Managing Anxiety - Treatment Basics

The relationship between worry and anxiety was outlined in the last blog.  Common symptoms of anxiety were also discussed, as were markers for predisposition.  One of the most important points in my last blog was that anxiety has served as an effective warning system for our mind and body to communicate about impending danger.  It is only when that communication system gets over aroused or stuck in constant danger mode that anxiety becomes a diagnosable condition.

Treatment for anxiety is not dependent on meeting diagnostic criteria. Cognitive –behavioral therapy (CBT) has become the most widely validated treatment option for anxiety related thoughts and symptoms. Let’s explore some fundamentals!

A primary premise of CBT involves identifying, challenging and revising our automatic thoughts.  Automatic thoughts just “pop” into our heads, they are so second nature to us that we neither actively think about them nor question their accuracy.  For example, an automatic thought might be: “If I fail this exam, I’ll never graduate.”  Well, it is almost a certainty that if this individual does not “catch” that thought and challenge it (i.e. asking yourself “really?”) that his or her body will react with symptoms of anxiety.  Underlying our automatic thoughts is our core belief.  In this example a core belief may be: “Only losers fail.”  Those core beliefs are rarely motivating and frequently paralyzing.  The key is to catch the automatic thought – it will lead to the core belief.  Getting there takes practice though.  Initially we often don’t catch the thought until after we begin to feel anxious!  It all begins with identification of both the automatic thought and the core belief.

In phase two, the goal is to challenge the automatic thoughts and their underlying core beliefs.  Sometimes it can be as simple as asking yourself: “really?”  Frequently these thoughts are very exaggerated and their perceived assumptions extremely dire!  In the above example, it is highly unlikely that one exam would prevent an individual from graduating.  It is also a faulty assumption to connect one failed exam with identifying oneself as a loser.  The goal is not to deny reality; it is to challenge the faulty assumptions or the exaggeration of those assumptions so that our bodies don’t inadvertently prepare for battle.  We have come to understand that when the mind prepares for battle (worry), the body reacts with undesirable physical symptoms (anxiety).

When recognizing and challenging our automatic thoughts becomes second nature, the final task becomes to revise those automatic thoughts and the core beliefs.  The premise is to remove the exaggerated thoughts and replace them with more balanced thoughts and a more accurate core belief.  For instance, one failed exam does not equate with failure as a person.   A revised automatic thought could be; “I need to spend more time studying this topic.”  The core belief could be “ It takes effort to become successful.”   The goal of these revisions would be reducing the likelihood of any physical reactivity to the thought. Ultimately, the process trains the mind-body alarm mechanism to exercise discretion in responding.  This often results in a more empowered and confident individual!

Today the outline of this process has been simplified and is meant to give a brief overview of one of the effective strategies utilized in anxiety management.  It is also often utilized in concert with techniques of thought stopping (refocusing), visualization and relaxation training.  There are several user-friendly workbooks that I have found to be a great adjunct to therapy.  It is often very helpful when learning the techniques of how to reframe our thoughts to be able to label the automatic thought, the core belief, the challenge and the revised core belief in some visible record.  A workbook that offers that template would be advisable.

If you are struggling with worry and anxiety, seek the support of a licensed mental health professional that has received training in Cognitive–Behavioral Therapy.  Become a wise consumer.  Do not assume that all therapists have received this training or that all therapists are equally comfortable with this modality.  Ask them! Take the time to learn the foundations from a qualified mental health professional.  Then seek out the self-help workbooks as practice tools if recommended by your therapist.

Remember that your anxiety did not occur over night; it will take some time and considerable effort on your part to manage it!  Be patient with yourself during the process.  Negativity and self-criticism only compounds the very symptoms you are seeking to eradicate! The sooner you begin the process, the sooner you can reap the rewards.

Understanding Bipolar Disorder

Are you plagued by significant mood swings that surprise even you? Do you feel as if your emotions have a life of their own, meaning that simple anger can escalate into rage in minutes?  Is it common for you to feel either boundless bursts of energy or debilitating fatigue?  Among my clients, one of the most widely misunderstood and feared diagnoses is Bipolar Disorder.  Let’s understand what it is, its’ symptoms and treatment options. 

Simply put, the definitive feature of Bipolar Disorder is the cycling of polar opposite emotions (think ecstasy/despair or rage/meekness).  Humans experience a broad spectrum of emotions, although individuals with Bipolar Disorder report experiencing cycles of emotional extremes.  Many individuals report feeling “crazy” because, despite their best attempts to balance their thoughts and feelings, their emotions frequently overpower their thoughts and drive unwanted behaviors.  A diagnosis of Bipolar Disorder is not based upon a single snapshot in time but rather, observation of patterns of behaviors characteristic of both depression and mania.  To receive this diagnosis a myriad of diagnostic criteria must be met.  Let’s briefly examine the symptoms of depression and mania.

Depression

I doubt that anyone who has experienced life is unfamiliar with feeling depressed. Today the term depression will be limited to the experience of an overwhelming sadness and even despair regarding the past and present as well as a profound sense of hopelessness regarding the future.  Behaviors associated with depression can include sleep disruption, appetite impairment (too much or too little) and inability to focus and/or concentrate.  Often an individual may question whether life is worth living and possibly become 
actively suicidal.  Emotions may range from irritation to rage, 
increased tearfulness to feeling  “numb.”  Social isolation frequently occurs, as does a noticeable disengagement from  once pleasurable activities.  For example, the avid runner may stop all physical activity.  Physical symptoms like unexplained pain, gastrointestinal distress and migraines may appear without obvious triggers. 

Mania

The polar opposite of depression is mania.  Some hallmarks of mania include: scattered thoughts (so many wonderful ideas that you cannot focus on just one) and heightened creativity (many projects are begun but not completed).  Speech may be pressured (you interrupt others while they are speaking because you have too much to say and no time to waste) and emotions run high (bouts of uncontrollable laughing or crying).  Sleep and appetite may become erratic based upon elevated energy levels.  There is also frequently an increased motivation to engage in reckless behaviors like speeding, daring sports and/or illegal activity without
considering the possible consequences. Physical symptoms may include a sense of restlessness (feels like an engine is running inside of you), irritability (shorter than normal fuse), agitation and increased anxiety (nervousness, racing heart, sweaty palms & pacing).

Cycles

A qualification of Bipolar Disorder is an observed history of both mania and depression. An individual’s transition from depression to mania and vice versa is known as cycling.

While some individuals may experience both mood states at the same time, that is not common. Cycles are directly related to brain chemistry and therefore are specific to each person.  A cycle may occur several times a day to once per year.  Again, this is highly dependent on the individual.  Often my clients will report feeling restless or agitated and/or significantly fatigued prior to the onset of a cycle. An increased vulnerability to self-medicate through alcohol, food, illegal drugs, promiscuity or gambling may occur in an attempt to mask these uncomfortable feelings during a transition.

Origins

Bipolar Disorder is a physiological imbalance within the brain.  Some research suggests that there may also be structural abnormalities within the brain. Research findings also predict a genetic contribution among blood relatives.  There is an equal likelihood of occurrence among males and females.  Stress, significant life events and a history of significant childhood trauma may also contribute to the development of Bipolar Disorder. 

Treatment Options

Clearly Bipolar Disorder is a dis-equilibrium in the naturally occurring neurochemicals within the brain.  Therefore a primary treatment consideration is effective medication management.  Psychiatrists specialize in highly specific medication protocols that are tailored to an individual’s symptom profile.  It is not uncommon to be prescribed a mood stabilizer as well as an antidepressant and perhaps an anti-anxiety medication.  As a patient, it is vital to develop an open and collaborative relationship with your psychiatrist in order to effectively manage your symptoms.
   

Therapy is the second component of treatment. Mood swings can be exhausting not only for the client, but also for those that they love.  Ongoing therapeutic support that combines identifying and then understanding the cycles and the accompanying risky behavioral responses is the first step in mood management.  The next step is learning and then implementing less risky behaviors as alternative coping strategies.  Research indicates exponentially greater success when a team approach to treatment is utilized.

An obstacle to treatment is often a client’s reluctance to forgo the manic cycle.  Although maladaptive, it had often served as motivation for task accomplishment as well as increased feelings of well being. Similar to the patient-psychiatrist relationship, the client-therapist relationship must also feel comfortable and collaborative.  A client’s treatment team often becomes an enduring relationship.

Conclusion

The stigma attached to Bipolar Disorder needs to be eradicated! The fears attached to being labeled “crazy” prevent far too many individuals who would benefit from treatment to seek it out.  Stereotypes of “crazy” within the entertainment industry have reinforced the stigma. Why?  Mania has been sensationalized!

The Oscar award winning film, Silver Linings Playbook has begun to challenge this stigma.  Bradley Cooper, Jennifer Lawrence and Robert DeNiro brought to life the real struggle of Bipolar Disorder within families.  Catherine Zeta-Jones, Robin Williams, Jean-Claude Van Damme and Jane Pauley are celebrities who have publicized their personal challenges in managing their cycles.  Their goal has been to “break down the stigma.” 

The diagnosis itself does not necessarily limit personal growth and success.  Once an individual understands and takes responsibility for their symptoms, effective management begins.  Refusing or halfheartedly following a treatment regime will ultimately impact relationship, professional and personal success. 

If this post has raised questions about yourself or someone you love, don’t delay – schedule an appointment with your physician and/or a licensed psychologist.  NOW is the perfect time!

Is Dating a Game?

Relationship success has become a high stakes industry. This industry represents a diversity of professionals yet it lacks specific criteria for education, professional conduct and personal experience. All forms of media, coaches and experts alike believe they found the solutions to your loneliness. There are numerous television shows whose entire focus is matchmaking: for millionaires, bachelors and bachelorettes. Love happens while surviving on an island in the South Pacific, as well as racing across the globe and even while competing in a fierce battle to lose weight and become healthy. Viewers are left wondering why their quest for a mate is so difficult when it seems so easy on television.

That raises an important question and the basis of this post: Is dating a game? If so, are there specific rules and winners and losers? Are relationships games as well? If not, how do they differ?

If the goal is meeting your soul mate, then dating presents a platform to discover potential partners. Assuming that both individuals share this common goal, often the approach is more deliberate than casual dating. So what are the parameters of a deliberate approach? Are there secrets that once revealed will minimize the heartache that results from incompatibility? Are there really systematic processes that, if followed, will guarantee a proposal within a year of dating? 

Let’s begin with a brief synopsis of the self-help section on dating/relationships. Here is where many singles begin their search for answers. A quick survey reveals two themes among male authors: instructing women how to catch a man (is that similar to catching a fish?) or a more serious topic of what qualities identify a woman as a keeper (sorry, another fishing metaphor). There are so many conflicting suggestions! “Why Men Marry B*#&*$@” and apparently, why they also fall in love with them. Then there are books/podcasts/videos written by self-proclaimed bad boys serving as both a warning and an enticement. After following the steps (aka traps) and attending a very pricey seminar, you too will catch your own bad boy and ride off into the sunset on his chopper. Finally, there are the male relationship coaches turned authors, who claim that there are essentially three qualities that you must possess for a man to commit to you (i.e., “you become a keeper”). Really? It only takes a year subscription and a few seminars to suddenly possess these qualities? If only it was that simple!

Next is a category for women by women. I will make a very simplified distinction of subsets within this category: (1) Love yourself the way you are and love magically follows; (2) Change yourself (diet, exercise, plastic surgery) then love magically follows; and (3) Commit based purely upon his assets and/or potential access to those assets and who cares if love follows. The operative word in the first two subsets is magically. While love may feel magical, it is not magically bestowed upon you; dating is relationship building and that involves compromise and a personal commitment to growth. If it were a simple process this industry would not enjoy such success!

Are all of these how to strategies without merit? Absolutely not! Many of them make solid points but lose their validity by overpromising success. As a consumer, I would be very wary of taking relationship advice from a professional who has not yet experienced a successful relationship. That being said, I have not found one source that provides a comprehensive strategy that I would endorse in my practice. Why? Quite simply, one size does not fit all. 

Again, dating and relationships are not without challenges! They were not simple as teenagers and they certainly become more complicated as we re-emerge as adults. Unresolved pain we carry into a new dating experience and/or potential relationship increases the likelihood of disappointment and eventual heartache. No book, video or podcast can guide you through the process of self-awareness and eventual healing. That is a process that requires commitment and consistent effort. 

Equally relevant is the faulty belief that we are “perfect” and the right mate will recognize that. I agree that the essence of our personalities needs to be appreciated! But make no mistake: acknowledging that we have much to offer a potential mate does not constitute a free pass to forego ongoing improvement and maintenance of our intellect, our emotional stability, our appearance, our social skills and our overall health. The laws of attraction assert that interesting individuals attract interesting individuals! 

My original question was whether dating is a game. It very well may be if that is your choice. Base your decision on an honest evaluation of your motives. If you then choose to view dating as a game, seeking advice from experts who attempt to positively impact your relationship potential would be an unproductive endeavor.

However, if you are seriously seeking a relationship and have not been able to connect, here are a few suggestions: (1) Consider stepping away from the dating scene for a while; (2) Get into a professional relationship with a psychologist and explore your emotional barriers. Heal from your past relationships. Bolster your self-confidence by getting to know yourself better; (3) Give the self-help materials a well-deserved break. At some point they become overwhelming! (4) Get healthy: try a new sport or hobby because it interests you; and (5) Learn to feel comfortable being alone: Once you like that person, others will be drawn to you as well. 

From my perspective, dating can be fun without making it a game. While love is never a game, the journey needs to be fun! Listen to your heart, do the work to make yourself the best possible you, consider it an adventure rather than your life's mission, and never give up hope!

Confusion -The Hidden Gem of the Emerging Adult

Many emerging adults ages 16-24 are anxious and confused yet feel isolated in their suffering. Anxiety attached to feeling confused has become the dirty little secret that replaced emergent sexuality and underage drinking of generations past. Who fits this profile? This post explains that confusion is an essential element of this life stage that functions as a catalyst for growth. Therefore, it is the anxiety attached to feeling confused rather than the confusion itself that actually inhibits this process of healthy development. 

The young adults of whom I speak are often very accomplished, having been groomed since elementary school to excel in at least one sport, a fine art and boasting stellar academic records replete with the maximum possible number of Advanced Placements units. Many have equally impressive records of community service, maintain full social calendars and are considered Ivy League college candidates. 

A difference emerges among these candidates with respect to their parents. In one camp are young adults walking in the footsteps of their professional parents; in another are young adults carrying the added burden of setting a new standard for their families when it comes to academic and intellectual achievement.

Parents are not the singular force behind creating young adults who feel enormous pressure to embrace what lies before them. Certainly the practice of creating a resume has been either initiated or reinforced by well-intentioned educators and guidance counselors. These are cultural norms developed by adults who want to streamline the process for their children. Yet most adults can recall key missteps that created for them significant opportunity. Why deny the next generation this life experience? 

Erik Erikson, an infamous psychological scholar identified eight psychosocial life stages that form a healthy personality. Two salient stages in this discussion are Identity versus Role Confusion (ages 13-18) and Intimacy versus Isolation (ages 18-40ish). These stages have specific expectations for growth: exploring who we are and what we believe and then branching out and connecting deeply with a mate or through significant friendships. My clients appreciate knowing that what they are feeling has been identified as healthy in Erikson’s theory. 

Many of my young adult clients feel significant amounts of anxiety when the path that heretofore was finely crafted becomes an anchor cementing them to the past. They have often discovered a passion that better fits who they have become. Frequently they need to change majors, or perhaps transfer to a completely different academic institution. Socially, they may feel less connected to their established circle of friends who may have not questioned their path and are seemingly content. As a result, they either become isolated or assume the façade that life is great. One path is active isolation, the other - equally damaging - is emotional detachment.

How do young adults admit to their parents that they may feel confused and/or that they have deviated from the course they jointly crafted? Some young adults avoid the topic; others sabotage themselves by failing; some become physically ill in anticipation of the backlash; and a few, especially if they are rounding out the developmental stage of Identity versus Role Confusion, confidently lay their cards out on the table. The act of exposing their situation is of great value in establishing their identity and autonomy. Parents, on the other hand, often call my office and accuse me of undermining their authority! 

My suggestions to the young adults are two-fold. Rejoice in your confusion because how would you arrive at certainty without it? Understand that it is a component of a vital developmental stage. Also understand that remaining confused is equally as detrimental as following a preordained path that doesn’t fit! You will not magically arrive at the next stage of your journey. You must stay actively engaged in the process of not only exploring options, but also trying them on for size! That feeling is better labeled excitement, rather than anxiety generated from dread or boredom!  My second suggestion is to break the silence with your peers! That is how your relationships transcend the superficial and become significant – your next developmental challenge. 

Allow your parents the opportunity to understand the underpinnings of your angst. It is unfair to blame and dump your anxiety and anger in their laps and then smugly walk away. Engage in many conversations through SKYPE if you are away at school or face-to-face if you are local. This conversation would not ideally be had over the phone or through email. Engaging in self-sabotage through failing, illness and/or avoidance diminishes the credibility of your assertion to pursue your chosen path. Parents want their children to be happy and successful. Extend to them some time to shift gears and embrace your journey. In the meantime, continue to address your anxiety through self-care (diet, exercise, & adequate sleep), doing the difficult work in therapy and nourishing your friendships. You ultimately are responsible for your life choices so honor the process!

The Roller Coaster of Grief

In recent posts, I have discussed grief relative to life transitions. Today I would like to discuss bereavement; grief related to loss from death. While you may notice some similarities with burnout and other life transitions, the major difference with death is that there is no opportunity for a second chance. The finality of the experience is undeniable. This grief invades our body, mind and emotions in very real and expected ways and is neither correlated with personal strength nor weakness.

Undoubtedly grief hurts! It can literally take your breath away. Physical symptoms resembling a heart attack are not uncommon and are directly related to the intense anxiety associated with the loss. There are also real physical manifestations that often present as excessive fatigue, malaise, joint pain, gastrointestinal distress, elevated blood pressure, chronic headaches and a suppressed immune system. Have you ever noticed, quite often after the fact that you became ill near important markers such as the deceased’s birthday, one month after their passing or your wedding anniversary? That is no coincidence! Our bodies often serve as channels for our deepest emotions. Sleep (inability to fall asleep and/or remain asleep) as well as appetite impairments are also very common.

Cognitive impairments are also very expected during the grieving process. This may include impaired attention and concentration, obsessive thoughts that focus on the days, hours and minutes that preceded the death and quite the opposite, an impaired memory for details. Quite often, the grief stricken, especially when the loss was sudden, often seems to need to replay the events far too frequently when judged by the casual observer, but the grieving need this because their memories can neither embrace nor retain the reality of their loss. Our minds have a unique protective mechanism that allows only a designated amount of trauma to be absorbed at any given time before it simply shuts down. The extreme cognitive stress that is exhibited is often the result of a combination of emotional, mental and physical exhaustion. Depending on the circumstances surrounding the loss, it may take months for your memory to return to its previous level of functioning.

Emotional reactions to grief can often be characterized as extremes. In the early stages of grief, fear is amplified – fear of forgetting the deceased, fear of being alone, fear of living and a fear of dying. It is not unusual to hear your deceased’s voice, to turn around only to see them, and to experience dreams that feel so real that you dread awakening. Our emotions struggle to keep up with the reality of the recent event. At some point in the grieving process, complete despair is not an uncommon feeling neither is an overwhelming longing to be reunited with your loved one.

Feelings are often experienced in an all or nothing fashion. Along the spectrum of profound sadness, one may display seemingly non-stop crying to a complete inability to cry despite feeling as if it would bring to them a sense of relief. Feelings of apathy (staying in your p.j.’s all day and not getting out of bed) may transform to hyper motivation (cleaning, organizing and completing numerous unfinished tasks often until the wee hours of the morning). Irritability may be displayed as mild frustration (directed at seemingly benign events or individuals) to moderate irritability (rudeness and impatience) to extreme anger (road rage, physical aggression and/or property destruction). It must be noted that these extremes feel and are completely “foreign” to the individual because they did not occur prior to experiencing this loss. Many of my clients have reported feeling “crazy” due to the unpredictability of their responses to the world.

Our previously adaptable coping mechanisms (exercise, social connectedness and engaging in hobbies we once enjoyed) may require far too much energy and therefore are temporarily replaced with maladaptive coping mechanisms that could include an excessive consumption of food, alcohol, prescription drugs, illegal substances and even hyper-sexual behaviors.

The above symptoms seek to illustrate the highly individual and often solitary journey that characterizes grief. The circumstances surrounding the loss often affect and may complicate the grieving process. Complicating factors may be the ages of the deceased as well as the survivors, the suddenness of the loss (anticipated versus untimely and unexpected) and the nature of your relationship with the deceased: was your relationship in emotional order or were there things left unsaid? The specific details surrounding the loss (suicide, homicide, terminal illness or natural causes) as well as the survivor’s loss history (is it the first or fifth and in how many years) may further complicate and extend the grieving process.

So how does does the grieving person effectively tackle their grief? There are numerous theories and published bodies of work authored by thought leaders in this field. The common thread is the notion that grief follows a fairly predictable process from onset to recovery. To work through grief requires moving through these processes and with my clients, often while concurrently redefining themselves. Grief is truly a journey that lasts at the very least one year and more realistically, many years with varying degrees of intensity. Attempting to delay or avoid grieving predisposes the survivor to the possibility that their bereavement and grief develops into a clinical depression, a diagnosable anxiety disorder and/or an identifiable addiction.

When you think of grief as a multiple year journey, how do the survivors gather the initial energy to face it as well as the stamina to go the distance? In the early phases of loss there are close family and friends who rally to support the grieving. Eventually the demands of their own lives split their priorities, and often their support becomes insufficient in meeting the enormity of your need. The option for the grieving at this point is to either become angry when their friend seems to withdraw support or finally reach out for support in the form of individual therapy and/or grief support groups. Ultimately this transition provides an opportunity for your relationship to recalibrate to its previously balanced state.

During my initial session with grieving clients, a visual framework is introduced and as therapy continues, it becomes even more relevant. I equate grieving to riding a roller coaster. What is the first thing you do once you board the roller coaster? You fasten your seat belt! It helps you to stay grounded throughout the ride. Think of therapy as your seat belt on this roller coaster of grief. Just when you think you are once again feeling like your old self, something ignites an emotional spark and down you go. Yet, if you are securely fastened, it is far less scary! The beauty of grief is that with support, you may often climb to heights you never anticipated before the next inevitable dip occurs. At that point you may feel as if your progress has been thwarted, although it quickly resumes when you once again begin the ascent.

Since you can’t avoid the ride, why not step in, fasten your seat belt and hold on for dear life? Your continuing journey through life depends on it…. one step at a time!

Way Beyond Tired....What Is IT?

In a perfect world there would be ample time to accomplish all of our daily responsibilities as well as sufficient amounts of energy left to engage with our friends and family, exercise, relax, and retire at a decent hour, waking up refreshed and ready for a brand new day. We would be paid well, valued for our contribution and have the autonomy to express our creativity within our chosen professions.

If your reaction after reading this description was laced with cynicism you are not alone. The Baby Boomers as a generation have striven to accomplish this goal and have expected that the amount of effort they expended to that end would reap those well-deserved rewards. Unfortunately, elements out of their control economically, politically, and culturally thrust many into a position that severely compromised their best-laid plans.

Does this scenario more accurately reflect your life experience? You hit the ground running after hitting the “snooze” button far too many times, grab a travel mug, fill it with coffee, skip breakfast, jump into your car and face the morning commute, conference calling while driving and arriving late to your first appointment because of traffic delays. Your desk resembles your home office- piles of papers that have some relevance, but you are not certain to what, and as you rush to your next meeting, you make a vow to “clean that up” next week. You then rush off to a luncheon meeting, combining business and a meal (bonus!) then work four plus additional hours and hit the commute home.

Once you arrive home, your kids need to be chauffeured to their activities, dinner needs to be either prepared or picked up, they need help with their homework, and oh yes, then depending upon the day of the week, you run to the gym and hit the treadmill while watching CNN or catching up with your reading. If you forgot to remove your Bluetooth, you rationalize that at least you can listen to your voicemails that you had no time to check during the day.

After the kids are settled in, there is laundry, bookkeeping, the family pets, checking in with mom and dad, and next thing you know, it’s three am and you are on the couch, the television is urging you purchase the latest fitness equipment and you decide to stumble off to bed, knowing that your ill-fated alarm will sound in a few short hours….and ugh, it’s only Tuesday!

We have become masters of multi-tasking, delaying vacations, minimizing the need for self-care, and expecting to have the stamina to continue that pace indefinitely. We were not wired to perform like hamsters on a wheel, yet we often attribute success with being able to meet or exceed this expectation. Realistically what occurs is a systematic multi-system shut down characterized initially by fatigue and ultimately exhaustion – mental, physical and emotional.

Mental exhaustion can be exhibited by reduced capacity to focus, learn and retain novel information, recall important as well as insignificant facts, names, and places, increasing difficulty with mental computations, decreased problem solving skills, waning creativity, indecisiveness and procrastination. Ultimately, it can manifest into “why bother?”

Physical symptoms include initial subtle changes such as higher resting heart rate, elevated blood pressure, and perhaps reduced or increased appetite, libido, and need for sleep. As the fatigue progresses it can manifest as increased risk for a cardiovascular event, joint pain, migraines, and gastrointestinal problems that have no identifiable organic etiology. At this point, increased absence from work and more frequent doctors visits are common as is chronic tardiness.

Emotional fatigue is frequently observed by a marked difference in the capacity to feel and display empathy towards even those who matter the most, increased social isolation, lack of motivation, and diminished frustration tolerance. As the fatigue transitions into exhaustion, there may be feelings of helplessness, depression, increased anxiety, inappropriate anger outbursts, cynicism and sarcasm. There may also be an increase in suicidal ideation, or a stated desire “just not to wake up” (aka passive suicidality). Unhealthy coping mechanisms such as drinking, increased prescription consumption, gambling, promiscuity, and illegal drug use may be utilized as an “escape” or to “numb out.”


What I have just described are characteristics of burnout. It runs rampant across many professions. Compassionate burnout has been specifically identified as a phenomenon of the helping professions - physicians, nurses, mental health professionals, first responders, clergy, and anyone who provides vital human services. It needs to be expanded to all caregivers, from stay at home parents to adult children caring for their declining parents as well as those caring for spouses and children who suffer from major physical and/or mental illnesses.

In the business world, burnout is not reserved for the C-suite executive who must make significant and often highly impactful decisions that have far reaching effects. It filters down to mid-level managers, direct reports and line staff. The common denominator in burnout is a lack of perceived control over your environment. With the multi-tiered demands of life, the reality is that we are all potentially susceptible.

Burnout has been identified as mental weakness, flippantly as a symptom of menopause, and occasionally the justification for a spontaneous purchase of a convertible sports car. Equally erroneous is the thought that a two-week vacation will cure it.

What is the solution? One is that we as a society decide to recognize burnout as a normal human phenomenon. Normalization could lead to the possibility for earlier intervention because of a heightened awareness of symptoms contributing to this condition. Education directed toward at-risk professions needs to be incorporated in continuing education services as well as elevated to a topic that is addressed at corporate retreats. Human resource departments and managers need training in identifying employees whose performance declines, whose attitudes deteriorate, and who have increased absences or chronic tardiness. Developing relationships with direct reports so that there is awareness of increased demands in other areas of their lives could also serve as early intervention and help prevent the increased costs incurred from absences and disability claims.

As individuals, we need a good dose of honesty with ourselves regarding our limits. If you don’t know where or how to go about learning this, seek professional consultation. Get into therapy with a licensed professional. Utilizing denial, rationalizations, and excuses only reinforces the archaic notion of “burnout=weakness.” The ultimate goal is balance. As you take steps towards that goal, add one cluster of healthy behaviors at a time, like exercise and diet improvements. Do not attempt to change every area in a month’s time. The likelihood of sustaining sweeping changes, especially when already feeling some level of fatigue is a set-up for failure.

Solicit an accountability partner, this not only deflates the solitary burden that accompanies burnout, but provides a social and hopefully an emotional connection. Schedule regular mini-vacations rather than delaying them for a grand event; try limiting the number of activities that your children are engaged in that require your assistance as either a coach or chauffeur. If poled, children would prefer fewer activities rather than a “crabby” parent!

If you are a caregiver, seek out regularly scheduled respite care, hire a dog walker, and engage in some activity that gives you a feeling of satisfaction and renewal. These strategies begin only after burnout is conceptualized as a function of an excessive drain on a finite resource rather than a stigma attached to the weak. Get off the hamster wheel… your well-being and longevity depends on it!

The Value in Teaching Your Child How to Fail

Our generation, primarily as a knee–jerk reaction to the more harsh parenting techniques that we as children endured, have raised a generation that believes that they can succeed at most everything, are perfect the way they are and really expect to win without expending the necessary effort to truly savor the victory.

This is a slight exaggeration, although it is primarily true. As parents we anguish when our child suffers. Good parents attempt to shelter their child not only from physical, but mental and emotional harm. In its purest form this is exemplary. My question is how does that prepare our precious ones for the world?

Children are cruel. Once your child steps onto the school playground, harsh reality checks begin and for the most part, go uncensored. Unfortunately these reality checks are rarely accurate because their peers, who are of the same generation and who safeguard their own egos at any cost, levy them. Is your child prepared to cope with this embarrassment and blow to their confidence?

Peers, especially as your child enters the tween years and beyond carries much more clout than their parents. What can be created is a dissonance within the child that actually inadvertently lowers their self-esteem. The dissonance is the dichotomy between “I am great” as told to them by their parents and “I don’t measure up,” freely expressed to them by their peers.

This generation is unfortunately at a distinct disadvantage when the real competition begins in high school, college, and ultimately in the corporate world. If a child is shielded from experiencing the agony of defeat, of losing or failing, the perceived impact on them when it inevitably occurs can be devastating as well as over-exaggerated. For example, observe the child who doesn’t get a trophy for coming in fourth place in Little League, or who’s parents don’t complete or help them complete challenging homework and so rather than receiving an ‘A’ they receive a ‘C’ on that particular assignment. By most standards this child failed relative to their peers. Yet, when these children face defeat later in life, they have mental and emotional templates to fall back on that assists them in coping with the hurtful feelings and temporary embarrassment. They can successfully reason with themselves in a very believable way that this event is not catastrophic because they have already been in a similar situation and persevered.

The college coed who lacks such a template because they have never been allowed to fail can develop aversions to challenge, become depressed, panicked and even completely surrender when placed in an academic or athletic environment inhabited by many superstars besides themselves. They often do not know how to express and/or normalize their pain and embarrassment because they have no template... and quite often their parents are not close enough to give them the support they so desperately require.

As adults, how many of you have witnessed this in your own professional environment? Who protests the loudest about inequities in bonus structures, advancement requirements, and workloads? Very often, it is the individual who possesses an over-inflated perception of self and no drive to prove their worth. Those roots run long and deep…long before their most recent promotion. For these individuals, consultation with a licensed professional provides the most opportunity for growth.

So what is the solution as parents? Monitor your children’s activities. Notice whether their activities are unbalanced, meaning that little effort is required of them because your child is a superstar. If they are gifted in sports, add an activity where they may need to struggle to advance. If they are excellent writers, challenge them with math and/or science. The key here is exposure and balance. A child is very able to assess their skill level compared to their peers. Do not over-inflate their accomplishments when they are mediocre. That does not mean that you need to be harsh, it means that you need to be honest.

The parents that I have had the privilege of working with share a universal desire to raise children who, when they leave their nests, have acquired the life skills to cope gracefully with both failure and success. Part of that learning curve is enduring the pain of witnessing your child struggle and the comfort lies in your ability to guide them through it. We have relatively few years to accomplish this goal, so while holding them tightly - be their most honest critic as well as their most loyal fan!

The Power of Should

Do you find yourself engaged in an internal dialogue that sounds something like: “I should (fill in the blank)?” If so, is your should list accomplished to your satisfaction, or is it a combination of years of seemingly important actions that have yet to take place?

The self-talk attached to feeling unable to accomplish the things we feel we should be able to accomplish is a direct assault on our self-esteem. Why? Simply stated, because as children we were taught right from wrong, in other words, what we should or should not do. Often, the bulk of these “shoulds" were NOT a source of debate - but an expectation. Failure and/or undesirable consequences were often connected with our inability to follow these rules. These rules of conduct were internalized by our psyches as an integral component in the formation of our conscience.

To become an emotionally mature and independent individual we need to identify the shoulds in our lives, question their ongoing applicability to our current life and either discard them as archaic, or “own” them as a component of our adult identity.

To discard or own… THAT is the question. An approach that has proven successful in my practice has been a three-prong approach of identification, challenge, and then rewording the core belief if applicable. Begin by keeping a running list of the shoulds that you either articulate to others or keep batting about within your mind. Step two is to challenge each line item with why should I? For instance if one of your shoulds is: “ I should make my bed every morning.” Ask yourself why should I make my bed every morning? If the answer is this is not my priority, then discard that should. If you do believe making your bed is important, then drop the should mandate and replace it with either need or want. Both of these words reinforce not only ownership, but also priority.

Ultimately what you have accomplished in this process is another aspect of individuating – taking responsibility for your actions not because you were told to but because you made a conscious choice as an adult. You can expect that your resolutions will have greater traction because they are yours rather than someone else’s that should be your priority.

This concept is also very applicable in the professional arena. How about your conversations with your direct reports, your fellow managers, and your peers? Do you find yourself telling them what they should do? Are their responses positive and proactive? How is this approach working for you?

Should is a word that is laced with undertones of incompetence and judgment. To the receiver of the should it can be seen either as a challenge to exceed expectations to prove competence or rebellion to reinforce personal autonomy. This one word may inadvertently push buttons from childhood in the recipient that actually promotes dissension not motivation. If ownership and buy-in is your goal, try substituting should with need and/or want. Notice if there is a shift in morale and higher productivity. I predict that you will optimize your ability to inspire a sense of renewed commitment and cooperation that will improve your bottom-line.

These steps in taking ownership of your shoulds may appear to be quick and easy - but execution is sometimes complicated by your early life experiences. If you feel challenged by this transition, reach out to a licensed psychologist for assistance rather than continuing to tell yourself: “I SHOULD BE ABLE TO CHANGE ON MY OWN.”

Great Changes Are Happening In My Life...So Where's My Mojo?

One of the most frequently asked questions in my practice centers around the notion that a positive life transition must be continually met with happiness and enthusiasm. This is an interesting phenomenon that deserves some clarification.

The media often portrays only the positive emotions related to major life transitions such as pursuing a degree, leaving our parent’s home as a young adult, receiving that much anticipated promotion or corner office, marriage and even retirement. There is often the inference that if you are not feeling similarly then you must lack self-confidence, charisma or even worse, must be suffering from depression. Why? because dichotomous thoughts and feelings don’t sell the new wardrobe, the prestigious vehicle, or the sexy vacation that a major life transition promises to afford.

What is seldom discussed is that all change requires not only our bodies but our psyches time to recalibrate. The equilibrium of what was “normal” is temporarily thrown off course. The stress attached to recalibration may cause our immune systems to weaken and despite proper self care target us for minor colds and flus precisely when we often feel motivated to “go the distance.”

Our psyches (thoughts and feelings) must also find a new set point. Regardless of the positive nature of the change, there is loss. Why? Our sense of the predictability of our world is temporarily thrown into a spin cycle. One change in our routines often brings a cascade effect of other unimagined changes. We need to redefine, sometimes in a major way, sometimes in a minor way, our new “normal.” We require time to grieve the losses that accompany this marvelous change. It is okay and even necessary to reconsider our choice, feel less confident and possibly more anxious for a reasonable amount of time. If there are many changes that result from a career change for instance, the longer it may take to regain a true sense of confidence and excitement.

In this instance grief does not equal depression. If a person denies this temporary internal conflict between thoughts, feelings, and motivation it may possibly manifest down the road as depression. That is why it is important to recognize and label these feelings as grief and this transition as a recalibration. Unfortunately, high achievers often just push themselves harder, longer and faster when this is an appropriate time to conserve your resources and allow yourself some time to grieve the chapters that have closed in anticipation of new beginnings.

If those around you are merely focused on the positive potential of your change, it may be a wise investment of your time and resources to seek some professional guidance to effectively work through the recalibration phase. This is one instance when proactive intervention can make the difference between grief as a reaction to life versus grief that left unattended morphs into depression.

Fear of Intimacy

You are in a relationship that appears to be everything that you have ever wanted. As the intensity of the commitment builds and the future seems inevitable, your mate changes the game plan. Do you find yourself wracking your brain and your heart wondering whether you are to blame? Do you feel you have been deceived? Do the events appear senseless? You may very well be involved or have been involved with someone who fears intimacy.

For the purpose of this commentary, intimacy covers a broad spectrum of emotionally connected behaviors that require an individual to experience vulnerability. This could mean the sharing of deeply held feelings, sexual experiences, and/or dreams, hopes, fears, and ambitions. This fear is often characterized by avoidance and withdrawal. Initially it is often masked not only from the partner but the individual as well.

Fears of intimacy most generally do not surface until a relationship becomes meaningful and the threat of loss cannot be denied. That is why it appears to the partner to have come out of nowhere. There are some common behaviors that may indicate that your partner may be experiencing a fear of intimacy. Do they exhibit a pattern of seemingly noble intent yet when the time comes to act on their plans there seems to be delays, withdrawal, or avoidance? When engaged in a disagreement, do they avoid engaging citing fatigue, stress, or overwork as the reasons? Do they vow to address the issues tomorrow, but tomorrow never comes? Do they rely on habitual behaviors that result in disengagement from you such as overworking, substance use, television, the internet, or video games? Have hobbies been replaced with solitary pursuits? Has conversation become superficial or repetitious? Has sexual intimacy waned or become mechanical? Are you left feeling empty after an encounter that was historically filled with wonder and excitement? In other words, is the connectivity missing?

Fears of intimacy are generated from an individual's early attachment to their parent. Parents who withheld love and affection, were harshly critical, abusive, or ambivalent set the gears in motion for their child to internalize the negative dialogues that were directed at them. With prolonged exposure, these voices become a part of the self image and lie dormant until a person experiences true love and positive regard from their mate. The love that the person has longed for their entire life now competes with the internal negativity that has become a part of their identity.

The anxiety that is generated from feeling love and acceptance often causes the individual who fears intimacy to withdraw into themselves or actively engage in behaviors that sabotage their chance to truly feel secure. They push away the very person who respects and loves them for who they are, a fundamental longing of healthy individuals.

Fear of intimacy is best addressed within the context of individual and couples therapy. It is not a condition that generally improves without a deep exploration of the primary relationships of the individual beginning with their parents. The partners of these individuals would also benefit from therapy to understand and adopt personal boundaries to protect their own self image. Loving a person more or better or differently is not the answer. In fact, it merely recharges the cycle.