January 7, 2018

Decide Not to Decide

It is quite common for people to enter therapy in the midst of a crisis. They want answers.

Is my marriage over?

Cognitive therapy is all about replacement thinking. A cognitive therapist will listen for faulty or dysfunctional thinking patterns that are contributing toward a client's lowered mood, anxiety, anger, or indecision.

And sometimes those problematic thoughts are questions. Especially questions whose answers involve major life decisions. Upheaval.

My job is horrible! Should I quit now or find a new job first?

One calming thought replacement is decide not to decide. At this moment, anyway. Perhaps for an undetermined period of time, if the situation allows. Give yourself the time to make a more informed decision.

I'm not happy here. Should I move back to the West Coast?

First we must explore whether there is an urgency to decide now. Many, if not most, of life's crises do not require immediate action. They may, at some point, require a decision. But right now? Not usually. And hasty decisions are often the source of regret or self-doubt down the road.

My neighbors are so toxic. Is it time to move?

What crises typically do require is calm and thorough deliberation. Careful consideration of the options available. Analyzing the situation so that we know what we're dealing with. Generating a range of steps to take before making a drastic change.

By the time someone has entered the therapy room, however, they are often worked up into a frenzy or feeling overwhelmed to the point of depression. They are not thinking clearly. They cannot focus. They are unable to come up with creative solutions. They're engaged in black or white, all or none, thinking.

So rather than focus on making the decision, we want the client to slow down, calm down, reduce the stress, increase the self care, and decide not to decide.

Concentrate on self-soothing. Take care of yourself until you are in a position where you can carefully assess the available information, until it can be gathered in a calm, deliberate and accurate manner. And then reflected on without haste. Seek opinions from respected experts or someone who has been in your shoes.

Slow down.
Get some good sleep.
Think of my options.
List pros and cons.
Get some support:
Consult with friends, colleagues, loved ones, a professional.
Take a walk. Appreciate the sky, the clouds, the trees. 
Sit on a park bench. 
Take deep breaths.
And full, emptying exhales.
And again.
Give myself the time to decide.
In good time.

Decide not to decide.
Until I am ready.

Sandy Andrews, PhD is a Licensed Clinical Psychologist and Psychotherapist in Austin, Texas
She practices Cognitive Behavioral Therapy or CBT

October 6, 2017

Beyond Fear

Sandy Andrews, PhD is a Licensed Clinical Psychologist and Psychotherapist in Austin, Texas
She practices Cognitive Behavioral Therapy or CBT

August 14, 2017

Taking Steps to Overcome Chronic Loneliness

There are many studies that look at loneliness and are finding it is increasingly common and associated with serious health problems.  Although social media is designed to connect people (facebook, instagram, twitter, and the like) psychologists and researchers are finding more people are feeling disconnected and lonely than ever.

Cultivating friendships becomes so important as a way to combat loneliness.  Dr. Randy Kamen makes numerous suggestions for making friends, here. I have written about strategies in previous posts, here.

I offer a few of the most often cited suggestions:

1.  Choose a volunteer activity.  One that helps a needy population or is helping solve a societal problem that concerns you will likely be most beneficial to you.  Engaging in meaningful work, whether a paid job or volunteer work, can help ease feelings of loneliness and increase feelings of positive well being.

2.  Explore support groups.  Support groups are usually led by volunteers, typically someone who has benefited from several years of experience in the support group arena. One support group I often refer to is Recovery International (formerly Recovery, Inc.).  This group helps it's members with skills to overcome anxiety, depression, and loneliness. You can email the contact person for the Austin, TX area, here.  I talk in more detail about this support group in an earlier post, here.

3.  Participate in group therapy.  Here in Austin, TX we have The Austin Group Psychotherapy Society which provides a convenient website that lists many group therapy opportunities available in the Austin area.  Click here to see the list and description of group therapy experiences available. For readers in other parts of the country, try contacting a licensed psychologist in your nearest city and ask for referrals to group therapy providers. Group therapy is lead by paid professionals.  I strongly recommend a professional who is licensed with a mental health certification in your state (licensed psychologist, clinical social worker, marriage and family therapist, etc.)

People who feel lonely sometimes are people who have struggled with shyness for most of their lives.  Many report feeling awkward in social interactions, feeling unable to converse in a way that helps them connect with others or in a way gains them reciprocal interest.  Group therapy, support group participation, and other types of settings which promote conversation between people (MeetUps for example) is one avenue to observe and practice the art of talking to people in a way that garners friendships.  Practice may not make perfect but it certainly can help shy and lonely people reach out more effectively.

Sandy Andrews, PhD Psychologist Specializing in CBT
South Austin, TX 

May 22, 2017

Advice for Grandparents Who Want More Time with their Grandchildren

Yes, even psychologists like to read advice columns.  Or at least this one does.  My thinking is we need to keep an eye on our competition. Gain a few common sense pointers for those tricky problems that outcome research hasn't studied yet.

My personal favorite is The Washington Post's Carolyn Hax.  I like the way she frames her answers. She takes many variables into consideration rather than jumping to the most obvious, and sometimes the most judgemental, conclusion.

Recently she tackled one of the most common dilemmas posed by grandparents who want to see more of their grandchildren.  When they feel left out, uninvited, unwanted, and unappreciated.  In a word, unloved, but that's certainly not how they put it.

So for any grandparents out there who wish their children would include them more often, I suggest reading, and considering the advice of Ms. Hax, here.  You might also consider scheduling an initial session with a licensed psychologist or licensed marriage and family therapist.  Sometimes the insights of a professional can help open doors with your children and grands.

January 16, 2017

Mindfulness is the New Black

Like orange is the new black, mindfulness may be the new psychotherapy.

Talking to a licensed therapist can be a critical step to wellness.  It can include sharing problems, worries, and yes, those reliable and messy mainstays, family of origin issues. Getting evaluated by a professional can be one of the most important tools for treating anxiety, depression, and other emotional disorders.

Learning cognitive behavioral tools ( CBT ) is another branch on the tree called getting back to wellness. One of the most up-and-coming, state-of-the-art CBT tools is mindfulness.  Thirty years ago, when I was walking my dinosaur on my college campus, mindfulness was never echoed in the hallowed halls of learning.  I'm not sure it was even a thing back then.  But it certainly is now.

Mindfulness is a form of meditation.  It is the art and skill of redirecting one's mind away from the everyday thoughts, worries, judgments, and distractions that occupy our brain when it's on auto-pilot. Where are my keys? Did I take the load of laundry out of the dryer? Don't forget to return those pants, pick up that prescription, talk to my professor, get the car inspected.   "Monkey mind" is what Dr. Alejandro Junger, M.D., cardiologist, calls collectively, all those pesky thoughts. As a stress reduction, happy heart tool, Dr. Junger recommends a five-minute mindfulness meditation that you can try, here.

For more ideas on how to learn about and practice mindfulness, have a look at Harvard University Medical School's suggestions, here.    Because maybe, just maybe, fifteen minutes a day is the new 60 minutes on the couch.

Sandy Andrews, Ph.D. Psychologist
Teaching CBT in South Austin, Texas

Psychologist Austin TX CBT Cognitive Behavioral Therapy Anxiety Depression Panic Disorder Anxiety Attacks Psychologist Psychothrapist Therapy e

December 15, 2016

Holiday Self Care

Whether your holiday plans involve spending time alone or spending time with a large gathering of family, it's often a good idea to come up with your own Holiday Plan.

What do I mean by this?

A Holiday Plan is one way of making sure the holiday is special and pleasurable for you.

A Holiday Plan can be therapeutic for people who are alone over the holidays. People in transition (recently divorced, widowed, relocated) are especially vulnerable to feeling lonely, alienated, sad, and in some cases, ashamed of their solitary status. Ashamed when others ask them, for example, "Who did you spend your holiday with?" The fear that others will judge them in some negative way or feel pity for them can weigh heavy. Many feel worse about their solo status when confronted with an onlooker's pity, no matter how caring and well-intentioned the concern may be. A Holiday Plan can help fill the gap when asked, "What did you do over the holiday break?"

Sometimes people who are alone prefer the solitude to merry making or the energy required to put on the facade of feeling merry. Take, for example, someone who works two jobs and is looking forward to the precious down time. Or someone who is grieving and prefers the quiet recovery time. Or the recovering alcoholics who refrain from a holiday gathering because they are newly sober and don't trust themselves to be around a spiked punch bowl. There are many reasons for choosing to be alone but the choice isn't always understood, or approved of, by others.

So back to a Holiday Plan. Think about ways you can make your holiday a special time of relaxation or pleasure or holiday ritual.

Make a list. This is a great time to consult with your personalized Pleasant Events List, discussed in an earlier post.

What are some activities that would give you pleasure? Which would help you feel the most refreshed? A hot bubble bath? Reading the latest edition of your favorite mystery series? Video gaming? A phone call to a friend or loved one? Taking a long walk along a scenic trail? Slipping out to see a movie? Starting a new knitting, art or woodworking project? Putting a puzzle together? Baking cookies? Sometimes getting caught up on household chores can be fulfilling. Just so long as it brings you pleasure.

If you expect to be around a large group over the holidays and you anticipate feeling drained rather than rejuvenated, as many of us do, give yourself permission to modify your plans. Excuse yourself for a walk after the large meal. Pass on the egg nog for a healthy drink you have brought as an alternative. Leave early so you can fit in some relaxing alone time at home or in your hotel room. Bring along a fun board game or favorite magazine as an alternative to the usual football game watching. Unless, of course, watching the bowl game is on your Holiday Plan.

Whatever your plan includes, be sure to give yourself plenty of time to prepare. Research a pleasant outing or day trip. Shop for needed supplies. If your list includes cuddling under a blanket, with a cup of hot cocoa (mini-marshmallows on top) while watching several rented movies with a pleasantly scented candle nearby, you will want to make your trip to the video and grocery store in advance. Most stores close or keep earlier hours during the holidays. You don't want your Holiday Plan foiled because you are caught empty handed.

Happy holiday planning, everyone!

Sandy Andrews, PhD is a Clinical Psychologist and Psychotherapist 
teaching CBT in South Austin

October 12, 2016

When Someone You Care About Is Grieving

Many years ago a very good friend of mine lost her husband. He died suddenly.  They were married a few short years. She was grief stricken. Inconsolable. I visited her whenever I could.  Tried to cheer her up but I failed miserably.  There was no cheering, I found.  I would leave her home, sit in my car, and feel helpless.  I couldn't make her feel better, I got that.  But worse, I didn't know what to say.  What does one say when someone has lost the love of their life?  Or their mother. Their child.

The Christi Center of Austin is a support network available for those recovering after a loved one has died. They "offer hope after the death of a loved one by providing support networks, community education and therapeutic activities that are free, peer-based, and ongoing."  On their website they provide numerous suggestions for those of us who want to offer comfort but don't know What to Say, including:

-Acknowledge the loss – “I heard that your _________ died.” It is ok to use the word “died”.
-Be genuine and honest – “I don’t know what to say, but I just want you to know that I care and I’m here for you.”
-The loved one’s name – “________” was a good person and a dear friend of mine. I will miss him/her.” Talk openly about the person who died.
-Ask how they feel – “Please tell me what you’re feeling right now – I have never been through something like this and I am here to listen whenever you are ready.” And then listen without judgment.
-Accept silence – “We don’t need to talk about this right now if you don’t want to – just know that I’m here when you need me.”
-Let them know they’re not alone – “We all need help at times like this – I’m just a phone call away, anytime.”
-Offer support – “Tell me what I can do for you.”
-Nothing – sit in silence, and just be with the person. Give them a hug or hold their hand.

AVOID saying things like “At least she is in a better place”, “There is a reason for everything”, “God needs him/her with him”, “I know how you feel”, “Be strong”, and “It has been awhile – you must get over this”. Minimizing, attempting to justify/explain, and putting a timeframe on the loss are not helpful at all.

Sandy Andrews, PhD  is a Clinical Psychologist / Therapist who provides CBT in Austin, Texas  

July 4, 2016

Why Does Weight Loss Have to Be So Hard?

We all know it is hard to pass on our favorite high-calorie foods. A struggle to limit portion size. Downright  daunting to get off the couch and stick to exercise goals. But these aren't always the hardest part of a weight loss plan. Keeping the weight off is usually the biggest challenge. Why is this? Learning more about the biology behind those re-appearing pounds is an important cognitive tool in the weight loss struggle. Many people find it helpful to know it isn't just me who finds themselves craving food, feeling less full, and losing less weight over time, despite reducing calories.

So do yourself a favor. Instead of that handful of cookies, grab a cognitive tool. Read My Fitness Pal's blog, Hello Healthy, for a breakdown of the physiological factors that interfere with long term weight loss. By understanding your body's hormonal changes, you can help yourself succeed over the long haul.

--Sandy Andrews, PhD 
Clinical Psychologist
Austin, TX

May 2, 2016

List of Common Cognitive Distortions

Whether the diagnosis be depression, bipolar, anxiety, anger issues, chronic pain or _______ (insert disorder of your choice), in other word, virtually all psychological conditions, identifying cognitive distortions is a very important step in treatment.

What is a cognitive distortion? Also known as automatic negative thoughts (ANTs), these are thinking patterns that are largely inaccurate. Using ANTs repeatedly and in a variety of situations can lead to any number of symptoms including:  anger outbursts, sadness, hopelessness, mistrust, procrastination and the darling of psychotherapy, guilt.  In a previous post I give a better explanation of cognitive distortions so I invite you to click here to learn more.

Today I'd like to share lists of commonly used ANTs.  Occasionally I go online to look for lists of faulty thinking patterns as a refresher or to learn a few that I'm not familiar with.  Like earlier this month, for example.  I was writing my notes and struggling to remember the pattern used by someone I am seeing.  I came across this list of 15 Common Cognitive Distortions posted by John Grohol, PsyD, at PsychCentral:

1. Filtering.

We take the negative details and magnify them while filtering out all positive aspects of a situation. For instance, a person may pick out a single, unpleasant detail and dwell on it exclusively so that their vision of reality becomes darkened or distorted.

2. Polarized Thinking. In my office, this is known as "All or None Thinking."

Things are either “black-or-white.” We have to be perfect or we’re a failure–there is no middle ground. You place people or situations in “either/or” categories, with no shades of gray or allowing for the complexity of most people and situations. If your performance falls short of perfect, you see yourself as a total failure.

Here I will add the All or Nones that I hear frequently:  

Every (especially when followed by, "Single. Time!")

Listen to your words the next time you are arguing with a loved one.  Or theirs.  I bet you will here more than a few of these words sprinkled throughout.  

3. Overgeneralization.

We come to a general conclusion based on a single incident or piece of evidence. If something bad happens once, we expect it to happen over and over again. A person may see a single, unpleasant event as a never-ending pattern of defeat.

4. Jumping to Conclusions.

Without individuals saying so, we know what they are feeling and why they act the way they do. In particular, we are able to determine how people are feeling toward us. For example, a person may conclude that someone is reacting negatively toward them and don’t actually bother to find out if they are correct. Another example is a person may anticipate that things will turn out badly, and will feel convinced that their prediction is already an established fact.

5. Catastrophizing.  This one is big, folks.

We expect disaster to strike, no matter what. This is also referred to as “magnifying or minimizing.” We hear about a problem and use what if questions (e.g., “What if tragedy strikes?” “What if it happens to me?”).

For example, a person might exaggerate the importance of insignificant events (such as their mistake, or someone else’s achievement). Or they may inappropriately shrink the magnitude of significant events until they appear tiny (for example, a person’s own desirable qualities or someone else’s imperfections).

6. Personalization.

Thinking that everything people do or say is some kind of reaction to us. We also compare ourselves to others trying to determine who is smarter, better looking, etc. A person sees themselves as the cause of some unhealthy external event that the were not responsible for. For example, “We were late to the dinner party and caused the hostess to overcook the meal. If I had only pushed my husband to leave on time, this wouldn’t have happened.”

7. Control Fallacies.

If we feel externally controlled, we see ourselves as helpless a victim of fate. For example, “I can’t help it if the quality of the work is poor, my boss demanded I work overtime on it.” The fallacy of internal control has us assuming responsibility for the pain and happiness of everyone around us. For example, “Why aren’t you happy? Is it because of something I did?”

8. Fallacy of Fairness.  Another big one.

We feel resentful because we think we know what is fair, but other people won’t agree with us. As our parents tell us, “Life is always fair,” and people who go through life applying a measuring ruler against every situation judging its “fairness” will often feel badly and negative because of it.

9. Blaming.

We hold other people responsible for our pain, or take the other track and blame ourselves for every problem. For example, “Stop making me feel bad about myself!” Nobody can “make” us feel any particular way — only we have control over our own emotions and emotional reactions.

10. Shoulds.  One of the easiest to identify.  You hear the word?  Change it.  

We have a list of ironclad rules about how others and we should behave. People who break the rules make us angry, and we feel guilty when we violate these rules. A person may often believe they are trying to motivate themselves with shoulds and shouldn’ts, as if they have to be punished before they can do anything.

For example, “I really should exercise. I shouldn’t be so lazy.” Musts and oughts are also offenders. The emotional consequence is guilt. When a person directs should statements toward others, they often feel anger, frustration and resentment.

Here's an example of changing a should:  replace with a "want" or a "wish" statement.  

I shouldn't eat this candy.         ---------->      I don't want to eat this because I want to lose weight.

11. Emotional Reasoning.

We believe that what we feel must be true automatically. If we feel stupid and boring, then we must be stupid and boring. You assume that your unhealthy emotions reflect he way things really are — “I feel it, therefore it must be true.”

"Feelings are not facts" is a common phrase heard at Recovery, Inc., support group meetings for people suffering with depression and anxiety disorders.  And as I like to put it, just because I feel it, doesn't make it true.  Just because I am angry doesn't mean the person I am angry at did something to deserve my yelling or cursing at them.  

12. Fallacy of Change.

We expect that other people will change to suit us if we just pressure or cajole them enough. We need to change people because our hopes for happiness seem to depend entirely on them.

13. Global Labeling.

We generalize one or two qualities into a negative global judgment. These are extreme forms of generalizing, and are also referred to as “labeling” and “mislabeling.” Instead of describing an error in context of a specific situation, a person will attach an unhealthy label to themselves.

For example, they may say, “I’m a loser” in a situation where they failed at a specific task. When someone else’s behavior rubs a person the wrong way, they may attach an unhealthy label to him, such as “He’s a real jerk.” Mislabeling involves describing an event with language that is highly colored and emotionally loaded. For example, instead of saying someone drops her children off at daycare every day, a person who is mislabeling might say that “she abandons her children to strangers.”

14. Always Being Right.  Anyone spot the All or None language right in the name?

We are continually on trial to prove that our opinions and actions are correct. Being wrong is unthinkable and we will go to any length to demonstrate our rightness. For example, “I don’t care how badly arguing with me makes you feel, I’m going to win this argument no matter what because I’m right.” Being right often is more important than the feelings of others around a person who engages in this cognitive distortion, even loved ones.

15. Heaven’s Reward Fallacy.

We expect our sacrifice and self-denial to pay off, as if someone is keeping score. We feel bitter when the reward doesn’t come.

What to do about these negative thinking patterns?  Dr. Grohol was kind enough to include a link to Fixing Cognitive Distortions, another tool for helping rid oneself of these pesky, repetitious thoughts.

--Sandy Andrews, PhD 
Clinical Psychologist
Austin, TX

April 7, 2016

Is Porn Bad for Your Relationship?

I remember a client who felt demoralized after a couples therapy session.  The therapist essentially condoned the partner's use of porn.  He's a man and men are visual, said the therapist. Don't interfere with the male prerogative.

Many professionals view porn differently. If both partners enjoy viewing porn together, and neither find the material objectionable, it may not be a problem.  But in An Open Letter on Porn, psychologist and relationship researcher, Dr. John Gottman, Ph.D., concludes that porn can interfere with intimacy between couples.  Couples with one partner viewing porn regularly have sex "far less" often, his sources indicate. It would be ironic, wouldn't it, if viewing porn, assumed by some as a quintessential masculine activity, predicted less real-life sex.

One of the reasons porn enthusiasts have less sex may stem from something known as the "supernormal stimulus" phenomenon:

  "...Research on the effects of pornography use, especially one person frequently viewing pornographic images online, shows that pornography can hurt a couple’s relationship...because pornography can be a “supernormal stimulus” ...  a stimulus that evokes a much larger response than one that has evolutionary significance. One effect of a supernormal stimulus is that interest wanes in normal stimuli."

I have heard several clients express just such a fear,  "If my partner is getting off to air-brushed images of uber-beautiful, surgically enhanced models (supernormal stimulus), how could he possibly want to have sex with me?"  Gottman's Open Letter suggests such fears may not be rooted in insecurity or jealousy but in a hard, lonely truth: Porn can be bad for a couple's intimate relationship.

Sandy Andrews, PhD  is a Clinical Psychologist / Therapist who provides CBT in Austin, Texas