When It’s More Than Just a Little Stress

 

Written by Talia Kaplan

Consider the following three people:

Joseph is a 35 year old married man whose father died from stomach cancer 5 years earlier. Recently, Joseph has begun to worry that he too may develop cancer. He has gone to several medical doctors and has had numerous scans, all indicating that he is healthy. Joseph continues to worry despite his doctor’s, his wife’s and his family’s reassurances. Any time Joseph feels nauseous or pain in his stomach he begins googling the symptoms to see if it is possibly stomach cancer. Joseph severely has limited the type of food he eats, stopped exercising, and stopped working due to his fear of stomach cancer. Recently, he has noticed that he is worrying about a hernia and other types of medical problems. When he went to see his general practitioner, he was referred to a therapist.

Nancy is a 60 year old divorced mother of three children who has a fear of flying on planes. Her three children live all across the United States, but Nancy has never been to visit her children due to her fear. She has never met her grandchild, and has become depressed as a result of her strained relationship with her children. Nancy’s daughter will be getting married in 2 months and she would like to be able to attend the wedding.

Michael is a 25 year old single male who obsessively worries about the remote possibility that he might kill someone, despite the fact that he has no desire to do so and zero history of violent behavior. Michael works as a barista in a coffee shop, but recently had to take a leave of absence because he kept thinking that he may have accidentally put detergent in a person’s coffee which might kill them. Michael would therefore re-do each cup of coffee he made three times before handing the cup to the customer. Michael’s supervisor noticed what he is doing and has threatened to fire Michael as a result of his inefficiency.

The three people listed above experience debilitating levels of anxiety. Their anxiety has moved beyond regular daily stress. It has moved beyond the frustration of frequently experiencing anxiety in difficult situations. For the people in these vignettes, anxiety has become the thing to fear, and a significantly inhibitory factor in their lives. The first person, Joseph, experiences hypochondriasis (health anxiety); Nancy has a specific phobia of airplanes; while Michael has OCD. While it is expected for all people to worry at times, anxiety can prevent people from living their life in the way they would want to. In cases like these intensive outpatient treatment involving exposure therapy, can help people make rapid gains in treatment over a short period of time.

Exposure therapy works on the premise of behavioral learning models. By avoiding the feared stimulus, people’s anxieties tend to get worse because their fears take over their life decisions. Exposure therapy re-teaches people that they can fully engage in life. Sometimes the feared outcome takes place, and sometimes it doesn’t, but their fear does not dictate whether it will happen. In intensive exposure-based treatment, the therapist and patient first work to ensure understanding of the core fear. For example, for some people the fear of flying in an airplane is that the plane may fall out of the sky, for others it may be that the airplane may hit turbulence and the passenger may experience nausea. Second, the therapist and patient collaborate to develop a hierarchy of feared situations. This hierarchy serves as a map for treatment progress. Patient and therapist then spend a series of half- or full-days together to move in a linear fashion to tackle areas of avoidance for each patient. An example of a first stage in a hierarchy for Michael might be thinking about a person spilling hot coffee on themselves and thereby slightly burning their hand because of a hot cup of coffee that he gave them. The therapist and patient work methodically to help the person re-engage fully in their lives despite feared situations. In many cases of intensive treatment, patients have seen significant improvement in their ability to live the life they want to be living within a week.

One important aspect of doing this type of short-term intensive treatment is attending to bodily sensations. For a patient like Joseph, bodily sensations are often interpreted as dangerous or scary. Through the use of mindfulness techniques, therapists work to teach patients how to re-interpret the daily aches and pains of daily life. Research suggests that intensive treatments can be used to help a person meet a short term goal that they have been struggling with for years. It can help a person reconnect and rebuild interpersonal relationships, allow a person to keep their job, and help people feel more satisfied with their lives.

Five Rules for Giving Instructions that Children Will Obey

Written by Jacquelyn Blocher

Previous blog posts have addressed several strategies to decrease your child’s problem behaviors, from being consistent with discipline (link) to the power of praise and attending to positive behaviors (links). Learning to give attention to the behaviors you like and minimizing attention for behaviors you don’t like can solve most of your child’s minor behavioral problems. There are some instances though when you need to tell your child to do something that cannot be ignored.

All too often though, many parents find themselves at a bit of a loss for how to best tell their child to do something that really needs to be done. The same instructions are repeated more than once. Negotiating or bending the previously enforced rules becomes the norm. Frustrations increase as children whine, stall, or plead in response to parental commands or limit setting.

So why has giving effective directions to your child become something that is so challenging? Often, parents and their children have fallen into a pattern in which their words no longer carry the same meaning they were intended to have. This happens when a parent does not consistently follow through on what he or she says, and over time the child learns that he does not always have to do what he is told. Bottom line, as with other parenting techniques, consistency is crucial. If you say it, mean it, and show your child you mean it by always following through. If you don’t have time to be consistent or follow through, avoid giving instructions, and in turn avoid teaching your child that they do not have to do what you say.

Are you ready to consistently follow through on your instructions? To increase the likelihood that your child will do what you tell him to, follow these five rules below. While they may seem simple, it takes practice and consistency for them to work effectively.

  1. Your statement of instruction should make it clear that your child is being told to do something, and she/he is the one expected to do it. For example, imagine that you have just finished coloring pictures with your daughter. She needs to put away the crayons from the table so there is room for you and your family to eat dinner. An effective command in this situation would be, “Sarah, please put the crayons back in the drawer.” This is a direct statement in which you told her exactly what you expected her to do. Avoid instructions that ask a child to do something like, “Could you please out the crayons back in the drawer now?” Additionally, stay away from directions that make it unclear who is expected to perform the action such as, “Let’s put the crayons back in the drawer,” or “We’re going to put the crayons away now.” In these statements, it is unclear if the task will be a joint effort between you and the child. Also, instructions that begin with question words or words like “let’s” or “we” imply a suggestion or choice rather than something that is non-negotiable.
  1. Make your command positively-stated and specific. Make sure your command tells your child what to do, and avoid telling them what not to do. If you give an instruction by telling her what you don’t want, how does she know what you are expecting her to do? Going back to the crayon example, I did not say, “Please, stop coloring” or “Don’t color anymore pictures.” Negative statements can lower your child’s self-esteem, and also increase negativity in your parent-child relationship. Additionally, do you want your child to just stop coloring? No, you want her to clean up and get ready for dinner. Think about what it is that you want your child to Be specific and positive in your phrasing.
  1. Only tell your child to do one thing at a time. When you give instructions that have multiple parts, and a child only obeys a portion of what you tell her, it is hard to know if the child forgot or if she is deliberately disobeying. To prevent this problem, give only one instruction at a time. If you want your child to put away the crayons and then set the table, first give one command about the crayons. Then, after she obeys, give a second command about putting the silverware on the table. This way you’ll avoid having to deliberate about how to follow through if your child only does part of your two-part command.
  1. Give your command in a normal, neutral tone of voice. Teach your child that all commands are expected to be followed. By teaching your child that polite commands are optional or can be ignored, you will stay away from teaching her only to obey instructions when you use raise your voice. Further, instructions given in an angry tone lead to unpleasant interactions. Keep in mind that as your emotions rise, it becomes more difficult to think and act clearly, which can lead to less consistency and ultimately ineffective commands.
  1. After you give a command, avoid speaking and watch and wait. Be ready to give a warning and to then follow up with a consequence. If you give a command and don’t watch and wait for it to be completed, you are essentially telling your child that you do not expect it to be done. If after some waiting, the child doesn’t obey, reinforce your command by giving a warning “If you do not put the crayons in the drawer, then you will not be able to play with them tomorrow,” or “If you do not put the crayons in the drawer, then you will not get dessert tonight.” After the warning, watch and wait once more. Then, follow through with your consequence if your child does not do what you told her to do. Avoid saying anything else, including answering questions or negotiating, until after your child has obeyed or the consequence has been delivered. Say your warnings and consequences with as few words as possible. If you give into negotiating or changing your consequence, you have taught your child that you do not mean what you say. You have also started the cycle of making your commands less effective.

Consistency is key to teach your child to obey your commands. Remember, once you say an instruction, show your child you mean it by following through!

Making New Years Resolutions Work

Written by Ariel Campbell

For many of us, entering into the New Year can bring about thoughts of change. It can be a time of retrospection when we reflect on our life choices and consider improvements we would like to make. It’s probably the case that most of us, at one time or another, have set a New Year’s resolution aimed at bettering ourselves in some way. However, it’s probably also the case that most of us have experienced that initial sense of eager excitement and commitment gradually fizzle out into something more like a faint suggestion.

Despite our best intentions, making lasting changes in behavior can be hard. Luckily there are a number of strategies that can help us increase the likelihood of staying on track and achieving our goals. Whether it’s losing weight, improving an important relationship, or finally getting around to writing that novel these tips can help you make positive changes that last through 2017 and beyond.

The first step towards change is choosing appropriate goals. While we likely all have various areas of self-improvement that we could target, attempting to work on multiple areas simultaneously can be an overly ambitious undertaking. Focusing all of your energy for change towards one goal at a time will boost the odds in your favor. Additionally, aim to choose positive rather than negative goals. Positive goals are new patterns that you would like to see whereas negative goals involve current habits that you want to stop. It’s much easier to learn new habits than to unlearn old ones.

When setting goals, remember the acronym SMART to increase your chances of meeting your objectives. Setting Specific goals means being very clear and precise about what you want to achieve. If you’re working towards a long-term goal, breaking it down into smaller, clearly defined steps will help you to get started and stay on track more easily. Choose Measurable goals in order to track your progress. For example, if you want to find a new job choose to send out five applications per week. Make sure to set goals that are Achievable, or in other words goals that are in line with your abilities. Additionally, it is important to be sure that your goals are Realistic. Select a goal that is not only in line with your resources, but also with your larger life priorities and obligations. And finally, set Timely goals, meaning goals with a clear time frame and end date.

Now that you’ve set attainable goals, you’re ready to start working towards them. Making real changes in behavior is hard but following a few principles can help tip the scales in your direction. As you set out on each new step, consider any obstacles that may get in the way of reaching your goal. It’s impossible to anticipate all possible challenges, but predicting the most likely obstacles you might face and making a plan for how to manage them ahead of time will help to keep you on track. Repeating new behaviors is also key to achieving lasting change. With repetition, new patterns will begin to feel habitual. Once they do, you can tack on the next step in your plan and promote continued progress.

Another important tip to keep you moving in the right direction is to approach setbacks with the right mindset. It’s inevitable that old habits will creep in from time throughout the change process. Therefore, expecting setbacks and being kind to yourself when they do occur will help you to reflect on the things you could have done differently so that you’re better equipped to deal with future challenges. While being armed with the tools discussed so far will maximize your chances of making meaningful and sustainable changes, incorporating a few additional strategies that target your environment should make you unstoppable on the path towards achieving your goals.

One of the main reasons that it’s so hard to change our behavior is the fact that our surroundings are filled with cues that signal old habits. Embedding environmental cues that prompt new behaviors, like visible reminders or attention-drawing changes, can be extremely helpful in promoting change. Including significant others in efforts to change is also a valuable tool. Involving others can mean sharing your goals and progress with friends and family, paring up with someone who’s pursuing similar goals and can help to keep you motivated and on track, or joining a support group where you can share your struggles and successes and find encouragement. Whatever your goals may be, these strategies can help you to achieve them. Equipping yourself with these powerful tools will help you to effect and maintain the positive changes you want to see.