Tell It Like It Really Is

Systems Thinking in Trauma Response

"Systems thinking brings an overt sensitivity to both intrapersonal and interpersonal family processes that are related to increased stress in the contexts of disaster and trauma, and this fosters and elicits positive individual, relational and family growth in both the acute and long-term phases of support.  It promotes an appreciation for respective family members' unique perceptions of meaning, and facilitates members' co-creation of new meanings in the evolution of healing and post-trauma growth.  It pushes us to consider our own role in the helping process and how the contribution of our training and background fits withing the larger efforts of our team's mission.  Finally, systems thinking commands attention to our own functioning, and highlights our obligation to self-care."

Mendenhall, T.J., & Berge, J.M. (2010).  Family therapists in trauma-response teams:  bringing systems thinking into interdisciplinary fieldwork.  Journal of Family Therapy, 32, 43-57. 

Harmonizing Mind-Body-Spirit

For the last two years I have been conducting a dangerous experiment:  How far can you stretch a girl before she breaks?

This experiment would not have made it past the Human Subjects Review Board.

The experiment is now happily suspended indefinitely.

What I learned along the way about coping is now coming in handy for others.

It is that time of the year - school has just started and people are already stressed.  I have been getting calls from people trying to cope.

Here is a list of what has worked for me.  This list is entirely subjective so please experiment with an open heart and mind.  For instance, I love, love, love acupressure but my husband went to the same guy and felt nothing.  On the other hand, my husband really vibed off our massage therapist-turned-acupuncturist and I did not.  So there you have it.  Have fun exploring healing practices that might work for you.

Please remember, as I learned (finally!), no matter how much you try to cope, there is a limit.  Take a step back and reflect on whether you have taken on more than you can chew.  Sometimes our eyes are bigger than our appetites and we have to say no to a project even if it seems really juicy.  There is time enough for it later if we take care of ourselves now.  Work up the courage and faith to make a big change if necessary, including changing your unrealistic expectations. Your spirit may be trying to tell you something with all that discomfort and dis-ease. By all means ask yourself, what do I really want? and trust your inner voice.

The List:

Prayer and/or meditation. Regular practice is key.

Supportive friends and/or family.  Regular contact with people rooting for you and who you can talk to about almost anything.

Eating well.  We have so many food allergies we are unaware of - listen to your body or go to the doctor to get tested.  Because of my gall bladder disease, I stay away from butter, cream and fat from red meat (I miss caldo de res, chorizo, and cream-based soups). If I eat these foods, my belly swells up six-months pregnant-style or I wake up in the middle of the night to a burning ring of fire around my torso.  Generally speaking, our bodies need and thrive on plant-based foods. Food is medicine.

Supplements & Medication.  Find a healer to help you find the combination that works for you. For me, high grade Salmon Oil, the Vitamin B series and Vitamin E (makes my eyelashes longer even) works.  Unfortunately, there is a lot of shame around taking medication for mental health. Please don't let that stop you from being well.  I know a lot of wonderful, intelligent and beautiful people who swear by it, including myself.

Sleeping well.  We need 8 hours.  Every night.  Insomnia is epidemic and you are not alone.  It is a sign that our mind-body-spirit is out of balance.  There is so much to do to address this.  Reach out to healers.  I like to try exercise, chamomile tea, a super dark room, a warm bath, counting my breaths, getting up in the middle of the night to write if I have a lot on my mind, George Lopez or the Pixies on my iPod, etc.  I talk more about hypnotherapy later but I found a free downloadable podcast at HypnosisDownloads.org to stop insomnia.

Exercise.  Do whatever seems fun and safe and do it often. I like to sweat it out at the gym as often as possible.  I like to blast a tennis ball weekly to channel my aggressive drive.  I like to dance whenever I can to move the spirit.  My massage therapist said I can naturally re-align my body through dancing - woot woot.  My shaman said I need to spend more time in nature, so I am taking it outside and adding hiking to the list of things I do to move my body.

Laughter.  Whatever it takes to make you laugh, baby.  Laughter releases the body's natural painkillers - really good medicine. Even if she doesn't get the joke, my daughter laughs when I laugh, enough said I think.

Sex.  Yes, energy for sex and sex for energy.  The more sex we have the longer we live - I would add the happier we are, too.  As long as it is mind-body-spirit safe.   Good medicine.

Forgiveness.  I went to a workshop at a local church about forgiveness. The speaker, Connie Domino, is a public health nurse who developed a curriculum for achieving your goals.  She found that some people got stuck and others bounded ahead.  She noted the least successful were bitter and resentful and the most successful were forgiving.  So now she teaches how to forgive.  She has a book, The Law of Forgiveness: Tap in to the positive power of forgiveness and attract good things to your life, with a great script for releasing people, dead or alive, with forgiveness. I heard Oprah quote that resentment and not forgiving someone is like drinking poison and expecting the other person to die.  Forgive and live.

Reading or Listening.  I love reading books, mostly non-fiction.  Okay! If you must know I have read a lot of self-help/self-improvement books.  I hate that the genre is stigmatized.  Cynics and hipsters, please look away now.  One of my favorites is, The Power of Positive Thinking by Norman Vincent Peale.  I really believe it is important to be selective about what we feed our brain.  What or who are we reading, listening to and letting in?  We have a choice.  It makes a difference.  I read a Children's Bible to my daughter at bedtime.  I learn something new every time I read the same stories over and over.  I love Paulo Coelho, Iyanla Vanzant, Napolean Hill, Martin Seligman, Emmy Werner, and so on.  Check out the recommended reading list on the right hand side of this blog.  The words of these wonderful spirits now live on in me because I have read them and internalized them.  Some lyrics have the same effect on me - Susana Baca, Tears for Fears, Bad (live) by U2, and many others stir the passion in my soul and make me feel bold or happy.  Or they help me to embrace sadness and pain before letting these feelings go.  I like singing and reading the hymns at church on Sunday mornings as well.  I like filling myself with good stuff.  Good stuff in - good stuff out.

Alcohol, marijuana and other drugs.  I know many people who use alcohol and other drugs to manage their emotions.  I have no judgments, I get it.  Personally, these methods don't work for me.  I don't have a strong taste for alcohol and I don't get a buzz, I get a headache.  One time I tried medical marijuana for stress and it gave me allergies.  When I was a kid in East Los Angeles, I participated in an after-school program called "Get High On Life" at Salazar Park.  We played, did crafts, went camping.  Hearing my daughter laugh, laughing at my husbands jokes, dancing to live music, watching fireworks at the Hollywood Bowl, playing tennis and so on - all these things give me a natural high.  If you are looking for alternatives to coping, please read on.

Hair, Face, Hands & Toes.  Getting your hair did, getting a facial or wax, getting a mani or pedi - it all feels like a getaway and love wrapped into one, especially if they throw in a massage.  Good stuff.  Sometimes you just want to leave work at lunch time and have someone wash your hair, like mama did when you were a baby.

Acupuncture.  I have gone for stress or body pain.  I know others who have gone for weight loss assistance and fertility issues.  I have a really good referral for this type of healing - email me if you are interested.

Acupressure. Wow, this cleared out a lot of stuck energy.  Sobbed for awhile.  Good stuff.  My acupressure guy moved away :(

Massage.  This has been really good for me after sports activity. If you tend toward being anxious/worried or have a high stress job (hello, social workers!), then this is good on a regular basis, say weekly or monthly.  I see a lot of sidewalk signs for $45 massage while driving on Fair Oaks, Wilshire Blvd., or Santa Monica Blvd.  I would say buyer beware.  Get referrals and experiment.  I have a great referral who charges $70 an hour and does home visits if you are in the Northeast Los Angeles area  - email me if you are interested.  I also have been to dtox spa in Atwater Village (a referral from Josh) and Burke Williams in Pasadena (I like going on a Friday night when I feel like I got the whole place to myself. Beware: bathing suit or birthday suit in the Jacuzzi?  I have seen both.  Wear whatever you are most comfortable in.)

Chiropractor.  Sometimes life throws me out of alignment.  I usually need to go to a chiropractor, massage therapist and acupuncturist all in the same week if I am really in a bad way - from structural to soft tissue repair.  I have a great referral in Silverlake.

Yoga.  A lot of research dollars have poured into testing this ancient spiritual healing practice.  So far the results are really good for anxiety, depression, arthritis, asthma, heart disease, and so on.  After the final resting pose, I feel as calm and relaxed as I do after a one hour massage.  $10 per yoga class if you can muster the energy to move the energy yourself or $45+ if all you can do is crawl to the massage table.  Again, I got a good referral for the Northeast Los Angeles area (my massage therapist extraordinaire also teaches yoga).

Energy Healing.  Okay, I can't explain this one very well but my practitioner clears away negative energy and charges me up with healing energy.  I have referred nearly a dozen friends to her and most all come back to me with stories about healing and transformation. When I interviewed her for a paper on healers for a UCLA class on Latin American Medicine, Shamanism & Folk Illness, she said most people come to her saying they are stressed and need something. She trained at the Lion Heart Institute and charges $70 an hour.  Email me if you are interested in this referral in the Northeast Los Angeles area.

Hypnotherapy.  I have yet to try this professionally myself.  When I was in grad school for the MSW, one of my preceptors was in an LCSW exam prep group and all but one of the members tried hypnotherapy before the oral exam.  All but one passed the exam on the first try.  Anxiety can make our thinking brain shut down so any treatment that calms and relaxes our mind-body helps us to perform better.  I hear this type of treatment is especially good for weight loss efforts, I have to track down the reference for that one. I downloaded some podcasts from HypnosisDownloads.org on weight loss, positive affirmations and how to stop insomnia.  I listened to the positive affirmations at bedtime with my daughter.  It is a very sweet recording and reminds me of the things a loving parent would say.  According to the website, we don't hear the good stuff enough.  One of my mentors swears by this type of treatment for his PTSD and anxiety.  I have a referral in the Pasadena area if you are interested...

Talk Therapy.  There is room for all healers in the 21st century.  I have met helpful therapists for individual, group, family and couples counseling.

Shamanic Treatment.  I had focused on mind-body-spirit healing for most of my life and neglected soul healing.  I didn't realize spirit and soul were distinct.  Shamans do soul retrieval and spirit helper work.  In traumatic situations, pieces of our soul can check out and not return until it is safe.  A shaman can journey to retrieve parts of our soul that have checked out.  We don't have to walk around with a maimed soul.  Spirit helpers are like guardian angels and may show up in the form of animals consenting to help and protect us.  Shamanic practices are part of almost every culture in the world, originally from Siberia, you will find shamanism in Korea, China, Australia, Africa, Latin America, Medieval Europe, Alaska, Native America, etc.  My ancestors are from Latin America and I had been completely cut off from our traditional spiritual healing practices, until now.  I met a gifted and experienced shaman in the greater Los Angeles area who charges $75 per hour or a flat rate of $100 per treatment and anything in between as you are able, please email me if you are interested...

Be well.

Freedom & Friends

I took a course on Stress and Disease last quarter and it scared the s$!# out of me.

I have always known that stress is toxic but it is literally killing many of us through heart disease, high blood pressure, depression and metabolic disease (such as diabetes).  Accumulated stress is especially fatal.

For the last two years I have dangerously juggled family (wife and mother), school, and part-time work. So I recently decided to take a full-leave from work.  It didn't really occur to me that I could financially pull it off.  But anything is possible and the risk on my health was no longer an option.

Juggling so much and stretching thin, I often cut out exercise and socializing with friends to meet all my responsibilities.  Bad call.

Demands - Resources = Stress

When demands exceed our ability to cope, then we become stressed out.  Friends are a resource, a source of support, so cutting out time with friends severely imbalances the stress-demand equation. When demands accumulate, don't voluntarily cut time with your sources of support in order to get things done. (Duh)

Now I am balancing self-care, family, friends and the last major projects of my doctoral program.

There is space to breathe and smile.

There is time to exercise and counteract the more than 20 years of overwork that have taken their toll on my body.

There is time for bedtime reading which my 10-year old daughter still loves (me too).

There is time for friends, old and new.

I don't want more stuff - just more freedom.  A friend of mine said that the people who seem to "have it all" are paying for it with debt.  My many years of reading financial articles, books and Oprah episodes taught me that if you bought it all on debt then you are living a lie.  One financial set-back and it can all be gone.  In the meantime, the debt can weigh on you (like low-grade anxiety) and the quality of your sleep.

So I have decided to re-organize and split the pie up in such a way that reflects my priorities better. Freedom and friends have made the cut.

Smiling more.

Chronic Stress, Disease & Balance

"The HPA axis and Sympathetic Nervous System are triggered as a response to a physical or psychologic demand (stressor), leading to a cascade of physiologic, behavioral, and psychological effects, primarily as a result of the release of cortisol and catecholamines (epinephrine and norepinephrine). This response leads to the mobilization of energy needed to combat the stressor through the classic 'fight or flight' syndrome.

Over time, the constant state of hypervigilence resulting from repeated firing of the HPA axis and Sympathetic Nervous System can lead to dysregulation of the system and ultimately diseases such as obesity, diabetes, autoimmune disorders, depression, substance abuse, and cardiovascular disease."*

Chronic stress is not good for our health - regardless if our fight-flight response is triggered by chronic exposure to violence or ruminative thoughts that stress us out.

Our parasympathetic nervous system (rest and digest) works in complementary harmony with our sympathetic nervous system (fight-flight), modulating our heart rate and vital functions.  An over-active  or frequently activated fight-flight response taxes our system. Chronic or accumulated stress can lead to early disease and death.  Balance and calm leaves us healthier.

How do you balance and calm?

Cannabis Findings

Title: Stress-related factors in cannabis use and misuse: implications for prevention and treatment

Author:  Hyman, Scott M; Sinha, Rajita

Source:  Journal of Substance Abuse Treatment, vol. 36, no. 4, pp. 400-413, 2009

Abstract:

We examined the role of stress as a risk factor and motivation for cannabis use/misuse. A systematic review of studies gathered from PsycINFO and MEDLINE databases was conducted. Findings suggest that cannabis is commonly used as a stress-coping strategy. Negative life events, trauma, and maladaptive coping were all related to consumption.

Cannabis use for stress-coping purposes was most evident when examining chronic as compared with experimental use. Although many individuals may be able to use cannabis without consequences, there appears to be a subset of individuals who experience greater life stress and who may be more likely to use for stress-coping purposes. These individuals may be at greatest risk for addiction. Chronic use may potentiate stress-related motivation to use/abuse cannabis and is associated with decision-making deficits and alterations in brain-stress pathways that may exacerbate compulsive drug seeking and sensitize individuals to stress-related drug use. Overall, stress-coping interventions and harm reduction focused on reducing the amount ingested may facilitate prevention and recovery efforts.

Stress and Disease

"Exposure to chronic stress markedly increases vulnerability to adverse medical outcomes. This holds true across a wide variety of mental and physical conditions.  For example, persons facing chronic stress are more likely to develop an episode of clinical depression, experience symptoms of an upper respiratory infection following viral exposure, suffer from a flare up of an existing allergic or autoimmune condition, and show accelerated progression of chronic diseases such as acquired immunodeficiency syndrome and coronary heart disease...This phenomenon is apparent across the entire lifespan. From early in childhood to late in adulthood, chronic stress is accompanied by worse health and the magnitude of this effect is substantial: In some cases, exposure to chronic stress triples or quadruples the chances of an adverse medical outcome."

Miller, G.E.,  Chen, E. & Zhou, E.S. (2007).  If It Goes Up, Must It Come Down? Chronic Stress and the Hypothalamic-Pituitary-Adrenocortical Axis in Humans.  Psychological Bulletin, 133 (1), 25–45.

Writing is Healing

Pennebaker (1997) wrote about writing as therapy.  Here are some gems from the article:

"For the past decade, an increasing number of studies have demonstrated that when individuals write about emotional experiences, significant physical and mental health improvements follow."

"The mere act of disclosure is a powerful therapeutic agent that may account for a substantial percentage of the variance in the healing process."

In ancient indigenous cultures in Mexico, there was a community leader called "Comedor de Pecados" or "Eater of Sins."  It seems we have always needed a place to put it - a ritual for disclosure.


In this article, Pennebaker shares the standard script or writing directive used in his studies:

"For the next 3 days, I would like for you to write about your very deepest thoughts and feelings about an extremely important emotional issue that has affected you and your life.  In your writing, I'd like you to really let go and explore your very deepest emotions and thoughts.

You might tie your topic to...
...your relationships with others including parents, lovers, friends, or relatives
...to your past, your present or your future
...or to who you have been, who you would like to be or who you are now.

You may write about the same general issues or experiences on all days of writing or on different topics each day.  All of your writing will be completely confidential.  Don't worry about spelling, sentence structure, or grammar.  The only rule is that once you begin writing, continue to do so until your time is up."

"Even though a large number of participants report crying or being deeply upset by the experience, the overwhelming majority report that the writing experience was valuable and meaningful in their lives."

Writing has been found to be associated with...

• significant drops in doctor visits from before to after writing
• beneficial influences on immune function
• long-term improvements in mood and indicators of well-being compared with writing about control topics
• significant reductions in distress
• improvements in grades among students who write about emotional topics
• getting new jobs more quickly and reduced self-reported alcohol intake among Senior professionals who have been laid off from their jobs 
• lower rates of absences among university staff members who write about emotional topics compared to control participants

"When individuals write or talk about personally upsetting experiences in the laboratory, consistent and significant health improvements are found.  The effects are found in both subjective and objective markers of health and well-being.  The disclosure phenomenon appears to generalize across settings, most individual differences, and many Western cultures, and is independent of social feedback."

Reference:
Pennebaker, J.W. (1997).  Writing About Emotional Experiences as a Therapeutic Process.  Psychological Science, 8(3), 162-166.

If Stress Kills, Then What Brings Us Life?

We are not at our best when we are overly-stressed and being chronically over-stressed kills.

If stress is epidemic (pandemic?), then what is the equal and opposite force? What brings us life?

I am starting a personal list - please feel free to join in...

• Unconditional Love and Loving Relationships. My husband and daughter mean the world to me. They inspire me and nurturing our relationship is the most important, satisfying, meaningful and difficult of any work I choose to do.
• Forgiving myself and others. Empathy - understanding the story behind the story - helps me to forgive. It is realizing there is a good reason why we do what we do - acceptance. Imagining or knowing the story helps put behavior and relationships in context (Oh, I get it - that makes sense now). And forgiveness is liberating - it feels lighter than anger that lingers into bitterness.
• Meditation and Prayer. A family retreat at a Buddhist monastery helped me to finally experience the calm that my clinical supervisor always advised in order to be an effective parent. Praying in the car (with my eyes open and out loud) on my commute to work really does make my day and work go better. Writing is also a form of meditation practice and brings me peace.
  
• Supplements. Salmon oil (really good grade, not Target or Trader Joe's brand, unfortunately) and B vitamins (B3, B6, B12, etc.)
• Exercise. Whatever makes me feel happy while doing it, works for me - dancing, tennis, walking around the Rose Bowl with friends (walking and talking has replaced doing lunch to catch up). Working out with weights is also really effective for me - good results without a lot of strenuous effort. And the fact that muscles burn fat while I'm reading feels like cheating (in a good way).
• Going to church. Growing up, I used to go to church two to four times a week (!). Now I go whenever I please. And when I do, I never regret having gone. After a small tour of every church in a 20 mile radius, I found one I can live with and feel proud of - All Saints in Pasadena. The hymns, the sermons by Ed Bacon, communion every Sunday, and so on, rejuvenate me.
• Saying No whenever possible. Also known as setting limits and boundaries. In this way I focus on the things that are most important and essential to me right now without overextending myself and feeling stretched thin.
• Saying Yes to help. There is no shame in accepting help from others. Sooner or later, everybody needs help. That's just how we are built. Helpers are no exception. Accepting help is being resourceful.
• I matter - You matter. At a recent massage in Ojai, a massage therapist shared that in her training she was taught to "practice not injuring yourself in order to help others." This entails setting energetic and physical boundaries with clients (and others).
  
• Self-Reflection. Our own still, small voice will speak to us in whispers but scream if we don't listen. If you have ears to hear, then you had better listen.
  
• Hope. Always there is hope and sometimes all we have is hope. And when all we have is hope, hope is enough. We tend to get what we expect, so hope is a pretty good intention to set in motion. Martin Seligman talks about the research that shows how optimism makes us more likely to be healthy, happy and productive. Seeing the glass as half-empty or half-full is more than an issue of semantics, it has real-life consequences.
• Balance. Freud said that good mental health consists of work, love and play. My clinical supervisor taught me that being whole meant integrating our inner parent, adult and baby parts into equal parts.
• Laughter. Do I really need to explain this? Natural pain killers are released in our bodies when we laugh...but you know that because you can feel it on a visceral level. That's one of the many reasons I gravitate toward funny friends.
• Strengths. Focusing on who I am, what I want and what I do well grounds me. It steers me toward my purpose and motivates me, even in dark times, to be persistent.
  

Okay, okay, nothing on this list is revolutionary or anything that you have never seen or heard before. But the point is when we are stressed we tend to be forgetful and not just about where we left our car keys! Making a list or being reflective is an exercise in gentle reminders when we need them most.

Digging into Resilience & The Equation of Balance

Emmy Werner followed, from the prenatal period to adulthood, 505 babies born in Kaui in 1955.

In particular, she was interested to see what would happen to high risk children - those born to poverty, perinatal stress and a disorganized caretaking environment.

One out of every three of the high risk children, 10% of the total cohort, had developed into a competent, confident, and caring young adult by age 18.

Young men and women in this study who were able to elicit primarily positive responses from their environments were found to be stress-resistent, even when living in chronic poverty or in disorganized homes with disturbed parents.

(Is there a connection to the 3 to 1 positivity ratio foreshadowed here?)

Those that provoked negative responses from their environments were found to be vulnerable, even in the absence of biological stress or financial constraints.

As disadvantages and the cumulative number of stressful life events increased, more protective factors in the children and their caregiving environment were needed to counterbalance the negative factors and to ensure positive developmental outcomes.

From Overcoming the Odds: High Risk Children from Birth to Adulthood, Emmy E. Werner and Ruth S. Smith.

Excessive stress occurs when the demands made on an organism exceed that organism's reasonable capacities to fulfill them.

From When the Body Says No: The Cost of Hidden Stress, Gabor Mate, MD

Stress: Demands > Capacity

This explains why we all have a breaking point. Stack enough stressors and we are all vulnerable. Possible combinations of “what is demanding” and “our capacity” are infinite and unique, but the process is not. I just got through reading an autobiography of Nina Simone, I Put a Spell on You, and her breaks from reality seem to have come long after the traditional late adolescence onset and more likely related to chronic exhaustion and a life extremely out of balance. There is also a question about the connection between creativity and madness which Jung described as: "Schizophrenics drown in the same waters as mystics delight in" or something like that, but that's another post.

Is there a balancing human equation? When demands are greater than capacity, what resources (human, personal, environmental, tangible, metaphysical, etc.) can be drawn upon to sustain us?

Adaptation: Capacity (+ + + + + + + + + + + +) = Demands

If you had to list them, what are your + + + + ?

Do we know when to call on our resources?

Do we feel entitled to fight to survive, adapt or succeed?

Staying Healthy Even When Highly Stressed

Kobasa (1979) hypothesized the following:

Highly stressed persons who stay healthy possess to a greater extent than highly stressed persons who get sick:

(a) the belief that they can control or influence the events of their experience

(b) an ability to feel deeply involved in or committed to the activities of their lives, and

(c) the anticipation of change as an exciting challenge to further development. (Kobasa, 1979, p. 415)

It breaks my heart that Kobasa (I want to french kiss Kobasa for these words) came up with this in 1979. Why have we not been shouting this from the rooftops?! Can you feel the powerful vibrations from the truth of these words?