Contact Us

CONTACT US

IF YOU WOULD LIKE TO INQUIRE ABOUT TREATMENT AT CSAM, PLEASE FILL OUT THE FORM AND A THERAPIST WILL CONTACT YOU TO MAKE AN APPOINTMENT.

You may also contact us via phone or email:

Phone: 858-354-4077

Email: info@csamsandiego.com

Name *
Name
Phone *
Phone
OK to leave a detailed message on this phone? *
How did you find CSAM? *

7860 Mission Center Ct, Suite 209
San Diego, CA, 92108

858.354.4077

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.

Blog Awards 1:18.jpg

Blog

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

 

Filtering by Tag: ptsd

Mental Health Awareness Month: Fitness #4Mind4Body

Jill Stoddard

by Annabelle Parr

May is Mental Health Awareness Month. Every year, Mental Health America designates a particular theme for the month to highlight an important aspect of mental health. This year’s theme is Fitness #4Mind4Body, and it focuses on acknowledging the connection between mental and physical wellbeing. #4Mind4Body explores the role of nutrition, exercise, the gut-brain connection, sleep, and stress in our overall wellbeing and examines the ways each of these areas impact our functioning. Below is a summary of the topics covered in the Mental Health Toolkit from Mental Health America.

Diet and Nutrition

brooke-lark-254998-unsplash.jpg

Eating a well-balanced, nutritious diet is an integral part of health. Diets high in processed, fried, and sugary foods can increase the risk not only for developing physical health problems like diabetes, heart disease, obesity, and cancer, but are also linked to mental health problems, including increased risk for depression symptoms. A healthy diet consists of a variety of fruits, vegetables, legumes, whole grains, fish, nuts, and olive oil. Maintaining a balanced, nutritious diet is linked with a lower risk for depression and even an improvement in depression symptoms.

Exercise

Regular exercise not only helps control weight, increase strength, and reduce the risk of health problems like high blood pressure, cardiovascular disease, and some cancers, but it also helps boost endorphins and serotonin, among other important proteins and neurotransmitters that impact mental health. Endorphins serve to mitigate pain in the face of stress and increase pleasure in the body. Serotonin affects appetite, sleep, and mood, and is the target of SSRIs, a class of antidepressant commonly used to treat anxiety and depression. Just thirty minutes of exercise per day can help improve mood and mental health.

jenny-hill-202432-unsplash.jpg

The Gut-Brain Connection

The gut, also known as the “second brain,” communicates directly with the brain via the vagus nerve and via hormones and neurotransmitters. The communication goes both ways, so anxiety, stress, and depression can impact the gut and result in gastrointestinal symptoms, but changes in the gut microbiome can impact the brain and mood, exacerbating or even resulting in symptoms of anxiety and depression. Eating a nutritious diet that includes prebiotics and probiotics is an important part of maintaining a healthy gut and a healthy mind. 

Sleep

Quality of sleep impacts the immune system, metabolism, appetite, the ability to learn and make new memories, and mood. Good sleep for adults means getting between 7-9 hours of mostly uninterrupted sleep per night. Problems with getting good quality sleep can increase the risk of developing mental health symptoms, and symptoms of anxiety and depression can negatively impact sleep, creating a negative cycle. Cognitive Behavioral Therapy for Insomnia (CBT-I) can help clients reestablish healthy sleep patterns through addressing negative thoughts and worries as well as behavioral patterns that are impacting sleep habits.

Stress

Stress is a normal part of life, and the body is equipped with a fight or flight response designed to help mobilize internal resources to manage stressors. After the stress has passed, the body can return to its regular equilibrium state. However, when stress becomes chronic, it can cause inflammation, impaired immune system functioning, muscle aches, gastrointestinal problems, sexual dysfunction, changes in appetite, and increased risk for heart disease. Too much stress can also impact mental health.

Mental health involves a complex interplay between numerous factors, including but certainly not limited to the areas listed above. Furthermore, though maintaining a healthy diet, regular exercise routine, good sleep habits, and utilizing stress management techniques can help prevent or improve existing mental health symptoms, if you are struggling with mental health issues, it can be difficult to attend to these areas.

If you are struggling with anxiety, stress management, depression, chronic illness, or insomnia, seeking professional assistance can be helpful. Evidence based therapies like Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help to address problematic thoughts and behaviors that are contributing to emotional distress. Therapy offers a warm, supportive, safe environment to explore painful issues. A therapist can also provide support in helping the client to develop good self-care habits, like those mentioned above.

This year’s mental health awareness theme reminds us of the importance of recognizing the multiple avenues through which we can approach mental health, and the variety of tools we have at our disposal to improve overall wellbeing.

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

Mental Health America. (2018). 2018 Mental Health Month Toolkit. Retrieved from http://www.mentalhealthamerica.net/sites/default/files/Full_2018_MHM_Toolkit_FINAL.pdf

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:

Trauma, Panic, and EMDR: Eye Movement Desensitization and Reprocessing

Jill Stoddard

by Annabelle Parr

When you search Google Images for “therapy,” the first thing that comes up is a client laying on a couch talking, while the therapist listens and takes notes. Therapy typically does involve a fair amount of talking and listening, but rarely is it that simple. For example, cognitive behavioral therapy (CBT) is a talk-based form of therapy that involves an active approach where therapist and client work together to change unhelpful thoughts and behaviors that affect the client’s mood.

Though most psychotherapy is talk-based, there are a few exceptions. One form of therapy that is particularly unique and relies on little talking is known as EMDR, or Eye Movement Desensitization and Reprocessing.

What is EMDR?

EMDR is a form of psychotherapy often used to treat trauma, where the therapist asks the client to imagine the distressing event while simultaneously engaging the client in some sort of bilateral stimulation. Typically, this involves therapist directed eye movements from one side to another, but it can also involve taps or tones.

How and why does EMDR work? 

It can be difficult to imagine how therapy might work without relying on much talking. But sometimes we cannot access all of the information that our brain has stored. If we can’t access it, we can’t talk about it. And sometimes, we can rationally understand something, but still feel stuck in painful emotions.

Trauma can be particularly difficult to process because the frontal lobe (the part of the brain involved in higher level processes, like thinking and language) is not always able to fully access the traumatic memory. So we can try to wrestle and reason with it, but find ourselves frustrated by a lack of progress as far as our emotional response goes. EMDR purports to help us approach trauma from a different angle, so that the brain actually reprocesses the way the trauma is stored.

EMDR changes the client’s relationship to the trauma.

Clients tend to find that their thoughts and feelings around the traumatic memory change fairly quickly with EMDR (EMDR Institute, Inc., 2016). There is often a deeper sense of being able to cope with trauma on an emotional level.

EMDR is now offered at CSAM.

CSAM is excited to announce that Dr. Terra Fuhr is now certified in EMDR. Dr. Fuhr explained that she decided to pursue certification because she saw several colleagues find great success using EMDR. Then she began to occasionally refer clients for simultaneous EMDR treatment, and saw firsthand the remarkable healing that it facilitated. She found that EMDR helped clients break through in places where they got stuck using only CBT. This effect was so powerful that she felt inclined to add EMDR to her mental health tool belt as a modality to help her clients, so that now she can offer EMDR in conjunction with CBT and ACT.

What can EMDR be used to treat? 

EMDR was originally used to treat trauma and PTSD, but today is applied to numerous other issues. Dr. Fuhr describes how helpful it can be in treating panic disorder. One reason for this is that clients’ most severe panic attack is stored as a trauma. Using EMDR to heal the trauma of panic can be enormously helpful in helping the client break out of the panic cycle. It can also be applied to “small traumas,” like an embarrassing moment, negative thinking patterns or feelings such as low self-esteem (EMDR Institute, Inc., 2016).

While there is some debate in the scientific community regarding the how and why EMDR helps, studies have offered support for its efficacy, and over the 25 years that it has been in existence, millions of people have been successfully treated using EMDR (EMDR Institute, Inc., 2016). EMDR can be offered on its own, or in conjunction with CBT or ACT. For some clients, it can be a helpful adjunct to their healing process.

CSAM IS HERE TO HELP

If you or someone you love might benefit from eye movement desensitization and reprocessing (EMDR), 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 csamsandiego@gmail.com.

For more information about Eye Movement Desensitization and Reprocessing, visit The EMDR Institute.

References:

EMDR Institute, Inc. (2016). What is EMDR? Retrieved from: http://www.emdr.com/what-is-emdr/

How To Listen When Someone You Love Is Struggling

Jill Stoddard

by Annabelle Parr

Life presents us each with challenges.  While it is often uncomfortable and painful to grapple with adversity, to experience this struggle and to feel pain is to be human.  At some point, we will all find ourselves in this place, as will those we love.  So how can we help each other?  How can we listen when someone we love is struggling, whether it is with a mental health condition or with a painful experience in his/her life?

 LET GO OF THE IMPULSE TO TRY TO FIX

Source URL: https://scott-williams.ca/2013/03/

Source URL: https://scott-williams.ca/2013/03/

It is painful to watch someone we care for struggle or hurt.  And it’s natural to want to take away her pain or try to fix the problem at hand.  However, despite our best intentions, trying to “fix” does not actually help.  It tends to make the person struggling feel as though she cannot share her pain, sadness, or anger.  Trying to “fix” sends this message: “I can’t handle seeing you in pain, so I have to make everything better.”  It also implies that it is not okay to feel sad or angry or anxious, and that these feelings should be avoided at all costs.

AVOID ADVICE

Just like our impulse to fix the pain, we also often believe that the best way to help is to offer advice.  But advice is usually not helpful for several reasons.

  1. If we offer good advice, our loved one will think that anytime he is struggling, he needs our instruction. 
  2. If we offer bad advice or our advice doesn’t work as we hoped, our loved one can place the blame on us instead of owning responsibility.
  3. Advice takes away the gift of helping our loved one to realize that she knows herself best, and ultimately she is capable of navigating difficult situations herself.  (Though, of course, she will always have our love and support).

LIMIT SHARING YOUR OWN SIMILAR EXPERIENCES

Source URL:  http://www.lifehack.org/articles/communication/the-biggest-communication-problem-not-listen-understand.html

Source URL:  http://www.lifehack.org/articles/communication/the-biggest-communication-problem-not-listen-understand.html

If you have had a similar experience or believe that you have felt the same way, you can share this with your loved one.  But don’t make it all about you.  Keep your story brief, and make sure the purpose of the story is to let him know that he is not alone.  Also, be sure to include that you understand that your experience, while maybe parallel in some ways, is yours, and you are not claiming to have experienced the exact same situation or feelings.  This allows him to feel comfort in not being alone, but also gives him space to communicate how his experience may be different.

If we shouldn’t try to fix the pain or offer advice, and we should limit how much we share of our own experience, what can we do to help?

REFLECT OR PARAPHRASE BACK TO YOUR LOVED ONE WHAT YOU HEAR HIM/HER EXPRESSING

This shows that we are listening, and gives us the opportunity to clarify that which we don’t understand fully.  While it may sound too simple to just reflect what our loved one is saying, it actually makes the person feel heard and understood.  It also offers her the opportunity to hear what she is expressing, and to clarify how she feels or what she wants.

USE NONVERBAL SIGNALS TO SHOW YOU ARE ENGAGED

Nodding and using eye contact and engaged body language shows that we are interested and open to what our loved one is sharing.  It gives him the space to express himself, and makes him feel heard.

SHOW EMPATHY

Empathy is: “I see that you are struggling and hurting right now, and I am so sorry.  I can’t fix it for you or take it away, but I will sit here with you and listen to your story.  As much as this hurts, it is okay to feel this way.”

Check out Brene Brown’s brilliant short on empathy.

Sometimes, all our loved ones need when they are in pain is to be heard; to be given a space with someone they trust to express how they are feeling.  Sometimes, however, they may need some extra support or professional help.

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:
Brown, B.  (2013, Dec 10).  Brené Brown on empathy. Retrieved from https://www.youtube.com/watch?v=1Evwgu369Jw

 

Trauma and the Brain

Jill Stoddard

by Jan E. Estrellado, Ph.D.

Responses to trauma can be found in both the mind and the body.  In the mind, people can experience unwanted, intrusive thoughts that remind them of the traumatic event.  They may feel misunderstood, isolated, and irritated with others around them.  Their beliefs about the world might change from a sense of safety and stability to one of unpredictability and danger.

In the body, people can feel “on edge,” like something bad is about to happen.  They may feel more anxious than usual, with symptoms of an increased heart rate, sweatiness, hyperventilating, difficulty focusing, or even a panic attack.  This is more likely to be true when they are exposed to an internal or external cue reminding them of the traumatic event, but for others, it can feel like it comes out of nowhere.

Trauma Response in the Brain

For an individual with PTSD, much of the response to trauma can be found by understanding what is happening in the brain. 

When something might be dangerous or threatening, it first goes to the thalamus, which is responsible for receiving sensory input (what you see, smell, taste, touch, and hear).  From the thalamus, it can go in one of two directions.  In the first direction, the “more sensible” direction, the sensory cortex accurately appraises the event as non-threatening and the hippocampus (responsible for memories), confirms or modifies this response.  This direction, while slower than the second direction, is often more capable of accurately assessing true threat.

In the second, “less sensible” direction, the thalamus sends signals to the amygdala (the emotion and fear center of the brain), which then goes to the hypothalamus, where action is taken to get relief.  This direction is often seen as tapping into the “fight or flight” response to fear.  While this direction is quicker and engages our survival mechanisms, it can also get us into trouble if our response is bigger than the situation calls for.

For individuals with PTSD, their brains often go in the second direction.  Their amygdala is on “over-drive” and cannot help them evaluate what is a true threat and what is not. 

Re-Training Your Brain

If your brain is trained to fire its amygdala at will, what can you do about it?  Enter the pre-frontal cortex.  This part of the brain is responsible for planning, strategizing, executing, reasoning, and decision-making.  At CSAM, we often encourage our patients with PTSD to engage their pre-frontal cortex in various ways: deep breathing, mindfulness practice, even coloring!  Any grounding activity that helps you stay in the present moment will help you engage your pre-frontal cortex.  These are effective short-term strategies for helping to manage an individual’s immediate PTSD-related anxiety.

Longer-term strategies include Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), and Acceptance and Commitment Therapy (ACT).  These interventions have strong support in the scientific literature showing their effectiveness to manage PTSD.  In CPT and PE, patients “re-train their brains” to reduce their reactivity to distressing cues, often related to the traumatic event.  They continually re-write or re-tell the story of their traumatic event until they make new meaning of the trauma, learn that the trauma memories are not dangerous and discover that they can handle the upsetting responses that come with remembering the traumatic event.  In Acceptance and Commitment Therapy, patients practice mindfulness in order to understand what distressing thoughts they have when they recall the traumatic event.  They develop a willingness to engage with the memories and feelings of the traumatic event, so that they are “freed up” to live a life based on their values and what’s important to them.

CSAM is here to help

If you or someone you love might benefit from CPT, PE, or ACT following a traumatic experience, or if you would like more information about our other therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

U.S. Department of Veteran Affairs (2015).  How common is PTSD?.  Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp

Pursuing Values over Resolutions in the New Year

Jill Stoddard

by Jan E. Estrellado, Ph.D.

 

2016 has arrived!  As we say good-bye to 2015, it’s time to look forward to setting intentions for the new year.  Knowing that resolutions don’t always work out, what if we tried basing those intentions on our values rather than on our goals?

Image source: http://allisonpataki.com/set-new-years-resolutions-january/

Image source: http://allisonpataki.com/set-new-years-resolutions-january/

The Problem with Resolutions

It seems that while many people make resolutions every year, only a few are able to maintain those changes.  According to the Statistic Brain Research Institute (2015), 45% of people in the U.S. make resolutions, but only 8% of people successfully achieve them.  In 2015, the top three resolutions for the new year were losing weight, getting organized, and spending less/saving more.

Why might it be so hard for us to accomplish the resolutions we set so hopefully at the beginning of each year?  And perhaps more importantly, how do we deal with and recover from the guilt, anxiety, stress, and embarrassment that often come when we fail to meet these goals?

For some helpful answers, we might look to Acceptance and Commitment Therapy (ACT), an evidence-based intervention that, in the words of Happiness Trap author Russ Harris (2008), “helps people create a rich and meaningful life, while effectively handling the pain and stress that life inevitably brings.” 

According to ACT (pronounced as one word), it is the struggle with “what’s wrong” in our lives that causes much of our suffering.  We’ve all been there: the slice of chocolate cake we couldn’t resist, the day we chose to stay home instead of going to the gym, or spending more than we wanted to eating out.  It is normal to feel ashamed, guilty, or frustrated with ourselves, often accompanied by thoughts of self-judgment and doubt (i.e., I have no self-control, I was doomed to fail from the start, etc.).  It is so easy to spend time and energy beating ourselves up for what we should have done, that we end up in a worse place than when we started.  How many of us have eaten that second slice of chocolate cake to soothe our guilt about eating the first one? 

Values-Based Living

Normal 
 0 
 
 
 
 
 false 
 false 
 false 
 
 EN-US 
 JA 
 X-NONE 
 
  
  
  
  
  
  
  
  
  
  
 
 
  
  
  
  
  
  
  
  
  
  
  
  
    
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
   
 
 /* Style Definitions */
table.MsoNormalTable
	{mso-style-name:"Table Normal";
	mso-tstyle-rowband-size:0;
	mso-tstyle-colband-size:0;
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-parent:"";
	mso-padding-alt:0in 5.4pt 0in 5.4pt;
	mso-para-margin:0in;
	mso-para-margin-bottom:.0001pt;
	mso-pagination:widow-orphan;
	font-size:12.0pt;
	font-family:Cambria;
	mso-ascii-font-family:Cambria;
	mso-ascii-theme-font:minor-latin;
	mso-hansi-font-family:Cambria;
	mso-hansi-theme-font:minor-latin;}
 
    Image source: http://www.sanitygurus.com/relaxation/

Image source: http://www.sanitygurus.com/relaxation/

In contrast to resolutions, values are never finished.  Think of values as the direction you are headed in (“westward”) versus a destination west of you (“Hawai’i”).  One can continue on in that direction indefinitely and it will never be done.  It is a series of choices we make over and over again to carve out a path in the direction of that value. 

What might values-based living look like as an alternative to New Year’s resolutions?  Let’s take the #1 resolution of 2015: losing weight.  Why might losing weight be important to you? Do you want to feel good in your body, to invest in your physical health, to live longer for your family or to model healthy behaviors to your children?  Clarifying why we choose a goal might be more important than the goal itself.  For example, if I want to live long enough to see my kids grow up, my choices might focus more on being active with my kids and less on counting calories.  I may or may not lose weight, but keeping my choices and behaviors aligned with my greater value moves me toward the person I would like to be.

Acting in service of our values does not mean that the path will be easy or comfortable.  In fact, choosing our values means that we also choose the pain that will inevitably come.  Living from our values means we accept that painful and unwanted outcomes sometimes happen. Staying the values-based course as the painful stuff happens is what gives us meaning and purpose.

Are you willing to give values a try this year?


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 a chronic medical illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Statistics Brain Research Institute (2015).  New years resolution statistics.  Retrieved from http://www.statisticbrain.com/new-years-resolution-statistics/

Harris, R. (2008).  What is acceptance and commitment therapy?  Retrieved from   http://www.thehappinesstrap.com/about_act