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Tuesday, November 23, 2010

Strategies for Managing Stress at the Holidays

For people prone to anxiety, the holiday season may be stressful as well as exciting. The subjective feelings of stress may interfere with the ability to be mentally present with family members and to enjoy the fine food and break from work. There are many reasons for anxiety related to work, finances, family, travel, and entertaining. We may feel pulled in different directions or unable to get everything done that is expected of us. We may not have planned in advance, leading to last minute panic about getting everything ready in time. People who are alone or away from extended family during the holidays may feel lonely and anxious about arrangements for the holiday. Below are some common sources of anxiety and ways to adapt our thought processes to manage them better.

(1) Too Many Demands
November means the end of the year is almost upon us. This can cause anxiety because we may not have met our work goals yet. Work may have piled up or we may have procrastinated and now we're running out of time. Unexpected demands may emerge because others have been procrastinating too. The increased crowds and people on the road or people being out of the office make it harder to get anything done. Additionally, we may be planning festivities, sending out cards, or shopping for gifts, all of which distract us from working. With new austerity policies, not everybody will have the whole weekend off work. This can lead to envy or resentment when we think that everybody else is out celebrating or family members may be disappointed by our absence.

(2) Finances
In these difficult economic times, most people are stretched financially. Property tax season seems to come all too soon and there may be presents to buy, the cost of entertainment or travel. Try to make choices about money that reflect your family's values and priorities and that take into account the realities of your situation. Children enjoy spending engaged time with parents more than they do expensive gifts. One or two special gifts is all that is needed. kids don't need hundreds of toys to play with. Cooking together with kids can create special family memories without much cost. Cut travel costs by going by car, staying with friends or relatives, or taking advantage of special deals. To reduce anxiety, make your choices and feel good about them, without feeling guilty or second-guessing yourself. And have realistic standards. Your holidays can be good enough. They don't have to be perfect. Most importantly, try to enjoy the moment and the company of friends and relatives or the break from your regular routine. Reflect on your blessings such as health and family and take time to feel gratitude.

(3) Crowds and Travel Delays
Unfortunately, there is often nothing you can do about these sources of stress except planning to do shopping early and booking the first flight of the day. If you face unavoidable lines or delays, this is a good time to use distraction or be mindful. Accept that there's nothing you can do about the situation and try to stay in the moment and relax. Or practice distraction by bringing a book to read or some games for kids to play. Or use the time to call a friend or make a to do list. Alternatively, you can plan a staycation and avoid all the travel stress. If you suffer from panic attacks or agoraphobia, try to minimize exposure to crowds and practice coping strategies such as deep breathing or thinking reassuring thoughts.

(4) Coping Strategies

To cope with anxiety, say to yourself "What's the worst that can happen if I don't get this done in time?" Most of the time, the consequences will be bearable and not the end of the world. Although this isn't a desired outcome, it's important to reduce our worry about not getting things done so it doesn't interfere with our concentration. We may be able to negotiate deadline extensions. If this isn't possible, we may be able to get work done by delegating, paying for services, or asking for help from others. We can divide tasks into essentials like ordering the turkey versus less essential tasks such as folding the napkins perfectly, and prioritize the essential ones. Scheduling one's time and taking advantage of 20-30 minute breaks between appointment to get small tasks done will prevent things from piling up. Remember to breathe and stretch at regular intervals to reduce muscle tension. Try not to miss your time at the gym or your exercise. Aerobic exercise can improve our ability to focus amidst distractions. Reducing perfectionism and just getting things out is another useful strategy for less important tasks. Its not important to have perfect handwriting on every holiday card or to send cards to every acquaintance. Also, remember that the point of the holiday is to feel gratitude for what we have, so make sure you take some time to check in with yourself and count your blessings.

Wishing you a healthy and happy holiday season. If you live in Marin County or San Francisco and need psychotherapy services, please visit my website at I have a sliding scale of fees and use evidence-based cognitive-behavioral and mindful strategies to treat anxiety and related mental health problems.
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A Psychologist's Guide to Making the Most of the Holiday Season

The Winter holidays are upon us once again, bringing an opportunity to take time out to celebrate with family and friends. Department stores are filled with glittery, silvery, wintery decorations and the fashionable, trendy spanking new merchandise for sale. Not to mention the beautiful candleholders, ornamental pumpkins and fall leaves, and colorful table runners and napkins that provide a backdrop for the feasting. This is a time of national celebration and family togetherness. Yet amidst all this celebrating, there is also the potential for psychological stress and hidden pitfalls. It is important to be mindful of these so that our thoughts and actions during the holidays do not lead to distress or regret. Below are some tips I have learned from my work as a clinical psychologist in private practice in Mill Valley, CA.

1) Celebrate Joyfully, But Don't Go Overboard

Moderation in all things is the key to enjoying the celebration but not using it as an opportunity to abandon sound judgment and healthy practices. This is a special time, with great food, so eat something special or taste many favorite foods, but do some anticipatory planning and think about your choices and food goals before you get into the tempting situation. Once you're standing next to the food table, its much harder to resist temptation if you haven't mentally prepared yourself. Practice positive self-talk, reminding yourself of the importance of making healthy choices and your ability to stick with your food plan. Tell yourself its ok to enjoy a reasonable amount of good food without feeling guilty or ashamed. Both avoiding excessive eating and enjoying the food you do eat are part of healthy, mindful self-care.

(2) Shop Mindfully

The after-Christmas sales are notorious for splendiferous selections, bargain-hunting, chaos and crowds. In all of this frenetic activity, its easy to get carried away and exceed your budget, potentially leading to debt that will take the next year to pay off. Advertisers and stores know how to pull the emotional strings to get the pursestrings to open. They display idealized images of snow, warm and cosy firesides and family fun and togetherness. In reality, many families are a mixed bag emotionally, and the mobility of our society may result in your living far from family. Some of you may be single or recovering from a recent loss or breakup. Some may be working through most of the holiday season for economic reasons or money for gifts may be scarce this year. Its important to see your own life for what it is without comparing it to a commercially-created idea of how things should be. If your holiday celebration wouldn't meet Martha Stewart's standards, it does't mean that you are a failure. Don't buy things you don't need or too many gifts because you're trying to create a fantasy world. Make the most of the life you have, even if it doesn't contain Juicy or Tory Birch. Buy a few special things and gifts you can afford and that are thoughtfully chosen based on the person's interests or personality. Write a special card to convey loving sentiments. Celebrate in a way that expresses your uniqueness and your family's values. And go home with some cash to spare.

(3) Balance Self-Care with Giving to Others

The holiday season is a time for parties and celebration, enjoying the arts or the outdoors, sending cards to long-lost relatives, cooking, entertaining, worshiping and volunteering. These are all potentially enriching and energizing activities that create a sense of togetherness and community. That is, if you choose your commitments wisely and keep in mind the need to balance self-care with giving to others. Often family obligations rear their heads, or couples feel torn between demands of the two sets of parents. Sometimes extended family members want you to visit or spend all your time with them. Remember you always have a choice about how you spend your time. If you enjoy the company of family, family visits can be a lot of fun. It can be valuable for children to feel connected to older relatives and for parents to be respected and appreciated for what they have given. However, if the relationships are strained or psychologically unhealthy, family togetherness can lead to resentment and feelings of being burdened rather than healthy connection. Remember, it is not necessarily the amount of time spent, but the quality of time that counts. It is also important to feel free to express what you feel and be yourself, rather than playing some role to please others. And it is important to leave some time for relaxing, taking stock, setting goals, and getting organized for the next year. So connect with others this holiday season but also connect with yourself.

(4) Avoid the Comparison Trap

Another common holiday pitfall results from a wandering and judging mind. In mindfulness terms, we sometimes refer to this as "big deal mind." This happens when your mind makes a big deal over some goal or outcome and uses this as an assessment of your ultimate success or worth as a human being. Your mind then starts comparing your life to those of other people with more money, bigger houses, or larger families and decides that you fall short. Single people may wish they were married. Married people may wish their relationships were happier. Almost everybody wishes they were more successful. People start feeling unworthy because their holiday celebration doesn't measure up or because they don't have a big friendship network, or because they're not a master chef and entertainer or because they're alone. The holidays are therefore a great time to develop a mindful attitude. Try to observe your thoughts as they wander, withholding judgment, and bringing your attention back to your immediate present and sensory experience. Be aware of your wishes and wants, but don't let feelings of inferiority determine your actions. Think about your values and the things in life that are most important to you. Use these values to guide your decisions and efforts, while trying to let go of focusing on the outcome. Efforts are controllable while outcomes may not be. Try to develop compassion for yourself and a feeling of connection with all living things, rather than competition. We are all part of a larger universe and if we seek to contribute rather than compete and compare, we can make an important difference to our world. And that is the real spirit of the holidays!

To find out more about my clinical practice or contact me, please visit my website at I am also available for speaking, blogging, writing, or consulting engagements. Have a happy Thanksgiving. Melanie A Greenberg, Ph.D.
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Monday, November 15, 2010

The Benefits of Pilates Exercise for Fitness, Pain, and Stress

Pilates is a form of exercise, originally designed for dancers and athletes, that focuses on building spinal stability and core strength as well as stretching and building lean muscle. Its no wonder this exercise has become so trendy among celebrities and movie stars who need to maintain a strong and healthy body to adhere to the demands of public visibility and high-pressure projects. I personally have an active 2 to 3 X a week Pilates practice, working on the Reformer machine. After practicing Iyengar yoga for many years, I started doing Pilates because I wanted to build better strength and balance, while keeping the focus on precise alignment and posture. The mixture of challenging/strengthening and stretching/relaxing movements provides considerable stress relief, and the engagement and focus required improves concentration and mental alertness. I recommend a complementary Pilates or yoga practice to my psychotherapy clients as a way of managing the deep emotions and personal vulnerability which therapy brings up. Below, I summarize some major potential mind-body benefits of Pilates practice:

(1) Mindfulness & Focus
Pilates exercises require a mindful focus on the body so as to maintain stability of the core muscles in spine and abdomen while moving arms, legs, or torso. The movements are smooth, stretching, and flowing, leading to a relaxed body awareness and focused attention. The philosophy of pilates is to understand and accept one's current capacities and slowly work towards improvement, rather than trying to force things. Such an approach builds self-awareness and self-acceptance that can be applied to other aspects of life. Also, the focus on moving mindfully rather than automatically can be applied to other life areas.

(2) Spinal Stabilization
Pilates is particularly helpful to individuals with back pain or arthritis because it stabilizes and strengthens the muscles around the spine. Research shows that the transverse abdominus and multifidi muscles are involved in spinal stabilization. Following an injury, the spine can get out of alignment, either due to the injury itself or the person's attempts to compensate by making postural changes. The deepest layer of transverse muscles in the abdomen wrap around the spine and help to stabilize it. Therefore strengthening these muscles can both prevent and diminish low back pain as well as improving posture and strength.

(3) Core Strength
The core muscles are those in the back and abdomen. Pilates exercises strengthen these muscles, leading to better posture, better balance, flatter abs, and more resistance to injury. This physical strength can also translate into more mental resilience and ability to withstand stress and demanding routines. Body image is also enhanced, suggesting that people with subclinical or clinical eating disorders might benefit. Building lean muscle can also enhace weight loss.

(4) Breathing and Relaxation
Pilates exercises require a focus on the breath as participants move with in and out breaths. Breathing may be lengthened to accommodate the movement, and awareness of breathing is enhanced. The combination of deep breathing and rhythmic stretching movements can lead to deep relaxation and stress relief. More intensive Pilates also has an energizing quality, because of improvements in the flow of oxygen through the body. Two to three times a week Pilates constitutes a moderately challenging fitness routine that can enhance performance in other sports as well.

Optimal health requires work on both the mind and the body. In my opinion, the most beneficial body work is in harmony with mental and emotional functioning. Exercises such as Pilates strengthen and condition both mind and body and give my clients strength to enact behavioral changes that are an important part of successful therapy.
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