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Dry January… and Beyond?

Did you participate in Dry January? For those that are not familiar, Dry January is choosing not to drink alcohol during the month of January. This has been primarily practiced in the UK, but has gained traction in the US in recent years. The idea behind Dry January is to help your body “reset” after the indulgences of the holidays and to kick start a New Years commitment to health. Whether you participated, continued with your usual habits, or have never heard of it, everyone can benefit from taking a look at their drinking habits and relationship with alcohol.

What is “problem” drinking exactly?

I often hear statements like “I don’t drink alone, so I must not have a problem” or “I don’t drink in the morning, so I am certainly not an alcoholic.” However, problem drinking is more complex and multifaceted than that. Rather than solely focusing on how often and how much you drink, we instead identify the ways in which alcohol may be having a negative impact on your life.

Some questions you can ask yourself to determine if drinking may be a problem for you are:

  • When I drink, do I have more drinks than I planned to? Am I drinking more often than I want to?
  • Have I tried to cut down but haven’t been able to?
  • Am I spending a lot of time drinking, or a lot of time recovering from a hangover?
  • Am I having cravings or urges to drink?
  • Am I neglecting responsibilities at work, home, or school because of drinking?
  • Is drinking contributing to problems in my relationships?
  • Have I given up hobbies, interests, or friendships because of drinking?
  • Have I put myself in dangerous situations when I’m drinking (i.e., driving a car).
  • Do I have physical health problems that are made worse by drinking?
  • Does drinking alcohol negatively impact my mood, anxiety, or other aspects of my mental health?

If you answered yes to 2 or more of these questions, you may want to consider changing your drinking habits. However, change does not necessarily have to mean never drinking again or attending AA meetings (though both are great choices for many!). Below I will discuss some other options.

Sampling Sobriety

This is essentially what Dry January is. Committing to a set amount of time alcohol free (e.g., 2 days per week, 1 week, 1 month), gives you the opportunity to directly experience what life is like without alcohol in it. For those wanting to sample sobriety, I encourage them to track their mood, sleep, and other changes they notice, so that after the sampling period is over they can make an informed decision about their drinking going forward. What if you try to sample sobriety and aren’t able to do it? That may be a sign drinking is a problem for you and it is time to reach out for help.

Harm Reduction

The harm reduction approach involves changing your drinking habits so that they have less of a negative impact on your life. This can be accomplished in a number of different ways, but it almost always involves reducing how much and/or how often you drink. Two strategies that help with this are measuring and counting drinks – often times what you think is 1 drink is more like 2 or 3 because of the quantity of liquor in it or the size of the pour. Also, it is important to make a conscious effort to cultivate activities and hobbies that do not center around drinking. Commit to a morning run when you otherwise may have stayed in bed, meet friends for coffee rather than drinks, or take that hike you haven’t made time for yet because an afternoon at the brewery has sounded more appealing.

If after reading this you are questioning your drinking habits, psychotherapy can provide you a space to explore the pros and cons of change. And, if you decide to move forward with reducing or stopping drinking, it can offer you the support, accountability, and tools to increase your likelihood of success. If you live in the Austin area, I would love to speak with you about your situation and see if I may be able to help. I can be reached by email at laura@drlaurawahlstrom.com or by phone at 512-521-1531.

New Year, New Me

Happy New Year! Around Thanksgiving, I wrote a blog about how the holidays are difficult for many people. However, most folks I work with tend to feel increasingly optimistic as the calendar rolls over to a new year. Even though there is nothing objectively different between December 31 and January 1, the new year represents a fresh start. Many people also identify areas they want to change and things they want to accomplish, aka “resolutions.”

If you want to change something in your life, not having goals is like setting out on a road trip without a map (or smartphone!). It’s a lot of aimless driving, confusion, frustration, and ultimately not ending up where you want to. When I have used this analogy in the past, some folks have told me “that sounds really fun!” However, the analogy is meant to illustrate that without goals, we are less likely to succeed at making positive changes and moving toward living the life we want to live.

Have you ever heard of SMART goals? SMART is an acronym (more on that in a minute) that outlines criteria for setting effective goals. Adhering to these criteria when setting your goals ensures that you are clear on what you want to achieve, when you will accomplish it by, and how you will make it happen. In other words, it sets you up for a greater likelihood of success! So, let’s walk through what each of the letters stands for and look at an example:

Specific

Your goal should be simple and clearly define what you want to do.

Measurable

Your goal should be able to be objectively measured, so it is crystal clear if you accomplished it or not.

Achievable

Your goal should be a stretch, but not so challenging that it is not realistic to accomplish.

Relevant

Your goal should be related to what you actually want to accomplish.

Time-bound

Set a date by when you will accomplish your goal. Be as specific as possible.

Example: Let’s say you want to get healthier. Health is something that is aspirational in nature (i.e., there is no definitive way to know we have accomplished it, but instead we continue to work toward), but you will likely set several SMART goals to help you achieve better health. One goal may be to lose weight. If we set our goal for that consistent with SMART criteria, we would say “I want to lose 15 pounds by June 1.” Or, another goal may be to get better sleep. A SMART goal would be “I am going to meditate using Headspace for 15 minutes each night before bed.”

Here are some other tips for successful goal setting and achieving those goals:

Consider setting “mini goals.”

If you want to quit smoking, maybe your goal is to completely quit by August. In addition to that “end” goal, each month you set a “mini” goal to reduce the number of cigarettes you have per day by 2. This provides you with more frequent, tangible evidence of your progress, and reinforces your efforts!

Don’t set too many goals.

You may be entering the new year with lots of things you want to change. And, that’s great! However, trying to change too much sets you up for failure (again, the A in SMART is for achievable!). You’re much more likely to succeed if you pick 1 or 2 things you want to accomplish, and also use my previous tip to set mini goals along the way.

Be kind to yourself.

Change is hard. Really hard. And, most of the time when we are working toward something, we experience setbacks. It is easy when these setbacks happen to start to believe we are back at square one, so continue to remind yourself that they are normal and part of the process. Something that helps with this is to journal or write down your progress as you go so you can review it when this happens.

Enlist help.

As I said above, change is hard. And, with anything that is hard, support helps. See if a friend or family member wants to make the change with you. Or, if they have another goal, you can check in with each other on how it is going. Technology is also a great resource – there is an app for just about anything these days. Lastly, consider finding a therapist to help you with the process.

If you are in the Austin area and would benefit from extra support in identifying and sticking with goals for 2019 (and beyond!), I’d love to talk with you and see if I am a good fit. Please contact me at laura@drlaurawahlstrom.com or 512-521-1531.

Common Misconceptions of Cognitive-Behavioral Therapy

In this previous post I provided an overview of cognitive-behavioral therapy (CBT), a therapeutic approach based on the idea that our thoughts (i.e., running commentary in our heads), feelings (i.e., emotions), and behaviors (i.e., things we “do”) are all related to and influence each other. To follow up, I thought it would be useful to address some of the common misconceptions people have about CBT. Given how popular it is, there is plenty of information about CBT on the web, not all of it good or accurate.

CBT teaches you to think positively.

Because CBT theory emphasizes the interaction of thoughts and emotions, a major component of therapy is challenging unhelpful patterns of thinking (i.e., cognitive distortions), such as all-or-nothing thinking (“My girlfriend recently broke up with me, I’ll never find anyone to love me”) or catastrophizing (“Since I got a bad grade on this test, I’ll likely fail this class and won’t graduate”). Because the vast majority of these distortions are negative, many people assume that one goal of CBT is to replace negative thoughts with positive thoughts. However, that is not quite correct. The key is the word “distortion” – the goal of therapy is to challenge thoughts that are not rational, helpful, or based on evidence, and replace them with more adaptive thinking. See this video from the Beck Institute for a great explanation of this issue.

CBT is rigid and manual-based.

A common misconception of CBT is that it is a rigid, one-size-fits-all therapy based on manuals. I believe this belief is popular because there are a variety of CBT manuals for therapists attempting to learn the technique and for use in clinical trials evaluating the effectiveness of the therapy. However, well-trained therapists are skilled in tailoring the approach to the needs of individual clients, and most will also incorporate techniques from other therapy approaches as needed (see my example below of how to use motivational interviewing and CBT together!).

CBT only works with motivated clients.

Because it often includes exercises (homework!) done outside the therapy session, it’s commonly assumed that CBT is only effective with very motivated clients. There are a few reasons why this is not true. First, any therapist, regardless of their orientation, should be trained in how to engage clients through the careful use of language, matching their interpersonal style to that of the client, or by leveraging the rapport built in the therapeutic relationship.

Second, many therapists are trained in a range of therapeutic approaches and can combine approaches as necessary to meet the needs of their client. One approach I’ve found effective is blending techniques from Motivational Interviewing with CBT. It’s a relatively common approach (common enough for an entire book to be written about it!). The thing I like most about motivational interviewing is that it is a “meet your client where they are at” approach that is supportive, gentle, and non-judgmental.

Lastly, one nice feature of CBT is the notion that the therapist and client work on small, approachable goals throughout therapy. A client is not asked to take on more than feels manageable or reasonable, and they get to quickly see tangible results of their efforts. This is reinforcing and often strengthens motivation.

CBT is only supported for use with anxiety and depression.

Cognitive behavioral therapy was developed by Dr. Aaron Beck, who originally applied his theory to the treatment of depression. Since then, it has also become recognized as the gold standard for the treatment of anxiety. However, CBT is recognized as an effective therapy for a wide range of psychological disorders including schizophrenia, ADHD, and eating disorders. See this analysis by the American Psychological Association evaluating the evidence supporting the use of CBT for a variety of disorders.

I hope that you have found this blog post helpful today. If you are in the Austin area and contemplating starting psychotherapy, I am happy to speak with you on the phone to answer any questions you may have, including those about CBT. Please reach out to me at laura@drlaurawahlstrom.com or 512-521-1531.

3 Tips for Surviving the Holidays

The holidays are upon us! Social media, TV commercials, and Hallmark movies depict it as “the most wonderful time of the year.” While that may be true for many, for others it is a time filled with anxiety, loneliness, and bad memories. Regardless of if you are filled with holiday cheer or can’t wait for January 2, here are some tips that will make the holidays go a little smoother.

Watch your drinking.

Between the holiday parties and cold nights hunkered down at home, people tend to increase their alcohol consumption during the holidays. Not only does drinking (especially excessively) exacerbate depression and anxiety, it also makes it more likely you may embarrass yourself at the company party, get in a fight with Aunt Jean about politics at the dinner table, or skip that morning run that helps you feel energized and ready to tackle the day.

Keep up your healthy habits.

Let’s face it: between the constant supply of cookies at the office, cold weather, and hectic social schedule, healthy habits tend to fall by the wayside during the holidays. The best way to keep your mood stable is to practice moderation and continue with a healthy exercise, diet, and sleep regimen. Haven’t made these things a priority in 2018? No need to put off making a change until January 1 – now is the perfect time to create new healthy habits.

Say no.

When we overextend ourselves and don’t take the time we need to recharge, those holiday parties end up feeling like a chore. You know yourself – if two parties in a weekend is too much, choose the one that is more important to attend and send your regrets to the other. Or decide you are going to go to each for a set amount of time, say 1 hour.

In addition to social and work obligations, family get-togethers can be extremely stressful. If you find that you are emotionally depleted after a trip home for a few days, it may be best for you to limit your time with family. It is better to spend a few hours together and have it be pleasant than stay for several days and end up in an argument or leave feeling depressed.

If adhering to the above suggestions sounds difficult, or you feel too overwhelmed to make those changes on your own, it may be time to enlist help. Just like you don’t need to wait until January 1 to make lifestyle changes, you also do not need to wait until then to start psychotherapy. If you are in the Austin area, please reach out to me at laura@drlaurawahlstrom.com or 512-521-1531 to discuss your situation.

The Power of Breath

Not long ago I was watching the Today Show, and the topic was how to live a longer and healthier life. One of the segments was focused on deep breathing and how researchers believe may play a key role in slowing the aging process. Deep breathing, also known as diaphragmatic breathing (more on that shortly), is one of my go-to skills I teach my therapy clients. Why? It is highly effective, and can be used anywhere, at any time. And, now I may be able to add to that list it helps you live longer!

Our typical breathing tends to be shallow and happens in our chest. When we experience anxiety or stress, our breathing tends to become even more shallow and rapid, and can set off a downward spiral of physical symptoms, thoughts, and behaviors. Hyperventilation (i.e., an imbalance of our oxygen and carbon dioxide levels) may set in, which leads to feeling dizzy or lightheaded, which leads to thoughts that something is wrong with you, which leads to more rapid breathing, which leads to…

You get the idea, right?

One of the keys to stopping this cycle is to change your breathing. This is where diaphragmatic breathing (also known as deep breathing and belly breathing) comes into play. Instead of taking rapid, shallow breaths from your chest, you take slow, deep breaths from your belly. This encourages full oxygen exchange, slows your heartbeat, and lowers blood pressure. All of those scary physical symptoms that are signaling to you “something is wrong with me!” have been thwarted.

What if you don’t struggle with anxiety – can diaphragmatic breathing help you? Absolutely! For those who deal with day-to-day stress, have difficulties, winding down, difficulties sleeping, trouble “shutting your brain off” at the end of the day, diaphragmatic breathing can help you relax.

Diaphragmatic Breathing Instructions:

To start, find a quiet, comfortable place to sit or lie down. Place one hand on your belly, and begin taking a slow, deep breath in. You should feel your chest expand, and your belly rise. Then, slowly expel the air from your chest. Continue breathing this way, counting as you breathe in and out. Each person is unique, so the number of seconds for the in and out breaths do vary some. I usually start with “In… 2… 3… out… 2…. 3” with my clients and adjust from there. You do not want to breathe so deeply that you are feeling dizzy or lightheaded – that is specifically what we are trying to counteract! If you find that happens, breathe more shallow or take shorter in and out breaths.

It is most helpful, especially at the beginning, to have someone else (therapist, friend, spouse) count for you while you breathe. There is also a great app you can download called Breathe2Relax that will give instructions and guide you through diaphragmatic breathing exercises.

There are 2 things I think are crucial for diaphragmatic breathing to be effective:

Expectancies – Simply put, if you believe in the rationale and science behind diaphragmatic breathing, it is more likely to be effective. If you believe it is simplistic or silly, it probably won’t help you.

Practice – How likely do you think it is you would make the Olympic track and field team if you had only run one time in the last year? Just like athletes need to train to improve their physical fitness and skills, diaphragmatic breathing needs to be practiced to be effective. A good place to start is daily practice of 5-10 minutes,during a time you are not in the throws of anxiety or significant stress.

I’ve included some helpful links on diaphragmatic breathing below. If you are interested is learning more about anxiety management and relaxation, and live in the Austin area, please reach out to me at 512-521-1531 or laura@drlaurawahlstrom.com.

Mayo Clinic: Decrease Stress by Using Your Breath

Psychology Today: Diaphragmatic Breathing Exercises and Your Vagus Nerve