Pandemic Parenting Tips

Pandemic, coronavirus, COVID-19. Regardless of what you choose to call it, this globally-impacting disease translates to one universal fact—these are challenging and unprecedented times for all. In the midst of a new normal, mental health is sacrificed while many scramble to establish structure in their daily lives. In other words, life doesn’t simply stop, even when it may feel like we’re in a perpetual state of limbo. With survival mode as our shield of armor, we learn to shift and adapt.

Now picture this: school is closed for the remainder of the academic year, and parents suddenly have to tackle new roles including teacher, tutor, therapist, mediator, and friend—just more skills to add to your repertoire as a parent. Children are ripped from their routine, and in turn, may be manifesting these sudden changes in the form of anxiety, depression, and developmental regression. You may find that your fiercely independent six-year-old is now begging you to let her sleep in your bed. Your sweet and shy four-year-old is kicking and screaming with every ounce of his being. Your Tic-Toking teen has officially locked herself in her room and is refusing to engage with the rest of her family. Here’s where the good news kicks in—you are not alone, and this is not your fault—nor your children’s.

Below are some tips and tricks to tackle common behavioral and emotional concerns that parents are facing today, and more importantly to start welcoming mental health back to the forefront of your mind.

1.     Gut over guilt: Parental guilt is inherent, and especially now can be at an all-time high. It’s understandable to feel upset that your child was robbed of the joys and benefits of school, yet your desire to fill the void and promote happiness may be hindering them. By needing to fulfill their every demand, wish, and desire, you are strengthening your child’s capacity to eventually push back against structure and defy your requests. Follow your parental gut, the one suppressed underneath the guilt, and follow accordingly when something isn’t sitting right. It’s okay to delete that extra toy out of your Amazon cart, or to have difficult conversations with your child, even if it may upset them.

2.     Establish structure: This is both to your benefit and theirs. Create a makeshift school or daycare, one where rules are written and verbalized. Sit down with your child and identify at least three rules or tasks to be followed daily. Including your children in this activity places the accountability in their court. Children thrive off structure, even when they crave chaos and spontaneity. Find a happy medium and attempt to create a weekly schedule to check off homework, meals, and playtime.

3.     Negative attention = attention: Highlight positive behaviors you are desiring more of, and practice selective ignoring when the negative behaviors are not posing a safety threat. This applies to children across all ages. Ignoring your child does not make you neglectful, so long as you are boosting their confidence and recognizing them for their polite manners, problem-solving skills, and following the rules. Replace words that are trigger points for children including “don’t” or “stop” with positive statements that promote the behaviors you are wanting to see in them (e.g. please use your inside voice; please keep your hands to yourself).

4.     Set consequences: This one is tough. Every family has a different tactic and strategy when it comes to discipline. However, removing desirable objects and activities from your child of any age when they are breaking important rules or acting defiantly is an effective measure to establish greater harmony at home. Sit down with your child and identify three consequences that can be enforced in a single day if a house rule is broken. These may include losing electronic privileges such as the television or cellphone for four hours after refusing to complete homework, or losing coloring time for 20 minutes after screaming at a sibling. Setting concrete consequences removes the power struggle and heated arguments by simply identifying and sticking to the structure. Selective ignoring will be a key player if your child attempts to refute.

5.     Spend quality time with your family:  You’re probably wondering why that would be a suggestion when you are with your loved ones more than ever, but there is a difference between physical presence and emotional connection. Go for walks as a unit, play board games, spend a few minutes each day letting your child pick the activity to build their confidence and assurance that their opinions matter, and remind every family member that you love and appreciate them. These are trying times, but your family will get through this as a team, one day at a time. Remember to prioritize your mental health—your silent, but efficient, captain chartering new territory in the right direction.

Dr. Bahar Rahnama obtained her Doctor of Clinical Psychology degree at the APA-accredited California School of Professional Psychology at Alliant International University, Los Angeles (CSPP-LA). Dr. Rahnama completed coursework and field-based training in congruence with her graduate specializations across family, child, and couple dynamics. Through both research and clinical practice, Dr. Rahnama’s interest encompasses the correlation between enactment of cultural norms and parent-child attachment styles. Her examination and focus on these factors have led to a multitude of clinical opportunities and advancements including her UC-Davis certification in Parent Child-Interaction Therapy (PCIT), an evidence-based model that meticulously targets disruptive behaviors in children between the ages of two and seven while enhancing a positive and healing bond between caregiver and child.

Making the Decision to Pursue Therapy

There are myriad reasons why people decide to seek therapy. Some individuals want to explore recurring patterns in their lives. They may find themselves making the same mistakes or ending up in situations where they feel chronically dissatisfied and unfulfilled. Others may be searching for clarity or closure on an issue, desiring increased insight and self-awareness, or simply seeking a safe place to process their thoughts and emotions. Some folks may notice that they are not coping well with life’s stressors, such that they are consuming more alcohol than usual, using substances, or avoiding situations or people. Impairment in sleeping and eating habits, frequent conflicts with loved ones, decreased motivation to perform work and household tasks, and a sense of isolation may also be signs that professional support can be helpful. Seeking counseling may be about obtaining feedback about how one is doing and preemptively gaining support before reaching “rock bottom” (one’s subjectively lowest point).

The decision to begin the challenging, yet often rewarding process of psychotherapy can be a difficult one. It is normal to feel uncertain and to experience mixed emotions. This is known as ambivalence, which Merriam-Webster defines as: “simultaneous and contradictory attitudes or feelings (as attraction and repulsion) toward an object, person, or action.” As per Dr. Derek Lee, ambivalence is often characterized by uncertainty, indecision, and fear; he states, “it is a tension between opposing beliefs, feelings or behaviors.” He indicates that our motivation to pursue action may change depending on our complex and sometimes conflicting needs and priorities at a given moment. Rollnick, Miller, and Butler agree that competing motivations—“to simultaneously want and not want [change] are normal and common” (2008). Ambivalence may manifest as simultaneously wanting to lose weight, but hating exercise/diets or wanting to quit smoking/drinking alcohol for the personal health benefits, but needing the stress relief it provides.

The prospect of change can be exhilarating, while terrifying and overwhelming all at once. There may be a comfort in the familiar and a tendency to stay in the exact same situation, even when it is clearly dysfunctional or unhealthy. One need not hit “rock bottom” in order to decide that it may be helpful to seek the services of a mental health professional. If you recognize that something needs to change, but do not know what or how to make the change, you may benefit from professional counseling services. Perhaps you know that you are miserable in a relationship, job, or otherwise, but you cannot figure out how to resolve this dilemma or there is a discrepancy between your current self-perception and how you wish to see yourself. You might have a hard time identifying goals or overcoming the obstacles (i.e., low motivation/energy, poor organization) to achieving them.

Why is change in your life necessary and important? Achieving self-growth and actualizing one’s goals can be empowering and improve our sense of self-confidence and agency that we CAN achieve and are in control of our lives. The capacity to change demonstrates mental flexibility, which is believed to be a sign of emotional health and well-being (Ebberwein, 2010). Sometimes it can be helpful to stir things up in a positive direction. If you decide to pursue therapy, remember that you are not necessarily making a lifelong commitment. Try framing therapy as an opportunity to try something new. Imagine what you can learn about yourself! Of course, along with all the potential benefits of therapy, there are some intrinsic risks as well. Learning about yourself may be helpful in the long run, but it may also illuminate aspects of your personality or ingrained behavioral patterns that are not congruent with how you would like to see yourself, thus, potentially causing some temporary distress as you figure out how to reconcile this discrepancy.

These are some questions/issues to consider when deciding whether or not to begin therapy:

1)    What are your expectations of therapy? Clarify any misconceptions and get more information as needed.

2)    Consider your goals and what you hope to get out of counseling. This may be a collaborative process between you and your therapist, who may facilitate the development of realistic, achievable goals.

3)    What are you willing/able to afford on a weekly basis? Will you be using insurance or paying for services out-of-pocket?

4)    Does your health insurance cover mental health (also called “behavioral health”) services? What is your co-payment and deductible? The therapist’s office should be able to assist you in obtaining this information if you have difficulty.

5)    Consider the pros and cons of starting therapy. Pros may include: having an outlet to share concerns with an objective third party, working with a professional toward personal goals, learning new coping skills, becoming aware of patterns that may not have previously been clear. Meanwhile, cons may include: actively confronting the thoughts and feelings you may have been avoiding or repressing, in addition to investing time, financial resources, and energy “doing the work” required to effect desired changes.

6)    What are the motivating factors pushing you to seek help (i.e., what do you want to be different)? What values are perhaps incongruent with your current behaviors (i.e., you value health and quality of life, yet cannot seem to quit smoking)?

7)    What is your availability and willingness to commit to therapy, even for a trial period?

8)    Conduct research online to find a therapist who is both qualified and seems to be a good fit for your needs. Consider someone’s credentials and training relative to the problems you are hoping to address (i.e., a life coach may be suitable for certain concerns, whereas someone with a master’s or doctoral-level education may be better equipped to help you through more complex mental health or relationship issues). Do you want someone who specializes in a particular area (i.e., weight loss, medical illness, couple’s work, grief counseling, relationship concerns, LGBTQ issues)? Do you feel more comfortable speaking with a counselor of a particular gender, someone who is younger or more senior in the field, someone who shares a similar cultural background or speaks your native language? You may contact your insurance company for referrals and/or find referrals for local providers through comprehensive websites such as Psychology Today.

There is no right or wrong decision about whether to pursue therapy. Consider the above to determine if it is the “right” choice for you at this time. 

Dr. Jacquie Talesnick is a licensed clinical psychologist at the Rowan Center for Behavioral Medicine who has trained in both cognitive-behavioral and psychodynamic therapeutic approaches. She considers herself to be an integrative therapist, pulling from different methodologies and theories to tailor treatment to each individual with whom she works. She offers psychotherapy services to the adult population in individual and couples modalities. She specializes in working with individuals in the LGBTQ community. Her other specialties include treatment of relationship difficulties, trauma, depression, and anxiety. She has a special interest in the benefits of animal companions, as well as supplementing traditional “talk therapy” with creative approaches (i.e., writing, art). 

 REFERENCES

Ebberwein, C. (2010, May). Practicing Flexibility for Good Mental Health. Retrieved September 08, 2016, from http://www.yourmindyourbody.org/practicing-flexibility-for-good-mental- health/ 

Lee, D. (n.d.). Ambivalence in Therapy: Exploration & Resolution. Retrieved September 8,  2016, from http://www.psychodelights.com/pdfs/ambivalence1.pdf

Rollnick, S., Miller, W.R., & Butler, C. (2008). Motivational interviewing in health care: Helping patients change behavior. New York: Guilford Press.

Hypnosis: How Does It Really Work?

For many, hypnosis conjures images of a man with a vest, swinging a pocket watch, speaking slowly and encouraging sleepiness. Alternatively, hypnosis has been incorporated into many stage shows, with depictions of previous shy audience members, bursting forth into maniacal dance moves while hypnotized. However, the use of clinical hypnosis has been gaining momentum over the past several years. It is now accepted as a valid subject of scientific research and is a useful clinical tool for a variety of medical conditions, including: 

  • Acute and Chronic Pain

  • Phobias

  • Anxiety

  • Depression

  • Eating Disorders

  • Smoking

  • Obesity

There are many theories on hypnosis and how it works. It is often referred to as a procedure involving cognitive processes in which an individual is guided to respond to suggestions for changes in sensations, perceptions, thoughts, feelings, and behaviors. Alternately, hypnosis can also be defined of its effect (Barnier & Nash, 2008). This refers to the fact that not all individuals will respond the same way to a hypnotic suggestion during treatment or even become hypnotized. Therefore, the response to hypnosis can differ from widely from one individual to the next. In short, hypnosis can either be defined by “what it looks like” (hypnosis-as-procedure) or “what it does” (hypnosis-as-response; [Jensen, 2011]).”  

Hypnosis begins with an induction and is followed by one or more suggestions for making positive changes. At times, these suggestions are designed to result in a positive response during the treatment, as well as after the session, becoming “permanent and automatic.”  In the first phase, hypnotic induction, the individual is guided through suggestion to relax, concentrate, and/or to focus his or her attention on one thing. The second phase, hypnotic suggestion, is when the individual is guided to undergo changes in experience. There are different types of suggestions including: 

  • Ideomotor Suggestions – experience a movement

  • Challenge Suggestions –told he or she will not be able to do some particular thing and then is asked to perform the prohibited behavior

  • Cognitive Suggestions – experience changes in sensations, perceptions, thoughts or feelings

Hypnosis is generally used as a clinical tool for making direct suggestions to reduce symptoms or as an addition to other forms of psychological treatment. For example, hypnotic analgesia helps a patient undergoing a painful medical procedure (e.g., surgery, a lumbar puncture, spinal tap) by suggesting that the affected body part (i.e., the back) is numb and insensitive to pain through hypnosis. Hypnosis can alter and eliminate the psychological experience of pain and the brain’s neurophysiological processing of pain. Remember that not everybody responds the same way to a hypnotic suggestion during treatment or even becomes hypnotized. 

There are simple tasks, known as test suggestions, that can help determine how a person may respond to hypnosis. The number of test suggestions that a person responds to (or passes) indicates their level of suggestibility. Each individual will differ in terms of how high or low they fall on suggestibility, which is a marker for how much or how little a person will respond to hypnosis. Below is a simple task called the Chevreul Pendulum Demonstration that can be used to test whether a person is suggestable or not.

Instructions:  

  1. Obtain scissors, string, and ½ inch washers at a hardware store.

  2. Cut a 5-7-inch length of string and tie it to the washer.

  3. You will have an opportunity to experience an imaginative suggestion.

  4. Place your right elbow on your right thigh and hold the string between your right thumb and index finger so the washer is suspended beneath.

  5. Hold your hand as still as possible.

  6. Now imagine that the washer is beginning to move from left to right. The washer is beginning to move from left to right. Continue imagining that the washer is moving from left to right. Continue to imagine this for another minute or so.

  7. Now I want your hand return back to normal.

*NOTE. There will be a range of responses.  Some of you will show no response at all.  Others will find that their washer moves quite a bit. The degree of movement is suggestive of your degree of suggestibility. Remember suggestibility accounts for a portion of how much or how little you respond to hypnosis. However, research strongly indicates that the vast majority of people can benefit from hypnosis interventions.

Common Myths about Clinical Hypnosis (NONE OF THE BULLET POINTS BELOW ARE TRUE)

  • Individuals undergoing hypnosis lose control and can be made to say or do whatever the hypnotist wants.

  • Individuals may not be able to come out of hypnosis.

  • Hypnosis only affects naïve and gullible people.

  • Hypnosis reliably enhances the accuracy of memory.

  • Hypnosis enables people to re-experience a past life.

  • Hypnosis depends primarily on the skill of the hypnotherapist.

Dr. Narineh Hartoonian is a Clinical Health and Rehabilitation psychologist at the Rowan Center for Behavioral Medicine. She has several years of interdisciplinary clinical and research experience in health and rehabilitation psychology and has served the needs of many individuals with chronic medical conditions and disability. Dr. Hartoonian received her Bachelor and Master of Science in Physiology from the University of California, Los Angeles (UCLA) and her Doctorate in Clinical Psychology from Loma Linda University (LLU). She has taught various graduate and undergraduate courses in the physiological sciences, health and psychobiology.

REFERENCES

Barabasz, A. F., & Barabasz, M. (2008). Hypnosis and the brain. In M. R. Nash & A. Barnier (Eds.), The Oxford handbook of hypnosis: Theory, research and practice, 337-363. Oxford, UK: Oxford University Press

Jensen, M. P. (2011). Hypnosis for chronic pain management: Therapist guide. Oxford University Press, USA.

Feelings Part 3: Expressing and Communicating Feelings

In parts 1 and 2 of this blog series, we explored what feelings really are and the negative consequences of suppressing feelings. We also discussed some techniques to get in touch with and identify long suppressed feelings. In this blog, we will discuss how to express feelings and effectively and respectfully communicate them to others.

Feelings can be likened to charges of energy that need some sort of release from the body. Physical and psychological wellbeing is improved if you are willing to acknowledge and express your feelings relatively close to the time they occur. Release of feelings can come from talking to someone, writing your feelings out, or physically discharging your feelings

Talking with a supportive and trusted friend, partner or counselor is one of the best ways to express your feelings. It is important that you feel safe enough to let your feelings out rather than just talk about them. Expressing your feelings through talking works best when the person you are sharing with merely listens rather than jumping in with advice, opinions, or suggestions. 

Another way to express emotions is through writing them down. It is sometimes helpful to keep a feelings journal where you can enter your strong feelings. Tracking your strong feelings over time can be helpful in identifying patterns or themes in your life. Whether you choose to save what you’ve written or not, writing feelings down can serve as an effective outlet of expression.

Often people report greater difficulty expressing perceived negative emotions such as sadness and anger. When working with these emotions it is helpful to consider some specific techniques designed to assist with discharging these emotions. 

Sadness

People often report that they feel like they are on the verge of tears or have a lump in their throat but are unable to cry. Crying can be a very cathartic release of grief and sadness that helps people stabilize following a loss or disappointment. If you are having trouble letting out sadness, consider listening to evocative music that has personal significance to you. Watching an emotional movie or reading poetry and literature can bring unexpressed sadness to the surface. 

Anger

Often people chronically suppress anger because of fear of hurting others. As discussed in my previous blog, this can lead to psychological and physical illnesses. At times it can be helpful to engage in physical motions associated with aggression in order to bring anger to the surface. Examples of this include hitting a pillow, hitting a punching bag, throwing eggs against a wall or into a bathtub, yelling into a pillow, hitting a tennis racket against the bed or working out vigorously. A word of caution here though, these techniques are to be used sparingly and only when you are having a difficult time bringing anger to the surface. Evidence suggests that ventilating anger too frequently can lead to increased feelings of anger. 

Communicating Your Feelings

In the section above we were focused on expressing or discharging feelings. Now we turn towards communicating our feelings toward specific people, i.e. letting them know that your feelings are related to something they said or did. Communicating long-held feelings to the person you have them about can be the final step towards being able to release the feelings and move on. There are some important things to consider when communicating your feelings. First, you need to make sure that the person you are going to disclose your feelings to is willing to listen. If your feelings are miscounted or you leave the conversation feeling misunderstood, your sadness, fear or anger toward the person may increase. It is important that you clearly ask for the person to set aside some time to listen to you. You also need to be prepared to ask for the person to wait until you are finished if they interrupt you. 

You should avoid blaming or belittling the person. People are much more likely to listen if they are talked to in a respectful and non-blaming way. Using first person statements helps the listener to remain non defensive. By taking responsibility for your feelings, you avoid such statements as, “You made me so mad when you didn’t pick up the phone.”  A better way to express this is, “I feel angry when you don’t answer my phone calls.” 

A second rule of thumb is to remain focused on the person’s behavior rather than making a personal attack. It is important that you take the time prior to the discussion to clearly identify what the other person said or did that angered or frightened you. By focusing on specific behaviors, there is hope that something can change to remedy the conflict.

The third rule of thumb is to avoid judgments. If you begin judging others, there is less likelihood that they will be willing to hear you out and negative feelings and interactions are likely to continue or even escalate. 

By implementing the above strategies for expressing and communicating your feelings, you are cultivating a value of respecting yourself and those with whom you are in a relationship with. 

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.

Feelings Part 2: Identifying Feelings

As mentioned in my previous post on feeling, many people go through much of their lives ignoring or suppressing their feelings. This can be for a multitude of reasons including fear of falling apart through experiencing strong emotions and messages from childhood that labeled certain feelings as bad or unacceptable. Because suppressing feelings becomes so automatic for many, many report that they don’t even know what they are feeling. By learning to recognize the characteristics of suppressed feelings and tuning into your body, you can become much more adept at identifying what you are feeling. 

Even though feelings are suppressed, they typically don’t just go away. They often manifest in a number of bodily and psychological symptoms.

Free-floating anxiety: Anxiety is a very normal and common reaction to any multitude of situations. However, if you are feeling anxious and uneasy for no identifiable reason, it may be due to unexpressed feelings. If this is a state you are familiar with, try to observe if this free-floating anxiety arises the next time you hold in your anger toward someone. 

Depression: Depression can arise when we hold in grief or feelings of sadness over a loss. Indeed, a grief reaction that is not fully expressed can evolve into a depressive episode. Getting in touch with our grief, crying and fully mourning often allows us to feel better and begin the healing process. If you have not experienced a recent loss, your depression may be anger directed towards yourself. This is particularly true if your find yourself attacking and criticizing yourself. 

Psychosomatic symptoms: Frequent headaches, gastrointestinal symptoms, high blood pressure and asthma often occur as a result of chronically withheld feelings. Holding in feelings over the course of many years is a form of stress that takes a toll on bodily systems. Often people find that when they learn to identify and express strong feelings, their physical symptoms abate.

Muscle Tension: Tense muscles are a particularly effective cue that feelings are being chronically withheld. We tend to hold tension in different body groups depending on what feeling we are suppressing. Anger tends to lead to the tightening of the neck and shoulders, while grief and sadness often results in tightening muscles in the chest and around the eyes. Fear typically reveals itself through the tightening in the stomach and diaphragm. While these are typical patterns of muscle tightening, these are not absolute. That’s why it is important to get to know your own particular physical experience of various feelings.

Tune Into Your Body

Thinking about your worries and concerns keeps your primarily in your head. It is necessary to shift focus from your mind to your body. The following steps have been adapted from Eugene Gendlin’s work on experiential focusing can be quite helpful in getting in touch with your physical experience of feelings.

  1. Physically relax. Spend five to ten minutes using a relaxation technique such as progressive muscle relaxation or meditation to slow down the mind and relax the muscles of the body.

  2. Ask yourself, “What am I feeling right now?”

  3. Tune into the place in your body where you usually experience emotional sensations such as anger, fear and sadness. Often observing the area of your hear or gut will reveal some sensations, but this may be different for you. Try to identify your particular place where feelings arise in your body.

  4. Observe what you sense when you tune into your body. Don’t try to analyze, figure out, or judge what arises. Just allow your self to wait and observe any feelings that are surfacing.

  5. Many find that they get stuck in steps 3 and 4 and are inundated with racing thoughts. If this occurs for you, simply begin at step 1 as this may mean that you need some more time to relax. You might try a few minutes of slow deep breathing.

  6. Once you have come into contact with a sense of what you are feeling, ask yourself:

    • Where in my body is the feeling?

    • What is the shape and size of this feeling?

    • If the feeling had color what would it be?

Hopefully, this exercise will help you begin to get in greater contact with your physical experience of various feelings. If you are still having a hard time identifying what you are feeling, you might find the feeling list below helpful. 

Positive Feelings                Negative Feelings

Affectionate        Great                                                            Afraid            Hostile

Alive                   Happy                                                             Angry            Humiliated

Amused             Hopeful                                                         Anxious        Hurt    

Accepted        Joyful                                                               Apprehensive        Ignored        

Beautiful        Lovable                                                            Ashamed        Impatient

Brave            Loved                                                                  Awkward        Inadequate

Calm            Loving                                                                  Bitter            Incompetent

Capable        Loyal                                                                  Bored            Indecisive

Caring            Passionate                                                      Confused        Inferior

Cheerful        Peaceful                                                           Contemptuous        Inhibited

Cherished        Playful                                                           Defeated        Insecure    

Comfortable        Pleased                                                   Dejected        Irritated

Competent        Proud                                                        Dependent        Isolated

Concerned        Quiet                                                          Depressed        Jealous

Confident        Relaxed                                                       Despairing        Lonely

Content        Relieved                                                         Desperate        Melancholy

Courageous        Respected                                            Devastated        Miserable

Curious        Safe                                                                 Disappointed        Misunderstood

Delighted        Satisfied                                                    Discouraged        Muddled    

Desirable        Secure                                                        Disgusted        Needy

Eager            Self-reliant                                                   Distrustful        Outraged

Energized        Sexy                                                           Embarrassed        Overwhelmed

Excited        Silly                                                                 Exacerbated        Panicky

Forgiving        Special                                                       Fearful            Tired

Friendly        Strong                                                          Foolish            Touchy

Fulfilled        Supportive                                                 Frantic            Trapped

Generous        Sympathetic                                          Frustrated        Troubled

Glad            Tender                                                          Furious        Unappreciated

Good                                                                                  Guilty            Unattractive

Grateful                                                                             Hateful            Uncertain

                                                                                            Helpless        Uncomfortable

                                                                                            Hopeless        Uneasy

                                                                                            Horrified        Unfulfilled

In my next post, I will be providing some suggestions for expressing and communicating your feelings, so they no longer have to remain suppressed. 

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.

Feelings Part 1: Defining Feelings

Many people who come into therapy report that they are disconnected from their feelings. A notable symptom of many psychological conditions including depression and anxiety is disconnection with one’s own feelings. It makes sense that people who are experiencing emotional pain and trauma often suppress their emotions. This coping strategy is often very effective in reducing distress in the short-term but the long-term ramifications can be painful and far-reaching. One negative effect of pushing down negative emotions is that positive emotions are also muted. Another consequence of emotional repression is that after a period of many years people sometimes cannot identify what they are feeling. Others may be able to identify their feelings but cannot express them. Many people find themselves feeling chronically depleted and unfulfilled. 

What exactly are feelings? Feelings are a total body response that involves the limbic system and autonomic nervous system. When you feel emotionally excited you may notice increased heart rate, increased respiration, sweating and even trembling or shaking. Extreme feeling states such as those experienced during panic attacks are characterized by our bodies’ fight of flight response, which mobilizes our ability to respond in the face of danger or threat.

Feelings do not just occur out of nowhere but are influenced by your thoughts and perceptions. The way we view the external world as well as internal events such as self-talk, imagery or memories affects the feelings we experience in response to stimuli. For example, shortness of breath and a racing heartbeat can be attributed to fear when in the presence of something we perceive as dangerous such as a growling dog. The same physiological sensations could also be interpreted as excitement if we’ve just seen our favorite sports team score a point. 

Feelings exist in two groups- basic and complex. Basic emotions include anger, grief, sadness, fear, love, excitement and joy. Complex feelings may be a combination of more basic emotions and are often mediated by our thoughts. Examples include eagerness, relief, disappointment and impatience. Often, we find the complex feelings last a longer time and are more tied in with thinking, while basic feelings are better characterized by their short duration and the prominence of physiological symptoms. Many times, we experience a mixture of many feelings. When having interpersonal difficulties with a loved one, we can experience a multitude of emotions including anger, sadness, guilt and love. 

Feelings give you energy and getting in touch with and expressing your feelings can make you feel energetic and vibrant. People who are out of touch with their feelings often report being lethargic, numb or depressed. Furthermore, blocked or withheld feelings often result in stress and anxiety.

Feelings are not right or wrong – they simply exist. Experiencing fear, joy, guilt, sadness or anger is not wrong or invalid. Typically, recognizing and expressing your feelings in appropriate ways is more healthy than denying them. It is important not to judge yourself or anyone else for the feelings they have. 

We often suppress our feelings by actively controlling them or holding them in. This may occur because the context is not appropriate for expressing our feelings. For example, when you are at work and feel annoyed with your supervisor’s request. In this scenario, immediately expressing your feelings would not be effective. Other times, we may experience unpleasant feelings and immediately busy ourselves by trying to ignore our feelings. This unconscious avoidance or evasion of feelings is what is referred to as repression. When we get in the habit of suppressing feelings, we often find that we have a hard time expressing feelings appropriately or even accurately identifying them. This can lead to chronic feelings of emptiness or numbness and a lack of contact with your core sense of self. 

When feelings are suppressed over a long period of time, individuals may sense that they have surrendered or can experience a partial loss of control when experiencing emotions. Chronically suppressed feelings become large and overwhelming and people sometimes feel that they are going to lose control or go crazy if they give full voice to long-suppressed emotions. However, by accepting and experiencing your feelings fully, they become less scary and help us develop greater awareness of ourselves and our relations to others. 

In my next post about feelings, I will be exploring ways to identify, express and communicate feelings in healthy ways. 

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.

Life-threatening Pediatric Medical Diagnoses and Treatment: Overcoming the Adversity

Pediatric patients diagnosed with a life-threatening medical condition and their families are catapulted into crisis mode as they embark upon a challenging journey with numerous potentially traumatizing situations.  These children and adolescents may experience frightening diagnoses, emergency room visits and multiple hospitalizations with unknown duration, painful or distressing procedures, adverse side effects, and repeated losses related to one’s underlying illness or disability. Even with such experiences, both research and clinical experience have shown that many of these youngsters and families and are resilient, meaning that they are able to cope and adjust effectively to the challenging circumstances; however a subset of patients and families continue to experience emotional and adjustment difficulties that can lead to significant disruption to their lives. 

Life-threatening pediatric medical conditions and treatment can hinder the achievement of normal developmental tasks of pediatric patients, especially for adolescents. A medical illness may impede their ability to establish an identity, make decisions about education and career paths, and form relationships (Dahl, 2004).  Particularly challenging can be the clash between their need for independence (and sense of invincibility) and the dependent status as a patient.  In addition, their usual concerns with body image and emerging sexuality may be worsened by the changes in physical appearance related to the medical condition and treatment, such as weight gain, hair loss, and scares from procedures/surgeries.  Mintzner and colleagues found that 16.3% of adolescents who underwent solid organ transplant met all criteria for post-traumatic stress disorder (PTSD), and an additional 14.4% endorsed post-traumatic stress symptoms (PTSS).  In study of 63 cancer patients (ages 7-20 years), 25.4% met the DSM-IV criteria for Major Depressive Disorder (MDD), 14.3% for anxiety disorder, and 12.7% for comorbid MDD and anxiety disorder (Gothelf et al., 2005).  These symptoms are alarming as it can not only impact one’s quality of life, but also lead to avoidant behaviors that negatively impact treatment and recovery (e.g. missing clinic appointments and being non-adherent to their treatment regimen). 

Of note, pediatric illnesses have a significant impact on parents and siblings, representing a psychological health risk for the whole family.  Caregivers must often absorb complicated medical information and make critical decisions about treatment, witness the child in pain and undergoing intensive treatment, as well as face uncertainty about their child’s future.  Thus, it is not surprising that PTSS have been well documented in caregivers.  In particular, Kazak et al. (2001) found that 11% of mothers (who had a child diagnosed with cancer) met criteria for PTSD diagnosis, while 95% of them met criteria for the re-experiencing symptom cluster and 53% for the hyperarousal cluster; for families who had two participating parents, 80% had at least one parent with moderate-to-severe PTSS (Kazak, Boeving, Alderfer, Hwang, & Reilly, 2005). Similarly, Farley and colleagues (2007) reported 19% PTSD prevalence among parents of children who underwent heart transplantation.  Similarly, healthy siblings may be suddenly separated from family members for long periods of time, witness the physical and emotional pain of the ill brother/sister and parent distress, and deal with the uncertainty of the future.  Research has shown that siblings experience mood disturbances, conduct problems, poor academic achievement, and difficulties in social relationships (Alderfer, Labay, Kazak, 2005; Barbarin et al., 1995).  

Overcoming the Adversity:

While mild symptoms of most children and family members will be resolved without formal psychological or psychiatric intervention, evidenced-based treatment is indicated for those who continue to have elevated and/or escalated psychological distress. While there is no one specific template or road map for maneuvering the pediatric illness journey, trauma-focused cognitive-behavioral strategies have demonstrated efficacy for traumatized children and their families, and should be considered the first line treatment.  Psychopharmacological treatment, involving Selective Serotonin Reuptake Inhibitor (SSRI), is recommended for the treatment of PTSD in combination with psychotherapy; it is considered as a first line medication for children who are not responding effectively to psychotherapy or when symptomatology is severe (Forgey & Bursch, 2013).

It is important to note that the effects of traumatic experiences may not be universally negative.  In fact, childhood cancer survivors have shown to report increased maturity, greater compassion and empathy, new values and priorities, new strengths, and recognition of one’s vulnerability and appreciation for life (Parry and Chesler 2005).  In addition to being resilient, research and clinical experience have also revealed the phenomenon, posttraumatic growth (PTG), which is the positive psychological change that results from a struggle through a life-altering experience (Seligman & Csikszentmihalyi 2000; Levine et al., 2008).  Picararo and colleagues (2014) conducted a literature review and posited that PTG may involve numerous components, including greater appreciation of life, improved interpersonal relationships, greater personal strength, recognition of new possibilities in one’s life course, spiritual or religious growth, and reconstruction of a positive body image.  They authors revealed that parents and children may experience PTG following medical trauma through a combination of cognitive and affective processing of their subjective experience.  These findings are encouraging as psychotherapy provides a safe place for such cognitive and affective processing to take place, guided by a skilled and empathic clinician.   

A family-based approach to assessment and treatment is central to the overall adjustment and well-being of the pediatric patient.  Given that a secure attachment to a caregiver, healthy parental psychological functioning, effective parenting skills, and cohesive family functioning have demonstrated to be protective factors in the face of adversity (Laor et al., 1996; Lavingne & Faier-Routman, 1992), families can benefit from treatment that aim to foster these relationships and skills.  When receiving support that is grounded in trauma-informed care, many can experience posttraumatic growth and develop resilient characteristics that allow them to overcome ongoing or future adverse experiences. 

Dr. Kanchi Wijesekera, is a licensed clinical psychologist currently completing a postdoctoral fellowship at University of California, Los Angeles (UCLA).  Here, she provides trauma-focused assessment, consultation, and treatment to children, adolescents, and families who have been exposed to a wide range of challenging life circumstances and traumatic experiences.  In addition to providing services in the general family trauma clinic at UCLA, she’s also part of two multidisciplinary teams that serves the needs of patients and families in the pediatric heart transplant and hematology-oncology outpatient clinics.  She co-facilitates support groups for caregivers of solid-organ transplant pediatric patients who are admitted to Mattel Children’s Hospital as well.  Dr. Kanchi has many years of experience working with youth and families; using evidence-based treatment, she builds upon the current strengths of her patients and offers tailored treatment to bolster coping skills and optimize their emotional health. She also provides outpatient treatment to children, adolescents, and families in her private practice office in Westwood, CA, located within just 1-mile of UCLA. She can be reached for questions or consultation at (310) 800-7112.

REFERENCES

Alderfer, M., Labay, L., Kazak, A. (2003).  Brief report: Does posttraumatic stress apply to siblings of childhood cancer survivors? Journal of Pediatric Psychology, 28(4), 281-286. doi: 10.1093/jpepsy/jsg016

Barbarin, O., Sargent, J., Sahler, O., Carpenter, P., Copeland, D., Dolgin, M., et al. (1995). Sibling adaptation to childhood cancer collaborative study: Parental views of pre- and postdiagnosis adjustment of siblings of children with cancer. Journal of Psychosocial Oncology, 13, 1–20.

Dahl, R.E. (2004).  Adolescent brain development: a period of vulnerabilities and opportunities. Keynote address.  Annals of the new York Academy of Sciences, 1021, 1-22.

Farley, L., DeMaso, D., D’Angelo, E., Kinnamon, C., Bastardi, H., Hill, C., Blume, E., Logan, D. (2007). 

Parenting stress and parental post-traumatic stress disorder in families after pediatric heart transplantation. Journal of Heart Lung Transplant; 26(2):120–126.  

Forgey, M. & Bursch, B. (2013).  Assessment and management of pediatric iatrogenic medical trauma. Current Psychiatry Reports, 15(2):340.

Gothelf, D., Rubinstein, M., Shemesh, E., Miller, O, Farbstein, I, Klein, A., …, Yaniv, I. (2005).  Pilot study: fluvoxamine treatment for depression and anxiety disorders in children and adolescents with cancer.  Journal of American Academy of Child and Adolescent Psychiatry, 44(12), 1258-1262.  

Kazak, A., Barakat, L., Alderfer, M., Rourke., M.,Meeske, K., Gallagher, P., et al. (2001). Posttraumatic stress in survivors of childhood cancer and mothers: Development and validation of the Impact of Traumatic Stressors Interview Schedule (ITSIS). Journal of Clinical Psychology in Medical Settings, 8, 307–323

Kazak, A., Boeving, C., Alderfer, M., Hwang, W., Reilly, A. (2005) Posttraumatic stress symptoms during treatment in parents of children with cancer.  Journal of Clinical Oncology, 23, 7405–7410.

Laor N, Wolmer L, Mayes LC, et al. (1996). Israeli preschoolers under scud missile attacks: a developmental perspective on risk-modifying factors. Archives of General Psychiatry, 53(5), 416– 23.

Lavigne, J. V., & Faier-Routman, J. (1992). Psychological adjustment to pediatric physical disorders: A meta-analytic review. Journal of Pediatric Psychology, 17, 133-157.

Levine, S. Z., Laufer, A., Stein, E., Hamama-Raz, Y., & Solomon, Z. (2008). Posttraumatic growth in adolescence: Examining its components and relationship with PTSD. Journal of Traumatic Stress, 21(5), 492-496.   

Mintzer, L., Stuber, M., Seacord, D., et al. (2005). Traumatic stress symptoms in adolescent organ transplant recipients. Pediatrics, 115, 1640-4.

Parry, C. & Chesler, M. (2005).  Thematic evidence of psychosocial thriving in childhood cancer survivors.  Qualitative Health Research, 15, 1055-1073.

Picoraro, J., Womer, J., Kaza, A., and Feudtner, C. (2014).  Posttraumatic growth in parents and pediatric patients.  Journal of Palliative Medicine, 17(2): 209–218.

Seligman MEP., Csikszentmihalyi, M. (2000). Positive psychology: An introduction. The American Psychologist, 55, 5–14.

Core Beliefs Part 2: Creating Healthier Core Beliefs

In my last post, I wrote about how to identify and understand your core beliefs. As a refresher, core beliefs are those underlying ideas that we have about ourselves, the world, and others. In some cases, these beliefs help us to get our needs met and make us feel good about ourselves. However, in some cases they can lead to feelings of anxiety and depression when they indicate that the world is dangerous or that we are unworthy or helpless. 

In the case of negative core beliefs, we want to begin to examine and change those thoughts that are causing us problems. Changing core beliefs allows us to improve how we feel in our own skin and in the world around us. 

Ways to Change Your Core Beliefs

There are several approaches that you can take to change your core beliefs. One important way to help you think in a new way is to look for the facts that support and negate your negative core beliefs. 

One powerful way to chip away at your core negative beliefs is to begin to examine the evidence for and against the automatic thoughts that are associated with the belief. Often, it is easier to find the automatic thoughts so this can make the work a bit more straightforward. 

For example, if your belief is that you are a failure and that leads to a thought that, “I never get things right.” Then you can start by looking for evidence for and against that idea that you NEVER get things right. Likely, you will find that sometimes you get things right and sometimes you don’t. If are able to prove to yourself that you are able to get things right then over and over then it will begin to see that sometimes you may fail but there are many times when you do things well; therefore, you are not a failure you are simply a human being that succeeds and fails. 

You can also challenge your core beliefs directly. This process works in the same way as challenge your automatic thoughts. However, it often requires you to not only identify your beliefs but to also take a look a the “big picture” of your life.

For example, if you have the core belief that, “My life is stuck” then you would start by looking at ways in which you could make changes in your life and ways that you may not have choices. You might discover that although there may be aspects of your life you can’t change immediately, there are changes that you can make. You may also find that a series of small steps could lead to movement in your life that would help you escape this sense of being stuck. In the end, you are likely to discover that there may be ways in which you are stuck at a given time, but that there are still opportunities to get out of being “stuck.”

Another way to challenge your thinking is by taking another perspective. Many therapists will often ask their patients to think about what they might say if a close friend or family member shared that same thought about themselves. What we find, is that most people are able to be a lot kinder with others and more flexible in their thinking when talking to a friend.

For example, if your best friend told you that s/he was worthless what might you say? My guess is that you would begin to share with that friend all the ways in which they mean something to you and others. You would help them to see their significance and work to reframe that belief. Now think about what it might be like to do that for yourself.

So many people have negative core beliefs about themselves and the world that get in the way of their happiness and ability to reach their full potential. If you find that you are being held back by these underlying thoughts, try some of these techniques to see what a difference it can make to change your thinking and ultimately your core belief system.

Dr. Stephanie Davidson is a licensed, clinical health psychologist and co-founder of the Rowan Center for Behavioral Medicine specializing in the use of cognitive-behavioral, humanistic and existential approaches to treat patients with a range of medical and mental health challenges. She has a strong interest in acceptance and commitment therapy and other mindfulness-based interventions to heal the body and mind. Her focus is on collaboration with the goal of assisting patients in adjusting to difficult experiences and achieving a greater sense of well-being, balance and peace in their lives.

Core Beliefs Part 1: Identifying and Understanding Core Beliefs

Core beliefs are the underlying ideas we hold about ourselves, others and the world. These ideas develop during childhood as you begin to use your relationships with caregivers and your own experience to interpret the world around you. From this learning and interpretation, you develop specific thoughts and rules that allow you to get your needs met. 

While in many cases these beliefs can be helpful, there are times when they can cause negative emotions. For example, it is has been suggested that those individuals who experience  symptoms of depression are more likely to have core beliefs that tell them that they are helpless and/or unloveable (McQuaid & Carmona, 2004). Those with anxiety are more likely to have beliefs that suggest that the world is an unsafe place. If you find that you are suffering from symptoms of depression and/or anxiety then it can be very helpful to examine what your core beliefs may be. 

Identifying Core Beliefs

The first step in identifying problematic core beliefs is to first learn to identify those thoughts that are bouncing around in your head every day. We refer to these thoughts as automatic thoughts because they simply arise and pop into our heads without conscious thought. 

There are two relatively easy ways to identify your automatic thoughts. The first is to simply sit quietly and observe your thoughts. You can do this at any time but are likely to find this technique most helpful when you have been feeling down or edgy and anxious for a period of time. The idea is not to ponder whether these thoughts are true or false. Instead the goal is simply to begin to identity the thoughts. The other way to identity your automatic thoughts is to look for times when your feelings or mood shift abruptly such as when you begin to feel angry. Again, the goal is not to spend time ruminating on the thoughts. We simply want to label them as thoughts and take note of the content. Once you can identify these thoughts it is very helpful to write them down. 

The next step is to use those automatic thoughts to dig down to the underlying core beliefs. One of the most powerful techniques for identifying core beliefs is the downward arrow technique. Essentially, the downward arrow technique asks you to begin to ask questions about your automatic thoughts. Here are some questions that can be helpful (adapted from McQuaid & Carmona, 2004):

  1. What does this statement say about me in this situation? What does it mean?

  2. What does this thought tell me or say about how I view the world, my friends or my family?

  3. What is the worst thing that this statement or thought may say? Why is this situation, thought or feeling so bad?

  4. What thoughts do I have about myself that would make this thought or situation so bad? What is causing me to feel so upset?

The Downward Arrow in Action

Here is a example of this technique in action:

Joe applies for a job and gets a call that the position has been filled. His first thoughts is: “of course, I didn’t get the job.”

Joe takes note of this thought when he realizes that he is feeling both angry and sad for several days after the call. So he asks himself, “What does this thought say about me?”

He concludes that, “It means that I never get the job.” And “I am always the second or third choice.”

He then asks himself, “What is the worst thing about not being selected?”

He learns that, “It means that I am not good enough.”

He then asks, “Why is this so upsetting to me?”

He realizes that it means that, “I feel like I am not worthy of a good job”

Joe’s underlying core belief is, “I am not worthy.”

Now it is clearly disappointing to not get a job offer when you are excited about the potential position; but, for Joe, this is about more than simply being let down. He finds that he is having a strong negative reaction that has gone on for a period of time. Not only does this core belief make him feel bad, it could lead to him being less likely to try for another position. Therefore, it is important for Joe to be able to understand why he is having so much trouble in this situation. Without understanding his core belief, Joe is powerless to change it. Once he is able to recognize this negative idea he has about himself, he is capable of working to improve his view of himself. 

Core beliefs are powerful underlying messages that we send ourselves, often without evening understanding what is happening. Therefore, it is extremely helpful to begin to notice the thoughts that you are having when you feel upset. You can then dig deeper to understand what core ideas you hold that could undermine your view of yourself and others so that you are able to take steps to change them. 

If you are interested in more information on how to change your core beliefs, look for our next post that focuses on how to change your core beliefs.

Dr. Stephanie Davidson is a licensed, clinical health psychologist and co-founder of the Rowan Center for Behavioral Medicine specializing in the use of cognitive-behavioral, humanistic and existential approaches to treat patients with a range of medical and mental health challenges. She has a strong interest in acceptance and commitment therapy and other mindfulness-based interventions to heal the body and mind. Her focus is on collaboration with the goal of assisting patients in adjusting to difficult experiences and achieving a greater sense of well-being, balance and peace in their lives.

Part 2: Advanced Hug Physiology

Some of you may remember my earlier blog titled “Part 1: Hugs Not Drugs”. The blog explained that simply hugging someone can boost a range of hormones and chemicals in your body, including oxytocin. A quick synopsis of how oxytocin impacts our body is provided below:

1)     Protects our cardiovascular system (Grewen et al. 2003 & 2005).
2)     Reduces free radical production and other inflammatory markers lowering the risk for heart attacks. 
3)     Increases nitric oxide production causing the dilation of blood vessels, which decreases blood pressure, inflammation and plaque build-up.
4)     Helps with depression (Scantamburlo, 2007; Arletti and Bertolini, 1987; Andeberg and Uvnas-Moberg, 2000).
5)     Helps with decreasing anxiety symptoms (Scantamburlo, 2007; Andeberg and Uvnas-Moberg, 2000).
6)     Acts as an anti-stress neuropeptide (Legros, 2001; see figure 1).
7)     Reduces the production of cortisol (Ditzen et al. 2009; Taylor, 2006; Heinrichs et al. 2003).
8)     Improves sleep quality by decreasing levels of cortisol.
9)     Boosts your immune system (Gimpl & Fahrenholz, 2001; Carter, 2014).
10)  Lowers pain sensitivity (Dunbar et al. 2012; Mazzuca et al. 2011).

The last blog focused on WHAT oxytocin does. Today’s blog focuses HOW oxytocin works in our body and how it positively impacts our stress response and improves our mental and physical health.

This figure may seem a bit overwhelming, but I promise I will explain every step the best I can. Enjoy! 

There are two main pathways in this figure that I will discuss. The first pathway is the stress-response pathway that ultimately leads to the release of cortisol. The second pathway is the oxytocin pathway that leads to the release of oxytocin and is typically activated when you give someone a hug, during intimacy, childbirth and is involved in the milk let-down reflex and social bonding.  

The Paraventricular Nucleus (PVN) is located in our hypothalamus (a region of the brain responsible for coordinating and controlling homeostasis). Neurosecretory cells and other neurons, located in the region of the PVN are responsible in releasing neuropeptides and hormones, including oxytocin and Corticotropin releasing hormone (CRH), into the systemic venous and hypopheseal portal system (a collection of blood vessels that connects the hypothalamus to the pituitary). Depending on the situation, one of those two pathways may be it activated.

Let’s start with the stress response pathway. During the stress response, the cells located in the PVN release CRH which then act on cells of the anterior pituitary to release Adrenocorticotrophic Stimulating Hormone (ACTH). ACTH then acts on the adrenal cortex to release cortisol (cortisol is a natural occurring steroid called a glucocorticoid). Cortisol is also known as the stress hormone. Chronic elevation of this hormone can negatively impact our mental and physical health including memory, sleep, depression, metabolism, immune system, wound healing, electrolyte balance, gastric secretion etc.

Now, if you look to the right of this figure (the second pathway) you will see that the PVN also releases oxytocin neuropeptide into the blood stream. Oxytocin is associated with lowering the release of CRH and ACTH (look at the arrows with the red [-] sign). If CRH and ACTH are suppressed, then glucocorticoid (cortisol) production decreases. In addition to acting on the Hypothalamic-Pituitary-Adrenal Axis (HPA Axis), oxytocin acts on the parasympathetic nervous system (PNS) and the sympathetic nervous system response (SNS) which make up our Autonomic Nervous System (ANS). More specifically, it increases the PNS activity and decreases the SNS activity. The PNS is responsible for “resting and digesting,” lowering heart rate and blood pressure. The SNS on the other hand prepares us for “Fight or Flight” by increasing heart rate above 100 beats per minutes, stress response, and shutting down our digestion when signaled. However, with the release of oxytocin the SNS activity is lowered to its original threshold. This can be achieved by a simple hug.

How is this related to mental health:

In individuals with anxiety, the SNS and HPA Axis are often being activated and the release of the stress hormones increase, resulting in the symptoms that many individuals with anxiety experience (i.e., increase in heart rate, dizziness, excessive sweating, sleep difficulties, shortness of breath, increased alertness, excessive worry, restlessness, etc.). Hence, when you activate the oxytocin pathway the activity of the SNS and the HPA decrease, resulting in lowering your stress-response (Carter, 1998; Insel, 1997). Also being able to control the chronic elevation of cortisol can limit memory impairment, sleep difficulties, and depression and can also help with metabolism as well as immune system functioning etc.  

*Tips for General Public: remember in order to feel and benefit from the effects of a hug you must hug for at least 20 seconds with each hug. Also the more hugs you give and receive (resulting in repeated exposure of oxytocin release), participation in social bonds might gradually bring about long-term changes in stress reactivity (decrease in SNS and increase in PNS activity) that promote not only psychological feelings of comfort and security, but also cardiovascular health.

*Tips for Mothers: More often than not mothers give their little ones frequent hugs and adequate caregiving, which is important because even a  simple hug has many benefits for your child. In contrast, inconsistent caregiving and not providing infants with adequate care has been shown to increase insecure attachment in children, lowering vegal tone, increasing anxiety, depression, anger and stress for the child. So providing consistent caregiving and care is vital for a child’s health. In animal studies, simple maternal touching reduces the entire stress response in children (Pihoker, Owens, Kuhn, Schanberg, & Nemeroff, 1993; Wang, Bartolome, & Schanberg, 1996) so as so continue to give your little ones a hug at least 1-2x per day.

***Note. A hug is not intended to substitute for conventional medicine. If you have been prescribed medication by a physician please follow your physicians recommendation. You can always use a hug as a complimentary method but not as an alternative treatment method to reduce the above mentioned effects.

Dr. Narineh Hartoonian is a Clinical Health and Rehabilitation psychologist at the Rowan Center for Behavioral Medicine. She has several years of interdisciplinary clinical and research experience in health and rehabilitation psychology and has served the needs of many individuals with chronic medical conditions and disability. Dr. Hartoonian received her Bachelor and Master of Science in Physiology from the University of California, Los Angeles (UCLA) and her Doctorate in Clinical Psychology from Loma Linda University (LLU). She has taught various graduate and undergraduate courses in the physiological sciences, health and psychobiology.

REFERENCES

1.     Andeberg, A.M., Uvnas-Moberg, K., 2000. Plasma oxytocin levels in female fibromyalgia syndrome patients. Z. Rheumatol. 59, 373–379. 

2.     Arletti, R., Bertolini, A., 1987. Oxytocin acts as an anti-depressant in two animal models of depression. Life Sci. 41, 1725–1730.

3.     Bartz, J.A. et al. (2010) Oxytocin selectively improves empathic accuracy. Psychol. Sci. 21, 1426–1428.

4.     Carter, C.S. (2014). Oxytocin pathways and the evolution of human behavior. Annu Rev Psychol.

5.     Carter, C.S. (1998). Neuroendocrine perspectives on social attachment and love. Psychoneuroendocrinology, 23, 779–818.

6.     Ditzen, B. et al. (2009) Intranasal oxytocin increases positive communication and reduces cortisol levels during couple conflict. Biol. Psychiatry 65, 728–731.

7.     Dunbar RIM, Baron R, Frangou A, Pearce E, van Leeuwen JC, et al. 2012. Social laughter is correlated with an elevated pain threshold. Proc. R. Soc. B 279:1161–67.

8.     Gimpl G, Fahrenholz F. 2001. The oxytocin receptor system: structure, function and regulation. Physiol. Rev. 81:629–83.

9.     Grewen, K.M., Anderson, B.J., Girdler, S.S., Light, K.C., 2003. Warm partner contact is related to lower cardiovascular reactivity. Behavioral Medicine 29, 123–130.

10.  Grewen, K. M., Girdler, S. S., Amico, J., and Light, K. C. (2005). Effects of partner support on resting oxytocin, cortisol, norepinephrine, and blood pressure before and after warm partner contact. Psychosom. Med. 67: 531–538.

11. Heinrichs, M., Baumgartner, T., Kirschbaum, C., Ehlert, U., 2003. Social support and oxytocin interact to suppress cortisol and subjective responses to psychological stress. Biol. Psychiatry 54, 1389–1398.

12.  Hurlemann, R. et al. (2010) Oxytocin enhances amygdala-dependent, socially reinforced learning and emotional empathy in humans. J. Neurosci. 30, 4999–5007.

13. Insel, T.R. (1997). A neurobiological basis of social attachment. American Journal of Psychiatry, 154, 726–735.

14. Legros, J.J., 2001. Inhibitory effect of oxytocin on corticotrope function in humans: are vasopressin and oxytocin ying–yang neurohormones? Psychoneuroendocrinology 26, 649–655.

15. Mazzuca M, Minlebaev M, Shakirzyanova A, Tyzio R, Taccola G, et al. 2011. Newborn analgesia mediated by oxytocin during delivery. Frontiers in Cellular Neuroscience. 5(3); 1-9.

16. Pihoker, C., Owens, M. J., Kuhn, C. M., Schanberg, S. M., & Nemeroff, C. B. (1993). Maternal separation in neonatal rats elicits activation of the hypothalamic-pituitary-adrenocortical axis: A putative role for corticotropin-releasing factor. Psychoneuroendocrinology, 18,485-493.

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