to allow them to attend face-to-face appointments. For those who are currently juggling many responsibilities, such as caring for children while trying to work from home, reducing the travel time required to come to a face-to-face appointment provides them with valuable extra minutes in the day. Finally, some patients have found value in being able to share aspects of their home environment with their therapist, whether that be increasing connection by sharing their pets or giving their therapist a real glimpse of their organizational difficulties in their office.
WHAT IF I AM STILL NOT COMFORTABLE DOING TELEHEALTH?
Please consult with your therapist or our staff if you have reservations about telehealth. They may be able to answer your questions or alleviate your worries. In addition, many of our therapists are providing the option of face-to-face therapy. If you choose to come to our office in person, rest assured that we are cleaning all surfaces multiple times per day, maintaining appropriate distancing in our waiting rooms and offices, wearing masks to protect our patients, and following all recommended procedures.
Can a Massage Help Back Pain
JOHN HOPKINS MEDICAL LETTER ARTICLE PUBLISHED IN AUGUST 2008
Nonspecific back pain (pain that isn’t from a condition or injury) can be frustratingly difficult to treat, but there are potential benefits to massage therapy. Message can relax tight muscles and may improve blood circulation to the body’s tissues, which can help reduce pain and inflammation. Massage also stimulates the release of hormones called endorphins may be why people often experience a heightened sense of well-being following a massage.
Sustained pain relief may require commitment: Studies on massage typically involve a course of therapy, not just massage. For instance, in a study from the Archives of Internal Medicine, among 262 people with chronic back pain, patients who received one massage per week for 10 weeks reported less back pain up to one year after the study ended.
Combining different approaches may also improve your chances of success. A recent Cochrane review of 13 clinical trials that included over 1,500 participants with chronic back pain found that massage therapy was more effective at reducing pain and improving function when participants also incorporated stretching exercises and basis education about behaviors (like poor posture) that contribute to back pain.
Massage is safe, except for people with phlebitis (inflammation of a vein), deep vein thrombosis, advanced osteoporosis, bone fractures, skin infections, burns, or eczema. Find a licensed massage therapist who is nationally certified through the National Certification Board for Therapeutic Message & Bodywork or the American Massage Therapy Association. Medicare and most private insurance do not cover massage.