C-19: Go Ahead and Plan for A Panic Attack

Go ahead and plan for a panic attack?

This may sound counter-intuitive, but hear me out.

First, we are in extraordinary times facing incredible uncertainty for prolonged periods of time.

Second, panic can stem from our sympathetic nervous system’s response to stress. We have all of the energy of fight and flight, but we may not be able to complete the stress cycle. We end up holding onto that extra stress in the body and then we react to our bodily sensations.

Lastly, it is natural to brace against the onset of panic attacks or to vow never to have another one…but this bracing can increase the intensity or likelihood of a panic attack.

Having a Plan in place can help us with a sense of control

So, I return to the point that planning for a panic attack helps in case you have one during this pandemic. It is hard to think of coping skills in moments of high stress and panic so having a plan in place can be helpful should you or someone in your circle have a panic attack during this pandemic.

Please click here to read about the AWARE method of approaching panic attacks.

C-19: Good Enough is Good Enough

Our culture has gone through SO many changes this week. If we are able to work, we are most likely using new technology (shout out to all of my fellow psychotherapists and health care professionals) to do our work or we may be working in a way we never have before. One of my neighbors is a manager at a grocery store. She has worked in grocery stores for over 10 years and posted to social media this week that she had never seen anything near the intensity of last Friday (or most days since).

This is a lot.

So, today, I wanted to send out a blog post in case you feel the pressure of perfectionism or even to keep up to your previous levels.

The problem with perfectionism or operating as we did before COVID, is that it leaves a lot of area for frustration (at best) and shame (at worst). And that is not helpful to stew in right now. You are doing what you can do given that the world has changed. Be patient with learning new things or if you are taking on new demands. Notice that you are doing “good enough” and “good enough” is really great right now.

To share some examples: I am writing these daily posts to connect. So I write what I have in mind each day, read over it once to make sure I am saying sentences, and I post. These are less than ideal posts and may have some typos. But I believe sending them out as is is better than not getting them out or spending a large portion of my day on them.
I am also touched by the parents who are not keeping the perfect daily schedule that has been posted to social media. Are your kids’ basics taken care of? Do they know you love them and you’ve got them? Good enough parenting at it’s finest.

It is also good to count your small successes. I finally got a video to upload after 10 tries, and it was a huge success when it did. We made risotto this week, and it turned out decently and was yummy . These successes are good enough for now.

See you tomorrow.

C-19: "Nexting" and the Connection to Hope

I recently borrowed the book Making Hope Happen by Shane Lopez from a friend. I started the book and then somehow couldn’t find it in my home this week as the social distancing began. The irony is not lost on me.

Well, the book turned up yesterday, so I can go back to this reading. But today, I wanted to share a concept from Lopez’s work on hope theory that has been on my mind: nexting. In hope theory, hope is active, and we have to be able to imagine pathways to our goals for the future. Nexting is part of this imagining the future. For example, we think of the next time we will see friends, when our next dental appointment is, when the next Marvel Universe movie is coming out. Kids as young as 3 can do some nexting in that we can say, “Next, we are going to brush your teeth…next, we are going to get in bed and read a story.” And this ability to imagine the future is quite helpful psychologically and in creating hope.

And then the pandemic was announced last week and our ability to do our normal nexting has taken a huge hit. We don’t know when we will next socialize, go to a concert, go to school or work, get a next paycheck, or be able to go to the grocery store at regular hours.

I listen to a podcast that comes out twice a week. This Monday’s episode was focused on the pandemic, and the host signed off by indicating that the show might be back later in the week. It really bothered me. I think I even talked back, saying, “Oh, no, you’d BETTER be back on Thursday. I need this podcast.”

Truth is, I enjoy the podcast, but I don’t need it. I am noticing the need and desire to connect with what is next. And I imagine that others do, too.

This brings up the balance of acceptance and changing what we can. We can practice acceptance that the world is different right now. We may experience feelings of frustration, panic, and sadness about this, but there are things we cannot force to be different. I cannot force my podcasters to create another podcast this week. I cannot decide when a comedy show that I had tickets for will be rescheduled.

Then there are things that we can change and work on. We can decide what book to read next or what TV series we will watch next. We can look at our available food and decide when to next go to the store. We can decide when to reach out to a friend or go outside.

Best wishes in finding and noticing your nexts.

See you tomorrow.

COVID-19 (C-19): Guided Loving Kindness Meditation

May All Beings Be Happy, Healthy, and Free.

This is the basis for Loving Kindness Meditation, which is one of my favorites. I am linking to a recording I did of Loving Kindness Meditation and previously posted.

See you tomororw.

COVID-19: Guided exercises to ground and breathe right now

I’m hearing that folks are feeling restless, anxious, and unfocused right now. Sounds totally normal to adapting to an unprecedented time. I do want to offer some practices you can use to come into the present moment, and observe your breathing and your body. This is from an earlier post, but the practices still apply:

Breathing is one of the simplest ways to come into the present moment and connect to the body. Breathing increases regulation when you are pulled into experiences of the past or are spiraling into worries about the future. It is also a way to focus the mind, even if is it only briefly. For these reasons, it is commonly recommended to spend time on breathing when one is anxious, angry, stressed, or overwhelmed.

While you can definitely just put your attention on your breath, there are other variations of breathing that can increase grounding and connection to the body. Try these breathing exercises and become familiar with them as both a regular practice and to use when you feel anxious or disregulated. Discontinue and return to your regular breath if you feel overwhelmed, dizzy, or short of breath. 

1. Belly Breath

Lie down on your back or sit comfortably. Feel the connection of your body with the floor or chair, and feel your body getting a little heavier. Start to observe your breath as it is. You may want to close your eyes or let your focus be soft in front of you.

As you inhale, feel your lower chest, ribs, and belly gently expand. When your inhale is complete, gently draw in the navel to push the air out of the belly and chest. Continue at your pace. To increase relaxation, you can let your exhale be one to two beats longer than your inhale. You can put a hand on your upper abdomen or both hands on the side of your lower ribs to get the feedback of touch as you breathe. Continue for several minutes before returning your attention back to the room. Observe how your body is feeling.

2. Mainstream Breathing

Start in a comfortable seated position. Put your attention on your breathing without trying to change it. Just sit for about a minute with your focus on your breath. Gently bring yourself back to your breath if you get distracted.

Turn your attention to something you see that is pleasing to you. It could be a tree or the sky, an object in the room, a color. Give that your attention. Look at every detail, shadow, the perceived texture, shape, and so on with your full attention and curiosity. Then, turn your attention back to your breath for about a minute, imagining the air traveling in and out of the body through the nose.

Next, gently close your eyes and pay attention to the sense of sound. Imagine that you are opening your ears so you can take in all of the sounds, obvious and subtle, that are in your environment. Take a moment here just listening. Then, turn your attention back to your breath and listen to the sound of your breath coming in and out of your body through your nose.

Turn your attention to your sense of smell. Notice any smells in your immediate environment, even if they are very subtle or nonspecific. Just put your attention on this sense for a moment. Then return your attention to your breath, noticing the air coming in and out of your nostrils.

Place your attention on the sense of taste. This may be the taste in your mouth or imaging a taste that comes to mind. Just take a moment to notice this sense. Then return your attention to the breath, noticing the breath coming into the chest and belly on an inhale and leaving on an exhale.

Finally, place your attention on the sense of touch by touching something pleasant in your immediate environment. This could be the cloth of some of your clothes, an object in the room, or the surface you are sitting on. Notice all the details associated with touch such as texture, size, density, and temperature. After a moment here, return your attention to your breath. Notice how your breath feels inside your body.

You can opt to go through fewer than five of the senses. For instance, you can just pay attention to the senses of sight, sound, and touch.

I learned about this technique from Dialectical Behavior Therapy and Somatic Experiencing readings and trainings.

3. Circle Breathing

Start in a comfortable seated position with the soles of your feet on the floor. As you inhale, imagine that you are breathing in from the bottom of one of your feet. The air travels up your leg on that side, through your leg and torso to your upper chest. The air then moves to the other side of your body, and you exhale it down and out that side, all the way out the foot. Repeat this cycle. It does not matter whether you start with the right or left side, and you can try starting with the opposite side the next time you visit this breathing exercise.

Circle breathing is a technique from Freedom From Pain by Peter Levine and Maggie Phillips.

4. Bee’s Breath or Chanting “Om”

This breath involves making sound on the exhale. You can either put your lips together and hum like a swarm of bees (hence the name “bee’s breath”), or you can chant a deep “Om” sound, with half of the exhale being on the long “O” sound and half the sound vibrating the “mmm.” Inhale through the mouth and exhale “Om” or hum like a bee. Repeat four times and then observe the effects of this breath.

The louder that you make this sound, the more tension you create in the jaw, so try making a softer sound and being aware of how your jaw feels.

I hope you enjoy trying out these breathing practices and seeing how you experience them. While it is normal to notice some change in energy from doing breathing exercises, please discontinue any exercise that causes you pain, and consult a physician if you are concerned that you may not be able to do these exercises due to other health concerns.

COVID-19: Boundaries

Okay, so what do these two rabbits have to do with boundaries? These rabbits are a bonded pair of rabbits. They are spayed and neutered so that they don’t multiply, but they are each other’s touchstone and security. They groom each other, lay together even when it is really warm, protect each other, and eat out of the same bowl or bin (alternating who takes the next bite). Even though they are pretty enmeshed, these two will still set a limit with their partner by nipping, chasing, or thumping that the other rabbit has stepped over a line. Even the most bonded rabbits—who get along 99% of the time—still have to set limits with their partner.

Also, rabbits are cute and we could all use cute pictures right now.

Part of responding to COVID-19 means redefining our boundaries and negotiating them with folks in our homes (partners, children, pets), with our friends and community groups, and with working relationships. We are negotiating based on factors such as: what information we have about COVID-19, how our nervous systems tolerate change and isolation, and what our circumstances are.

Here are some examples of boundary differences coming up:

• One partner wants to listen to the news because it helps her feel informed but her partner becomes easily anxious by hearing news stories.

• Teenagers in a home are persistently asking their parents to let them go out to hang out with friends at each others’ homes, but the parents are saying no because of social distancing measures.

• Everyone in a volunteer group wants to proceed with a committee meeting for some important organization business. Many group members want to meet in person because “we’re all healthy and feel well; we’ll be fine” and they are frustrated with other members who want to postpone the meeting or meet through other forms of technology.

• Your mother-in-law criticizes you for going to your grocery store job and believes you should stay home, no matter what your financial circumstances or what protections your employer has put in place.

Boundaries are something we can work on throughout our lives. The COVID-19 pandemic is causing us to renegotiate so many aspects of our lives in a very quick period of time under a lot of stress. Here are a few tips for clarifying and expressing your boundaries around COVID-19:

1. Notice if someone’s requests are making your uncomfortable, frustrated or angry. This may be a sign that they are stepping over your boundaries. Our feelings and sensations are meant to give us messages to explore.

2. We can’t see corona virus or COVID-19, so we have to go on the information we have about best practices to slow down the spread. Others may disagree about what precautions to take. For instance, if someone believes that healthy people will not get the virus, this will impact the boundaries that they set.

3. If you notice a difference in how you and someone else are dealing with boundaries, state your boundary with a non-accusatory I-statement that names what you are going to do. For instance, one can say to their co-volunteers, “I am not going to in-person meetings right now because of the pandemic. We can do our next meeting using Zoom or we can wait until things change with the pandemic.”

4. You may be able to educate someone, if they are open to it. If so, you can provide them with a few trusted informational sources, like the CDC’s website.

5. You also don’t have to educate the other person or entity. If someone continues to push you after you have set a boundary, try not to have an argument. Instead, you can restate your boundary and suggest a way to move on given the reality of your different boundaries.

6. Avoid name calling or criticizing the other person’s character. Accusing someone of being a germaphobe or insinuating that they are unintelligent won’t help the immediate conversation or navigating the boundary. It’s like adding gasoline to a fire.

7. Setting boundaries can feel uncomfortable. You may worry that you’ve upset the other person or that your are wrong because setting boundaries may be new to you. Even if you set the boundary well, the other person may push back or be upset with you. Sometimes the best thing we can do is to realize that we are going to take a different action than someone else and that is okay. Please do what keeps you safe and aligned with your values.

8. If someone is setting a boundary with you about their needs, respect it. If a friend says “no” to hanging out because of social distancing measures, that is their decision. Find other ways to stay connected with that friend or find a friend who is fine with hanging out together.

I’ll go back to the pair of bonded rabbits again. You are also allowed to ask for closeness and support and to snuggle a loved one right now. Noticing and navigating new boundaries is hard work, partially because we have to think of so many new scenarios. Keep up some compassion for yourself and others as we are all figuring out how to best face this pandemic.

See you tomorrow.

COVID-19: A note on connection and empathy

With the ever changing closures in our communities, I have been pleased with the ways that people are finding ways to connect and let folks know, “I’m here for you.” It is so touching to see neighbors reach out with texts, calls, video calls, Next Door posts offering to get items for folks from stores. Houses of worship are stepping online. DJ Mel is hosting Living Room Dance Parties on Facebook.

Matt the Electrician, one of my favorite local musicians, did a virtual concert tonight on Facebook. It was lovely to hear his voice and get the concert experience through my phone. In lyrics to his song It’s a Beacon, It’s a Bell, Matt sang the line, “When my heart got bigger, I could see you bigger.” It’s one of my favorite lines, and I enjoyed hearing it tonight, especially thinking about how we are all needing the connection and empathy that comes with being able to see each other better. Stress makes us go inward and see fewer possibilities, but connection and empathy buoy our mental health.

Stepping back to the nervous system: it is totally normal to be in fight, flight, and freeze and those experiences can cut us off from social connection and seeing others. For example, when someone cuts a person off in traffic, we might label that person an “idiot”out of a fight response before we see them sheepishly wave and realize they are an imperfect human as well. We exhale and let our nervous system release a little bit. We might wave back and even remember times when we’ve made driving mistakes, too.

So, while we are all going to run through a lot of different states during this pandemic, we can also remember to think about how this pandemic is part of the human experience and we are all going through it. We can have empathy and wonder about our immuno-compromised folks (there are a lot of folks in this category), those with limited transportation, those with a small business that has already been hit hard, those worried about relatives far away, those who have upcoming medical procedures or are giving birth soon…the list goes on. Our hearts can get bigger and we can take the time to slow down, reach out, and see others better. And sharing empathy is a buoy for our mental and emotional health.

Human beings really want to get away from pain (physical or emotional). It is one of our biggest motivators. We are also motivated to help others. I think empathy leads us to better connection and can help us to understand how we can help. One way we can help is to limit physical movement and in-person contact right now. While this can be a challenging experience for us, we are helping others by social distancing, in ways that we might never know. I appreciated the tweet on the right side of this post:

Be creative in how we reach out, while keeping folks safe.

See you tomorrow.

COVID-19: Those "What If" Questions?

“What if” questions pair up with anxiety and take on a frenetic and panicked pace:

“What if I get corona virus? What if I don’t know I have it? What if someone at work doesn’t wash their hands enough? What if we run out of hand sanitizer? What if we have to cancel….”

This new virus is leading to a lot of uncertainties because we as a culture have not practiced social distancing and quarantining in such a mass before. And we only tend to cancel so many parts of our busy lives when we are under attack, responding to a threat such as a pandemic or a terrorist event.

So, it is really normal for our nervous systems to be searching for danger and trying to predict. That’s the job that they do when they are trying to keep us safe and want to be prepared. The issue comes in when the questions take off at a rapid pace and we become irritable (fight), panicky (flight), or can’t move past the questions to possible solutions (freeze). We go past the point of effectively meeting stressors to being in so much distress that we can’t take effective action.

And just a reminder, it is normal for your mind and body to try to take care of you and get a bit stuck at points. There is no shame in that. We just want to work on taking steps to come back into a more effective and less anxious place. Notice that I didn’t say that you should be relaxed. Because that wouldn’t be effective either. The idea is to take the anxiety down a few notches from pure fight, flight, and freeze,

So, with “what if” questions, you can take a few steps:

1. Recognize when they are happening by noticing the pace of your thoughts, tension in your body, or maybe the feedback from a trusted person. A little awareness can take us out of the spiraling energy of “what if” questions.

2. Do something to come into the present. Put your feet on the floor. Notice your breath. Pet your animals and notice the feel of their fur and warmth of their bodies (as well as how cute they are). Splash water on your face. Take a walk. Go to the floor in child’s pose. The body will drive your thoughts so do something in the present and grounding before moving on.

3. Break up the onslaught of “what if” questions and examine one or two that are most important to you. Maybe write them down with some room to answer them each as writing things down can help us slow down and stay on one questions at a tim

   Answer what you can answer of your most important “what if” questions, going to trusted sources to do so. When anxiety is too high, we get in the way of actually answering the questions. We may stop trying to find answers and the questions just pile up. So if your questions is “What happens if I get COVID-19?” or “What if I feel symptoms like fever, cough, and shortness of breath?” you can start to imagine a few things that you would do. You would go to a trusted source for directions, like your doctor or public health department. You would follow the instructions from the CDC or City of Austin and react based on your symptoms. You would isolate to the best of your ability and do things like hydrate to treat your symptoms at home unless your symptoms were more severe.
   
   It can be helpful to have a trusted person to talk to you when you have your “what if” questions. I want to stress the word “trusted”. There are still folks (although fewer every day) who might gaslight you for your concerns or tell you “don’t worry about it, you’re not going to get sick”. This does not help people to feel less anxious; it just causes shame and isolation as folks are trying to take care of themselves.

   Also, there will be points where you can’t come up with a plan. That is normal. We like to think we can predict everything, but there will be points where we have to accept what we don’t know or know that we will deal with it when we have to. For instance, if we have symptoms of COVID-19, we can call our doctor’s offices. But we don’t know every step that we will take all through the illness because we don’t know how the course of our illness would go. Answer that you can as you can.

   See y’all tomorrow. Wash your hands, stay hydrated, and breathe the whole time.
   
   

COVID-19: The Stress Bell Curve

Hello, everyone,

It’s been a bit since I have interacted on this blog, but now seems like a good time.

I am here in Austin, Texas. I am still in private practice part-time and I work for a large agency part-time. My agency has closed it’s services and we are going to tele-health as of today. With schools and large businesses closing, I imagine many of you are navigating this new landscape, too. I thought I would try to post something each day about mental health that could be relevant to managing anxiety, utilizing yogic practices, or staying connected during “social distancing.”

First up, is an oldie but a goodie: the stress/anxiety bell curve. I have drawn this a bunch of times on my purple dry erase board and will link to picture of the graph here: https://hbr.org/2016/04/are-you-too-stressed-to-be-productive-or-not-stressed-enough

Basically, the idea is that we are SUPPOSED to respond to stressors. If someone throws an object at your face, you should duck or block your face with your hands. If your boss asks for a project by a certain deadline, you will be more successful if you pay attention to that deadline, and make a plan to get the project done. If you a tiger comes into your home, you should run!!! So responding in an appropriate manner that meets the stress effectively is what we are designed to do and that is why we are most productive in the middle of the bell curve. If we have zero stress, we can get hit, fired or eaten. And if our stress rises to be too high, our thoughts and tensions get in the way of us being able to act. We may ruminate about all of the possibilities, try to take control over a situation that we can’t possibly have, we might not eat or sleep because we are so activated.

Same with the COVID-19 pandemic. If you do not have COVID-19, you can assess your situation and decide what is an effective response based on your needs. Ruminating on the what-ifs or scrolling through every story on social media or cable news may increase your anxiety and keep from responding to your household and community’s immediate needs. Rolling your eyes and declaring that you are healthy and not a “germaphobe” may leave you underprepared.

So, today, maybe notice where you are on the curve and see if you can make adjustments. Maybe you need to respond more to the impacts of COVID-19 by making sure that elderly folks in your life are okay or that you have all of the prescription meds you need. Maybe you need to go to the cdc site and read over their recommendations and see if your household or business needs to adjust. Maybe you will keep working from home but will need to notice if you are rushing or your breath is tight from stress. Maybe planning things that you GET to do from home or connecting with friend by phone or Internet means will be helpful. Maybe you limit how much you are watching news or social media because it is a bit overwhelming and you can only take it in limited doses.

Later, Jamie