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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.

 

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HOW TO SLEEP BETTER WITHOUT SPENDING ANY $$$ ON SLEEP MEDICATION

Jill Stoddard

a guest blog repost by Alisa Palioni

Do you often find yourself lying awake at night, staring at your alarm clock as it ticks away the time? Or, do you wake regularly during the night, leaving you feeling as if you haven’t slept at all?

According to the National Sleep Foundation, nearly half the population reports suffering from at least one symptom of insomnia (difficulty falling asleep, frequent nighttime awakenings, waking up too early, and waking up feeling unrested).

Many of your daily habits likely play a bigger role in your nightly struggles than you think. Both our ability to fall asleep, and the quality of sleep we have are highly dependent on a variety of external and internal stimuli.

Learning about how each activity impacts your sleep patterns can help you make changes and finally get a good night’s rest.

1. Exercise

Why An Exercise Routine Helps Regulate Sleep

Body heat: Part of the natural changes our circadian rhythm brings about over the day are changes in body temperature.

The rise and fall of our body temperature associated with exercise mimics the natural fluctuations which lead up to sleep.

This can be enough to gently nudge your circadian rhythms back into ideal synchronization if exercise is performed at the right time of day. 1

Beneficial stressor: Exercise is a “beneficial stressor” in that it activates sympathetic nervous system (our flight-or-fight response). Your body compensates by increasing the time spent in deep sleep - leaving you feeling more rested. 

Decrease stress, anxiety and depression: Many of us experience difficulty falling asleep due to ruminating thoughts related to real or perceived stress.

Exercise has been scientifically proven to reduce reactivity to stressors, so that we are better able to manage stressful situations when they come our way.

It has likewise proven itself to be effective in reducing the symptoms of anxiety and depression. 2

What Kind Of Exercise Should I Do?

When it comes to improving your quality of sleep, aerobic exercise wins. Numerous studies have documented the efficacy of regular aerobic exercise programs for treating chronic insomnia. 

Aerobic exercises (“with oxygen”) include any that involve sustained activity which requires the body to consume large amounts of oxygen, such as walking, swimming and biking.

Whereas, weight training and sprinting are anaerobic exercises. While an important component of a healthy lifestyle, these activities are not effective for promoting sleep. 3

What Time Of Day Should I Exercise?

While fitting in exercise whenever feasible for your lifestyle can go a long way towards improving your sleep, studies have shown that exercising in the late afternoon or early evening has the greatest impact.

The reason for this relates back to how exercise promotes better sleep: In order to take advantage of the drop in body temperature you’ll want to complete your workout approximately 3-5 hours before bedtime.

How Long Should I Exercise?

While exercising for 15-45 minutes daily is the optimal duration; however studies have shown that 150 mins/week is sufficient to see improvements in quality of sleep up to 60%.

2. Diet

Your diet impacts your sleep through more means than just providing calories: What we eat and when we eat it can enhance or inhibit our sleep.

Foods That Inhibit Sleep

While some foods are well known for their ability to interfere with sleep, other dietary staples are equally responsible for keeping you up at night.

1. Coffee: Caffeine has a half-life of 5 hours: which means that 10 hours after drinking your coffee, 25% left in your system; and 20 hours later 12.5% of the caffeine still remains.10

So, while an early afternoon coffee as a post-lunch pick-me-up may seem like a good idea, it might be what is keeping you up at night.

2. Alcohol: Alcohol is a little more tricky in how it affects sleep; because it causes drowsiness many mistakenly believe that a drink can serve as a sleep-aid.

However, research has shown that while alcohol increases slow-wave sleep during the first half of the night, it actually leads to an increase in sleep disruptions during the second half. 4

3. Chocolate: Chocolate, particularly dark chocolate, can contain high levels of caffeine and thus needs to be treated similarly to coffee and other caffeinated beverages. 

In general try to avoid any kind of sweets in the evening though since it will not only improve your sleep but your overall health as well.

4. Spicy Foods: Capsaicin - the molecule which gives your spicy foods that kick - can causes changes in body temperature that can cause a disturbance in your circadian rhythms if consumed late at night.

5. High-Fat Foods: We all know that certain unhealthy fats negatively impact our health; but there’s also evidence that they may be keeping you up at night.

Animal studies have shown that high-fat diets are associated with more fragmented sleep, along with excessive daytime sleepiness.

Researchers speculate that this may be linked to the neuro-chemical orexin -- which plays an integral role in our sleep-wake cycles. Rats who were fed high-fat diets showed a decrease in orexin-sensitivity. 5

Foods That Promote Sleep

There are many foods that are lauded for their ability to promote a better, more restful sleep. These are the key components you want to be on the lookout for when planning your bedtime snack:

1. Magnesium and potassium: One of the symptoms of magnesium deficiency is insomnia, so you’ll want to load up on healthy sources of this mineral such as leafy greens, beans and lentils, and bananas. 6

Magnesium and potassium promote muscle relaxation, and thus not only help you feel more comfortable but can help deal with nighttime leg cramps.

2. Tryptophan: Tryptophan is an amino-acid found in both animal and plant proteins. Our bodies use tryptophan to create serotonin -- a neurotransmitter involved in both mood regulation and sleep cycles.15

Many foods are great natural sources of tryptophan, such as milk, bananas, peanut butter and walnuts.

3. B Vitamins: B vitamins are essential for both the synthesis and release of certain neurotransmitters and hormones that are part of the sleep-wake cycle: such as serotonin and melatonin.

Supplements are often prescribed to treat restless-leg-syndrome - a nighttime movement disorder which significantly disrupts sleep.

However, there’s no need to take a supplement. You can get your fill from legumes (chick peas), dark green vegetables, whole grains and fish. 7

4. Theanine: Theanine is yet another useful amino acid when it comes to treating sleep disorders. Research has shown that administering a theanine supplement improves sleep quality and increases sleep efficiency, while decreasing nighttime awakenings.

There is one superfood packed with theanine: Green tea. However, while green tea has significantly less caffeine than a cup of joe, it is recommended to opt for the decaffeinated kind if your goal is a good night’s sleep. 8

5. Melatonin: Melatonin is naturally produced by your pineal gland under direction of your circadian rhythms and is what makes us feel sleepy as we near bedtime.

It usually begins to release around 9 p.m. and remains at a high level for the next 12 hours, throughout the night into the next morning.

While there are certain foods that contain melatonin, you can also purchase this essential sleep-inducing hormone in capsules at your local pharmacy or health food store.

Taken at the right time of day, and in the right dosage, melatonin supplements can help reset your biological clock to optimal levels and is often used as a natural treatment for sleep disorders.19

However, you don’t need to take supplements: simply add tart fruits, like cherries and pineapples, to your diet. Oats, walnuts and bananas are likewise great natural sources of melatonin.

Here are some more foods that will help you to sleep better.

via    Well+Good

Timing Your Meals

It’s not just what you eat, when you eat also counts.

Research at Yale’s School of Medicine has revealed just how vital the timing of our meals is to maintaining optimal circadian rhythms.

For instance, when we wake in the morning and our central clock is being stimulated by the light of day, but we decide to skip breakfast we have just given our body conflicting information that can in turn disrupt our circadian rhythms. 9

The main takeaway from this study and similar research is that you should not be eating close to your intended bedtime; but the recommendations for how long before bed you should refrain from eating vary: some saying not to eat after 7 pm, while others suggest 5 hours before lights-out and still others indicate a minimum of 12 hours before you eat breakfast. 

It’s also recommended to reserve large meals for the first half of your day, and consuming lighter snacks in the evening.

3. Environment

Mattress & Pillows

When it comes to choosing a mattress and pillows, there’s no universal rule for everyone to follow. Whether you should opt for firm or soft, memory foam or pocket coil all depends on your personal preferences, particularly the position you sleep in.

Back SleepersSleeping on your back is often the sleep position recommended by doctors, since it allows the body to lay relatively straight.

However, that does not mean there is no pressure being put on your spine as you sleep.

You should have a mattress which is both able to support the spine -- and not allow the exaggeration of any curves -- but is also plush enough to not cause painful compression.

  • Opt for a medium to firm mattress
  • Memory foam is more ideal since conforms to natural curves while maintaining support
  • May substitute for a pocket coil with pillow top.

Side Sleepers: Sleeping on your side has its own benefits: It can help reduce acid reflux, reduces the pressure on the lungs, and promotes better blood circulation.

The main complaints of side-sleepers are achiness in the shoulder and hip area. The way to circumvent this is to ensure your mattress adequately cradles these parts.

  • Medium to soft mattress
  • Memory foam is ideal for reducing number of pressure points

Front Sleepers: Sleeping on your front is by far the worst for your health: Not only does it put pressure on your stomach, but the spine is the least supported in this position.

While it is recommended you switch sleeping positions, there are certain considerations when choosing a mattress that can help alleviate some of the negative side-effects.

Opt for a firmer mattressPocket-coil mattresses are a big no-no, as the entire front side of your body is exposed to the pressure points and they will not support your spine.

Bed Sharing

There’s no doubt that sharing beds can add to your difficulty getting a good night’s sleep.

It’s unlikely that both people with have identical wants and needs when it comes to their sleep position and mattress preferences; and when one partner is uncomfortable their tossing and turning can quickly cause problems for the other.

Upsize to a Queen: A Full-sized bed will leave you and your partner with only 27 inches of space -- which amounts to the size of a baby’s crib.

Opt for memory foam, or ditch your box spring: While memory foam is the optimal choice for reducing the transfer for movements, replacing your box spring with slats can serve as a quick fix.

Invest in a mattress designed for couples: The Sleep Number mattress let’s you and your partner select your ideal level of firmness, comfort and support so you don’t have to compromise.23

Colors

Research has shown that people who sleep in blue rooms tend to sleep longer than when compared to other colors. Blue toned walls can serve as yet another signal telling your brain it’s time to sleep.24

It’s important that your bedroom makes you feel comfortable and relaxed. It’s less important to follow a strict guide than to follow your own intuition.

Light

Light is one of the most powerful cues for your body’s internal clock, it’s thus important to ensure that you are exposing yourself to light and dark during the optimal times.

Try to keep your bedroom as dark as possible while you sleep by using black-out curtains.

However, lighting is not just important when you are sleeping. It’s recommended to dim the lights one hour before heading to bed to cue your brain it’s time for sleep.

For this reason it’s also best not to stare at bright screens (TVs, computers, and smartphones) during this time period, although many phones do offer a “night-mode” setting that can help.

In fact, the blue light -- in the 460-nanometer range -- emitted by electronics and energy-efficient lightbulbs has been shown to delay the release of melatonin.25

Temperature

Generally speaking, the optimal temperature for sleep is between 60-70 degrees Fahrenheit (15.5-19 degrees Celsius).

This, yet again, links back to the natural changes that occur as part of your circadian rhythms: your body temperature drops during the night, and thus maintaining a cooler room will help maintain this.

Setting your thermostat far below or above this ideal point can make it more difficult to fall asleep, lead restlessness and even affect the time you spend in REM sleep.26

The material of your mattress, pillows, bed linens and pajamas can significantly impact your temperature while sleeping. Look for fabrics that are breathable and won’t trap heat such as cotton; likewise choose pillows made of natural materials over synthetic.

As for mattresses, memory foam is the best option when it comes to temperature control.

Noise

Your brain continues to register noises while you sleep, which although unknown to you may be causing you to toss-and-turn or wake briefly.

It’s more likely for a noise to wake you up while in stages 1 and 2 of sleep, than while in 3 and 4. Additionally noise tends to cause more sleep disruptions in the second half of the night.

There’s also evidence that you’re more likely to respond to a sound while sleeping if it is emotionally significant to you: Such as when a mother hears her baby crying.27

If noises outside of your control are keeping you up at night, white noise can be used to “drown” them out. White noise works by reducing the difference between the ambient noise and a sudden, “peak” sound -- like a toilet being flushed -- lowering the chances your sleep will be disturbed.

There are many white noise generators you can purchase, and now there are even phone apps that can do the trick. However, a simple fan or air purifier may be sufficient to help you sleep through the night.

4. Meditation

Fifty percent of people who experience difficulty sleeping blame stress and worry for their troubles.

Meditation, in relieving feelings of stress and anxiety, and - over time - improving our overall response to stressful situations, has been proven to improve both the duration and quality of sleep, with the effect increasing with prolonged practice.

Researchers at the Stanford Medical Center conducted a pilot study to investigate the effectiveness of meditation in treating insomnia. 10

Following a six-week mindfulness meditation training program, 60% of the participants no longer fit the qualifications for the diagnosis - falling asleep twice as quickly as they had previously.

A 12-month follow-up revealed that the majority of the benefits were long lasting.28 Similarly, experienced meditators show enhancement in both REM and non-REM sleep; as well as experiencing fewer awakenings when transitioning between cycles. 11

Meditating at any time of day helps to reduce stress and improve sleep; however, incorporating meditation into your bedtime routine can be especially effective in preparing your body and mind for sleep.

5. Structuring Your Bedtime Routine

Sleep is a behavior: You can teach yourself to sleep well, but you can equally teach yourself to sleep poorly. Our habits surrounding our bedroom routines have a much more significant impact on the quality of our sleep than many of us believe.

Children often have bedtime routines to encourage the onset of sleep, but this is just as important for adults.

Our body needs time to adjust and cool down after a busy day: Just as sleep inertia affects our ability to feel alert after being abruptly roused from a nap we need to allow our body and mind time to transition into a state of relaxation and finally sleep.

When structuring your bedtime routine the main goal is to reinforce your natural circadian rhythms. By developing a scheduled routine of activities at bedtime we can form habits that promote sleep, while avoiding those that impede it.

General Guidelines:

  • Follow a scheduled pre-sleep routine
  • Avoid stimulating activities and all screens for 30-60 minutes before bedtime
  • Reserve your bed for sleep and intimacy
  • Get rid of your alarm cloc

Rituals

Maintain a regular sleep/wake schedule (even on weekends): While it may seem like a treat to sleep in way past your usual waking time on the weekends, altering your sleep-wake schedule for just one night is sufficient to cause disruptions in your circadian rhythms that will affect you for days following.

Choose a favorite relaxing activity to wind down: Close off your day with a period of relaxation by incorporating one of your favorite calming activities into your bedtime routine.

Choose what works for you -- while one person may find reading relaxing, if you aren’t a bookworm yourself this will be counterproductive.

Some suggestions include:

  • Reading
  • Listening to music
  • Stretching (yoga)
  • Meditating

Prepare your room for sleep:

  • Dim the lights
  • Lower the temperature

Make your bed: A recent poll conducted by the National Sleep Foundation revealed that making your bed may be more than just a morning nuisance.

Those who reported they made their bed every morning had a 19% higher chance of getting a good night’s sleep than those who skipped this chore.

While the reason behind this is still unknown, researchers speculate that it’s related to feeling good about where you sleep.

Decluttering and maintaining a tidy bedroom can go a long way towards promoting better, more restful sleep.31

6. Tools And Resources

Nowadays there are many helpful tools to help you sleep better available at the click of a mouse -- or the swipe of a finger.

Sleep Cycle

Sleep Cycle Alarm Clock will revolutionize the way you wake up. This innovative app actually tracks your sleep patterns, and uses this information to gently rouse you when you’re in a light stage of sleep -- preventing sleep inertia.

The app achieves this by monitoring your movements throughout the night, as these vary depending on what stage of sleep you’re in.

There are two modes: Either using your phone’s microphone which “hears” your movements, or the accelerometer, which is placed on your mattress to detect your movements throughout the night.

At only $0.99 on iTunes it’s a small price to pay for waking up feeling refreshed.

F.lux

F.lux began as a software which adapts the colors of your computer’s display for different times of the day: Not only optimizing your viewing experience, but reducing your exposure to blue light - which inhibits the release of melatonin, a hormone essential for sleep.

While the app is still under construction, there are plenty of similar ones to choose from on iTunes and Google Play Store, so you can enjoy your devices in the evening without disrupting your sleep.

For iOS you can also use the built-in Nightshift mode to adjust white balance of your screen based on time of day.

White Noise

White Noise by TM Soft allows you to choose from a library of sound loops including beach waves, air conditioner and running water.

The app comes in three versions: Free, Full and Pro; with even the freebie coming with 40 sound loops as well as additional alarm sounds.

Whether you are looking for a way to drown out nighttime noise disturbances, or need a substitute for your favorite fan while traveling, White Noise’s variety will suit any preference.

Headspace

For those interested in experiencing how meditation can transform your sleep, Headspace is a great place to start.

With short guided meditations readily available on both desktop and mobile devices Headspace makes it easy to incorporate meditation into your bedtime routine.

You can try their Take 10 program for free, or choose from a variety of subscription options to get started today.

GoodnighT

While lying awake at night staring at your alarm clock waiting for sleep to come may make you feel powerless, there are a lot of concrete actions you can take to conquer your sleeping problems once and for all.

It’s not necessary to undergo a total life overhaul in order to enhance the quality of your sleep. Start by experimenting with the tips that are most appealing to you and see how they impact your sleep.

Keeping a journal can help you track what works and what doesn’t. Once you’ve felt the effects of a good night’s sleep you’ll wonder how you ever got by without it.

Originally posted on NestMaven.com.

The Importance of Boundaries

Jill Stoddard

by Annabelle Parr

Do you ever feel like you can’t say no?  Do you believe that you are responsible for the emotions of others?  Do you take others’ opinions and needs into account before your own?  Do you find yourself unsure of what you want or need (Eddins, 2015)?  If so, you are certainly not alone.  However, your feelings, thoughts, and needs matter.  By setting some boundaries in your life, you can begin to treat your needs as important.

Boundaries and Anxiety

Image source: https://blogs.goarch.org/blog/-/blogs/boundaries-healthy-limits-or-barriers-to-relationships-

Image source: https://blogs.goarch.org/blog/-/blogs/boundaries-healthy-limits-or-barriers-to-relationships-

For people who struggle with anxiety, learning how to create healthy boundaries can be a helpful tool.  Though sometimes people cope with anxiety by creating unnecessary boundaries or avoiding situations that serve as triggers, other times anxiety is experienced as a result of unclear lines between self and other.  When you don’t protect your sense of self, it is easy to feel overwhelmed and take on responsibility for everything and everyone (Eddins, 2015).  This can lead to feelings of guilt and anxiety.  It is not hard for a vicious cycle to ensue, where a lack of boundaries leads to anxiety, and where anxiety leads to a feeling that you cannot set clear and effective limits.

What Are Boundaries

So what exactly are boundaries?  Boundaries help us to define who we are.  They orient us in our relationships, and signify to us and to others where “I end and you begin” (Eddins, 2015).  Boundaries can apply to any area of our lives, and can range from material boundaries to physical, mental, or emotional boundaries to sexual or spiritual boundaries (Lancer, 2015).  Boundaries are very personal, and there is not a right or wrong answer regarding to how to set ones that work for you.  They are based on your beliefs, values, opinions, and needs (“12 Signs,” 2015).

Boundaries as an Act of Love

A common misconception for people who struggle in this area is that setting boundaries is selfish.  However, self-care is not selfish.  Have you ever flown on an airplane, and heard the stewardess tell the passengers in case of an emergency to put their own oxygen mask on before helping others with theirs?  This “oxygen-mask” rule is a profound metaphor for the idea that we cannot take care of others if we have neglected to take care of ourselves first. 

Image source:  http://www.thedynamicturnaround.com/healthyboundaries.htm

Image source:  http://www.thedynamicturnaround.com/healthyboundaries.htm

Setting boundaries for ourselves and giving ourselves permission to articulate our needs is an act of self-love (Strgar, 2010).  And in the wise words of Brené Brown, “we can only love others as much as we love ourselves” (2010).  Furthermore, when we set clear limits in our lives, we are better able to be compassionate towards others.  Brown (2010) states that “the heart of compassion is really acceptance,” and when we lack boundaries, we are not accepting our own needs and we may have a difficult time accepting others if we feel they are taking advantage of us. 

So contrary to this idea that boundaries are selfish, they actually help us love ourselves and others better.

How Therapy Can Help

You are the only one who has the ability to set boundaries in your life.  However, therapy can be helpful in navigating this challenging task.  Therapy offers a place where you can explore your values, your feelings, and your relationships.  Your therapist can help support you in the process of determining where you need to establish stronger boundaries or areas in which you might benefit from more flexibility.

Therapy can also be a good place to experience a relationship with very clear boundaries.  Dr. Irvin D. Yalom (2002) describes “therapy as a dress rehearsal for life,” meaning that it is a safe place to encounter challenging aspects of life and relationships before you face them outside of the therapy room.  An important goal of therapy is to take what you have learned and apply it to the rest of your life, but it can be helpful to practice new skills in a safe space first.

Don’t Forget to Be Kind To Yourself

One final thing to note is that boundaries are learned (Lancer, 2015).  If you are not used to setting clear limits in your life, know that it is a skill that takes practice.  The best way to start learning this skill is to cultivate self-awareness and practice asserting yourself (Lancer, 2015).  Remember, it is important to give yourself grace and to seek support throughout this process.  If you feel like you could benefit from some professional support in developing boundaries in your life…

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), 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 csamsandiego@gmail.com.

References:

12 Signs you lack healthy boundaries (and why you need them). (2015).  Harley Therapy Counselling Blog. Retrieved from http://www.harleytherapy.co.uk/counselling/healthy-boundaries.htm

Brown, B. (2010). The gifts of imperfection: Let go of who you think you’re supposed to be and embrace who you are.  Center City, MN: Hazelden Publishing.

Eddins, R. (2015). Keeping Good Boundaries & Getting Your Needs Met. Psych Central. Retrieved from http://psychcentral.com/lib/keeping-good-boundaries-getting-your-needs-met/

Lancer, D. (2015). What are personal boundaries? How do I get some?. Psych Central. Retrieved from http://psychcentral.com/lib/what-are-personal-boundaries-how-do-i-get-some/

Stgar, W. (2010). The importance of boundaries. The Huffington Post. Retrieved from http://www.huffingtonpost.com/wendy-strgar/working-boundaries_b_717339.html

Yalom, I. D. (2002).  The gift of therapy: An open letter to a new generation of therapists and their patients. New York, NY: HarperCollins Publishers.

Hoarding

Jill Stoddard

by Jan E. Estrellado, Ph.D.

Most of us know someone who has difficulty throwing things away or cannot seem to stop him or herself from buying things at bargain prices, even when he or she doesn’t need them.  Extreme versions of these behaviors (i.e. “clinical hoarding”) affect up to 5% of the U.S. population (Samuels et al., 2008). What might cause an individual to let these situations get out of hand?  And what can that person or a loved one do to help that person change?

What is Hoarding Behavior?

According to the International OCD Foundation (https://iocdf.org/), hoarding consists of three related issues: (1) collecting too many items; (2) difficulty getting rid of items; (3) problems with organization.  Hoarding behavior can result in significantly limited living or work space, strained relationships with others, and in extreme cases, unsanitary or hazardous living conditions.

A person with hoarding behavior may experience severe distress when attempting to get rid of items.  That person may feel he or she need these things or that he or she will eventually use them.  Even if the person’s belongings are of little material value or use, the person feels unable or unwilling to get rid of the items. 

Hoarding behavior negatively impacts relationships.  If one person in a household hoards, others living in the home may resent and/or blame that person for the status of their living conditions.  While it may seem like an “easy solution,” (i.e., “Just throw those things away!”) this is a much more complex process for the person who has difficulty letting go of material things. 

Why Do People Hoard?

A person’s beliefs about his or her posessions, as well as the meaning he or she attributes to them, are core parts of why a person hoards (Steketee et al., 2003).  A person may be extremely sentimental about his or her items and feel as if losing the item is “like losing a friend.”  The individual may feel exceptionally protective over his or her belongings and become very defensive or territorial when another person suggests he or she get rid of them.  

Source URL: http://www.dcputnamconsulting.com/hoarding-keepdonatedump/

Source URL: http://www.dcputnamconsulting.com/hoarding-keepdonatedump/

Wheaton et al. (2010) discuss the difficulty some individuals have with tolerating distressing emotions related to hoarding.  The actions a person takes or does not take in order to minimize upsetting feelings is called avoidance.  For example, a person who feels upset when trying to give or throw something away might avoid those feelings by saving the item.  By keeping the item, the person can also avoid feelings of loss that might result from not having the item.  An individual who hoards might also feel a “high” when acquiring new items, so he or she continues to obtain new items, even if the item is not needed.

Getting Help for Hoarding

Seeking mental health treatment for hoarding behavior might be particularly difficult.  By the time the individual shows up at his or her therapist’s door, it is possible he or she has been hoarding for years.  Treatment might not have been the person’s first choice, but was perhaps at the strong encouragement of a concerned family member or friend.

Cognitive-behavioral therapy (CBT) is the treatment of choice to address hoarding behavior.  In a recent review of the scientific literature on hoarding treatment, Tolin and colleagues (2015) found that those who received CBT for hoarding had significant reductions in symptoms, especially with regards to a core feature of hoarding behavior, difficulty discarding.  A hoarding-specific version of CBT combines a number of different elements, including resolving the person’s ambivalence towards his or her hoarding behavior, and using exposure therapy to help the person directly confront his or her discomfort regarding discarding items (Tolin, Frost, Steketee, & Murdoff, 2015).

Another significant finding from the same study (Tolin et al., 2015) is that greater improvements with discarding symptoms were associated with greater number of therapy sessions conducted in the person’s home.  In-home sessions are more effective than office sessions because the therapist can be there with the client to help build new discarding and acquiring skills.

CSAM is here to help

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for hoarding, 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 csamsandiego@gmail.com.

 

References:

International OCD Foundation.  https://hoarding.iocdf.org/

Samuels, J. F., Bienvenu, O. J., Grados, M. A., Cullen, B., Riddle, M. A., & Liang, K. Y. (2008). Prevalence and correlates of hoarding behavior in a community-based sample. Behaviour and Research Therapy, 46, 836 – 844.

Steketee, G., Frost, R. O., & Kyrios, M. (2003). Cognitive aspects of compulsive hoarding. Cognitive Therapy and Research, 27, 463–479.

Tolin, D. F., Frost, R. O., Steketee, G., & Muroff, J. (2015). Cognitive behavioral therapy for hoarding disorder: A meta‐analysis. Depression And Anxiety, 32(3), 158-166. doi:10.1002/da.22327

How Anxiety Affects Couples

Jill Stoddard

by Jan E. Estrellado, Ph.D.

Most of CSAM’s blogs focus on the experience of having a mental health condition, such as anxiety, depression, or PTSD.  This blog is a little different because it focuses on the impact of a mental health condition, anxiety, on couples.  What is it like to care for, live with, and support someone with anxiety?  What kind of strain might this cause in a relationship and what can couples do to sustain each other and their relationship?

Loving Someone with Anxiety

Partners or spouses of individuals with anxiety might experience feelings of helplessness.  When anxious loved ones feel intense fear (i.e., scared of having a panic attack or becoming severely preoccupied with worried thoughts) or avoid certain situations (i.e., not wanting to drive on the freeway or refusing to leave the home), partners may not feel there is much they can do to help reassure or calm them down.  When a partner does attempt to help ease his or her loved one’s suffering, those attempts (i.e., reassuring, problem-solving) may be rejected by the anxious individual.  This can be extremely hurtful and can lead to other intense feelings described below.  In addition, partners may try to help by offering to drive for the anxious partner, agreeing to skip a social event, or allowing the anxious partner to engage in compulsions so that he or she gets relief.  While these efforts are meant to be helpful, the avoidance partners are enabling actually contributes to and maintains the anxiety-related problems.   

The emotions that partners of anxious individuals can experience range and vary greatly.  They may feel anger and frustration that the anxiety inhibits their lives, and because their partner’s anxiety is outside of their control.  It is difficult to accept that a loved one may continue to feel anxious, regardless of the actions of the partner.  If a partner’s anger remains unresolved over a long period of time, this can turn into resentment, minimization, or blame.  Partners may feel overlooked or overshadowed by their loved one’s anxiety, perhaps feeling like their needs can’t be met when calming their partner down feels the most urgent.

Being the Anxious Partner in the Relationship

The partner who experiences extreme worry can easily feel guilt, shame, and embarrassment at their lack of ability to manage anxious feelings.  They may also feel misunderstood and alone.  These negative feelings, if not addressed or acknowledged effectively, might actually contribute to further anxiety.  If an anxious person feels his or her partner is getting frustrated, that person might shut down, withdraw from the relationship, or engage in unhelpful coping behaviors, such as smoking cigarettes or shopping excessively. When worry and stress take up a lot of space in a relationship, the anxious individual often feels responsible for his or her partner’s feelings of frustration, hurt, or helplessness.  These feelings of guilt or embarrassment compound the individual’s pre-existing feelings of worry, increasing the suffering of that person. 

It may be difficult for the anxious partner to know what he or she needs.  Perhaps he or she is too ashamed to ask for support when so much help has already been requested of the partner.  When a person experiences intense fear in the moment, it can be challenging to know what is helpful and perhaps even more challenging to communicate those needs effectively.  Intense fear, by nature, prevents a person from thinking logically or rationally and it can be tough to know how to reign one’s self in during those moments.

Sustaining the Relationship

What can a partner of an anxious individual do to help make the relationship work?  One crucial element is for the partner to make sure that he or she is able to maintain his or her own health and wellness.  A partner can feel guilty for taking care of himself or herself, especially knowing that his or her loved one may be suffering.  However, if both partners are suffering, especially over a long period of time, the relationship is no longer sustainable.  A partner might need to seek this support outside of the relationship.  Examples of support outside the relationship include trusted friends, family members, health providers, faith leaders, co-workers, and therapists.

In addition, a person may want to communicate his or her needs to the anxious partner, even if it is difficult.  If only one person’s needs are being met or paid attention to consistently, the relationship feels one-sided—another predictor of an unsustainable situation.  Asking for one’s needs to be met can also include discussing feelings and reactions to the partner’s anxiety.   While communicating feelings in an authentic, yet caring way, can be challenging, both partners might experience some relief and a greater connection, and the likelihood of resentment decreases.

An anxious individual may not want to wait until he or she experiences intense fear to know what help the partner can provide.  Rather, identify wants and needs during more calm or grounded moments.  When an anxious person knows what works, it is easier to engage his or her partner in a collaborative manner.  Having a “game plan” can ease some of the intensity of fear in the moment. 

Finally, as we say in Acceptance and Commitment Therapy, anxiety can have a place in the relationship, but it shouldn’t be “driving the bus.”  When anxiety appears to be controlling the direction of the relationship despite the couple’s best efforts, it’s time for one or both individuals in the relationship to seek outside support.

CSAM is here to help

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), 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 csamsandiego@gmail.com.