Individuals with anxiety disorders experience excessive anxiety, fear or worry, causing them to either avoid situations that might precipitate the anxiety or develop compulsive rituals that lessen the anxiety. While everyone feels anxious in response to specific events, individuals with an anxiety disorder have excessive and unrealistic feelings that interfere with their lives in their relationships, school and work performance, social activities and recreation.
Dialectical behavior therapy (DBT) is a type of cognitive behavioral therapy. Its main goals are to teach people how to live in the moment, cope healthily with stress, regulate emotions, and improve relationships with others.
I have been learning a lot about CBT – DBT is an interesting take on it as well.
As a social work graduate student, I worked in a medical hospital. One of my projects included studying the “revolving door” patients — those individuals who came into the emergency room on a regular basis.
Some of these patients came into the hospital for chronic issues, such as back pain and breathing difficulties. I identified the patients who lived alone. With their permission, I began calling them on a regular basis to check on them.
Sometimes they wanted to talk about their health. At other times, they wanted to share stories about the past. I allowed them to talk about whatever they wanted and just listened.
Then, we tracked their emergency room visits. Once the calls began, their hospital visits were greatly reduced.
I think there were two reasons those phone calls reduced their visits to the hospital: they felt less lonely, which helped them feel better physically, and feeling connected with someone meant they were less likely to go to the emergency room simply to have human contact.
That was just a graduate school project with a small sample, and not exactly a peer-reviewed study. But it did give the hospital some interesting feedback about how they might be able to support some of their frequent emergency room visitors.
Once you recognize you’re burned out, you can pull yourself back from the ledge, but it’d be best to never get there in the first place. Luckily, the signs are usually right in front of you: you just don’t want to see them, or you’re too busy actually working to recognize them. If you keep an eye out, you’ll be able to cut off burnout before it takes hold so hard you can barely get up for work.
The Early, Subtle Signs of Burnout
Most people only think about beating burnout after it’s gotten really bad. We’ve explained how to bounce back, how to get motivated again, how to re-engage with your work, and they’re all great…after you’re already feeling overwhelmed. In reality, the best things you can do to beat burnout start before you hit rock bottom. Here are the early warning signs to watch for:
- Disaffection and snark about your work, workplace, or colleagues. If you catch yourself reacting poorly to things you would normally take in stride, or suddenly showing a ton of snark or contempt for even minor announcements around the office, you’re suffering from the first, earliest signs of burnout. Don’t get us wrong—a little snark about work is normal. When the boss starts talking about “synergizing core competencies,” it’s normal to roll your eyes. But if you’re rolling your eyes more than you think about what’s being said, it’s time to step back.
“It emotionally hijacks us and intensifies our negative feelings.”
Some people know rumination — the repetition of the same thought in your head over and over — as obsessive thinking, and for those who experience it, ruminating can be a frustrating state.
Thinking over and over about a missed opportunity, an ex, or when you misspoke — it’s bad enough to live through a negative experience once without beating yourself up in an unvirtuous mental loop. While it can often be beneficial to allow yourself the time and space to think about things that are important, too much of a good thing might actually be a bad thing. And when it comes to dealing with issues like depression or anxiety, allowing too much time to ruminate could keep you stuck in a mental rut.
“Rumination is associated with depression,” writes clinical psychologist Dr. Suma Chand for the Anxiety and Depression Association of America. “Research shows that people who ruminate are more likely to develop depression compared to those who don’t.” Maybe up to four times more likely, she says.
This goes the other way as well: A Canadian study conducted among college students found that those who experienced higher levels of anxiety or depression already tended to engage in more ruminative behaviors. Another study in China found similar results among the elderly population. Rumination, it turns out, becomes a vicious double-edged sword.
What Does Rumination Look Like?
Everyone at one time or another may feel like they’re “obsessing” over some idea or thought. The difference between a healthy amount of thinking about a topic, versus harmful rumination, is the end result. For example, if you find yourself thinking about a particular problem in order to come up with the best solution, you’re probably not ruminating. But if the thing on your mind has no solution, or may not be in your control, then you might want to ask yourself if you’re ruminating.
Depending on whether you’re experiencing depression, anxiety, or another mental health issue, rumination can take varying forms. One of my clients describes her anxious worrying as “catastrophic thoughts.” She often begins with a fairly benign thought, such as “This traffic is going to make me late to work.” This becomes “I’m a horrible employee who can’t even show up on time,” which turns into “I’m definitely going to get fired from my job.” For the rest of the week she’s sweating over a small, common mistake that wasn’t her fault.
“One of the things I find hard to articulate to people is that if I keep bringing something up or making jokes about it, that’s an indication I’m ruminating about it,” writes Alexis Schuster for The Mighty. I’m guilty of the same “tell” in my own ruminations. I find all sorts of creative ways to discuss the thing I can’t stop thinking about, from joking about it to asking rhetorical questions to asking others if they’ve ever had similar thoughts. Then I start obsessing over whether I’m annoying everyone with my ruminations.
It can feel lonely to be stuck in your head with your thoughts; sometimes letting them out is the only way to feel like you’re releasing the tension that’s building, to feel like you’re not the only one bearing the heavy load. However, once you let out some of the steam, it’s likely going to build up again. That’s when it’s time for a better solution.
Each student in this Winnipeg classroom has a kit full of mental health and mindfulness tools
In a middle-years classroom at Champlain School in Winnipeg, a group of students are sitting quietly on yoga mats. They’re ready for their next assignment.
At the front of the class their teacher, Catherine Siller, tells them what to do:
Anything that might be bothering us from the morning or the weekend or even from recess, I want you to focus on that energy right now. Take a deep breath in, and push that negative energy right out. – Catherine Siller
Siller is leading her Grade 5 and 6 class in a mindfulness meditation. All year long, this group of young students has been learning about the importance of caring for their mental well-being.
“What do we say?,” Siller asks as they finish the meditation.
“Namaste,” the class responds.
Building mental health toolkits
The students have been getting help throughout the school year from a cardboard box. Each student has a “Thrival Kit“, which is filled with tools to help young people work on their mental health.
Addictions, like snowflakes, have one thing in common – they are all absolutely unique.
The intricacies of a snowflake pattern can be an easy metaphor for the intricacies of human experience when it comes to trauma, addiction, resilience, success or failure. What makes one person reach for alcohol to deal with her social anxiety makes another person become a public speaker to conquer that fear.
A fortunate child growing up in a household filled with love, attention and given lots of opportunities to develop academically might not thrive at all, might drop out of school, and might become addicted to pills. Why? Too much prosperity? Some traumatic event at school? Or something that another person would consider trivial, like being made fun of at a party? Another sibling from the same family can go on to become a successful psychologist, a parent to a bunch of happy kids, but then will suddenly crumble in her 40s and start drinking. Why? Did something happen in her childhood that only surfaced when she reached middle age? And reversely, a woman who grew up in a single-parent household, surrounded by addiction and abuse and poverty, grows up to become a successful entrepreneur who enjoys wine but only as far as vintage goes and only by a glass.
The point I’m trying to make is that there’s really no way to predict what will turn someone into a person with substance use disorder and what will make another immune to it. For this reason, we cannot also make false and stigmatizing assumptions about groups of people who “tend” to suffer from greater incidence of problems such as addiction. We cannot develop any kind of sure formula that will help us identify those who might be more prone to addiction than others – this is not to say that research, and especially genetic research, should be ignored, as there seems to be a genetic component to addiction, but we cannot assume a child will grow up to suffer from substance use disorder even if both parents have had it. Sure, the child will have a greater chance of developing it, but she might also completely skip that genetic sequence and be entirely resistant to her genetic “fate.” I know of two sisters who came from the exact same environment and who would score high Adverse Childhood Experiences, and one of them has struggled with addiction for more than two decades where the other one has never gotten more than a little tipsy at a party (and, frankly, says, hates the effect that alcohol has on her).
It is only natural for humans to want to know the cause of illnesses, and especially something like addiction – so widespread a problem that it is now considered an epidemic. We think that if we know the cause, we will be able to eliminate it. That’s what we’ve done with infectious disease. Maybe there is a way to vaccinate people against addiction? Probably not. I tend to believe that substance use disorder is a condition so complicated that the physical element is just one of its many components – for those reasons I am skeptical about medication used to eradicate it. I don’t believe we’ll ever come up with the right formula because there are so many targets to aim for.
In his book In The Realm of the Hungry Ghosts, Gabor Mate talks about how we simply cannot compare each other’s pain or capacity to endure suffering. He writes, “People who have overcome severe addictions deserve to be celebrated, and they have much to teach, but their example cannot be used to condemn others who have not been able to follow in their foot steps.”
Icon? Yup – I would have called John Moore an icon even 10 years ago. But listening to his talk and his coming back to radio? I’m a 54 year old man and I am in tears of happiness right now.
Thank you for having this courage to share. And to offer hope to so many others.
You’re a class act. Always knew that. But … this upped it a few more levels yet again.
Falling is the leading cause of fatal injury among seniors and the greatest safety threat faced by older adults who want to age in place. Avoiding falls and staying safe at home depends on several factors, including environmental modifications, exercise, and regular visits to your doctor. With the right precautions, your life needn’t be dominated by a fear of falling.
Seniors should have unimpeded walkways from room to room with no electrical cords, footstools or unsecured rugs in the way. Boxes, plant stands and coffee tables are also tripping hazards, and shoes and clothing should be safely stored away. Railings should be securely installed in stairways and hallways, which should also be well-lit with ambient, non-glare bulbs. Install motion-activated sensors for automatic lighting in the bedroom and darker parts of the house, with night lights in the bedroom, bathroom and hallway.
The bathroom is an especially hazardous part of the house for seniors, so make a careful assessment of potential dangers. Place non-slip surfaces in the shower and in front of both the sink and toilet. Safety rails should be firmly anchored into the wall in the shower and next to the toilet. Stepping in and out of a bathtub or shower can drastically increase your chances of falling, so consider installing a zero-entry shower with a chair or bench.
Exercise your core & lower body
Regular exercise is an important addition to your lifestyle, especially because it helps strengthen your core and legs, helping to improve balance. Strength can be improved with easy-to-do exercises that don’t require a gym. Lunges and leg lifts, repeated every day, will make it easier to get around safely and climb stairs without stumbling or falling. Walking, water exercise, tai chi and yoga are also good ways to maintain flexibility, muscle strength and balance. Consult your doctor or physical therapist if you aren’t sure what exercises are best for you.
Schedule regular visits to your doctor and make your healthcare providers aware of any changes in your condition. Take a full list of prescription and over-the-counter medications to each appointment. Your doctor will need to assess the risk of side effects that medicine interactions may cause. For example, a dizzy spell while in the shower or on the stairs could cause a serious injury. If any medication is making you feel fatigued or disoriented, your physician will need to reassess your medication regimen.
An eye or ear disorder can increase your risk of falling, so be prepared to address such problems with your doctor. Numbness in the feet or legs, joint pain, or shortness of breath can also lead to in-home accidents. Make your doctor aware if you’ve fallen recently, or if you’re feeling unsteady as you move around the house.
Shoes and assistive devices
Sometimes simply changing to footwear can reduce your risk of falling. High heels or hard shoes with slick soles can lead to an accident on hard flooring, like tile or hardwood, while loose-fitting sandals may cause you to trip on carpeting or a loose rug. Wear sturdy shoes that fit properly, and consider switching to rubber-soled shoes, which may be your best option. Above all, avoid walking around the house in socks or stockings, especially if you have a lot of hardwood, tile or laminate flooring. Talk to your doctor or physical therapist if you require a cane, walker or another type of assistive device to move around.
Aging in place safely is all about taking precautions. Providing clear walkways, using safety rails and installing adequate lighting are essential modifications, especially in the bathroom. Be sensible about footwear and make a point of exercising every day, especially your lower body.
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