Play Outside: An Earth Day Reflection

I don’t normally do a great job of keeping up with all the various holidays and points of celebration. But Earth Day is near and dear to my heart. And not for any deep political reason. Earth Day is special to me because it reminds us to look outside and celebrate the amazing planet that we live on.

I am an outside girl. Even as a kid who just wanted to be left alone with my books, I wanted to be left alone with my books while I was perched in the crook of a big old tree. Some of that is a reflection of many family summers spent camping and playing outside. Our vacations almost always included (still do, actually) lots of hiking and visits to beautiful parks and trails.

There has been plenty written about the possibility that our kids might be experiencing an over-scheduled, over-stimulated, electronically padded nature deprivation.

I think that adults are at risk of nature deprivation too. We all need the experience of fresh air, or spring flowers, or the sound of wind in the trees. It touches something deep inside us. For me, it fills those places that are longing for some peace and quiet.

I’m going to keep this post short & sweet today. My Earth Day gift to you is an invitation: get outside! Put your toes in the grass, plant a seed, walk in the park, watch the birds, smell a hyacinth. . .you get to pick, just enjoy a few moments of connection with nature today. I bet you’ll feel a tiny bit renewed too.

 

Breathing Through Heartbreak

My post earlier this week was more about my own processing of the tragedy that unfolded in the Kansas City area last weekend. In addition to that violence, our community is also coping with an ongoing source of fear. There have been more than twenty incidents in the past few weeks where someone has shot at cars on our roads and highways. So far, there hasn’t been serious injury, but that is a result of luck or divine intervention (depending on how you explain moments of grace).

My clients who struggle with anxiety (and many of the rest of us too), are having a really hard time right now. One of the tools that we use to cope with anxiety is to explore all of the evidence that fears are not in response to actual danger. We talk about how rare it is for people to engage in random violence–we look at the facts.

This week, in this city, our facts are tougher to handle. Even if random violence really is rare (and it still is), we feel as though we have been exposed to a LOT of it. Most of us out there are still very safe in our cars. Most of us can go to the community center and not be at risk.

But, but, but. There are two families facing the fact that, for their loved ones, rare came true. There are more than 20 drivers who have bullet holes to prove that they aren’t responding to a hypothetical threat.

If you are anxious at all–these truths feel bigger than the truth that we’re still as safe as we were before. In fact, even if you aren’t anxious, it is hard to feel safe with these headlines. Honestly, I’m not a terribly anxious person, and I am struggling to feel as safe as I did two weeks ago.

It is tempting to freeze. To limit the trips we take. To call in sick. To hunker down, with our loved ones close to us, and just hide out until the world feels safe and sane again. Centuries of human history have taught our brains that the appropriate response to danger is to get away from it. To run, or if we can’t run, to freeze and hope that danger doesn’t notice us.

I have said it before. Random bad stuff happens. None of the three folks who died last weekend was doing anything wrong. None of the passengers on the Malaysian plane deserved to disappear. None of the families with bullet holes in their cars deserved to be assaulted. We can’t prevent or avoid random bad things.

But we can refuse to let the possibility of random awfulness rob us of lives that are rich and full of meaning. We can make choices to take action. We can reach out to one another. We can shine our own small lights in the darkness. Have you ever been in a dark room that was then progressively lit by many individual candles? It’s amazing. No one light is enough to really change the darkness, but each single light contributes to the creation of light for and with the others around it.

So today, and tomorrow, and the day after that, I am refusing to freeze.

Don’t get me wrong. I am afraid to drive my normal routes (which include the areas that have had shootings). But I probably will anyway, at least sometimes. I have felt like putting my family on lockdown. But I refuse. I will not let the random bad stuff rule my life. I will show up and connect and stand for what I value.

If you’re refusing to freeze, let me know, or let us all know in the comments. If I can support you, let me know that too.

Rebooting

Rebooting. Restarting. Recommitting.

This topic isn’t a new one for me. In fact, I write about it at least once a year. Because at least once a year, I get off schedule and it takes me longer than I want or expect to get back in my groove. This time around, I gave myself permission to take spring break week off–I didn’t even schedule an archive post. (That was partly a choice, and partly a reflection of how busy I was before I left town).

And that part is just fine. I talk all the time about how important it is to walk your talk when it comes to self-care. Taking a week off isn’t a big deal.

The problem is this–it wasn’t really about spring break. My writing schedule had been off balance for a couple of weeks before I left town, and it’s taken me almost two weeks to get started again. The problem was my time management. I’m really busy in the office right now (therapy is a cyclical thing, and late winter is busy season!). And I wasn’t building in enough time to write. So, even though my writing is a commitment to my readers, even though it’s a part of my week that I really enjoy and look forward to, I let it drop.

I got out of the groove, and the ideas weren’t flowing as easily as I had gotten used to.

I changed my practice and following through got a lot harder.

I started to feel embarrassed about the fact that I hadn’t been on schedule, and that made it even harder to write.

Does any of this sound familiar? Does it parallel how you might be thinking or feeling about something that matters to you? Have you been trying to exercise, or meditate, or eat vegetables, or keep a journal? Did you do it for a little while, and begin to enjoy it? Were you starting to find your groove? And then life happened. The car broke down, or you had a flare-up, or work got busy. Something happened that interrupted your new habit.

Welcome to the club. The truth is, this cycle of committing and recommitting is what relationships (with ourselves or anyone else) are all about. We try, we succeed, we try, we drop the ball. The most important thing is that we keep on trying. And that we are compassionate and nonjudgmental with ourselves. This is what life includes. Getting out of sync isn’t a failure, it’s a sign of being present in a busy, dynamic, messy real life.

So, if you are in the “offline” position with your own self-care, I’m inviting you to join me. I’m rebooting. I’m activating my compassion and I’m reconnecting to my commitment to write.

What reboot are you starting?

Connecting the Dots: Health & PTSD

Many of my clients would not say that they have suffered from trauma. But many of them have faced serious health challenges. So, one of my early tasks in therapy is to help them explore how much trauma they may have experienced without knowing it. Here’s how Merriam-Webster’s dictionary defines trauma:

trau·ma
noun \ˈtrau̇-mə, ˈtrȯ-\: a very difficult or unpleasant experience that causes someone to have mental or emotional problems usually for a long time

medical : a serious injury to a person’s body

So, would you characterize an insulin crash as “very difficult or unpleasant”? What about cancer treatment? Or a stroke? Or chronic pain from rheumatoid arthritis?

These questions and the definition are the long way around to my point that health challenges are frequently traumatic. They include pain, disruption in life, and other major stresses. And surviving a traumatic event puts you at risk for developing post-traumatic triggers.

What’s a Post-Traumatic Trigger?

Good question. A post-traumatic trigger is something that creates a reminder or re-visiting of your initial traumatic experience. That means that nearly anything can be a trigger, because your brain created a unique set of associations with your initial trauma. Some frequently identified triggers are tests or scans, doctor’s appointments, the smell or sound of hospitals or hearing about someone else’s health challenges.

What Happens if I’m Triggered?

The experience of trauma and post-traumatic stresses is different from person to person. A few of the most common responses are freezing, flooding, or dissociating. These are only a few types of response, there are many other possibiliteis as well. Let’s look at the most common responses a bit more:

  • Freezing: When faced with a post-traumatic trigger, you may find yourself feeling unable to move, act or respond. This can include either physical or mental responses.
  • Flooding: Flooding includes an intense rush of physical and emotional sensations. If you don’t know that you have been triggered, you may feel completely taken off guard.
  • Dissociating: Dissociating is a fancy word for “completely disconnecting”. Most of us have some experiences of dissociation pretty regularly–have you ever gotten home and not remembered your drive? You were dissociated while you were driving. If you experience a post-traumatic trigger, you may dissociate (it happens automatically) and then find yourself “checking back in” without knowing what happened.

So Then What?

I don’t know about you, but many of my clients are initially relieved to have some labels that help their responses make sense. However, once the relief of being able to name and understand post-traumatic responses wears off, they also want tools to help with those responses.

There are lots of resources for coping with PTSD and post-traumatic triggers. Here are a few easy-to-learn strategies that you can begin right away:

  1. Know what is happening. There is huge relief in being able to name the fact that you have had a traumatic experience and that you may experience future triggers. You’re not losing control. You are having a natural response to a painful event.
  2. Use breathing to help ground you in your body and mind. Even 3-5 slow, deep breaths will help you move away from a triggered state and into a more comfortable relationship with your body.
  3. Remind yourself that you are safe and out of immediate danger. Trauma responses are part of your body’s emergency protection system, and reminding your brain of your safety can help lower the response level.
  4. Be aware that you probably won’t know all of your triggers–post-traumatic stress can sneak up on you. Be patient with yourself as you move through the cycle of identifying and responding to triggers.
  5. Ask for help. Support groups and therapy can be good places to get additional coping support.

Have you been through this yourself? I’d love to hear your favorite strategy in the comments. And if you need help, you are always free to reach out to me.

Road Less Traveled


I’ll be visiting my sister and her family next week over our spring break. They live in Virginia, and we’ll be driving. It’s a bit over 1000 miles from my house to hers.

I’ve been fascinated this week by people’s responses when I say we’ll be driving. They range from pity to horror to plain old disbelief.

I often say that it’s easier to drive with kids, that we have more control over our trip. I think that those things are true. But that’s not really why we drive.

We drive because we like to drive. Because the experience of being on the road gives us a chance to explore, to see new things, to take back country “highways.” Because we can stop at whatever interesting thing we want. Driving leaves us the chance to have adventures.

And that has gotten me thinking. How often in your day to day lives do you miss the chance for adventure? How often do you continue through the steps of your routine, driving the same way you did yesterday, following the same rules, seeing the same sights?

It is easy to get into routines. In fact, our brains encourage it. Routines require less mental investment than new behaviors do. Routines allow you to check out, to multitask. And sometimes, routines are a life-saver. Routines for handling work, and school planning make mornings much more pleasant. Routines in hospitals help prevent errors.

I’m not knocking routines. I appreciate mine–they’ve taken a lot of time and effort to develop.

Even though your brain likes routines and habits, sometimes it needs the challenge of something new.

And, while routines can serve a valuable role in your daily tasks and responsibilities, they can also keep you stuck.

So, my question for you today is this: when was the last time you took a risk, stepped outside of your comfort zone and walked down that “less traveled road?” You don’t need to take on a 2000 mile road trip to do it. That’s how I roll, but it might be extreme for some folks.

Instead you could try shaking things up in small ways:

  • Drive a different path to work than normal.
  • Find a park or local attraction that you’ve never visited.
  • Play a game you’ve never tried.
  • Reach out to a new friend.
  • Try a new activity (art class, fitness class, cooking–you name it)
  • Eat food you’ve never tried before.

You don’t need to get extreme, but I challenge you to build some adventure into your week. And if you’d like to share it here–I’d love that!

METAvivor Won’t Go Quietly Into the Night

Ann Becker-Schutte, Ph.D. | Licensed Psychologist:

This is an important issue in healthcare education and advocacy–talking about more difficult diagnoses.

Originally posted on The Healthcare Marketer:

An Introduction to METAvivor

METAvivors are different from traditional cancer survivors (http://www.metavivor.org). This is a community of people living with stage IV cancer, and advocating for the research that may, one day, save their lives or the lives of others like them. The “meta” in METAvivor is a reference to Metastatic Breast Cancer (MBC) – or stage IV breast cancer. When breast cancer has spread to non-adjacent parts of the body (brain, spine, lungs) it is considered to be metastatic. The cancer has metastasized. This is the advanced breast cancer that kills; and it kills as many as 40,000 people each year. It is important to note that there has been no decline in the number of annual deaths due to MBC over the last two decades. None. Yet, of the billions raised annually for breast cancer research, only 2% goes to MBC – even though 30% of …

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Doing Better in Healthcare

Disclaimer: This post includes stories that were shared with me by clients. Any information about their experience was used at their request and with their permission. Clients reviewed this post before it was shared with the public, and were given the opportunity to revise the post so that they felt that their privacy was protected. All clients connected with this post want their story to be shared to help improved education and other patient experiences. Nothing about their experience in therapy is revealed in this post.

I have written for a while now about the fact that I passionately believe mental health has so much to bring to the table with other health care professionals. I have also written about the need to include and value patient voices in health care conversations. Sometimes, since I interact with many committed, caring professionals and with many competent, compelling patients, I think that I forget how much more there is to do.

But I have had two experiences in the past few weeks that have brought home to me the clear reminder that we still have a long way to go.

The first was sitting with a client who has been dealing with a cluster of chronic health issues her entire life–initially diagnosed before she was two with asthma. Recently, the biggest challenge has been severe allergic reactions: nearly constant itching, swelling of lips & throat, rashes, etc. This client sought help at a specialty clinic. There she experienced several things that just blew my mind:

  1. Despite her clear statement that her concern was the allergic reactions, both her assessing clinician and their supervisor focused on her breathing.
  2. This capable, professional, adult woman was told something that approximated, “I am the doctor. You don’t tell me you have allergies. I tell you if you have allergies.”
  3. She was “diagnosed” with . . . drum roll please . . . asthma. A diagnosis she has had nearly all her life. Presented as significant new information.
  4. Despite expressing concern about any new medication because of a history of difficult (read life-threatening) side effects, she was given a prescription and told not to worry because it was an antihistamine. Upon reading about the medication, she learned that it is in fact a tricyclic antidepressant.

The second was with another client who has a life-long history with a chronic condition. She has managed this condition without any major complications, and has been diligent about her self-care. Her specialist recently retired, and she had a series of life stresses that did lead to a minor complication with her chronic condition. She made an appointment with a new specialist, who cancelled that appointment. My client had to reschedule several more times because of work commitments (appointments with other people in the office, not specialist). When she did finally get to meet the new specialist, before greeting her or learning her history, the new specialist said something to the effect of: “I am Dr. X, and the first thing you need to understand is that you don’t skip my appointments.”

The precise words used by my client were, “I didn’t know what to do. He just made me feel so small.”

These stories aren’t unique to my clients. I hear stories like this in the ePatient community all the time. I hear stories like this in my office all the time.

Let me be clear. This isn’t about bashing medical doctors. I know that these stories only illustrate a small part of what is going on in healthcare. I know that for each doctor who dismisses a presenting concern, there are many, many more who do great listening. In fact, in the same week, I had another patient tell me how a specialist made her feel heard and supported in a challenging medical quest. I know that for each patient who is made to feel small, there are hundreds of patients who are lifted, educated, & supported by their health care team. I know that for each specialist who fails to listen, there is a mental health professional who makes a snap judgment.

I don’t share these stories to point fingers or pass blame. In fact, I’ve been very careful to avoid any information that might identify doctors, clinics, or patients.

Instead, I am sharing these stories for three reasons. First, I want to continue a commitment to support everyone in healthcare who is trying to do better. To commit to real listening, engaged empathy, and respect of patient experience. Secondly, I share these stories to validate that we need patients in the healthcare communication process–to bring these moments to light. And finally, we have to know what is going wrong before we can make it go better. I want to help it go better.

So let’s talk about that. What can we do to minimize these moments in healthcare? Is it a training issue? A patient empowerment issue? A collaborative care issue?

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