Motivation: Start Lifting Yourself Up and Stop Beating Yourself Down

Motivation, non-judgment, authentic life
Listen to the Audio Version of Dr. Bando’s Article.
Often, clients or prospective clients approach me for help with motivation. We all want to live vibrant lives and maybe increase exercise, change the foods we eat, stop eating late at night, make that health care appointment, or countless other important things. Today passes, then tomorrow, then a week goes by, and we realize we haven’t made that change we wanted at all. We can’t seem to find that Motivation, so we get frustrated and feel defeated. Our self-talk becomes harsh: “Ugh, I am so bad at this!” “Why can’t I just do what I’m supposed to?! It should be easy!” “I’m hopeless.” “I’m an idiot!” We give up for the moment and throw in the towel, abandon our goals, and try to accept things as they are, giving up hope that we will ever make that change.

Finally Fed Up?

Maybe we finally decide to get serious. We are disgusted enough with ourselves that we make a strict plan to ensure we adhere to the behaviors we “should” be doing. Then one day passes, then another, then a week, and then here we are: still stuck, still without change.

Perhaps we even make the change for a brief time. Maybe we start eating in a way that makes us feel nourished and energized while helping to reach a target weight. Then, time goes by, and we are sick of being restrictive and “depriving” ourselves, so we give in and “indulge,” feeling stuck in old behaviors, staying unmotivated, and continuing the cycle.

It’s Time to Get Motivated!

MOTIVATION happens when our goals align with our values, then the behaviors we take to move toward our goals link closely to our values, and we reinforce those behaviors. I know from personal experience that the key factors in staying Motivated are reinforcement, which inspires and ignites Motivation, and punishment, which extinguishes Motivation. When we narrow it down to these two simple principles, we begin to realize how straightforward it is to start down a path to lasting change. By reinforcing yourself with simple things like clear goals, being in tune with what is truly important to you, and staying passionate (by focusing on what works and reinforcing the hell out of it), you are guaranteed to break yourself free from that cycle.

Audio Meditation for Motivation:

Listen to Dr. Bando’s Audio Meditation
To stay motivated and moving toward goals that you value, you must build the muscle of Reinforcement. Finding what you are already doing that is working, or taking very small steps forward, and then rewarding those actions creates sustainable motivation for change. Think of it this way: punishment extinguishes motivation and reinforcement creates, ignites, awakens and maintains motivation. Where you have reinforcement, you can create motivation.

Let’s practice building this muscle:

Start with noticing your breathing. You do not have to change or alter your breath. Simply notice that you are inhaling and exhaling. Pay attention to where in your physical body you feel your breath.

Now, for the next three to five breaths, pay attention to where you feel your breath in your physical body and when your mind wanders away or zones out, gently bring your attention back to your breath.

When you notice yourself wander and bring you attention back to your breath, you can think of this as a weight lifting rep, or an exercise to build your ability to put your attention where you want it.

Now, let’s go further. Using this idea of placing the mind where you want it to be in the moment, recall one thing you did in the past day that was effective. Unless you achieved a huge goal in the past day, this exercise requires you to let go of judgments and find where you were effective. Do not dismiss anything for not being “good” enough or “big” enough. If you were tired and you got up on time, that is an accomplishment. If you felt depressed and did not want to get out of bed but you took a shower, perhaps that was effective. It does not matter how big or small you think this action was, take a moment and pick one effective action you engaged in over the past day.

When you have that behavior in mind, reinforce it. You can reinforce this behavior a number of ways: you can reinforce with self-talk, such as, “Good job,” or “I did it,” or “Nice!” Remember, your focus is on what you did well and reinforcing it. If your mind wanders to telling you that it wasn’t good enough, your practice is to gently bring your focus back to what you did well and reinforce it. You may also reinforce your behavior through soothing touch. Maybe if feels soothing to place your hands over your heart center and notice the warmth, or one hand over the other hand, or gently cup your face with both hands. This is touch that feels loving and sweet. Again, when your mind wanders to you or your behavior not being good enough, gently bring your attention back to what you did well and reinforce it.

This is the practice of increasing your motivation in a way that is sustainable and reliable. You can practice this every day – find one thing you did well and practice turning your mind toward noticing what you accomplished and reinforcing it. When your mind goes toward judgments about you or your behavior not measuring up, this is punishment. It will extinguish your motivation and ability to move forward. It’s not wrong, this is just what minds do, they wander, and they come up with judgments. Your task is to calmly notice when this happens and bring your attention back to reinforcing your accomplishment. Practice, practice, practice this and you will notice your motivation grow and your ability to take more steps toward your goals increase.


When Others’ Opinions Get You Down (and What to Do When You Feel Fat)

judging ridicule others' opinions feeling fat
We’ve all been self-conscious about our appearance, and have at one point or another worried about what other people think of us. Whether it’s how we dress, speak, act, or even weigh, that concern can at times be overwhelming. While it’s important to take in others’ opinions (this gives us a reflection of ourselves and how we are perceived), over-valuing what others think or may think, while under-valuing our own ideas can damage our self-respect. If you’d like to spend less time concerned about others’ opinions and more time embodying your own values, I’ve put together a few strategies that will help you in this area.

Tuning In

Tuning in requires focusing on your internal voice and turning up the volume so that it is louder than the opinions around you. When you find yourself in a situation where you feel over-worried about what someone else may think of you, ask yourself, “What, in my deepest values, do I believe about this situation?” You may also ask yourself how you would respond to a friend who was in your shoes. Would you shame and browbeat her or tell her that you understand where she is coming from and she did not do anything to be embarrassed? The strategies of asking how you feel, what you believe and to what standard you would hold someone you care about, gives you valuable feedback about whether you want to correct your behavior or if the problem is not your behavior but worry thoughts and shame entering your mind and body.

Your Values, Thoughts, and Emotions

When you have discovered that you have behaved, dressed, spoken, etc., in line with your values but are still plagued by embarrassment and worries about what others think of you, the first step is DON’T CHANGE YOUR BEHAVIOR. If you change your behavior when your behavior is not the problem, you are sending yourself a confusing message and shame is likely to build.

For example, Marla (pseudonym) found herself concerned that she was not “thin enough” and felt embarrassed about her appearance in certain social situations. As a result of this embarrassment, Marla would tug on her clothes, check herself often in the mirror, avoid being in pictures, and plan her outfit days in advance in response to excruciating worry thoughts. When Marla asked herself about her values, she realized that she would never ever treat a friend the way she was treating herself. She would never judge a friend based on her weight or fit of her clothes and would not want to associate herself with anyone who would judge in this way. Yet, she had been behaving as though she should be ashamed.

Marla’s strategy became clear: Treat her body as perfectly fine and refuse to apologize for how she looks. This means that Marla resisted urges to tug on her clothes, plan the perfect outfit in advance, and even volunteered to be front-and-center in photos. Initially, her self-critical and worry-thoughts increased, and she felt embarrassment wash over her when seeing a full-body picture posted on Facebook. Marla was determined, though, and she persisted.

Over time, her mind and body understood the consistent message that Marla was sending. The message was, “I will not apologize for how my body looks because there is no reason to apologize.” Her self-hating thoughts and worries about what others thought of her began to quiet and feelings of embarrassment lessened over time. Now, when Marla feels a surge of her old urge to apologize for her appearance rear its ugly head, she knows what to do and prioritizes her mental health and self-respect.

As my wise Zen teacher says, “You cannot force yourself to be different. All you can do is practice every day until one day, you become what you have practiced.”

Your Breath and Sensations

If you find it difficult to tune into your values and priorities, start with your breath. Any of my past or present patients will tell you that at least once per therapy session, I will ask them to stop and notice three inhalations and exhalations. This offers an opportunity to notice what the breath is doing in the body. Stop and try it now – place your awareness on your breath for three inhales and exhales. Notice: Where in your physical body does your attention go as you are placing your awareness on your breathing? Your breath is a readily available sensation that can help you start to tune into your body and then your wisdom.

After noticing how your breath feels in your physical body, you can also start to pay attention to sensations. Start to ask yourself questions, such as, “How does my body feel when I am having fun, trusting myself, following what feels right?” Are you relaxed in some areas, tense in others? Do you notice changes in your posture? How about temperature or a feeling of moving energy in various parts of your body? The more you tune into how your body feels, you will begin to get clear messages from your wisdom and be able to sharply access your values and priorities in different situations.

Now What?

The more you practice paying attention to your breath, listening to your body and feelings, identifying your values and behaving as though they matter, the easier it will become. With any new behavior practice, practice and then more practice is needed to help the new habit stick. As my wise Zen teacher says, “You cannot force yourself to be different. All you can do is practice every day until one day, you become what you have practiced.”

Identify a step from this article that you can put into practice today and practice doing this every day until it becomes easy for you. Then, identify and take a next step. If you are a person who has loud self-critical thoughts, it will take a while for them to calm down and for value-driven thoughts to take up your mind space. Give yourself the time you need and devote yourself to one small practice every day.

If you want additional help learning how to truly experience and enjoy your life, contact Dr. Bando today for an online consultation and start shifting from surviving to thriving!


In an Exercise Rut? 5 Steps to Get Unstuck!

exercise rut, healthy habits, staying active

 

If you are in an exercise rut or not exercising at all, you are probably associating exercise with a “have to” rather than a “want to.” If you’re not having fun and exercise feels more like a punishment than a reward, you will not keep doing it. The way your brain is wired, it remembers situations that feel punishing and avoids them. This means that if exercise feels like a chore, your brain will make it harder and harder for you to engage in that activity. You will notice your motivation continue to decrease.

We all know that a sedentary life brings countless health problems. Most people agree that exercise has extreme health benefits: strength and muscle maintenance, slows down the aging process, weight management, mood regulation, skin health, balanced hormones, increases energy, promotes sound sleep, andimproves circulation. Exercise also regulates your brain chemistry, including the neurotransmitter serotonin, a key chemical involved in depression and anxiety.

Since you know exercise is beneficial to your overall health and well-being, how about making it rewarding instead of punishing? Follow the 5 Steps below to get out of the rut and feel vibrant and energized moving your body again!

STEP 1: Identify where exercise could be enjoyable.

What, realistically, would be a step toward enjoyable exercise that you can take this week? Before you respond with, “No exercise is enjoyable,” really open your mind here. Most, if not all of us enjoy moving our bodies in a way that feels good. What way of moving your body feels pleasurable to you? Perhaps you miss going on a morning walk and listening to the birds. Maybe you enjoy the feel of the water when you go swimming. Perhaps you feel powerful lifting weights. If exercise is new to you, think about environments you enjoy being in and how you might inject just a little bit of movement. Perhaps you enjoy that first big stretch before getting out of bed in the morning? No movement is too small. For Step 1, just start identifying where or when you enjoy moving your body. Put judgments aside and think about what feels good in your bones.

STEP 2: Figure out a small and realistic next step based on where you are right now.

Be honest with yourself. If you take advanced yoga classes three times per week, lift weights, and hike regularly, your next step will look very different than if you fancy yourself a couch potato and haven’t exercised in years. It doesn’t matter where you start or how small your first step seems to be. I once had a client who was sedentary, and years ago, she used to love to walk outdoors in her neighborhood. Her first steps toward exercise involved finding and then cleaning her walking shoes. These steps took a couple of weeks, and then she was off and walking. I viewed this as a tremendous success because she had been trying to bully herself into walking for years, with no success. By putting judgments aside (she initially thought these steps were too “small” and “silly”), she was moving regularly, and feeling energized and motivated in a matter of a few weeks.

STEP 3: Take the first step!

This may seem obvious, but many people can get stuck in the planning stages. Planning exercise is not exercise. Once you have identified a first do-able step, take it! Go for it! HINT: If time goes by and you are not taking that first step, break it down further into much smaller steps until you can follow through and take one.

STEP 4: REINFORCE!

There is a reason this step is in all CAPS. I cannot emphasize enough the power of reinforcement. If you respond to the step you have taken by telling yourself it is “too small” or “not enough,” you are punishing yourself for the effort you just put forth and can look forward to another exercise slump and watch your activity level wane. In contrast, reinforcingyourself for doing it, giving yourself positive feedback and being proud of what you are accomplishing is how you can keep your momentum, or build it. (Scroll to the bottom of this article for more specifics on reinforcement and how to do it.)

STEP 5: Keep taking this same step and reinforce it until it becomes easy.

Resist the urge to take on more until you have mastered this step. If you do, you risk becoming overwhelmed and may give up before you’ve reached your exercise goals. Keep taking this step until it no longer feels like a challenge but feels rather easy to do. Once mastered, it is time to increase the difficulty and, you guessed it, reinforce. (Expert tip: Once the step has become easy, reinforce it only sometimes before tapering off the reinforcement altogether. This is called intermittent reinforcement, which is the most effective way to lock in a behavior and make it permanent.)
These steps still apply even if you have an active lifestyle. Are you feeling stalled because you have plateaued, or have been doing the same workout so long that it is easy or boring now? Then make it a little harder, step it up, and move towards a more challenging work out using the five steps above. Immediately jumping ahead to something that is very challenging to you right away can only work if you accept that the road to a new habit or skill is not a straight line. For more on that, visit the earlier article on how change really happens:REINFORCEMENT is the most effective way to achieve lasting change.

Some ideas for reinforcement:

DEFINITION: A REINFORCER is anything that increases the likelihood of a behavior occurring again.

  • TIMING counts!
  • Make sure to reinforce your progress as soon as you can after engaging in the desired behavior. (e.g., You just put on your shoes to go for a short walk to increase fitness. REINFORCE yourself right then. “Nice!” “I did it!” Don’t wait. REINFORCE immediately!)
  • Remember, the brain is making connections. The most powerful connections are made when the behavior and reinforcer happen close together in time. You can do it!
  • Find REINFORCERS that work.

Make a note of the REINFORCERS you want to try from the list below or use the list to help you brainstorm some of your own reinforcers.

  • Congratulate yourself (“Good job!” “You did it!”).
  • Make and enjoy your favorite flavor of tea.
  • Write a smiley face on your list next to the task you accomplished.
  • Stop and notice sensations of pride in your body.
  • Enjoy a small bit of nourishing food you enjoy and really taste it (e.g., a sip of fresh orange juice, a small piece of chocolate).
  • Look in the mirror and say, “I’m really proud of you.” Mean it and take it in. Feel the effects.
  • Choose an activity you enjoy to reward yourself (e.g., coloring, a favorite TV program, listening to a favorite song, play with Play-Doh).
  • Dance around the room.
  • Pat yourself on the back or give yourself a hug and feel the effects.
  • Gently rub the back of your hand while acknowledging your efforts.
  • Keep joyful pictures on your phone and take a moment to look at them and enjoy.

The key, no matter how many good tunes are on your iPod or what new sport you’re trying, is that you reinforce yourself- give yourself credit for all the work you do, even and especially when you are moving towards your goals but have not hit them yet.

For professional help with changing habits and creating a thriving life in alignment with your values, contact Dr. Bando today.

 


5 Thoughts to Help Cope with Anxiety in The Moment

Anxiety can feel overwhelming, often involving unpleasant physical sensations accompanied by rumination that just won’t stop. Anxiety can creep up and spoil an otherwise pleasant moment. The very best thing you can do to cope with anxiety when it rises is welcome it in! It’s entirely counter-intuitive to do so, yet it works. In fact, it is the most effective treatment for anxiety.

When you try to avoid feeling anxious, push it away, or try to distract from it, you are feeding the monster and anxiety will continue to grow. If you attempt to escape anxiety, you are learning that anxiety is something dangerous to be feared, which in turn increases your experience of anxiety. When this happens repeatedly, you become more and more anxious. When you not just face anxiety, but welcome the experience in, you will learn that anxiety is not to be feared, you can cope with whatever comes your way, and then, and only then, will anxiety subside and become tolerable.

Use these to encourage yourself to cope with anxiety in-the-moment.

 

 1. “This is a moment of suffering”

Acknowledging that you are in a painful moment is a first step toward tolerating it. Taking a mindful approach by simply labeling that “this is a moment of suffering,” can help you notice and attend to what is happening. When you mindfully label this experience, it can give you some space to decide how to respond. Instead of being caught in the hurricane of anxiety, you can take an internal step back, put words on your experience, and have a moment to get a little perspective to cope with anxiety. Acknowledging when you are in a moment of suffering is also a first step in the practice of mindful self-compassion, a therapy developed to alleviate human suffering.

 2. “I can do it”

Anxiety and fear can make you freeze up, holding you back from some task you need to do or a goal you want to go after. Remind yourself you can do it (after all, you made it this far). Sure, it may not turn out perfect or exactly as you want. However, when you commit to trying, there is hope that it can work out. When you try, you also get a chance to learn. Saying to yourself, “I can do it,” reminds you that even if you are feeling so anxious that you are sweating and shaking, you can still continue to put one foot in front of the other, gently moving toward your goals. Anxiety and fear may come along for the ride, and they don’t have to stop you from getting to where you want to be.

5 Ways to Cope with Anxiety in the Moment

 3. “I can get through this”

Maybe you have tried something new, and it’s not working out. You may feel like your world has crashed down and thoughts like “I can’t cope with this” and “I can’t get through this difficult situation” may cross your mind. Anxiety is a common trigger for the belief that we cannot cope or we can’t make it through. Remind yourself you can get through this. Chances are, you have already faced challenges in your life. Each time, you managed to make it through and learn from the situation – you may have even ended up with a better outcome. Draw upon this inner reflection on strength and resilience to get through this situation too.

 4. “I am here now”

One of the biggest causes of anxiety is the tendency to live in the past and the future, rather than the present. Sometimes, you may dwell on the past with regrets. You may worry about the future and what could be. This adds to anxiety by keeping your mind spinning in many different directions and adding the pain of the past and possible pain of the future to an already difficult moment. Use gentle reminders to pull yourself into the present. You can also support a present-focused mindset with mindfulness techniques, such as slow, deep breathing or noticing and labeling your surroundings, such as describing the shape and color of objects in your environment.

 5. “I am okay”

Fear is a hard-wired response that you have developed through many years of evolution. Fear tells you a threat is near, and you must take action. However, fear does not always fit the facts. Anxiety is fear run amok and the fear of possible threats. When you feel anxiety, check things out. Look at your emotions and the facts of the situation. Evaluate whether that anxiety is well-founded or a false alarm. Sometimes your anxiety is well-founded, and you should react. Most of the time, anxiety is your mind working in overdrive and there is no real life-or-death threat in your path. In those cases, remind yourself that your brain is trying to keep you safe, but you are okay. It helps to notice the fear so you can cope with anxiety and understand that it is the experience of it and, you are okay.

If you struggle with persistent anxiety, you might benefit from the help of a therapist. Mental health providers who use Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT) can help you recognize and challenge your thoughts, tackle anxiety, and provide one-on-one solutions empowering you to manage and cope with anxiety. If needed, contact a qualified therapist to help and start shifting from surviving to thriving today!

 

 


4 Tips for Returning to Therapy

For an audio recording of this post, visit here: Dr. Bando on Soundcloud 

When you make the investment of time, energy and money in therapy, you want to experience progress and change. If you’ve been in therapy before but haven’t achieved the results you want, you may be wondering what you can do to make those changes. Talk therapy can feel helpful, allowing you to have some real ‘aha’ moments and gain insight into the cause of your problems. However, talk or what’s called “supportive” therapy often does not help you change and meet your goal. Often, what is needed is to learn practical, concrete skills that will help you foster lasting change and healing. This can be achieved through treatment with a results-oriented therapist.

If you’re thinking about returning to therapy and want to create more effective change, here’s what to do:

Four things to keep in mind.

1st- Know That Returning to Therapy Takes Readiness and Commitment

If you have decided on returning to therapy, that’s a great sign that usually indicates you have some readiness and commitment to do what is needed to make changes. The most important first step is finding a therapist who aligns with your goals and who you feel comfortable working with. This can help you stay committed and focused.

Many clients prefer a results-oriented therapist who will work with them to make specific changes toward goals, rather than attending therapy indefinitely. The right therapist can help you identify and build upon your goals from the start and keep you motivated to do what is needed for lasting change.

returning to therapy, return to therapy again California online

2nd- Develop A Plan

While the idea of planning your therapy might seem strange, having a goal and a plan in place makes it much more likely you will succeed in making changes. Sometimes people attend therapy to just talk or vent, but to transform your life you need to work systematically to plan and implement change.

The therapist you choose to work with should develop a case formulation within your first few sessions. This formulation offers expert reflections and additional insight on your current situation. A skilled therapist will indicate a thorough understanding of your unique situation and collaborate with you to make sure this formulation is on target. By the third or fourth session, you and your therapist should have treatment goals and a treatment plan that will guide your future sessions, help you better understand what to expect out of therapy and ensure you both keep your eyes on the prize and moving toward your goals.

 3rd- Take What You Learn in Therapy Outside the Session

One benefit of therapy can be receiving support from your therapist and leaving sessions feeling relieved or empowered. Keep in mind, this is not enough. If you are working to make changes, then you must take the work done in therapy with you, outside of the session, and into your day-to-day actions. A therapist focused on getting you the results that you want will probably ask you to do “homework” or to practice new skills throughout the week. It is essential to follow the recommendations of your therapist and do your assigned practices so that you can reap the benefits of therapy and translate them into your daily life. Practice in between sessions is imperative to change. It also arms you with information about what happened when you tried these new skills, and you and your therapist can troubleshoot and hone the skills in your next session. Your practice and feedback are invaluable in helping you and your therapist stay on track with moving toward your goals.

Depending on your therapist’s style and theoretical orientation, they may be able to implement additional ways to help you achieve change. For example, therapists that have been trained in Dialectical Behavior Therapy (DBT) might ask you to complete weekly Diary Cards, so you can plan to try out and practice newly learned skills and then keep track of what happened and have a straightforward way of reporting this in your next session.

4th- Discuss Problems with Your Therapist

 Therapy does not always happen on a linear path without hiccups. At times, problems may arise. Whether you felt misunderstood by your therapist, your homework did not seem to hit the mark, or you are not making the changes you expected as quickly as you wanted, it is important to talk about this honestly with your therapist. This can be an excellent time for you and your therapist to revisit your identified goals, refine your treatment plan, and figure out any adjustments that need to be made. Although it might seem like a challenging conversation, talking with your therapist about what is not working may help you discover some factors that are holding you back or halting change, making this a valuable part of your treatment. Do not underestimate the value of the feedback you give to your therapist. Once your therapist knows your experience, thoughts, and feelings, he or she has the opportunity to respond effectively, make any necessary adjustments, and this ensures you can get the quality care you want and need.

With the right approach, you can make effective and lasting changes when returning to therapy, learning new and valuable skills that lead to a more rewarding and satisfying way of life.

Remember, life is too short to just survive, that’s why I help people thrive. I’m Dr. Amanda Gale-Bando, licensed psychologist. Thank you for reading and best wishes to you in making the lasting changes you want.

 


What Happens When You Stop Depressant or Anxiety Medications?

Anti-depressant and anti-anxiety medications work to alter your brain chemistry and support a more balanced mood state. Since psychotropic medication changes your brain chemistry and may also come with side effects, deciding to take medication should not to be made lightly.  It’s helpful to understand how the medication you are prescribed works and what to expect when discontinuing it before deciding to stop. It’s always advised to be under the supervision of a doctor who can ensure your safety and help minimize any side effects before discontinuing psychotropic meds.

(Please skip to the last section of this article if you would like to consider alternatives to psychotropic medication and discuss your options with your prescribing doctor and other healthcare professionals.)

Psychotropic medications, taking medicines, psychotherapist

Why Take Psychotropic Medications?

If you are struggling with depression or anxiety in a way that is significantly affecting your life, your doctor may recommend anti-depressant or anti-anxiety medications. Medications are also sometimes prescribed to alleviate symptoms, making therapy more helpful and useful. When feeling burdened by emotional overwhelm, at times it can be impossible to participate in your therapy in a way that promotes the change you need or motivate yourself to follow up on homework in-between sessions. When this is the case, your doctor may recommend psychotropic medication to help you engage in therapy in the way that you need to give you some relief from the symptoms you are experiencing.

Current-day research supports the use of both psychotropic medication and Cognitive Behavior Therapy (CBT) to treat diagnoses associated with depression. Medication may help you be fully involved and benefit from therapy. CBT will help you make the chemical changes in your brain for the long-term so that if you decide to taper off your medication at some point, you can maintain the brain changes you have worked to achieve in therapy.

In other cases, psychotropic medications may be prescribed to address chronic forms of depression and anxiety. Some people suffer from depression and/or anxiety for years. Despite trying many approaches, they struggle with symptoms on a daily basis. In these cases, medication may be a helpful option. Some people choose to maintain their medication regimen for a lifetime because when the medication is withdrawn, symptoms quickly return. Sometimes, even when engaging in all the behaviors necessary to support your health, the chemical components of the disorder you suffer from are just too strong, and medication is an essential part of your health routine. Each person is unique, as are the type, dosage and length of time prescribed medication works best.

It is very important to note that psychotropic medications may be contraindicated for some anxiety disorders and interfere with treatment and prognosis. Evidence-based treatments for anxiety require that you are able to experience the anxiety to its fullest extent in therapy in order for the treatment to be effective. If you are taking medication to decrease your experience of anxiety, in some case, this may interfere with your therapy. Talk to your treatment provider so that you can collaborate about the most effective treatment for you.

 

How Do Psychotropic Medications Work?

Different anti-depressant and anti-anxiety medication work in distinctive ways. Some medications stimulate the brain to produce more neurotransmitters (chemicals in the brain that regulate mood and other processes). Some help the brain by blocking the effects of neurotransmitters. Others, affect the brain by encouraging it to hold onto extra neurotransmitters. Because it takes some time for these medications to affect and balance the neurotransmitters in the brain, anti-depressant and anti-anxiety medications need to be taken for a minimum period of time before results are noticed. Your prescribing doctor can advise you the time needed to experience the affects from your medication.

 

Why Stop Taking Psychotropic Medications?

People often decide to stop using their medications once they start to feel better. This can be a mistake. It is important to carefully consider this decision and preferably, discuss your desire to discontinue medication with your healthcare professional. Often, it’s wise to wait a while after feeling better before discontinuing your prescription. When people quit taking their medication too soon, symptoms can return and sometimes the medication does not have the same effect or potency on mood symptoms the next time around. It is often preferable to wait until you have made changes in your health behaviors and maintained them for long enough where they have become habits. Once you have made the changes needed to support your sustained mental health, you’ll want to make sure they are engrained and part of your life so that you will continue to be supported in this way after your medication has stopped. Other times, people may find the medication they are taking no longer works and they may need to stop one type of medication to start another. Additionally, people may need to discontinue using their medication due to some other health concern (possible side effects, drug interactions, or in cases of pregnancy).

 

What Happens When You Stop Anti-Depressant or Anti-Anxiety Medications?

If you are taking an anti-depressant medication and suddenly stop, it can cause unpleasant symptoms including nausea, vomiting, headaches, dizziness, nightmares, and paresthesia (unpleasant sensations in the skin). If you are taking an anti-anxiety medication (or anxiolytic) and suddenly stop, symptoms could include nausea, vomiting, seizures, sweating, weight loss, heart palpitations, migraines, muscle pain, insomnia, and even suicidal thoughts. Specific side effects are unique to the medication and the person who is taking it. In either case, you may experience a rebound of psychological symptoms.

Because suddenly stopping anti-depressant or anxiety medication can cause unpleasant side effects, it is very important to consult with a doctor before you stop taking prescribed medications. A doctor can help to assess whether this is the right choice. They will also help you slowly reduce your dosage so that you are weaned off the medication safely, which helps to prevent uncomfortable side effects.

When you start or stop medications, it can be helpful to also seek the services of a qualified therapist who can help you address thoughts, feelings and emotions that may be affecting your mental health. A Dialectical Behavior Therapist (DBT) can provide specific education and skills to help you naturally cope with life’s ups and downs, without medication in some cases. A frequently used DBT slogan is, “Skills over pills.” This means that with learning and practice of DBT skills, often people can reduce or eliminate medication and lean on the DBT strategies they have learned to help them function effectively. The most important thing is to work together with your doctor and therapist to find the healthiest and most effective treatment solution for you.

 

Alternatives to Psychotropic Medications

Taking any type of prescribed medication is a personal choice. While doctors can advise you and make recommendations, ultimately, the decision whether to take psychotropic medication is up to you. Many times, making lifestyle changes can significantly impact your mood and decrease the need for prescription use. However, making these changes can be difficult and requires work. Only you and your wisdom can decide whether you are in a position and have access to the support needed to make these changes, or if now is not the time and medication is a worthwhile option.

If you are interested in making changes to your health behaviors to support a more balanced and stable mood, consider consulting with a Health Psychologist, such as Dr Bando. Health Psychologists are trained to understand all the factors maintaining the ineffective behaviors you are engaging in and help you directly target and change those behaviors to better support you. A good therapist can take out the guesswork and help you move toward your health goals with ease and precision.

Whatever your choice, please consult your wisdom and be gentle with yourself. In a time of difficulty (like experiencing depression or anxiety), increased self-compassion is needed.

Take action today and start shifting from surviving to THRIVING!


Feeling Over-“stuffed”: 4 of 4

How to Focus on What Matters During the Holidays (and Keep Yourself Feeling Merry).

Part 4 of 4 of the Holiday Stress Survival Guide

Overeating during the holidays is a shared experience. Everywhere you go seems to be ripe with opportunities to stuff yourself. Cookies, cakes, desserts, and rich meals abound. If you already struggle with overeating, this time of year can feel like a nightmare. Even if overeating is not typically a problem for you, many people gain weight during the holidays and pay with colds, flu and feeling sluggish, and tight clothes in the months following. Read on for some ideas on eating in a way that makes you feel proud of your behavior and connected to your body.

 

AM I HUNGRY?

During the holidays, our self-care behaviors can be on automatic pilot. There is a lot to pay attention to and noticing how we are feeling or what our body needs may not be on the top of the list or even make it on our radar.

 

It may seem obvious, but asking yourself the question, “Am I hungry?” can change your relationship with food and the choices you make about eating. Here’s how to practice: Take a breath (or three) and notice where in your body you feel your breath. Now ask yourself the question, “Am I hungry?” and notice what your body tells you. Put on a curious hat here and notice. Does your mind come up with words? Do you notice sensations in your body? What happens when you ask yourself if you are hungry?

 

Advanced: You can extend this practice and further ask yourself, “How do I know I am hungry (or full)? Where do I feel it in my body?” Try to notice and describe this to yourself.

 

Extra Credit: While eating, pause now and then to take a breath (or three) and ask yourself these questions again. What do you notice now?

 

Why this works: Taking a few breaths and moments to notice what your body is feeling in relation to food and nourishment can help you connect in, be aware of what your body needs or wants and give you some intention before eating. Eating is designed to be enjoyable, nourishing and deeply satisfying. It is a basic need we all share. Practicing connecting with your body in a nonjudgmental, curious way before and during a meal, can change what you eat, the quantity, or how you feel about it. Experiment and notice what happens!

 

Over eating Therapy, Califorinia Psychologist, online therapy

SELF-COMPASSION

I am trying to come up with one person I know who does not have judgments in relation to food. I can’t think of anyone. Our society breeds food and body judgments: good vs. bad, right vs. wrong, fat (bad) vs. thin (good), worthy (thin and fit) vs. unworthy (fat and unfit). We see people on TV commercials celebrating weight loss through packaged food that really doesn’t taste very satisfying. Probably 99% of actresses or actors do not exceed a certain weight limit. We are given the impression that if we just eat “right,” we should be able to look like these characters and the role our genetics play in body shape and size is minimized. We all, to varying degrees, develop a complex about food, size, and worth. Ironically, food is a basic need that must be satisfied to survive. How strange to be taught guilt, shame and judgment about fulfilling a survival need.

 

Most of these judgments are an intellectual and heady experience that has little to do with the body. While reading labels on food and trying to eat healthily are worthwhile pursuits, it leaves out understanding how the body feels and our ability to respond to the body’s needs. I have clients who thrive while eating mainly a plant-based diet and others whose bodies sing while eating animal products. Others feel great and lose inches and bloat on a high-fat eating plan. Some people have food allergies. Every body is different. Every body has its own, unique experience with food. So, doesn’t it make sense to ask how our body is feeling about eating and respond accordingly?

 

Rather than think about a “good” food to eat, practice asking your body what it needs. See what your body says and how it feels during and after eating. This is a much more compassionate and nurturing way to feed yourself. This process also gives you information. What does your body want and when? What happens when you give this food to your body? Do different quantities of this food affect how your body feels?

 

This approach urges you to develop a supportive relationship with your body, kind of like giving yourself the gift of good parenting. This is especially important if you did not receive nurturing parenting or your body has long been deprived of sweet, gentle compassion. When babies are fed, it is a soft, quiet experience, often followed by sleep. Preferably, soothing tones are spoken, and a gentle touch is given. Imagine feeding yourself in this way. Imagine letting go of judgments, giving your body what it wants to eat in the amount that feels right. Checking in and adjusting type or quantity of food as your body calls for it. What a different experience!

 

In addition to practicing asking yourself if you are hungry, try offering yourself some gentle compassion at your next meal. Maybe place a hand on top of your other hand, as a reminder to bring loving awareness to the experience. Perhaps nourish yourself with a deep breath or words of encouragement such as, “This can be hard. Let’s go slow and see how this feels.” Practice calling up the image of someone you love dearly and while you eat, treat yourself with the love and gentleness you would treat this person. Feed yourself compassion with every bite and see what happens to your relationship with food.

 

REMEMBER, CHANGE IS A PROCESS

My Zen teacher reminds me often, you cannot force change. All you can do is practice. Keep practicing, every day, until one day it becomes who you are.

Happy Holidays! Wishing you a gentle, loving, compassionate experience with yourself and the food you eat.

Please remember, life is too short just to survive. Use these practices to help you THRIVE!

 

Read the whole series

Feeling Over-”stuffed” Part 1: Holiday Stress

Feeling Over-”stuffed” Part 2: Navigating Relationships

Feeling Over-”stuffed” Part 3: Loneliness

Feeling Over-”stuffed” Part 4: Overeating

If you use any of the practices suggested, please feel free to share your experiences and send your comments to contact@drbando.com. While Dr. Bando will not answer personally, your comments and feedback help inform future posts.


Feeling Over-“stuffed”: 3 of 4

How to Focus on What Matters During the Holidays (and Keep Yourself Feeling Merry).

Part 3 of 4 of the Holiday Stress Survival Guide

 

The holiday season is filled with so much extra stuff – packed schedules, gifts to buy, errands, food (more on that in Part 4), and people! You may feel over-“stuffed” yet still experience loneliness. Feeling sadness or struggling to enjoy the holiday season is a common experience. Many people find the holidays a stressful time of year. As mentioned, sometimes you may feel lonely (even in a room full of people), have a history of disappointing holiday memories, or have experienced a loss associated with the holiday season (such as the death of a loved one). It can feel like everyone around you is enjoying time with loved ones and the warmth of the season while you feel left out in the cold. If you find this a particularly difficult and lonesome time of year, take heart and read on for some ideas for finding comfort.

 

MAKE MEANING

Research shows us that even in the direst situations (being held in a concentration camp, surviving 9/11, or losing a loved one) people who are able to make meaning have a better quality of life and report more happiness overall in the years following that event. I mention these heart-wrenching examples because when you are down in the dumps and someone tells you, “everything happens for a reason” or some other encouragement geared toward making meaning, it can often feel invalidating and infuriating. The skill of making meaning or purpose in the midst of a painful experience can get you through and help you thrive. Research with survivors of tragic historic events shows us this is true.

 

Here’s what meaning-making is not: Making meaning out of pain is not forcing a smile and pretending everything is okay. It is not people-pleasing and making everyone else happy and comfortable while you suffer inside. It is not telling yourself that this situation happened for a reason or you must have deserved it.

 

What making meaning does involve, is finding a way to derive some purpose, something you can gain, out of the suffering you are in. In other words, how can you play the terrible hand of cards you have been dealt in the most beneficial way possible? Here is an example: I know a woman who has struggled with infertility and it is not possible for her to have children. This is very painful for her and every time the holidays come around, she aches to have a family. Every ornament that is hung and tradition experienced reminds her that she will not be passing any of this on to her own children. She feels pain. Although at times, she may be angry and want to scream how unfair this is, what brings her the most peace is finding meaning through her own spiritual and meditative practices, which she believes she would not do if she had not been met with so much sadness about something she cannot fix. She views her situation as driving her closer to practicing her spiritual beliefs and, as a result, extending increased compassion toward others. This does not make the state of affairs or her pain go away. What this meaning-making practice does, is help her focus on her values and find something of worth in the midst of her circumstances. When she feels lonely, sad, hopeless, she turns to her spiritual practices and finds comfort. This is making meaning.

 

Meaning making is a skill taught in the Distress Tolerance module of Dialectical Behavior Therapy (DBT). Distress Tolerance skills are designed for getting you through the moment when you cannot immediately solve the problem or source of your pain. At times, the holidays can be painful and because of the circumstances, we cannot completely change this. We feel pain, sadness, and loneliness. Making meaning can help us get through until, as with everything in life, this pain too shall pass. There will come a day that you smile and laugh and find pleasure. Remind yourself of this. Don’t let holiday loneliness get to you. Here are some tips to cope with Holiday Season sadness.

 

Online therapy. Loneliness, DBT, video therapy, California psychlogist

 

ENJOY JUST A MOMENT

Another DBT skill, this time from the Emotion Regulation module, is to engage in pleasant activities. The reasoning is that if you don’t have pleasant activities in your day, you cannot have a pleasant life. Sometimes, when you are very low, as you may feel during the holiday season, it feels like nothing gives you pleasure or joy. This is where you must get creative.

 

Instead of looking for bliss, try adjusting your expectations and finding one small thing that you can somewhat enjoy for a few seconds. Some examples are your first sip of coffee, those first few moments of getting into bed after a long day, taking a moment to inhale the delicious aroma of the food you are about to eat, or stopping to notice a beautiful flower. When times are rough and we cannot feel sustained happiness, it does not eliminate our need to be nourished with joy. When we start to notice the little things, even for a few seconds, we begin to build our emotional bank account with some pleasant experiences.

 

Think about having an empty bucket of loneliness or sadness. Every time you notice something even a little bit pleasant, like the moment you take off your shoes when arriving home, you are filling the bucket with a drop of pleasure. Of course, one drop does not make a big difference in a large, empty bucket. If you keep it up, drop by drop, over time, the bucket fills. Although it can feel like a slow process, every single time you turn your attention towards something even a little bit pleasant, you are a drop closer to filling that bucket. When you have accumulated many pleasant events, you will build the ability to feel more pleasure and happiness. Don’t force it. Just keep practicing and it will happen.

 

TAKE TIME TO REMEMBER

If your holiday season is a sad time because of loss and grief, you can make remembrance and the celebration of a loved one’s life a part of your holiday tradition. My grandmother used to make pies during the holidays. She would roll out the extra pie crust, spread it with butter, sugar, and cinnamon, and make special cookies for me to nibble while the pies baked. Now, whenever I make a pie, I use my grandmother’s fabulous pie crust recipe and say a little “thank you” to her for creating this memory for me. My husband now sometimes joins in, and instead of feeling sadness and lack, it has become a bonding experience that brings up nostalgia and gratitude. Rather than trying to push your pain aside or focus only on the positive, you may find a more authentic and touching experience when you take a few moments to remember those you have lost and commemorate this, even with a little “thank you.”

 

I hope that these strategies and activities make the holiday season a lot more enjoyable. If, however, your holiday blues are more severe or do not seem to reduce even after taking steps to help, then you may want to consider visiting a therapist. Therapists trained in Cognitive Behavior Therapy (CBT) and Dialectical Behavior Therapy (DBT) can be particularly helpful in dealing with the realities of the holiday season and finding effective coping strategies. Get in contact with a therapist to find out how they can provide that extra support to help you get through the holiday season, and perhaps feel even better about it.

 

Happy Holidays! Please remember, life is too short just to survive. Use these practices to help you THRIVE!

Read the whole series

Feeling Over-”stuffed” Part 1: Holiday Stress

Feeling Over-”stuffed” Part 2: Navigating Relationships

Feeling Over-”stuffed” Part 3: Loneliness

Feeling Over-”stuffed” Part 4: Overeating

If you use any of the practices suggested, please feel free to share your experiences and send your comments to contact@drbando.com. While Dr. Bando will not answer personally, your comments and feedback help inform future posts.

 

 

 

 


Where Does Anxiety Come From?

We’ve all experienced stress, worry, and anxiety from time to time. For some of us, or at certain times in life, it occurs frequently and can feel overwhelming. At its worst, anxiousness can even impair daily functioning. A lot of factors work together to cause the experience that we call anxiety. Let’s take a look at some specific ways that it develops:

From Chronic Stress Conditions 

Most of us equate stress with anxiousness, and oftentimes, these two do go together. However, when we talk about anxiety as opposed to a passing stressor (a stressful life event that comes and goes rather quickly), there is a lot more to it than just feeling stressed. Some people grow up or live in incredibly stressful environments (e.g., low-income households, experiences of neglect and abuse), and these long-term stressful conditions can make people more vulnerable to anxiety, and in some cases, weaken their ability to handle stress. If your system is already taxed by dealing with chronic, daily stress, your ability to manage more stressors thrown your way will very likely be compromised. A buildup of chronic stressful situations that do not go away quickly can lead to an experience of anxiety.

From Reinforcement

Have you ever heard someone say, “You don’t need to worry,” and you want to answer with, “I do need to worry!”? When we are experiencing anxiety, we often believe it’s helpful, because it gets reinforced. When we feel anxious about something and spend time ruminating and worrying, often everything turns out just fine. We can then believe that anxiety helped achieve the desired outcome. There is an old quote by an unknown author that goes, “Worrying works! 90% of the things I worry about never happen.” We continue to feel anxious and sometimes become almost fearful that if we are not anxious, things will not work out. Most of the time, this isn’t even a process we choose. The cycle gets reinforced, and the brain keeps it going without our intent. Reinforcement is brain food; when a behavior is reinforced, it is likely to occur again.

 

Anxiety, anxious, anxiousness, worry

 

From Avoidance

One function of anxiety is that it helps us to avoid other issues. This can be the most puzzling reason for anxiety. Most of us hate the experience of anxiety, and at first glance, it does not make sense that we would use anxiety to avoid anything. Rather, we want to avoid anxiety! Think of it like this: Anxiety gives our mind something to chew on. We may not like it, and it may not feel pleasant, but it occupies us, nonetheless.

Anxiety tells us that something is wrong and we need to fixate on it, wring our hands, figure it out, look up facts, check out others’ opinions, etc., and it keeps us very busy. Sometimes it keeps us so busy that we can’t focus on much else. If we are having an uncomfortable emotional experience or find ourselves in a painful situation that cannot be solved (e.g. a job we cannot quit, the death of a loved one), sometimes we are so overwhelmed that anxiety jumps in to try to give relief. We may prefer (on some level) the experience of spending our time figuring out an unfixable problem than sitting with the feeling of grief or helplessness.

 From Other Emotions

Another function of anxiety is its ability to hide other, more difficult emotions, because it is a secondary emotion. Anxiousness (or any secondary emotion) happens when the primary emotion is not sufficiently experienced and processed. In other words, your anxiety serves as an avoidance (see above for more explanation on this). When we experience it, we don’t feel the underlying emotion. Our way out of anxiety is to feel this primary emotion. When we resolve a primary emotion, the secondary emotion regulates.

 From Itself

One of the most unpleasant aspects of anxiousness is that once we are aware of it, we can start to feel anxious about our anxiousness. The more we work to avoid it, ignore it, fight it, or self-criticize it, the more space it takes up in our mind. We end up feeling anxious about having anxiety and sometimes anxious about the rare times we do not feel anxiety. We may also experience additional concern about others noticing or criticizing our anxiousness.

If you struggle with anxiety, consider seeking therapy. Therapy can help you safely address and resolve unrelenting anxiousness. A therapist who practices Dialectical Behavior Therapy (DBT) is a good choice. DBT can help you build skills to address any vulnerabilities you have, to identify and cope with primary emotions, and to make more effective choices than avoidance. They can also teach the skill of Radical Acceptance, which is learning how to accept things that cannot be changed, rather than adding to your suffering by fighting it or feeling more anxious. If you could benefit from these skills, contact a qualified therapist and start shifting from surviving to thriving today!


What is DBT and How Can It Help Me?

Seeking help and going to therapy can be stressful. Choosing the right approach can ensure you get the care you need to make the changes you want. In this article, I’m going to give you introduction to Dialectical Behavior Therapy (DBT), a treatment that may be helpful if you want more balance in your emotional life. DBT has become a popular technique used to help individuals cope with the stressful challenges life throws their way, and the intense emotions that can follow. The scientific research for this treatment is strong. Individuals often report huge, impactful, positive life change as a result of DBT. DBT focuses on helping people change their reactions and behaviors to create more resilience in life. Understanding what Dialectical Behavior Therapy is and how it works can help you decide if it is the right approach for you.

What Is Dialectical Behavior Therapy?

Dialectical Behavior Therapy is a form of Cognitive Behavioral Therapy (CBT) that was initially developed for people suffering from chronic suicidal thoughts and behaviors, and those diagnosed with Borderline Personality Disorder. However, implementing DBT revealed that it is helpful for people in a range of situations having difficulties managing emotions, and can help to reduce anxiety and improve coping mechanisms under stressful circumstances. DBT teaches you coping techniques and strategies to deal with difficult emotions without being caught up and swept away in them.

California therapist, psychologist, telemedicine with CBT, DBT therapies

What Does Dialectical Behavior Therapy Involve?

DBT is best administered by an experienced therapist, with a history of training and supervision in DBT by experts in the field. Full program DBT involves weekly individual therapy in addition to attending a weekly DBT Skills Group. Treatment length varies by person and treatment goals.

DBT includes –

  • Collaboration – working with a skilled therapist can help you identify what you want out of life and obstacles getting in your way. Bringing awareness to both your goals and challenges in a specific, systemized way is a key step toward making the changes you want.
  • Learning skills – one of the most important aspects of DBT is learning specific skills to incorporate into your everyday routine for growth, happiness, and fulfillment.
  • Practice – DBT is a behavioral therapy. This means that new behaviors must be practiced for change to occur. Practice, practice, practice, and then some more practice, is a common mantra in DBT.

The Four Modules Of DBT Skills

The four areas of skills learned in DBT are designed to help you better understand your thoughts and feelings, and change your behaviors to better achieve and support the life that you want. These modules include:

  1. Mindfulness
  2. Distress Tolerance
  3. Interpersonal Effectiveness
  4. Emotional Regulation

Who Can Benefit From DBT?

DBT has been shown to be successful in a number of different areas and for those suffering a range of issues including:

  • Relationship problems
  • Low self-esteem or shame
  • Weight management
  • Eating disorders
  • Anxiety
  • Depression
  • Borderline Personality Disorder

DBT can also be used in many other situations, even where a specific diagnosis may not be defined. Under the guidance of an experienced and well-trained DBT therapist, you can learn life-changing skills to make a profound impact on your well-being.

DBT is an inspiring treatment method that can help change your life for the better. Talking with a DBT therapist can help you determine whether DBT is the right therapy approach for you. Contact me today if you may be interested in finding out more about DBT and shifting your life from surviving to thriving!


© 2017 Amanda Gale Bando Phd · Designed and Developed by D-Kode Technology

Dr. Amanda Gale-Bando

Dr. Amanda Gale-Bando