I am amassing quite a collection of therapy memes. Who knew this would be a thing? My favorite part of this trend is that most of the images you see above are screenshots sent to me by patients. I say this as an inroad to breaking down some of the anxiety around entering therapy. Especially if you are entering therapy for the first time, that anxiety typically occurs in the face of the unknown. What will therapy be like? What can I expect? Will I have to lie down on a couch? Will my therapist say "tell me about your mother?" Will my therapist just silently stare at me?

Colorado therapist Kelsey Shane says of therapy: ​

Therapy looks a bit different for each individual, and for each individual therapist. I do have a couch, but it's really more of a love seat. Most people are comfy but do not actually lie down. Sometimes people come to therapy for help in dealing with a very specific situation, for example, coping with a loss, making decisions about moving forward during a time of transition, or managing anxiety related to social situations. Others seek therapy to understand and shift long-standing problematic behavior or relationship patterns. Sometimes we do in fact talk about mom. Sometimes we game-plan how to resolve conflict at work or at home. Sometimes we practice mindfulness and specific breathing exercises to reduce the frequency and severity of panic attacks. Sometimes we unpack puzzling dreams. Sometimes we draw connections to books and films (our cultural mythology). I know a perhaps surprising number of my patients' Hogwarts houses and how others relate their own origin stories or redemption arcs to characters in the MCU. We do sometimes cry, we often laugh, and I am privileged to witness growth on a daily basis.

If you have more questions or would like to learn a bit more about the process of therapy, you might enjoy the video below by psychologist, Dr. Ali Mattu in which he answers commonly Googled questions about therapy.

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As psychologist Guy Winch explains, "Much as accountants' busiest time of year is tax season in April, we therapists see our practices overflow in November and December. Why? ‘Tis the season of family gatherings."

Family gatherings have the potential to help us feel connected and loved, but even within the best of family dynamics, cooking, cleaning, and coordinating schedules can be stressful. And the fact of the matter is that not every family shares the best dynamics on display in Hallmark Holiday Specials. Family gatherings can bring old wounds to the surface, and leave many feeling less connected, less understood, and alone despite the holiday crowds. For those who live far from family and friends, singles, and those who are newly separated, divorced or grieving, the family-focused holidays can be a painful and lonely time. Add these factors to the days getting shorter, the weather colder, spending less time outdoors in the sun, and it is easy to understand how the holidays can leave us feeling stressed out and blue. 

​The following resources can help you survive and thrive through this holiday season:

• Psychologist Guy Winch writes a thoughtful column on dealing with loneliness at the holidays, including suggestions on developing your own traditions and tribe. (Guy also has much-loved TED Talks on the importance of emotional first aid and healing a broken heart.)
• PsychCentral has compiled a master list of resources to help you navigate the holidays. Find help with everything from reducing holiday stress, maintaining healthy boundaries through the holidays, navigating the holidays when you struggle with depression, and much more.
• The Mindfulness and Grief Institute compiles resources to help in managing grief during the holidays.
  
• The American Psychological Association (APA) hosts a Holiday Stress Resource Center covering topics such as managing difficult family conversations (including politics) and dealing with financial stress during the holidays.
• Finally, this Psychology Today blog post by Dr. Michelle McQuaid is an oldie-but-goodie, describing small (research-based) changes you can make to help you flourish during the holiday season and throughout the upcoming year.

If you find yourself feeling overwhelmed with stress or sadness, know that you are not alone. Talking with a therapist about coping with the holidays specifically, or untangling long-standing relationship patterns, can be useful and help you move through the holidays and into the new year with less stress, more understanding of yourself and others, and more skills to navigate this time of year with more grace and less stress in the future.

There has been a lot of talk in therapy this week about the October 20 tornadoes we experienced in Dallas. If you or people you love went through these storms, please know that it is normal to feel heightened anxiety, numbness/detachment, sadness and tearfulness, often all within the same day or hour. I have spoken with a lot of folks who not only feel really anxious, shaken and sad, but also feel guilty about feeling that way because they were not in the direct path, as if they don't have the right to feel that way. There is nothing you do or don't do, are or are not to "deserve" anxiety or depression. It is just an is. I spoke with a neighbor yesterday who said that she never really understood PTSD until she went through that storm (her home suffered damage). I explained that part of the textbook definitions of Acute Stress and PTSD are "exposure to actual or threatened death or serious injury" that occurs through directly experiencing a traumatic event , witnessing in person the event as it occurred to others, or learning that the event occurred to a close family member or close friend. Many of us in the Metroplex have recently been through that. It is ok to feel anxious and sad. That doesn't make you selfish or take away from the heartbreak you feel for those who have suffered losses. It also doesn't mean that you're going to develop PTSD. It is just an is - a response to a traumatic event. The best thing you can do is talk about it. Talk with your family, your friends, your neighbors. If the feelings are unbearable or linger for what feels too long, there are also great professionals in the area who can help you process this experience. As is usually the case, we'll all get through this together.

For more information on how to reduce weather-related anxiety and how to talk to children about their anxiety, see this post by the Anxiety and Depression Association of America.

Ryder Carroll, creator of the Bullet Journal Method, strikes a great balance of practical tips and philosophy in this guide to using pen and paper to organize your life, develop the practices of mindfulness and living intentionally, and give a newfound sense of priority and urgency to your goals. 

"Psychologist Ryan Howes began National Psychotherapy Day because he believed that psychotherapy as a profession has an image problem. Therapy takes place behind closed doors, so the public relies on movies and TV to tell them what therapy is like, and those depictions are rarely accurate. Howes set out to demystify therapy, educate the public about what real therapy looks like and how effective it can be, and create a fun way to celebrate therapy, rather than hide it."

On the 6th annual National Psychotherapy Day, I encourage you to learn more about psychotherapy and spread the word. You can read more from Dr. Howes and learn about how psychotherapy can help cultivate self-acceptance here. I also highly recommend the Moments of Meaning video series sponsored by National Psychotherapy Day. This video series featuring therapists speaking from the heart about the transformations that take place between therapist and patient in psychotherapy. The whole series is well done and provides an insightful and moving glimpse into real therapy sessions (all stories are shared with the permission of individual patients, and altering identifying information).  If you have ever wondered about the benefits, process, or new perspectives that psychotherapy might offer, take a look at this Moments of Meaning video featuring licensed clinical psychologist, Dr. John Dilley, as he shares his experience of entering psychotherapy as a patient himself.

Facebook executive, Sheryl Sandberg, is an enormously successful technology executive (named one of the 100 most influential people in the world by Time magazine in 2012), author and speaker. Over the past few weeks, she has been making the rounds on day and nighttime talk-shows promoting something much closer to her own heart, her new book, Option B: Facing adversity, building resilience and finding joy. The book, written with Sheryl's friend, psychologist Adam Grant, is at once a deeply personal reflection on Sheryl's sudden loss of her husband Dave to heart failure at age 47, and inspiring call to find meaning, purpose, and develop resilience in the face of adversity. As Sandberg writes, we are not born with a set amount of resilience, after which small and large challenges threaten to overwhelm us. But rather, resilience is like a muscle, that can be strengthened and developed throughout our lives. 

Option B, the book and the organization, promise to be excellent resources for those coping with loss and adversity, and all those searching for meaning and joy.

Here you can read excerpts or listen to the full recent interview on NPR in which Sheryl discusses her new book and advice on how to help someone who is grieving.

The Heads Together campaign has partnered with this weekend's London Marathon to help raise awareness and encourage people to speak up about and prioritize their mental health (all the runners will be given Heads Together headbands, modeled by the Royal Family above). ​

Journaling can be an invaluable resource for therapy. When someone describes an unusually good (or bad) day in session, I often ask them to reflect on what was different. Answers of "I don't know." or "Nothing, I think." are supremely frustrating in that they leave a person feeling helpless, as though a good or bad day comes out of the blue or passes them by completely outside of their control. More often than not, there are concrete things someone did, thought, or felt that either contributed to a better day or perhaps kept a bad day or experience from "taking over" or becoming unmanageable.

Take for example the few pounds we all may or may not have added over the holidays. We can be perplexed when we look at the scale now and wonder, "How did that happen?" But we also know that people who log everything that they eat or drink 1) tend to eat and drink more mindfully and healthily, and 2) can readily identify that pumpkin cheesecake or second helping that likely added to the scale come January. Journaling can provide that level of insight for your mental health.

Identifying patterns can be empowering and can provide you with your own individual data on what works, and what doesn't, what contributes to a great week, and what behaviors, skills, and experiences help you nip anxiety or depression in the bud. This process can help you clarify thoughts and feelings and solve problems more effectively.

Journaling can improve your body as well as your mind. University of Texas social psychologist and researcher, James Pennebaker has found that regular journaling strengthens immune cells (lymphocytes). A study published in Advances in Psychiatric Treatment noted improvements in both physical and psychological health in clinical and non-clinical groups after just 3-5 15-20 minute journaling sessions. Other research suggests that journaling offers not just emotional, but physical benefits to individuals battling terminal or life-threatening illnesses. Perhaps we see these benefits because, as Pennebaker suggests, writing about stressful events helps you come to terms with them and reduces the impact of these stressors on your physical health. Remind you of therapy? Journaling and therapy can beautifully complement one another. The work that you do journaling over the week can build on the momentum, insights, and positive changes you are developing in therapy. 

Adding space for a gratitude journal can provide time and space to reflect on positive thoughts, feelings, and experiences in a way that can actually help re-train your brain to more readily identify (rather than discount) positive experiences.

Including self-care ideas for when you notice triggers or early signs of depression or anxiety can help you easily identify tried and true methods to change course or help manage those negative feelings before they become overwhelming.

Here are some additional tips to get you started:

• Write every day. Whether you are more comfortable writing page long entries, drawing about your day or feelings, or using bullet points to capture the essentials, writing every day can help you build a consistent practice of mindful reflection. This can begin to change not just how you reflect on experiences after the fact, but also how you live them in the moment. If you have a negative interaction with a co-worker or spouse, you may find yourself thinking, "This is definitely going in the journal." That thought begins to change the experience. You begin to think about how you might write about it. Will your journal entry say that this conversation kicked off a terrible day? Or will you write about how you used the opportunity to practice stopping a spiral of negative thoughts, or how you used other coping skills to turn it around?​
• ​Make it easy. Before you set up a goal or "resolution" (e.g., to exercise 5 times a day or get 8 hours of sleep each night) start with tracking where you are now. Be curious, mindful, and take some time to learn about your current baseline. Once you've established that, you'll be better able to set realistic goals. ​

​Make it yours. Your journal can be as minimalistic and straightforward or artistic and detailed as you want. Are you the type of person (this month) who delights in a To Do list? Or does a listing these tasks and obligations bring you additional stress? If so, you may find you are better served by a "Done" list. Find your own style and what works best for you. The beauty of making a journal your own is that it can change with you from week to week, and month to month. Build on what works for you, and leave what does not behind without guilt (recognizing each of these is progress in and of itself!).

​Finally, I'm personally a proponent of putting pen to paper. One of the benefits of a journal that you physically create yourself is that you have complete control in customizing it to fit your needs as opposed to having pre-printed pages that you don't love or use in a day planner or maintaining multiple tracking apps. That said, if a physical journal just feels too analog for your life, there are a number of apps out there that track habits, moods, and provide space for journaling. Just be aware of protecting your privacy and online presence if you choose a digital route.

Happy journaling!

Additional Journaling  Resources:

BulletJournal.com offers a videos, tips, and tutorials on how to start a bullet journal.

Rachel Wilkerson Miller and Anna Borges at Buzzfeed offer a lighthearted and insightful collection of ways to use journaling to track and improve your mental health.

Steven Stosney at Psychology Today, describes the research on the results of journaling and gives tips for reaping the benefits of journaling while avoiding the pitfalls. ​

This divisive political season and election have heightened anxiety throughout the US. A Harris Poll on behalf of the American Psychological Association found that 52 percent of American adults report that the 2016 election is a very or somewhat significant source of stress (read more here).

As we attempt as a country to come together with respect, compassion, and courage, psychologist Guy Winch gives us concrete advice on overcoming post-election anxiety. "Regardless of its source, anxiety tends to operate in similar ways, which means there are clear things you can do to manage post-election anxiety." Guy has recommendations on actions you can take now to begin lowering your anxiety. Read his full article here:

​Three Ways to Lower Post-Election Anxiety

And remember, "sitting with emotional distress of any kind is neither wise nor necessary. If you feel upset, unsettled, and anxious—take action and make decisions that prioritize your emotional health and make you feel better."

You can also view Guy's viral TED Talk on boosting emotional health below.

Take care of yourself and one another out there.

The field of social genomics is granting us new insight into the power of connection and meaning at the level of our DNA. Researchers have known for some time that the stress response stifles the body's immune system and increases the inflammatory response (which in turn promotes the growth of cancer cells, plaque in the arteries, and increases our susceptibility to neurodegenerative disease). Researchers John Cacioppo, professor of psychology and behavioral neuroscience at the University of Chicago, and Steve Cole, professor of medicine at the University of California, Los Angeles, revealed that the brains of many of their participants interpret loneliness as a danger or threat, in short, loneliness triggered a damaging chronic stress-response. Fascinatingly, this response is triggered at the level of genome expression. 

Inspired by Cacioppo and Cole's work, Barbara Fredrickson, noted positive psychologist from the University of North Carolina at Chapel Hill, became curious as to whether the opposite would hold true. The answer was yes. People who described feeling socially connected, engaged in personal projects, or that they were living in a way that fulfilled meaning and purpose showed the opposite response pattern to lonely and chronically stressed participants.

Read more about this Cacioppo, Cole, and Fredrickson's research here.