Client Tools of the Month 

Client Tool Box

July, 2017​
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Anxiety a Frequent Visitor by Gregory Hasek MA/MFT 

As mentioned in the Therapist Corner, this month we are addressing the issue of anxiety. Research shows that in order for anxiety to get better, you have to first address how anxiety and/or trauma has impacted the body. That is the starting place for recovery. The following tools are suggestions to help you combat anxiety from a body perspective. 

Massage: We often recommend that our clients see a massage therapist, which is why we have one here on staff. The new research that is coming out on trauma is beginning to show that massage is very helpful to relax the body, loosen tight muscles and help move the client from always being in a state of fight or flight. For more information, you can read about it on our Massage Page. 

Breathing Exercise: I highly recommend this if you are struggling with anxiety, panic attacks, sleep problems, to name a few. This is the only conscious way to address the unconscious heart rate and breathing. I would suggest starting out with 2 x a day for at least 10 minutes. Taking a slow breath in as breathing in through a straw and then a long slow breath out while saying a word such as "relax". It is also helpful to listen to quiet music such as classical and music that may contain some sounds of water at the same time. You can access these songs from the Songs Page. If you wake up with anxiety, don't just lay there in bed. It is best to get up and find a place to do some deep breathing and listen to quiet music prior to coming back to bed. I also recommend that you use this breathing exercise anytime you feel anxiety coming on during the day. 

Acting on Your Flight: Those that have experienced trauma in your life, will sometimes feel trapped in social situations or places such as elevators etc. The reason this happens is because your body is basically remembering sometime in your past when you felt trapped and/or didn't have control. It is important to not inhibit your "flight". What I mean by this is pay attention to when you have this panicky feeling and notice when you want to leave a place or situation. This is the time to honor your "flight". This can be done by simply going for a walk and letting your body have the time and space to take deep breaths. You can then later come back once you have allowed your body to calm down. This is often a coping mechanism I teach clients in marriage counseling when a conflict begins to escalate. 

August, 2017
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Emotions: A Frequent Visitor of Anxiety by Erika Pineros MA​​

​As mentioned in the therapist corner, this month we are focusing on the impact of emotions on anxiety. The following tools are to help in the process of emotional regulation.

Mindfulness: Mindfulness can basically be defined as staying in the present moment. Often times, anxiety creeps up when a person is focused on the past or future. Emotions get the best of some people when they experience a sense of losing control. By bringing attention to the present moment, we can gain greater control of those overwhelming emotions. Some ways to practice mindfulness include participating in the practices of meditation, prayer and yoga.  

Wise Mind: In Dialectal Behavioral Therapy, there are three states of the mind: reasonable mind, emotional mind and the wise mind. When a client is in the emotional mind they are ruled by their moods, feelings and urges to say certain things. When a client is in the reasonable mind, they are ruled by logic, facts and reason. The wise mind considers both the emotional mind and the reasonable mind, so it is the middle ground of the other two states. It is like having a mental referee. I encourage clients to think about what state of mind they are often ruled by. They can do this by looking at a specific example of a past argument and then analyzing the reaction. The point of this exercise is to bring awareness of which state of mind is most often in dominance and then we can discuss in therapy possible ways to achieve a wise state of mind.  

Responding from a wise state of mind can be very difficult and it takes conscious effort to respond from this state of mind. It is important to practice reaching this state of mind. One way to achieve this is by doing breathing exercises. Inhale (say the word “wise”) and exhale (say “mind”). This helps you as a client to settle into the wise mind. While continuing to do the breathing exercises, you can ask yourself whether the action or thought being experienced is part of the wise mind. This tool will help with the calming of the emotion being experienced, at the same time help you in identifying whether the thought, plan or action is part of the wise mind.
 
You can download more information on this tool by clicking here.

September, 2017
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​How Thinking Affects Anxiety by Natalie KLas MS/MFT​

When we integrate cognitive behavioral therapy into our thought processes, it can restructure the brain to think rationally and use appropriate strategies. Through treatment, new neural pathways grow and a new belief system is created. Here are three tools below that I hope you find helpful. 
 
Thought challenging—also known as cognitive restructuring—is a process in which you challenge the negative thinking patterns that contribute to your anxiety, replacing them with more positive, realistic thoughts. This involves three steps:
  • Identifying your negative thoughts
With anxiety disorders, situations are perceived as more dangerous than they really are. One strategy is to ask yourself what you were thinking when you started feeling anxious.
  • Challenging your negative thoughts
Strategies for challenging negative thoughts include conducting experiments, weighing the pros and cons of worrying or avoiding the thing you fear, and determining the realistic chances that what you’re anxious about will actually happen.
  • Replacing negative thoughts with realistic thoughts
Once you’ve identified the irrational predictions and negative distortions in your anxious thoughts, you can replace them with new thoughts that are more accurate and positive.
 
 Create a Worry Thought Journal
1. Coping Statements: On the first couple of pages, create positive coping statements that you can tell yourself when you are experiencing irrational thoughts that create anxiety. Here are some examples:
  •  This feeling isn’t comfortable or pleasant, but I can accept it.
  •  I can be anxious and still deal with this situation.
  •  I can handle these symptoms or sensations.
  •  This isn’t an emergency. It is okay to think slowly about what I need to do.
  •  I am going to go with this and wait for my anxiety to decrease.
  • This is an opportunity for me to learn to cope with my fears.
  • There is no need to push myself. I can take as small a step forward as I choose and feel comfortable with.
  • I can do my coping strategies and allow this to pass.
  • These are just thoughts…not reality.
  • I don’t need these thoughts, I can choose to think differently.
  • Fighting and resisting this isn’t going to help – so I’ll just breathe, relax and let it pass.

2. After that is completed, you can observe and write down negative worry thoughts. This will help you become more aware of your thought patterns and what you are worrying about. Replace the worry thought with a coping statement, when you observe yourself using negative self-talk. 

Senses- Use Your Senses To Help Calm Down
Our senses can be used to help us relax and to calm down; they can be used to make us more alert, and they can also be used to help us feel more organized and in tune with our body.  Since early childhood, we are conditioned to comforting smells, textures and environments. Take some time and observe what helps you feel relaxed and what is making you feel more alert. 
Here are some examples:

Smell
Calming: Soothing scented candle
Alerting: Strong perfume

Taste
Calming: A cup of mint tea
Alerting: A glass of fresh lemonade

Oral Motor
Calming: Sucking on a sweet lollipop
Alerting: Sucking on a lime popsicle

Vision
Calming: Watching fish in an aquarium
Alerting: Looking at blinking lights

Hearing
Calming: Listening to a relaxing music
Alerting: Listening to loud intense music  

Touch
Calming: Having a massage
Alerting: Being tickled

Proprioception
Calming: Doing Yoga
Alerting: Brisk walking

Vestibular Sense
Calming: Rocking slowly in a rocking chair
Alerting: Dancing around the room 

October, 2017
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​​Post Hurricane Stress and the Recovery Process by Gregory Hasek ​MA/MFT

As I mentioned in the Therapist Corner this month, we as a community, as families and as individuals experienced trauma in September as a result of hurricane Irma. Not only can the recovery process be slow for clean up and rebuilding etc., but the emotional recovery process can take some time. Often times when people go through trauma, there can be a delayed emotional response to the trauma after the person moves out of the stage of shock and being in survival mode. This stage can bring on a lot of emotions out of the blue. One day you might find yourself just breaking down and crying. You might also find yourself extremely physically tired. This is very normal. After riding the adrenaline high of survival mode, one's body, mind and emotions begin to experience the toll of the recent event. In this tools section this month, I want to offer some specific suggestions for your recovery from what was a traumatic September for many. 

The Importance of Debrief
Debriefing after a traumatic event can be very helpful in the weeks after the event takes place. Debriefing can be as simple as getting together with people you care about and being able to share questions such as, "What was the hurricane like for you?" Another question might be, "What was the scariest or most difficult part?" It can be done in a more formal setting such at a church small group. If it is done in a larger group I would recommend it being led by someone professionally trained in Critical Incident Debriefing. What I am suggesting is that it is healthy to talk with others and get your emotions out. It is better than isolating and not sharing your individual experience. Research has shown that Post Traumatic Stress Disorder symptoms seem to decrease if debriefing happens not long after an event. Another powerful factor of debriefing is that you don't feel alone in what happen. Others have experienced the same thing and by hearing others stories, you can feel supported and understood. 

Dealing With Reminders 
As you walk around your neighborhood, it is not difficult to miss the piles of storm debris, blue tarped roofs, broken pool cages, bent signs etc. It's hard to believe that all this happen in one day and will take a long time to clean up and recover from. These reminders are not easy to deal with if the hurricane was traumatic for you. They remind you of the day it happen and the fear leading up to that day. These reminders are no different than when I work with a client who had an affair and there spouse is reminded of the affair by certain places in town she might drive by. This experience is very similar. I want to offer a few suggestions when dealing with reminders or triggers. First you have to understand that just because the reminder might trigger a fear in you, doesn't mean it is going to happen again. It is important to try to stay present and not go back to the day of the hurricane. Say to yourself, "The pile is just a pile in this moment now. Ground your thought in just today and resist allowing your mind to go back and not stay present in today. I would encourage you to access our mindfulness page for more ideas on how to stay present. 

As time goes by, the reminders will have less power. I encourage you to have the mindset of taking back what was taken from you. What I mean is not to avoid but confront the reminders with some positive thoughts, and allow your self to think good things that can come out of the bad. Perhaps getting together with neighbors and being proactive to help get rid of another neighbor's trash pile, can be a positive way to take back a part of your neighborhood. When people go though trauma and the element of having no control is present during the traumatic incident, in recovery it is important to establish some kind of control back in your life and this can be a way of doing that. 

Choosing to Normalize One Thing in Your Life that Brings You Joy and Peace
After something traumatic happens it is common for people to get stuck in survival mode and not reinvest back into doing life prior to the trauma. It can be as simple as going to the gym or taking time out to enjoy a walk. It can also be as simple as allowing oneself to laugh and enjoy being happy. As a Christian, it could mean getting back to having a quiet time in the morning with God that brings you peace. It can also look like purposefully coming home after work and listening to some quiet music that is relaxing prior to having your dinner. 

Why is it important to take these small steps? After a trauma, people sometimes become stuck. Because of being in survival mode it is like they become somewhat frozen. It is very difficult for them to then get back to things they enjoyed before. It is very similar to after someone dies. If you find yourself stuck after hurricane Irma, I would encourage you to choose one thing that you can start doing again that brings you happiness. This small step can be very powerful in creating some normalization in your life. 

Winter 2018

​Depression and a Christian by Gregory Hasek MA/MFT

Tools for Finding Hope to Get Through to the Other Side of Depression 

Find a Support Group or Support Person
It is important when you are feeling really depressed and hopeless to find a support group or support person who understands and has been there. They are the ones that know exactly how you feel. They have been where you have been in your darkest hour. They are the ones that can give you advise as to what helped them the most. Even though it is hard for you to reach out, it is in those times that you will find you need someone the most. These are the people you will remember later that were there for you to walk with you through it to the other side. 

Don't Trust the Present
When clients are depressed and have thoughts of suicide, they are often in so much pain, they are not able to see any glimmer of hope out of their dark despair. It is in these times, no matter what you have to say to yourself, "I can't trust my present feelings, thoughts and reality." You have to trust that there will be a day where you will one day again experience the sun shining on your face and experience a glimpse of happiness again. 

Don't Punish Yourself More
Often times when people are depressed it is very difficult for them to allow themselves any type of happiness. It is like they want to subconsciously punish themselves more. You need to resist this as much as possible. Allow yourself to do some things that would make you happy and laugh, even though everything inside you is saying the opposite. Little things such as watching a comedy or talking a walk on the beach can help create some normalcy in your world. 

Spring 2018
Depression: A Common Reason for Counseling by Erika Pineros MA​

As mentioned in the Therapist Corner this month, depression and anxiety are the most common symptoms clients present with in counseling. These tools are focused on helping you when you are experiencing depression. 
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​1. Physical Exercise: Depression leads to little motivation and lack of energy. The last thing on a client’s mind is to get out of bed or off the sofa in order to do some physical activity. However, physical activity is greatly needed in order to release endorphins. Endorphins are chemicals in the brain that produces a general feeling of well-being. The release of endorphins are also correlated with reduction of pain. Research states that it is a natural painkiller. During the first few sessions of counseling I urge clients to start to engage in some physical activity. It is important to start off with realistic goals. For example, starting with a ten-minute walk can be a good start for someone who has not engaged in any type of physical activity in a long time.

2. Scheduling of Basic Needs: Basic needs for survival usually consists of food and sleep. If these two basic needs are not being met, your daily functioning will be compromised. When a client has depressive symptoms, they often neglect nutrition and rest. Clients often forget to eat throughout the day and/or don’t have an appetite. Clients will either oversleep or undersleep. Since it is important for the body to get it’s nutrients and adequate sleep, it is recommended that you as a client create a schedule. During therapy, I have clients create a daily schedule that will include a wake up time, breakfast time, snack time, physical activity, lunchtime, social activities, dinner time and bedtime, among others. Usually the schedule is very detailed and it will account for every hour of the day. The purpose is to have a plan of what is needed to be accomplished throughout the day. Again, the goals are to be realistic, it is important for the client to create a good baseline with the therapist so the client does not feel overwhelmed.

​3. Self Love: When clients are depressed they often experience negative thinking and negative self-talk. Statements such as “I’m worthless” and “ I will never be good enough” are good examples of negative self-talk. This self-talk becomes automatic and the client does not even realize that they are participating in this type of behavior. One way to move from negative self-talk to positive self- talk is simple, just create some words of affirmations and say them daily. The theory behind this is simple, but it’s the application that is difficult. Clients often feel very uncomfortable saying positive things about themselves and have difficulty identifying the positives. A good starting point is to identify three things that the client considers to be their strengths and then create some words of affirmations. In therapy, the negative self- talk is disputed and client creates new statements that alter their self-perception.

"Anxiety does not empty tomorrow of it's sorrows,
​but only empties today of it's strength.”

- Charles Spurgeon