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7860 Mission Center Ct, Suite 209
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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: therapy

Finding the Right Therapist for You

Jill Stoddard

by Annabelle Parr

Therapy can be incredibly helpful and healing in the midst of struggle, but it’s not “one size fits all” and sometimes it can be challenging to find the right fit. If you have tried therapy before and been frustrated by a lack of progress, it’s possible you haven’t found the right therapist for you. Having some knowledge about therapy and the different options available can help when you are seeking out help.

What do therapists do?

A therapist’s role is to provide you with empathy, help you learn healthy coping methods and give you tools to manage your emotions constructively. They are there to help you connect with your personal values and get in touch with your own internal strength, while offering you compassionate support and understanding along the way. They are like “training wheels” to help you learn to engage in life in a new way.

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What don’t therapists do?

They are not there to pass judgement, minimize your feelings, or offer you advice. No advice means that they are not there to make decisions for you, such as whether or not to stay in a relationship or a job; they can, however, assign you homework to help you make progress and teach you coping mechanisms.

If you ever feel judged or like your therapist is minimizing your feelings, discuss this with them. This will allow you to discern whether you misunderstood their message or whether maybe they are not the best fit for you. It is important to talk with your therapist about the therapeutic process itself, especially if something feels off.

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Note: therapy can be helpful and it can be hard.

Therapy is challenging. It requires active work on the part of the client and it requires facing uncomfortable and painful emotions, and likely making difficult changes. As James Hollis (1998) notes, “no one enters the therapist’s office whose adaptive strategies are still working.” So sometimes, clients may feel worse before they feel better because change is inherently uncomfortable. This kind of “feeling worse” is a vital part of the growth process, not a further descent into the same struggle that brought you into the office.

If it feels like you have tried various therapies or therapists, and have not progressed despite your commitment to finding help and engaging in the therapeutic process, you may not have found the right therapist yet. Here are some things to look for when seeking therapy.

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  1. Connection with the therapist. Therapy requires that you let another person in on your innermost thoughts and feelings. This is not an easy thing to do, so it is important that you feel comfortable with the person you choose. Research shows that the therapeutic relationship itself is the most important aspect of therapy – accounting for about 30% of the variance in treatment outcome, which is more than any other factor including the technique the therapist uses. So make sure that the therapist you choose to see is someone you trust and whom you are willing to talk to. If it doesn’t feel like the right fit, it probably won’t be.
     
  2. The therapist’s areas of expertise. While the relationship is the most important piece of therapy, specialization and technique are still very important pieces of the puzzle. When looking for a therapist, make sure to search for someone who has experience working with individuals dealing with your particular concerns. Otherwise, you may end up wasting time and money working with someone who might not conduct a proper assessment, or who does not have experience working with your particular issue. Ask them about their experience working with others who have concerns similar to yours, including the techniques they use and the degree of progress and healing that they typically see in their clients.
     
  3. Evidence based treatments. There are lots of different treatment options out there; a good place to start is searching for a therapist with true training in modalities that are supported by solid research (such as Cognitive Behavioral Therapy or Acceptance and Commitment Therapy). Ask questions about their training and choice treatment modalities, what a typical session will look like, how your individual needs will be addressed, whether you will receive homework, what will be required of you in the process, how your progress will be evaluated, and what steps will your therapist take if they find that your progress has prematurely plateaued.

If you are struggling and considering reaching out for help, this knowledge can help you navigate choosing a therapist and can help you recognize sooner rather than later if it’s not the right fit. If you have tried therapy before and have been frustrated by a lack of progress, you are not alone. Remember, effective help is available when you know what to look for.

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 csamsandiego@gmail.com

References: 

Hollis, J. (1998). The eden project: In search of the magical other. Toronto, ON: Inner City Books.

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/

A ‘Yes’ Community

Jill Stoddard

a guest blog repost by Dr. Nic Hooper

Two days ago, Thursday June 1st 2017, an article in The New Scientist magazine was published that I co-wrote. It is a great achievement because it will be one of the largest impact writings about Relational Frame Theory (RFT) i.e. it is possible that more people will lay their eyes on this article than for any other RFT article that currently exists.

At a personal level it feels like a big deal; it feels like an ‘I made it’ moment. And, of course, ‘I made it’ moments matter only because of the history of moments where me making it wasn’t, by any means, a sure thing. I think of my A-Levels where I studied like hell for Psychology and scraped a B. I think of the first two years of my degree where my average mark was 57 (see picture below) and I think of starting my self-funded PhD where some members of staff in the Psychology Department weren’t happy about me being accepted onto the program because I wasn’t ‘PhD material’. How the hell did I, an average boy from a working class family, make it to a point in my life where I publish in a magazine that has a readership of over 100,000 people?

The answer is quite simple. When I was 20, I started reading a book about a new approach to human suffering named Acceptance and Commitment Therapy (ACT). This is when everything changed for me. Prior to this point, unhelpful thoughts and feelings heavily influenced my decisions. Sure, they kept me in a comfort zone where I was safe but in that comfort zone I could make no progress towards the things that were important to me.

Have you seen the film ‘Yes Man’ with Jim Carrey? The film documents how a man’s life changed when he started saying ‘yes’ to everything. It’s a cool idea and following what I learned about ACT it is pretty close to the way I began interacting with the world. Of course, I differ from ‘Yes Man’ in that if someone asks me to steal a pig from a farm and paint it green then I wont say ‘yes’ (most of the time). However, if someone asks me to do something that is in line with my values, and provided this something wont infringe too much on my ability to self-care, then I say ‘yes’.

Over the years I have especially said ‘yes’ when the offer made me feel uncomfortable or when my mind fed me thoughts like: ‘You’re going to get found out – you’re not smart enough to do this’. My values guided my decision-making. Yes to a PhD, Yes to presenting my work at international conferences, Yes to travelling to the US to meet people like Steve Hayes and Kelly Wilson, Yes to lecturing in Cyprus, Yes to writing a book, Yes to going to the ACT Dublin Conference, Yesto meeting up in Bristol with some people I met at that conference, Yes to setting up an ACT centre with those people, and Yes to trying to write this New Scientist article with those people. Sure, it wasn’t plain sailing and it brought me plenty of failure and discomfort along the way but there is no doubt that I am where I am because of how readily I said ‘yes’. And I was able to say ‘yes’ because ACT taught me that saying ‘yes’ to things that are important to you, even when they bring discomfort, is a way of living that brings liberty and fulfillment (see any recent work by Aisling Curtin and Trish Leonard to learn more about ACT inspired comfort zones).

I guess you might be wondering why I am telling you these things. Well, for two reasons. Firstly, I wanted to advocate for ‘yes’ living because of the positive effect it has had on me. However, secondly, and more importantly, I wanted to make a prediction for the future. Here I am, one average person, who became introduced to ACT, started moving outside of his comfort zone when his mind told him that he wasn’t worthy or capable, and started to achieve remarkable things (relative to what I thought was possible). But I am not the only person in the ACT community with that story. You see the thing about ACT is that it isn’t an approach you ‘do’ to other people; it is an approach that starts with oneself. So here is my prediction: ACT will get bigger and will stay the course. I don’t think this will happen because ACT will win therapy wars with 1000’s of studies (those wars don’t have winners). I think it will happen because over time more and more ‘average’ people will start to achieve remarkable things by saying ‘yes’ when their mind tells them that they aren’t good enough. If this does happen then although none of us will be remembered as individuals, as a ‘yes’ community we might just change the world.

Originally posted on NicHooper.com

Don’t Believe Everything You Think: Cognitive Distortions

Jill Stoddard

by Annabelle Parr

Whether you recognize the term or not, at some point you have dealt with a cognitive distortion. These are thoughts that feel like the truth, but they describe an emotional reality rather than an objective one. For those struggling with stress, anxiety, or depression, often chronic and significant cognitive distortions play a big role in the struggle.

Dr. David Burns (1980) outlined 12 of the most common cognitive distortions in his book, Feeling Good: The New Mood Therapy. Dr. Burns’ list is adapted below with examples. As you read through the list, see if you recognize examples of any of these distortions in your life.

1. All-Or-Nothing (Black and White) Thinking: You see things in black and white terms, refusing to see any gray area.
Distortion: If I’m not nice to everyone all the time, I’m a jerk.
Reframe: I’m allowed to be assertive and set boundaries. I don’t have to be nice to someone who is being disrespectful to me. Standing up for myself doesn’t make me a jerk.

2. Overgeneralization: You see one or several negative events as a sign of an endless pattern of defeat.
Distortion: I got a bad grade on this math test, so I will never get a good grade on a math test.
Reframe: I got a bad grade on this math test. Maybe I didn’t understand the material or studied wrong. I will talk to my teacher to better understand my mistakes, and hopefully I will do better next time.

3. Mental Filter: You exclusively notice the negative aspects of a situation and magnify them out of proportion. At the same time, you filter out/fail to notice the positive aspects.
Distortion: My presentation went terribly. I lost my train of thought because I got nervous, and I forgot a key point I wanted to make.
Reframe: I stumbled over my words a little bit, but no one besides me seemed to notice. I also forgot a key point I wanted to make. But I got good feedback and everyone seemed engaged during my presentation. Next time I will practice a little bit more, but overall it went pretty well.

4. Minimizing/Disqualifying/Overlooking the Positive: You turn positive experiences or comments into negative ones by deciding that they don’t count for some reason. You overlook positive things about yourself or your environment. You don’t just filter out positive things; you actually turn them into negatives.
Distortion: He only invited me to come to his party because he feels sorry for me and knows I’m a loner.
Reframe: He invited me to come to his party because he wants me to come.

5. Mind Reading: You assume that someone is thinking or reacting negatively to you even though you do not know what they’re thinking.
Distortion: She didn’t wave at me because she doesn’t like me.
Reframe: She didn’t wave at me. She probably didn’t see me, or maybe she had something on her mind.

6. Fortune Telling: You think that something bad is going to happen even though you do not yet know what the outcome will be. This causes you to worry, overreact, or give up too soon.
Distortion: Even though things are going well now, I think he will eventually break up with me and I am afraid I will get hurt. Maybe I should just break up with him now to avoid getting hurt.
Reframe: Things are going well now. I’m not sure what will happen in the future. But for now I will try to be present and enjoy what is.

7. Magnifying/Catastrophizing: You exaggerate the importance of something, or you imagine that something that might happen would be terrible or earth shattering, when it would not actually be as bad as you imagine or you could cope despite it being difficult.
Distortion: I can’t accept the promotion because then I will have to give presentations. I’m terrified of public speaking, and I will get too scared and embarrass myself in front of everyone and then probably lose the job anyway.
Reframe: If I accept the promotion, I will have to give presentations. Lots of people are scared of public speaking. I might make a mistake and I might feel embarrassed or scared, but that’s part of being human. It won’t be the end of the world.

8. Emotional Reasoning: You assume that your feelings reflect the truth, even though your feelings are based on erroneous thinking.
Distortion: I feel like a failure, which means I am a failure.
Reframe: I may feel like a failure right now because I am still looking for a job, but job hunting takes time. I am not a failure.

9. Should Statements: You have a list of rules set in stone about how you or others “should” behave, but these rules are arbitrary or unrealistic. You feel guilty or inadequate when you “break” a rule, or get angry or frustrated when others do so.
Distortion: I should have enough time and energy after work to play with the kids. I feel guilty if I let them watch TV while I finish up some work instead, and I feel frustrated with my spouse when he/she does the same. 
Reframe: I want to have enough time and energy after work to play with the kids. But sometimes I will be too busy or tired. I will do my best to spend quality time with them, even if sometimes that means cuddling on the couch watching TV while I finish up some emails. On those nights when I really can’t find the time, I will give myself (and my spouse) grace.

10. Labeling: When someone makes a mistake, you don’t objectively evaluate the mistake. Instead you label the person – “I’m a failure” or “They’re an idiot.”
Distortion: He forgot to lift the toilet seat again! He is so inconsiderate. Or I forgot my kids had a half day today. I’m a terrible parent!
Reframe: He forgot to lift the toilet seat again. He must have had something else on his mind. Or I forgot my kids had a half day today. Today was really busy and I had too much on my mind. Maybe I need to write down half days on my calendar from now on.

11. Personalization: You think that things that others do or things that happen to you are personalized reactions to you, even if this is not the case.
Distortion: My friend didn’t return my text because she thinks I’m annoying.
Reframe: My friend didn’t return my text. Maybe she is really busy or has something going on in her life I don’t know about. Sometimes I forget to return texts too.

12. Probability Overestimation: You overestimate the likelihood of something bad happening.
Distortion: If I drive, I will get in a car accident, so I am not going to get my driver’s license.
Reframe: Accidents can happen anytime, but the odds are not high. Most people drive every day and nothing bad happens.

Cognitive distortions are not constructive, but experiencing a distortion every now and again is simply part of being human. However, when you are not able to reframe your distortions, or when cognitive distortions begin driving your behavior, they can become a problem.

Cognitive Behavioral Therapy (CBT) works to help clients notice, address, and alter these destructive thoughts. When you believe your own destructive thoughts, you may also tend to avoid certain situations on the basis of a false belief. CBT also works to help clients slowly learn to approach rather than avoid such situations. Having a warm, empathic therapist come alongside you throughout this process is healing. She can model compassion for you, helping you learn to have compassion for yourself, while still challenging you to see things in a new and healthier way.

If you find yourself feeling overwhelmed by cognitive distortions, stress, anxiety, and/or depression, you do not have to struggle alone.

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 csamsandiego@gmail.com.

THE POWER OF BREATHING

Jill Stoddard

by Annabelle Parr

Whether or not you struggle with an anxiety disorder, we have all found ourselves overwhelmed by stress or anxiety at some point.  We each have slightly different stressors that trigger our body’s natural stress response, but we all know what the response feels like: sweaty palms, racing heart, tense muscles.  This bodily reaction can feel overwhelming, as if it controls us.  It is easy to feel powerless to our biological response to stress, but we have more control than we think.

THE STRESS RESPONSE

Source URL: http://www.gestaltreality.com/2012/07/11/metabolic-diet-supplements-an-exploration/

Source URL: http://www.gestaltreality.com/2012/07/11/metabolic-diet-supplements-an-exploration/

Before we deem our biological reaction to stress bad, let’s talk about what happens and what purpose it serves.  When we get stressed out or anxious, our body begins preparing us to face threat.  Stress activates our sympathetic nervous system, triggering the fight-flight-or-freeze response.  This causes the sweaty palms, racing heart, panicky breathing and muscle tension (McGonigal, 2013).  We often look at the stress response as inherently bad, because it is not healthy to be in the fight-flight-or-freeze mode chronically (McGonigal, 2013).  However, it’s important to remember that when your heart starts racing or your palms get sweaty, your body is just trying to help prepare you.  Nevertheless, these sensations can feel overwhelming, and perpetuate our experience of anxiety.  So how can we calm ourselves down once this cycle is in motion?

DEEP BELLY BREATHING

Using our breath, we actually have the power to activate our parasympathetic nervous system.  The parasympathetic nervous system allows our body to “rest and digest” as opposed to the sympathetic nervous system’s fight or flight response (Hunt, 2016).  While “take a deep breath” is common advice, how we actually take that breath is important.  This is how to use the breath to calm down:

Source URL: http://goodrelaxation.com/2015/05/deep-breathing-for-headaches/

Source URL: http://goodrelaxation.com/2015/05/deep-breathing-for-headaches/

  1. Find a comfortable, relaxed seated position with your feet planted on the ground; alternatively, you can try breathing laying down.  Now begin to bring your focus to your breath.
  2. With each breath, your belly should rise as you inhale and fall as you exhale
  3. Your shoulders and chest should remain still.  If you notice your shoulders rise, or your chest move, drop the breath down to the belly.  Breathing into your chest is reminiscent of hyperventilating, which will only further activate your sympathetic nervous system (Hunt, 2016).
  4. Now focus on breathing into your belly for four counts.  Hold your breath for a second or two.  Now exhale for five counts and relax (Hunt, 2016).  Repeat this process, focusing on your inhalations and exhalations, and making your belly rise and fall.
  5. You may notice that your heart rate speeds up at first.  Don’t panic or give up.  Your body is not used to calming itself down, and is simply adjusting.  After a few cycles of inhaling and exhaling, you should notice your heart rate begin to relax. 
  6. If you begin to get distracted or thoughts pop into your mind, simply notice they are there and then come back to focus on the breath
Source URL: http://goodrelaxation.com/2015/05/deep-breathing-for-headaches/

Source URL: http://goodrelaxation.com/2015/05/deep-breathing-for-headaches/

See if you can practice doing four or five deep belly breaths a day.  Then see if you can work your way up to thirty seconds at a time.  Then maybe a minute.  Eventually, you will be able to sit in this space with your breath for a long period of time.

Being able to tap into your breath to find a calm, centered space, no matter where you are, is an invaluable resource.  This diaphragmatic breathing essentially turns off your sympathetic nervous system and turns on your parasympathetic nervous system (Hunt, 2016). 

This is not to say that you will never feel stressed again, or that you will never experience the fight-flight-or-freeze response.  But using deep belly breathing can help you to calm your body down and lessen the biological reaction to a stressful situation.

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:

Hunt, M. G. (2016). Reclaim your life from IBS: A scientifically proven plan for relief without restrictive diets. Toronto, ON: Sterling Publishing Co., Inc.

McGonigal, K. (2013, June). Kelly McGonigal: How to make stress your friend [Video File].  Retrieved from: https://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend?language=e

Mental Health, & Stigma as a Barrier to Social Support

Jill Stoddard

In honor of the National Alliance on Mental Illness (NAMI) San Diego's Mental Health Awareness Walk, this blog delves into the importance of social support for those with mental illness, and how stigma may become a barrier to the support that is needed by so many.

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