Coping with Emotional Upheaval During COVD-19

Our world and our individual psyches have been infused with uncertainty in the wake of the COVID-19 pandemic. Plans and routines are increasingly disrupted and collective anxiety – even panic - is palpable in public spaces such as grocery stores.

Feeling some anxiety makes sense right now – it’s a normal reaction to emerging news about the coronavirus. Many of us ponder the uncertainty of the virus’ impact on ourselves and loved ones in the weeks and perhaps even months to come.

Anxiety alerts us to potential threats. It activates us and helps us move toward safety. Our human nervous systems are now more alert and oriented toward survival. If this energy is channeled appropriately, it will help us be prepared. Unwelcome anxiety side effects may include a shorter fuse or feelings of paralysis.

Mindfulness Instructor Stan Merrill made an important distinction between planning and worrying. Planning offers reasonable control and opens up possibility. Worrying closes it down to the same loop of worst cases, playing over and over in our imaginations. Considering this, here are some thoughts on how to mindfully be with the anxiety of the coronavirus:

• Stick with websites that we know are giving us accurate, updated, and fact-checked information. Be mindful of overconsumption of news and social media, and how this may affect your anxiety level
• Focus on what you can control. When washing hands, mindfully breathe in and out five times
• During social distancing, stay in touch with loved ones via phone or video calls.
• If possible, spend time outside and engage in daily movement and exercise.
• Even when routines become disrupted, stick with a daily routine, including wake up times, meal times, and pursuing topics that feed your brain and heart
• Reach out to a mental health professional for support if worry, anxiety, and panic become unmanageable. Many mental health professionals may offer telehealth appointments while social isolation measures are in place.

Stay healthy and well!

Ask and Listen: Parts We Wish We Would Have Known Reflections on Kate Spade and Anthony Bourdain

We lost two beloved, complex, creative souls to suicide last week – reminding us that suffering not only affects all types, but remains largely hidden, even from loved ones. Time and again, the suicides of public figures who seem to live fulfilled and privileged lives have revealed this important take home message: Mental illness is nothing to be ashamed of. In the wake of Kate Spade’s and Anthony Bourdain’s suicides, many ask – how can I help a loved one who is suffering?

First, it’s important to note that there are many myths surrounding suicide. Check yourself if you believe these are true or false:

• Asking someone if they have thought about suicide may trigger them to actually do it. It may put the idea in their head or make them angry and impulsive.
• Once someone has made up their mind about suicide, you cannot stop them.
• Only experts can prevent suicide.
• People who consider suicide keep their plans to themselves.
• Those who talk about suicide don’t actually do it.
• Depression is the only risk factor for suicide.

All of these myths are false. Suicide is a highly preventable type of death and it’s everyone’s business. Providing a person who is considering suicide with a safe space to talk about their thoughts and feelings will actually lower their risk of completing suicide. Asking someone directly about suicide helps lower anxiety, opens up communication, and lowers the risk of an impulsive act of self harm. Other than depression, risk factors for suicide are plentiful, including financial or relationship losses, health concerns, legal issues, substance abuse and dependence, and other psychiatric illnesses.

The key is to ask and listen. Survivors report that being asked about suicide was a relief, and that the most important part was feeling listened to without judgment. Feeling connected and not alone has powerful healing properties for the person who is suffering.

Here are some tips on how to talk to a loved one who you suspect may be considering suicide:

• Ask them if they are thinking about killing themselves. (This will not put the idea into their head or make it more likely that they will attempt suicide.)
• Listen without judging and show you care.
• Stay with the person, or make sure the person is in a private, secure place with another caring person, until you can get further help.
• Remove any objects that could be used in a suicide attempt (weapons, pills, etc.).
• Do NOT offer advice or try to cheer them up. This can cause the person to feel invalidated and shut down.
• DO offer to help the person make an appointment with a health or mental health provider and to accompany them to the appointment.
• Enlist the help of others. Do NOT agree to keep someone’s suicidal thoughts a secret.
• Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and follow their guidance.
• If danger for self-harm seems imminent, call 911.
• Remember, suicide is highly preventable, help is out there, and people do recover.

Here are some additional resources:
American Foundation for Suicide Prevention: afsp.org/resources
Live Through This Project: livethroughthis.org/the-project

How To Be Alone

It is not impermanence that makes us suffer.  What makes us suffer is wanting things to be permanent, when they are not. ~ Thich Nhat Hanh

Society is afraid of alone - a striking line in a poem I ran across. How much of life is made up of loneliness avoidance, as if our worth as a human being depended on it? Afraid of loneliness, we keep trying to fill this feared hole with filler behaviors, perhaps unhealthy habits, relationships that are draining rather than energizing, drugs, food, alcohol, shopping, material fads, work - the list goes on.

The experience of loneliness is complex. First, there is the simple, objective matter of being by oneself, which in itself isn't (usually) harmful or dangerous. And then there is the "story" we tell ourselves about being alone, what we tell ourselves about our loneliness. And this is where the emotionally destructive hook is. That story may be about how we feel unappreciated or misunderstood, how we are not worthy of love and affection, how there must be something wrong with us to feel this way. Conquering loneliness has little to do with whether we have friends or not—we all know the feeling of loneliness even when we’re surrounded by others.  It has everything to do with examining and ultimately rejecting the story we tell ourselves about what it means to be alone.

If you silence the stories you tell yourself about being alone, a whole new world of wisdom can open up.  One insight could be that you are always here and everyone and everything else comes and goes. Everything is temporary.  No material possession, relationship, feeling, health state is here to stay.  Rather than it being depressing, this can increase the "wow" factor of life: You are the only thing that is always here with you, so how can you be good to yourself, love yourself?

How To Be Alone by Tanya Davis

(Available as a video poem below)

If you are, at first, lonely - be patient. 

If you've not been alone much or if, when you were, you weren't okay with it then just wait, 

you'll find it's fine to be alone... 

once you're embracing it. 

We could start with the acceptable places: the bathroom, the coffee shop, the library. 

Where you can stall and read the paper, 

where you can get your caffeine fix and sit and stay there, 

where you can browse the stacks and smell the books 

you're not supposed to talk much anyway, 

so it's safe there. 

There's also the gym. 

If you're shy you can hang out with yourself in the mirrors, you can put headphones in. 

And there's public transportation 

- because we all gotta go places - 

and there's prayer and meditation 

no one will think less if you're hanging out with your breath 

seeking peace and salvation. 

Start simple, 

things you may have previously avoided based on your avoid-being-alone principles. 

The lunch counter, where you will be surrounded by chow-downers, 

employees that only have an hour 

and their spouses work across town 

and so they, like you, will be alone. 

Resist the urge to hang out with your cell phone. 

When you are comfortable with eat-lunch-and-run, take yourself out for dinner, 

a restaurant with linen and silverware. 

You're no less intriguing a person when you're eating solo dessert 

and cleaning the whipped cream from the dish with your finger; 

in fact, some people at full tables will wish they were where you were. 

Go to the movies 

where it is dark and soothing 

alone in your seat amidst a fleeting community. 

And, then, take yourself out dancing, 

to a club where no one knows you 

stand on the outside of the floor 

until the lights convince you more and more 

and the music shows you. 

Dance like no one's watching 

('cause they are probably not) 

and, if they are, assume it is with best and human intentions, 

the way bodies move genuinely to beats is, after all, gorgeous and affecting. 

Dance until you're sweating 

and beads of perspiration remind you of life's best things, 

down your back like a brook of blessings. 

Go to the woods alone and the trees and squirrels will watch for you. 

Go to an unfamiliar city, roam the streets, 

there are always statues to talk to 

and benches made for sitting 

give strangers a shared existence 

if only for a minute 

and these moments can be so uplifting 

and the conversations that you get in 

by sitting alone on benches 

might have never happened 

had you not been there by yourself. 

Society is afraid of alone though, 

like lonely hearts are wasting away in basements, 

like people must have problems if, after awhile, nobody is dating them 

But alone is a freedom that breathes easy and weightless 

and lonely is healing if you make it. 

You could stand, swathed by groups and mobs or hold hands with your partner 

look both further and farther 

in the endless quest for company, 

but no one's in your head 

and by the time you translate your thoughts some essence of them may be lost 

or perhaps it is just kept, 

perhaps in the interest of loving oneself, 

perhaps all of those sappy slogans 

from preschool over 

to high school's groaning 

were tokens for holding the lonely at bay. 

'cause if you're happy in your head then solitude is blessed and alone is okay. 

It's okay if no one believes like you 

all experiences unique, no one has the same synapses 

can't think like you 

for this be relieved, 

keeps it interesting, life's magic things in reach. 

And it doesn't mean you aren't connected, that community's not present. 

Just take the perspective you get 

from being one person alone in one head 

and feel the effects of it 

Take silence and respect it. 

If you have an art that needs a practice, stop neglecting it. 

If your family doesn't get you 

or a religious sect is not meant for you 

don't obsess about it. 

You could be, in an instant, surrounded, if you need it. 

If your heart is bleeding make the best of it 

there is heat in freezing, be a testament

The Art of Self-Nurturing

Feeling tense? Running on empty? Maybe work, finances, relationships, changes in routine, or daily life have you feeling overwhelmed. Warning signs include feeling anxious, irritable, fatigued, and having repeated intrusive thoughts about a stressful situation. Extreme stress can make you feel like there is nothing you can do. The key to regaining control is a radical return to self-nurturing, to recharge your emotional and physical batteries. Here are some strategies to foster the Art of Self-Nurturing.


Admit your stress. Admit when circumstances have got you down and change is needed. Admitting this creates a moment of calm and stillness, a space to breathe, and a space for observation and awareness. Moving forward is difficult unless you recognize the situation and make a commitment to help yourself through it.

Identify Your Hot Buttons. Figure out what is causing the stress–a relationship to a co-worker or loved one, work demands, a financial commitment, uncertainty about the future?  Write this down.

Acceptance. Take a look at your list of stressors and identify the things that can be changed as well as the things that can’t. Accept that some things are always going to be stressful. Then, attention can be focused on the things that can be changed instead. Try focusing on action steps to make the future less uncertain, such as acquiring skills, making friends and setting goals.  This also means not sweating the small stuff - pick your battles and invest your energy wisely.

Notice how you talk to yourself about yourself and others. Observe the language you use to create your reality, to define and judge yourself and others.  For example, you may say to yourself, "Here I go again, stressing out", when a more effective, self-compassionate statement would be, "Stress is part of life and I'm learning to address it effectively by taking it one day at a time."

Get Outside. Taking in natural beauty, along with physical exercise, can reduce stress and improve physical health. The color green has been shown to have soothing effects on body and mind.  Nature can provide a peaceful soundtrack, beautiful scenery and fresh air to help soothe the soul. Try hugging a tree or walking barefoot in the grass.

Let It Out. Bottling up emotions can increase stress through accumulated feelings of loneliness and helplessness. Communication, both with yourself and others, is key in addressing problems quickly and honestly.  If you need help identifying what's causing your stress, and how to effectively address it, talk to a trusted person or mental health professional.

Tips to Beat the Winter Blues

You are the sky...Everything else, it's just the weather. ~ Pema Chodron

Winter, with its shorter, colder and darker days, can give rise to occasional feelings of sluggishness, low mood, or Winter Blues. Below are some simple strategies you can use to help these occasional feelings.


Do:

• Try to have regular sleeping patterns. As you feel down, the urge to escape everything by just staying in bed can become stronger. Try to resist this (unless you are genuinely physically tired) as it can make things harder to deal with.
• Try to have a plan of what you need to do day-to-day and week-to-week. Make it realistic and review it regularly. Use it to check your progress. 
• Keep in contact with your friends and loved ones. Cultivate relationships that are close and supportive. If your family is supportive, try to tell them how you feel. Remember you are not alone. Consider the advice and help that others might try to give you as a positive thing in your life.
• Remember to do some of the things that you have enjoyed doing in the past. Reading, movies exercise, playing sport, spending time with friends, getting back to nature, etc. What works for you is what is most important. Sometimes just having a routine to follow can give you a sense of structure in your life.
• Practice ways to distract yourself away from negative patterns of thought. Activity and getting out of the house are good in this respect. 
• Negative thoughts can generate feelings of anxiety. Learning relaxation techniques can help a great deal. A therapist can help you to learn a variety of physical and mental relaxation techniques that will be useful for you in the future.
• Try to explore the way you are feeling. If you can recognize your emotions, talk about them with friends, and/or with a therapist. Write them down, and see how they may relate to your own thinking about yourself or to things that happen in your life. By doing so, you can avoid them controlling you. Then you can begin to get some control back in your life.
• Think of things that have helped in the past, if you've experienced the Blues before. Write these things down and remind yourself to keep using them. Allow yourself the time for them to have an effect.
• Daily exercise and a nutritious diet are important. If your appetite is low, try nutritious smoothies or juices - a liquid diet can be easier to manage if you are prone to gastrointestinal stress.

Don't:

• Don't be passive and allow your mood to take over, if you can help it. Make some plans for each day. 
• Try to avoid falling into the trap of "automatic negative thinking". Identify your negative thoughts, learn to monitor them and learn to challenge them. (i.e., look for evidence to support your negative thoughts or assumptions about yourself). Then you can begin to substitute more positive and therefore more useful patterns of thought. Try writing these things down in a notebook. A therapist can help you to develop this approach so that you can be more realistic about those things in your life that are positive. Click here to learn more about strategies for negative thoughts.
• Don't overindulge on alcohol. It’s a central nervous system depressant and it may make your blues worse.

What distinguishes occasional Winter Blues from Clinical Depression? Check these symptoms of depression or read information about depression. If you check 5 or more of these symptoms for 2 weeks or more, please talk to a mental health or medical professional.

• 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

Seeking appropriate mental health care for depression is important and possibly life-saving. Please contact a licensed mental health professional if you are concerned about depression in yourself or a loved one.

Do's and Don'ts for Helping Someone With Emotional Pain

“Happiness is not given to us, nor is misery imposed. At every moment we are at a crossroads and must choose the direction we will take.” ~ Mathieu Ricard

What are the best ways to support someone who's going through a tough time?

Knowing how to best support a friend or loved one who is undergoing a tough time is an important relationship builder. It's a skill that comes in handy in any relationship - with a spouse or romantic partner, family member, friend, or work colleague. Whether they are grieving a death or other terrible loss, received crushing health news, undergoing a break-up or any other major life transitions, read on for some skills to support someone in an emotionally fragile state.

One of the best ways to support someone who is experiencing emotional pain is to truly listen.  This is often easier said then done.  Take your time to truly sit down, spend time, and listen. Approach the situation with no assumptions or preconceptions in mind. Find a quiet, private space. Present yourself as a calm listener.

 
There are several skills to convey empathy and care:

1. Practice Thought Empathy: Paraphrasing the other person’s words. Mirror what the other person is saying in a non-judgmental way
Goal: To truly understand where the other person is coming from.
Example: “It sounds like work has been getting tougher because of all these new demands at your job".

2. Use Feeling Empathy: Acknowledge how the other person is probably feeling, given what they are saying to you.
Goal: To see if you are reading the other person’s feeling correctly.
Example: “Getting this feedback from your boss is stressing you out".

3.  Find something positive to reply to the person.
Goal: To show genuine curiosity and respect.
Example: “I appreciate you trusting me with this problem".

4. Ask gentle questions about what the person just told you. Open ended questions work best.
Goal: To learn more about what the other person is thinking and feeling:
Examples: How come...? This is because...? How did you come to be...? What do you think about....? How do you feel about…?

Are there things I shouldn't do when trying to support someone?

Even with the best intentions, we can directly or indirectly convey information to the person that may hinder the process of supporting and healing, or even shutting the person down.  One is by making dismissing statements.  Dismissing emotions can take many forms - watch out for these subtle statements.
1. Minimizing what the other person is feeling.

Examples: "You'll get over it", "Come on, it's not that bad". "Just dust yourself off and try again".)
2. Making an assumption about the person's situation or feelings, or predicting the future (which no one can). 

Examples: "Tomorrow, you will feel better". "Give it a week". "He'll come around". "I have a feeling you will be just fine". "It will work out next time".
3. Making the situation or their problem about yourself. 

Examples: "This reminds me of when my grandmother died…." "I feel the exact same way, let me tell you about….". "When my aunt had cancer, she tried this new treatment…." "After my miscarriage, we tried again right away and it worked! You should do the same!"

With trying to fix the situation, you risk making wrong/faulty assumptions, which can put distance between you and the person who is experiencing a tough time. It may also feel to the person like you are placing yourself above them with expertise, rather than meeting them where they are. Try to stay away from these assumptions:

1.The person wants "fixing", rather than perhaps just wanting someone to listen, sit with them or hug them.
2. Whatever you believe works for you or others you know, will also work for this person, in this situation. It may be far from it.

Some other helpful things to remember when supporting someone who's hurting:

Remember that their emotion isn't your emotion. Being a good friend or support doesn't mean you have to feel that same emotion or intensify the emotion for you and the person. Set healthy emotional boundaries for yourself so that you can truly be present with the person.

Also, when offering concrete support to someone in crisis, the question "Is there anything I can do?" can at times feel overwhelming to the person. They may not want to burden you or feel overwhelmed by trying to figure out what they want you to do for them. Offer something concrete: "I'm bringing over dinner tonight. If you don't feel like talking, I will simply leave it at the door".

Winterize Your Heart for the Holidays

Pain is inevitable. Suffering is optional. - Haruki Murakami

As the cold is upon us, many of us are in the process of winterizing - taking precautions to protect our bodies with extra layers, and our animals, plants, and dwellings with extra heat. The days are getting shorter, darker, and colder, which for many also has emotional effects. For some, it may be a mild and temporary case of the "winter blues" as you adjust to the season.

For others, emotional changes may be more intense. You may feel a lot more tired, your brain may feel sluggish, and your body may feel heavy. You may wake up in the morning only to spend all day looking forward to getting back to bed as soon as possible, with not much energy or motivation to socialize or do more than the bare minimum. There may be habits like spending too much time with electronic devices, and turning to unhealthy food and drink on a more regular basis. With the festivities and chaos of the holidays upon us, this feeling and need to cocoon may get more intense, which can create an extra burden if there's a social expectation to be out, about, and celebrating.

If this sounds familiar, you might have Seasonal Affective Disorder (S.A.D.). S.A.D. is a type of depression that affects some people during the fall and winter season when days become shorter and colder. The exact causes of S.A.D. are not fully understood, but it is likely the body's reaction to outside seasonal changes - causing changes in circadian rhythm and levels of melatonin and serotonin. Women, people with a history of depression, and those who have a family history of S.A.D. and/or depression are at the greatest risk for S.A.D.

Regardless of your susceptibility to the winter blues or S.A.D., it's a good idea to winterize our hearts and souls, if anything, for preparation and prevention's sake. Don't wait until you're caught in the chaos or out of sync. Here are some things you may wish to consider to take care of yourself this season.

• Get outside. Even though the instinct may be to hunker down, just a bit of time spent in daylight can help increase energy levels and improve mood. You can layer up and try a walk, or even jog or run. Even going for a drive, getting a cup of coffee, or meeting up with a friend can help reset your mood and activity level. 
• Move your body. Again, snuggling with Netflix may sound a lot more appealing. However, exercise doesn't have to take long, and joining a friend in an outdoor movement activity can boost positive effects with activity and social support. Or join an exercise class - knowing that others are there sweating with you can boost motivation. A body in motion stays in motion. 
• Eat high quality foods. When it's cold and dark, fast, fatty, and comfort foods become more alluring. Just make sure your food includes healthy components - dark, leafy greens, fruits and veggies across the color spectrum, nuts and seeds, whole grains. Omega 3 fatty acids have been shown to boost brain power. Healthy soups and stews can be made ahead and frozen for later use. Try to avoid alcohol over-use, as it is a depressant and can lead to more sluggishness. 
• Nourish your spirit and soul. Lots of small things are at our fingertips to do so. The trick is to add soothing, positive energy and take away draining energy. Spend time with a quality friend who adds positive energy to your life. Meditation, yoga, hot baths, nice candles, aromatic oils, and a good book can provide much needed nourishment that isolation and electronics cannot give. 
• Reach out to others in need. Stepping outside of ourselves and giving back helps draw attention to the bigger picture in life and away from internal negative rumination. Check in on a friend or smile at random strangers. Buy coffee for someone, or pick up volunteering if you can.
• Practice gratitude. 
• Ask for help. If it is difficult to get out of the winter blues or you believe you may have S.A.D., help is available from physicians, psychologists, counselors, and other healers. By working with a professional, you can determine how to best manage your concerns. 

I am a Houston psychologist. For more information about my practice, visit DrGortner.com.

Help! I Have Intense Emotions!

Feelings are like children:  You don't want them driving the car, but you don't want to stuff them in the trunk either. (Quote from the movie "Thanks for Sharing")

Most of us have been conditioned by our environment that having positive emotions means success, and having negative emotions means failure.  However, both positive and negative emotions are a normal and desirable part of life.  Like children, they can be unpredictable.  Just the same, they can be brutally honest and teach us about ourselves.  Unlike rational thought, the experience of feelings is often non-linear, it can feel like a spiral or circle, or an endless loop.  This can be a challenging experience.

Some emotions can create an intense experience.  Feelings such as anger and fear can leave us with the perceived notion of feeling overwhelmed or out of control. When faced with such intense feelings, we may often feel compelled to stuff them away and supress them. We may have been taught not to listen to, show, or express our feelings.  Most of us believe we shouldn't have negative or challenging emotions or that if we allow ourselves to have them, we may lose control and something "terrible" might happen.  So when we are faced with a difficult situation in our life, we may feel upset or angry, and tell ourselves that we shouldn't be feeling this way.  Our habitual response may be to stuff those emotions in the trunk of our car.  But what happens? The stuffed away emotions start knocking, screaming, and expressing their discontent at being in the trunk.  So we try to block out the noise.  In real life, this manifests as numbing out: by staying busy and filling our lives with escapes, pursuing addictions and distractions such as overworking, substances, food, shopping, sex, getting in and out of relationships, or other impulsive behaviors.  This can give us the false illusion that the emotion has gone away.  This may work...temporarily.

What's the true "fix" for intense emotions?  Some musings and food for thought:

• There is no need for a "fix".  Emotions are merely experiences that are temporary.  Usually they can teach us some important insight about ourselves.  
• It's important to accept there is nothing wrong with having emotions: being afraid, angry, upset, surprised, disgusted, being happy, being excited.
• Try not to get caught up in what your emotions mean about other people, but rather what they mean about yourself.
• If you have a tendency to stuff your emotions in the trunk of your car, play with the notion of putting them in the back seat instead.  Check on them in the rearview mirror - acknowledge that they're there, talk to them every once in a while.  Maybe listen to what they have to say.
• Letting go of the success/failure duality of emotions opens up amazing freedom.  Emotions just "are", without being good or bad, until we tell ourselves a story about what they mean, could be, or should be.
• Don't be scared of emotions, just ride the wave.  They are temporary.

This Holiday Season, Return To Simplicity

The holidays are a time when our inner self may be exposed to more vulnerability than usual.  Much time is focused on the external world – preparations, shopping, responding, caring for, tending to.  Lots of stimuli bombard us, and it’s not only the holiday consumer goods commercials and advertisements that now seem to be starting in October.  Our inner self is now working overtime responding to these stimuli.  There are both internal and external pressures to keep up with. 

So this creates a new layer of stress, or roughness, for our inner self.  Our inner self is our oldest friend, the most tender and vulnerable part of us.   Our inner self is our heart space.  The part that has endured hurts throughout our lifetime – fear, abandonment, unmet needs.   This is the part of us that can feel ravenous with emotional hunger as well as be walled off from potential hurts, all at the same time. 

The holidays are an interesting time.  Our inner self has two conflicting demands – responding to the many external pulls, which at the same time creates an increased internal need for love and protection. 

I’m advocating that at this time, you turn extra kind attention, loving care, and protection towards your inner self.  Like being your own mother responding to her upset (inner) child with care, patience, and compassion.  I may even dare to say that during this time, turn inward first before you turn outward. 

Listen to your inner self’s needs. 

Give the gift of self-compassion.

Sometimes it’s okay if the only thing you did today was breathe.

Trust the process. 

Consider embracing simplicity during the holiday season. For example, this may simply mean spending time with the people we love and who love us back. 

Keep calm and let go (perhaps of the things and circumstances that no longer serve you).

For more holiday coping advice, see:

Self-Care for The Holidays

Stay Sane During The Holidays

Staying Sane During The Holidays - Part II

Coping with Reverse Culture Shock (Re-Entry Shock)

For many expats and international students, as well as for anyone with an extended stay abroad, the idea of returning home* can stir up complex feelings.  You may have already weathered Culture Shock upon arriving in your host country, and returning home may come with mixed emotions, such as excitement, anticipation, sadness, and stress.  The phenomenon of Reverse Culture Shock (also known as Re-Entry Shock) can and should be expected - that is, the emotional reaction to re-adapting to one's home culture after having spent time in another culture.

A variety of reactions to Reverse Culture Shock are normal.  Upon arrival home, the experience of Reverse Culture Shock can catch us by surprise.  For those with lots of relocation experience, Re-Entry Shock may go away with time.  For other frequent relocators, it is an expected "part of the drill", with the knowledge it will be experienced for a few days while settling in.  As a German expat to the US, I experience Re-Entry Shock every time I "return" to either country.  I consider both countries my home and feel that Re-Entry Shock is like jet lag, a temporary discomfort.

Here are some hallmark signs and symptoms of Re-Entry Shock:

• It feels like you are viewing the world through a stranger’s glasses: Everything seems similar and familiar, but not the same.
• You feel like a foreigner in your own country.
• You feel like your friends and family don’t know you, or understand you, anymore.
• You feel like you’ve changed while everyone else has stayed the same.  Alternatively, you may also feel everyone else has changed whereas you have stayed the same.
• You become critical of your home culture. Having grown accustomed to the signs and symbols of everyday life in your host country, returning to your home culture can trigger feelings of annoyance, frustration, and overwhelm.  
• You feel bored, restless, depressed, confused, or isolated.
• You feel homesick for your "other" country, or host country.

Here are some other tried and true tips to help overcome Re-Entry Shock:

• Expect re-entry shock and connect with others who have been through it.
• Appoint a friend or family member to keep track of cultural fads, popular entertainment, trends, political events, economic changes, etc.  This way, they can fill you in and catch you up on topics that are important to you from a local viewpoint.
• Keep a journal and pictures of your host country accessible if you need a little mental vacation or to jog positive memories.
• Similarly, maintain meaningful connections with loved ones in your host country.
• Others may grow tired of hearing about your abroad experience, and they may let you know directly or indirectly. The sensation of others not sharing or understanding your experience is often experienced as the most jarring aspect of Reverse Culture Shock.  Stay in tune with your friends' needs and find other expats who can relate and share in your abroad experience.  This requires extra work on your end, but is well worth it.

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

*For the purpose of this article, "home" refers to one's country of origin and/or the country one is returning to.  We also recognize that for many expats, the concept of "home" is highly complex and often encompasses more than one place and country.

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!

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.

Third Culture Kids

A home away from home.  Caught between cultures.  A foreigner in your own land.  These phrases all describe the experience of a third culture kid.  The term "third-culture kids" refers to children who spend a significant amount of developmental or formative time outside their (parents') home culture.  Children of military, missionaries, or other expats are good examples.  This results in an interesting phenomenon - these children, caught between two cultures, create a culture of their own.  

Spending one's formative years in another country means that third culture kids internalize that country's customs, culture, and language, while also retaining their home culture and language.  At the same time, however, they are perceived as foreigners in their host country.  They create a "third culture" to deal with this tension.  This usually means spending lots of time with others who experience the same situation - usually other third culture individuals, who can bond around the same shared experience.  Often, third culture kids have multiple stays abroad, at times in multiple countries, therefore repeating this process over and over again.


Here are some interesting positive trends observed in Third Culture Kids:

• They usually do well academically (40% have postgraduate degrees or doctorates) and usually grow into successful professionals.
• They adapt to new situations quickly and are skilled at navigating culturally diverse social situations.  
• They develop excellent communication and diplomatic skills, and pick up new languages quickly.
• They have good self-confidence.

Some challenges faced by Third Culture Kids are:

• They may have difficulty immersing themselves completely in the host culture.  As adults, they may often feel like perpetual outsiders, regardless of their environment.
• Making new friends and saying goodbye becomes routine, often creating an out-of-sight-out-of-mind attitude.  It can be hard to maintain close friendships and relationships.
• Returning to one's home country after many years can lead to "reverse culture shock".  Third culture individuals are expected to remember how to behave at home, which can be hard when you've internalized other cultures.  Peers in the home country have moved on within their own cultural customs.  This, too, can lead to feeling like an outsider.
• For the third culture kid, the home country can prove to be more foreign than previous host countries, and many of them create and retain their own, separate identity as a third culture person.  Many move abroad again as adults, and will work and raise their family in a foreign country.

Support for third culture kids is crucial.  Their adjustment usually depends on their personality, the duration of the stay abroad, their age, the parent-child relationship, family support and circumstances, and parents' attitude.  Giving third culture kids a sense of stability and consistency is important.  Parents should encourage safe and supportive dialogue around cultural and social issues.  Parents are also encouraged to support safe immersion in the host culture and promote learning of the host language(s), and interaction with locals.  And when returning home, parents should expect their children to experience reverse culture shock, and be supportive and available in this process.  Finally, parents of third culture kids may need to get their own outside support to help cope with these challenges.

Resources for Third Culture Kids:

TCK World

Denizen Online Magazine

Book:  Third Culture Kids: Growing Up Among Worlds