DEALING WITH BACK-TO-SCHOOL ANXIETY IN YOUNG CHILDREN

a guest blog post originally posted on SitterCity.com

As parents prepare their children for the school year to begin, it’s easy to get swept up in all the details: Are the school medical forms filled out? What’s left on the school supplies list? Have you found an after-school sitter yet?

Ticking off all the items on your family’s back-to-school checklist is important, but it’s equally important to pay attention to your child’s behavior during the weeks leading up to school. Anxiety about advancing to a new grade or starting a new school is normal; after all, people of all ages need time to adjust to a new situation. Here are a few ways you can turn those back-to-school jitters into excitement.

(Please note: If you suspect that something more than garden-variety jitters is going on, call your pediatrician who can refer you to a child psychologist for a consultation.)

Get some sleep.

A well-rested kid is a happy kid. While it’s fun to stay up late and sleep in during the summer, it’s important to get bedtime on track at least a week before school starts. Kids can feel grouchy, upset or fearful when they’re sleep deprived. Start practicing normal school day wakeups a week or two in advance so they get used to their new schedule.

Attend the open house. 

Schools often host an open house a couple weeks before classes begin. Be sure to clear your schedule for it — it’s an invaluable chance for your child to meet their new teacher and start feeling comfortable with them, as well as a chance to check out their new classroom.

Plan play dates. 

If you’re new to a school, open houses are also a chance for kids to mingle with their new classmates a little with the safety of you still being around, so they’re not making as many introductions on the first day of school. As you chat with the other parents, see if any of them are open to the idea of a play date, even if it’s just meeting up informally at the playground so your kids can continue to get to know each other.

Do a practice run. 

If your child is starting at a new school, take the time to do a dry run of the morning commute. On one of the mornings they’re waking up early, be sure to get them dressed and out the door on time, too. Practice walking or driving to school — whatever your normal commute will entail. If your child is taking a bus to school for the first time, drive along the bus’s route and answer any questions they might have about what school buses are like.

Eat at a cafeteria. 

Is this the first time your child will be eating a hot lunch at school? Go to a cafeteria-style restaurant to help them practice holding a tray, waiting in line, selecting from multiple options and sitting at a bench-style table. Even if you’re planning to pack a bag lunch, it’s doesn’t hurt to get your child used to a cafeteria-like environment.

Visit the library.

It’s time to do a little back-to-school reading! There are plenty of great children’s stories that address back-to-school anxiety. A few worth checking out are First Day Jitters by Julie Dannenberg; The Night Before Kindergarten and The Night Before First Grade, both by Natasha Wing; The Kissing Hand, by Audrey Penn; and Miss Bindergarten Gets Ready for Kindergarten, by Joseph Slate. Talk to your librarian to see if they have any other recommendations as well.

Take care of the details.

Pay attention to little things that will help make the first week of school smooth sailing. Have them pick out some new clothes and a new backpack for the first few days of school so there are no morning wardrobe meltdowns. If they’re bringing their lunch, plan out a few of their favorite meals ahead of time. Create a morning “launch pad” for backpacks and coats. These may seem like little things, but they can add up to a lot of stress for a child, and they’re easy to prepare for in advance.

Listen to them.

Keep those lines of communication open! Ask you’re child if they’re excited for school, what subject they’re looking forward to most and what friends they’re excited to see. If they’re experiencing social anxiety this is a good time to start talking it out and reassuring them. Being understanding and supportive is the most important thing you can do to ensure your little one has a great back-to-school experience.

The Importance of Boundaries

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-

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

Image source: http://quotesgram.com/img/quotes-about-healthy-boundaries/1HBuCAOAF6/

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

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.

THE POWER OF BREATHING

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/

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/

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/

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

How To Listen When Someone You Love Is Struggling

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/

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

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

Hoarding

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/

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.

Source URL:  http://hoardercleanuplosangeles.com/?p=59

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

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.   

Image source:  http://www.recovering-couples.org/

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

Image source:  http://www.dralexandrasolomon.com/common-fights/

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.

Image source:  http://claudialistens.me/couples/

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.