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At The Center for Stress and Anxiety Management, our psychologists have years of experience. Unlike many other providers, our clinicians truly specialize in the diagnosis and treatment of anxiety and related problems. Our mission is to apply only the most effective short-term psychological treatments supported by extensive scientific research. We are located in Rancho Bernardo, Carlsbad, and Mission Valley.

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Read our award-winning blogs for useful information and tips about anxiety, stress, and related disorders.

 

Filtering by Tag: anxiety therapy

How Do I Know If I Need Therapy?

Jill Stoddard

By Annabelle Parr

Each May we celebrate Mental Health Awareness Month to draw attention to and reduce stigma around mental health issues. According to the National Alliance on Mental Illness, or NAMI, 1 in 5 people will be affected by mental illness in their lifetime. And as we discussed last May during #CureStigma, “while 1 in 5 Americans are affected by a mental health condition, 5 in 5 Americans know what it is to feel pain. The frequency, intensity, and duration can vary, but pain itself is a function of being human. When culture stigmatizes the 1 in 5 and simultaneously dichotomizes illness and wellness, the resulting message is that it is shameful to struggle and to feel pain. In essence, stigma says that it is shameful to admit our own humanity.”

Do I need therapy?

Given that all of us will at some point encounter painful experiences and emotions, this year we are discussing how to know when it might be helpful to seek therapy. Though it may be clear that those affected by a previously diagnosed mental health condition could benefit from therapy, for those who are either undiagnosed or are struggling with anxiety, stress, grief, sadness, etc. but do not meet diagnostic criteria for a mental health disorder, it may be harder to discern whether therapy is warranted.

How am I functioning in the important areas of my life?

For nearly every condition in the Diagnostic and Statistical Manual (DSM-V; APA, 2013), clinically significant impairment in an important area of functioning is a required criterion to receive a diagnosis. In other words, the presenting symptoms must be making it very difficult to function at work or school, in relationships, or in another important life domain (e.g., a person is feeling so anxious that she is not able to make important presentations at work, or so stressed that he is finding it difficult to connect with his loved ones).  When life has begun to feel unmanageable in some capacity, or if something that was once easy or mildly distressing has become so distressing it feels impossible, it may be worth considering therapy.

Could things be better?

It’s also important to note that you do not have to feel as though things are falling apart before you seek professional counseling. Therapy can be helpful in a wide range of situations. It can help you not only navigate major challenges or emotionally painful periods, but also can enhance your overall wellbeing by helping you to identify your values and lean into them. Maybe things are going fine, but could be better. A therapist can help you identify what could be going better and can help you learn to fine tune the necessary skills.

I want to try therapy, but where do I start?

Whether things feel totally unmanageable or it just feels like they could be better, it’s important to find a therapist with expertise relevant to what you would like assistance with. Working with children requires different expertise to working with adults, just as working with couples and families requires additional expertise to working with individuals. Different conditions also correspond with particular evidence based practices. For stress and anxiety disorders – including social anxiety, generalized anxiety, panic disorder or panic attacks, and phobias – evidence based practices include Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT). The gold standard of treatment for obsessive compulsive disorder (OCD) is Exposure and Response Prevention (ERP), and evidence based treatments for PTSD include Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) (all of these—ERP, PE, and CPT --fall under the CBT umbrella). So no matter what you are seeking treatment for, ensuring that the therapist you choose has expertise that aligns with the types of concerns you are struggling with is critical. For some more tips on finding and choosing a therapist, click here and here. For more information on the different kinds of licenses a therapist may have, click here.  

Though there is no right or wrong answer as to whether or not you need therapy, if you are unable to behave in ways that make life manageable and/or fulfilling because of difficult thoughts or feelings, you may find therapy beneficial.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, or insomnia, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

When You Stress About Stress You’re Stressed

Jill Stoddard

Image source: https://www.amazon.com/Stressed-Desserts-Spelled-Backwards-Poster/dp/B017C9AZUQ

Image source: https://www.amazon.com/Stressed-Desserts-Spelled-Backwards-Poster/dp/B017C9AZUQ

What is your go-to when you feel stressed out?  Do you like a few glasses of wine, an hours long vent session, or a creative excuse to get out of a social engagement?  These are all examples of experiential avoidance—an unwillingness to experience uncomfortable internal emotions or sensations and active efforts to change, reduce, or eliminate them (Forsyth and Eifert 1996).  Does experiential avoidance work to alleviate feelings of stress?  Yep.  It works or we wouldn’t do it.  But how long does that last?  Look at your personal experience and take inventory:

1.     what do you do or not do when you feel stressed?

2.     what does it get you (i.e., what discomfort does it relieve)?

3.     what is its cost?    

When our reactions to stress result in only temporary relief but come at a cost to our health, our relationships, or other areas of importance, it’s time to reevaluate our relationship to stress. 

Think of it this way (Stoddard, 2019):  Imagine I have you in a little booth suspended above a barracuda tank.  I tell you, “Whatever you do, don’t get stressed and you will be fine.  Unfortunately, if you do feel stressed, the floor of the booth will open, dropping you into the barracuda tank.  But just don’t get stressed and you will be totally fine!” 

What do you think is going to happen?  Right—you’re stressed…and fish food.  Is it because you just didn’t try hard enough to control your stress?  Was the incentive not quite high enough?  Of course not—our most primitive instinct is to survive.  So why did you get stressed and end up swimming with the fishes?  Because when you are unwilling to experience stress, you are stressed about stress so you are stressed (Hayes, Strosahl, and Wilson 1999).  See the trap?  Your relationship to stress becomes one in which you evaluate it as bad, dangerous, and deadly. 

So, of course, you are stressed about having stress. 

So what should you do the next time you hear on Good Morning America or in the Huffington Post “Stress is bad for you!  Stress will kill you!  You shouldn’t get stressed!”  It turns out, stress has been wrongfully getting a bad rap (McGonigal 2013).  While stress does release adrenaline (the hormone thought to be harmful to the body), it also releases oxytocin, the bonding hormone that enhances empathy and motivates us to seek and give care.  Oxytocin is a natural anti-inflammatory—it’s good for our bodies and actually strengthens our hearts.  And, fascinatingly, all we have to do to mitigate the negative effects of adrenaline is simply appraise stress as helpful.

Come again?  Stress, helpful?  YES--stress can motivating!  Stress is what prompts you to prepare for the important job interview, watch over your small children in a crowded place, and get ready for the big game.  If you were totally chill, you’d likely bomb the interview, lose your kid at the mall, and blow the game.  As it turns out, there is an optimal arousal zone when it comes to doing well (Yerkes and Dodson 1908):  when stress is very high or very low, it has the potential to negatively impact performance.  But a moderate level of arousal is helpful. 

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The best way to manage stress is simply to change your relationship to it.  So stop struggling to avoid and reduce your stress (how’s that working for you, anyway?), and instead work on accepting that to be human is to know stress, and stress need not be our enemy.  You can do that by remembering:

1.     stress is motivating and can improve performance at moderate levels

2.     stress prompts us to seek connection with others and this is good for our health

3.     stress is only damaging when we evaluate it as damaging

4.     when we are stressed about stress we are stressed

Now, don’t get me wrong—I’m not suggesting you give up your meditation practice because it makes you feel less stressed.  There is nothing wrong with getting your bliss on—as long as your strategies don’t come at the cost of other meaningful and important pursuits.  So go ahead and yoga-it-up—just don’t neglect your friends and family while you’re at it.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References

Forsyth, J. P., and G. H. Eifert. 1996. “The Language of Feeling and the Feeling of Anxiety: Contributions of the Behaviorisms Toward Understanding the Function-Altering Effects of Language.” The Psychological Record 46: 607–649.

Hayes, S., K. Strosahl, and K. Wilson. 1999. Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: The Guilford Press.

McGonigal, K. 2013. “How to Make Stress Your Friend.” Filmed June 2013 in Edinburgh, Scotland, video, 13:21, https://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend/transcript

Stoddard, J. 2019. Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry, and Stress Using Mindfulness and Acceptance. Oakland: New Harbinger Publications.

Yerkes, R. M., and J. D. Dodson. 1908. “The Relation of Strength of Stimulus to Rapidity of Habit-Formation.” Journal of Comparative Neurology and Psychology 18: 459­–482.

#CureStigma

Jill Stoddard

by Annabelle Parr

This year for Mental Health Awareness Month, NAMI (National Alliance on Mental Illness) is focusing on curing mental health stigma. The campaign manifesto on the NAMI website reads:

There’s a virus spreading across America. It harms the 1 in 5 Americans affected by mental health conditions. It shames them into silence. It prevents them from seeking help. And in some cases, it takes lives. What virus are we talking about? It’s stigma. Stigma against people with mental health conditions. But there’s good news. Stigma is 100% curable. Compassion, empathy and understanding are the antidote (NAMI, 2018).

Stigma is a nasty virus, but this manifesto fails to capture the fact that stigma doesn’t just hurt the 1 in 5 who are struggling with diagnosable mental health conditions. It hurts every single one of us.

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Mental health exists on a continuum. When we create a false dichotomy that suggests that some people are mentally ill while everyone else is healthy and well, we fail to recognize the range of experience that falls somewhere in the middle. And we fail to recognize that where you stand on the continuum can fluctuate and change throughout life.

The continuum enters the realm of DSM diagnosis when a person displays a clinically significant level of functional impairment. In other words, to qualify for a diagnosis, the person must be unable to function in an important area of life as a result of the presenting symptoms. But there are plenty of people who are functioning seemingly well in relationships, work, school, etc., who appear just fine from the outside, yet inside they are hurting and need some help. These folks aren’t feeling “well,” but they don’t necessarily meet the criteria for a mental health diagnosis.

The thing is, while 1 in 5 Americans are affected by a mental health condition, 5 in 5 Americans know what it is to feel pain. The frequency, intensity, and duration can vary, but pain itself is a function of being human. When culture stigmatizes the 1 in 5 and simultaneously dichotomizes illness and wellness, the resulting message is that it is shameful to struggle and to feel pain. In essence, stigma says that it is shameful to admit our own humanity.

With stigma, we all become isolated in our suffering. But with compassion (which means to suffer with), we can find connection in the midst of and even as a result of pain through our experience of common humanity. We all know loss, grief, heartbreak, anger, anxiety, sadness, regret, inadequacy, and disappointment. We all have our own version of the “I’m not good enough” story. What if, instead of burying these feelings deep in our shame vaults, instead we shared them? Stigma wouldn’t be able to survive.

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Just because pain is a part of being human, that doesn’t mean a professional can’t help us navigate the more difficult aspects of existence. Despite what stigma says, seeking therapy in the midst of struggle is a sign of strength and wisdom. Therapy can benefit anyone, no matter where the person falls on the continuum of mental health. In fact, even therapists benefit from therapy. A few of the CSAM clinicians decided to share a little bit of their own experiences as clients in therapy.

Dr. Jill Stoddard, CSAM Director, said:

I like to think of my mental health a lot like I think of my physical health--they both need ongoing attention and care to stay at their best.  When I get a small cough or cold, I might just manage it on my own with my neti pot and some Vics Vapo-Rub. But if I have strep throat or a broken bone, I'm going to seek out professional help and continue to follow up with my physician until I'm well.  Even when things are stable and there are no overt signs of trouble, I still see my dentist, optometrist, and dermatologist for regular check-ups.  So goes my mental health.  Life can get really painful.  If I'm dealing with smaller hassles, I might go to yoga or seek support from my friends or family.  But when my mom died, I went to therapy to help process my grief.  When my husband and I were feeling the distance that often comes with raising a young family while also working, we sought out couples’ therapy.  Now, our marriage is stronger than ever, AND we still see our therapist for sporadic "check ups."

Dr. Michelle Lopez, CSAM Assistant Director, wrote:

I think about mental health care as a lot like car care. If my car is having problems, it may need to be in the shop for a while. Other times, it might just need a quick tune up. It might also take me some time to find the right mechanic, and I might have to try a few out before I find the right one. But it’s important to pay attention to signs that the car needs service, because neglecting it is likely to lead to more problems. I’ve participated in therapy at various points in my life, and have sought help to work through life experiences and challenges such as coping with the physical and emotional pain of a physical injury, processing the loss of my dad, living with infertility, and creating a healthy work-life balance. Currently, my car is functioning quite well, but I make sure to take notice when that “check engine” light comes on. 

Dr. Janina Scarlet, CSAM psychologist and founder of Superhero Therapy, shared:

When my dear friend lost her battle with cancer, I was devastated. I couldn't sleep, I couldn't concentrate on my school work, and I found myself too overwhelmed to function. I decided to see a grief counselor. I had never been in counseling before and didn't know what to expect. My therapist was warm, compassionate, and understanding. She helped me process my grief and find meaning in this loss. I am extremely grateful for this experience as it allowed me to find myself again. 

Hopefully, in acknowledging the full range of human experience and removing the false dichotomy that currently separates us into We-Who-Are-Healthy and They-Who-Have-Pathology, we will begin to fill the space that is currently occupied by stigma with acceptance and compassion, both for ourselves and others.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References:

NAMI, 2018. Mental health month. Retrieved from: https://www.nami.org/mentalhealthmonth

Five Ways Parents Can Help Children with Political Anxiety

Jill Stoddard

Guest Post by Tracy Dunne-Derrell, writer at Teach.com

One hundred years from now, America in 2017 will exist only in history books. Those future writers will have plenty of material to work with: mass shootings, terrorism fears, international turmoil, and “fake news.” But those facts probably won’t capture the anxiety that’s been generated by these events. A poll conducted earlier this year by the American Psychological Association found more than half of American adults cited the current political climate as a source of stress.  

Children are feeling anxious too. A recent UCLA survey found that 51% of teachers reported more anxiety among their students. As a parent, the past year may have presented you with unique challenges as your children grappled with a range of emotions- from general anxiety to personal stress over the impact potential policies could have on them and their friends. You may have a child who’s finding that current events are causing anxiety, and are struggling to figure out how to best provide support.

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As an adult, you might be experiencing negative feelings too, but you have the advantage of being able to channel them productively by contacting elected officials and engaging in activism and service. And you’re more likely to have developed meaningful ways to help yourself get through uncertain, difficult times. But your children might not be able to grasp the concepts that are troubling and confusing to them, and they may lack the skills they need to identify and cope with their feelings. Here are some ways to help them.

1. Listen, but accept that you might not always have good answers. 

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As a parent, you may be tempted to help by dismissing and downplaying the concerns and worries of your anxious child. But this approach, while well-intentioned, isn’t helpful. Validating kids’ concerns and making sure they understand that it’s ok to feel what they’re feeling is important.  And unfortunately, you can’t magically erase the sources of stress for them. But you can be a sympathetic ear, and make a point to spend a little time each day talking to them about their concerns. Help them develop coping skills, which won’t eliminate the sources of negative feelings, but will help them learn to work through them. The ability to cope with challenging times is a necessary life skill.

2. Help them take action.

With so much beyond their control, your kids may find themselves feeling powerless. They might want to do something to distract them from their fears and help them feel like they’re contributing to the world in a positive way. Some adults are channeling their concerns into helping others, and there are ways children can do the same. Talk with them about some of the needs they observe in your community, and help them think of ways to address them. Young children can choose items from the grocery store to donate to a local food pantry, while older ones can join service-oriented local organizations, or look for a project to support, like a winter coat drive. Even small actions help students feel like they matter, and lead to a life-long involvement with community service.

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3. Connect with the school counselor.

Kids spend a substantial amount of time in school, and their counselors are a valuable resource. School counselors are already trained to help students learn to manage a wide range of situations and challenges. And they’ve got ample materials to help them work with students who are living with political anxiety. Last year the American School Counselor Association published a guide for counselors, with suggestions for supporting children experiencing post-election stress. Sitting down with a school counselor could be a great opportunity for your child to share his or her fears with a trained professional. Ask for ideas and strategies to use at home to talk about current events, and the feelings these events generate.

4. Examine the impact of technology.

News and social media might play a role in fostering negative feelings. Escaping bad news used to be as easy as turning off the television and radio. Now, with 24-hour cable channels, mobile apps, and social media, it’s almost impossible to get a break from current events. Consider the role screen time with televisions and gadgets may be playing in your child’s politics-related stress. Evaluate the amount of time your child spends watching and reading news, and discuss alternative activities which may help them manage their stress.

5. Talk about previous times our country experienced turmoil and got through it.

It feels like we’re going through unprecedented uncertainty, but America has faced crisis before, more than once. Our country has survived wars, recessions, and natural disasters. Your children likely have some awareness of challenging times in our history, but events of long ago probably feel abstract to them; they may not be able to connect past and present. Depending on your age, you may have your own personal stories to share which might resonate with your anxious children and help them feel more optimistic. For example, during the 1970s, Watergate dominated the news, and led to concerns about government. In the 1980s, the Cold War between the United States and the former Soviet Union generated fears as both countries and their allies engaged in an arms race, generating legitimate concerns over the possibility of nuclear war. Share your stories and take this opportunity to talk with your kids about America’s resilience.

Providing support for anxious kids is challenging, but it is possible. As a parent, you know your child better than anyone, and are the best person to help them manage stress and anxiety. However, if you need some outside support to help your child, you can check your child’s school for resources, and reach out to outside resources, like local therapists, as well.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

Anxiety Tools: An Expert's Advice

Jill Stoddard

reposted from Healthline.com

originally written by Healthline Editorial Team featuring an interview with CSAM Director Dr. Jill Stoddard

Anxiety disorders affect over 18 percent of U.S. adults each year, according to the National Institute of Mental Health. This includes generalized anxiety disorderobsessive compulsive disorderpost-traumatic stress disorder, and more.

Anxiety can work its way into many aspects of a person’s life, which is why it’s so important to find the resources, support, and advice you need — whether it comes from people’s stories, helpful phone apps, or expert advice.

Dr. Jill Stoddard is the founding director of The Center for Stress & Anxiety Management, an outpatient clinic in San Diego specializing in cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for anxiety and related issues. She’s also an associate professor of psychology at Alliant International University, and the co-author of “The Big Book of ACT Metaphors.”

We caught up with her to learn about some of the ways she recommends for managing anxiety disorders.

Dr. Jill Stoddard’s advice for anxiety

1. Use your senses

Anxiety narrows your focus onto perceived threats (i.e., whatever you’re feeling afraid of or worried about in the moment) which can impact your focus and memory. Practice mindfully broadening your view by using your senses — what do you see, hear, smell, etc. — to improve attention and experience.

2. Have gratitude

Practice gratitude as another way to broaden your focus. There are the things that you worry about, and there are also the things you’re grateful for.

3. Be accepting

Difficulty with uncertainty and a lack of perceived control amplify anxiety. To “fix” this, we often attempt to get more certainty and more control — for example, by doing internet searches about health symptoms. This actually increases anxiety in the long run.

The antidote is acceptance of uncertainty and control. You can read a book or watch a sporting event without knowing the ending. In fact, it’s the anticipation that makes it exciting! So try bringing this attitude of openness to not knowing, and letting go of control. See what happens.

4. Face your fears

Avoidance is anything you do, or don’t do, to feel less anxious and prevent a feared outcome from occurring. For example, avoiding a social situation, using drugs or alcohol, or procrastination are all examples of avoidance.

When you avoid what you’re afraid of, you get short-term relief. However, this relief never lasts, and before you know it, that anxiety has returned, often with feelings of sadness or shame for having avoided it. And often, the exact avoidance strategies you’re using to feel better and prevent a feared outcome (e.g. reading off your notes during a speech or avoiding eye contact) actually create the outcome you’re trying to avoid (namely, appearing anxious or incompetent).

Consider taking small steps to start facing your fears. What’s one thing you might do that takes you out of your comfort zone? You will build mastery and confidence, and your anxiety might even diminish in the process.

5. Define your values

Do some soul searching about what really matters to you. Who do you want to be? What do you want to stand for? What qualities do you wish to embody as you engage in work or school, or interact with people you care about? If friendship matters, how can you create space in your life for that? When you do so, what qualities do you wish to embody as you spend time with friends? Do you wish to be authentic? Compassionate? Assertive?

These are all values, and making choices in line with values — rather than in the service of avoidance — may or may not impact your anxiety, but will definitely add richness, vitality, and meaning to your life.

Healthline’s tips

To help you keep your anxiety in check, Healthline also recommends trying out the following products in your day to day: