About a year ago, I was working as an art therapist in private practice and I had a 12-year-old client struggling with anxiety and figuring out who she was in the world. I asked her to create a self-portrait—a great exercise for a girl trying to define herself. At one point I realized I had never made a self-portrait, at least not since grade school. So I went out, bought a canvas, took a “selfie,” and began my own personal process answering, “who am I?”

I began with a light sketch, trying to see myself from the observer view. Then I started painting, layering first in basic colors to assign shadow and light areas. I have a lot of experience painting, but painting a person is definitely challenging. Faces have complex layers of subtle shadows and highlights. I worked layer after layer. Too dark. Too light. Too dark again …

One night I came home and looked at the painting in process and wondered, “Have I gone too far? I just keep layering and layering, will it ever be finished? This painting is getting overworked.” I paused, contemplating this chosen word. That’s exactly what I had created: “overworked Michelle”. Working three jobs and always doing a lot, I was overworked and my self-portrait reflected this state.

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This is the beauty of art therapy: even though you’re not trying to do it, your self comes through in the art you create. There I was, “overworked Michelle,” in painting as in life. I didn’t like how she looked … and I didn’t like how it felt to be overworked Michelle, either. At that point, I stopped working on the painting and bought a new, blank canvas of the same size. “Who would I be if I wasn’t overworked Michelle?”

I challenged myself to make the Michelle I wanted to be, my ideal state of being. To avoid overworking the painting again I limited my work time to two sittings. In the beginning, I did not sketch anything, but started with paint on canvas, finding a portrait through color and strokes. Without a photo to reference I was free to make the face, body, and shading however I wanted. The result was a representation of how it feels to be me on the inside.

A few nights previously I had had a powerful dream about a mountain lion and when the hole in the chest appeared in my painting, I knew I wanted a cougar coming from the darkness. But how would I paint a cougar in such a short amount of time? Actually, I had already cut one out of a magazine and it was just hanging on my bulletin board nearby. Should I put collage in my painting?! I’d never done that before!

I found freedom in creating this painting. All rules went out the window. I could be whoever I wanted to be! This is the truth of life. We create imaginary confines around ourselves that don’t actually exist. With the focus of actually creating the me I wanted to be, I found myself soft and open, vulnerable and dangerous, with strong roots hanging down, looking for soil.

Art is a powerful medium. It reminds us that we are creators, born to make what we want out of life. Art is an opportunity to ask yourself, who do you really want to be? I practiced what I wanted in this painting, and then my life followed suit. I am no longer “overworked Michelle.” Now I have one job, and it is my passion—the place where I share my heart with others and practice vulnerability and openness. I take care of myself first, every day. I don’t feel overworked, because I love what I do. I continue to draw and paint what I want out of life because, in the very near future, it could all come true.

Michelle Lynn Baker is an art therapist and owner of MBodied Art Studio in Westminster, CO. She teaches art classes to children and adults and runs therapeutic art groups for parents and children. Michelle enjoys the spectrum of art as therapy from learning to healing.

“I wanted a perfect ending. Now I’ve learned, the hard way, that some poems don’t rhyme, and some stories don’t have a clear beginning, middle, and end. Life is about not knowing, having to change, taking the moment and making the best of it, without knowing what’s going to happen next. Delicious ambiguity.” —Gilda Radner

You’ve shown up for work only to be told that your position has been eliminated, and now you find yourself jobless and afraid. You find out that your spouse has been having an affair, and suddenly you are in a panic about what the future holds and how your life will change. You have a health condition and begin to live in a space where nothing seems certain. In moments like these, anxiety takes up residence in our minds: What will the future look like? Can I handle what is coming down the road? Will I be OK?

We’ve all been there at one time of another: stuck in uncertainty. It’s a scary place to be, and can leave you feeling out of control, hopeless, and helpless.

Although each of us differs in how much of life’s ambiguity we can tolerate, there are some situations that challenge even the most risk tolerant among us. Humans love a sense of order and predictability; chaos and the random nature of life can be very scary.

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When you are living with uncertainty and feel like some of your power in life has been taken from your hands, how do you cope? How do you manage to live in that ambiguous place without falling apart or dissolving into stress and worry?

This is a challenge I’ve faced as a person living in the shadow of cancer. As a cancer survivor, living with the knowledge that your cancer could come back and ultimately end your life is a significant challenge. Finding a way to manage and live with that uncertainty is necessary in order to lead a fulfilling and whole life, as it is with all uncertainty we face.

Here are some tips on how to find peace in an uncertain time:

1. Recognize That Total Certainty Is an Illusion

This is where we take a turn for the philosophical. In learning to live with uncertainty, it took me some time to recognize that the life I had been living pre-cancer was not necessarily any more secure than the life I am living post-cancer. In considering the temporary nature of all things and in acknowledging that change can come at any moment, we can see that total certainty in life is but an illusion.

As much as we would like to deny it, we are always in a state of uncertainty. We take for granted that things will remain relatively constant and have a hard time accepting that huge changes can befall us with nary a warning. As distressing as it is to consider, the truth is that your life can change on a dime.

Driving home from work today, you could be hit by another car and find yourself permanently paralyzed. You could find out that your newborn has a significant medical or mental health issue that will impact your family for the rest of your lives. You could arrive home to find that your house has been gutted by fire and you have no place to live. Alternately, a sudden windfall of cash could land in your lap from the estate of Great Aunt Agnes, or you could get a call from the employer of your dreams, asking you to join the team.

We like to believe we have total control over what lies before us, and, in truth, we do maintain a huge amount of control in the trajectory of our lives. But we don’t control all of it. It’s helpful to remember this during hard times. Just because you now recognize the uncertainty in your life because it is bolded, highlighted, and in flashing neon lights doesn’t mean uncertainty wasn’t there before. It just means it wasn’t as in-your-face as it is now.

Knowing that this is the case makes it much easier to accept that uncertainty is not necessarily an indication that things are going all wrong—uncertainty is the natural state of things. Once you recognize this truth, it’s easier to loosen from the grip of anxiety around the unknown.

2. Practice Meditation

A growing body of research shows that meditation can be of tremendous benefit to people coping with anxiety and depression. I will frequently draw in a mindfulness piece when working with people in therapy, and often this includes meditation.

The real benefit of mindfulness meditation is that it allows you to create some distance between you and your automatic thoughts and emotional reactions. Putting even a 15-minute practice into place in the morning will provide a space for your mind to calm and your anxiety to be reduced.

3. Utilize Exercise

I recently attended a workshop focused on releasing stress and trauma held in the body. The woman leading the workshop noted that, in the wild, animals often shake as a way to reduce tension. She pointed out that after an antelope runs from a lion and survives, it will spend some time shaking as a way to discharge the physical tension and release the energy brought on by the fight-or-flight response. Many animals release tension this way, but humans don’t have such a built-in response for discharging the stress we carry. Exercise can function for us in much the same way that the need to tremble functions for a dog.

Running, walking, aerobics, yoga, and weight training are all great for discharging physical and emotional energy that we carry with us during the day. Getting proper physical exercise can also help with getting good sleep, which is essential in thinking clearly and being our optimal selves.

4. Take Action Where You Can

Frequently when we are living with uncertainty, we feel as though our power to control the direction of our lives has been taken from us. This can feel very unsettling, to say the least.

While it’s important to acknowledge that uncertainty is a natural part of life, it’s also important to take action on those parts of your life that you have control over. Sometimes, the only thing we have control over is how we choose to react to the challenges we face. How you choose to face uncertainty is all up to you. Consider how you’d like to move forward with this in mind.

5. Get Support

When difficulties befall you, it’s easy to feel alone. The reality is that each of us experiences suffering. It’s a part of the human condition. The feelings you are feeling have been felt by millions of others. People all over the world, in your town, in your neighborhood, are dealing with uncertainty, too.

Reaching out to others for support can be helpful. Find that friend who has faced some really hard times, who has been through the wringer and kept going. Talk to them about what you are coping with. Some people prefer to seek out a therapist in this circumstance; therapy can be grounding during uncertain times. No matter whom it is, find someone who can help you reconnect with yourself when you start floating into anxiety about what the future holds.

Learning to live with uncertainty is one of the great challenges of life. It’s not an easy task, but learning to tolerate ambiguity is an essential skill for living a satisfying life. It will carry you through many challenging times, and you’ll find yourself living with more appreciation of the moment, which is really all we ever have anyway. Uncertainty can be a great teacher; allow it to be yours!

Stress affects us all. From minor instances, such as experiencing a poor night of sleep or arriving a few minutes late to work, to major instances, such as divorce, severe illness, or injury, stressors large and small will plague us throughout life. Our personal and professional lives are impacted when we’re stressed—we may lash out at loved ones, for example, or withdraw from friends; we may resort to using food, alcohol, or other substances to mask the tension; or the stress may manifest as physical symptoms. Sometimes stress becomes part of a vicious circle in which feelings of stress are compounded. Perhaps we feel uneasy due to stress, and this affects our resilience and ability to manage daily stressors, which ultimately leaves us feeling more stressed and susceptible to illness or mental health challenges.

Some of the most common sources of stress in the United States include workplace stress, financial strain, chronic illness, relationship difficulties, sleep problems, or excessive media consumption, including social media, television, or Internet usage. Symptoms may include muscle tension, irritability, anxiety, headaches, nausea, fatigue, or feeling emotionally overwhelmed or weepy.

Recognizing stressors, managing symptoms, and employing self-care strategies are some of the most critical preventive steps we can take to keep from feeling overwhelmed by stress. To facilitate these efforts, we’ve compiled a list of the 10 best online resources for help with stress—GoodTherapy.org excluded—in 2014. Our selections are based on quality and depth of content, presentation, and functionality.

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• The American Institute of Stress: The American Institute of Stress is a nonprofit organization that provides information and resources about various causes and symptoms of stress, as well as materials for stress solutions and treatment. Site visitors can participate in online forums, watch lectures on stress and stress management, and explore academic publications related to stress research. Free site registration enables you to interact with others on the site and use the forums. Health care professionals can seek certification from AIS to indicate their expertise in the field of stress and stress relief.
• Stress Cure: Stress often arises because of workplace issues, relationship problems, and other challenges in life. While it’s usually impossible to anticipate and prepare for these challenges, it is possible to cope with them when they do arise. On the site, Dr. Morton C. Orman offers 18 in-depth tips and suggestions for dealing with unexpected changes. The majority of other content has been moved or re-created at OrmanStressRelief.com, which is a more up-to-date resource for handling life stress.
• Totally Stressed Out: Created primarily for students, Totally Stressed Out offers stress-management solutions that can help with productivity and managing nerves. Academic issues can be constant sources of anxiety for students, hindering their ability to get things done, be creative, and commit knowledge to memory. By addressing symptoms of stress in both body and mind, Totally Stressed Out coaches students through relaxation and developing healthy habits for efficient, stress-free work.
• Caregiver Stress: If you’re caring for an ill or injured partner, an aging parent, or another loved one, you might not be aware of the toll it’s taking until you’re overwhelmed, perhaps even experiencing health problems yourself.This site provides an online assessment to help caregivers understand how their mental and physical health is affected by their caregiving responsibilities. With a blog that covers issues such as end-of-life care, financial problems, family communication, and specific health concerns, Caregiver Stress can help caregivers gain wisdom about practicing self-care and reducing stress.
• Stress Directions: If you’re not sure your level of stress is taking a toll on your health and well-being, or if you simply would like to learn more about stress and its symptoms, Stress Directions provides information and assessments that can help. Their Personal Stress Navigator test has 246 items that evaluate one’s susceptibility to stress, the symptoms a person may be experiencing, and the source of the stress. Site visitors can learn about what stress does in the body, including neuromuscular, cognitive, hormonal, and immune symptoms.
• Stressed Teens: For many teens, the ability to slow down and be present often does not come easily or naturally. They are usually fairly new to stress, and may not know or understand the symptoms or ways to cope. Created by Gina M. Biegel, LMFT, Stressed Teens teaches mindfulness practices geared toward teens and adolescents. Resources include tips for disconnecting from technology to reduce stress, mindfulness exercises for teens and parents, and simple activities that can help manage symptoms.
• Stress Relief Exercises: Physical activity has been shown time and time again to reduce stress, but stress-relief exercises don’t have to require physical exertion. Simple stretches, brain exercises, meditation, and mindful breathing techniques can help eliminate symptoms of stress. This site includes tutorials on all of these methods and others, including information about how each technique can help reduce stress. Other articles touch on further ways of destressing by clearing clutter in your home or adopting a pet.
• Stress Fish: On the left sidebar of StressFish.com, you will find a link that randomly generates a helpful—and occasionally strange or offbeat—tip for reducing stress immediately. One tip involves singing “Tumbling Tumbleweeds” and watching a GIF of a tumbleweed rolling across the screen. The description explains, “The StressFish thinks it’s funny, and claims that this has helped him in the past to clear his mind of unwanted fears and stressful imaginings.” Stress Fish aims to help children, adults, and everyone in between find effective ways to manage stress in fun, unconventional ways. The techniques may be silly, but the intent is earnest and authentic.
• Stress Free Kids: Family dynamics and conflicts can put a strain on all family members, creating stress and anxiety for children and adults alike. Parents can use StressFreeKids.com to introduce children to basic mindfulness techniques, help boost their self-esteem, and make bedtime easier. On the site, you can find specific tips for military families and helping family members with autism, plus free downloadable resources such as guided relaxation audio clips for kids. The StressFreeKids blog also offers information related to seasonal stressors, like going back to school and the holidays.
• Foundation for Well Being: The Foundation for Well Being promotes relaxation and peace of mind through articles and informative slideshows. If you are a teacher, parent, or caregiver, or if you learn best with visual aids, the Foundation for Well Being slideshows are a great way to learn and share information. Hidden gems throughout the site include information about de-cluttering your living space and improving feng shui, a collection of inspirational quotes about happiness, and a series of GIFs depicting rotating shapes (meant to calm nerves).

Have a website you would like to see in our Top 10? Recommend it here.

On November 4, 2014, Oregon resident Jillian McCabe drew international attention when she threw her 6-year-old autistic son to his death, over the side of the Yaquina Bay Bridge. Public response to the horrific event was divided. While some people, particularly parents of disabled or autistic children, advocated vigorous prosecution, others felt pity—pointing to the daunting physical, psychological, and emotional challenges McCabe faced while caring for her family.

Jillian McCabe was a live-in caregiver for her autistic son, as well as her husband who developed multiple sclerosis shortly after their son’s birth. She regularly blogged about the stress and frustration she faced as a caregiver and frequently stated that she was “trying to hold it together.” McCabe complained about hearing voices, which suggests that she may even have been experiencing symptoms of a serious mental health issue. Relatives also reported that she tried to commit suicide several times. Despite McCabe’s efforts to get help, relatives say she did not receive the services she needed.

While these psychological symptoms and the added stress of being a caregiver to multiple people certainly do not excuse an act of murder, it is possible that they played a role in the tragic outcome of the McCabe family. Could preventative steps have been taken?

A Caregiver’s Job Description

An estimated 44 million adults serve as caregivers in the United States today, and the stress can take a toll on their emotional and mental health.

Denver therapist Andrea M. Risi, LPC, a Topic Expert in health, illness, and medical issues, explains, “Caregiving means to help another person who is coping with a disability or illness without being compensated. Important qualities in a caregiver include empathy, patience, and reliability.”

Caregiving is not an easy task. It usually occurs within immediate families, but it can spread to friends and extended family members. A typical caregiver’s job description includes comforting companionship (e.g., conversation, stabilization while walking), domestic assistance (e.g., housekeeping, running errands), and personal care (e.g., bathing, grooming, toileting), without financial compensation.

Caregiving is widely viewed as a vital national health care resource worth an estimated $306 billion annually. However, most caregivers are ill-prepared to effectively fulfill their role, and many do not receive third-party support. Studies show that the strains of caregiving, coupled with a lack of caregiver support, can have serious consequences on a caregiver’s health.

How Caregiving Affects a Person’s Health

The mental, emotional, and physical demands of caring for chronically ill or disabled relatives can be particularly debilitating for caregivers. According to the Family Caregiver Alliance (FCA) (2006), more than one-third of America’s live-in caregivers provide health care assistance to others despite experiencing bad health themselves.

The FCA also reports that caregivers show higher levels of depression than family members who do not have caretaking responsibilities. It is estimated that 25% to 50% of caregivers meet the diagnostic criteria of major depression, and 40% to 70% show significant depressive symptoms. People who fill caregiving roles are also at higher risk of developing concurrent anxiety issues, chronic diseases, and substance dependence.

Caregivers also tend to experience higher levels of stress and frustration. A study by Schulz and Sherwood (2008) posits that caregiving is equipped with all the features of a chronic stress experience with high levels of unpredictability, uncontrollability, vigilance, and physical and psychological strain being major contributing factors. Roughly 26% of caregivers report feeling emotionally drained, and chronic caregiver stress has been linked with cognitive decline, including deficits in attention, memory, and verbal ability.

It is important to note that caregivers tend to go through greater psychological and emotional distress as the care-receiver’s functionality deteriorates (as in the case of a person with dementia), and these feelings might persist even after the care-receiver is placed in a nursing home.

Physical setbacks may also be experienced during caregiving. Caregivers are at greater risk for headaches, bodily pain, obesity, high blood pressure, heart disease, and cancer. Caregiver stress can also contribute to increased mortality. Elderly spousal caregivers (aged 66-96), who are exposed to caregiver stress, have a 63% higher mortality rate than non-caregiving peers of the same age.

How to Help Yourself or Another Caregiver

While the quintessential caregiver role involves the administering of treatment, it must be remembered that caregivers, too, are in need of care. One way for people to effectively manage caregiver stress and depression is to seek the assistance of a therapist.

“Therapy can help the caregiver cope with his or her own feelings about the other person’s illness. Often, involved family or friends have strong opinions about the course of care, and that can add stress to the caregiver. Having an unbiased person to talk to, like a licensed therapist, can help offer the caregiver different perspectives and insights into overseeing the person’s care. It can also help the caregiver deal with the mixed feelings and emotions that come with caregiving,” Risi said.

For individuals experiencing caregiver stress, Risi suggests the following practical points to facilitate effective and healthy caregiving:

• Take care of yourself. It is important for the caregiver to recognize his or her own needs and tend to them first. If you are experiencing burnout, you will not be able to effectively help the person in need of care.[fat_widget_right]
• Ask for help. Caregiving does not have to be solely your responsibility. Some caregivers have a difficult time asking for help from others, but getting support to share the responsibility can help you avoid caregiver burnout.
• Be realistic about the illness and prognosis. Educate yourself and ask questions in order to be prepared for the reality of the illness.
• Use respite care services. A wide range of services are available to give a break to caregivers and can last from a few hours to a few days. Informally, you can ask another family member or a friend to give you a break, but there are formal respite services available in most communities. Use this time to recharge and look after yourself.
• Find emotional support. You can talk with family, trustworthy friends, a support group, your pastor, or a therapist. Having someone to share your feelings with can help ease the burden of caregiving.

Other Caregiver Resources

• The National Alliance on Mental Illness (NAMI) provides a variety of education and support programs for family members of a person with a mental health condition, free of cost. These include NAMI Family-to-Family, NAMI Basics, and NAMI Family Support Group.
• For caregivers of people experiencing Alzheimer’s disease, the Alzheimer’s Foundation of America invites you to reach out for care by calling (866) 232-8484 for general information, counseling, and referrals to nationwide resources
• The U.S. Department of Veterans Affairs (VA) provides many resources for caregivers of military veterans. These include a toll-free caregiver support line (855) 260-3274, a caregiver support coordinator, adult day health care centers (ADHC), home-based primary care (HBPC), skilled home care, the homemaker and home health aide program, home telehealth, respite care, and home hospice care.
• Additionally, every Wednesday at 8 a.m., 12 p.m., and 8 p.m. Eastern Time during National Family Caregivers Month in November, the VA invites caregivers for military veterans to call (800) 767-1750, enter access code 73687 and press the # button. Caregivers will be treated to meditation activities on the phone, which will help them relax and restore their balance.

References:

1. Alzheimer’s Foundation of America. (2014). Caregiving tips: Strategies for success. Retrieved from http://www.alzfdn.org/EducationandCare/strategiesforsuccess.html
2. Family Caregiver Alliance. (2006). Caregiver health. Retrieved from https://caregiver.org/caregiver-health
3. Fantz, A. (2014). Mom blogged about son with autism she’s accused of killing. Retrieved from http://edition.cnn.com/2014/11/05/justice/oregon-mother-autism-son-death/index.html
4. National Alliance on Mental Illness. (n.d.). Education, training and peer support center. Retrieved from http://www.nami.org/template.cfm?section=Education_Training_and_Peer_Support_Center
5. Schulz, R. & Sherwood, P. R. (2008). Physical and mental health effects of family caregiving. American Journal of Nursing, 108 (9), 23-27. doi: 1097/01.NAJ.0000336406.45248.4c
6. United States Department of Veteran Affairs. (2014). VA caregiver support. Retrieved from http://www.caregiver.va.gov/support/support_services.asp

If you were to attend a professional training on trauma, the instructor would likely reference the nervous system and its window of tolerance. In recent years, trauma researchers and therapists have developed a deeper understanding of the nervous system’s role in regulating extreme stress, and have learned some techniques for regulating this system.

You have probably heard of the fight-or-flight response, which describes our impulse to defend ourselves or run until we reach safety. This is part of the window-of-tolerance model, but it’s not quite the whole picture. Let’s start with understanding a regulated nervous system.

A regulated nervous system experiences a stress and calming response throughout the course of a given day. Perhaps you are driving and someone brakes unexpectedly ahead of you; when your nervous system is regulated you will feel some stress, but once your body feels safe and you are able to act in a way to ensure your safety (i.e., press your own brakes), your system will calm back to baseline. Dr. Dan Siegel of UCLA coined the term “window of tolerance” to describe this space in which we can regulate ourselves without too much effort.

Make sense? You’ve probably felt some of these fluctuations in your system today—rushing to get somewhere and relaxing when you arrive on time, for example. Next we’ll explore what happens to the nervous system when a traumatic experience enters the picture.

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Trauma pushes the activation of the nervous system beyond its ability to self-regulate. When a stressful experience pushes the system beyond its limits, it can become stuck on “on.” When a system is overstimulated like this, we can experience anxiety, panic, anger, hyperactivity, and restlessness. This is the fight-or-flight mode; your body is activated and ready to move.

Some nervous systems will stay here, while others will dip below the normal range and become stuck on “off.” Below the window of tolerance we see symptoms of depression, fatigue, disconnection, and lethargy. Systems can get stuck above or below the line for prolonged periods of time, or they can vacillate between the two.

How can you discharge the traumatic stress and transition back into the window of the regulated nervous system? Here are a few tips:

1. Seek safe relationships. Being with someone who is safe and soothing will help your nervous system settle and create a safe space for you to connect and share your experience. We are social beings and we heal in relationship, so if you find yourself isolating or pulling away from social contact, consider instead seeking out people who feel supportive.
2. Practice mindful breathing. This trauma response is connected to the brain stem (basic physiological regulation) and the limbic (emotional) brain. Practicing mindful breathing helps connect a basic physiological process (breathing) with your prefrontal cortex (thinking brain), which helps integrate and shift our neurological state. To put that more simply: breathing has a HUGE capacity to calm the brain and regulate the nervous system.
3. Find a therapist who understands trauma and can help you get to know the habits of your nervous system. Recognizing when you are outside of your own window of tolerance and building personal strategies to soothe or stimulate your system is key to regulating in an ongoing way. For some people, sitting still is calming; for others, movement brings more peace. Find someone who can support you as you explore what works best for you.

There are many unique and healthy ways you can learn to support your nervous system and bring it back into its window of tolerance when something stressful occurs. Creating a support network that includes a trained trauma therapist is a helpful way to build your ability to heal and recover from traumatic experiences. When you learn to work with your nervous system, you may even build up a wider window of tolerance, which can allow you to move about the world feeling more grounded and connected to others.

Have questions? Please post them in the comments section below!

For many people, however, constant worry can become a serious problem, leading to both mental and physical health issues. Our causes of stress can include, among others, high demands at work, family problems, financial difficulties, traumatic events, divorce, illness, or the loss of a loved one. Unfortunately, many people deal with these types of issues in unhealthy ways by overeating, drinking or using drugs, excessive caffeine consumption, becoming a workaholic, or developing chronic anxiety or depression.

In order to deal with stress in a healthy manner, we need to implement some self-care strategies into our lives. The following are some effective ways of reducing the stress we face on a daily basis:

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1. Create a healthy work-life balance. If you are a workaholic constantly trying to complete the next project, learn to set some limits for yourself. Technology often allows us to continue to work even after we’ve gone home for the day. We need to learn to establish healthier boundaries, however, in order to avoid becoming burned out or getting sick. Determine a cutoff time for work so that you can decompress at the end of the day and enjoy some much-needed leisure time. Learning more effective time-management strategies can also be helpful.
2. Establish your priorities. If you find yourself with too many commitments and not enough time to get them all done, take time out to consider which ones can be delegated or eliminated and keep only the ones that are most important for you.
3. Include self-care practices in your daily routine. Make sure you incorporate some time in your schedule each day to nourish your body and soul. Even if you have only a few moments to spare, you can enjoy a warm bath, listen to relaxing music, or watch the sunset.
4. Engage in a physical activity several times a week. Going for a jog or working out are great ways to get rid of excessive stress. If you don’t have time to go to the gym, take a walk around the block on your lunch hour. Moving our bodies can keep us physically fit and healthier, which can make us feel better emotionally as well.
5. Spend some time in nature whenever possible. A change of scenery is always helpful for changing our viewpoint about whatever is troubling us. Enjoying a trip to the park, watching the waves at the beach, or gazing at the stars are all wonderful ways to commune with nature that can help us to put our problems into perspective.
6. Avoid emotional eating. When we feel stressed out, we often have a tendency to try to comfort ourselves by eating unhealthy foods, which only leads to negative feelings about ourselves afterward. Become more mindful of your eating habits when you are dealing with pressure, and have some healthy snacks on hand to fall back on rather than reaching for another doughnut or cookie.
7. Limit time spent on social media. When you have already spent a full day at work, try to avoid spending too much of your leisure time connected to yet another computer or device. Allow yourself to connect with your friends on social media for a limited amount of time each day and then unplug and unwind. Many people spend too much of their time online, which contributes to their already stressful days.
8. Practice meditation or relaxation techniques. Start a meditation practice, which can lead to lowered stress levels and a sense of greater equanimity. If sitting in meditation feels too daunting for you, practicing relaxation for 10 minutes a day can bring about many healing benefits for your mind and body. Numerous relaxation CDs are available to help you get started.
9. Be creative! Once a week, try to set aside some time to do a hobby or other activity that you enjoy. Exercising our creative muscles is enjoyable and can also help to generate new ideas and solutions to problems you may be dealing with.

Stress is an ongoing issue that we all have to deal with. If we do not find healthy ways in which to handle our daily pressures, they may end up taking a toll on our physical and mental health. If you have tried some or all of the suggestions listed above and are still having difficulties dealing with stress, you may want to consider talking to an empathic other, whether this be a friend, family member, or therapist, in order to obtain the help needed to start to experience a more peaceful frame of mind, even in the midst of an otherwise hectic life.

Americans are famous for being a hard-working bunch, taking the fewest paid vacation days off. I, for one, spent the summer studying advanced yoga therapy techniques on weekends, and working during the week, especially during the months of June and August. But I made sure to take some time off at the beginning and again at the end of the season so I could relax a bit, and I’m glad I did. Studying ways to help people relax is hard work, and it can be pretty stressful!

What did I learn at yoga school? I studied what happens to your body when it is subjected to relentless stress, and the importance of learning how to relax and let go. The stress response works great if you’re running away from a hungry tiger, but prolonged stress is bad for you because it weakens the body and the brain.

This is why:

1. Your adrenal glands pump adrenaline, which raises your heart rate, your blood pressure, and increases the amount of sugar in your blood. Your adrenal cortex sends out cortisol, part of the stress response. This helps you run fast when you’re escaping the tiger, but when it becomes habitual and there aren’t any tigers to run away from, it is destructive.
2. Stress kills brain cells; a calm environment permits their growth. It is not true that brain cells stop growing when you’re an adult, they just grow more slowly. So help them out and give them a nice place to live.
3. Stress is associated with depression and anxiety. No fun.
4. Your immune system doesn’t work as well as it should. Ah-choo!
5. The right amount of stress is beneficial, but too much is deadly.

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That’s why relaxation is as important as eating well and getting enough exercise and should be part of your regular health routine. It’s a way to take care of yourself and show yourself some love. So if it’s not a part of your usual day, you might want to think about adding it to your program. Don’t have much time? I bet you can find five or 10 minutes to call your own if you look hard.

Maybe your family is demanding. Make some demands of your own in return. You need a break just as much as anyone needs anything.

Working hard for a tyrannical boss? Find a way to make your work environment more pleasant. Look around and see if there’s some small thing you can do to make things better for you—adding a foot rest, for example, if your seat is too high for you, or wearing really comfortable shoes if you spend a lot of time on your feet.

One powerful relaxation technique is restorative yoga. Like all yoga, the sequence is based on bending forward, backward, sideways, and twisting. The difference is that these poses are held for a long time—five or even 10 minutes. You place yourself in a pose, child’s pose, for example, but your body is supported by bolsters so that you are in complete and absolute comfort.

I invite you to try the restorative version of child’s pose. Start child pose the usual way, but with the short end of a bolster in front of you, and then fold over it lengthwise so your body is supported by the bolster. There are many such adaptations of yoga poses you may already know. You can get DVDs that will show you how, but I think if you are able, it’s best to visit a class or two and learn directly from a teacher.

Finally, if you absolutely can’t stop the worried, anxious chatter in your brain and you’re always wired, consider seeing a therapist for some help.

Below are some of my favorite ways to relax. Like everyone, I need time out for myself, even if it’s only a few minutes. I don’t always feel like I have to respond immediately to help other people. I need to take care of myself first, and you do, too.

1. Take warm, relaxing baths.
2. Go for a walk in the park.
3. Water and admire your plants.
4. Fill the room with a lovely scent.
5. Take a yoga class, or give yourself one.
6. Meditate.
7. Read.
8. Listen to music.
9. Have a nice visit with someone.
10. Watch television.
11. Go swimming.
12. Breathe.
13. Give yourself enough time to do things, so you’re not always rushing.
14. Laugh. This is very important. Among other things, laughter opens up the airways and pumps fresh air into your lungs. Also, it’s fun.
15. Dance.
16. Jog.
17. Pet the cat, dog, or other pets.

I bet you have many other favorite ways to relax, things you enjoy doing. The secret is to remember to do them. Helping others helps with your stress, by the way, so why not post your favorite ways to relax and give us more ideas? (If you feel like it, that is!)

References:

1. Berzin, R. (2014, July 20). 10 Reasons Why Stress Is The Most Dangerous Toxin In Your Life. Retrieved from http://www.mindbodygreen.com/0-14560/10-reasons-why-stress-is-the-most-dangerous-toxin-in-your-life.html
2. Krantz, D., Thorn, B., & Kiecolt-Glaser, J. (2013). How Stress Affects Your Health. Retrieved from http://www.apa.org/helpcenter/stress-facts.pdf

Most of us experience work stress, but can too many responsibilities, unrealistic expectations, and personality conflicts at work lead to an experience of trauma victimization over time?

In my years of private psychotherapy practice, I’ve seen several cases where individuals experience signs similar to posttraumatic stress as a result of work problems. In the beginning, I found this slightly odd. I wondered: could negative work experiences really lead to reactions similar to trauma experiences, like war or sexual assault? Lately, in conversations with colleagues, I’ve discovered this is fairly common, particularly in certain professions.

How Your Work Environment Can Leave You Feeling Victimized

I recently interviewed Arkansas professional counselor Rev. Rebecca Spooner, an ordained minister who left ministry to become a therapist. She specializes in counseling pastors and their families, and said that feeling victimized and traumatized by their work environment is relatively common among members of the clergy. Rev. Spooner explained that the demands and expectations of modern ministry set pastors up for personal failure and emotional trauma.

“The paradigms in ministry are flawed,” Spooner said. “A hundred years ago, pastors had four jobs: marry, bury, baptize, and preach on Sunday. Today, ministers are expected to be marriage therapists and grief counselors, organizational leaders, facilities and staff managers, marketing coordinators, community relations specialists, bloggers, motivational speakers, spiritual teachers, salespeople (increasing membership and giving), budget managers, visit the sick, be a friend, and serve on regional committees! It’s completely unrealistic. It sets everyone up for disappointment.”

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These experiences are similar to what’s happening in private companies in recent times, particularly since the economic crash of 2008. Companies have laid off people and expect those who remain to do more work for less pay. New performance measures are adding pressure, and employees are micromanaged. Among the EAP (Employee Assistance Program) referrals I see in my office, stress related to new and unrealistic work performance expectations ranks at the top of the list.

The people who see me for help with work-related stress have complaints that are similar to what Rev. Spooner sees among clergy: insomnia, irritability, mood swings, anger, feelings of disappointment and disillusionment about their career and employer, confusion about why they are unable to meet the demands placed on them, hopelessness, anxiety and fear, fatigue, muscle tension, family problems, feelings of isolation, ineffective coping, and substance abuse. It’s a long list! Work stress is a big problem in America.

Many of us are familiar with trauma reactions after major catastrophes, but few of us realize that a work environment characterized by unrealistic demands, personality conflicts, and limited free time for leisure can, over time, create an experience of victimization.

3 Ways Cognitive Behavioral Therapy Can Help

Cognitive behavioral therapy (CBT) helps individuals shift from perceiving themselves as having little control over their circumstances to becoming empowered to either change outside pressures or learn to cope with and relate to them differently. With practice, CBT techniques can help reduce stress and anxiety, improve mood, and increase confidence.

CBT treatment has helped ministers reduce the experience of stress and trauma caused by the challenges of their profession. These same techniques can also help most people heal from various traumatic and emotionally difficult situations. CBT reduces distress and helps to restore emotional balance. Here are three techniques from cognitive behavioral therapy to use in your own life.

1. Learn to identify the thoughts that increase your anxiety and your self-doubt. A large majority of individuals who come to see me for anxiety therapy are quite surprised when I mention that their thoughts are likely causing their anxiety. Most people believe anxiety is something that happens to them, something over which they have no control. But in fact, how we talk to ourselves about the situations we face has a great deal to do with how we feel. For example, if a minister tells herself that because her church is not growing she is not an effective leader and has failed God, she is likely to feel emotionally upset and believe that she is not capable of growing the church. By repeating self-defeating thoughts in her head, her self-esteem erodes. Eventually, she may just give up trying altogether and become depressed. This is the trick trauma plays on us: it tells us that something is wrong with us and that we are helpless, but most of the time our thoughts are not true.
2. Dispute the thought. Once you’ve identified the anxiety-producing or self-defeating thought, it’s time to dispute it. Here’s an example: “If I don’t grow the church, I’ll get fired.” Let’s examine if that thought is true. In most denominations, firing a pastor takes effort. First, the leadership of the church has to vote that they have lost confidence in the pastor. Then, they have to bring the issue to a congregational vote. In many cases, a national mediator becomes involved to help resolve the conflict and improve the employee/employer relationship between the church and the pastor. So the thought, “If I don’t grow the church, I’ll get fired” is not exactly true. What’s much more likely to happen is that if the church is not growing and leaders are dissatisfied, a conversation will occur about why that’s happening. And hopefully, that conversation will lead to solutions. Notice your own thoughts and question them. Are they true? How do you know for sure? What are some alternative explanations that might be more true?
3. Learn to relax. The third CBT technique that Rev. Spooner uses is relaxation training. When we learn to relax the tension in our muscles and reduce the speed of our thoughts, our brains function better. They see things more clearly. Gen. Colin Powell has a rule. He tells himself, “It ain’t as bad as you think. It will look better in the morning.” That’s partly because when our brains are rested, we see situations differently. Relaxation training can teach you to rest your brain. My personal hope is that one day, we will collectively learn to be realistic about our demands and expectations of people and be kinder to one another. Until then, if you find yourself feeling victimized, excessively pressured, or doubt your worth or abilities, try CBT. It really can help!

Editor’s note: If you or someone you know is in crisis, please click here for information about seeking help.

Cutting is a popular way for teens to self-injure without the intent of suicide. Using scissors, razor blades, pins, pens, or other sharp objects, some teenagers puncture or cut their skin in various places on the body. If you’re a parent, you are probably wondering, “Why would they do that?” The answers may surprise and scare you.

Simply put, cutting is a maladaptive coping mechanism during times of stress and anxiety that is rarely accompanied by suicidal thoughts. According to the American Association for Marriage and Family Therapy, self-harming behavior such as cutting has no single cause. It does not discriminate across cultural and socioeconomic levels, but the behavior is predominately carried out by females.

Reasons behind teen cutting are varied. Often it can be categorized by those who already feel numb as a way to experience intense emotion and pain. Numbness may be due to being emotionally overwhelmed for too long, which almost short-circuits the system into a feeling of dullness—neither happy nor sad. Teens who feel numb often identify that the only way to feel alive is to cut.

Another way to categorize cutting is as a release of emotions, similar to a drain when the sink is overflowing. Teens who feel burdened by stress, anxiety, depression, and other emotions may use cutting to vent the unwanted leftovers of those difficult feelings.

Other reasons for cutting include an intense and overriding feeling of aloneness, feeling helpless, and feeling the need to punish or blame for something that happened.

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The theory behind why teens use cutting as a coping mechanism reasons that endorphins play a major role. When teens cut, endorphins rapidly invade the bloodstream, resulting in a feeling of pleasure and relief. For some teens, the cutting and the endorphin release make them feel “high.”

Take for example, a 16-year-old girl who is a high academic achiever, member of the elite volleyball team, and a positive role model for her younger sisters. She is an all-around overachiever, earning money babysitting and as a lifeguard, striving to excel in school to make sure she gets into a prominent university. Her volleyball team travels on the weekends, and she is looked at as a leader to the other members. In addition, she volunteers at her church and with her community. She dresses well and in fashion, and is always attempting to make sure her hair is perfect. Although she doesn’t love her body, she knows it could be worse, since she’s an athlete and in somewhat decent shape physically.

Emotionally, however, she’s not in shape, nor positive, nor excelling. She is overburdened by academia, struggling to achieve all A’s in her advanced classes. She has to study from the minute she gets home from school until volleyball practice, and then more upon returning. She is not sure her grades will get her into a “good enough” college. She is worried that her best friend is mad at her, and she’s certain that her father hates her. To make matters worse, her right knee has been bothering her, but she doesn’t tell anyone for fear that her team will be mad at her. She has had to cancel when invited out because she had too much homework and she promised her best friend she’d be available if she needed to talk.

At first glance, this teen seems to have a full and rich life, with opportunity abounding. However, she’s so overwhelmed that at night she uses her desk scissors to slice her wrists repeatedly. To make sure no one suspects anything, she hides the bloody tissues at the bottom of the trash can. She wears stacks of bracelets to cover the damage so no one asks. She doesn’t know what else can release the pressure she feels from school, family, friends, and her team. She heard about cutting during lunch a few years ago, and now uses scissors to pour her emotions out.

This is real life for some teens. As much as parents are disgusted by the idea, and instinctively react with shock about what their child has done to their body, it is an unwanted aftereffect of overworked, overscheduled, overwhelmed children. Never before have we put the same amount of pressure on our children and teens to succeed academically, socially, and beyond.

While it may not make sense that they cut their bodies, it makes sense that they find a way to release the pressure. Without learning new coping skills and understanding their triggers, teens often end up alone in their pressure-cooker lives. Through counseling, teens can learn how to handle distress, how to prioritize in their lives, and how to communicate about their feelings.

What if we told you that with a single simple phrase, you could turn a bad day into a great one and turn pessimism into an instantly brightened attitude? You could write “I am beautiful” in the fog on the bathroom mirror. You could repeat Aibileen’s mantra from The Help: “You is kind. You is smart. You is important.” Or, you could print out these nine affirmations and hang them around your home or office, tape them on the dashboard of your car, or commit them to memory to pull out during trying times.

Affirmations are statements that reflect a positive outlook on life, one’s abilities, one’s potential, and more. Because the verb “to affirm” means “to maintain as true” (Dictionary.com), affirmations inherently uphold truths. In other words, by repeating these phrases you aren’t teaching yourself anything new—you’re simply repeating and reinforcing truths. Sometimes it’s difficult to remember that you are kind, smart, and important. You may need to continue to tell yourself those things so your brain can recognize and accept them.

Repeating affirmations can relieve anxiety, ease day-to-day pressure and stress, and even have a positive effect on healing from other mental health issues, like addiction. Don’t believe us? It’s scientifically proven!

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GoodTherapy.org has reported before on the astounding benefits of using affirmations:

• For toddlers with autism, affirmations can increase language development.
• Teens develop a stronger sense of identity when using affirmations.
• Simply stating affirmations in times of stress can increase likelihood of success.
• Self-affirming can help people consume less alcohol.

Add these affirmations to your daily routine, and let us know in the comments how they’re helping you achieve goals, gain self-esteem, and foster positivity in life!

1. I have the strength to face the challenges before me.

2. I am worthy of love and respect.

3. I accept myself with all my imperfections.

4. I recognize my own talents and gifts.

5. I am unique. There is beauty in my differences.

6. I focus on what I can do, not what I can’t.

7. I have value and worth in my community and in society.

8. I am grateful for every learning experience I have had.

9. I can change.

Having a hard time accepting these statements to be true? You’re not alone—many people experience self-esteem issues, low self-worth, or reluctance to accept oneself. Therapy can help. Search the GoodTherapy.org directory for the right therapist for you, and take the first step to making a change in your life.

Twisted lips, contorted mouth; you know the look of someone who is biting the inside of their cheeks when they are stressed. Why do people do that? Most of us understand it as a bad habit similar to nail biting because on the surface, it would seem like a benign repetitive behavior. However, under further consideration, the behavior may be a byproduct of an obsessive and compulsive reaction to stress and anxiety.

The medical term for the behavior is chronic cheek bite keratosis, which is a body-focused repetitive behavior (BFRB) comparable to hair pulling, nail biting, and frequent blinking. It is categorized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) under obsessive-compulsive and related disorders, and is complementary with anxiety-related types of problems. Body-focused repetitive behaviors, such as cheek biting, most often begin in late childhood and can last throughout adulthood.

Since we often cannot escape the stress of daily life and the resultant anxiety associated with it, behaviors such as this manifest as a subconscious solution to ease emotional overload. While not an ideal choice, it does serve a purpose to those who use it as a coping method. Other times, it is common for boredom and inactivity to trigger the behavior. Cheek biting is self-injurious yet compulsive in nature since it feels almost normal and necessary in the mind of the biter. The compulsive nature is what makes it difficult to stop.

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Since this behavior usually happens mindlessly, damage to the mouth tissue can occur. It is not uncommon for the biter to bite too deep and injure the mouth. Often, cheek biters have a favorite area to bite and repetitively break the skin in the same place inside the mouth. What’s worse is that when the cheek skin has been chewed and is raw, the skin feels broken and jagged, creating an additional compulsion to smooth out the affected area by biting again. This endless cycle can create physical complications only a dentist or oral surgeon can see.

Biting the soft skin inside the cheek over and over again can lead to oral trauma such as mouth sores and ulcers, but is reversible with avoidance of cheek biting, according to the Oral Cancer Foundation.

Whether it is an anxiety-related problem, an obsessive-compulsive issue, or just a bad habit, it is clear that the behavior is not ideal and potentially harmful. However, stopping the biting is a challenge because the biter is not immediately aware of when it is happening and why it is being used as an answer to stress and anxiety. The first line of defense is to lower the affected person’s stress level and provide alternative and healthy anxiety solutions. Stress and anxiety can be lowered multiple ways, most effectively by exercising regularly and eating healthy. After that, removing stressful situations and triggers should be evaluated. Additionally, treatment including mindfulness training and meditation is almost always useful. Learning to be aware and present in each moment allows the person to be in control of behaviors. While easier said than done, mindfulness and meditation are empirically proven to improve mental health.

Often, body-focused repetitive behaviors such as cheek biting respond well to talk therapy that includes techniques drawn from cognitive behavioral therapy and its subcategories dialectical behavior therapy, habit reversal therapy, and acceptance and commitment therapy. Although no one approach works for everyone, an eclectic sampling may work well. These therapies are based on the idea that obsessions and compulsions, like body-focused repetitive behaviors, help people experience stress, anxiety, and emotions without reacting negatively to them in the form of a behavior. The goal is to experience life without needing a compulsive outlet, like cheek biting, to handle what comes.

Meow! I am a cat therapist. No, I don’t have the fancy degree and years of experience like my human does—but like other pets in animal-assisted therapy settings, I collaborate with my human to help in the therapy process.

So what is it like to work with a therapy cat? First of all, I’ll introduce myself and welcome you in to the office. Therapy cats are here to make you comfortable; we’re pretty laid back and we like to go with the flow. Therapy cats are used to being handled and being around humans big and small, as well as other animals.

Nervous about going to therapy? Studies show the presence of a therapy cat will lower your anxiety as well as your stress level. Go ahead—pet us. We lower your blood pressure and help your brain release feel-good endorphins like oxytocin. This might help you talk more openly with our humans.

Now, have a seat—I’ve already warmed it up for you.

There are many of us—probably in therapy offices all over the world! Consider us a perk of therapy if we happen to be in the room to accompany you in your journey to better mental health.

My human and I know that working through therapy can be hard. Therapy cats see a lot of people who are in pain, but we can help comfort them in hard times. We’re here for you, just like our human is.

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I can help people of all ages learn and grow while working through mental health issues. Humans have proven that cats like me can even help children with learning difficulties. Some kids read to me. I love the stories of faraway places, but the ones about dogs can be a bit ruff!

I can also lend an ear to someone working out language difficulties or someone experiencing problems with social interaction or anxiety. See, in our many lives we develop many talents!

People like visiting my office—excuse me, my human’s office—because both of us can listen to you without judgment. As for the paperwork? We’ll leave that up to the humans.