Simple Tools for Stress Management

Stress is part of everyday life, yet it is also a complex concept. Psychological stress occurs when a person perceives that the demands placed on them exceed their personal and social resources to help them cope.  This means someone can feel little stress when they have the time, experience, and resources to manage a potentially stressful situation. In other words, stress is not an inevitable consequence of an event - it depends on your perceptions of a situation and your ability to cope with it.  

Let's take the common everyday stressor of traffic.  If we perceive it as defeating and frustrating, and that we are helpless against it, we become di-stressed and sit in the car fuming.  If we accept it as just a fact of life, and that it's an opportunity to sit and meditate, catch up with a friend on the phone, or listen to an entertaining program, we create positive emotions for ourselves instead.  The prerequisite of this happening of course means that we have a phone or program available, and that we feel confident that these strategies will help us feel better.

Causes of Stress
To understand stress better, it may be helpful to think it terms of what usually causes people stress.  Here are four main categories that are common stressors in our society.

• Life Transitions (for example, moving, job loss/change, diagnosis of illness, marriage, divorce, pregnancy/childbirth, death of a loved one)
• Work- or school-related (for example, high demand job environment, boredom, team conflict, lack of support)
• Problematic relationships (eg, unreasonable demands, high conflict, persistent sense of being taken advantage of, lack of supportive relationships)
• Your environment (eg, housing problems, transportation problems, chronic traffic problems, noisy neighborhood, living in poverty, living and working in an environment that's not conducive to relaxation and recreation, dangerous living or working environment)

However, it's important to recognize that an accumulation of smaller, minor stressors can be at least as, if not more, detrimental to one's physical and mental health as one or two major life stressors.  Car trouble, an argument with your spouse, an important work deadline, and trying to plan a big family party all in one week can certainly add up.

Signs of Stress
The first step to effective stress management is understanding your own personal stress signals.  Stress can get expressed in many subtle ways.  Here are some examples - see if you recognize yourself in some:

• Feelings: Anxiety, irritability, fear, moodiness, embarrassment, frustration, and anger 
• Thoughts: Self-criticism, difficulty concentrating and making decisions, forgetfulness, preoccupation with the future, repetitive thoughts, fear of failure 
• Behaviors: Crying, being disorganized, sense of time pressure, “snapping” at love ones, acting impulsively, alcohol or other drug use, teeth grinding or jaw clenching, stuttering or speech difficulties, having more accidents 
• Physical: Sleep Disturbance, changes in appetite, tight muscles, headaches, fatigues, cold or sweaty hands, back/neck problems, stomach problems, getting sick more often, rapid breathing, pounding heart, trembling, dry mouth

Think Stress Away
One of the most important ways to bust stress is to practice positive thinking and keeping things in perspective.  Remember, how we perceive an event is a major contributor to stress.  If we can neutralize our initially negative perception of a stressor, we have more control over the impact it has on us.  In other words, re-think how you think about stress.

Here is a simple guideline:
1. Recognize your negative thoughts
2. Stop, breathe
3. Reflect: Is this thought really true? Did I jump to a conclusion? What evidence do I actually have? Am I letting negative thoughts balloon? What’s the worst that could happen? Does it help me to think this way?
4. Choose: Decide how to deal with the source of your stress. Create and write down an action plan. Recognize negative thoughts and let them go.

Here are some simple examples of negative thought patterns during stressful situations, and their more neutral alternative thoughts.

1. Should statements:
•I should be able to deal with stressful situations better.
•Better: I know how to deal with stress and I am having a hard time right now.

2. Disqualifying the positive:
•I hate my life, it always is so difficult.
•Better: There are some things going on right now that are difficult and also some things that are actually going right.

3. Emotional reasoning:
•I don't feel good right now so I can't handle anything.
•Better: I feel like I can't handle things right now and I know that I can.

4. Catastrophizing
•If I don’t do well on this presentation (insert other important task), I will be judged poorly.  I may become jobless and homeless.
•Better: Nobody’s perfect. I’ll do my best on the presentation and know that it’s not the end of the world if I don't do perfectly.

Relax Stress Away
A relaxing activity that provides relief from a stressful activity by reducing physiological activation.  Incorporating relaxation in your daily routine is paramount, as the physical effects of chronic stress can lead to many health problems, such as cardiovascular disease, cancer, and a susceptible immune system.
Healthy examples for relaxation:

• physical exercise
• a hobby
• spending time with friends and family
• a warm bath or shower
• prayer or meditation - here are some great meditation apps
• Guided Imagery/Relaxation - there are many great resources online; here's one example

Finally, talking to a mental health professional about your stress can help you organize your thoughts, determine where to invest your energy, and learn skills in managing stressful situations and people in your life.

Stop Being Taken Advantage Of: Know Your Rights

By popular demand, here's a little follow up to my previous post Are You Feeling Taken Advantage Of? , which describes basic concepts and skills of assertiveness.  As described before, assertiveness means standing up for your rights and not being taken advantage of. 

Many people, especially women, have difficulty with assertiveness for fear of seeming aggressive or "bitchy", thereby worrying about displeasing others and not being liked.  But how is being assertive different from being aggressive? Aggressive behavior is typically punishing, hostile, blaming, and demanding. It can involve threats, name-calling, and even actual physical contact. It can also involve sarcasm, catty comments, gossip and "slips of the tongue."  Being aggressive means standing up for yourself in ways that violate the rights of others. On the other hand, being assertive means communicating clearly, respecting your own rights and feelings and the rights and feelings of others.

The first step to developing assertiveness is knowing your rights.  This will make it easier to stand up for them.  Often we have difficulty standing up for ourselves because we don't know if we have the right to.  Here is a list of basic rights to consider when standing up for yourself:

• The right to be treated with respect.
• The right to say no without feeling guilty.
• The right to experience your feelings.
• The right to take time to slow down and think.
• The right to change your mind.
• The right to ask for what you want/need.
• The right to ask for information.
• The right to make mistakes.
• The right to say, “I don’t know.”
• The right to be listened to and taken seriously.
• The right to set your own priorities.

If we know and can remind ourselves of these rights, we can then formulate responses to difficult and stressful situations that require assertiveness.  For more tips on assertiveness, feel free to check out again my previous post.  For more information on my private practice in Houston, feel free to check out my practice webpage.

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What is Culture Shock? How Do I Cope?

Our big beautiful planet is becoming smaller and more accessible. And it provides lots of exciting opportunities for personal and professional growth. Besides travel, more and more people spend extended time abroad on work, study, language-immersion, and volunteer-related activities. Both short and extended stays in another culture come with certain challenges, including culture and reverse culture (re-entry) shock, which can afflict newbies and seasoned expats alike.

Culture shock is defined as the emotional reaction to living, studying, or working in a new culture. It is often described as feeling a lack of grounding after losing familiar signs and symbols of the daily life that we're used to. There are the obvious adjustments - such as a different language, climate, and food. But what makes culture shock often so tricky is an accumulation of several smaller losses, such as different accessibility of goods, services, and comforts, and new norms for social interactions. All this can take an emotional toll. Subtle cultural difference also should not be underestimated (eg, the US vs. Canada), because they can have a cumulative effect.

People who experience culture shock often report the following:

• Homesickness
• Boredom
• Withdrawing from other people
• Sleep Disturbance
• Frequent Crying and Sadness
• Irritability, having a shorter fuse
• Increased focus on ordering and cleaning one's immediate environment
• Aches and pains, feeling sick 

For most people, culture shock resolves after a few days or weeks as the mind and body adapt to the new conditions. For those struggling longer, or those who'd like to help themselves along in the adjustment process, here are some tried and true strategies:

• Make new friends, share your thoughts and ideas with others. Meet locals and ask them about their culture. It’s normal to feel shy when meeting new people, but with practice you will be more relaxed. Remember that lasting friendships develop gradually, if you keep trying.
• Read and learn about the new culture with an open mind. Openness and learning are important skills that help people adapt to their environment.
• Keep active and be curious about your new surroundings. Stake out museums, theaters, restaurants, and neighborhoods. 
• Look for opportunities to participate in community activities. For example, join a sports team or volunteer group. Joining others with similar interests helps with social adjustment around the globe, regardless of language or background.
• Keep working on language skills (if applicable) 
• Keep a sense of humor. A sense of humor is important because in another culture there are many things which lead one to weep, get angry, be annoyed, embarrassed, or discouraged. The ability to laugh off things will help guard against despair. Everyone makes mistakes in a new situation, and it's part of adapting and learning.
• The ability to respond to or tolerate the ambiguity of new situations is very important to intercultural success. Keeping options open and judgmental behavior to a minimum describes an adaptable or flexible person.
• Keep your expectations realistic and positive.
• Be patient with yourself and take care of yourself.

Living and learning in a new culture which may have different beliefs and values can be difficult. During this process, it is important to be in contact with the new culture. Yet, it is also important to take your time in this process of learning and adapting. There is some evidence that participation in more than one culture can actually lead to healthy adjustment. When we learn other ways to think and behave, we can develop adaptive strengths and flexibility, which can help in daily life.

If adapting to a new culture takes longer than expected, or if culture shock is interfering with your daily ability to work, study, and socialize, consider consulting with a licensed mental health professional.

Self-Care for the Holidays

Ah, it's that time of year again.  You may have started your holiday planning and shopping, RSVPing to various events, and/or getting ready to host.  For most of us, the holidays are a mix of excitement, gift giving and receiving, and spending time with the ones we love.

On the flip side, it may also involve running harried, stretching ourselves too thin, dealing with competing demands, and family drama.  Relationships may become (more) strained.  Whereas some level of increased stress is to be expected, the holidays can also bring out additional difficult feelings, such as grief and loneliness.

The need for self-care and boundaries is higher than ever at this time of year, although ironically we likely have less time to do so.  Here are some things to consider:

• Be kind and gentle with yourself.  When multiple demands compete for our energy and attention, it becomes increasingly difficult to stay in the present and enjoy the moment.  
• Identify now how you want to take care of yourself.  For some, this means scheduling time with a dear friend.  For others, it could be unwinding with hot tea or cocoa at night and sticking to an exercise routine.
• Notice when you become reactive.  When you notice having a shorter fuse, for example, take a long and gentle moment to reflect on what is really causing it.  What may initially feel like annoyance with slow moving lines or traffic, might really be about pressure to keep up, or feeling taken advantage of, or having familiar buttons pushed by a family member.
• Holiday stress may get acted out in relationships.  This may create a wish to withdraw from others or engage in various escape fantasies.  Be careful not to entirely give in - spending meaningful quality time with others usually leaves us feeling better. 
• Be aware how you respond to interpersonal conflict.  Do you pursue or withdraw?  These patterns may get exacerbated with holiday stress.  Just being aware can help you modify your responses to others.
• Be a clear communicator.  Let others know what you're willing and able to contribute, and also communicate what you are not able to do.  Read this post about assertiveness skills.
• If you are spending the holidays alone, plan quality time for yourself as well as some time to be around others.  Joining a community that has meaning to you, religious or secular, is good for mental health.  Volunteering and giving back during the holidays can be immensely rewarding.  Shifting focus from inward to outward can help put difficult feelings in perspective.  Plan your participation early as volunteer opportunities on holidays fill up quickly.
• Take note of what you are grateful for.  It helps put things in perspective.

Happy holidays to you and yours!

Relationships: When Cultures Clash

Every person is a cultural being.  And therefore, we each bring our own story, family history, and cultural background into our relationships.  Unlike 20 or 30 years ago, in today's globalized world, we are more likely to interact, make friends, and fall in love with people from cultures other than our own.

Whereas intercultural romantic relationships, like any romantic relationship, are based on mutual love, respect, openness, and sincerity, they also present with unique challenges that may only become apparent after the initial honeymoon period has passed.   Common challenges faced by intercultural couples are differences in family culture and expectations, religious and political differences, language barriers, and decisions around cultural practices, such as how to celebrate holidays and eating habits.  Down the road, these challenges may also play a role when the question of how to raise children may arise.

Other unique challenges and decisions faced by intercultural couples are:

o Response to stress & conflict

o Response to illness

o Sexual behavior

o Values

o Place of residence

o Friends and interpersonal relationships

o Finances

o Cultural and society’s acceptance of the relationship

o Parental/family approval

o Gender roles

o Cohesiveness of family

o Emotional expressiveness

Factors For Success
Facing all these challenges together as a couple takes much energy, patience, acceptance, and most importantly, the willingness to "go back to the drawing board" as often as necessary.  A first important step is to identify which cultural differences may cause stress and conflict in the relationship.  In this process, it's important not to make any assumptions about the other's standpoint.  Remember, differences are merely differences - they are neither good nor bad.  They are honest expressions of personal and cultural values.

As humans, we assume too quickly, and can accomplish much more if we are curious about each other.  Also, don't assume that understanding each other better necessarily means agreeing with each other.  Living with cultural differences takes constant work.

For additional relationship advice, see these blog entries:
Improving Relationships Through Vulnerability
Managing Expectations In Relationships
Are You In An Abusive Relationship?

I am a Houston psychologist who specializes in working with intercultural couples.  Please visit my webpage for more information.

Understanding Depression

A startling finding: The World Health Organization has determined that depression is the most burdensome disease in the world today. It robs adults of more productive days of life than AIDS, cancer, or heart disease.

What is depression?  What is it not?  We all know the feeling of being sad or "blue" after experiencing a loss or disappointment.  It may last a few days or a few weeks.  But when do we start talking about an actual "depression" in clinical terms?
Common signs of clinical depression include:

• Frequently feeling sad and/or guilty
• Eating more or less (including significant weight loss)
• Sleeping more or less
• Loss of interest in things you usually enjoy
• Low energy, fatigue
• Irritability
• Difficulty concentrating and making decisions
• Thoughts about death and suicide

While the above signs are more common, everyone is different.  The following may also indicate depression for some people:

• Increased use of alcohol and drugs
• Anger
• Difficulty envisioning a hopeful future
• Helplessness
• Increased aches, pains, or bodily ailments

Depressive episodes can be situational - that is, they occur after a stressful event or events (for example, death or loss of a loved one, diagnosis of severe or terminal illness, children leaving home, divorce, persistent stressful job conditions, academic stress/difficulty, job loss, and other extremely stressful situations).  Or, it can happen for what appears to be no reason at all, literally out of the blue.  Research shows that clinical depression can also occur when stressors in the environment combine with a genetic or biological disposition.  If depression runs in your family, you are likely more vulnerable to also being depressed.

Depression is a complex and serious illness, comparable to diabetes or heart disease.  You can't just "snap out of it" by pulling yourself up by your bootstraps or thinking happy thoughts.  People with depression need professional treatment, just like people with diabetes and heart disease do.

What helps?  Talk therapy can help individuals determine what life circumstances may contribute to their depression and how to address them.  Therapy can also teach important skills to lower stress and address recurring negative thoughts that happen with depression.  Antidepressant medications can help normalize chemical imbalances in the brain that contribute to depression.  A helpful analogy to consider when thinking about antidepressants:  Just like insulin can help a person with diabetes whose pancreas no longer produces it, antidepressants can help a person with depression whose brain may be low on certain chemicals, or neurotransmitters.  More and more novel treatments are being researched and becoming available for people with recurring and treatment-resistent depression.

Only about one-third of individuals with depression seek treatment.  It is quite common for someone to live with depression for years, even decades, before deciding to seek help.  The sooner a person can get treatment, the higher their chances for recovery.  

If you know someone who is depressed, offer a supportive, non-judgmental, and listening ear.  Then offer your support in getting the person professional help and treatment.  Remember - depression is an illness that can linger, worsen, and/or recur if left untreated.  Remember, there is hope and there is help.

 I am a Houston psychologist who specializes in treating depression.  Visit my website for more information on my services.  

Please click here for an inspiring article in the New York Times on new approaches of treating depression in developing countries, impacted by war, famine, AIDS, natural disasters, and other trauma.

You and Your Shadow

 "To confront a person with his own shadow is to show him his own light." ~ Carl Gustav Jung

Strong, negative emotions can catch us by surprise, and can be incongruent with who we know ourselves to be.  Feeling irritable for no apparent reason, or catching an unexpected frown on our face in the mirror, are perfect examples.   Wouldn't it be so wonderful to have a magic way to make fearfulness, anger, and insecurity disappear for good?  

We all have a "dark side", or shadow.  The shadow is represented by deep mental grooves that lead to negative feelings and behaviors.  Besides triggering strong feelings, it may result in unwanted habits, such as being habitually late, self-sabotaging, or spreading gossip about others.  Other examples are stretching the truth, erupting at the ones close to us, or masking insecurity with pride and boastfulness.  The shadow is the person you'd rather not be.  It personifies the selfish, unpredictable, primitive, egocentric, and violent aspects of yourself.  These undesirable aspects of self have often been dis-owned by consciousness, nicely packaged and filed away deep in the unconscious.  

As painful as these aspects can be, they have important lessons to teach us once we bring them into consciousness.  Let's take the example of Nora*, an administrative assistant at a medical office.  Nora took pride in being a conscientious worker and "always going the extra mile" for her supervisor and patients.  Over time, she found herself having resentful feelings towards her boss, the medical director, whom she perceived as neglectful and irresponsible in patient care.  She became irritable with him in meetings and found herself frequently rolling her eyes around him.  After meeting with a therapist and exploring her feelings and behaviors, Nora became aware that her judgment about her boss mirrored her judgments and fears about herself.  She herself was insecure and afraid of seeming "incompetent", which she covered by over-functioning in numerous ways.  When Nora became aware of the harshness of her inner judge, she was able to let go of the resentment and judgment of her boss.  Their relationship subsequently improved.  More important, Nora was able to feel more compassion for herself.

Raising awareness for one's shadow is important.  Getting to the root of these feelings and behaviors can be liberating and improve our relationships to ourselves and others.  So how do we do this?  Here are some tips:

• Listen to feedback from others about your behaviors (eg, about being habitually late, having a short fuse, etc.).  
• Notice when an encounter with a person leaves you feeling emotionally charged.  Look at your reaction to people you feel strongly negatively about.
• Recognize that the "dark" qualities you react to in others may be feared or unacknowledged aspects of yourself.  
• Consider what (harsh, unrealistic) expectations you have of yourself, others, and the world.
• Consider talking to a counseling professional to gain perspective and depth of understanding.

*Nora and her example are purely fictional for illustrative purposes of this article.  Any resemblance to actual people is purely coincidental.