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Thinking traps and anxiety in IBS – Part 1: All-or-nothing thinking

aurelie@drlucette.com (Aurelie Lucette) — Tue, 29 Aug 2023 18:26:05 GMT

“If I don’t check every single item on my to-do list, I have failed”

“I can’t just leave things half way done”

“I won’t feel okay until I can function as well as I did before my diagnosis.”

“Good enough doesn’t cut it”

“I won’t feel better until my pain is completely gone”

“I need to go back to feeling completely normal”

“I can never have a good day if I feel any type of pain”

Do some of those sound familiar?

These are all examples of all-or-nothing thinking.

In this first part of my thinking trap series, I want to talk about the infamous all-or-nothing thinking trap! All-or-nothing thinking is a cognitive distortion, also called a thinking trap or unhelpful way of thinking. *Breaking news* It is something that we all do. If you are a human being, you’ve engaged in all-or-nothing thinking at some point in your life (and it’s likely to have happened more than you realize!)

Read on to know more about what it is and how it can lead to uncomfortable feelings of anxiety, shame, disappointment, or low self-esteem.

What does all-or-nothing thinking look like - A "5-star review and nothing less" type of thinking

All-or-nothing thinking describes a very polarized and rigid way of thinking about ourselves and the world. When we think in all-or-nothing way, there’s no middle ground, no compromise, no good enough, no shade of grey. Things have to be just so. We have to be perfect. We have to nail it or else we have failed. It’s a very uncompromising way of thinking.

All-or-nothing thinking is not uncommon (at all!). Most of us sometimes fall into this “thinking trap.” However, when it becomes one of our default way of thinking, it can get us in trouble.

How you feel when you fall into an all-or-nothing thinking trap (cue anxiety)

All-or-nothing thinking is a very dichotomized and extreme way of thinking. It can feel like you’re either right or wrong. You are either a failure or a success. You either succeed 100% or it doesn’t count. AT ALL. Nada. Nothing. There’s no happy medium. No “pat on the back” for doing a good enough job. Nope.

Think about it. How would you feel if the following thoughts were running wild in your mind like an app on your phone you never closed:

“I’ll never feel normal until my IBS symptoms are completely gone”

“I didn’t meditate every day this week. It was an epic fail.”

“I can’t get it all under control. I feel like a failure.”

If that was the script running into your mind, my guess is that you would be feeling a mix of anxiety, frustration, disappointment, sadness, with a hint of shame! All-or-nothing thinking doesn’t leave much room for self-compassion and often leads to feelings of inadequacy, sadness, and anxiety.

What you do when you fall into the all-or-nothing trap (cue inadequate support and over/underdoing things)

Going back to the examples above, think about how you’re likely to respond to those thoughts, and how they might impact your behaviors. All-or-nothing thinking is all about the extremes (again, think failure vs. success). It is therefore not surprising that thinking this way is likely to lead to very extreme behaviors. All-or-nothing thinking can lead you to overdo things (hello overachievers out there in the world!), sometimes at a high cost to you (cue burnout and exhaustion), as you strive to deliver an unwavering five-star performance. At times, all-or-nothing thinking can also lead to inaction because the perfect standards you set for yourself are overwhelming and the idea of not being able to deliver on that five-star performance doesn’t feel okay. So you stall, you procrastinate, you just don't do anything at all!

If you are reading this and feeling like this sounds a lot like you, it is possible that you’ve fallen into an all-or-nothing trap at some point! And interestingly enough, all-or-nothing thinking is very tightly linked to perfectionism. If you are a perfectionist, or recovering perfectionist, you are likely no stranger to the feeling that anything less than perfect is not worthy of your time, cringing at the idea of settling for “good enough.”

All-or-nothing thinking can also lead to isolation. Most often, it is tied to the idea that in order to succeed, to be "perfect", you must do it alone, therefore making it less likely that you'll reach out for support.

All-or-nothing, IBS, and anxiety – The perfect storm

All-or-nothing thinking might get you in trouble when you’re navigating the stress of life with IBS. Having high, often unrealistic expectations of perfect outcomes (whatever that even means) can set you up for feelings of inadequacy and increased anxiety.

“I won’t be better until the pain is 100% gone”

“I didn’t do well with relaxation this week. I skipped two days. That messed up the whole week.”

“I don’t want to start dating until I’m 100% better”

“Things won’t feel normal until my IBS is completely gone.”

This last thought seems particularly salient in the clients with IBS I work with. The idea that life without IBS symptoms is the “normal” standard to aim for and that anything less than that is not normal and most definitely not acceptable seems particularly strong in many folks living with IBS. And as you can now tell, it is a very all-or-nothing way of thinking about health.

You either feel “normal” or “not normal”. And often times, the implied consequence of not feeling "normal" when IBS symptoms are still present (even though they may be less severe), is that you don’t allow yourself to live your life, to take some chances, to seek out new opportunities. You feel like you can’t start dating, that you can’t change jobs or start a new hobby. You feel trapped. Stuck. Anxious. Sad.

Now, what if we dropped the all-or-nothing thinking and started thinking a little bit more flexibly about life with IBS? What would that look like?

“I had abdominal pain only about 30% of the week. It’s still challenging but I’m seeing progress!”

“I practiced the diaphragmatic breathing most of the days. Some days I forgot or I was too tired. But it felt good when I did do it!”

“I’m feeling a bit nervous about dating when I’m still working on managing my IBS symptoms. But this is important to me and I want to start doing more of the things that matter to me. Even if I need to take it slow.”

Thinking more flexibly about your experiences often has ripple effects on the decisions you make and how you feel. Becoming more flexible with your thinking can impact your behaviors, allowing you to better manage your IBS symptoms. It can also lead to feeling less stress, which is also likely to have beneficial consequences for your health.

Now that you are starting to realize that all-or-nothing thinking might be exacerbating some of your anxiety and making it more challenging to manage IBS symptoms, you might also wonder how to learn to reframe those unhelpful thoughts. CBT for IBS can provide the support you need to start learning new ways to respond to your IBS symptoms and explore strategies to make your life less painful and more in line with your goals.

I’m a health psychologist and specialize in therapy for chronic illness

Did you even know that was a thing?! I am a health psychologist and work primarily with adults who struggle with physical or medical issues and want to better manage them to improve their quality of life. In addition to CBT for IBS, I can also use hypnosis as part of your treatment for IBS pain and other symptoms.

If you can’t find a chronic illness therapist near you, online therapy offers an excellent venue to engage in treatment for IBS symptoms. In fact, many of my current clients have opted for online counseling to find support with their IBS diagnosis.

If you live in Miami or surrounding cities, in-person therapy is also an option!

Elevator pitch for chronic illness – An underused tool to managing the anxiety of talking about IBS or other health issues

Wed, 12 Jul 2023 12:49:49 GMT

When talking about IBS or other health issues feels scary

If you live with a chronic health condition, you probably have experienced that feeling of overwhelm when asked about your health or when you feel you need to let others know about your diagnosis.

“I started dating and I don’t know how to bring up my health issues.”

"Talking about my GI symptoms is so awkward, no one wants to know!"

“What should I share with my new doctor when they only have 15 minutes to see me, I feel so rushed and I end up forgetting half of what I wanted to say?”

“I’m anticipating having to take some leave from work because of health issues, what should I say to my boss?”

“How much should I share? What exactly should I say? I can’t possibly give them my whole medical history!”

“If I say too much about my health at work, will I be given less opportunities?”

“What if I share too much and they freak out! Our relationship is so new.”

Sounds familiar?

Talking to others about chronic illness often brings up a lot of anxiety. Most people struggle to know how much to share about their health and where to even start. Yet, living with chronic health issues makes it very likely that you will need to share at least some information with some of the people in your life. You will need to communicate about your health needs with your medical providers to get appropriate care. You may need to share some information about your health at work if you anticipate needing some accommodations or leave. And you most likely need to fill in important people in your life about how you’re doing, as your health will impact many areas of your life. And most importantly, people care and want to be able to show up for you!

Obstacles to sharing about your IBS or chronic health issues

“People don't know what to say."

"I don’t want people to pity me”

“What if I scare them away”

“They’ll look at me differently”

“It’s awkward to talk about my IBS”

“I don’t want people to treat me differently”

One of the most common fears shared by those living with chronic illness is that people might treat them differently once they know about their health challenges. And it is a possibility. But it is also likely that most people can be allies if they know how to support you in a way that works for you. Before sharing information about your health with others, it can be helpful to ask yourself what you want them to know, and if the timing is right for you.

Having an “elevator pitch” for your chronic illness allows you to feel more prepared when going into a situation where you need to share some information about your health. An elevator pitch provides the cliff note version of your medical history or chronic illness , and it is a tool that can feel empowering. Think of it as a way to communicate your needs to someone, and sharing some important information about yourself on your own terms.

When might a chronic illness elevator pitch be helpful to talk about IBS or other health issues?

● Having a cliff note version of your medical record for a new medical provider to advocate for yourself

● Letting your new boss know of relevant health issues that might require certain accommodations, without going into details that you may not want to share

● You recently started dating and it’s important for you to share about your health after a few dates if things are going well

Five key points to help you craft a good (enough) elevator pitch for your IBS or chronic illness:

1) Keep it short(ish).

The idea is to highlight the important information that you want to convey at a given time. You can always provide more information later on if your needs change. The type of information you share will depend on your audience. But as a rule of thumb, and if you are going to share about your symptoms, it can help to describe the severity and frequency of the symptoms. A lot of people living with chronic illness also find that explaining their symptoms in terms of their impact on day-to-day functioning is often more helpful for others to understand rather than just telling them the diagnosis. For instance, saying that chronic migraines make it challenging for you to work a 9-5 job or get out of the house most days might be easier for someone to understand than explaining that you suffer from severe migraines.

2) Identify what you need

This is in my opinion the most important thing you need to clarify before coming up with your elevator pitch. What do you need to get out of it? Who is your target audience? What do you want your doctor/boss/new boyfriend to retain from that pitch?

Do you need empathy or strategy?

It can help to have a few, slightly different versions of your elevator pitch. What you need to communicate to your health care provider in order to inform your treatment plan is different from what you need to get across to your boss prior to asking for a leave. Obviously, your doctor will benefit from a lot more medical details and jargon than your boss.

3) Let the other person know how they can help

You want to communicate how the other person can help support you. Of course, the type of support you need from your healthcare professional will be vastly different from what a friend or romantic partner can do to help.

If you need emotional support, how can your partner help? Do you need a hug? Do you need to vent? Maybe you can let them know what has been helpful before to manage your symptoms (at work, in relationships, etc). Most people mean well but they may not know how to support you in a way that works for you, which may at times make it uncomfortable for you (cue feelings of pity from your boss or a friend).

4) Follow your own agenda

When sharing about your health, you can do it on your own terms! Having a chronic illness elevator pitch allows you to share only the information that you feel is relevant or important to meet your needs. People may ask follow up questions, but it’s always up to you to decide if sharing more would be helpful to you or would only satisfy the other person’s curiosity. It’s okay to set boundaries when sharing about yourself, whether you’re discussing your health or anything else. If you don’t feel comfortable sharing anything (more), you can let the other person know:

“This is something I would rather not discuss at this time.”

“Discussing my health in more details is not something I feel comfortable doing.”

“I don’t want to share any more about my health.”

“I appreciate you showing interest. I don’t want to discuss my diagnosis.”

5) Save your chronic illness elevator pitch somewhere readily accessible

Saving your chronic elevator pitch in a note on your phone can be helpful. You can access it anywhere, anytime! You can have a fully written pitch or a few bullet points to remind you of the information you want to share, and how to share it. Some people have found it helpful to email a new medical provider a summary of their health information ahead of their appointment or to have a printed document ready to hand to the provider on the day of to highlight important questions or details from their health history.

Need a therapist to help you manage the anxiety of living with IBS or another chronic illness? I am a health psychologist in Miami, Florida and I can help you deal with stress and anxiety related to your health

Did you even know that was a thing?! I am a health psychologist and work primarily with adults who struggle with physical or medical issues and want to better manage them to improve their quality of life. In addition to CBT for IBS or chronic illness, I also provide gut-directed hypnotherapy .

If you can’t find a chronic illness therapist near you, online therapy offers an excellent venue to engage in treatment for chronic illness. In fact, many of my current clients have opted for online counseling to find support with their IBS or other chronic illness.

If you live in Miami or surrounding cities, in-person therapy is also an option!

Managing anxiety: Try treating your anxious thoughts as spam!

aurelie@drlucette.com (Aurelie Lucette) — Thu, 19 Jan 2023 19:51:35 GMT

What if I have a panic attack?
What if I embarrass myself?
What if they don’t like me?
What if my symptoms get worse?
What if I can’t find parking?
What if the pain gets worse?
What if my heart starts racing?

And on and on and on goes the brain on anxiety! When you feel anxious, the what ifs can get so loud. And they are often endless when your brain gets started. Maybe you’re nodding as you’re reading those lines. Most people who live with anxiety are no stranger to all those “What ifs.”

And interestingly, the brain on anxiety mostly feeds you alarming “what ifs.” Really, when is the last time you started thinking about the best-case scenario can anxiety kicked in?! From a brain standpoint, all that worrying makes some kind of sense. You can think of it as the brain’s best attempt at preparing you for every possible worst-case scenario and keeping you safe. In other words, worrying is an attempt at keeping you safe and alive, although it's fair to say than no amount of worrying really helps in most cases!

Interestingly, when the brain starts its cycle of negative anticipation, or worrying, these thoughts in turn can impact your physiological wellbeing . In short, thinking worrisome thoughts causes the body to gear up for danger and protect you at all costs. That’s when you might experience a racing heart, shortness of breath, muscular tension, among other symptoms of anxiety. As far as the brain is concerned, there is no significant difference between an actual threat (e.g., a tiger running full speed toward you) and an imagined threat (thinking that a tiger might attack you if you step out or worrying about giving a presentation in a room full of people). While you might sometimes notice that cascade of events, it is not uncommon for people to experience symptoms of anxiety in their body, with limited awareness of the triggering thoughts. This is especially common with panic disorder.

Anxious thoughts are not (always) facts

In fact, very often, those thoughts aren’t based in any kind of facts or truth. And interestingly, most of those “what ifs” and all the worst-case scenario that keep you awake at night don’t end up happening. Yet, they can cause significant distress leading up to the dreaded situation or event.

Think about the last time you experienced anticipatory anxiety or were worried about an upcoming event or situation, what was the most distressing: the actual event or all the worrying leading up to it?

Most people find that the anticipatory anxiety leading up to a dreaded event is often more distressing than the actual event. More often than not, nothing catastrophic happens, even though there might be some discomfort. “Ugh, all this worrying for this?” you might say.

When you anticipate, your brain is free to run wild with all kinds of hypotheses and worst-case scenarios. It’s not bound by any type of facts in that moment, allowing you to think and worry about the most threatening and fearful predictions, which are arguably unlikely to come true in most cases. Once you are faced with the actual situation you were worrying about (the dreaded staff meeting, a doctor’s appointment, etc), you might notice that the anxiety is not as high as you once imagined it would.

Anxious thoughts are just another symptom of anxiety

One way anxiety escalates and snowballs into significant distress (sometimes culminating into a panic attack), is our tendency to cling onto our anxious thoughts and run with them. If we allow ourselves to focus on those scary predictions our brain feeds us, it’s no wonder that we feel increasingly anxious. The words that trickle in when you worry, “Heart attack”, “embarrassing”, “panic attack”, “pain”, signal to the brain that you MUST be on high alert. The brain is interpreting them as a dire signal of something catastrophic about to happen.

The brain is interpreting these anxious thoughts as facts. But here is the lie! Most often, these thoughts are NOT facts. They are most often string of (scary!) words that have no base in reality, nor are they a n actual sign of impending doom. Nope. These thoughts are another symptom of your anxiety, just like your racing heart or sweaty palms might be. Let me repeat this again, anxious thoughts, often preceded by the dreaded “What if”, are just another sign of your brain on anxiety!

What to do with anxious thoughts? Treat them as spam!

Now, what if you didn’t buy into every single thought our anxious brain fed you? What if you sometimes treated them as spam instead? Yes, you read this correctly, why not practice treating your anxious thoughts as spam or junk mail?!

If we keep in mind that anxious thoughts are another sign of anxiety, and not based in facts, it only makes sense to not engage with them or act on them. Similarly, you would likely not open every spam that ends in your inbox or write a lengthy email back for every of the many spammy emails you receive daily.

Over the next few days, practice treating anxious thoughts as spam. You may want to ask yourself one or a combination of the following questions:

· Is this thought helpful or should I file it under “spam”?

· What if I treated this thought as spam? What would happen then?

· Can I just take note of this automatic thought and then disregard it as spam?

Isn’t it a relief to realize that we don’t have to do something about every automatic, and anxious, thought? That not every thought that crosses our mind makes sense or is valuable?

Need help managing anxiety? I am a psychologist in Miami, Florida and I can help you deal with stress and anxiety

Wether you have received a diagnosis of an anxiety disorder ( panic disorder , generalized anxiety, social anxiety disorder) or you've noticed that anxiety has recently started creeping up into your life (hello, pandemic!), therapy can help. I am an anxiety therapist and would be happy to help you manage your symptoms using a range of research-based treatments such as Cognitive Behavioral Therapy (one of the gold standard treatments for anxiety).

I provide therapy for anxiety online throughout the states of Florida, New York, and New Jersey. And if you live in Miami or surrounding cities, in-person therapy is also an option!

Therapy for Irritable Bowel Syndrome - A health psychologist explains the benefits of CBT

aurelie@drlucette.com (Aurelie Lucette) — Thu, 13 Oct 2022 16:14:25 GMT

If you (or a loved one) have been diagnosed with IBS, you’re likely familiar with the impact it can have on one’s life when symptoms are flaring up . It disrupts relationships at times, making socializing more challenging, or at the very least more stressful. It gets in the way of day-to-day functioning at work and in other areas of living.

And when IBS symptoms subside, there is often a looming fear that they might flare up again , a lingering worry about your symptoms coming back. What if I can’t go on that trip? What if the symptoms get worse the next time around? Will I feel okay enough to celebrate my birthday?

There is anxiety when symptoms are present, and there is anxiety when they are gone, when your brain starts thinking about all the possible worst-case scenarios of what may happens next (something we call “catastrophizing). In a nutshell, anxiety often comes as a very unwelcome side-effect with an IBS diagnosis.

And as if that weren’t enough, you are then told that you shouldn’t feeling this anxious because it will make your symptoms worse. *eye rolls* It feels like you can never win, doesn’t it?

Is it in my head?

If your provider has suggested you try therapy for irritable bowel syndrome, you may have felt a ping of resentment if it was ever implied that your symptoms are all in your head.

I am here to make it clear that IBS is not “all in your head.” And if you’re reading this, you’ve likely experienced first-hand the challenges of IBS symptoms (diarrhea, constipation, bloating, gas, pain), and you know that they are very real! And, again, the fact that your symptoms are not immediately explained by structural or biochemical abnormalities doesn’t imply that it’s “all in your head” either. Rather, research suggests that IBS is due to a very complex array of factors.

IBS is considered a disorder of gut-brain interaction (DGBI). That means that we believe the communication between the brain and the gut (via the nervous system) is impaired in some ways . In that sense, IBS results, in part, from of a miscommunication between your stomach and your brain, causing visceral hypersensitivity and other disturbances in the GI tract. However, our brain likely contributes to some of the symptoms you are experiencing.

Health psychologists and therapists who specialize in chronic illness are an important part of your care team when learning to manage IBS, and they can help improve your quality of life. Having a team of providers who are all on the same page and supportive of your treatment teams can make all the difference! As a therapist specializing in GI psychology, I find that working alongside your gastroenterologist, dietitian, and other providers involved in your treatment allows for the best care. So, if your medical provider suggested therapy as a new treatment for irritable bowel syndrome, it is not that they’re trying to pass you along to someone else, it might very well be a helpful addition to your IBS treatment.

Irritable Bowel Syndrome Therapy – Introducing CBT for IBS

Cognitive Behavioral Therapy (CBT) is a relatively new form of treatment for IBS, which focuses on learning skills to manage the disease in order to improve someone’s quality of life. This treatment is short-term and emphasizes changes in behaviors and thoughts to improve your mood and mitigate stress and physiological symptoms.

Behavioral strategies for the treatment of IBS (The “B” in CBT)

IBS can present in different forms. IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), or IBS with mixed bowel habits (IBS-M). Regardless of your disease presentation, a key aspect of CBT for IBS is relaxation training , which is often introduced in the first few sessions. Relaxation t raining (including diaphragmatic breathing, progressive muscle relaxation, and visualization) is a n important skill to learn and practice, as it helps activates the sympathetic nervous system, the part of your nervous system that is responsible for relaxation and comfort. Relaxation practice can help turn down pain signals a notch and regulate gut motility. In other words, you can help turn down I BS pain by engaging in relaxation, a behavior that is under your direct control.

Another important goal of CBT for IBS is to help you engage in a range of activities that are important to you and which you may have been avoiding. Many of my patients share that they miss going out with friends and family, making them feel isolated and sometimes sad. They may also dread going on a trip or going to a restaurant or party, and described that IBS has taken away so much joy out of their day-to-day life.

Avoidance can result from a fear of experiencing uncomfortable or embarrassing symptoms in situations where you don’t have easy access to a restroom or a fear of eating certain foods that you worry might make symptoms worse. Exposures (e.g., eating at a restaurant, going out with friends, etc) and behavioral experiments are done gradually and with the help of a trained professional in order to allow you to participate more fully in activities and situations that are meaningful to you and to improve your quality of life. As you work with your therapist, you will take steps toward facing situations and challenging possible misconceptions about the impact of your symptoms.

Cognitive strategies for IBS (The “C” in CBT)

"I've made myself worse because of my anxiety"

"My IBS is flaring and it’s my fault, I’m too anxious”

"I'm so worried and I know it's not good for me, but I don't know what to do."

“I won’t be able to deal with the pain if I’m out of the house”

“It’s not reasonable to go out when I’m flaring up ”

Sounds familiar?

The above thoughts are fairly common in those living with chronic illness. Yet, if we take a closer look at them, we could argue that they are not necessarily 100% accurate. At the very least, it is fair to s ay that they are not always helpfu l. An important aspect of CBT treatment is to become more mindful of unhelpful or distorted thinking patterns and their impact on our emotions and the decisions we make.

The way we think about a situation can exacerbate our stress (e.g., “I will have an urge to use the bathroom in the middle of a discussion and will have to run to a bathroom, that will be so embarrassing”), and, in turn, make GI symptoms worse. One of the emphasis of treatment is to practice noticing when catastrophizing (i.e., thinking about the worst-case scenario) is kicking in or when we may be overestimating the probably of a negative outcome. With the help of the therapist, one can then practice thinking more flexibly about their symptoms and their ability to engage in a wider range of activities.

If you are reading this, you’re likely feeling overwhelmed by your GI symptoms and ready to learn another way to manage them as well as the anxiety that often comes along. Like you maybe, many of my patients realize that their anxiety and stress is exacerbating their symptoms, yet, they also find it difficult to do things different in a way that feels sustainable. CBT treatment can provide the support you need to start learning new ways to respond to your IBS symptoms and explore strategies to make your life less painful and more in line with your personal and professional goals.

I’m a health psychologist in Miami and specialize in therapy for chronic illness

Did you even know that was a thing?! I am a health psychologist and work primarily with adults who struggle with physical or medical issues and want to better manage them to improve their quality of life. In addition to CBT for IBS, I c an also gut-directed hypnotherapy as part of your treatment for IBS pain and other symptoms.

If you live in Miami or surrounding cities, in-person therapy is also an option!

5 strategies to spiral up and out of the anxiety rabbit hole

Mon, 03 Oct 2022 16:46:39 GMT

Have you ever gone down the anxiety rabbit hole , your brain jumping from one anxious thought to the next?

Do you ever feel like you’re trapped in an out-of-control anxiety spiral ?

Do you find that anxiety sneaks in at bedtime and spirals down, getting in the way of your precious and much needed sleep?

Is the anxiety so overwhelming that it sometimes ends up in a full-blown panic attack that leaves you drained and even more worried?

Maybe you’ve managed your anxiety fairly well for many years, but recently it feels like anxiety has jumped in the driver’s seat and is bossing you around, leaving you feeling overwhelmed and exhausted, and no amount of meditation has kept it at bay.

If you can relate to any of the above, and your anxiety often feels out of control, know that you’re not alone. Anxiety is overwhelming, and climbing out of that “anxiety hole” can feel physically and mentally draining.

Behind the scenes of our anxiety – When unhelpful thoughts are set on autopilot

While going down the anxiety rabbit hole feels like it happens in the blink of an eye, what often gets us to this place of overwhelm is a series of (somewhat) rapidly occurring little events that contribute to making your anxiety worse. For instance, the way we interpret a stressful situation, and our thoughts about that situation, can push us in that downward spiral.

What we see:

We open a work email, next thing we know, we feel completely overwhelmed and unable to focus or concentrate on anything.

Meanwhile, behind the scenes (aka, in your mind), it can look like:

“Ugh, I just received that email about yet another thing that I have to add to my to-do list” … “I really didn’t need that”… “I don’t think I can manage to get this all done”… “This is too much, I won’t be able to do it”…”What if I get behind at work”…” What if my boss is disappointed”…”I might not get that raise I’ve worked so hard for”… “What if I lose my job if I can’t step up my game”…

And on and on goes the brain on anxiety, dragging you to the worst-case scenario! It can also look like this:

Our stomach hurts, the next minute we are experiencing a full-on panic attack and worrying about something serious going on with our health. Meanwhile, this is what happened behind the scenes:

“Oh, my stomach feels funny”…”I’m wondering what’s wrong”…”I hope it’s nothing bad”…”What if my IBS is flaring up again”…”What if the medication stopped working”…”What will I do”…”I’m going to feel miserable again”…”I don’t be able to go on that trip”…”I will be such a disappointment to my family”… “I will be out of commission for another few months”…”I can’t deal with this again”…

Sounds familiar? One self-defeating though piling up on top of the previous one in a seemingly endless cycle!

What happens in our body (aka, our breathing gone wrong) can also contribute to anxiety

When our anxious mind kicks in, our body responds to the call. When we feel anxious, our body can respond by triggering the “fight-or-flight” system, the body’s built-in system that gets us ready to react to a threat. Interestingly, our brain can’t always make the difference between a tiger running full speed toward us or anxious thoughts on repeat in our brain. Both are deemed threats, and cause the fight-of-flight response to be activated.

Hyperventilation is one of the ways our body responds under stress. Have you ever noticed that your breathing becomes shallower when you’re anxious? Hyperventilation, or over-breathing, can in turn cause more physiological symptoms (e.g., dizziness, lightheadedness, shortness of breath), which, although they are not harmful, can be distressing and further add to your anxiety.

In short, unhelpful thoughts can cause physiological symptoms, and vice versa, in a dance that makes up spin and feel overwhelmed and dizzy with worry.

How do we stop the anxiety from spiraling down?

As much as anxiety makes you feel out of control, there are a few steps you can take to feel more in control of what is happening in the moment. The first one is to step out of anxious automatic pilot and become more aware of the cycle of anxiety. As you step out of automatic pilot, you can start taking small, intentional steps away from the anxiety, and begin spiraling up! As important as this step is, building the awareness of our thoughts and behaviors can prove a bit challenging at first, and asking for support from an anxiety therapist can help. Cognitive Behavioral Therapy (CBT) can be a good option to that end.

Below are five bite-size strategies that can help you get started with stepping out of the anxious cycle and spiraling up

1. Become familiar with your anxiety triggers and early signs that anxiety is rearing up its head.

The more you are aware of early signs that your anxiety is start to build, the more likely you will be able to interrupt that vicious cycle. You may noticed for instance that your breathing is becoming more labored (frequent sighing and yawning may also indicate that you are hyperventilating). Or you might catch yourself worrying about a possible worst-case scenario for something that hasn’t happened. This is your chance to pause for a moment and ask yourself: “What is one thing I can do right now to help take the anxiety down a notch?”

2. Practice deep breathing!

Deep breathing, also called diaphragmatic breathing or belly breathing, is the one way you can activate the parasympathetic nervous system, the part of your nervous system that is in charge of the relaxation response. Whether you practice breathing on your own or use an app, practicing deep breathing for a few moments can start bringing in some relief from anxiety.

3. Ground yourself.

Anxiety will often take you on a journey to the future, making you worry about things that haven’t happened and making you believe that thinking about all the possible “what ifs” will provide a sense of relief or calm (breaking news, it doesn’t!) Grounding techniques can help you reconnect with your environment and bring you back in the here-and-now, and away from that downward spiral of worst-case scenarios . Grounding can look like noticing 5 sounds in your immediate environment, planting your feet in the ground and noticing the contact they make with the floor, or even counting your breaths. More here on grounding techniques .

4. Kick your “buts”!

Remind yourself that you can experience (some) anxiety AND still be able to enjoy the moment or have a good time. So instead of systematically thinking “I was able to get out of the house and spend time with friends, BUT I felt so anxious”, practice reframing to “I felt anxious AND I was able to get out of the house and spend time with friends.” And see if that may make you feel any differently.

5. Compassionate self-talk.

Be kind to yourself when you struggle with anxiety. Talk to yourself the way you would a very dear friend. What word of comfort would you give them in a moment of anxiety?

Hi, I’m a Miami psychologist and I offer Cognitive Behavioral Therapy (CBT) for anxiety!

Anxiety relief is one of the number one reasons people seek help from a psychologist. Especially since the beginning of the pandemic, many people who previously were able to keep anxiety at bay have found themselves overwhelmed and needing more support. If that’s you, reach out for help and schedule a free 15-minute phone consultation to learn how counseling sessions using Cognitive Behavioral Therapy might help you find some relief from your a n xiety.

Gut directed hypnosis for Irritable Bowel Syndrome

aurelie@drlucette.com (Aurelie Lucette) — Wed, 27 Jul 2022 16:47:40 GMT

Your IBS has been flaring up. You want your life back and you're open to learning new ways to manage it and finally feel more like yourself!

Maybe your doctor suggested that you make an appointment with a GI psychologist to receive additional support your IBS symptoms . They may have recommended hypnosis or CBT for IBS, or someone you know mentioned its benefits to you.

You don't know much about it yet, but hypnosis for IBS has you intrigued. You may have gone as far as googling it and reading about the possible psychological and physical relief it provides. Now you want to know more!

Clinical hypnosis has become an increasingly common treatment for Irritable Bowel Syndrome (IBS), and many GI doctors now recommend hypnosis for IBS (also called gut-directed hypnotherapy ) as part of treatment . Clinical hypnosis is not new. It has been used to treat a range of psychological and medical issues for many years and was formally adopted as form of treatment by the American Medical Association and the American Psychological Association decades ago. In recent years, it has become a resource to help alleviate gastrointestinal distress.

What is hypnosis for IBS?

In the words of Olafur Palsson who pioneered the use of this treatment to address gastrointestinal issues, “hypnosis is a special mental state in which a person's focus of attention becomes narrow and intense like the beam of a bright flashlight in a dark room.” Gut-directed hypnotherapy (also referred to as hypnosis for IBS or gut hypnotherapy) involves a state of deep relaxation and focused awareness, as well as the use of imagery and suggestions focusing on soothing the digestive tract and reducing the focus on physical discomfort. The use of imagery is thought to help promote positive mental and physical outcomes.

The goal of hypnosis for IBS is to address the faulty communication between the gut and the brain , which is thought to contribute to gastrointestinal discomfort and symptoms in some patients struggling with GI disorders.

Medical hypnosis is an established form of treatment used by trained providers, unlike what you may have seen in movies with stage hypnosis. In other words, your psychologist will not make you quack like a duck during session! No one can be hypnotized against their will, and patients remain in complete control during sessions. Clinical hypnosis is simply a practice of deepened relaxation coupled with suggestions targeting GI discomfort.

What does hypnosis look like?

Interestingly, the way you feel when practicing hypnosis is a state you’ve most likely experienced before . It’s a normal state of consciousness that we go in and out during the course of our day. For instance, when you are so absorbed in your work that you lose track of time or what is going on around you . Or when missed your exit when driving . Or have you ever found yourself daydreaming and not immediately hearing someone calling your name? These moments of hyper focused attention are similar in many ways to the hypnotic state.

How long does hypnosis for IBS last?

Patients go through a 7-session protocol that has been well-researched . You will meet with your therapist for sessions and practice with recordings in between appointments. Some patients may benefit from additional treatment to address other stressors or lea rn complementary tools to manage their IBS. Cognitive Behavioral Therapy for IBS (also referred to as CBT for ibs) is another well-researched form of treatment for IBS, which has showed benefits f or patients' psychological and physical wellbeing.

Hypnosis for IBS in Miami and Florida

As a health psychologist, I am uniquely trained to understand the challenges of living with gastrointestinal disorders, and I can tailor treatment to address issues related specifically to your GI condition using gut-directed hypnosis for IBS or Cognitive Behavioral Therapy for IBS . And sometimes both treatments are used to provide you with a wider range of tools to address your specific therapeutic needs. If coming into my Miami office for therapy isn't an option, online counseling for IBS is a great option to access the care that you need , and it’s been shown to be just as effective as in-person treatment! Online therapy is also a great option to connect with a health psychologist when there isn’t you near where you live.

A health psychologist discusses the loneliness of living with chronic illness

aurelie@drlucette.com (Aurelie Lucette) — Sat, 02 Apr 2022 00:14:54 GMT

Do you ever feel like you shouldn’t "complain" about your health anymore because your friends might get tired of hearing about it or they won’t understand it? Or that there isn’t much else to talk about that’s “worthy” enough of a text. And maybe you stop reaching out.

You’re afraid that talking about your health is too much of a burden for others to handle.

And maybe you’ve tried to explain what it feels like to live in so much pain. The fatigue, the discomfort. Being forced to cancel plans. But it feels like no matter how much you try, no words can really convey the reality of your illness and what it feels like to be sick.

You cancel plans because the mere thought of being around people and pretending that you’re fine seems exhausting.

You feel lonely.

Many of my patients do. Like many of those living with chronic illness, they are in a lot of pain, often. And they often endure it in silence.

The loneliness of living with an invisible illness

Many of my patients live with an invisible illness; digestive disorder (IBS, ulcerative colitis, Crohn’s disease), cancer, migraines/headaches, etc. Although their symptoms are very different, they often share very similar feelings of loneliness . Some describe that friends have stopped reaching out over the years. Maybe they don’t know what to say. They might feel helpless or uncomfortable. Or they may don’t want to “bother you” when you’re feeling unwell.

Many also report feeling inadequate .

“They don’t need to hear about my health anymore”

“I shouldn’t burden them with it”

“I’m not fun to be around”

The fear that people will get tired of hearing about your health might keep you from reaching out when you are flaring up, when you're in pain, when you need them the most . It’s almost as if there was a finite amount of credits that you could use to talk about your health issues, and then you run out. It’s that little voice in your head convincing you that you can push through a bit more, a bit longer. That you shouldn’t reach out to people quite yet. That you need to power through and be “strong.”

Some have also shared the feelings of shame and embarrassment of having IBS or another GI disorder and having to justify needing to find a bathroom quickly or living in fear that others may ask questions they may not feel prepared to discuss. “I can talk about being in pain but I can’t talk about having frequent diarrhea” share many.

And there is the very disheartening reality of experiencing the disappointment of people not knowing what to say or saying the wrong thing . “You have to stop being so negative or you’ll get worse”, “Look at the silver lining”, “Oh, you seemed fine yesterday, what’s going on?” While we often mean well, the words we say to those living in pain can feel invalidating and dismissive, adding to the feeling of loneliness, of feeling unseen.

When you feel alone, answering the simplest questions or being around others can feel very daunting. In the rest of this article, I offer some ideas on how to receive the support you need (and deserve!) and feel less lonely when living with chronic illness.

No every single person can meet all of our needs, but one person can likely meet one need!

Most of us can think of someone in our lives who is a fairly good listener and won’t panic when you tell them you’re having a rough day. Other friends might feel more comfortable providing instrumental support; bringing food when you’re too sick to get out of the house or coming over to play with your kids while you take a nap.

Your go-to person may or may not be the best fit to help with that specific issue you’re struggling with. As you consider who to ask for support, think about anyone who could possibly help (or guide you to the right resource) : Family, friends, therapist, faith-based community, an organization in your community, online support group, etc. Writing down a list of names and resources might help provide some clarity into this decision.

In this moment, what would you need to feel a bit less lonely? Who can you reach out to for support that might bring a smile to your face or make you feel seen?

Read this for more thoughts on how to ask for help.

People can be helpful and supportive, even if they don’t fully understand what it’s like to live with chronic illness

As all-mighty as we make it out to be, our brain is not always our best ally when it comes to thinking about what we need and how to get it.

“People are busy, they don’t need me to burden them with my health issues”

“I shouldn’t complain about it”

“They can’t do anything about it”

Sounds familiar? Let’s pause. What if in fact most people want to help? I hear you, not everyone might be available at anytime, but most people want to help! They may not just know how.

And what if they could do something about it by just being there and reminding you how much they care about you? Wouldn’t it feel a bit less lonely to be in pain and with someone for a little while, rather than just in pain and yourself?

What if people are actually okay with hearing how you feel or reaching out for help? Because not knowing how you’re doing makes them worry even more?

What if those thoughts keeping you from reaching out to others were not 100% true?

Here is how you can start chipping away at the loneliness, one thing at a time, on day at a time:

● Reach out to someone who has been helpful in the past , someone you know to be caring, someone who never fails to bring a smile to your face at one point or another

● Be willing to take a risk and let people know how you truly feel, more than often, you might be surprised by how supportive they can be . And when the alternative is not sharing and feeling lonely, what is the worst that could happen? Is it worth the risk?

● Find a support group . Maybe you won’t like it and you won’t need to go back. And maybe you'll feel seen and validated in a way that feels new and uplifting.

● Seek therapy from a pain psychologist or health psychologist . Counseling can help you feel less lonely and develop the tools to build a supportive environment in a way that works for you.

● While some people may not understand, some people likely will and they might be able to show up for you and support you more than you might have expected . Sharing about your illness, and the ups and downs of your diagnosis, in a way that feels safe and respectful to your needs, allows you to create opportunities for people to show their love and support.

How to better understand panic attacks and 3 tips to manage them

aurelie@drlucette.com (Aurelie Lucette) — Wed, 09 Feb 2022 01:21:48 GMT

If you have experienced a panic attack, you’re not alone. Up to 30% of people will experience at least one over their lifetime. Panic attacks tend to be scary and memorable. If you’ve experienced a panic attack before, you probably remember where you were when it happened, whether it was in the middle of the night or on an elevator. Panic attacks are THAT intense!

“I thought I was dying”

“I ended up in the E.R. thinking I was having a heart attack.”

“I was completely paralyzed and disconnected from what was going on around me.”

“It was the most terrifying experience.”

What is a panic attack?

Panic attacks are defined as a very short, and intense burst of anxiety during which at least 4 of the symptoms listed below develop suddenly and reach a peak within 10-15 minutes.

- Racing heart

- Shortness of breath

- Sweating

- Shaking

- Feeling of choking or lump in your throat

- Chest pain or discomfort

- Nausea

- Dizziness

- Numbness or tingling

- Chills or hot flushes

- Fear of losing control of going crazy

- Fear of dying

- Feeling of unreality or “out-of-body” experience

Some of you may have experienced all of the above listed symptoms, others just a few. And while a panic attack is short-lived and most symptoms alleviate within 15 minutes, it is not unusual to experience residual anxiety for a little while after as your body and mind recover and stress hormones (e.g., adrenaline, cortisol) return to their baseline levels.

Your response to the panic attack may also create additional anxiety. For instance, if your response to a panic attack is “something is wrong with me”, “I should have been able to handle it better”, “I don’t have time for that to happen now” , you are more likely to experience more anxiety than if you are able to tell yourself “I just had a panic attack, I am safe, I will take a moment to help my body and mind calm down before I get back to what I need to do.”

Panic attacks, which are physically harmless, can also mimic other conditions, such as an asthma attack , which need to be treated promptly. Chest tightness is also a symptom shared by both panic attacks and heart attacks, which can further be cause for concern. Knowing the differences and seeking guidance from a healthcare provider is essential to receive proper treatment and manage anxiety.

What causes a panic attack?

A panic attack happens when our “fight-or-flight” response is activated. The fight-or-flight response is the body’s physiological, hardwired way of responding to a perceived threat or danger. In a nutshell, "there's a threat, I need to panic!" While this built-in system is useful when you're in the jungle being attacked by a predator, in the case of panic attacks, it is triggered in the absence of an actual threat (though there might be a stressor). While the trigger of a panic attack may sometimes be obvious, for instance, people reporting that they experience a panic attack every time they have to get on an elevator or a similarly confined space, other times, you may not be aware of what caused it. You may even have experienced a panic attack in the middle of the night, waking you up from a state of deep sleep.

Other situations that can prime the body to activate the flight-or-flight response include intense physical activity, too much caffeine, hyperventilation, environmental changes (e.g., waking into a very stuffy room or walking in the Miami heat in the middle of summer). Symptoms of illness may also induce physical changes that can be perceived as threats and cause a panic attack.

Panic attack vs. panic disorder

How to manage a panic attack

1. Talk to yourself as you ride out the panic attack

Remind yourself that panic attacks are harmless and short-lived. Talk to yourself gently, as you would a friend. You may repeat to yourself “I am having a panic attack. It is scary but I’ve done it before. I am safe and I can ride it out” , or some version of this that resonates with you. Remind yourself that your symptoms are caused by anxiety and that your body is not made to sustain high levels of physiological arousal. Soon, the symptoms will alleviate.

2. Breathe through it

Hyperventilation is associated with many of the symptoms you will experience during a panic attack (e.g., dizziness, shortness of breath, numbness and tingling in your extremities). Taking slow, deep breath can help reduce the feelings of panic and return your body to feeling calmer. Learning diaphragmatic breathing is a strategy that may help you cope successfully with a panic attack, as you learn to inhale slowly through your nose and exhale through your mouth. While taking deep breath is not rocket science, practicing this skill might require a bit of support to get it right at the beginning. Seeking guidance from a therapist or reviewing a video on diaphragmatic breathing (not in the midst of a panic attack) can help.

3. Become aware of the early signs of your panic response

Becoming more aware of the early signs of anxiety might allow you to prevent your symptoms from turning into a full-blown panic attack. You have the ability to intervene at the first signs that anxiety is creeping up. Think about your most recent panic attack. What were the first symptoms that you notice? Did you notice a tingling in your hands? Do you remember sighing pretty heavily (possibly a sign that you were hyperventilating)? Did you notice a tightness in your chest and feeling short of breath? And if you are unsure of what came first, try and observe your symptoms in the future. Pay attention to the way you feel. If and when you notice anxiety “red flags”, use your breathing skills and other techniques that you might have learned with a therapist to prevent the anxiety from further building up.

When to seek help for panic attacks?

If you are experiencing frequent panic attacks to the point that it’s either causing some distress or impacting your daily functioning, it might be time to seek help to break out of that cycle. Here are some indications that you might benefit from psychotherapy to manage panic attacks:

- You have been experiencing frequent panic attacks and it’s making you increasingly worried

- You are more and more concerned about experiencing more panic attacks in the future

- You’ve started making some (subtle) changes to the way you function in your day-to-day life as a result of having panic attacks. Maybe you’re avoiding certain places altogether or only feel comfortable going with someone you trust

- Your panic attacks are more and more frequent or distressing

- Someone has suggested that you should be seeking help

- You have been diagnosed with panic disorder

Panic attacks can be difficult to manage on your own and may get worse without adequate treatment. The good news is that we know a lot of panic attacks and panic disorder and how to treat them!

Treating anxiety and panic disorder with CBT

Finally, breaking out of the panic cycle also requires to take a look at how you respond to the panic attack . What thoughts are triggered by your panic attack? How do you interpret your symptoms? Additionally, what are you doing after you have a panic attack? Are you avoiding certain places and situations? Are you modifying your routine to prevent panic attacks from happening? Certain behaviors we think might help with anxiety often can maintain and exacerbate it. Together with your CBT therapist, you will learn to modify your response to panic attacks in a way that allows you to feel more in control.

The goals of CBT for panic disorder include:

- Reducing the frequency and severity of panic attacks

- Making you feel more in control , confident, and empowered

- Understand the relationship between your thoughts, feelings, and behaviors, and how they might be contributing to maintaining your symptoms

- Allow you to enjoy a range of situations and activities without having to worry about panic attacks

- Improving your quality of life!

And while it is not a “quick fix”, it is a research-backed treatment that a majority of people tend to benefit from. Yay *happy dance*

Counseling vs. medication for panic attacks

You may be asking yourself if counseling for panic attacks is the way to go or if you should take medications. CBT is often suggested as the first course of action to treat panic disorder or help with panic attacks (even if you don’t meet full criteria for panic disorder). You don't need to wait for your symptoms to get really debilitating to get help. The earlier you seek help, the shorter the treatment is likely to be, which is likely to increase your quality of life significantly. Certain situations may warrant the use of medications, depending on the severity of symptoms and the presence of other disorders. As always, getting a psychologist or healthcare provider on board to make recommendations is best!

Hi, I’m a Miami therapist who treats anxiety and panic disorder. I am trained in CBT and I have helped many, like you, who no longer wanted their panic attacks to be in the driver’s seat of their life.

Four tips to help you manage anxiety when going through a Crohn’s or ulcerative colitis flare up

aurelie@drlucette.com (Aurelie Lucette) — Fri, 07 Jan 2022 16:23:41 GMT

You often worry about your next flare. Especially if things have been going well for a little while and your symptoms are well-managed
When you are flaring up, it can feel never-ending and you sometimes struggle to believe that things will ever get better
In between flare-ups, you feel anxious about the slightest GI symptoms, wondering if it might the beginning of something more
Navigating flare-ups often feels like an emotional and physical rollercoaster
Even if things are going well, it feels like you’re always waiting for the other shoe to drop
You often feel overwhelmed and like you can never catch a real break

Anxiety: A common occurrence when living with Crohn's disease or ulcerative colitis

If you live with Crohn’s disease or ulcerative colitis (also known as inflammatory bowel disease or IBD), you know the dreaded feeling of never being fully able to enjoy the present moment. You sometimes find yourself waiting for your symptoms to improve or, when things seem to be going well, you can’t help but worry about the next flare. And these diagnoses are often unpredictable, although you may have noticed things that seem to worsen its course (e.g., stress, certain foods, skipping your medication).

If you are reading this and nodding your head, know that you are not alone. IBD is significant source of stress. Up to 40% of adults with IBD experience significant anxiety, and these numbers often go much higher during a flare up. A flare-up is broadly described as a resurgence or worsening of symptoms. Depending on your disease , it can be an increase in abdominal pain, fatigue, poor appetite, diarrhea and/or frequent bowel movements, etc. Some flare ups be mild, other may require more thorough medical care or hospitalization to stabilize your symptoms.

From an emotional standpoint, flare ups can be associated with significant anxiety due to the disruption in your day-to-day functioning at home and/or at work, impact on relationships, canceled plans, and the uncertainty of what to expect. Not knowing what’s coming, how long symptoms will last and how severe they will be is often described as an important source of stress and overwhelm.

As a health psychologist , I want to share 4 ideas that can help you cope with the stress of a Crohn’s or ulcerative colitis flare

1. Reach out for social support

Flare ups are often disruptive and may require some adjustment to your day-to-day schedule, making it difficult to fulfill some of the responsibilities you previously fulfilled. Maybe you’re struggling to get things done at work or can’t quite handle taking care of the kids without feeling exhausted before breakfast even rolls around.

Managing a flare up often requires shifting some of your time and energy to taking care of your health, which might leave less time and energy for the rest of it. Reaching out for instrumental support might be needed to handle day-to-day responsibilities. Looking at your to-do list, what are some of the tasks and activities that you might be able to delegate or get support with? Can a friend drop off groceries over the weekend? Can you partner take over school pick up? Is there someone who can give you a ride to your doctor’s appointment?

Emotional support might also be needed when you are in the midst of a flare up. Who have you turned to in the past who you feel comfortable sharing what you’re going through with? Which of your friends can lend an ear without providing unsolicited advice about your diet or make you feel like only positive thoughts are allowed?

Do you need a hug? Someone to re-watch Ted Lasso with? Do you need to follow up with your doctor to readjust your treatment? Maybe you need someone to take care of the kids for a little while so that you can take a nap or go to an appointment? Knowing what you need, re-assessing often, and communicating it to others is key. And if asking for help feels uncomfortable (let’s be honest, most of us feel like that at some point!) head over to this article for 5 tips on how to ask for the support you need.

2. Pace yourself

If your energy is low and you feel like you’re running on empty from the moment you wake up, it might be helpful to prioritize what you focus on any given day/week. Pacing yourself can also help manage pain .

Taking a look at your schedule, is there anything that can go altogether? Any plans or meetings that can be canceled or postponed? Things you don’t want to think or worry about right now?

What is your prime time? What time of day tends to be a bit better in terms of pain, focus, and energy? Can you schedule activities that are more cognitively or physically demanding during this “prime time”?

Using a timer to limit how much time you spend on any given task can also help!

Being more intentional about resting can help prevent significant increase in pain and/or fatigue. Can you block some time in your schedule to take a nap or retreat to your bedroom to read or rest? Can you re-organize your to-do’s to spread them out evenly over the course of the week instead of trying to sprint through your list by Monday evening?

Be clear about how much you can do and when you might need to tighten your boundaries , whether that means taking some time off from work to focus on your health, or asking for additional help because you are feeling overwhelmed and/or drained.

3. Manage stress

What has worked for you in the past? Do you feel more relaxed when you’re sitting outside soaking up the sun? Do you enjoy listening to a guided meditation? Could you benefit from seeking therapy to help manage nighttime anxiety? Does your body instantly relax when you snuggle with your pet on the couch?

Whatever you are doing (or not doing!), be gentle with yourself. As you learn to deal with demanding physical and emotional symptoms, some of which might be new or unfamiliar for you, showing yourself kindness and compassion are important aspects of taking care of your emotional needs.

4. Identify helpful coping statements

When going through a flare up, what do you need to hear? What statements are helpful and supportive? What words give you a sense of comfort?

I am not necessarily talking about inspirational quotes from your Instagram feed (you know, the “Look at the silver lining”, “Just focus on the positive”, “You are what you think”) or the pep talk from a stranger with little to no understanding of what you’re going through. I am talking about words that really resonate with you and your own experience at a given moment. Words that make you feel seen and cared for. Words that are gentle and yet provide encouragement as you may be feeling vulnerable, anxious, or overwhelmed.

Below are a few examples, and I encourage you to tweak them as needed or come up with your own as well.

“Everyday, I am learning to new ways to live and love with my diagnosis.”
“When I feel overwhelmed, I can take things one moment at a time and ask for support. “
“I am taking care of my body the way I know best.”
“I am resilient.”
“I will give my body the rest it needs.”

In closing, while anxiety and Crohn’s disease often co-occur, it doesn’t have to stay this way! If you feel overwhelmed and feel like you’ve tried everything you could on your own, therapy for anxiety might be a helpful next step to get you unstuck and receive help with stress caused by your diagnosis.

If you are looking for a health psychologist to help you navigate anxiety and stress related to your diagnosis, feel free to reach out!

7 ways to cope with chronic illness during the holidays

Mon, 16 Nov 2020 19:08:00 GMT

Holidays are meaningful, fun, and enjoyable for many people. Yet, it’s easy to make a big production out of them when we try and accomplish all the holiday to-dos. Cue the cooking marathon, never-ending errands, perfectly orchestrated family pictures, Instagram-worthy homemade meals, … should I say more?

Planning out the “perfect” holiday season while navigating chronic illness can become overwhelming . In fact, chronic illness is emotionally and physically taxing any day of the year, so adding to it the pressure of checking off every holiday “must-do” can lead to undue pain, fatigue, and symptoms flare.

Below are 7 ideas and tips to reclaim the fun of this holiday season and alleviate some of the stress.

1. Set boundaries

Setting boundaries can be as easy as saying NO! “I appreciate the invitation but I won’t be able to attend”, “I love that you’re hosting this event, I’ll pass this year. Hope you have a fun time!” And give yourself permission to turn down invitations without justifying yourself if you don’t want to.

Limit the number of events that you attend. Identify the ones you really want to be part of, whether you’re hosting or attending, and RSVP no to the other ones.

And before attending a party, it can be helpful to have an idea of how much time you plan on spending there. Know your limits! If you know from experience that you become fatigued and your pain increases significantly after one hour of mingling, standing, or being in a loud environment, give yourself permission to leave at the 55-minute mark. It can also help to share a “code word” with your partner or a friend giving you a ride. This way, they know that when you say “blue cheese” it’s time to leave!

2. Prioritize the things that bring you most joy and meaning

Be wise about how you spend your time, energy (and even money)! Prioritize activities, events, experiences that bring you joy or meaning. Ditch those that you don’t particularly care about.

It’s okay if your list of “must-do holiday things” looks different from that of your next-door neighbor or even from your list from the previous year. Make space and time for the very things that are important to you and your family, and let go of the rest. It may be that having a well-decorated house was important to you in years past, but the cost of decorating is now outweighing the fun of it all.

3. Simplify your life as much as possible

Some holiday experiences or items may be important to you, yet you’d rather not be in charge of planning or executing them. For instance, you may enjoy nicely wrapped gifts but wrapping gifts for hours increases your pain. You enjoy eating a traditional thanksgiving meal but can’t stand for hours cooking in the kitchen. Delegate ! Find support to make the holiday season meaningful without having to be the one in charge of all the logistics.

And allow yourself to take off your list all the activities and items that you’ve been doing but that don’t really bring you or your family much joy or meaning. It’s not rare that we find ourselves doing things out of habit only to realize that it’s not something that speaks to our values.

4. Self-care

Now is the time to double-up on self-care! The holiday season is without an ounce of a doubt one of the most stressful and busy time of year. Holidays are physically, emotionally, financially taxing. It’s important to be even more intentional about making time for your needs and prioritize your body and mind.

And if you don’t enjoy the holidays, it can also be difficult to go through this season. So taking care of yourself and reaching out for support might be much needed.

5. Pace yourself

Pacing is an important aspect of living with chronic illness. The holidays should be no exception. While your schedule might be more packed than usual and your to-do list might run longer, try as much as possible to plan errands and events in a way that allows for resting and recovery. For instance, don’t frontload your week or month with all your gift shopping. You might find yourself overwhelmed and in greater pain after pushing yourself too much.

The key word here is to plan!

6. Keep up with your routines

Over time, you’ve come to learn what behaviors and activities help alleviate your symptoms and allow y ou to support your health needs. Whether it’s stretching, getting enough sleep, walking daily or planning healthy meal options, some routines are essential to your wellbeing and should be maintained even during busiest times. We could even argue that they might be even more important to maintain in times of stress!

Make a list of your non-negotiable routines and plug them into your schedule before planning anything else. Then, you can schedule other events and errands around your routines, as much as possible.

7. Create traditions that are meaningful to you and your family

The holidays should be meaningful to you. As you learn to cope with chronic illness, you’ll learn to tend to your changing needs and remain flexible with your goals and plans. Going into each new holiday season gives you an opportunity to assess what parts of the holidays work for you and what you may need to adjust.

Creating fun traditions that are meaningful for you and your family AND respect your health needs is especially important. One family for instance started a new tradition for Thanksgiving, when each family member would order in their favorite food, and they would then share a meal in bed, picnic style, and it made for great memories! You can also plan on having a virtual Friendsgiving, which allows you to rest as needed and turn down the volume when you need to take a break.

As we enter this holiday season, take some time to reflect on what you want this season to look like and how you can focus on the most meaningful experiences without adding to much physical and emotional stress.

I am Dr. Aurelie Lucette , a clinical psychologist who provides individual therapy in Miami and online throughout the state of Florida. I can help with issues related to anxiety, stress , sleep, and depression. I also specialize in therapy for adults living with cancer , chronic illness, chronic pain , and caregiving stress .

Parenting with chronic pain

Thu, 05 Nov 2020 19:49:59 GMT

(If you're more of a reader, below is the information from the video you don't want to miss!)

How can I be the best parent possible for my kids when living with chronic pain?

Parenting is challenging. Parenting with chronic pain even more so.

You may find yourself saying no to your kids more often that you’d like or having to cancel plans , and that breaks your heart.

You worry that you’re asking too much of them and that they’re missing out on certain experiences of childhood.

You have to rsvp no to birthday parties and social events more than you want to, and when you don’t and push yourself too much, your pain flare ups.

You feel sad for not being able to get down on the floor to play games with your child or chase after your toddler.

Being a mom or dad with chronic p hysical pain can feel lonely, unfair, overwhelming .

Does parenting with chronic pain always have to feel this difficult? No.

Will it ever be easy? Most likely, no.

I want to keep it real and I don’t want to minimize the impact of pain on chronic pain. But I want you to feel confident that there are things you can do to make parenting a little bit less overwhelming and a little more rewarding and meaningful.

Below are four tips to help all parents and other caregivers navigate the challenges of parenting with chronic pain.

1. Revisit what it means to be a good mom or dad

What does it mean for you to be a good mom/dad?

As a society, we often hold unrealistic expectations about what it means to be a good parent. We think of being a good parent as spending a lot of time with our children and driving them to all their extra-curricular activities and play dates, “having it all together” at all times, spending a lot of time with them. These expectati ons are not always quite realistic.

There are many ways to be a good parent for your child , even though it does not look like what you had pictured it would be. Being a good parent is about about meeting your children’s needs for food, shelter, safety, love, support, etc. And there isn’t one perfect way to do that.

Exercise: What does it mean for you to be a good parent? What are some activities or experiences that are in line with those values and take into account your health needs?

2. Create new routines and family traditions that are fun and take into consideration your health needs

You can be pretty creative with this one! The idea is to create meaningful and rewarding experiences that also accommodate your health needs . It can look like many different things:

On thanksgiving, each member of the family gets to order their favorite food for take-out and you have a picnic at home (no need for long hours in the kitchen!)
Family brunch in bed on Sundays
Reading books as a family at bedtime
Putting on an end-of-year show or recital at home with family members livestreaming.

Involving your children in creating new traditions and fun routines is a great way to reinforce your bond with them and make them feel special!

3. Simplify your life

You can't do it all! At least, you can't do it all without feeling overwhelmed, tired, and with increased pain. So m ake your life as easy as possible!

Prioritize what you need or want to do on any given day . Keep your list short. One to three items is ideal! The more items you have on your to-do list, the more likely you are to overdo it, or experience feelings of guilt or anxiety if everything doesn’t get done.
Write down your to-do list to make your life even easier! Remembering what you need to do is more difficult when pain flares up.
Create a “bad pain day” checklist with reminders of things that you can do to to cope with pain and take care of yourself on a bad pain day!
Delegate ! Identify what takes the most energy out of you on a bad pain day. Is it cooking? Driving the kids to extracurricular activities? Standing up in line at the grocery store? Develop systems to delegate as many things as possible on bad pain days and enlist the help of others to make day-to-day functioning easier and allow you to focus on important to-do’s.

4. Practice self-compassion

What would you tell a friend or loved one navigating parenting with chronic pain?

Write it down and take a few minutes to go over your answers. Would you be telling them that they need to step it up and spend more time with their kids? Would you be telling them that they’re a great parent and that you love and support them?

Most human beings tend to do a better job at being kind to others than they are with themselves!

Exercise : When you feel guilty for not “doing” or “being” enough as a parent, ask yourself what you would tell your best friend if they were in the same situation. And then use that same language to write a love note to yourself. This is your reminder to be kind and gentle with yourself!

Photo by Alexander Dummer on Unsplash

Is anxiety a disorder?

Mon, 19 Oct 2020 13:31:05 GMT

Anxiety is a word that’s part of most people’s vocabulary. It’s become even more salient since the beginning of the COVID-19 pandemic! Anxiety can look like different things:

Worrying about all the what if’s of your relationship
Difficulty relaxing
Worrying about the future
Feeling more irritable than usual , and much more!

What is anxiety?

Anxiety is an emotion and, as such, is an experience inherent to being a human being. All of us will experience anxiety at some point, though the frequency, severity, and duration, as well as its manifestation, might vary greatly.

Anxiety happens in t he body. It is associated with a range of physical symptoms:

Difficulty relaxing, feeling tense
Increased heartbeat, nausea
Shortness of breath
Feeling lightheaded
Sweating
Shaking

Anxiety also happens in our mind:

Worrying about many things, big and small (e.g., health, relationships, the future, bad things happening)
Worrying about the worst-case scenario

Anxiety is sometimes noticed first by those around you who start to comment on how irritable you’ve been recently, how your performance at work has been declining, or how cranky you have become in the morning when anxiety starts messing with your sleep.

When does anxiety become an anxiety disorder?

While occasional anxiety is an expected part of life, too much anxiety can be a problem. In general, anxiety disorders are diagnosed when anxiety starts getting in the way of day-to-day functioning or causing significant distress, whether at work or at home. For instance, an anxiety disorder may prevent you from seeking medical care, initiating or maintaining relationships, moving up with your career, etc.

How is anxiety diagnosed?

Anxiety disorders, including generalized anxiety disorder, social anxiety disorder (“S ocial phobia”), specific phobias, and panic disorders are best diagnosed by mental health providers or physicians using a set of criteria . If you feel overwhelmed and anxiety is making your life challenging, reach out for help.

Up to 18% of adults in the United Stated experience an anxiety disorder i n a given year. If you’re struggling with anxiety, know that you are not alone. And if you need help with anxiety, there’s hope!

Cognitive Behavioral Therapy (often refers to simply as “CBT”) is the gold standard treatment for anxiety disorders. It can help you find relief from anxiety and get back into doing the things that are important to you. If anxiety is getting in the way of your life, reach out to a mental health provider or medical provider and ask for support.

Four tips to support someone through their cancer treatments

Mon, 12 Oct 2020 14:13:32 GMT

(If you're more of a reader, below is the information from the video you don't want to miss!)

How can I support someone going through cancer treatments?

Cancer is whirlwind, and it takes a village to go through the physical and emotional ups and downs of a cancer diagnosis. Having a friend, loved one or colleague diagnosed with cancer can feel pretty intimidating, and it is not uncommon to feel overwhelmed by the fear of saying or doing the wrong thing. In this video, I discuss four ways to help someone going through cancer treatments (chemotherapy, radiation, surgery, etc).

Tip number one is to offer support with day-to-day operations.

Cancer treatments can be overwhelming. Not only can they be time-intensive, there are also a lot of side effects (fatigue, pain, nausea, anxiety) that can make day-to-day functioning challenging. Even the little things that we take for granted, such as getting out of bed, showering, eating breakfast, getting the kids ready for school can become quite overwhelming. Any support that you can provide with these activities, any help you can give your friend to make their life easier is likely to be much appreciated.

I would also recommend asking their primary caregivers if there’s a website that has been set up, such as www.caringbridge.org or www.mealtrain.com to coordinate the patient’s care , and then sign up for any item listed that you can support them with. If they haven’t set up a website to coordinate support for your friend or loved one, offer to set it up for them!

Tip number two is to stay in touch with your loved one as they go through cancer treatments.

You may very well be thinking “Hey, they’re going through a whole lot right now, they probably need some space and time.” YES, they do need space and time to go through treatments, recuperate, and take care of their body. But NO, they don’t want you to disappear from their life, most likely. They still need friends, they still need to talk about other things than their cancer diagnosis. So, stay in touch, check-in on them! Send them a text, call them, send them a note, or a care package. But show up in their life!

And often times, what prevents people from showing up for their loved ones, friends, or colleagues when they have cancer is not knowing what to say or being afraid of saying the wrong thing . Keep it simple, keep it brief. It can sound like “I’m thinking about you, I’m sorry you’re going through this”, “I don’t know what it’s like to go through cancer but I’m here for you, I love you, and I want to support you.” Again, keep it brief, show up for them, and take it from there!

Tip number three is to offer support to their primary caregivers and close family members.

We know that cancer not only affects the patient, but it also impacts their loved ones. And loved ones, not only do they have to process the emotions of seeing someone they love go through cancer, they also often have to step in with responsibilities and roles that they may not be used to or have a lot of time to do (e.g., running more errands, being responsible for all the childcare, etc) which can be overwhelming. Check in with them and offer support with running errands, meal planning for instance, and also ask them how they’re doing from an emotional standpoint. If it feels comfortable, ask them if they need to talk or if they need help with anything.

Tip number four is to ask for permission.

Ask for permission if you want to stop by their house to see how they’re doing and say hello. They may not be in a place where they want to see anyone. They may be tired or dealing with side effects and needing some rest. Also ask for permission before asking questions about their diagnosis. They may or may not want to talk about their cancer diagnosis, so take their lead. And ask permission if you want to give some advice related to cancer or anything health-related. It’s important to tread very carefully when it comes to advice-giving. I often err on the side of not giving any advice, but if you feel that some information or resources may be useful to them, ask them if it’s okay to share it with them.

For more ideas and resources on coping with a medical condition or supporting a loved one, sign up for our bi-weekly newsletter !

I am Dr. Aurelie Lucette , a clinical health psychologist who provides individual therapy in Miami and online throughout the state of Florida. I can help with issues related to anxiety, stress, sleep, and depression. I also specialize in therapy for adults living with cancer , chronic illness , chronic pain, caregiving stress .

Four tips to mentally prepare for surgery

Wed, 23 Sep 2020 14:42:58 GMT

(If you're more of a reader, here's the info from the video you don't want to miss!)

Let's talk about the emotional rollercoaster of surgery and how to mentally prepare for it!

Up to 75% of patients feel anxious prior to surgery. People often worry about the anesthesia, possible complications, dealing with chronic pain after surgery, their body looking and feeling different, and much more. Anxiety in the weeks or months leading up to surgery can keep you up at night and cause significant distress.

Developing coping skills to manage the stress and anxiety of surgery is essential, yet it’s often left out of the checklist you're provided to prepare for your procedure.

Below are four tips to help you mentally prepare for surgery.

Tip number one is to identify stress management strategies and to use them often. Stress management can look like a lot of different things (e.g., deep breathing, progressive muscle relaxation, mindfulness meditation, yoga). Find something that works for you (it may be a relaxation technique you've used before!) and practice daily in the weeks leading up to surgery. The more you practice, the easier it will become to manage your anxiety!

Tip number two is to prioritize your basic needs. Make sure that you're protecting your sleep, that you're drinking enough water, that you're eating well, and that you're making time for self-care. Try not to schedule anything stressful or emotionally taxing in the weeks leading up to your surgery (no big projects on the house or job interview ideally!) Prioritizing your body and mind is important to successfully managing stress.

Tip number three is to be informed and advocate for yourself . From the moment you've had your appointment with your surgeon, keep it a list of questions and concerns about your surgery on a piece of paper or in your phone. Every time something comes up, write it down. Then run those questions through your medical team. You can also do some research online (but don't overdo it because it might make you even more anxious!). You can also find some answers and support through online communities of patients who share the same diagnosis.

Tip number four is to ask for help ! Lean on people, lean on your medical team, on your friends and family, on an online community of patients. Ask for help and accept the help that's offered. The truth is that most people want to help, but they don't always know how to. Be assertive about what you need, and tell people what you need in a way that works for you.

I want to feel better: Should I go to therapy?

Tue, 01 Sep 2020 02:39:05 GMT

“I want to feel better”

“I’m so stressed out; I can’t get anything done.”

“I’m overwhelmed.”

“I feel stuck.”

“Things only seem to be getting worse.”

When I first meet a new patient and ask them how I can help, this is the response that I hear most often; “I want to feel better.”

Like many, my clients are smart, caring, and have many dreams, but life has been tough. They try and stay “positive” and “upbeat” because that’s what they’ve been told they should do. “It’ll get better, don’t worry” is what they often hear.

They’ve thought about going to counseling but initially second-guessed themselves.

“What if I keep going just a little bit longer, maybe things will get better?”

“I guess things could be worse?”

“Others can figure it out. Why can’t I?”

If that sounds like you, you're not alone! Below are a few thoughts on when therapy might be helpful.

1. Your symptoms are getting in the way of work, relationships, and your overall wellbeing

You may have been able to manage your symptoms for a little bit, but suddenly it feels like they are managing you . No matter what you do, you can’t seem to get better. You can’t stop worrying. You’re overwhelmed and can’t get anything done. Your work is affected, your relationships take a toll, you just don’t feel like yourself. As a rule of thumb, therapy might be a good idea when you feel like your problems are interfering with your personal or professional life, or causing significant distress. If you can’t focus on anything else, it may be time to seek out counseling.

2. You feel stuck

Something in your life just doesn’t seem like it’s working anymore. It may be a relationship, a job, or a routine that isn't quite getting you where you want to be. You want to get back into a life that feels more like you and you don’t quite know how to get there. Or maybe you do but you can’t figure out how to keep up with the changes you want to make. Therapy can provide the support you need to help you: 1) Figure out what you need or want, and 2) give you the tools to get you unstuck and moving toward your goals.

3. Friends and family are concerned about you

Your loved ones may have mentioned that they’re concerned about you. They’ve noticed that you’re isolating yourself or that you seem worried, tired, or sad. Or maybe someone at work commented on a significant shift in your productivity. It sometimes takes someone else to bring up some concerns about your wellbeing for us to realize that we may need help to address our mental health.

4. You need support coping with a life-changing event

When life changes suddenly, adjusting to a new reality often requires a lot of support. Big life changes (a medical diagnosis, a divorce, a loss, etc) can force you to take on new responsibilities and require some lifestyle changes that are often challenging. While gathering the support of friends and family is important, therapy can also offer additional support to help you go through the ups and downs of the challenges you are facing. Psychotherapy is also a safe place to discuss difficult topics you may not quite feel ready to bring up with your loved ones.

5. You are living with painful or challenging physical symptoms

Living with chronic illness or chronic pain for instance can be very hard to adjust to and is often accompanied by many losses. Therapy is a place to address emotional and physical difficulties and receive support to help navigate the ups and downs of life with a medical condition. Health psychologists are a good resource to help you cope with these challenges.

6 . You feel lonely

7. You’re doing fine but you want to continue growing and learning

You don’t need to be in a crisis or feel completely overwhelmed to seek therapy! It’s perfectly fine to use therapy as an opportunity to reflect on your accomplishments and your goals, and continue to learn and grow.

This is in no way an exhaustive list of reasons to go to therapy. I could think of so many more! And if you find yourself reading this article and still question whether you want to give therapy a try, know that many therapists offer a free phone consultation. That may give you a chance to discuss what resources may be a good fit for you at this time.

“You need to accept your diagnosis”: What accepting your diagnosis can look like

Tue, 25 Aug 2020 18:41:25 GMT

“You need to accept your diagnosis.” If you (or a loved one) live with a medical condition, you’ve probably heard that from a family member, a friend, someone on your medical team, or even a stranger on social media.

Yes, acceptance of one’s illness is a meaningful goal to work towards. Ultimately, acceptance can lift some of the suffering that comes with living with an illness.

But being told to accept a diagnosis that is challenging every aspect of your life can sometimes be perceived as dismissive and invalidating. Why is that? Acceptance is often misconstrued as many things that it is NOT, which can lead to unrealistic expectations and tough emotions to navigate.

What acceptance does not sound like:

“ What’s the point, there’s nothing that can be done for me.”
“I give up on trying to get better”
“I can’t win the battle against chronic pain, I give up.”
“Whatever happens happens,”
“It’s totally fine, everything will be okay.”

What acceptance can sound like:

“ Some days are hard. Some are better. I take things one day at a time.”
“Chronic pain will most likely always be a part of my life. And I still plan on finding joy through it.”
“I’ve learned to shift my priorities since being diagnosed.”
“I don’t like being ill. But I’m learning to enjoy the good days.”

Let's take a closer look at what acceptance is (and is NOT).

Acceptance is NOT giving up

Acceptance doesn’t mean giving up on feeling better or finding new resources (internal and external) to cope with your symptoms.

INSTEAD: Acceptance means recognizing that things are a certain way in the here and now (e.g., your body hurts, you’re feeling exhausted, you may be worried or sad) and having hope that you may be able to change some aspects of your experience or influence the way your diagnosis impacts your life.

Acceptance is making space for the symptoms that you cannot change in this moment, the losses you've experienced, and feeling empowered to continue taking small actions that are: 1) under your control (e.g., learning new ways to manage your stress, reaching out for support, finding a doctor that makes you feel listened to), and 2) consistent with your values.

Acceptance is NOT wearing rose-colored glasses at all times

INSTEAD: Acceptance is acknowledging that there is uncertainty attached to your diagnosis (and to life in general!) It’s knowing that you cannot control or anticipate the future and still holding hope that your experience won’t always feel as heavy.

Acceptance is NOT ignoring or dismissing your emotional or physical experiences

INSTEAD : Acceptance is being willing to acknowledge or even turn toward those difficult experiences, rather than running away from them.

Acceptance is NOT something that happens overnight

Acceptance is not as easy as turning on a switch once and for all.

INSTEAD : Acceptance ebbs and flows. You may be able to sit with your pain one day and resist it with all your might or try to avoid the pain in any way possible the next. There may be parts of you experience that you might find easier to accept (e.g., not being able to socialize outside of the house as much) and others that you just can’t reconcile quite yet as part of your reality (e.g., not being able to have a family or have a full-time job).

Acceptance is NOT an all-or-nothing process

INSTEAD : Acceptance happens on a continuum. In The mindful self-compassion workbook , Kristin Neff, describes 5 stages of accepting difficult emotions, which are also relevant to accepting a challenging, and often painful, diagnosis.

Resisting : “I can’t stand to feel this way. I’ll do anything to distract myself from it completely.”

Exploring : “How am I really feeling?”

Tolerating : “This isn’t comfortable but I can stand it.”

Allowing : “I can make space for these symptoms/feelings.”

Befriending : “What am I learning from feeling this way? What can I learn from living with this diagnosis.”

Acceptance can start with tuning into your experience in the here-and-now and observing with curiosity what it looks or feels like to live with your illness and the emotional/physical symptoms that come along. Later you may be able to create more space for emotions and sensations to come and go without judging or resisting them. At times, you may find that you are able to lean into this new reality and acknowledge that you grew from it.

The process of acceptance is fluid. Acceptance can sound like many different things, as everyone's experience is unique and ever-changing.

As you learn to live with your diagnosis, remember to practice self-compassion and extend the kindness you would offer others to yourself as well.

"I need help (and I hate asking for it)" Learn how to ask for the support you need in 5 steps

Tue, 18 Aug 2020 16:50:51 GMT

Raise your hand if you don’t like asking for help.

If the idea of having to ask for help makes you cringe; you are not alone! Asking for help makes a lot of us feel uncomfortable, vulnerable, anxious, even avoidant.

Yet, no one can go through the ups and downs of life without support. Well, you may be able to do it all by yourself, but you will likely end up burned out, overwhelmed, and fairly depleted. The COVID-19 pandemic has made reaching out for support even more important, as we are forced to juggle multiple demands without the resources we previously relied upon.

Before we get into the nitty gritty of how to ask for help, here are six important reminders I want to share with you:

When you go through a time, most people in your life likely want to help ! But they may not know how to best help you and can’t always figure out what you truly need in that moment (not what they think would be helpful). Hence the importance of asking them!
Having good social support has been linked to better psychological health . We tend to be happier and have a better quality of life overall when our social needs are met and we reach out for support in times of stress.
As uncomfortable as it makes you feel, the more you practice asking for support, the easier it becomes . It’s like practicing a yoga pose over and over, every day feels a little easier. The same applies to our social skills. Practice, practice, practice! Get out there and exercise your “social muscle.”
Asking for help is a form of self-care.
You deserve to receive help.
You are enough. And that means that you’re worthy of love and respect on a good day and on a challenging day, when you do it alone and when you ask for help!

Now on to the step-by-step recommendations to learn how to ask for help:

Action step: Right now, I need support with {fill in the blank}

2 . Identify who you can ask for support

No one person can meet all your needs! Let me repeat this, no one person can meet all your needs! Some of your loved ones might know just the right thing to say when you’re having a tough day, others might not always provide the emotional support you need in those moments. Some friends might feel comfortable helping with your kids while others may prefer to drop off some home cooked meals.

Think outside of the box! Your go-to person may or may not be the best fit to help with that specific issue you’re struggling with. As you consider who to ask for help, think broadly about anyone who could possibly help (or guide you to the right resource): Family, friends, therapist, faith-based community, an organization in your community, online support group, etc. Writing down a list of names and resources might help provide some clarity into this decision.

Action step: {Name of person/organization} might be able to help me with {identified problem}

3 . Identify possible obstacles

As you get ready to reach out for help, what obstacles get in the way? Identify them and problem-solve.

Is the person you wanted to ask unavailable? Is there someone else who could help?
Are you unable to identify some with the knowledge/expertise/experience needed to help you with an issue? Can you check online?
Is anxiety kicking in and making you want to hide instead of reaching out? Can you talk back to your anxiety and give yourself some compassion?
Is your brain feeding you all the reasons why should NOT be asking for help?
“I don’t want people to know what’s going on”
“They’ll think I’m weak or needy”
“I can probably manage by myself”

Psst, if these thoughts sound familiar, click here to download your free mini-workbook “Asking for help made easier” and learn some ways to challenge those unhelpful thoughts!

4 . Ask for support

Now is the time to go into action mode and reach out for help! Pick up the phone, write a little note, an email, or leave a sticky note on their desk. Just do it!

5 . Follow up with a thank you… not a sorry!

“I’m so sorry to bother you with this but…”
“I’m sorry I have to ask.”

Does that sound familiar? We are prompt to apologize for asking for help, even before the other person has had a chance to respond to the request. But remember, you deserve to get some support! As long as your request is reasonable and respectful (and that you’re not blackmailing someone into helping you!), there’s no reason to apologize for asking for help. You’re not “making” someone help you, they have free will. If they agree to your request, it’s most likely because they want to help.

Action step: After someone has helped you, follow up with a thank you, not a sorry! Instead of this: “I’m so sorry for making you take time out for this.”, try this: “Thank you for being there for me, I appreciate your support right now.”

As you practice this skill, be gentle with yourself. Reaching out for help and getting the support you need is not always easy.

Perfectionism and chronic illness: 4 ways to practice letting go of unrealistic expectations

Fri, 07 Aug 2020 02:16:31 GMT

“If I push myself enough my life can remain as it was before my cancer/chronic illness diagnosis”
“I had to cut short my yoga class. That was a complete waste.”
“I need to figure out the perfect diet and stick to it every single day to help me control my symptoms.”
“I can’t let negative emotions ever ruin my day. I have to stay positive.”

If that sounds like you most of the time , it’s likely that you are prone to perfectionism!

Perfectionism is often characterized by setting unrealistically high expectations for yourself and striving for flawless outcomes. If you were like this before your diagnosis, it’s likely that these tendencies have followed you after you were diagnosed and may be impacting your life right now.

Perfectionism can look like:

Spending day after day researching the best food to eat and worrying endlessly about not having the right diet, no matter how stringent your meal plan becomes.
Repeatedly beating yourself up when you fall short of your expectations.
Pushing yourself relentlessly (and often to the point of exhaustion) to prove to yourself, your family, your boss that you are still the same person and/or that you can remain as productive/social/athletic as you were before your diagnosis.
Beating yourself up for missing one yoga class despite a 100% attendance the rest of the year.
Procrastination . Because you like to know everything there is to know and learn about a new activity or project before committing to it, and you want to know that you will be able to execute it perfectly before getting started!

And perfectionism can sneak into every aspect of your life, dictating the way you engage in self-care, the way you eat, sleep, think, relate to other people, etc.

Perfectionism is downright exhausting… and it can impact your mental and physical health.

Perfectionism can cause feelings of anxiety and worry, as well as feelings of overwhelm, as you find yourself going down the rabbit whole of figuring out the perfect way of doing something. And when you can’t find it (*breaking news*, there’s no such thing as perfect), it feels like a failure and causes further emotional distress.

Perfectionism has been linked to greater symptoms of anxiety, insomnia, and depression in cancer patients . It’s also been associated with more physical symptoms in those with chronic illness such as chronic fatigue syndrome, fibromyalgia, and irritable bowel diseases such as Crohn’s.

Perfectionism also takes away from being in the here and now and enjoying life as it unfolds. It keeps you focused on the outcome and can get in the way of enjoying being in the moment with your loved ones or with yourself.

4 ideas to start letting go of perfectionism

1. Challenge your perfectionist thoughts

As you become aware of perfectionist thoughts your mind is feeding you day after day, gently push back and come up with alternative, more helpful statements (and find more examples here ).

“If I push myself enough, my life can remain as it was before the diagnosis” becomes “This diagnosis is now part of my life, I don’t like it, but I need to adjust the way I do things.”
“I need to figure out the perfect diet that will help control my symptoms” becomes “I’m going to make gradual changes to my diet as recommended by my team, I’ll do my best, and it’s okay.”

2. Practice doing things that are “good enough”

It may help to set some limits surrounding certain behaviors . Limit yourself to proofreading an article or report you wrote only once before submitting it. You can also set a timer to limit the amount of research you do on a project for instance. You may also challenge yourself by deliberately stopping working on a project before you see it as “perfect” or skipping one exercise class. As you practice being "good enough", notice how it feels.

3. Set realistic goals

Practice setting up goals that are realistic and flexible to accommodate the ever-changing demands of your diagnosis. Setting SMART goals is a good practice!

SMART goals are:

Specific : Identify a behavior or action that will be taken

Measurable : The behavior has to be quantifiable

Achievable : Plan for something you can complete with available resources (equipment, time, energy levels, etc)

Relevant : The goal should be meaningful to you

Time-based: You should state a time frame for this goal

For example: “I will exercise” is fairly vague. Using the SMART rules listed above, you could further define your goal as follows: “I will practice chair yoga for 20 minutes on M/W/F before breakfast.”

4. Develop self-compassion

Be gentle with yourself. Be kind! You will experience discomfort and disappointment. You’ll be scared at times, angry, sad. Practice meeting your inner critic with compassion and kindness. Notice the pain and hurt, and meet them with loving kindness. Here are some great self-compassion exercises by Kristen Neff, a researcher and expert on self-compassion!

Things not to say to someone diagnosed with cancer (or any other medical condition) ... and what to say instead

Wed, 29 Jul 2020 14:48:30 GMT

Raise your hand if you’ve ever had a loved one, friend, colleague, neighbor diagnosed with cancer or another life-altering medical condition. Yup, that’s most of us.

When illness strikes someone close to us, we may feel sad, angry, overwhelmed by fear. Sometimes we feel shocked. Guilty. Numb. {Fill in the blank}. And because we are human beings and that we care deeply, witnessing (or even imagining) the pain that comes with a loved one's medical condition can be paralyzing.

What should I say ? What can I do ?

We try and figure out the perfect time to reach out to them. We think about the right thing to say , not wanting to add to their pain or sadness or fatigue. We research the appropriate food or gift or book to bring them.

That same discomfort and fear of not knowing what to say or do can also resurface when our loved one receives difficult news, when they have to go into surgery, when their appearance starts to change, or when we realize that maybe they won’t get better or go back to who they were before.

I want to offer a few ideas to reflect on that I hope will provide some guidance as well as the reassurance that you are not alone if you struggle with knowing what to say or do.

If you’re paralyzed by the fear of saying the wrong thing, it’s very likely because you care about them and feel empathy for what they’re going through. You’re being a human being and experiencing very real, human emotions.

If a loved one or friend is dealing with a cancer diagnosis, I would bet that you are thinking about them. Let them know!

There is no such thing as a perfect line when it comes to providing comfort to a loved one. Just do it. It’s about being there, showing up, being willing to sit with your discomfort to provide space for your loved one and let them be seen, just the way they are.

If you hold the expectation that you have to make their pain disappear, you will likely feel incompetent and inadequate. Instead, remind yourself that a more realistic goal can be to provide support to your loved one and make them feel cared for and seen as they navigate this challenging time.

As I mentioned a few paragraphs ago, there is no such thing as a perfect thing to say in response to a loved one’s illness. But there are certainly some statements that may be perceived as upsetting. Below are just a few examples that many people leaving with a medical condition have reported as unhelpful (although they may help some, and it’s okay too!):

“You’re going to be okay”
“Just think positive thoughts” or “You have to stay positive”
“At least it’s not {xyz}”
“ You have to look at the silver lining”
“Look at the bright side”

“Everything happens for a reason”

This may or may not be true! And it’s also often not the way your loved one may be seeing this situation. They may very well be feeling angry and sad as they grieve the many losses that come with a medical condition.

“I don’t know how you do it” or “You’re so strong”

Many clients I’ve worked with over the years have taken issue with this statement. "What other choice to I have?!", "This is not how I feel at all."

“I have an aunt who died of cancer”

Nope. This is the very last thing your loved one wants to hear about.

“You should try this diet; I’ve heard it can help with {symptoms/illness}”

Unless they ask for advice, it’s generally a good idea to not offer any. And if you think it might be helpful information, ask them first if it’s okay for you to share it.

If you feel guilty for saying some of these things in the past, you are not alone. And kudos to you for being willing to learn new ways to support your loved one! And if you now feel even more confused about what’s appropriate to say, read on!

I’ll repeat myself again first by saying that there’s no perfect string of words you can say. But as a rule of thumb, it’s helpful to use words that convey empathy and validate the difficult reality of your loved one’s disease.

In the words of Kelsey Crowe and Emily McDowell (I can’t recommend their book enough, check it out: There is no good card for this ):

“Your job is to hear , not to fix someone’s worry.” And I would add that it’s also not your job to fix their pain/suffering/illness.

Other ways to show support and empathy are to listen, ask questions and monitor their responses, let them tell you as much or as little as they want/need, show compassion. Be the awesome human being they’ve gotten to like over the years!

And show some compassion for yourself as well.

Having a loved one diagnosed with cancer or chronic illness can bring forth difficult emotions for you (hey, you’re a human being too!). Show yourself some kindness. Take care of yourself. Seek your own support if you need to.

"I can't sleep": Tips and ideas for getting better sleep

Sun, 19 Jul 2020 01:35:39 GMT

Do you toss and turn for a while at night and have difficulty falling asleep?

Do you feel that your brain just won’t shut down when you’re trying to sleep?

Do you find yourself worrying about work, your loved ones, your health when you should be sleeping? Or mentally going through your to-do lists instead of sleeping?

Do you wake up during the night ? And then look at the clock only to worry about being wide awake in the middle of the night?

Do you check your phone at night more than you care to admit?

What about your day? Do you feel tired? Irritable? Maybe you have difficulty concentrating or getting things done?

Do you refill your coffee more than you used to?

If you’ve answered yes to some (or all!) of the above, know that you are not alone . “I can’t sleep.” I hear those words from most of the clients who come to me for therapy. At least 1/3 of the population suffer from insomnia , and many more report some issues with sleep. In the hustle and bustle of our lives, sleeping well has become more challenging. Add to this a global pandemic and your sleep is likely to be significantly disrupted !

But there is hope! Making certain behavioral changes can be part of the solution to your insomnia. Below are some tips and ideas that can help you get back to more restful and healthy sleep.

Sleep hygiene can help you re-set your sleep habits and improve your sleep

Practice relaxation. The more stressed or anxious you are, the less likely you are to get a good night’s sleep . And the less you sleep, the more stressed and irritable you will be. Learning tools to better manage stress can help improve your sleep. This can be done by practicing deep breathing, mindfulness (the Headspace app is a great resource), or other relaxation exercises.

Limit naps to 20-30 minutes , and preferably not in the later part of the day (not after 2pm). Naps are not meant to allow you to catch up on the sleep you're not getting at night. Sleeping too much during the day can further prevent you from sleeping at night.

If you're not asleep within 20 minutes, get out of bed. Go to the living room or another area of your house, read or do something that's not too stimulating for your brain (no screens!) When you feel sleepy (your eyes are very heavy and you're struggling to stay awake), go back to bed and give sleep another chance.

Maintain a comfortable sleep environment. Avoid screens in the bedroom as much as possible. Make sure the room is dark enough and that the temperature is comfortable. And remember that your bed should be reserved for sleep or sex. No reading, screen time, eating, etc. The goal is for your brain to associate being in bed with sleep.

What you do during the day also matters! Exercise is conducive to better sleep , but try to avoid exercising in the hours preceding bedtime. The following should also be limited prior to bedtime: Caffeine, alcohol, nicotine, and heavy meals. Exposure to natural light is important as it helps regulate your internal clock (go outside every day and open the curtains to let natural light in). Finally, certain medications can interfere with sleep, you may want to discuss this with your physician if you think it’s contributing to your sleep difficulties.

While stress is a common cause of sleep problems, many other factors can contribute to insomnia, including psychiatric disorders (depression and anxiety), chronic pain, certain medications and medical conditions . For instance, insomnia is very prevalent in those with a cancer diagnosis or chronic pain . Developing an understanding of the underlying causes of your insomnia can help address it appropriately.

My sleep hygiene is top-notch and I'm still not sleeping. What should I do?

I look forward to helping you get better sleep and feel more balanced!

7 little reminders for when living with cancer feels overwhelming

Tue, 14 Jul 2020 14:34:30 GMT

Thinking about missing out on your loved ones’ milestones keeps you up at night.
You worry about the future , your loved ones, your health. At times you worry about dying. You may even worry about worrying.
You don’t recognize yourself in the mirror and your body aches in unfamiliar ways.
You feel tired, yet you push through day after day to prove to your family, your boss, yourself that nothing has changed.
You often ask yourself, “why me?”
You have been told to “relax”, “stay positive”, or “find a new normal” but none of that makes really makes sense to you.

Life with cancer is tough. And it’s confusing.

A cancer diagnosis comes with new responsibilities, to yourself, your loved ones, your health, etc. You are expected to make difficult decisions for which you were not prepared, from the moment you get diagnosed and throughout the illness trajectory. You are asked to commit to treatments and frequent medical appointments. Yet, life in between doctors’ appointments is overwhelming.

You go home with instructions to manage treatments side effects but no one gives you a handbook on how to cope with the complex emotions that unfold after a cancer diagnosis.

1. Cancer doesn’t come with a manual. There is no one way to respond to cancer and there’s definitely no “perfect” way to cope with cancer. With time, you’ll what works best for YOU. You’ll figure out which foods you can tolerate during chemo, the people you can rely on for grocery delivery or emotional support, what you need from others, etc.

2. It’s okay to feel sad, anxious, hopeful, guilty, angry, numb, confused, and all the emotions in between! You are a human being going through a very challenging time. You are not expected to “think positive” at all times. It's okay to feel all the feels. If you don't quite know how you're feeling, it's okay too.

3. It’s okay to ask for help. Reach out to your spouse, your best friend, your medical team, an online cancer support community, your church, etc. Ask for a ride, a hug, help with child care, information about financial resources, and everything else you may want or need.

4. Make some time to rest and take care of yourself. Like many, you may be used to taking care of others and always being on the go. Going through cancer is physically and emotionally demanding. You’ll need to rest. That may look like taking naps, not picking up the phone every single time, ordering take out more often than you're used to, or asking friends to help with meals.

5. Life with cancer can be a lot. While experiencing uncomfortable emotions is expected, depression and anxiety are not just another “normal” side effects of cancer and they shouldn’t be dismissed or ignored. Depression is depression. And there are available treatments to help you better cope with disruptive mood symptoms if you're having a hard time coping.

6. Therapy can help . Treatment offers a safe space to show up as yourself every week and share the complex and moving emotions that make up your experience ; the fears, hopes, wants, complaints, and everything in between. Getting support for your mental health will allow you to be better equipped to cope with the ups and downs of your cancer diagnosis. You don’t have to do this alone!

7. Be kind to yourself. Before navigating away from this page, take a piece of paper and write down a little love note to yourself. Write it as if you were talking to your best friend as they were going through a difficult time. Read it aloud.

Therapy for stress and anxiety: Spend less time worrying and more time living

Thu, 09 Jul 2020 18:13:54 GMT

You worry about the future , money, your health, your relationships.
Your brain won’t shut off at night when you try to sleep.
You always think about the worst case scenario ("What if I don't get better?", “What if the COVID-19 pandemic never ends!”)
You just can’t seem to relax!
People have referred to you as a “worrier” or “worry worm.”

Anxiety and stress are common, yet they are also very disruptive. They get in the way of your happiness and can interfere with both your physical and mental health. They make life overwhelming and just plain difficult!

What is anxiety?

Anxiety happens in your mind…

- You worry about many things such as your health, the future, relationships, finances, your loved ones, bad things happening

- You often think about the worst case scenario and “what ifs” of life

- You find it difficult to stop worrying

… body …

- You can’t relax, you feel tense

- You’re prone to stomach pain, nausea, headaches

- You feel exhausted

- You’ve experienced sweating, shaking, shortness of breath, a rapid heart beat. Maybe you’ve had a panic attack before

… and behaviors

- You are easily annoyed or irritable . People may have noticed you have a short fuse.

- You don't sleep well

- Focusing on a task is difficult

- You avoid certain places or situations

If you feel anxious, know that you are not alone. Anxiety disorders are common. More than 18% of the U.S. population experiences anxiety each year. These numbers are even higher in those living with a medical condition , such as cancer , chronic illness, or coping with chronic pain. People can feel anxious or worried about one or many things. Sometimes the cause of the anxiety is well identified (fear of blood and needles, fear of social interactions, etc), and other times the anxiety is more diffuse and generalized. Anxiety can be chronic or more acute.

Why are we anxious?

We are all different when it comes to anxiety. No two people diagnosed with an anxiety disorder (e.g., generalized anxiety disorder) are going to “look the same.” One may present as a “worrier”, often thinking about the worst case scenarios, when another another one may come across primarily as very irritable and on edge.

We often think about negative life events causing anxiety, such as a divorce, relationships issues, a job loss, financial difficulties, being diagnosed with a medical condition, a pandemic (yes COVID-19, I’m talking about you! ) . Yet, anxiety can also be triggered by life events often seen as positive. You may find yourself worrying constantly after welcoming a baby into the world, or stay up at night with anxiety after being promoted at work. And sometimes anxiety comes out of the blue, without a known cause or trigger.

Anxiety is complex and it’s caused by multiple factors, including genetics, life events, personality factors. And while the cause of your anxiety may not always be known, its consequences on your life are likely real and overwhelming.

Despite being a fairly common issue, many people living with anxiety do not receive appropriate treatment or diagnosis. And anxiety, when left untreated for extended periods of time, can cause significant pain and suffering, and promote unhealthy coping skills (e.g., avoidance, substance use) that make life even more difficult. And while you may not be diagnosed with an anxiety disorder (e.g., panic disorder, generalized anxiety disorder, specific phobia), anxiety can still be disruptive.

But if you feel ready to get better, there’s hope!

Anxiety keeps your mind worried about the future. Therapy can give you the tools to claim your life back and enjoy the present moment!

Cognitive Behavioral Therapy (CBT) for Anxiety

Therapy can help you get unstuck. You can learn tools to better manage anxiety and live life more fully. Specifically, cognitive behavioral therapy (CBT) is considered the gold standard treatment for anxiety disorders. It’s the treatment with the most evidence supporting successful outcomes.

CBT is a form of therapy that is structured, fairly short-term, and focuses on the present. It targets unhelpful thoughts (it’s the C part of CBT that refers to cognitions) and teaches clients to replace those negative thoughts with more helpful ones. The goal is not to “think positive” or minimize stressors, but to develop a more objective and adapted self-talk.

For instance, “Diabetes is ruining my life, I’ll never be able to get better.” can become “Being diagnosed with diabetes is challenging but I have access to resources and support, and I can start making small changes to better manage my glucose levels.”

CBT also helps clients engage in healthier behaviors (it's the B part of CBT, targeting behavioral changes) that alleviate anxiety, by learning relaxation or mindfulness, incorporating exercise or body movement into your lifestyle, or learning breathing techniques that can help prevent a panic attack.

As an anxiety therapist, I help clients develop an anxiety toolkit that they can carry through life to better manage their symptoms.

Anxiety therapy doesn’t remove stress from your life, it gives you the tools to better manage it. It can help alleviate the severity of your anxiety symptoms, so that you’re able to go through your day without constantly feeling overwhelmed.

What would your life look like if anxiety wasn't so overwhelming? What would you be doing more of or differently? What meaningful goals would you like to work on if anxiety wasn't getting in the way?

I look forward to helping you find more peace and balance in life!

Activity pacing: Learning to better manage chronic pain

Tue, 30 Jun 2020 16:42:40 GMT

You often push yourself until you’re in so much pain that you have no other choice than to stop, being forced to rest for long periods of time.
When you have a good day, you try and cross off as many things as possible on your to-do list.
You don’t like to stop until you’ve completed a task.
You’re used to getting things done, and slowing down has been a struggle.

Does that sound familiar?

If you live with chronic pain, chances are that a loved one or medical provider has told you before that you need to slow down or pace yourself.

Activity pacing helps with:

1. Promoting increased functioning and doing more of the things that matter to you.

2. Preventing avoidance of physical activity or overexertion. Doing too much or too little can have detrimental consequences.

3. Decreasing the frequency of pain flare ups.

4. Feeling more in control of the way your days unfold as you learn to engage in periods of rest and activity proactively.

What activity pacing is NOT

Being forced to rest after pushing yourself too much.

Overdoing it on a good day and staying busy until the pain flares up and your body is begging you to stop.

Staying in bed to avoid pain or symptom flare ups.

Getting everything done on your to-do list when you feel well.

Having to complete a task before you take a break and rest.

Requiring extended rest after overdoing it and experiencing intense pain.

The statements listed above describe the pain cycle, which refers to long periods of forced rest to allow your body to recover after pushing yourself too much. This cycle can contribute to increase in pain and is likely to make you feel defeated, tired, and overwhelmed.

What activity pacing looks like

Termination of an activity is time-contingent, not pain-contingent.

This is the most important aspect of activity pacing. The idea is that you end an activity after a set period of time, rather than when pain starts to flare.

To determine your baseline, record the average amount of time you can engage in a given activity before the pain flares.

After determining your baseline, set a time target for periods of activity. The starting goal should be less than your baseline. Reduce your baseline by 20% (you can do that by multiplying your baseline by 0.8). For instance, if pain flares after 20 minutes of walking, start with a 16 minute-walk (20*0.8=16 minutes). You will then gradually increase your activity, as tolerated.

It is expected that each activity will have a different baseline. For instance, back pain may kick in faster when walking than when lying down.

You may want to start pacing yourself with activities that you tend to overdo on a regular basis (e.g., house chores, working at your desk, exercising).

Pacing may be challenging if you’re used to doing things non-stop. Scheduling periods of activity and rest on your phone or writing them down on a calendar can help keep you on track.

Use a timer to remind you to stop an activity!

Record your progress by keeping track of pain levels and feelings of accomplishment and mastery throughout the day. Adjust your goals as appropriate.

Spread activities evenly throughout the day and week (e.g., don’t plan to accomplish all house chores on Monday!)

Maintain a flexible schedule. Life happens. You may need to squeeze in a last-minute meeting or trip to the store. Avoid crowded schedules of activities to allow for unexpected to-do’s.

Be gentle with yourself! This may be the most important piece of advice here. Changing the way you do things is tough! If you find yourself feeling frustrated, anxious, or upset, don’t give up! Challenging the way we do things often forces us to rethink the way we are, which can take time. Learning to apply pacing to your life will likely take trials and errors. BE KIND TO YOURSELF as you learn this new skill.

This blog post offers an overview of activity pacing. Learning to apply this skill may require some help and additional guidance. Therapy can offer a venue to guide your progress as your learn to better manage chronic pain in your life.

Four tips to set up a new routine when living with chronic illness

Wed, 10 Jun 2020 04:00:00 GMT

Life with chronic illness comes with a fair amount of uncertainty.

It may look like not knowing whether you will wake up in pain or not, how long your migraine will last, when the next symptom flare-up will show up, or if that new treatment will work.

Dealing with the physical and emotional ups and downs of chronic illness can therefore make it challenging to make plans and stick with behaviors in the long-run, even those very behaviors that make you feel better or that you enjoy.

However, setting up a routine is not impossible if done flexibly and with some planning. Below are some actionable steps you can take to set up a routine while remaining flexible to meet the demands of your health.

1 . Keep it simple

Identify one small, manageable action you can start implementing. Ideally, it should be something that can be done fairly easily in the near future (e.g., adding 5 minutes of stretching or deep breathing before bedtime, sit outside for 15 minutes every day), not something that requires complicated logistics or resources you don’t currently have access to.

Keeping this behavior manageable and realistic is important to increase the likelihood that you will be able to engage in it on good days… and on challenging days!

If the behavior you have in mind seems too challenging, ask yourself this question: What is the very first step I need to take to make this happen in the future? For instance, getting in the habit of cooking homemade meals every day is not easily achieved overnight. But you can start by focusing on breakfast or a small snack every other day or cook a homemade dinner every Friday, and then move on to the next step as appropriate.

As you identify a behavior you want to integrate into your routine, think of something that would easily fit in with your current routine. It could even be expanding on something you are already doing.

Action step: Identify a realistic and manageable behavior you can add on to your current routine.

2 . Make it relevant and meaningful

It’s very important to make this new routine meaningful! Do something that matters to YOU, not to your partner, best friend, therapist, or medical provider. It can be something that makes you feel better emotionally or physically, something that makes your life easier, something that makes you laugh or inspires you. Everyone on social media and in your life may be raving about yoga or journaling, if it doesn’t make you feel good or if it feels like a chore, this is not the routine you want to begin with. It has to make sense and be relevant to YOU.

Understandably, some routines may be dictated by your diagnosis (e.g., medication taking, frequent resting, etc). Taking the time to reflect on why a given behavior is important to you before engaging in it may increase the likelihood of keeping up with it. For instance, realizing that resting before your pain flares up allows you to be more engaged with your family makes this behavior more meaningful and valuable that seeing it as yet another challenge brought forth by your diagnosis.

Action step: Before you implement a new behavior, take some time to reflect on your WHY. Why does that behavior matter to me? And remember that meaningful doesn’t always imply enjoyable or pleasant.

3 . Figure out your “prime time”

When do you tend to have most energy? At what time of day or week (weekday vs. weekend) do you have some free time? At what time of day do you usually do your best creative work?

It is understandable that most days are unpredictable and that pain flare ups may come out of the blue.

Living with chronic illness makes it more challenging to find a time that always work for you or when you always feel energized and upbeat. But it is likely that, over the years, you’ve noticed times when you often tend to feel a bit better. For instance, your ability to focus may be greater in the morning shortly after taking your pain medication or getting some sleep, which could make it a good time to engage in reading or gentle exercise.

To figure out the best time for you to implement a new routine may take some trials and errors. It’s okay to re-adjust and reschedule as you figure out what works for you and what doesn’t.

Action step: Identify your “prime time” and schedule your new routine accordingly.

As you work on implementing this new routine, it may be useful to have a placeholder in your schedule at the time intended for that new behavior. The idea is that you plan on engaging in the target behavior as scheduled, but if you are unable to because you’re feeling tired or in pain for instance, you can use that block of time to do a shorter version of the behavior or something else that better accommodate your health needs on that day. For instance, if you are unable to go outside for a walk, you may be able to engage in gentle stretching indoors for 5 minutes.

Action step: Identify alternative, less physically and/or mentally demanding activities that you can substitute for your target routine on days when you feel tired or in pain.

Bonus idea:

Create fun rituals with your loved ones!

Coming up with rituals with family or friends may help you connect with them and have fun. That may look like a family picnic in bed every first Sunday of the month, virtual Netflix date with your best friend on FaceTime once a week, or going people watching over brunch with your partner on your birthday.

5 grounding exercises you can use when feeling anxious or overwhelmed

Tue, 21 Apr 2020 16:42:42 GMT

Life has been stressful. Add a pandemic on top of that, and it can quickly become overwhelming.

Your mind is racing and you can’t shut it down. You think about a million different things at once, day and night.

It makes it difficult to focus on things you are supposed to do. Sleep is hard to come by.

You sometimes feel out of control.

You can’t sit still. You can’t relax.

At times it’s so bad that you feel completely overwhelmed and can’t get anything done.

When your anxious mind does its finest job keeping you thinking about all kinds of possible catastrophic scenarios that may happen in the future, grounding helps bring you back in the here-and-now.

1. The 5-4-3-2-1 exercise

This exercise uses your five senses to help you re-focus on the present moment, and away from your thoughts. It is one of the most popular grounding techniques.

Start by taking a few deep breaths. Look around you and name out loud:

FIVE things you see in the room where you are or outside the window

FOUR things you can feel (e.g., “the chair against my back”, “the AC blowing cool air on my face”; it’s often easier to start by focusing on things you can touch that are close to you such as the chair you are sitting you, a table in front of you, etc)

THREE things you hear right now (cars passing by, someone’s voice outside the door, the ticking of a clock, etc)

TWO things you can smell

ONE thing you can taste (for this one you can grab a piece of candy or gum or take a small bite of food if you have anything handy; if not, think about the taste of your favorite food)

2. 4-7-8 breathing technique

Focusing on your breathing is another way to quiet your mind and stop the endless chatter that keeps your anxiety up.

First, exhale through your mouth. Close your mouth and inhale through your nose to a count of FOUR. Hold your breath to a count of SEVEN. And exhale through your mouth with your lips pursed (as if blowing through a straw), to a count of EIGHT.

Repeat another three times.

If holding your breath this long feels uncomfortable, find a pattern of breathing that works best for you. The key is to maintain the ratio, but the total length of each cycle is less important.

This breathing exercise is one of many. You may use other breathing techniques to help ground yourself when feeling overwhelmed or experiencing intense emotions. If you’ve had success with another technique before, it’s a great time to practice it again!

For instance, you may write:

“Right now, I am going to take a shower”, “I can call my therapist to schedule an appointment”, “Now is a good time to go outside and sit in the sun.”

And then do it. And then move on to the next small thing!

One small thing at a time.

4. Allow your thoughts to come and go

Have you ever noticed how we tend to feel stuck with our thoughts when we feel anxious?

In our worried mind, thoughts just repeat themselves like a broken record. No matter how much we try to ignore them or get rid of them, they come back, louder and more obnoxious each time.

Next time you feel overwhelmed, try something different. Instead of giving your thoughts the cold shoulder, observe them from a distance. Observe your thoughts with a curious mind. Imagine yourself looking at the sky, watching the clouds go by. Whenever a thought pops into your mind, put that thought on a cloud, and let it float by. Some clouds may go by fast, others may seem to barely move. Just observe the clouds do what clouds do! Observe your thoughts come and go, without trying to respond to them.

5 . Look at an object with a curious mind

Pick a small object next to you and observe it with a curious mind, as if you were seeing it for the first time. Observe its shades and colors, look at the way the light bounces off it. Pay attention to its shape. Notice any patterns, imperfections, dents, holes. Hold it in your hand and notice its weight. Notice its texture under your fingers.

While this exercise can be done with anything readily available, I suggest keeping a small rock or another small object somewhere handy, so that you can reach out for it when you feel the anxiety creep up and you need to calm yourself down.

As you learn new ways to manage your anxiety, remember to stay kind to yourself, and give yourself the love you deserve in this difficult time. While these grounding techniques may provide short-term help to relieve your anxiety, additional support may be needed if you find yourself chronically anxious or overwhelmed.

And if anxiety (or any other mental health issues) feels too much right now, or if it’s starting to get in the way of your functioning, it’s okay to ask for help. Talk to a medical provider, a therapist, a friend. You don’t have to do this alone!

5 tips to cope with cancer or chronic illness in the COVID-19 era

Sun, 29 Mar 2020 16:42:43 GMT

The coronavirus pandemic has sent shock waves through all spheres of our lives.

Life has been confusing. Confusing and oh, so overwhelming!

We are forced to rethink the way we work, the way we take care of our physical and mental health, the way we plan for the future.

The pandemic is also reshaping the way we relate to one another.

For those of you living with cancer or another chronic medical condition, social distancing is nothing new. In fact, many of those who are immunocompromised have had to avoid social gatherings or public places for months at a time, sometimes years, in order to protect their health.

Yet, this pandemic introduces a whole new set of stressors and challenges for the medically ill population. Some of the resources you may have been relying on consistently to manage your health or chronic pain may no longer be available to you at this time.

You may be worried about finding the food that you need due to dietary restrictions.

The social support you rely on may look a lot different , as people are no longer accessible in ways we are familiar with. Your medical team may have recommended that you be seen through Telehealth for some of your appointments. Your friends and family may not be able to come by to spend time with you or help with your day-to-day needs.

This unprecedented crisis is causing significant emotional distress.

The COVID-19 crisis may also bring back difficult memories of other times when life suddenly felt more unpredictable and you felt more vulnerable . For instance when first being diagnosed with cancer or another illness, or when undergoing difficult treatments.

While there is no textbook on how to deal with this pandemic, I want to share some ideas of things you can implement as you navigate this stressful time. I am writing these words hoping that they can provide you with a sense of hope and help you cope.

1 . Shift your priorities to focus on your most immediate needs

Now may not be the best time to tackle a big project or start a new hobby (although it’s absolutely fine to do so if you have the energy for it and you find that it helps you cope)! You may feel a bit more depleted, emotionally and physically, and your bandwidth is best used to take care of your immediate and basic needs.

SOMETHING TO PRACTICE : Stick with the basics! Make sure you maintain adequate nutrition and water intake. Stay on top of your treatments. Get all the sleep and rest you can. Exercise if you are able to and if medically cleared for it.

Bonus idea: Write down a list of things you no longer want to spend your time or energy on (e.g., feeling guilty for saying no, wearing make-up to get out of the house, cooking something new at every single meal, etc)!

2 . You are resilient!

Yes, this is HARD. You feel shaken, angry, afraid, resentful, and so many other things. This took you by surprised and is forcing you to change course and readjust some of your routines and be extra cautious with your health. You may feel overwhelmed and out of control.

Yes, this is hard. And you’ve done very hard things before. Some of them related to your health, others not.

SOMETHING TO PRACTICE:

Think back on the challenges you’ve faced in the past and take stock of prior accomplishments and successes. Big and small.

You may find some comfort in writing this down. Doing this may not immediately make things easy or less scary, but it will remind you of some of your strengths. Intentionally applying those strengths to cope with current stressors may in fact help you feel better about yourself and this challenging situation.

3. Feel all the feels…

I’ve said this before many times, but this is worth repeating: Your emotions are valid. ALL. OF. THEM! It’s okay to feel worried, sad, resentful, hopeful, frustrated, [Fill in the blank]. And your emotions are complex too! It’s okay to feel all these emotions are the same time. You may feel worried and grateful. Sad and hopeful.

Sometimes your emotions may not quite make sense. Or you may surprise yourself for being more at ease than you would have anticipated. There is no right or wrong. Emotions will ebb and flow, as emotions do.

You do not have to justify yourself for feeling a certain way, nor do you have to work hard to “find the silver lining” or “think positive.” We’re in the middle of something new and scary. It’s okay to feel all the feels.

SOMETHING TO PRACTICE: Take note of the way you feel. Acknowledge your emotions without judgment. “Right now I feel [fill in the blank].” You can also write these emotions on a sticky note and look at them from a distance. This can help alleviate the weight they carry.

4. … and practice self-compassion

“This is a moment of suffering. Suffering is part of life. May I be kind to myself in this moment. May I give myself the compassion I need.” Kristin Neff

Through the fear and hurt, practice being kind to yourself, the way you would to another human being you love!

SOMETHING TO PRACTICE : Below is an example of a self-compassion practice. You may use this as a guide or check Kristin Neff’s website for other exercises in self-compassion.

5. Limit your exposure to media coverage

An article hot off the press suggests that too much media exposure relating information about a public health crisis can increase anxiety and amplify our stress response. Being informed is essential. It allows us to make wise decisions and implement good health precautions. Yet being flooded with information continuously is not helpful. We need to strike a balance when consuming information from the media.

SOMETHING TO PRACTICE : 1) Set times during the day when you will check the news and read updates about COVID-19 and/or other news. 2) Consume news from trusted sources (e.g., CDC, WHO, your hospital and/or medical team). 3) Set boundaries with others who may be sharing a lot of information with you so that you remain in control of what information you read and when. That may sound like “I appreciate your concern about my health. I would prefer to be the one initiating our discussions about the pandemic right now, it helps me manage stress better.”

And as always, reach out for help from friends, your medical team, a therapist if you feel like anxiety or other mental health issues are getting in the way of your functioning. Many resources continue to be available at this time via telehealth to continue providing you with the support you need.

Life with cancer: 5 tips to cope with mom guilt

Fri, 13 Mar 2020 16:42:44 GMT

Mom guilt refers to the idea that, as a mom, you are failing your kids to some extent or falling short of your responsibilities towards them. Maybe you feel as if you are not doing enough, or not doing things just quite the way you should.

Mom guilt may feel like not spending enough time with your child, not reading enough books at bedtime, not feeding them the right type of food, not showing up to all the “meet the teacher” events at school, buying a store-bought cake for their birthday party, not wanting to play Lego, losing patience, wanting to take some time for yourself, having to work on the weekend, not organizing more playdates.

The list is endless.

No matter how much you do, mom guilt has probably stolen the joy out of your day more than once in your career as a mom!

And you’re not alone in this. I yet have to meet a mom who has never experienced an ounce of it!

And then, cancer happens. And mom guilt skyrockets as the demands put on body and mind increase, and you find yourself not able to participate in your children’s life as much as you would want to.

Dear mom, it’s okay to not have all the answers right now. You are doing the best you can dealing with a diagnosis that didn’t come with an instruction booklet.

Here are a few thoughts and suggestions I want to share with you:

1 . The predictability of routines can be helpful to children as they process the diagnosis and adjust to the many ways it impacts their life.

You will learn with time what works for you and your family. You will establish new routines that take into account your physical health and find new ways to show up for your children and loved ones. For instance, you may start eating breakfast in bed with your children on Sundays before they go to soccer practice or find comfort in reading their favorite book at bedtime. It will not happen overnight and routines may be adjusted when you have a good day, or when you just ended a round of chemo and need to focus on resting. But you will settle into a routine.

2 . Start a F-it list!

Yes, you read that right. Keep a list of things that are low priority in your life and that you no longer want to spend your energy on. Keep adding to the list as you go along. I want to share this blog post I came across not long ago about a lymphoma survivor and mom of 2, who started keeping her F-It list after being diagnosed with cancer. What’s on YOUR F-it list? Take out your phone, keep a running list of those things and keep adding on to it!

A few ideas of what it may look like: Keeping socks in pairs when folding the laundry (delegate or send your kids with non-matching socks!), circling around waiting for a parking spot (valet once in a while!), worrying about what others will say if you go out without a wig, cooking dinner every single day of the week, etc

3 . It is okay to feel all the emotions.

You are not a “bad mom” for experiencing sadness, grief, or anger. Let me repeat this once again, you are not a bad mom when you feel sad, angry, lost, overwhelmed, worried. You are human being dealing with a really tough situation, and experiencing a range of emotions is normal. Likewise, you are not a bad parent if you don’t think positive at all times. Again, you are not a robot, you are a human being!

4 . Figure out what it means for your to be a “good mom”

A study previously identified “being a good parent” as one of the most salient concerns of parents after being diagnosed with cancer. Being a good parent is not measured by the number of times you show up to soccer practice or the number of hours spent playing board games. It is about parenting in a way that feels authentic to you and is consistent with your core values (aka, the stuff that matter to YOU) while meeting your children’s needs.

What are your core values when it comes to parenting?

Maybe you value having fun with your kids . What's a new way you can incorporate fun in your relationships when you are not able to chase them around the house? Maybe you can watch a comedy with them or allow yourself to be silly with them at dinner time!

Maybe being present in their life is something that’s salient to your role as a parent. What are some new ways you can show up in their life while being mindful of your health? Being present right now can look like asking them about their friends because you remember all their names and have met them all. Or sitting with them as they practice their instrument. Or snuggling with them in bed at bedtime.

The take away message here is to stick with your core parenting values and adjust your routines flexibly.

5 . Be kind to yourself!

Have compassion for yourself. Give yourself credit for everything you are doing. Actually, go ahead and take a piece of paper right now. And jot down all the things you are doing great as a parent. Nothing it too big or small.

It may look like: Kissing your children goodnight and tucking them in, reminding them how much you love them every morning, reading their favorite book, being a great role model by taking care of yourself and resting when you need to, showing them that it’s okay to ask for help , ordering their favorite food, remembering to sign them up for soccer before the deadline, rallying a team of people to love on them and cheer them on as you take some time to rest , etc

Your health matters: 5 ways you can benefit from seeing a health psychologist

Wed, 04 Mar 2020 17:42:46 GMT

Does any of the following statements resonate with you?

Life with a chronic health condition has been overwhelming.
Chronic pain gets in the way of your quality of life.
You have been told by your doctor that you need to change your diet, exercise more, or reduce your stress.
You’ve been having a hard time adjusting to your cancer diagnosis.
You are recovering from an injury.
You’re fairly healthy and want to continue doing everything you can to stay this way!

Any of those issues or goals can be addressed by a health psychologist.

Health psychology is a totally awesome (can you tell I love my job?!) area of psychology that focuses on factors that influence physical health and wellness.

1. Living better with a medical diagnosis

Managing a medical condition can feel like a full-time job. It disrupts your routine, your relationships, your sense of identity. It also often distracts you from doing other things that matter to you. Adjusting to life with chronic illness requires time, energy, and a lot of support from loved ones and your medical team.

A clinical health psychologist has received specialized training to help you manage the emotional and physical stressors of your medical diagnosis (e.g., diabetes, cancer, cardiovascular disease, lupus, multiple sclerosis, endometriosis, HIV/AIDS, etc).

Together, we can address difficult emotions (anxiety, sadness, guilt, anger, etc) that ebb and flow over the course of your illness. A clinical health psychologist can also help you cope with physical side effects of you treatments or teach you ways to relax your body. We know for instance that practicing relaxation skills can help alleviate nausea during chemotherapy!

As your symptoms change over time and you go through the ups and downs of your disease, seeking therapy can give you the support and the tools to make life a bit less overwhelming.

2 . Making healthy lifestyle changes

There are many things we cannot change or control that may contribute to illness. Genes, family history, gender, ethnicity.

However, a significant number of risk factors responsible for chronic diseases (cancer, heart disease, diabetes, respiratory disease) are modifiable. Yes, they are many things we can do to support our health and prevent illness!

By now most of those factors that promote health should not be surprising to you. Eating healthy foods, staying away from tobacco, being physically active. Yet, implementing all these recommendations consistently in your life can prove to be a challenge.

Raise your hand if you are struggling to stay physically active or eat regular, healthy meals! Change is hard! Sticking with new routines takes time, commitment, and support.

Stress and lack of time often come to mind as key factors that prevent us from achieving our goals. But Many others, more subtle factors can also derail you from staying on track (depression, high anxiety, health beliefs, inadequate goal setting, unhelpful expectations, lack of coping skills, poor social support, to name a few).

There are many ways to get to a goal and the response to your unique needs or difficulties is not a “one-size-fit-all” approach. Working with a clinical health psychologist can give you the tools to identify and address the obstacles that get in the way of your health goals.

3 . Caring for the caregivers

Being diagnosed with a disease or suffering an injury impacts the whole family. No one would argue against this. It shifts priorities, leads to difficult emotions and tough questions, puts stress on relationships and requires new routines to be implemented. Loved ones often participate to the care and day-to-day life of those impacted by illness or a disability. Being a caregiver is often a role that one choses, but it can also be dictated by circumstances.

The caregivers and family members face many stressors throughout the illness trajectory, sometimes leading to symptoms of depression, anxiety, guilt, or loneliness. Seeking therapy can help by providing the support needed to cope with the demands of caregiving and ensure that loved ones tend to their own health needs, which can often be put on the back burner in times of stress.

4 . It takes a team! Collaborating with other providers

Health is comprised of many components that interact closely together. Your psychological health influences your physical health, and vice versa. It therefore makes sense to look at all these moving parts together, as much as possible!

Clinical health psychologists are trained to work alongside other healthcare professionals and provide care that makes sense to the patient. Collaboration and communication are therefore very important to give you the best care possible. In my work with clients, I tend to open the lines of communication and consult with other providers on the client’s team as much as possible (and with my clients’ consent of course)! Better understanding your medical regimen for instance can help me learn about any side effects on your mood. Similarly, letting your medical team know that you are working on stress management can help by enrolling their help on treatment day, as they remind you to take deep breath or use imagery to manage pain or stress.

An added bonus of ongoing consultation with other medical providers and our specialized training is that we learn to speak (some) medical jargon! Being able to understand your labs or being familiar with health and illness vocabulary allows me to understand your experience better as you sit across me in the therapy room, discussing recent medical updates or treatment side effects.

Take away message

Invest in your health by addressing your physical and emotional needs throughout the journey that is life, when you are well and when you are coping with an illness or disability. And when extra help is needed to cope with a disease or overcome obstacles towards your health goals, a clinical health psychologist can provide support and tools to help you get unstuck!

"I have cancer. Should I go to therapy?" 5 questions you may be asking yourself before making a decision

Wed, 19 Feb 2020 17:42:46 GMT

You have been thinking about going to therapy and started looking up therapists on google or psychology today, but can get yourself to make a call
You were recently told by a loved one or doctor that you should talk to a therapist
You are feeling overwhelmed, sad, anxious, but still feel unsure about talking to a therapist
You don’t know if now is a good time to start therapy
Will therapy even help me deal with cancer?

If you are reading this, it is likely that you have been struggling with adjusting to life with cancer. Yet, committing to therapy has been difficult.

I get it!

A majority of my clients have confided that they felt conflicted about starting therapy at some point before making the call. I am glad you ended up here! I hope that reading through this post will help with some of the questions or concerns you may have about going to therapy.

Below are some common questions or concerns that have come up in my practice.

1. “Can I just talk to my friends?”

Yes, you should absolutely talk to your friends and family! You need a team of people cheering you on, loving on you, showing up on chemo day, or bringing you a meal. It takes a team to successfully deal with a chronic medical condition. Yet, it is likely that not all of your emotional needs can be met by your friends or family, no matter how caring and dedicated they are.

2 . “I need to focus on treatment right now.”

It is not uncommon for those who are in treatment to feel that they need to focus all their energy on treatments and medical appointments. I hear you! You are going through tough treatments and may be dealing with a number of side effects. What you need at that time is to rest and take care of yourself.

Here are some less known facts about ways therapy can help improve your quality of life as you navigate treatments:

Decreased side effects (nausea, vomiting)
Less anxiety and improved quality of life
Less fatigue
Improved sleep
Seeking online therapy is also a way to getting the help you need while preserving your energy.

3 . “I don't want my family to worry”

Going to therapy makes things real and it can be hard to acknowledge that you are not doing well and that you need help. And you certainly don’t want to worry your loved ones even further, “they are already going through so much with my diagnosis.”

You are right though, your loved ones probably worry about you, because they love you and care about you!

Going to therapy may give you a chance to deal with some of the emotions and symptoms that impact your quality of life, which may positively benefit your relationships with your loved ones as you learn new ways to adjust to stress. It is also possible that your loved ones could benefit from going to therapy (you can go to therapy with your partner or family if appropriate, or they may go to their own therapist).

Going to therapy can help your relationships in a few different ways:

As you are better able to cope with difficult emotions, you may find yourself better able to connect with others.

It can help you become more confident in communicating your needs to your friends and family, and finding the support you need.

Therapy can give you the tools to learn how to be present for your children and parent them in the best way possible with your current limitations.

Here are just a few examples of reasons why my clients have sought help:

Making lifestyle changes (e.g., increasing exercise, learning stress management) after cancer treatment ended
Coping with chemo brain
Getting ready for surgery
Coping with chronic pain
Finding a way through depression
Finding the words to talk about cancer to their children or colleagues

5 . “I have cancer, not depression. Therapy won’t help with my illness.”

Yes and no!

No, therapy is not a cure for nor does it prevent cancer. But therapy can help significantly with physical issues. As I discussed a few paragraphs above, therapy can help alleviate treatment side effects (nausea, vomiting, lack of appetite), improve sleep, manage chronic pain, and so much more!

Cancer turns your world upside down, and while you may not feel depressed, dealing with the many changes the diagnosis causes is hard work. Therapy helps with just that, all the changes you are forced into! Certain mental health providers are uniquely equipped to help you cope with cancer. As a health psychologist for instance, I specialize in helping adults with cancer and other chronic illnesses adjust to the many stressors of your diagnosis, both physical and emotional.

So, at the end of the day, “Do I need therapy?”

Therapy is not inherently good or bad. As you make a decision, ask yourself it will be helpful or not to help you cope with the current issues you are dealing with, both in your mind and body.

If you think you need therapy but still feel ambivalent about it, one place to start may be to discuss your questions or concerns with a mental health provider. I encourage everyone considering therapy to ask questions to the therapist on the phone before scheduling an appointment. Most of us provide a free phone consultation, which gives you a chance to ask questions and learn more about whether it would be a good fit.

If you live in Miami and are interested in going to therapy at this at this time, call me today for a free phone consultation!

Cancer survivorship: 5 tips to help you figure out your "new normal"

Thu, 13 Feb 2020 17:42:47 GMT

Raise your hand if you were ever told to find your “new normal” since finishing cancer treatments!

You may have heard to “find a new normal” from your medical team, a well-meaning friend, someone at work, your therapist (yes, guilty at charge, we do say that quite a bit as well), a total stranger, or all of the above. You also probably came across that phrase in a magazine or brochure in your doctor’s waiting room or online on a blog discussing everything cancer.

Yet you feel confused about what a new normal is supposed to look like. Nothing feels normal at all since you have been diagnosed with cancer and you don’t quite know where to go from there.

Finishing cancer treatments can prove challenging for many. While you feel a huge sense of relief from being done, other, more challenging emotions can also show up around that time. You may experience feelings of sadness, guilt, and fear.

As challenging as treatment was on your mind and body, it came with many expectations dictated by your medical team. Doctors’ follow-ups and treatments may have become the priority, with everything else being worked around your health needs. As you move into survivorship, doctors’ visits become far and few and your schedule is no longer filled with medical appointments.

Life no longer moves to the rhythm of you doctors’ visits and treatment cycles.

You are sent home with an order to return to the clinic in a few months for follow-up, take care of yourself, and figure out your “new normal.”

Here it is. I said it again! But what is a new normal?!

Finding a new normal implies a few things:

This statement implies that things will go back to something norma l (aka, a routine that feels like you). Yes, you’ll likely be able to work, parent, be the awesome friend you used to be, and so many other things that you did before. Things will not always seem as uncertain and confusing as they may feel right now.
But the routine that you will settle in will likely be new in many ways. Things will not go back to the way they were before your diagnosis . You will not be the same person you were. My patients often talk about having lost this ability to go about life without worrying about it ending one day. Cancer brings the reality of death into our awareness and can make you feel more vulnerable. Treatment may also have left its mark on your body, forcing you to slow down or preventing you from doing certain activities.

Things are different.

You are different.

Not better or worse necessarily, just a different self, shaped by the experiences you just went through.

2. Go back to the basics

As you adjust to this new phase of your life, one that often comes with a fair amount or stress, make sure that you take good care of your physical and mental health! Eat nutritious food, stay hydrated, remain physically active, sleep, engage in relaxing activities. Yes, this is very basic. But in times of stress, we tend to overlook those important health behaviors. Having a plan to stay on track with addressing your basic needs can help tremendously.

3. Identify your core values

Values are those things that matter most to you in life. They tend to be fairly stable and withstand the storms of our lives.

Taking some time to reflect on the values that are most important to you can help you re-connect with yourself and guide your next steps, at a time when everything else feels like it’s uncertain or shifting.

To identify your core values, ask yourself what kind of person you want to be as an individual and in relation to the world or others. Who do you want to be as a parent, friend, partner, colleague? What matters the most with regard to your health, your career, your finances?

4. Make decisions that are in line with those values

You may not know quite yet what you are supposed to do next or even if you need or want to do anything differently. But as you go through your day-to-day life, be intentional about doing things in a way that is in line with the core values you just identified. If being creative is something you value, think about activities that you can engage in that would allow you to express your creative self. Maybe being active is something you value. How can you embody that in your life despite your current limitations? If you used to dance but are no longer able to due to fatigue or chronic pain, what are some other ways in which you can be active?

5. Ask for help when you need it

Change is hard and receiving support may help you through the process of figuring out what new normal you feel comfortable with. Reach out for the type of support you need. It could be from old friends or a partner, or from a therapist or local support group. Different people may address different needs. Know when you need some time for yourself and when getting some support would help you make feel better. Always remember that you are not alone!

Cancer survivorship: 3 tips to cope with complex emotions after cancer treatment

Fri, 07 Feb 2020 17:42:50 GMT

The day finally came. After going through cycles of chemotherapy or radiation that took every bit of energy out of you, you are done with treatments. Everyone celebrated. Your friends and family may have come with you to the last treatment. Maybe you rang the celebratory bell before walking out of the hospital, and your loved ones and medical team cheered you on.

Everyone had been anxiously awaiting that day. You felt a huge sense of relief thinking about the challenges your body and mind endured, the moments of doubts and anxiety, the pain and fatigue that took over your body, all of which now belonged to the past.

But the sense of relief and joy you had initially felt starts fading as the days go by. Feelings of anxiety or sadness may start creeping up and you may not fully understand why. You find it difficult to make plans and don’t quite know where to focus your energy or where to start.

All of a sudden you are discharged with instructions to come back every few months. The busyness of treatments and appointments is over and you find yourself coping with lingering side effects and a life that doesn’t feel quite like what you knew before your diagnosis.

Alongside feelings of relief or hope, other emotions can show up as well that are not as easy to manage or even understand:

Anxiety and depression

Feelings of sadness or depression are common after cancer treatments end. The seriousness of your diagnosis may start to sink in as you pause and reflect on the past few months or years. You feel overwhelmed by feelings of sadness for what you just went through and fear about the future that now feels uncertain. You may still be coping with challenging side effects or changes in your body image following treatments, all of which you are now fully realizing.

Guilt

You may feel guilty for being sad, stressed or overwhelmed when everyone else around you is celebrating the end of treatment. You may also feel guilty for not being able to fully embrace this new life when other patients you may have gotten to know during treatments are still in the midst of fighting to get better.

Fear of recurrence: “Will the cancer come back?”

Many of those who complete cancer treatments share a deep concern that the cancer may come back or progress. This fear may be triggered by physical symptoms or sudden occurrences of pain. It may also show up at the anniversary date of your diagnosis, follow-up doctors’ visits, driving by the hospital or when you are reminded of your diagnosis when someone you know share they have cancer.

1. Acknowledge that all your emotions are valid

We have a tendency to think in black or white. “I should feel happy right now, not sad.” The reality is that we can feel both! Feeling sad or worried about the future doesn’t mean that you are not relieved that treatment is over. Allow yourself to become aware of all the emotions and experiences, whether comfortable, painful, or everything in between.

“I am both happy and sad at the same time, and I'm still trying to figure out how that could be.”

Stephen Chbosky, The Perks of Being a Wallflower

2. Stay on top of your medical care and mental health care

Before doctors visits become few and far between, talk to your medical team about what to expect in the months following treatments. Get some information about side effects and how to manage them. Stay on top of follow up appointments. Know what symptoms to be on the lookout for. And talk to your team about anything else you can do at this time to improve your health and quality of life. That could include making lifestyle changes to reduce your risk of developing future health conditions, or alternative treatments to relieve the side effects of treatment.

The American Society of Clinical Oncology has developed a survivorship care plan , which is a great tool to use with your medical team to plan for your continued care post-treatment.

As you transition into survivorship, take time to address your mental health needs as well. While a majority of patients will experience fear that their cancer might come back, this fear tends to decrease as time goes by. Occasionally, the fear may become so intense and frequent that it causes significant distress. For those who feel paralyzed by fear, making plans or thinking about the future may feel challenging. Talking to your medical team or reaching out for help from a mental health provider may be helpful at this time. Similarly, if symptoms of depression or anxiety are so salient that they get in the way of your ability to function, reaching out for help can be necessary to help you get better.

3. Self-care

Self-care refers to all the things we can do to address our emotional, psychological, and physical needs and alleviate the impact of stressors.

Self-care is intentional. You have to plan for it. It doesn’t happen on its own.

What self-care is not:

Forcing yourself to go to yoga classes every day just because yoga is mentioned in every self-care article
Things we have to buy
Selfish

What self-care can look like:

Learning to say no
Eating a balanced diet
Re-working your schedule to allow for an earlier bedtime
Joining a support group or seeking therapy
Being on top of your medical care
Reconnecting with a friend you haven’t seen in a long time
Creating time each day to do something that brings you joy
Learning a new hobby
Relaxation
Self-compassion

There is no “one-size-fits-all” approach to self-care. It is something that you design to meet your needs.

Before you close this window and move on to the next thing on your to-do list, take a minute to think about one thing you can do for self-care today.

What will it be and when will you do it?
Be specific. Write it down.
Put it in your phone with a reminder!

You are NOT your diagnosis. What to do when cancer challenges the way you think about yourself.

Thu, 23 Jan 2020 17:42:51 GMT

I am a(n) {fill in the blank}

What are the first thing(s) that came to mind?

I bet it was NOT “cancer patient”, “cancer survivor” or “cancer victim.”

You are many things to many different persons. A partner, best friend, child, parent, grandparent, friendly neighbor, yoga teacher, colleague, confident, first love, etc. You may be an optimist, problem-solver, morning person, old soul, dreamer, artist, leader, bookworm, dog-lover, coffee aficionado, rule breaker. And so much more.

Yet, your diagnosis seems to have taken over your life and the way you see yourself.

All the roles you once fulfilled, some with much joy, others reluctantly, the tasks you completed on auto pilot, all these roles are being challenged by a diagnosis you neither asked for or expected.

You no longer have the stamina or desire to create and start questioning your “artistic self.” You suddenly feel flooded with worry (about yourself, the future, and everything you once believed in), challenging the idea of yourself as “relaxed and happy.” You don’t feel like the partner you used to be and worry about burdening your spouse. One of my clients once shared how much he struggled with not being able to show up to help by his wife and adult children:

“I used to be the problem-solver of the family. People would come to me with problems and I was able to fix them. Now I don’t feel like I can fix anything or have the strength to even listen to them. I feel weak when I used to be strong.”

Others’ reactions to the cancer diagnosis may also challenge the way you see yourself.

Whether intentionally or not, you may notice that others are more cautious around you. They offer unsolicited help or take over roles you previously endorsed. Some may stop inviting you to social events under the assumptions that you may not “feel like it” or may be too fatigued to attend. The way you love people and the way they love you in return may look different.

Who you are may even look different as your body is subjected to treatments and surgeries that leave their marks on your skin, some temporary, others more permanent.

Everything changes as cancer threatens who you once thought you were and the future you had imagined living.

You take on new roles while others seem pointless, too tiring, or overwhelming to fulfill.

It may feel like you ARE your diagnosis and everything else is out of reach.

How do you manage changes in your identity after a cancer diagnosis?

1. Recognize that things are different, that you are different

2. Discover new ways to be with yourself and others.

You are NOT your diagnosis. Yet, cancer has had an impact on your life that cannot be ignored, forcing you to rethink who you are while taking into account this uninvited guest. You have cancer AND you are a parent, spouse, best friend, teacher, boss, and so much more.

Take a piece of paper and jot down some thoughts about what it looks or feels like to be a partner, friend, problem-solver, best friend, {fill in the blank}, and have cancer. What makes you uniquely you at this time in your life?

As you read over the different roles or attributes you came up with, some may now feel a bit foreign and others may feel more meaningful than other before. For instance, you may struggle to feel like a provider as you have had to step down from your job to focus on your health. At the same time, being a parent has become a more salient component of your identity as your priorities shifted with your diagnosis.

Allow yourself to revisit ways in which you can still embody important roles in your life.

What are some new ways you have been showing up as a partner? What does it look like to be a friend despite not being able to spend time socializing outside of the house?

You may also become aware of new aspects of your identity that may not have been present before.

3. Be patient with and kind to yourself.

You may still struggle to be okay with the way cancer has impacted your identity or find that the way you think about yourself changes from one day to the next. And it is okay! Change is incredibly hard. Unexpected change even more so.

As you navigate these changes and strive to get a sense for who you are, remind yourself to be kind to yourself. We often do a better job at being kind to others, our partner, children, best friend, even strangers! Remind yourself as often as you need to extend that same kindness towards yourself.