Using Temperature to Manage Anxiety

There are many approaches to managing anxiety in the moment. One of my favorite methods is using temperature, specifically cold, to bring anxiety down. When our anxiety level is high, especially if we’re heading into panic, our bodies go into overdrive to meet what it perceives is our need: fight or flight. Our hearts pump faster and harder, our breathing speeds up, our adrenaline kicks in. It can feel like we have no control over our physical selves in those moments.

The quickest and easiest way to combat that is to shock our system with cold. The fastest, but also most complicated, way is to hold our breath and stick our faces in a bowl of ice water for 10 seconds or so. Dramatic, I know, but it works. If you’re at home and have access, this can be a great tactic. It triggers our dive reflex, which slows the system down and adjusts everything to protect our most vital internal organs. It has the lovely side effect of stopping an anxiety attack in its tracks.

Of course, sticking your face in a bowl of ice water is rarely convenient or appropriate. Can you imagine trying that at work? Or the grocery store? So, what else can you do? I recommend keeping frozen bottles of water in the freezer at home or work, if that’s an option. You can place one against your neck and wrists to help calm your system. If that’s not an option, try holding a piece of ice. If none of those options are accessible, you could go to the bathroom and splash cold water on your face. I’ve also had some clients keep instant ice packs with them for emergencies. These are particularly convenient for outings to places without access to freezers or cold water. Pop the pack, shake it up, and place it against your pulse points on your neck or wrist (or both!).

Of course, it’s always important to remember to breathe deeply anytime you’re trying to control your anxiety. What tricks do you use to manage your anxiety in the moment?

Sliding Scale

When you start looking at therapy as an option, it’s not uncommon to have a little sticker shock. I know the first time I looked into therapy, I gave up almost immediately because the price was well beyond anything I could afford. As a therapist, I now understand why rates are what they are, but that doesn’t make it any easier if you can’t afford $100 or more an hour.

What’s a client or therapist to do when someone can’t afford the full fees? Many therapists choose to offer Sliding Scale slots on our caseloads to provide services to those who need them. That means we adjust our rates to something more affordable for you. In my case, I talk with my clients about what their goals are and how often they feel like they need to go to therapy, and then we talk about what’s affordable for them based on how often they think they will be coming. We set the rate together to make sure it works for us both. If at some point in the future their situation changes, we reevaluate their fee at that time.

It can feel uncomfortable to ask about Sliding Scale, but it’s important to think about whether it’s more uncomfortable to ask about that or to continue dealing with the feelings you’re having that lead you to consider therapy in the first place. Even if you’ve determined I’m not the right therapist for you, I encourage you to keep searching for another therapist who will be a better fit that offers Sliding Scale.

Open Path Collective is great place to start. This therapist directory only lists therapists who work with Sliding Scale clients, so you can be sure that everyone on there is welcoming of those who need to discuss reduced fees. They also require that therapists agree to a specific rate range ($30-60/hr for an individual session, $30-80 for a family session), so you know that you'll be looking at therapists who will have a Sliding Scale in that range. I maintain certain number of slots for clients who come through this referral source. I also maintain a certain number of slots for clients who can afford more than the Open Path rate, but who cannot afford my full fee. Psychology Today also lists Sliding Scale therapists, though it does not necessarily indicate what a therapist's sliding scale range is.

There are many more options available for therapy than most people realize, and it really can be accessible for just about everyone. If you think therapy would be helpful to you, I strongly encourage you to keep looking until you find someone who is a good fit for you. If you're struggling to find someone, feel free to reach out to me for some guidance. I'm happy to help!

The Practice of Gratitude

Studies have shown that the practice of gratitude actually changes the way your brain functions. It creates an opportunity to view life through a more positive lens. When we choose gratitude, we choose to see the positive outcomes, even in difficult situations. When we focus on gratitude as a daily practice, we sleep better, have decreased levels of pain, stress, anxiety, and depression, and have increased energy.

Gratitude seems like an easy concept, right? I’m thankful for a roof over my head, my dog laying on my feet while I read a book, the yummy dinner I had last night. Easy, right? But how do we maximize the use of gratitude to achieve all of those awesome benefits? It needs to be a regular practice, and we need to intentionally find gratitude, even in difficult things. Often, when I first ask my clients what they are grateful for they give me standard answers: family, friends, a job, and a place to live. We should be grateful for all of those things, of course.

The challenge comes in trying to find gratitude for circumstances or people with which we struggle. There are so many things in day-to-day life that can make it hard to find gratitude. Traffic on the way home from work. An angry client or customer. Another task on top of your overloaded to-do list. Dinner that didn’t turn out right. The list could go on and on. What if, instead of focusing on those things, you found the positives in every day? What if you found the lessons learned that can make your life better going forward?

I try to practice gratitude every day. For me, it works best when I am getting ready to go to bed at night. My distractions are naturally limited (Do Not Disturb with Bedtime is the best invention ever), and it gives me an opportunity to review my day. What good things happened? What things could I have done better and how? What lessons did I learn from those things? Who and what made a positive impact on me today? Who and what pushed me to do my best?

As we head into the New Year, I challenge you to make gratitude a part of your day to day life, too. Start small. Find three things everyday for which you are grateful. Choose one person, one thing, and one experience each day. As time goes on and you get more comfortable with the practice, expand your list.

I invite you to try an end of the year gratitude practice: Look back over the last year. Choose at least one person, thing, or experience you were grateful for each month, and then add it to next year’s calendar for that month so you can remember to stay grateful for them, and to stay grateful in general.

Wishing you a Happy (and Grateful!) New Year!

DBT - Why I Love It and Why You Should, Too

Dialectical Behavioral Therapy. Those three words left me baffled the first time I heard them used together. Specifically, Dialectical…. What does that even mean? It’s easy to get turned off by that word alone. The truth is, for most of us, we don’t really need to know what a Dialectic is. What we need are DBT Skills! Let me tell you, there are tons of them. Literally, tons. The skills manual is not a lightweight or small book. Luckily, we typically already use many of these skills in our day to day lives. We just don’t label them the same way.

Have you ever found yourself overwhelmed by a strong emotion and chosen to distract yourself with something benign like a crossword puzzle, word search, sudoku puzzle… you get the idea. Maybe you chose to watch a movie or TV show that provoked an opposite emotion for you. Have you ever planned out a conversation ahead of time to make sure you stay on point and get what you want? Well, guess what? You’ve used DBT skills!

DBT encompasses four broad areas: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness.

Mindfulness is the practice of participating in something fully and from a balanced place in our mind. In our modern lives, we are constantly being distracted by notifications on our phones, smart watches, computers… distractions are everywhere. When we are mindful, we push away distractions to maintain our focus on what we’re doing. When is the last time you spent time with someone and remained fully present with them the whole time? No responding to text messages, emails, social media notifications…. just being present with that person? If you’re like most people, it’s probably been a while. When our attention is focused, we get so much more out of our experiences. Try eating a food you enjoy while focusing solely on that food. It’s a much more fulfilling experience. Now try playing with your child or talking with a friend with no distractions. It’s also a much more fulfilling experience, right?

Distress Tolerance means managing an emotional crisis effectively. Think back to the last real crisis you faced. Perhaps it was a death of a loved one or the loss of a relationship you thought would last forever. How did you handle it? What did you do to make it through? What do you wish you had done differently? Distress Tolerance skills give us concrete actions we can take to get through a crisis without making it worse. I’ll give you an example of something that worked for me. First, it’s important to know that I have a phobia of snakes. I am absolutely terrified of them. I don’t like pictures. I change the channel when they’re on TV. I didn’t even like typing the word. It’s irrational, but it’s a fear nonetheless. Several years ago, I was at work and out on the playground with my children’s group. What comes slithering onto the playground? A snake. A tiny, baby snake that all the kids thought was the coolest thing ever. Now, I couldn’t very well panic, run inside, and climb on top of a table the way I wanted. I had a group of children under my care and a slithery creature I couldn’t identify as being safe. So, instead, I chose to distract myself and the children by starting a physically active game away from the invading snake and simultaneously notified a snake-wrangling coworker that I needed help. She came running to the rescue, the kids were all safe, and I did not have a heart attack. It was a good outcome, and I had used two different Distress Tolerance skills at once. I distracted from the crisis (snake) and incorporated vigorous exercise to alleviate my body’s adrenaline response to the crisis. I recommend everyone have at least two good Distress Tolerance skills in their back pocket because you never know when a slithery invader might show up on your playground.

Emotion Regulation is the practice of creating a healthy baseline for emotional functioning and also employing skills to manage emotional reactions that don’t serve you well. The foundation for managing our emotions effectively is in both understanding our emotions and taking good care of ourselves physically. Emotions are complex, and we often experience multiple emotions at the same time. It can be difficult to break apart those emotions to determine what, exactly, we are feeling. It can also be quite difficult to prioritize basic self care in our current world. We burn the candle at both ends, rush and stress to manage everything on our plates, and often fail to get appropriate sleep or eat well. If we’re exhausted, stressed out, and hungry, it’s no wonder we struggle with managing our emotional reactions to things. Sometimes, we can have emotional reactions to things that lead us to behave in ways that don’t serve us well in the situation. One day when I hadn’t slept well, had been at work far too long for one day, and hadn’t eaten lunch because I was too busy, I came home ready to eat the dinner I had picked up on the way home. I opened my meal only to discover it was not what I had ordered and was actually something I hated. I burst into tears and found myself paralyzed and unable to make a decision to get myself fed. Now, my rational, well-rested, non-starving self sees that as an utterly ridiculous reaction. But I was hungry, tired, and stressed, and I simply didn’t have the reserves to make a reasonable decision in that moment. That’s where the skills to manage that emotional reaction would have been very helpful - I wanted to cry and give up and go to bed hungry, but Opposite Action would suggest I push through my discomfort and take steps to feed myself in some manner. The beauty of Emotion Regulation skills is that they are both preventative and reactive to a specific situation.

Finally, Interpersonal Effectiveness is one of those skills that most people think they have… and then realize they may not be quite as skilled as they thought they were. It basically breaks down into three main skills to help you ask for what you want/need, maintain relationships, and set limits and boundaries in your relationships. Relationships are complicated, whether it be a romantic, family, or work relationship. Having a guide for handling difficult discussions can be so helpful, especially if you have the opportunity to prepare for them ahead of time. For example, let’s say you’ve got a coworker who is always asking for your help with their projects. You’ve tried to say no, but somehow always end up helping out anyway. Interpersonal Effectiveness gives you a guideline to set a boundary with the coworker. Interpersonal Effectiveness skills are some of the most important and effective skills for so many of the people I see, whether they need help setting limits or in maintaining relationships. Effective communication can make so much difference in the relationships in your life, and that can make a huge difference in anxiety, depression, or whatever other issues you might be facing.

In my experience, DBT is the most effective and useful therapy modality I’ve studied. You may read a lot of things about DBT that seem confusing, and at first, it can definitely seem that way. With time and practice, though, the skills become second nature and are so useful in day to day life. I truly believe that everyone can benefit from DBT at some level. If you're interested in learning more, please don't hesitate to reach out.

How to Get Started in Therapy

Before meeting with new clients, I always like to do a phone consultation to make sure I'm a good fit for your needs and that our schedules will work together. During this call, we'll talk about what's leading you to therapy and what kind of therapy you think would be most helpful for you. It's okay if you're not sure what kind of therapy you want or need, though. I can help you determine that when we speak.

If we both feel like it's a good client-therapist match, then we'll schedule your initial assessment. Before your appointment, I will send you some basic forms that I require of all clients, as well as a quick intake questionnaire. During your assessment, we'll talk about what's brought you to therapy, what your goals are, and your history. This lets us decide which path to take and helps narrow down some specific things you want to work on.

After the initial assessment, we'll meet on a schedule we'll decide together. We'll work together to set small goals to help you achieve your bigger goals over time. Every client is different, so there's no prescribed plan of sessions or how many times we will meet. As we go along, we will evaluate your needs and adjust the schedule to meet them. How long you participate in therapy depends on you - what works for you, what you want out of it, and how long it takes to accomplish your goals.

If you have looked through my site and feel like I would be a good fit for you, I welcome you to schedule a phone consultation with me. During this call, we’ll talk about what’s leading you to therapy and make sure we will work well together, and also discuss what is a feasible payment for you. From there, we’ll schedule your initial assessment appointment. If I don't offer the specialty you're looking for or don't feel like the right therapist for you, I'm also willing to give some suggestions about other therapists that might work better. I'm also happy to respond to emails looking for other referrals.