We all have busy schedules that can sometimes make self-care and stress management challenging. Many of us understand the importance of a daily 30-minute fitness regimen, meditation practice, or yoga class for our overall well-being. So are we out of luck when we don’t have 30 minutes in the day for a stress-buster? Are we doomed to be flooded by stress hormones all day long? Absolutely not. There is plenty we can do with only minutes in the day to de-stress.

Mini-mental health workouts can be the answer on these hectic days. Additionally, these exercises can be used to complement your other self-care practices to create even more stress management benefits. These mini-mental health breaks are fun and will help reduce stress hormones while leaving you feeling replenished and energized.

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While mini-mental health workouts can go a long way toward managing mood and decreasing stress levels, they should not replace more substantive self-care practices such as cardio workouts or yoga classes. Here are a few exercises anyone can easily incorporate into their daily activity to help de-stress and feel good:

1. Strike a pose: That’s right, do your best Wonder Woman or Superman pose with arms fixed on your hips and legs shoulder width apart for 2 minutes. Alternatively, celebrate like you just climbed Mount Everest, with hands raised above your head in a “V.” These are only a few of the power poses studied in 2010 by Amy Cuddy, social psychologist and professor at Harvard Business School. According to her research, 2 minutes is all you need to change your body chemistry to promote confidence while decreasing cortisol (stress hormone) levels. These simple poses can brighten your mood and reduce your anxiety in short order.
2. Pictures of nature: Don’t have time to go for a walk outside? Then try this trick for your brain, mind, and body. All you have to do is spend at least 5 minutes looking at snapshots of nature and greenery to potentially see a change in your stress levels. This powerhouse mini-mental break mobilizes the calming parasympathetic nervous system and may produce a relaxation response, leaving you feeling refreshed (van den Berg, et. al., 2015).
   These five simple and fast tools weaved into your routine may help increase your productivity while minimizing the energy-depleting effects of stress.
3. Listen to a song: Have a list of “feel-good songs” you can play when low on energy or feeling stressed. Rock it out for a couple of minutes when you need to. If you have some privacy, consider pairing your feel-good song with a dance party, your best air guitar, or air drumming for increased physical movement which will allow for the release of the feel-good chemical dopamine. The movement combined with the music packs an extra punch.
4. Simulated or genuine laughter: Laugh it up for a couple of minutes. Try watching a funny video clip or a scene from one of your favorite comedies. Laughter is often said to be the best medicine, and there is plenty of science to back that up. Since the 1980s, Dr. Lee S. Berk, a researcher at Loma Linda University, has found laughter has amazing benefits. She discovered laughter can mobilize the relaxation response in the body by decreasing stress hormones and stimulating the release of feel-good endorphins. If you can’t think of anything to help create a laugh, don’t worry—a simulated belly laugh can be just as powerful, with the same potential yield.
5. Deep breathing/diaphragmatic breathing: Taking deep, rhythmic breaths is one of the most powerful ways to put the brakes on the sympathetic nervous system and stimulate a relaxation response. This means taking in breaths through your nose to the count of five and then holding for five seconds before exhaling through pursed lips to another count of five (select a breath count that is comfortable for you) can have immediate positive effects. Many meditation practitioners and behavioral health experts believe deep breathing is one of the most powerful weapons in combating stress.

So next time you have to skip your cardio boot camp class, don’t fret—you still have options for stress management. By implementing these mini-mental health workouts into your day, you may be better able to manage your stress and mood. These five simple and fast tools weaved into your routine may help increase your productivity while minimizing the energy-depleting effects of stress.

All you need is 120 to 300 seconds throughout the day to employ these tools. Anyone can do that!

References:

1. Carney, D. R., Cuddy, A. J.C., & Yap, A. J. (2010). Power posing: Brief nonverbal displays affect neuroendocrine levels and risk tolerance. Psychological Science, 21(10), 1363-1368. doi:1177/0956797610383437
2. van den Berg, M. M. H. E., Maas, J., Muller, R., Braun, A., Kaandorp, W., van Lien, R., van Poppel, M. N. M., van Mechelen, W., & van den Berg, A. E. (2015). Autonomic nervous system responses to viewing green and built settings: Differentiating between sympathetic and parasympathetic activity. International Journal of Environmental Research and Public Health, 12(12), 15860-15874. doi: 3390/ijerph121215026

Somatic psychotherapists often use the informal metaphor of a “container” in describing a person’s state of overwhelm or resilience.

It’s a simple concept: If Janelle is experiencing a lot of stress, and/or her system isn’t very resilient, then one can say her container is overflowing, or close to it. On the other hand, if she successfully deals with her feelings and the external situations that cause them, she would create more “room” in her figurative container and she wouldn’t be so vulnerable to becoming stressed out. She could also work with a therapist in order to develop affect tolerance and self-regulation. She would then be making her container larger and less brittle, increasing her resilience across many life situations.

The container can be filled by our response to events earlier in our lives that we’ve repressed and not dealt with. Researchers and clinicians working with intergenerational trauma believe our containers hold the trauma passed down to us from the experiences of earlier generations. Such experience includes but is not limited to systemic racism and oppression. The field of epigenetics looks at changes in gene expression (which pieces of our DNA strands are being expressed, and which aren’t). These changes are thought to be responses to the environment, either current or historical. On the other hand, our containers can also be filled by present-day, acute stressors that we’re all too aware of. In practice, it’s usually a mix of both, and they can be interrelated.

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Sometimes it isn’t immediately evident how full the container is becoming, because we are experts at hiding this from ourselves and the world. When talking about this with a person in therapy, I’ll often use the metaphor of my coffee cup. It’s a metallic travel mug, and when I hold it up, you can’t immediately tell how full it is. It could be nearly empty, or it could be close to overflowing. (It’s just a visual example. No fair trying to gauge my mood in order to figure out how much coffee is inside me rather than still in the cup!)

If the level inside the cup gets too close to the top, it overflows easily. This overflow would represent having a “meltdown”: panic attack, relapse into addictive behavior, major depressive episode, etc. Sometimes this surprises the person, as they hadn’t been consciously aware of the rising level in their container.

Psychology is the study of human thoughts, feelings, and behaviors. It shares some overlap with sociology, political science, anthropology, etc. However, most clinical psychology focuses on the individual and their cognitive, developmental, marital, or family dynamics. After many years in this field, I would guess that the majority of what’s discussed in therapy rooms does not focus on larger cultural, sociopolitical, large-scale economic, or environmental factors. Or such factors may be acknowledged, but therapeutic interventions usually focus on the micro (person/family) rather than the macro (environment). In that sense, therapy can be a bit myopic at times.

If the level inside the cup gets too close to the top, it overflows easily. This overflow would represent having a “meltdown”: panic attack, relapse into addictive behavior, major depressive episode, etc. Sometimes this surprises the person, as they hadn’t been consciously aware of the rising level in their container.

However, just because we’re repressing something doesn’t mean it’s not affecting us and filling our figurative containers. The emerging fields of ecopsychology and ecotherapy assert that humans have an ecological unconscious. That is, since we are born of earth and our entire existence depends on our fragile biosphere (and the other species we share it with), anything threatening our planet causes stress and anxiety in us. Just about everyone I talk with has tremendous anxiety about the future of our environment, and for good reason. This often invisibly adds to the total “volume” inside our containers; and since people often tend to feel helpless about large-scale events, it may increase their tendency toward immobility and dissociation.

For some people, it might be a useful exercise to write out a list of all the things they can think of that could be impacting their stress levels. However, for many other people, if their container is filling up, then the exercise of looking at everything at once could send them into depression, immobility, or even panic (“Oh, my god, it’s so much worse than I’d thought!”). Somatic therapists are trained to gauge a person’s autonomic stress response on a moment-to-moment basis and intervene as needed, coaching the person in taking on a manageable amount at any one time, and using that experience to grow stronger.

In my opinion, the goal of therapy is to increase a person’s self-regulation, which increases coping, health, joyfulness, and myriad other desirable outcomes. People who are able to self-regulate tend to be more aware of their overall stress levels, including “whole-world issues.” They may be less prone to anxiety, depression, and immobility, so they can engage in effective self-care, including taking action to better their lives and the greater world.

References:

1. Bell, A. (2016). What is self-regulation and why is it so important? Retrieved from https://www.goodtherapy.org/blog/what-is-self-regulation-why-is-it-so-important-0928165
2. Sashin, J.I. (1985, April). Affect tolerance: A model of affect-response using catastrophe theory. Journal of Social and Biological Structures, 8(2): 175-202. Retrieved from http://www.sciencedirect.com/science/article/pii/0140175085900089
3. Shulevitz, J. (2014). The Science of Suffering. New Republic. Retrieved from https://newrepublic.com/article/120144/trauma-genetic-scientists-say-parents-are-passing-ptsd-kids
4. Smith, D.B. (2010). Is There an Ecological Unconscious? New York Times Magazine. Retrieved from http://www.nytimes.com/2010/01/31/magazine/31ecopsych-t.html
5. Weinhold, B. (2006, March). Epigenetics: The Science of Change. Environmental Health Perspectives, 114(3): A160-A167. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1392256/

In my therapy practice, I dedicate considerable time to helping people understand what’s happening deep inside of them, in the layers of the nervous system where the conscious mind blurs into the unconscious. This is the part of us that some therapists call the “bodymind.” Understanding the communication of the bodymind creates the ability to “talk” with our inner self: to understand what it is trying to tell us, and even to work with it in its own “language.” It is my experience that the bridging of this gap is ultimately what eliminates most symptoms.

My previous article on self-regulation explains that most symptoms that bring people to therapy are the result of, or strongly related to, difficulties in maintaining this biological balance. It’s important to be aware of this underlying process. After all, we can’t manage things if we’re not aware of them!

This article expands on our understanding of self-regulation. It’s about developing our capacity to be calm, aware, and present, even in stressful situations. For those who have genuinely struggled with this despite repeated and intense efforts, it’s time to stop blaming yourself. As it turns out, this capacity is largely biological. And although we often forget this, biology is the platform upon which social and emotional interactions play out.

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Self-regulation of the autonomic nervous system (ANS) can essentially be broken down into two opposing functions: it goes up or it goes down!

In a car, we can press the gas pedal to access more energy, or the brake pedal to slow down or stop. Similarly, the ANS has two parts, or branches: the sympathetic nervous system (SNS), which makes us go up into greater arousal, and the parasympathetic nervous system (PNS), which helps us come down into calmer, less aroused states.

Upregulation means there’s more firing of nerve cells (neurons) along a nerve pathway. So, upregulation of the SNS refers to when this “going up” branch of the nervous system is more active. This “pressing of the gas pedal” increases the amount of energy available in the body. This is why the SNS is often referred to as the “fight-or-flight” nervous system, although it can also upregulate in pleasant situations requiring more energy.

Its opposite, and the focus of this article, is downregulation. Sympathetic downregulation brings down the charge along the pathways of the SNS. At the same time, the PNS upregulates, which helps the SNS downregulate. (We will examine the important exception to this general rule in a future article.)

Both upregulation and downregulation of the SNS are biological processes that we can feel and experience happening within us. Recently, a woman I work with in therapy was able to describe the involuntary muscular tensions, unpleasant pangs, and fluttering sensations of her anxiety (upregulation). She also described the wonderful (downregulation) sensations of her body finally letting go into blissful sleep when she settles down in bed at night.

As most of us can intuit, SNS upregulation can feel terrible when it’s a response to something stressful happening. However, SNS upregulation can also feel great when it’s in response to something fun or exciting: our team scoring a touchdown, or dancing when our favorite song comes on. In contrast, SNS downregulation almost always feels soothing, calming, or relaxing.

I am focusing on SNS downregulation because it’s incompatible with states of anxiety, rage, or stress. Additionally, SNS downregulation keeps the SNS in check, so that it doesn’t “overshoot” and produce too much stress to effectively cope with a problem.

So, then, how do we encourage SNS downregulation? How do we help the body settle down into a state in which it can rest, digest, and repair? For that matter, how do we know when we’re in a downregulated state?

Well, here’s the catch. Downregulating the stress response is an acquired capacity. It’s like a muscle: you have to build it over time in order for it to be strong.

Although infants are born with the capacity for stress response (fussing, crying, etc.), their parasympathetic pathways, which help downregulate the SNS stress response, are not online at birth. This means babies can go up, but they can’t come down on their own. (They will go into a “freeze” state if ignored long enough; this looks calm, but it really isn’t.) The baby’s nervous system develops the ability to calm down through thousands and thousands of supportive, soothing interactions with caregivers. At first, the caregiver is essentially functioning as the child’s parasympathetic nervous system. The development of this “braking system” continues throughout childhood, through continued positive interactions that meet the child’s needs.

There are many situations in which a child may not receive enough soothing in order to learn to downregulate sufficiently. These situations are not always the fault of the parents. Perhaps the child’s mother had a lot of her own unmanaged anxiety, was depressed, and/or experienced posttraumatic stress. Or maybe the family lived in poverty, with constant stressors impacting everyone’s sense of safety. Perhaps someone in the family passed away or suffered a major illness, rendering them unavailable for care. Maybe the child grew up in wartime or, unbeknownst to their parents, was frequently bullied at school.

Great things happen when we are parasympathetically dominant. Our breath is full, slow, and deep. The digestive system works well. The body can focus on repair, including reduction of inflammation, tissue repair, and hormone production. Subjectively, people feel fully present and alive. Many report feeling a pleasant softness and warmth, perhaps even throughout their bodies.

It’s important to point out that disconnecting from stress is not the same as resolving (downregulating) it. Alcohol and drugs, eating disorders, exercise or sexual compulsion, or even “zoning out” on the internet may make the chronically stuck upregulation of the SNS seem to go away for a time. However, as the people I work with in the therapy room could tell you, it’s not the same as sinking into a lovely, full-body sense of calm and relaxation.

Great things happen when we are parasympathetically dominant. Our breath is full, slow, and deep. The digestive system works well. The body can focus on repair, including reduction of inflammation, tissue repair, and hormone production. Subjectively, people feel fully present and alive. Many report feeling a pleasant softness and warmth, perhaps even throughout their bodies. When the SNS is on “standby” and the PNS is more active, people have a “buffer” for stress. They have energy to get through their day, but they can stay calm and present in challenging situations.

One of my first tasks in therapy is to assess and support the person’s ability to downregulate their stress responses. After they are provoked by something, how quickly and smoothly does their system deactivate? Are they still bothered by a small aversive event hours or days afterward?

Here’s a vital point often overlooked by therapists who haven’t had sufficient training in this area: In therapy, it is essential to make sure the person has the ability to downregulate the stress response before going into highly stressful material. In other words, you should never go into material that’s overwhelming, because overwhelming inherently means it’s bigger than your capacity to deal with it. So instead of the issue resolving, more symptoms arise. The way around this is to first support the capacity for downregulation. Then, only after this “braking system” is on board, take the difficult material a small bit at a time.

If someone doesn’t have a strong enough ability to come out of the stress response, how can they develop it?

• Therapy: Working with downregulation of the stress response can be tricky, as it involves the deepest survival energies of the body. It is advisable to work with a therapist who has extensive training in this area. Remember, SNS downregulation was originally designed to come online under the guidance of another person (usually a parent) whose nervous system is well-developed.
• Relaxation: Some people benefit from seeking activities or situations that cause the relaxation response and then deliberately spending time “feeling into” the resulting good sensations in their body. However, in relaxation states, some people experience a rebound in tension, stress, or anxiety. This is called “relaxation-induced anxiety” (RIA) or, in severe cases, “relaxation-induced panic.” In my experience, people with RIA are well served by working with a trained practitioner.
• Physical exercise: Exercise is often helpful, as it tends to burn off excess SNS charge and encourage the production of endorphins. Exercise promotes good mood, self-esteem, and a sense of accomplishment.
• Meditation: There are many forms of meditation, some of which specifically aim to produce downregulated states. However, in my experience, meditation can be unhelpful for some people who have a lot of traumatic response stored in their nervous systems. In these cases, their nervous systems simply won’t cooperate, and those around them may not have the awareness or tools to work with this issue.
• Resonance: Simply put, resonance is the feeling you get from being around another person or other living being. I usually explain it by asking people to think of how they feel when they place their open palm onto the rib cage of a calm, happy dog. That feeling of warmth, relaxation, and well-being is a downregulatory feeling obtained via resonance with the dog’s nervous system. Of course, when others around us are tense, our bodies tend to pick up on that and become tense too. Thus, being around stressed, anxious, or angry people is usually the opposite of what’s needed to develop SNS downregulation.

In summary, the ability to go within and really settle oneself is developed during infancy and childhood. This capacity to downregulate stress states is important in maintaining health, relationships, and happiness. Those whose life circumstances didn’t permit development of this capacity during childhood can still develop it through awareness and work with a skilled professional.

References:

1. Dychtwald, K. (1986). Bodymind. New York, NY: Pantheon Books.
2. Hamblin, J. (2012). Relaxation-induced anxiety. The Atlantic. Retrieved from http://www.theatlantic.com/health/archive/2012/11/relaxation-induced-anxiety/265313
3. Moore, M., Brown, D., Money, N., & Bates, M. (2011). Mind-body skills for regulating the autonomic nervous system. Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. Retrieved from http://www.dcoe.mil/content/Navigation/Documents/Mind-Body%20Skills%20for%20Regulating%20the%20Autonomic%20Nervous%20System.pdf
4. Sharma, A., Madaan, V., & Petty, F. D. (2006). Exercise for mental health. National Center for Biotechnology Information. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658
5. Yuan, J., McCarthy, M., Holley, S., & Levenson, R. (2010). Physiological down-regulation and positive emotion in marital interaction. UC Berkeley Information Services and Technology. Retrieved from http://www.learningace.com/doc/1047040/bc95860e894457e838c865c3b7297551/206-physio-down-regulation-and-posemo-in-couples

Stress has a way of upending our lives—it can cause tension in our relationships, anxiety in our thoughts, and tightness in our bodies. You may have a self-care practice in place, or yours may need some shoring up.

Either way, mindful music listening can be a wonderful way to reduce your stress and reconnect with your body and breath. Mindfulness—the practice of being in the present moment—can be practiced at any time and anywhere. I often use mindfulness exercises with people in therapy as a way to tune into their body, breath, and mind. Mindfulness is not about having an empty mind, but simply noticing whatever is there, thoughts and all.

However, if you find mindfulness challenging (or haven’t tried it!), the addition of music can help you stay focused, while simultaneously helping you to connect with music as a source of strength and creative energy. Music can be a powerful way to experience the present moment.

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Take a moment to think about the music in your life. Do you listen to music regularly? Is it live music? Recorded music? What kind of music moves you? Helps you relax? Energizes you? Do you play an instrument or sing? What music do you hear around you (perhaps music your kids or partner listen to)?

Now think about your relationship with music for a moment. Is it a source of frustration or a joy? Do you feel disconnected from music sometimes? Does music soothe you when nothing else seems to work? Do you have a lot of music on your phone but never listen to it?

Whether you listen to music all the time or rarely, mindful music listening can help you slow down and be in the moment. Here’s how:

1. Choose a piece of music to listen to. I usually use instrumental pieces, as lyrics can add a whole extra layer, but it’s up to you. It can either be a familiar or unfamiliar piece (it’s interesting to repeat this exercise with the opposite of what you choose this time, just to notice if anything feels different).
2. Take a moment to breathe and ground yourself—no matter where you are, or what’s going on around you. Inhale gently through your nose, and exhale deeply through your open lips. Notice your body, and tune into how it feels, whether you’re standing, sitting, walking, or laying down. Just notice any physical structures your body is touching (the floor, the chair, or your shoes) as well as any physical sensations (tightness, tension) in your body.
3. Just listen. Use headphones or earbuds if that helps you focus or shut out external noise. Give yourself permission to only listen to the music, without simultaneously checking your email or refreshing your Facebook feed. If it helps, close your eyes (if that’s challenging, it’s likely because you really need the break!).
4. Notice. Let yourself be aware of anything you notice, without judgment or self-criticism. Notice the pace of the music, the sounds of the different instruments, or the shifts in volume. Notice if you’re more aware of a certain part of your body as you listen (i.e., “I often feel vibrations of cello music in my chest”). Notice any thoughts or feelings that come up—perhaps the music is connected to a memory, or perhaps an anxious thought is trying to pop through. Let any thoughts just pass through your awareness, and then gently bring yourself back to the sounds of the music.
5. Reflect. Take a moment to breathe and check in with your body, breath, and mind (see step 2). Does anything feel different? Do you notice any shifts after listening to the piece of music? Do you feel calmer? If the piece you chose didn’t feel like a good fit, what might you look for in another piece (i.e., slower, fewer instruments, louder)?

This short mindfulness experience can be a useful thing to practice daily, much like meditating. You might experiment with different types of music as a way to notice different responses. You may also find that repeating the same piece of music is a sort of touchstone, a way to continually reconnect to that place inside where gentle pausing and noticing can happen with ease.

I’d love to hear what piece of music you chose to listen to. Feel free to leave a comment below.

When you find yourself between jobs and under pressure to find a new one as quickly as possible, depression and anxiety are real risks. Attending interview after interview and receiving rejections—or, worse, hearing nothing—can be discouraging, especially when the interviews seemed to go well, and feelings of frustration, anger, and depression can develop. Anxiety can accompany these feelings: What if I mess up this interview? What if I can’t find a job? How will I pay my bills? How will I provide for my family?

These thoughts can be debilitating. They may loop repeatedly, keeping you up at night, affecting your mood, and causing more stress. Thought patterns like these also have the potential to affect productivity and the ability to think clearly, which can have a negative impact on the job-hunting process.

To improve your outlook and ability to think clearly, deeply, and strategically during your job search, try the following tips:

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Separate Planning from Doing

When you are anxious about your career prospects, you may find yourself wanting to do something—anything—to get a job. But anxiety can narrow your thinking tremendously. You may find yourself making list after list, plan after plan, but stall before completing these tasks. Separating planning from doing can make it easier to stay productive and focused on realistic goals. Planning the steps you will take in the following days and weeks can be helpful, but carrying out the steps you’ve listed is not only likely to help you feel a sense of achievement, but may pay off in the form of a job.

Write It Down

Set aside a specific time every evening to write down how you will make the best use of the next day. Doing it in the evening is key. If you try to do this in the morning, there is a sense of urgency that compels you to just do something, and this is likely to detract from your focus rather than increase it. Actually put pen to paper so your plan can be by your bedside when you wake up and so you can cross things off when you finish them. Making a plan for the next day at night can also help you relax before bed: you’ll already know what you need to do the next day, and you can take a break from thinking about it.

Exercise Daily

Include at least an hour of exercise in your daily written schedule. Exercise can boost your mood, help relieve stress, and help you sleep. An added benefit of exercise is a change of scene: sitting at home in front of a computer or on the phone can make anyone short-sighted. Movement, fresh air, and activity can help you regain perspective.

Try Strength Training

Consider strength training in addition to daily cardiovascular exercise. Strength training does more than build muscles: it can improve self-confidence, which can be a benefit when trying to sell yourself in the job market. A gym membership isn’t necessary: push-ups, crunches, dips, squats, and calf raises are all great exercises that require no equipment. A mini-workout is also an excellent antidote for moments of paralyzing stress. For moments of extreme anxiety, try spending five or 10 minutes doing super-sets.

Don’t Isolate

An item that should be on every job hunter’s daily schedule is social contact. Social contact might be meeting a friend for lunch or even a phone conversation with a supportive family member. Many people instinctively react to hard times by isolating, but this tendency is often a factor in feelings of depression and anxiety. Resisting the urge to isolate can help combat these feelings and may prevent them from developing or becoming overwhelming.

Find Fun Things to Do That Are Free or Inexpensive

Money being tight can have an impact on your typical social activities, but don’t let that keep you stuck in the house.

Money being tight can have an impact on your typical social activities, but don’t let that keep you stuck in the house. Think of things to do that cost little or nothing, and invite someone you care about to join you. Make plans to take a walk, prepare a meal from scratch, or host a tea or coffee social. Keep an eye out for free things to do. Libraries often have daytime, weekend, and evening activities for children or adults, and many museums have free admission one day a month.

Be There for Others

Being in between jobs doesn’t mean you have nothing to offer—you are still the good friend you were when you had money. If it becomes challenging to believe this and self-doubt or self-pity become overwhelming, think of someone who might like to hear from you and give them a call or send a text. Volunteering is another way to fight isolation, and it has the added benefit of allowing you to give back to the community. Volunteering can also provide valuable networking opportunities.

Keep a Regular Sleep/Wake Schedule

Going to bed and waking up at the same time every day can help you stay productive and will also regulate your mood. Set an alarm Monday through Friday, and go to bed early enough to get a full night’s sleep so you are well-rested and ready to do your best in the morning. When you have a whole day to yourself it can seem like you have all the time in the world, but this time goes by quickly. Having a plan for each day can help you make the most of your working hours and help prevent feelings of self-recrimination at the end of the day. A regulated sleep/wake pattern may reduce the risk of depression or be part of a treatment strategy. Eating and exercising at the same time each day can help, too.

Take Time for Reflection to Solidify Learning

Taking time to reflect can increase your chances of learning from your experiences. At the end of each day, look at your list and cross off the things you’ve accomplished. Try writing down what you feel proud of accomplishing that day. Give yourself credit for the steps you took, big or small, toward re-employment and toward staying focused and healthy. Consider whether there is anything you want to do differently the next day. Did you learn any lessons or discover any changes to make? Put your energy into making these changes, not being hard on yourself for any mistakes, in order to have an even more productive day tomorrow.

References:

1. Bayer, R. (2009, February 20). Stress management – 11 tips to help you sail through your job search. Retrieved from http://www.itworld.com/article/2770626/careers/stress-management—11-tips-to-help-you-sail-through-your-job-search.html
2. Landau, E. (2012, June 15). Unemployment takes tough mental toll. Retrieved from http://www.cnn.com/2012/06/14/health/mental-health/psychology-unemployment
3. Warrell, M. (2012, June 12). Bouncing back from job loss: The 7 habits of highly effective job hunters. Retrieved from http://www.forbes.com/sites/womensmedia/2012/06/12/bouncing-back-from-job-loss-the-7-habits-of-highly-effective-job-hunters/#4ee648725b15

By nature, humans are emotional creatures. When things are going well, you are likely to experience positive emotions that often lead to increased motivation and productivity. However, in times of hardship or stress, it can be challenging to leave negative feelings at home and keep them from impacting your work.

Whether you work in an office or from home, staying productive in times of personal crisis is no easy task. When a loved one is diagnosed with an illness, a pet passes away, or your partner loses a job, the added stress, grief, or anxiety can be distracting and sometimes even debilitating.

At some point, you may face a time when life stressors come up, and you may not be able to put your professional life on hold. Here are 11 tips to help you stay focused and remain productive in a time of personal crisis.

1. Adjust Your Schedule

In a time of crisis, you may need to adjust your schedule to accommodate personal matters. Time management is key to maintaining your professional life when your personal life requires more attention than usual.

Take a look at your schedule and see how you can adapt it. In medical situations, you may need to attend health appointments in the mornings and work later in the afternoon, or vice versa. Try to plan your day efficiently to maximize the value of the time you are able to put in at work. Consider scheduling your time in blocks with frequent breaks. Taking a break can help you reset and prevent emotional overwhelm.

2. Practice Self-Compassion

Be gentle with yourself. Don’t beat yourself up for not performing as well as you think you should. Remember: you are human. If you’re grieving the loss of a loved one, anxious about a medical diagnosis, or stressed about some other personal matter, allow yourself to recognize your emotions as a normal part of the experience.

Feeling distracted or foggy during stressful times is not uncommon. It may take time to bounce back, so give yourself a break. Honor your feelings and do the best you can under the circumstances. Praise yourself for what you do manage to accomplish rather than feeling frustrated by any difficulties you may be experiencing.

Amy Armstrong, LPC, suggests embracing difficult emotions rather than suppressing them.

“For many of us, it’s tempting to tamp down those unpleasant feelings and hide them. This usually just increases your stress levels,” Armstrong said. “Confide in friends you trust. Get professional or peer support, if you are comfortable with that. Go for a run. Have a good cry. Most importantly: feel what you need to feel and let it out. I’m not advising anyone to freely cry at their desk because that can be problematic in other ways, but it’s important to own your feelings and give yourself an outlet. If you can do it in a fairly controlled way, those emotions are less likely to just pop up in places where they are less helpful to you—like in the middle of a stressful meeting.

3. Share with Discernment

[fat_widget_right]When times are tough, talking about your situation can provide you with support and help you process your emotions. However, it is important to use discernment when sharing personal details.

Depending on your situation, you might be obligated to share some information with your supervisor, but you may want to be more cautious when sharing information with coworkers.

Ask yourself how sharing this information could impact the relationship and your personal situation. Do you work in the type of workplace that is friendly and open with personal concerns? Are you prepared to hear any advice or input your coworkers may have about your situation? How might telling your coworkers impact your performance at work?

In some instances, sharing your situation with your colleagues may make things easier for you. In others, it could become more challenging. Consider the effects and use discernment before you choose to share.

4. Practice Living in the Moment

Meditation and mindfulness practices can help you embrace the moment and find feelings of inner peace and acceptance even during the hardest of times. By practicing being present, you can prevent yourself from ruminating about your problems, dwelling on the past, or worrying about the future. A daily meditation practice can help you to remain mindful and present at work and help you stay focused on the task at hand.

It may also be helpful to reframe your time at work as an escape from what is happening in your personal life. Focusing on another task can provide temporary relief from any turmoil or crisis you may be dealing with at home.

5. Use Your Support System

Sometimes it can be tough to ask for help from others, even when it is needed the most. If you are dealing with a crisis, it can be very difficult to stay productive without a solid support system. Seek out the people in your life who you can count on during times of hardship and reach out to them. Perhaps you need someone to take your child to school, prepare meals, clean the house, or just to listen to you. If you try to maintain everything on your own, you’re more likely to experience emotional overwhelm, which will not only increase your stress, but it can wind up making you less productive in the long run.

6. Prioritize and Delegate

Recognize that your productivity potential will likely be lower during times of crisis. So make the best use of the productivity you have by prioritizing your tasks. Create to-do lists and prioritize the most important tasks first.

“Even though it’s difficult, this is a time to be diligent about saying no to extra commitments to people in your personal and professional life,” Armstrong said. “You’ve gone the extra mile for others when they were having difficulties, and you can do so again, but this isn’t the time.”

Delegating tasks to others can also be helpful. Look to your co-workers for assistance when possible, rather than trying to conquer everything on your own.

7. Practice Self-Care

When you are under a large amount of stress, it can be easy to forget about the importance of taking care of yourself. In times of crisis, people tend to be more vulnerable and self-care may be more important than ever. Do your best to take good care of yourself. Remember to eat healthy foods, exercise, and take time to rest.

“Self-care during times of personal crisis is crucial,” Armstrong said. “Don’t skimp on things like sleep, baths, workouts, walks, massages, or just time spent kind of zoning out for 10 minutes. Taking the time to take care of yourself is the best investment you can make during difficult times. It helps you maintain your resilience (and your sense of humor) when you need it the most.”

8. Acknowledge Difficult Days

Remember you are human. You are allowed to feel emotions. Some days will be more difficult than others. There may be days when you don’t have the strength to get out of bed. Even when you’re trying so hard to focus on what’s important, some tasks may slip your mind, and that’s okay.

“Even though it may sound selfish and may seem like everyone says this, if you are going through a personal crisis, you need to make sure that you put yourself first and are honest about what you can and cannot do,” Armstrong said.

Don’t berate yourself for your feelings. Instead, allow yourself to feel the emotions at the surface, knowing that everything passes in time.

9. Choose Positive Coping Skills

Stress often makes it easier to reach for a vice. Whether it’s smoking cigarettes, drinking alcohol, overspending, gambling, or some other addictive habit, everyone has weaknesses. While vices may relieve some stressful feelings immediately, they usually wind up making things worse and increasing stress over time.

Rather than engaging in a bad habit, use positive coping mechanisms to deal with your stress. These might include spending time with loved ones, exercising, eating a healthy and delicious meal, napping, meditating, trying a new hobby, or working on a creative activity.

10. Take Some Time Off

As much as you might want to be productive, sometimes it is necessary to take some time off to heal. If things get too challenging to maintain, use some of your vacation or sick days and take some time away from work.

Though Armstrong advocates for a combination of an improved self-care routine, increased exercise, and therapy, she suggests people do an honest self-assessment on how they’re coping with everything.

When you are under a large amount of stress, it can be easy to forget about the importance of taking care of yourself. In times of crisis, people tend to be more vulnerable and self-care may be more important than ever.“If you are seriously considering taking a leave of absence from work, talk to your doctor and mental health professional as soon as possible regarding appropriate documentation. Also, contact your Human Resources department regarding the Family and Medical Leave Act (FMLA),” Armstrong said. “Do not tell your manager or co-workers about your personal crisis. It may seem tempting, but if you are considering a leave of absence, it is crucial that all of your information remain confidential and that starts with you. Even the Human Resources department should only be provided with the minimum amount of documentation required to substantiate your request for leave, and all of that should come from medical professionals, not you. It’s important to remember this because even though nobody is supposed to press you for details, they often do.”

Armstrong suggests the best time to request a leave of absence is before a personal crisis starts to affect your work performance. Don’t be afraid to ask for what you need from your employer. Oftentimes, people will be willing to work with you to come up with a solution that works for everyone. Many people may feel guilty for missing work, but remember emotional crises can sometimes be as debilitating as physical illnesses, and some time off may be the best way to start the healing process.

11. See a Therapist or Attend a Support Group

Therapists and counselors play an important role in helping people cope with a crisis. Psychotherapy can help individuals assess their situation and create positive coping skills to manage their stress.

Support groups can also be a valuable means of support. They are widely available for those facing many different life challenges, from cancer to divorce to drug addiction. Whatever you’re dealing with, being able to talk with another person who can empathize with your situation can be helpful.

I just realized a few days ago that April is (or was—it’s almost over) Stress Awareness Month. This is fitting, considering just last week I wondered why the world seems to be piling one stressful situation after another upon my shoulders. It seems like just yesterday, yet also decades ago, it was April 1 and I was bummed I didn’t have time to plan any April Fools’ Day jokes, and now all of a sudden the month is nearly over and I’m wondering where the past several weeks went.

When things get busy and life gets hectic, our physical and mental health tend to pay the price. I’ve noticed a trend regarding coping with stress among several of the individuals I work with: when it rains, it pours, and when stress begins to pile up, it doesn’t just add up—it seems to multiply.

Over the past several weeks I’ve faced several situations that have generated various levels of stress: running a fundraiser, helping with a difficult move, dealing with sick kids, fielding crisis work calls, figuring out summer plans, and trying to maintain a good work-life balance. In and of themselves, each of these things would have been relatively easy to plan for and tackle, but it’s when we are pulled in a million directions and can’t seem to get a break that we become overwhelmed by stress.

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I stopped at the pharmacy the other day, between leaving a meeting and picking up my daughter from school, only to find my sick dog’s prescriptions hadn’t been filled and I needed to contact the vet. I nearly had a meltdown. I got back in my car feeling like an utter wreck because I really wanted to just break down and cry.

So often I find that on top of the stress, people tend to pile on a load of guilt. They beat themselves up for feeling stressed, argue that their stressors are not “big deals,” claim they “should” be managing better, and talk about how other people are able to handle these things with “ease.” Along with the stress and feelings of guilt come engulfing feelings of “I suck” and “I’m weak.”

What people fail to realize is, while each thing may be relatively insignificant on its own, it’s the combination of a lot of little stressors at once that ends up getting the best of us. Sure, most people could handle a setback at the pharmacy, but when the car breaks down, your babysitter is late, you double book an appointment, and you can’t seem to fight off a cold all at the same time, many people would feel, at the very least, irritable.

During therapy sessions, I often put my hand out in front of me to demonstrate the threshold for stress of the person I’m working with. And as I list all the issues they are dealing with, I raise my hand up, up, and up. When you are dealing with stressors that fall under or meet the original threshold, you are able to cope, keep it together, and effectively manage your various tasks. But as you pile more and more stressors atop that threshold, you may become overwhelmed, run down, and irritable.

Sure, most people could handle a setback at the pharmacy, but when the car breaks down, your babysitter is late, you double book an appointment, and you can’t seem to fight off an irritating cold all at the same time, many people would feel, at the very least, irritable.

It doesn’t matter how minor or insignificant an event may be. Whether it’s a little aggravation or a major trauma, you can be pushed over your threshold and sent into a tailspin. Negative emotions, such as anger, frustration, depression, and despair, can become heightened, and for some people, physical symptoms such as stress headaches or muscle tension can set in.

Rather than beat yourself up for feeling like a complete basket case, take a step back and acknowledge you have a lot on your plate. Sometimes just bringing awareness to your stress can help keep it at bay. When you recognize you are overwhelmed and can let go of any feelings of guilt, you open yourself up to a greater capacity to face the challenges at hand and to more effectively organize a strategy to tackle everything on your agenda.

Take a step back. Breathe. Remember to take care of yourself—take breaks, eat, and get rest. It’s easy to forgo good self-care when we are stressed and overwhelmed, but doing these things will help you recharge and be better equipped to cope.

During my string of stressful weeks, I decided to put as much as I could on hold and get to the gym. As I ran, I listened to the song “Let It Go” from Disney’s Frozen (the only thing currently on my iPod; updating it has been on my long to-do list for months!). I heard the lyrics: “It’s funny how some distance makes everything seem small. And the fears that once controlled me can’t get to me at all!” Oddly, these words helped put everything into perspective. It made me realize I need to practice what I preach, take a step back, and acknowledge I was feeling overwhelmed.

The Holmes-Rahe Stress Inventory is a scale originally used to determine whether stressful events may cause various illnesses. I like to encourage people to become familiar with this inventory because, sometimes, just being aware you’re dealing with one or more items on this list can help you recognize you’re nearing that stress threshold.

Once you are aware you’re facing stress, experiment with strategies that work for you. Many people find it useful to make to-do lists, break things down into smaller chunks, and cross things off as they go. Some people need to take a step back and put things into perspective, while others need a reminder to ask for help and support. Having a mantra or affirmation to connect to during times of stress, such as “this, too, shall pass,” can also help keep you grounded.

Compassion fatigue can be a serious occupational hazard for those in any kind of helping profession, with a majority of those in the field reporting experiencing at least some degree of it in their lives. This is no surprise, as it is typically those with the most empathy who are the most at risk.

Compassion fatigue is characterized by physical and emotional exhaustion and a profound decrease in the ability to empathize. It is a form of secondary traumatic stress, as the stress occurs as a result of helping or wanting to help those who are in need. It is often referred to as “the cost of caring” for others who are in physical or emotional pain. If left untreated, compassion fatigue not only can affect mental and physical health, but it can also have serious legal and ethical implications when providing therapeutic services to people.

While it is not uncommon to hear compassion fatigue referred to as burnout, the conditions are not the same. Compassion fatigue is more treatable than burnout, but it can be less predictable and may come on suddenly or without much warning, whereas burnout usually develops over time.

Because it can arise so abruptly, it can be important for therapists and others in the helping professions to protect themselves from this condition. Here are 11 ways to prevent compassion fatigue from happening to you:

1. Get Educated

If you know you are at risk for compassion fatigue, taking the time to learn the signs and symptoms can be a helpful means of prevention.

The most common signs and symptoms of compassion fatigue include:

• Chronic exhaustion (emotional, physical, or both)
• Reduced feelings of sympathy or empathy
• Dreading working for or taking care of another and feeling guilty as a result
• Feelings of irritability, anger, or anxiety
• Depersonalization
• Hypersensitivity or complete insensitivity to emotional material
• Feelings of inequity toward the therapeutic or caregiver relationship
• Headaches
• Trouble sleeping
• Weight loss
• Impaired decision-making
• Problems in personal relationships
• Poor work-life balance
• Diminished sense of career fulfillment

[fat_widget_right]Knowing the signs and symptoms and continuing to check in with yourself can help you better prevent and manage compassion fatigue if it arises. Many people find that ranking their level of compassion fatigue on a scale of 1-10 is an effective strategy. For example, a rank of 6 might mean you are declining social invitations due to feeling drained and a 7 might be difficulty sleeping due to excessive worry about someone else’s well-being.

Cultivating a high level of self-awareness and understanding of how your 6 differs from your 7 can help you gage where you are so you can implement necessary strategies to avoid the red zone that would likely be a 9 or 10.

It is not only the work itself that poses a risk, but the person’s life conditions as well. For example, someone who is not only taking care of people at work, but also caring for a child or adult family member at home may be even more susceptible to compassion fatigue. If you are currently experiencing increased life stressors at home as well as in the workplace, prevention strategies against compassion fatigue may be important.

If you think you may be experiencing compassion fatigue, you can take a compassion fatigue self-assessment developed by the Compassion Fatigue Awareness Project here.

2. Practice Self-Care

Practicing self-care can be a critical method of protecting yourself against compassion fatigue. It is not uncommon for those who are constantly concerned with the needs of others to wind up neglecting their own.

Those who practice good self-care are significantly less vulnerable to stress and compassion fatigue than those who fail to do so. A good self-care regimen will look different for each person, but it should generally include:

• Balanced, nutritious diet
• Regular exercise
• Routine schedule of restful sleep
• Balance between work and leisure
• Honoring emotional needs

Making time for these self-care activities leaves less room for overworking, which can lead to compassion fatigue, said Nicole Urdang, MS, NCC, DHM, a holistic psychotherapist based in New York.

“Overworking is often at the heart of compassion fatigue and its first cousin: vicarious trauma,” Urdang said. “Taking the very best care of yourself includes setting limits.”

3. Set Emotional Boundaries

It can be especially important for therapists, social workers, nurses, and caregivers alike to set firm emotional boundaries to protect themselves. Empathy and compassion are generally at the forefront of a human services career.

If left untreated, compassion fatigue not only can affect mental and physical health, but it can also have serious legal and ethical implications when providing therapeutic services to people.The challenge is to remain compassionate, empathetic, and supportive of others without becoming overly involved and taking on another’s pain. Setting emotional boundaries helps maintain a connection while still remembering and honoring the fact that you are a separate person with your own needs.

If people in a human services career are exposed to too much trauma, they may begin to feel overwhelmed, and people may feel that overwhelm in different ways, Urdang said.

“It might manifest as insomnia, overeating, skipping meals, addictive behavior, isolating oneself, depression, anxiety, or anger. We might find ourselves fighting with partners or children, having no patience, feeling exhausted, noticing a lowered libido, unmotivated, and, paradoxically, being less interested in what our clients have to say,” she said. “Believe it or not, these are all helpful, as they quickly alert us to our depleted state. If we are paying attention and are committed to radical self-care, we can act on this awareness by rebalancing our life. If that is not possible, simply taking short breaks throughout the day to close your eyes, focus on your breath, or put your hands on your heart and send yourself some compassion can all make a big difference.”

4. Engage in Outside Hobbies

Maintaining a solid work-life balance can help protect you from compassion fatigue. When all your time is spent working or thinking about work, it can be easy to burn out. Studies have shown work-life balance is becoming more important to workers, and making time for leisure activities and personal hobbies outside of work can help lower stress levels and improve overall life satisfaction.

5. Cultivate Healthy Friendships Outside of Work

While it is great to have strong relationships with your co-workers, it is equally important to cultivate and maintain healthy relationships outside of work. It can sometimes be difficult for co-workers to avoid talking about work even outside the workplace. Connecting with friends who are not aware of the ins and outs of your work situation can provide much needed emotional and professional relief.

6. Keep a Journal

Journaling is an excellent way to process and release emotions that may arise from your line of work. Taking the time to cultivate self-awareness and connect with your personal thoughts and feelings can help prevent suppression of emotions, which can lead to compassion fatigue over time.

7. Boost Your Resiliency

Resilience is our ability to bounce back from stress. While some people seem to naturally be more resilient than others, resilience is a skill that can be learned and cultivated.

“Resilience can be thought of as the ability to adapt to and become stronger through adversity,” said Marjie L. Roddick, MA, LMHC. “It can be a protective factor against compassion fatigue, so those with higher resiliency are better able to prevent compassion fatigue. Resilience is something that can be learned, and enhancing or boosting it can reduce the effects of compassion fatigue as new coping methods are learned.”

8. Use Positive Coping Strategies

While it may be tempting to wash away the stress and emotional burdens of your job with alcohol or drugs, this can actually work in the reverse and compound stress in the long run. Consider making a list of positive coping strategies to use in times of stress. This might include deep breathing, meditation, taking a walk, talking with a friend, watching a funny movie, or relaxing in a hot bath.

9. Identify Workplace Strategies

Workplace strategies are often an important part of compassion fatigue prevention. If your employer does not currently have any in place, consider suggesting their implementation.

Some workplace strategies that have been proven to be beneficial are:

• Support groups and open discussions about compassion fatigue in the workplace
• Regular breaks
• Routine check-ins
• Mental health days
• Onsite counseling
• Relaxation rooms, massage, meditation classes, etc.

10. Seek Personal Therapy

If you find yourself feeling emotionally vulnerable, significantly stressed, or overwhelmed, consider seeing a therapist who can help you process your feelings and implement strategies to help you combat compassion fatigue and maintain a healthy work-life balance.

References:

1. Badger, K. (2008). Preventing compassion fatigue: Caring for ourselves while caring for others. Phoenix Society’s Burn Support News. Retrieved from http://www.phoenix-society.org/resources/entry/preventing-compassion-fatigue
2. Brooks, C. (2013, March 5). Career success means work-life balance, study finds. Retrieved from http://www.huffingtonpost.com/2013/03/05/career-success-means-work-life-balance_n_2812707.html
3. Boyle, D. A. (2011, January). Countering compassion fatigue: A requisite nursing agenda. The Online Journal of Issues in Nursing, 16, (1). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-16-2011/No1-Jan-2011/Countering-Compassion-Fatigue.html
4. Mathieu, F. (2007). Running on empty: Compassion fatigue in health professionals. Rehab & Community Care Medicine. Retrieved from: http://www.compassionfatigue.org/pages/RunningOnEmpty.pdf

Stress is a state of physical, mental, and emotional strain or tension resulting from adverse or demanding circumstances. It can also be a reaction people experience as they encounter rather routine changes in life, if the changes are frequent and ongoing.

Stress is a normal reaction, but it can have a number of negative effects on the physical body. According to the National Institutes of Health, “long-term stress may contribute to or worsen a range of health problems including digestive disorders, headaches, sleep disorders, and other symptoms. Stress may worsen asthma and has been linked to depression, anxiety, and other mental [conditions].” In addition, stress is known to suppress the human immune system. For all these reasons, it is particularly important for people living with HIV and AIDS to manage the level of stress in their lives.

It’s important to note that the last sentence reads “manage” stress and not “eliminate” stress. For nearly all of us, experiencing a certain level of stress is a routine part of our daily lives. Stress often arises as a response to change, and change, for better or worse, is a constant in most of our lives. So rather than spend time and energy toward eliminating stress, people living with HIV/AIDS could benefit from reducing and managing their stress levels.

Decades of research has shown that both physical and emotional/mental stress suppresses the human immune system. This essay will not focus on how this happens, but it is worthwhile to note that stress reduces the production of T-cells in the body. These are cells that help fight infection. Unfortunately, it is also the class of cells that HIV attacks in infected people. An individual living with HIV/AIDS may have a lowered level of T-cells due to HIV. Ongoing physical and emotional/mental stress will only add to this deficit.

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In my years of experience working with the HIV/AIDS community, I’ve learned many individuals in this group live with additional life stressors and, thus, elevated levels of stress. A few of these stressors include:

• Shame and stigma
• Fear of unwanted disclosure of HIV status
• Managing a complicated medication regimen and numerous medical appointments
• Changes in occupational status
• Changes in financial status
• Chemical addiction

Numerous HIV-positive people have come to me over the years, concerned that ongoing stressors in their lives are causing anxiety and depression. Many seek therapy to help support them with their stressors, but just as many are interested in learning how to relax in the hope of lessening their stress before it adversely affects their immune systems.

Fortunately, there are several easy, low-impact, and free forms of relaxation available, some of which can be taught and practiced during a therapy session. They include:

• Progressive muscle relaxation
• Deep breathing
• Meditation
• Exercise (as low impact as walking) including yoga
• Massage
• Acupuncture
• Healthy diet and sufficient sleep

Massage and acupuncture are often considered complementary or alternative therapies. Both have been offered free of charge to HIV-positive individuals at numerous social service agencies in New York City, among other places. Many people, particularly those living with HIV/AIDS, report that therapeutic touch brings on a deep sense of relaxation and well-being. For those with relatively good physical health, moderate exercise, including walking and yoga, can be a big source of stress reduction. Many people over the years have reported that joining a gym or exercising in a park on a regular basis have helped reduce anxiety and depression symptoms.

Some individuals may find that their stress and tension has brought on anxiety that they feel unable to control despite many attempts to do so. They may seek treatment with psychotropic medications. There are numerous antianxiety psychotropic medications, many of which are widely known by the general public. They include Klonopin, Valium, and Xanax. These medications are all controlled substances and can be obtained only through a prescription.

For both mental and physical health, I have learned from experience to never underestimate the benefits of a good night’s sleep. One of the most common symptoms of stress I hear reported is insomnia. Feeling refreshed and fully awake helps make it easier to handle life’s daily stressors. Without a sufficient amount of sleep, many people experience an impaired ability to concentrate, regulate their emotions, digest food, and stay awake throughout the day.

References:

1. Segerstrom, S. C., & Miller, G. E. (July 2004). Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry. Psychological Bulletin of the American Psychological Association, Vol. 130(4), pp. 601-630. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361287/
2. U.S. Department of Health & Human Services: National Institutes of Health. (n.d.). Stress. Retrieved from https://nccih.nih.gov/health/stress

In our fast-paced society, more and more people find it challenging to juggle unrealistic work and home life demands. We frequently have to deal with high levels of daily stress, which negatively affects our physical and mental health. Many of our most common physical ailments, such as headaches, digestive problems, high blood pressure, insomnia, and an impaired immune system, can in many cases be attributed to stress. The same is true for many of our psychological issues, including anger, irritability, depression, and anxiety.

Finding ways to lower our stress levels is therefore extremely important for our overall health. Eating right, exercising, getting enough sleep, and meditating on a regular basis are all factors that can contribute to a more balanced lifestyle. When these self-care techniques fail to help us to feel better, seeking help from a third party may be beneficial.

Some of the signs that might indicate counseling could be helpful in your situation include the following:

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1. Feeling sad and unmotivated. If you have had feelings of hopelessness, decreased energy, sadness, irritability, thoughts of suicide, feel overwhelmed and unable to cope, or are no longer finding pleasure in activities you used to enjoy, you may be dealing with depression and may benefit from talking to a professional.
2. Excessive worry. If you feel as though your anxiety is interfering with your ability to do normal activities and/or you are unable to sleep at night due to ongoing rumination about your difficulties, you may want to consider seeking help.
3. Trauma or abuse. If you have experienced any type of traumatic event or abusive relationship, coming to terms with your experience by talking to an empathic other can be extremely helpful. Trauma and abuse can leave long-term scars that, if left untreated, can negatively impact your life, relationships, and ability to experience joy or happiness.
4. Relationship problems. If your relationship has become unfulfilling and you feel you are no longer able to communicate effectively with your significant other, seeking out couples counseling can be a helpful step in getting your relationship back on track.
5. Difficult life transitions. We all face difficult life situations at times–the loss of a job, a move to a new city, a divorce, or the loss of a loved one. When difficulties such as these arise and you find it difficult to move on, talking with a counselor can be an effective way to process your feelings and work through any lingering grief.
6. Addictions. If you are struggling with any type of addiction—substance abuse, an eating disorder, gambling, or sex addiction—this could be a sign you are trying to cope with unresolved issues or feelings in unhealthy and inappropriate ways and may obtain benefit from professional help.
7. Obsessive or compulsive behaviors. If you are spending too much time double checking to make sure you have turned off the stove, obsessively washing your hands, or are consumed by compulsive thoughts, receiving counseling could be extremely beneficial in getting your life in order.
8. Children excessively acting out. If your child or children have been misbehaving and you are at your wit’s end trying to figure out what to do, talking with a professional who has experience with children’s issues can be helpful. A counselor or therapist can frequently provide you with some additional parenting tools to make your life easier.

In addition to helping with the issues above and others, obtaining professional help may provide you with more insight and awareness. Although it can sometimes feel scary to take the first step to reach out, reducing your symptoms and learning to cope in healthier ways can make doing so more than worthwhile.

The expression, “If it bleeds, it leads,” has been used to characterize media coverage of lurid stories since the early days of newspapers, and today’s around-the-clock news cycle has made avoiding negative news nearly impossible.

The near-constant barrage of stories about disease outbreaks, war, and natural disasters are taking a toll on people who consume the news, said Dr. Mary McNaughton-Cassill, a psychologist who studies the connection between stress and the media.

“What I believe happens to most people is that it adds to a feeling of malaise—a feeling that the world is just not going well,” she said.

Psychologists have studied the connection between repeated exposure to negative news items and an increase in feelings of depression and anxiety among news consumers. Some people may experience compassion fatigue or secondary traumatic stress, becoming less sympathetic to the plight of others over time due to an overabundance of stories of violence and suffering in the media. Others may experience a reaction similar to those who have experienced trauma firsthand.

Connection Between Media Exposure and Acute Stress

A 2013 study looked at the effect of continuous media coverage of the Boston Marathon bombings on a group of respondents from New York City, Boston, and the rest of the United States. A total of 4,675 adults took an Internet-based survey within a two to four-week period after the bombings on April 25, 2013; of that sample, about 10% were directly exposed to the bombing and 9% experienced the lockdown in Boston while police were looking for the suspects. Other respondents without direct exposure to the bombing reported six or more hours of daily media exposure to bombing coverage.

[fat_widget_right]The results indicated those respondents viewing news coverage for six or more hours were nine times more likely to report high acute stress levels than those with minimal media time. Those who had direct exposure had continuous acute stress symptoms but were less likely to exhibit high acute stress, perhaps, as researchers suggest, because emergency responders were on the scene to provide support. Researchers say repeated exposure to traumatic imagery through the media can activate fear circuitry in the brain and cause flashbacks—two precursors to developing posttraumatic stress (PTSD).

E. Alison Holman, PhD, lead author of the study, recognizes the results are correlational and the relationship between media and trauma is complicated.

“There are so many factors one needs to consider—prior life history (trauma, stress, health, social, family circumstances), ongoing post-Boston Marathon Bombing stressors, coping skills, and emotion regulation skills,” Holman said. “It is possible that this could happen, although I would caution that many people have acute stress symptoms that dissipate over time. We are currently looking into the question of quantity (hours) versus content (images, sounds) that might predispose someone to developing lasting posttraumatic stress and other mental health issues. At this point, all I can say is that it seems that both really matter.”

In a 2007 study, 179 college undergraduates were shown a 15-minute news broadcast, followed by a 15-minute relaxation exercise or a 15-minute lecture. The negative feelings induced by the newscast returned to a baseline level only in the group exposed to the relaxation exercise, suggesting that simply diverting attention was not enough to buffer negative feelings.

Coping With Negative News

The ways in which people cope with grim subject matter in the media can be categorized in three ways, McNaughton-Cassill said. The first group—hypervigilant and prone to anxiety—are the most self-selecting of what news they view and will generally tune into a message they agree with.

“If they’re not plugged in, they feel they’re missing something,” she said.

“If your work requires that you engage with frequent media stories—especially if they are of graphic violence—build stress-relieving activities into your routine so that you can counteract the negative effects.” —E. Alison Holman, PhD

The second group may tune out entirely and be unaware of what is going on the world, McNaughton-Cassill said, while the third group—the middle-ground category that most people fall into—is viewing news in a random manner and not consciously thinking about media exposure.

McNaughton-Cassill admits neither extreme is ideal but suggests people should be willing to set limits in terms of how often they check news and what items they choose to pay attention to.

Those who work in journalism may need to take extra precautions to neutralize potentially negative outcomes. Holman cautions people to avoid watching a 24-hour news cycle filled with negative news, as it is often sensationalized for shock value.

“There are studies showing that reporters who are frequently exposed to images of graphic violence report experiencing more mental health-related symptoms, and women may be more vulnerable to having a stronger physiologic stress response than men after subsequent stress when primed with reading negative news articles versus neutral news articles,” Holman said. “If your work requires that you engage with frequent media stories—especially if they are of graphic violence—build stress-relieving activities into your routine so that you can counteract the negative effects.”

Because media outlets are now under immense pressure to produce a continuous stream of news content, it is becoming increasingly difficult to filter out what information represents a legitimate threat and what is more benign.

“The way our memory works, we’re wired to pay attention to negative, scary things,” McNaughton-Cassill said. “The truth is, on objective measures, we’re much better than in the past.”

McNaughton-Cassill sees a silver lining to negative news if it propels people to action and toward contributing a solution to the problem. She suggests a solutions-based approach to counteract the negative aspects of news.

“I think the tagline that is missing in the media is ‘What can we do?’ What is the solution?” she said. “They need to show more people who are trying to solve problems.”

References:

1. Holman, E. A., Garfin, D. R., and Silver, R. C. (2013). Media’s role in broadcasting acute stress following the Boston Marathon bombings. Proceedings of the National Academy of Sciences of the United States of America, Vol 111 (1), 93-98. doi:10.1073/pnas.1316265110
2. Moeller, S. D. (1999). Compassion Fatigue: How the Media Sell Disease, Famine, War and Death. New York, NY: Routledge.
3. Schwarzer, R. (1997). Psychosocial Notebook. Retrieved from http://www.macses.ucsf.edu/research/psychosocial/anxiety.php
4. Szabo, A. and Hopkinson, K.L. (2007). Negative psychological effects of watching the news in the television: Relaxation or another intervention may be needed to buffer them! International Journal of Behavioral Medicine, Vol 14 (2), 57-62. doi:10.1007/BF03004169

A seizure is a sudden and unexpected loss of control accompanied by abnormal body movements or convulsions, a loss of consciousness, or both. Though epileptic seizures are caused by sudden, rapid, and chaotic electrical discharges in the brain, not all seizures are epileptic.

Psychogenic nonepileptic seizures (PNES) are not caused by abnormal discharge of electrical brain signals, but instead are emotional in nature and usually triggered by stress or anxiety. Although these seizures are rarely discussed, they are not rare. PNES have a prevalence similar to that of multiple sclerosis.

Statistically, one in five people sent to epilepsy centers experience PNES rather than epilepsy. In fact, a team of physicians and psychologists at Johns Hopkins Hospital reported that more than one third of patients admitted to the inpatient epilepsy monitoring unit were experiencing stress-triggered seizures rather than true epileptic seizures.

Diagnosing Psychogenic Nonepileptic Seizures

Because PNES can mimic epileptic attacks, they are often misdiagnosed. At least 80% of patients experiencing PNES are treated with antiepileptic drugs for several years before a correct diagnosis is made.

[fat_widget_right]The source of this dilemma is multifaceted. Most physicians do not have access to electroencephalogram (EEG) video monitoring, and even those who do can easily misread an abnormal EEG without video if they have not been specifically trained in epileptology. A 2005 study of 46 patients published in the Neurology journal revealed that 54% of EEG readouts were misinterpreted as epilepsy.

Epileptic seizures tend to be more serious than PNES. If there is any doubt, a neurologist will usually treat the more serious condition. If medication fails to treat seizures, a patient is then referred to an epileptic center, and it is often there that the diagnosis of PNES is made.

With proper equipment and specialized knowledge, an epileptologist can easily distinguish between epilepsy and PNES. An EEG-video monitoring system monitors a patient for several hours and sometimes days until a seizure occurs, though there are techniques that can be used to trigger a seizure to speed up the monitoring process if necessary or desired. By analyzing the video of the seizure, a diagnosis of PNES can be made with 100% certainty.

Causes and Risk Factors

PNES is a somatoform illness, meaning that emotional stress creates physical illness in the body. These seizures are emotional in nature—induced by stress—and often result from traumatic experiences, some of which may have been repressed or forgotten. Such traumas may include divorce, physical or sexual abuse, death of a loved one, incest, or any other great loss or sudden upheaval in one’s life.

Individuals without developed coping skills may be more susceptible to PNES than those with a high level of resiliency to stress. A team of neuropsychologists and neurologists at Johns Hopkins University School of Medicine found that people with PNES don’t necessarily have a higher frequency of stress and/or trauma than others, but they seem to lack effective coping mechanisms to deal with stress and are thus more affected by it.

Coping with Diagnosis and Stigma

Psychosomatic illnesses like PNES are often misunderstood by family members and even by physicians and other health care professionals. A person may be reluctant to accept the diagnosis and become upset when told the seizures are psychological. Some people completely refuse to accept the diagnosis and continue to take antiepileptic drugs even as symptoms continue. This places responsibility on the physician to stop administering the drugs.

A lack of public knowledge and awareness of PNES only increases the misconceptions, misdiagnoses, and stigmatization of the illness. Somatoform illnesses like PNES are real—resulting from real stressors and traumas—and should be treated as such.

Treatment and Outcomes of PNES

Overall, PNES can be treated if properly diagnosed. The earlier the diagnosis, the better the outcome may be. About 70% of people who receive adequate treatment for PNES eventually experience a complete disappearance in seizures. The recovery time will vary from patient to patient depending on the severity of the traumas and stressors involved, as well as the person’s established coping mechanisms and resiliency to stress.

While a neurologist typically treats epileptic seizures, PNES tends to be treated by a psychologist or other mental health professional. Someone who has been newly diagnosed and has been taking antiepileptic drugs will need to work with a neurologist to gradually come off the drugs rather than stopping use abruptly.

About 70% of people who receive adequate treatment for PNES eventually experience a complete disappearance in seizures.Treatment for PNES typically involves various types of psychotherapy. Cognitive behavioral therapy (CBT) may be used to help people develop adequate coping skills to deal with life stressors. Relaxation techniques and biofeedback are also used to help manage and cope with stress.

For those whose seizures are a manifestation of past trauma, PNES is typically treated as posttraumatic stress. In this case a physical seizure may be the body’s way of expressing what the mind cannot. Some physicians have also found eye movement desensitization and reprocessing (EMDR) to be an effective treatment for PNES.

EMDR is a synthesis of many different therapeutic approaches including CBT, psychodynamic, interpersonal, body-centered, and experiential therapies. This information-processing therapy occurs in eight phases—attending to past traumas that contribute to the pathology being treated; the current situations, beliefs, and sensations that are triggering the dysfunctional emotions; and the positive experiences needed to improve mental health and well-being in the future.

The costs of being treated for misdiagnosed epilepsy are high and should not be ignored. As the incidence of misdiagnosed PNES continues, it is important for neurologists, psychiatrists, and psychologists to work in collaboration to raise public awareness, remove the stigma, and provide proper diagnosis, treatment, and support.

References:

1. Benbadis, S.R. and Heriaud, L. Psychogenic (Non-Epileptic) Seizures: A Guide for Patients and Families. (n.d.). Comprehensive Epilepsy Program: Tampa General Hospital & University of South Florida College of Medicine. Retrieved from: http://hsc.usf.edu/COM/epilepsy/PNESbrochure.pdf
2. Desmon, S. (2012, April 10). Symptoms that Mimic Epilepsy Linked to Stress, Poor Coping Skills: Patients with “Pseudo-Seizures” Often Misdiagnosed. Johns Hopkins Medicine. Retrieved from: http://www.hopkinsmedicine.org/news/media/releases/symptoms_that_mimic_epilepsy_linked_to_stress_poor_coping_skills
3. The Truth about Psychogenic NonEpileptic Seizures. (n.d.). Epilepsy Foundation. Retrieved from: http://www.epilepsy.com/article/2014/3/truth-about-psychogenic-nonepileptic-seizures
4. What is the actual EMDR session like? – EMDR International Association. (n.d.). Retrieved from http://www.emdria.org/?120