A Simple, Yet Not-Always-Easy, Solution to Reducing Depression and Anxiety

Summer is right around the corner, which can be a stressful time for many. Maybe you have kids who will be out of school, which means your home will be noisier and days will be busier. Maybe you have a busy social calendar filled with trips, weddings, and barbecues. Maybe you are dreading the triple-digit Texas temperatures and having to spend more time inside.

During times of stress, healthy habits tend to fall to the wayside. Same is true if we find ourselves increasingly struggling with depression or anxiety. We do things that we think are helping us (i.e., sleeping more, eating more high carb/fat foods, drinking alcohol), and do less of things that actually help us.

Exercise is a powerful, but often overlooked, tool in managing these issues. Research indicates that an exercise regimen is as effective at treating depression as anti-depressant medication. Even better? The effects are immediate – most people feel the mood-boosting effects about 5 minutes after completing their exercise.

The mechanisms whereby exercise improves your mood is two-fold. When you exercise, physiological changes occur in your body that have a direct impact on your mood. Endorphins (natural painkillers) and serotonin (a neurotransmitter that plays a key role in happiness and wellbeing), increase, and stress hormones (cortisol and adrenaline) decrease. Exercise also contributes to improved sleep, which we know plays a key role in both depression and anxiety.

Psychologically, exercise contributes to a feeling of accomplishment (“yay! I did something today besides watch Netflix!”), increases self-efficacy (“when I feel bad I can do something to change it!”), improves healthy coping skills (“wow, a quick run makes me feel a lot better than a couple glasses of wine!”). For those that suffer from anxiety, which is usually marked by a lot of physical symptoms, exercise induces a lot of the feared physical symptoms (heart racing, sweating). The repeated experiencing of these physical symptoms helps you to become less afraid of them and attach new, more helpful, meaning to them.

However, exercise is simple in terms of concept, but not always easy to execute. To overcome this, I have a few suggestions. First, keep in mind the law of inertia. It is far more difficult to get something moving than it is to keep it moving. Try to get started on your new exercise regimen on a day and time that you are feeling most motivated or energized, for example, on Saturday morning after a cup of coffee. From there, set reasonable goals and be consistent. You are not going to be able to run at the same pace you did as a high schooler in cross country if you haven’t gone out for a run in years. Any exercise is progress and movement in the right direction! Also, keep in mind you are not always going to feel like exercising. And, the good news is, you don’t have to in order to do it! Keep a journal and write down the positive effects you feel after you exercise, and revisit those entries when you need some extra motivation. Lastly, be kind to yourself and expect that it isn’t going to go perfectly. You may miss a workout, or fall back into old habits. Acknowledge that this has happened, and resume your routine.

If you live in the Austin area and feel like you would benefit from support and guidance on managing depression or anxiety, please reach out to me via telephone at 512-521-1531 or email me at laura@drlaurawahlstrom.com to discuss your situation and see if I may be a good fit to help.

Moving On After a Relationship Ends

Your boyfriend or girlfriend has just dumped you. Initially, you feel numb and in disbelief that the relationship is over. As more time passes, you cycle amongst sadness, anger, and feeling okay. Despite the relationship being over, you continue to follow them on social media. On the one hand, it relieves the anxiety of wondering what they are up to, but you also recognize that it is keeping you from moving forward.

Does any of this sound familiar? Moving forward after the end of a relationship can be a long, painful, and frustrating process. In my blog post today, I will discuss the treatment approach I use when working with folks who are having difficulty moving on after a breakup, and provide some practical tips for how to cope.

When working with individuals looking to heal after the end of a relationship, I have found Acceptance and Commitment Therapy (ACT) to be highly effective. The ACT approach centers on the notion that pain and suffering are an unavoidable part of human existence, and in spite of that we can cultivate a rich, meaningful life. Rather than identifying and changing your thoughts (as is the focus of cognitive therapy), ACT teaches you how to create “space” for your thoughts. This allows you do better evaluate what thoughts are helpful versus unhelpful, and have unhelpful thoughts have less of an impact on you. Having that space also allows you to do more of things that are important to you.

How can this help when going through a breakup? In the early stages after a breakup, and often times for a while after, your thoughts are consumed by that person. How are they feeling? Are they struggling too? Have they moved on? If it has been a long time since the breakup, we may feel shame or frustration for continuing to think about that person and try to push those thoughts out of our mind. However, this doesn’t work! Let’s say for example, I tell you not to think about a pink elephant. Think about anything except a pink elephant. What are you thinking about? A pink elephant! Because the act of trying to push something out of our mind involves thinking about that very thing.

Instead, try allowing that thought or image to be there, but in a different way. In ACT, we learn skills called defusion and mindfulness. Oftentimes we are so “fused” with our thoughts we believe we are one with them, that they are fact, or that we need to act on them. Not the case. Our minds generate something like 50,000 – 70,000 thoughts per day – isn’t that incredible? And imagine if we acted on every thought our mind generated. That would be pretty bad, right?

Instead, we learn to be aware of our thoughts, but not get “hooked on them.” We let go of the judgments about what it means we are having these thoughts, and judgements about the thoughts themselves. We notice that the thoughts are there, and this what our mind does – generates thoughts. And then, we allow them to pass.

Below are some ways to practice defusion:

  1. Put “I am having the thought that” in front of any self-statements.
  2. Imagine your thoughts typed out on a computer screen, and then imagine yourself changing the font and colors.
  3. Repeat a word in which you tend to use when judging yourself harshly over and over aloud until the word becomes meaningless.

Below are some ways to practice mindfulness:

  1. Imagine yourself sitting by a stream. Imagine your thoughts on a leaf in the stream, and allow them to float away.
  2. Imagine yourself sitting on the beach. Imagine your thoughts written in the sand, and watch the tide wash the writing away.
  3. Imagine yourself lying on a blanket in a field on a warm day. Imagine your thoughts on clouds, and allow the clouds to float away.

At this point you may be thinking, okay, so I am working to allow my thoughts to be there, but is that it? No, that’s not it! When we are feeling sad or anxious, our tendency is to withdraw and not let other see us that way – to hunker down at home, in front of the television watching Netflix, eating a bowl of ice cream. Those behaviors seem like they help us to cope, when actually they maintain depression and anxiety.

So, go against what your mind is telling you to do (defusion!) and get active! And don’t just get active, get active doing things that matter to you. A relationship (and subsequent breakup) can sometimes take you away from things that you value. Is health something that is important to you? Join a bootcamp or running club, or sign up for a cooking class. Is family important? Schedule lunch with a family member or, if they are far away, book a trip to see them. As I see it, you have two choices. You can feel sad or anxious and do nothing, or you can feel sad and anxious and be doing something that may improve your situation. Just because you don’t feel like doing something, doesn’t mean you can’t do it (again, defusion!).

If you are struggling with the end of a relationship and live in the Austin area, please give me a call at 512-521-1531 or email me at laura@drlaurawahlstrom.com to discuss your situation and see if I may be able to help. Below I have also included links to some ACT resources if you found my suggestions helpful and would like to learn more about it.

The Happiness Trap

Get Out of Your Mind and Into Your Life

*Note: Defusion and mindfulness strategies are taken from ACT Made Simple by Russ Harris, PhD

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.