2007 February

Counseling Patients with Cancer

February 28, 2007 By Dr. Dawn-Elise Snipes

Each year millions of Americans are diagnosed with cancer. Nearly 500,000 of those will be diagnosed with breast or prostate cancer. Many of our patients will have, or have had cancer. It is important to understand the range of emotions, causes of distress and interventions available to help them.

There are many things that affect how a patient adjusts to cancer. It is difficult to predict how a person will cope. The following factors influence how a patient adjusts to cancer: The type of cancer, cancer stage, and chance of recovery.
The phase of cancer such as newly diagnosed, being treated, in remission, or recurrent cancer.
Individual coping abilities.
Friends and family available to support the patient.
The patient’s age.
The availability of treatment.
Beliefs about the cause of cancer.

Adjusting to a diagnosis of cancer is an ongoing process in which the patient learns to cope with emotional distress, solve cancer-related problems, and gain control over cancer-related life events. To add to the stress, patients are faced with many challenges that change as the disease and its treatment change. There are, however, certain predictable times when a patient is more likely to experience significant crisis. These include hearing the diagnosis, receiving treatment, completing treatment, hearing that the cancer is in remission, hearing that the cancer has come back, and becoming a cancer survivor. Each of these events involves specific coping tasks, questions about life and death, and common emotional challenges.

Patients are better able to adjust to a cancer diagnosis if they are able to continue fulfilling normal responsibilities, cope with emotional distress, and stay actively involved in activities that are meaningful and important to them. In counseling, patients can learn to develop coping strategies to change problem situations, manage emotional distress, and understand what impact cancer may have on his or her life. Patients who adjust well are usually committed to recovery and actively involved in coping with cancer.

Distress can occur when a person feels that he or she does not have the resources to manage or control the cancer. Patients who have the same diagnosis and are undergoing the same treatment may have very different experiences and ways of expressing distress. Anxiety and depression are common among patients with cancer. It is important, however, to ferret out whether the anxiety and depression are solely emotionally based or are caused/made worse by insomnia, fatigue, pain or side effects of medication.

Anxiety
Anxiety is a normal reaction to cancer and may increase feelings of pain, interfere with one’s ability to sleep, cause nausea, and interfere with the patient’s (and his or her family’s) quality of life. Persons with cancer will find that their feelings of anxiety increase or decrease at different times. Contrary to what one might expect, patients with advanced cancer experience anxiety due not to fear of death, but more often from fear of uncontrolled pain, being left alone, or dependency on others. Many of these factors can be alleviated with treatment. Helping patients identify their own cycles and plan for those times is a useful activity in therapy.

Patients may benefit from other treatment options for anxiety, including: psychotherapy, group therapy, family therapy, participating in self-help groups, hypnosis, and relaxation techniques such as guided imagery, or biofeedback. Medications may be used alone or in combination with these techniques. It is important not to avoid anxiety-relieving medications for fear of becoming addicted. A side benefit of many of the antianxiety medications is that they cause muscle relaxation which can often ease some of the aches and pains patients are experiencing.

Depression
While some patients become anxious, others become depressed, and even others are both anxious and depressed. Depression affects about 15% to 25% of cancer patients. Affecting men and women with cancer equally. People with cancer will experience different levels of distress. Issues which may contribute to depression in cancer patients include:
Fear of death.
Interruption of life plans.
Changes in body image and self-esteem.
Changes in social role and lifestyle.
Money and legal concerns
Guilt at not being around for their children
Regret for delaying diagnosis
Survivor guilt (If the patient survives and his/her friend does not)

People diagnosed with cancer will react to these issues in different ways and may not experience serious distress. It is also important to remember that patients and their family members or caregivers need to be evaluated for depression throughout their treatment. Children are also affected when a parent with cancer develops depression, and often develop emotional and behavioral problems.

There are many misconceptions about cancer and how people cope with it, such as the following:
All people with cancer are depressed.
People with cancer should be shielded from stress
Depression in a person with cancer is normal.
Treatment does not help the depression.
Everyone with cancer faces suffering and a painful death.
Depression and anxiety are always mental health issues

Sadness and grief are normal reactions to the crises faced during cancer, and will be experienced at times by all people. Because sadness is common, it is important to distinguish between normal levels of sadness and depression. An important part of cancer care is the recognition of depression that needs to be treated. This is depression that causes a person to lose pleasure in most activities more often than not for at least two weeks and can be accompanied by sleep and appetite changes, suicidal thoughts, confusion and difficulty concentrating. Counselors with a knowledge of cancer and cancer treatment can help people deal with their depression. Specific goals of these therapies include the following:
Assist people diagnosed with cancer and their families by answering questions about the illness and its treatment, explaining information, correcting misunderstandings, giving reassurance about the situation, and exploring with the patient how the diagnosis relates to previous experiences with cancer.
Assist with problem solving, improve the patient’s coping skills, and help the patient and family to develop additional coping skills. Explore other areas of stress, such as family role and lifestyle changes, and encourage family members to support and share concern with each other.
Ensure that the patient and family understand that support will continue when the focus of treatment changes from trying to cure the cancer to relieving symptoms. The health care team will treat symptoms to help the patient control pain and remain comfortable, and will help the patient and his or her family members maintain dignity.

When the depression or anxiety is being made worse by symptoms or medication, the counselor can advocate for the client, help the client communicate with his/her physician and educate the client about possible interventions.

Fatigue
Fatigue occurs in 14% to 96% of people with cancer, and has physical, psychological, and behavioral causes. People with cancer may describe it in different ways, such as saying they feel tired, sluggish, weak, exhausted, weary, worn-out, heavy, or slow. To be treated effectively, fatigue related to cancer and cancer treatment needs to be distinguished from other kinds of fatigue.

Fatigue can become a very important issue in the life of a person with cancer. It may affect the person’s self-esteem, his or her daily activities and relationships with others, and whether he or she continues treatment. Some of these treatments may include adjusting the dosages of pain medications, administering red blood cell transfusions or blood cell growth factors, diet supplementation with iron and vitamins, use of antidepressants or stimulants, exercise, and helping the patient identify a reasonable schedule so as not to tire too quickly.

Since fatigue is the most common symptom in people receiving outpatient chemotherapy, patients should learn ways to manage the fatigue. According to the American Cancer Society, patients should be taught the following:
The difference between fatigue and depression
Possible medical causes of fatigue (dehydration, electrolyte imbalance, breathing problems, anemia)
To observe their rest and activity patterns during the day and over time
To engage in attention-restoring activities (walking, gardening, bird-watching)
To recognize fatigue that is a side effect of certain therapies and medications
To participate in exercise programs that are realistic
To identify activities which cause fatigue and develop ways to avoid or modify those activities
To identify environmental or activity changes that may help decrease fatigue
The importance of eating enough food and drinking enough fluids
Respiratory therapy may help with breathing problems
To schedule important daily activities during times of less fatigue, and cancel unimportant activities that cause stress
To avoid or change a situation that causes stress
To observe whether treatments being used to help fatigue are working

Pain Management
Pain is another major cause of insomnia, anxiety and depression. Counselors can work with physicians and patients to create a comprehensive pain management plan.

Physical Interventions include:
Muscle/bone pain may be treated with heat (a hot pack or heating pad); cold (flexible ice packs); massage, pressure, and vibration (to improve relaxation); exercise (to strengthen weak muscles, loosen stiff joints, help restore coordination and balance, and strengthen the heart); changing the position of the patient; restricting the movement of painful areas or broken bones; stimulation; controlled low-voltage electrical stimulation; or acupuncture.

Thinking and behavior interventions give patients a sense of control and help them develop coping skills to deal with the disease and its symptoms. Beginning these interventions early in the course of treatment is useful so that patients can learn and practice the skills while they have enough strength and energy.

Thinking and Behavioral interventions include:
Relaxation and imagery: Simple relaxation techniques may be used for episodes of brief pain (for example, during cancer treatment procedures).
Hypnosis: Hypnotic techniques may be used to encourage relaxation and may be combined with other thinking/behavior methods. Hypnosis is effective in relieving pain in people who are able to concentrate and use imagery and who are willing to practice the technique regularly.
Redirecting thinking: Focusing attention on distractors other than pain or negative emotions including counting, praying, or saying things like “I can cope,” music, television, talking, listening to someone read, or looking at something specific. Patients can also learn to monitor and evaluate negative thoughts and replace them with more positive thoughts and images.
Support groups and religious counseling: Since depression tends to increase pain, and pain tends to increase depression, support groups help many patients. Many online support groups for patients and their families can be helpful for those patients who have restricted movement. Visit: http://www.acor.org/

Sleep
Finally, sleep problems can contribute to depression, anxiety and the patient’s ability to manage pain. Sleep disorders that are related to cancer may be treated by eliminating the cancer and side effects of cancer treatment. To promote rest and treat sleep disorders the following may be considered:
Create an environment that decreases sleep interruptions and promotes sleep by:
Lowering noise.
Dimming or turning off lights.
Adjusting room temperature.
Aromatherapy
Keeping bedding, chairs, and pillows clean, dry, and wrinkle-free.
Using bedcovers for warmth.
Placing pillows in a supportive position.
Encouraging the patient to dress in loose, soft clothing.
Encourage regular bowel and bladder habits to minimize sleep interruptions.
Increasing consumption of fluids and fiber during the day.
Taking medication for incontinence before bedtime.
Eating a high-protein snack 2 hours before bedtime.
Avoiding heavy, spicy, or sugary foods 4 to 6 hours before bedtime.
Avoiding drinking alcohol or smoking 4 to 6 hours before bedtime.
Avoiding drinks with caffeine within 12 hours of bedtime
Exercising (which should be completed at least 2 hours before bedtime).
Keeping regular sleeping hours.
Stretching before bed
Journaling to get closure on the day and “vent” stressors
Setting a regular routine so your body is “cued” to get sleepy
Massage
Medications may also be used to help relieve sleep problems.

As a clinician working with a cancer patient, there are many things you can do to aid him/her in leading the highest quality of life. It is important to remember that patients with cancer who are seeking counseling are often in crisis, so write down suggestions or interventions they are to try at home.

Filed Under: Anxiety, Depression, Grief, Mental Health Tagged With: cancer, Counseling, death, dying, Grief, hospice

Post Traumatic Stress Disorder

February 21, 2007 By Dr. Dawn-Elise Snipes

Over the past decade, as I have worked with cops, firefighters, abuse victims and children of addicts, I have learned that there are many causes for PTSD. It has also affirmed my belief that PTSD is real and harmful, not only to those who have it, but also to those around them. It impacts the way we act, react, our motivation and our capacity to feel–well, anything.

Terrifying experiences that shatter people’s sense of predictability and invulnerability can profoundly alter their coping skills, relationships and the way they perceive and interact with the world. The criteria for Post Traumatic Stress Disorder (PTSD) are 1) exposure to a traumatic event(s) in which the person witnessed or experienced or were confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and 2) the person’s response involved intense fear, helplessness or horror DSM IV p. 427-28). Gradual Onset Traumatic Stress Disorder can be caused by repeated exposure to “sub-critical incidents” such as child abuse, traffic fatalities, rapes and personal assaults.

Nevertheless, not all people exposed to trauma are “traumatized.” Why? In 1998, Pynoos and Nader proposed a theory to assist in explaining why people have different reactions to the same event. They asserted that people are at greater risk of being negatively impacted by traumatic events if any of the following are present: 1) they have experienced other traumatic events within the preceding 6 months, 2) they were already stressed out or depressed at the time of the event, 3) the situation occurred close to their home or somewhere they considered safe, 4) the victims bear a similarity to a family member or friend and 5) they have little social support.

It has been argued that officers, emergency service personnel, children of addicts and abuse victims experience traumatic events or threats to their safety on an almost daily basis. Being abused, not knowing when or if your parents will come home, repeatedly seeing children murdered, people burned in car fires and devastated victims starts to take its toll. People like idealistic officers who joined the force to change the world and protect the innocent begin to feel like nothing they do makes a difference, they cannot even keep their zone safe (criteria 3). This is especially problematic for officers who live in or near their work zone and often leads to frustration and burnout (criteria 2). Children start to feel that the whole world is uncontrollable and unsafe.

It is still not totally accepted within the law enforcement community for officers to discuss the impact of situations on them. Anger, humor and sarcasm are but a brief outlet for what many officers dream about at night. As their condition worsens, many officers withdraw, because they are fearful of seeking help or support for fear it is a one way ticket to a fitness for duty evaluation or will get out and be an obstacle for future promotions. Several studies in recent years have shown that Post Traumatic Stress Disorder (PTSD) is among the most common of psychiatric disorders.

Another thing that distinguishes people who develop PTSD from those who are just temporarily overwhelmed is that people who develop PTSD become “stuck” on the trauma, keep re-living it in thoughts, feelings, or images. It is this intrusive reliving, rather than the trauma itself that many believe is responsible for what we call PTSD. For example, I have worked with officers who have responded to child abuse calls and had a child of their own who was a similar age (criteria 4). In the course of daily life children get hurt and have bad dreams. As parents they have seen looks of pain and fright on their kids faces. This makes it just that much easier to envision the looks of terror and agony on the face of the child as their parent beat them. Sometimes this visualization gets corrupted and officers suddenly they start to see their child in their mental re-enactment of the trauma, obviously a much more powerful memory. These officers are much more likely to be “traumatized” by the incident and potentially get “stuck.”

Traumatized individuals begin organizing their lives around avoiding the trauma. Avoidance may take many different forms: keeping away from reminders, calling in sick to work, or ingesting drugs or alcohol that numb awareness of distress. The sense of futility, hyperarousal, and other trauma-related changes may permanently change how people deal with stress, alter thier self-concept and interfere with their view of the world as a basically safe and predictable place. In the example above, these people often became even more overprotective of their children, suspicious of others, and had difficulty sleeping, because every time they close their eyes they see the child.

One of the core issues in trauma is the fact that memories of what has happened cannot be integrated into one’s general experience. The lack of people’s ability to make this “fit” into their expectations or the way they think about the world in a way that makes sense keeps the experience stored in the mind on a sensory level. When people encounter smells, sounds or other sensory stimuli that remind them of the event, it may trigger a similar response to what the person originally had: physical sensations (such as panic attacks), visual images (such as flashbacks and nightmares), obsessive ruminations, or behavioral reenactments of elements of the trauma. In the example above, sensory triggers that triggered some of the officers memories were certain cries, hearing or seeing a parent spank their child, returning to the same neighborhood for other calls and, of course, television shows or news reports that involved descriptions of abuse.

The goal of treatment is find a way in which people can acknowledge the reality of what has happened and somehow integrate it into their understanding of the world without having to re-experience the trauma all over again. To be able to tell their story, if you will.

The Symptoms of PTSD
Regardless of the origin of the terror, the brain reacts to overwhelming, threatening, and uncontrollable experiences with conditioned emotional responses. For example, rape victims may respond to conditioned stimuli, such as the approach by an unknown man, as if they were about to be raped again, and experience panic.

Remembrance and intrusion of the trauma is expressed on many different levels, ranging from flashbacks, feelings, physical sensations, nightmares, and interpersonal re-enactments. Interpersonal re-enactments can be especially problematic for the officer leading to over-reaction in situations that remind the officer of previous experiences in which she or he has felt helpless. For example, in the child abuse example above, officers may be much more physically and verbally aggressive toward alleged perpetrators and their reports tend to be much more negative and subjective.

Hyperarousal. While people with PTSD tend to deal with their environment by reducing their range of emotions or numbing, their bodies continue to react to certain physical and emotional stimuli as if there were a continuing threat. This arousal is supposed to alert the person to potential danger, but seems to loose that function in traumatized people. This is sort of like when rookie officers start and a hot call is toned out, they usually have an adrenaline rush. After two or three years, the tones hardly have any impact on them. Since traumatized people are always “keyed up” they often do not pay any attention to that feeling which is supposed to warn them of impending danger.

Numbing of responsiveness. Aware of their difficulties in controlling their emotions, traumatized people seem to spend their energies on avoiding distress. In addition, they lose pleasure in things that previously gave them a sense of satisfaction. They may feel “dead to the world”. This emotional numbing may be expressed as depression, and lack of motivation, or as physical reactions. After being traumatized, many people stop feeling pleasure from involvement in activities, and they feel that they just “go through the motions” of everyday living. Emotional numbness also gets in the way of resolving the trauma in therapy.

Intense emotional reactions and sleep problems. Traumatized people go immediately from incident to reaction without being able to first figure out what makes them so upset. They tend to experience intense fear, anxiety, anger and panic in response to even minor stimuli. This makes them either overreact and intimidate others, or to shut down and freeze. Both adults and children with such hyperarousal will experience sleep problems, because they are unable to settle down enough to go to sleep, and because they are afraid of having nightmares. Many traumatized people report dream-interruption insomnia: they wake themselves up as soon as they start having a dream, for fear that this dream will turn into a trauma-related nightmare. They also are liable to exhibit hypervigilance, exaggerated startle response and restlessness.

Learning difficulties. Being “keyed-up” interferes with the capacity to concentrate and to learn from experience. Traumatized people often have trouble remembering ordinary events. It is helpful to always write things down for them. Often “keyed-up” and having difficulty paying attention, they may display symptoms of attention deficit disorder.

After a trauma, people often regress to earlier modes of coping with stress. In adults, it is expressed in excessive dependence and in a loss of capacity to make thoughtful, independent decisions. In officers, this is often noticed because they suddenly begin making a lot of poor decisions, their reports lose quality and detail and they are unable to focus. In children they may begin wetting their bed, having fears of monsters or having temper tantrums.

Aggression against self and others: Both adults and children who have been traumatized are likely to turn their aggression against others or themselves. Due to their persistent anxiety, traumatized people are almost always “stressed out,” so it does not take much to them set off. This aggression may take many forms ranging from fighting to excessive exercise or obsession about something—anything to keep them from thinking about the trauma.

Psychosomatic reactions. Chronic anxiety and emotional numbing also get in the way of learning to identify and discuss internal states and wishes. May traumatized people report a high frequency of headaches, back and neck aches, gastro-intestinal problems etceteras. Since the stress is being held inside, the body begins to become distressed.

Summary
After a trauma, people realize the limited scope of their safety, power and control in the world, and life can never be exactly the same. The traumatic experience becomes part of a person’s life. Sorting out exactly what happened and sharing one’s reactions with others can make a great deal of difference a person’s recovery. Putting the reactions and thoughts related to the trauma into words is essential in the resolution of post traumatic reactions. This should, however, be done with a professional specializing in PTSD due to the wide range of reactions people have when they start confronting and integrating the memories of the trauma.

Failure to approach trauma related material gradually is likely to make things worse. Often, talking about the trauma is not enough: trauma survivors need to take some action that symbolizes triumph over helplessness and despair. The Holocaust Memorial in Jerusalem and the Vietnam Memorial in Washington, DC, are good examples of symbols for survivors to mourn the dead and establish the historical and cultural meaning of the traumatic events. There are several events for survivors of traumas that officers can also take part in. These events remind survivors of the fact that there are others who have shared similar experiences. Other symbolic actions may take the form of writing a book, taking political action or helping other victims.

PTSD is real, and can be resolved with time, patience and compassion.

For more information on treating PTSD, see All CEUs

Filed Under: Anxiety, Grief, Mental Health, Trauma Tagged With: Counseling, PTSD, stress, therapy, Trauma, traumatic stress

Learning Styles

February 20, 2007 By Dr. Dawn-Elise Snipes

One of my main issues with the public school system is that they do not cater to multiple learning styles. My son was in Montessori for pre-k and thrived because it accommodated multiple learning styles. Many people cannot homeschool their children, but you can arrange their learning environment at home to help them learn how to learn. The following article will give you tips and tricks to maximize your or your child’s learning experience. First, watch your child. When he learns something on his own, how does he do it? What things interest him? Does he just haveto take everything apart to see how it works? My son is a global learner. He finds some huge concept like “space” or “the environment” that he is interested in and we slowly dissect it getting movies, books and doing activities. I also noticed that he can hear a song once or twice and know it by heart. Therefore, we use music and rhythm to help him learn lists and concepts. How many of you remember when Potsy on Happy Days learned the circulatory system by singing “Pump, Pump, Pump Your Blood” (By the way, you can still hear that song on the Bayer Aspirin website).

We learn every day. We learn about ourselves. We learn about news and current events. We learn about others. We learn a new job or computer program. We learn stuff just to learn it. How much less stressed and more successful could our children be if we worked with them in a way that was meaningful to them… Learning styles are just another potential barrier to effective education. That is, we are not going to be nearly as successful and risk frustrating our kids and ourselves when we are trying
to teach them something in a way that they do not effectively learn. Many people are kinesthetic or visual learners. Nevertheless, we insist on putting them in groups and lectures and environments that are not conducive to learning for them. Although we may not be able to change the “system” completely, we can help kids learn how to function within it. For example, kids who are visual learners can be provided worksheets or encouraged to take notes. Small group activities to discuss
information or apply key points of the lesson are always helpful for kinesthetic learners. Read on to find out more ways to meet the needs of your kids and help them help themselves.

The first step in developing a realistic learning environment is for people to know their personal tendencies. What works for them? What adds extra dis-stress? What is the most efficient way to approach things based upon how they learn and their personality. A learning style is a name for relatively consistent pattern of behavior showing how people learn or adapt to their environment. People are often a combination of more than one learning style, but one style usually predominates. Learning style is the way people prefer to learn. It does not have anything to dowith how intelligent they are or what skills they have. There is no such thing as a “good” learning style or a “bad” learning style per se, and it is important for people to be aware of how their brain learns best in order to optimize their learning experiences.

Where does it come from?
Like temperament, learning style is largely in-born. Interestingly (and probably obviously) temperament and learning style interact. One of my “must-reads” for my students is Effective Teaching, Effective Learning: Making the Personality Connection in Your Classroom“. This book can help you learn to modify your environment to best meet your learning needs. Learning is affected by many things. As parents, we do not have the ability to change them all, but we can try to use them as much as possible, especially when helping with homework and extracurricular activities. The following link explains in great detail the differences in learning preferences across temperaments. Learning Styles

Learning styles can be conceptualized along 5 continuums:
• Environmental (The environment you need to learn best)
• Active/Reflective (When you process information)
• Auditory/hearing, visual/seeing, or kinesthetic/doing (methods for receiving information most effectively)
• Sequential or Global (How you conceptualize information)
• Sensing vs. Intuitive (What you pay attention to)
Understanding where your kids fit in each of these 5 areas will help you better design your presentations and their treatment plans and understand how to more effectively communicate with them.

Environmental Aspects of Learning
Aside from the way you prefer to receive information, there are many other things that affect your learning. Think about the last time you had a training and the room was uncomfortable, or the class was at a bad time for you. To determine your child’s learning environment preferences, have them answer the following questions.
1. Do you prefer silence, or background noise (television, others chatting), vocal music or instrumental music while concentrating or studying?
2. Do you prefer soft, dim or bright light while concentrating.
3. What level of temperature do you prefer while involved in studying and/or other learning activities?
4. Do you like to have a fan on and a breeze?
5. Do you prefer to study sitting at a traditional desk and chair, or do you like a more informal arrangement with different types of furniture, such as a couch, a recliner, or pillows and carpet on the floor?
6. For any topic, you have to decide the extent to which you are interested in learning. Are you self-motivated (intrinsic) by a desire to learn constantly or externally motivated through interest in a topic or positive feedback and reinforcement from peers and/or superiors?
7. Persistence relates to your attention span and ability to stay on task. Do you have a preference for working on one task until it is finished or do you prefer to work on a variety of tasks simultaneously?
8. Can you get lost for hours in a task if it something you are interested in?
9. Do you prefer to work independently without with little supervision, guidance or feedback, or do you prefer to have frequent feedback and guidance?
10. Do you prefer being told exactly what the learning task is, how you should proceed, and what is expected of you, or do you prefer to be given an objective and then be left alone to decide which procedures or options you use to reach the objective?
11. When working on an assignment, do you prefer to work alone or in a group?
12. If you prefer working in a group, do you like large groups or pairs or does it matter?
13. When working in a group do you prefer to be the group leader or just a member?
14. Do you like to work together with a supervisor or subject expert or do you react negatively to having authoritative guidance?
15. Do you like routines or patterns or do you prefer to work on what ever strikes your fancy at a given moment?
16. Do you prefer to chew, eat, or drink something while studying, such as a soft drink or coffee?
17. People’s energy levels vary at different times during the day. Do you prefer to work on a task that needs concentration in the early morning, late morning, early afternoon, late afternoon, or evening?
18. Can you sit still for a long period of time as long as you are interested in what you are doing, or do you prefer to move constantly — standing, walking, shaking your foot, tapping your pencil, changing body positions?

Now, use the answers you provided above and create the best learning environment for your
client.

Active and Reflective Learning
Which group of statements helps your child learn best?
• Reflective learners prefer to think about it quietly first “Let’s think it through first”
• Reflective learners, prefer working alone.
• Reflective learners can sit through lectures without getting to do anything physical but take notes
• Reflective learners often get more out of an activity if they do it as homework so they can have time to mull it over.
• If you spend too much time reflecting you may never get anything done.
• Active learners tend to like group work
• Active learners need to talk it out. Have them walk you through their thought process. Encourage group participation instead of always asking rhetorical questions.
• If you are an active learner in a class that allows little or no class time for discussion or problem-solving activities, study in a group in which the members take turns explaining different topics to each other.
• If you always act before reflecting you can jump into things prematurely and get into trouble.
How can you as a parent alter your child’s study and learning environment to meet the her needs? How can your child work within the confines of the “system.” and get the most out of the experience.

Auditory/Visual/Kinesthetic
This is how you best take in information.
Tips for kinesthetic learners
• Active kinesthetic learners tend to retain and understand information best by doing something active with it–discussing or applying it or explaining it to others. “Let’s try it out and see how it works”
• Work with others to guess what you will be asked on the next test and figure out how you will answer.
• You will always retain information better if you find ways to do something with it.
• If you are a reflective learner in a class that allows little or no class time for thinking about new information, when you study don’t simply read or memorize the material; stop periodically to review what you have read and to think of possible questions or
applications.
• Paraphrase and write-down important point as you read/talk/listen. (This is especially important if someone is trying to communicate something complicated)
• Manipulate the material through teaching or doing it whenever possible
• Use self-assessment quizzes to help clients identify issues
• Use skits or acronyms to remember important ideas
• Volunteer to make posters or overheads for group presentations (or a training manual if you are learning a job)
• Manipulate the information by making multiple choice tests or applying it in different situations
• Try to relate it to something you already know how to do

Tips for auditory learners
• Read your material out loud whenever possible
• Tape record your notes and listen to them while you drive, work out etc.
• Try to partner with a visual learner if you need to borrow notes
• Listen attentively to lectures
• Try to block out extra auditory (verbal) interruptions.
• If possible, tape record the class so you do not have to worry about taking notes
• Working in groups can be particularly effective: you gain understanding of material by hearing classmates’ explanations and you learn even more when you do the explaining.

Tips for visual learners:
• When you read material, visualize it in your mind. Then, try to recite it from memory.
• You may find you “hear” better if people write you letters or memos
• Rewrite your notes in a format which is easy to visualize and learn such as: outlining, color coding, underlining…
• Take mental “pictures” of things that must be remembered
• Use flash cards to learn and test yourself
• Use visual memory tricks where possible: acronyms, “a friend is a friend to the end” is a way to remember how to spell the word friend
• Visual learners remember best what they see–pictures, diagrams, flow charts, time lines, films, and demonstrations.
• Ask your instructor, consult reference books, and see if any videotapes or CD-ROM displays of the course material are available.
• Prepare a concept map by listing key points, enclosing them in boxes or circles, and drawing lines with arrows between concepts to show connections.
• Color-code your notes with a highlighter so that everything relating to one topic is the same color.
Have your children make a list of techniques they can use to best learn information in general and best learn about themselves.

Sensing Vs. iNtuitive Learning
Everybody is sensing sometimes and intuitive sometimes. Your preference for one or the other may be strong, moderate, or mild. If you are strong on intuition, you may miss important details or make careless mistakes in calculations or hands-on work; if you overemphasize sensing, you may rely too much on memorization and familiar methods and not concentrate enough on understanding and innovative thinking.
• Sensors often like solving problems by well-established methods and dislike complications and surprises
• Sensing learners tend to like learning facts
• Sensors are more likely to resent being tested on material that has not been explicitl covered in class.
• Sensors tend to be patient with details and good at memorizing facts and doing hands-on (laboratory) work
• Sensors don’t like courses that have no apparent connection to the real world
• Sensors remember and understand information best if they can see how it connects to the real world. If you are in a class where most of the material is abstract and theoretical,you may have difficulty. Ask your instructor for specific examples of concepts and procedures, and find out how the concepts apply in practice. If the teacher does not provide enough specifics, try to find some in your course text or other references or by brainstorming with friends or classmates.
• Intuitive learners often prefer discovering possibilities and relationships.
• Intuitors like innovation and dislike repetition.
• Intuitors may be better at grasping new concepts and are often more comfortable than sensors with abstractions and mathematical formulations.
• intuitors don’t like “plug-and-chug” courses that involve a lot of memorization and routine calculations. Which best describes you?
• If you are an intuitor and you happen to be in a class that deals primarily with memorization and rote substitution in formulas, you may have trouble with boredom. Ask your instructor for interpretations or theories that link the facts, or try to find the
connections yourself. You may also be prone to careless mistakes on test because you are impatient with details and don’t like repetition (as in checking your completed solutions). Take time to read the entire question before you start answering and be sure
to check your results

Again, review what your child does during learning time at home and at school to identify ways she could make her environment work better for her.

Sequential vs. Global Learners
People who have a preference for global learning are concerned with the whole meaningand the end results. They need to start with an overview of the big picture before they deal with details and facts. People who prefer sequential style of learning prefer to learn one detail at a time in a meaningful sequence. Once they know all the parts, they put them together and comprehend the big picture. Which do you prefer?

Tips for Sequential Learners
• Sequential learners tend to gain understanding in linear steps, with each step following logically from the previous one.
• Sequential learners tend to follow logical stepwise paths in finding solutions;
• Sequential learners may not fully understand the material but they can nevertheless do something with it (like solve the homework problems or pass the test) since the pieces they have absorbed are logically connected.
• Sequential learners may know a lot about specific aspects of a subject but may have trouble relating them to different aspects of the same subject or to different subjects.
• If you are a sequential learner and you have an instructor who jumps around from topic to topic or skips steps, you may have difficulty following and remembering. Ask the instructor to fill in the skipped steps, provide an outline of topics to be covered at the beginning of class or fill them in yourself by consulting references. When you are studying, take the time to outline the lecture material for yourself in logical order. In the long run doing so will save you time. You might also try to strengthen your global thinking skills by relating each new topic you study to things you already know. The more you can do so, the deeper your understanding of the topic is likely to be.

Tips for Global Learners
• Global learners tend to learn in large jumps, absorbing material almost randomly without seeing connections, and then suddenly “getting it.”
• Global learners may be able to solve complex problems quickly or put things together in novel ways once they have grasped the big picture, but they may have difficulty explaining how they did it.
• Strongly global learners may have serious difficulties until they have the big picture. Even after they have it, they may be fuzzy about the details of the subject.
• If you are a global learner, just recognizing that you aren’t slow or stupid but simply function differently from most of your classmates can help a great deal. However, there are some steps you can take that may help you get the big picture more quickly.
• Before you begin to study the first section of a chapter in a text, skim through the entire chapter to get an overview. Doing so may be time-consuming initially but it may save you from going over and over individual parts later. Instead of spending a short time on every subject every night, you might find it more productive to immerse yourself in individual subjects for large blocks.
• Try to relate the subject to things you already know, either by asking the instructor to help you see connections or by consulting references.
• Above all, don’t lose faith in yourself; you will eventually understand the new material, and once you do your understanding of how it connects to other topics and disciplines may enable you to apply it in ways that most sequential thinkers would never dream of.

My son is a global learner. You might as well hang it up if you are going to try to teach him the “building blocks” before showing him what he can do with them. He was this way with math, phonics and, well just about everything else. Once he learned about space, then he started wanting to know about numbers and distances and speed…you have to learn addition before you can do that stuff. Likewise, once he discovered books on space and dinosaurs he quickly saw the benefit in learning phonics so he could read on his own. That is only the first part though. He still was never going to learn well by rote memorization. He learned his phonics by reading. Slowly, steadily reading. He would read a page then his father or I would read it fluently so he actually understood it. The same with math. He is not fond of just doing drills, but if he has to solve equations to win a mission, beat me at Math War or something else, then he is unstoppable.

Other suggestions to take away the mundane
Make flashcards out of index cards and play trivial pursuit or Jeopardy
For math, comparing quantities and alphabetizing, we play the card game war. (obviously one subject at a time)
Create a new game. Get round and rectangular stickers, some poster board, index cards and dice and go to town making up your own game.
Brainpop
Time4Learning

Filed Under: Counseling Techniques, Parenting, Relationships, Self Help Tagged With: learning styles

Mommy and Me Fitness: Belly Huggers

February 20, 2007 By Dr. Dawn-Elise Snipes

Helping your children develop coordination and a love for fitness begines by immersing them in an environment that promotes physical activity. The following activities are suggestions only. Remember to always support baby’s head and neck and ensure you do not bounce or jostle her too hard as her brain is fragile.

AGE: 0-3 Months: Belly Huggers
Skills and Goals:
Trust Flexibility
Bonding Arm/Chest Strength
Interest in Others Abdominals
Object Permanence Lower Back
Self-Other Upper Back
Purposeful Motion Lower Body Strength
Cause-Effect Activities
Experimentation
Rhythm
Muscle Memory
Gross Motor Coordination
Upper Body Strength
Lower Body Strength
Flexibility/Range of Motion

Baby Airplane
o Parent remains standing
o Hold baby on forearm, belly down, head supported, arm tucked in as in a football hold
o Place your free hand on top of baby’s back for added security
o “Fly baby around”

Bouncing balloons
o As baby develops cause and effect knowledge, she will delight in bouncing a helium filled balloon that is tied to her arm (never leave baby unattended with balloons or string)

Rock the Baby (Sing with Rock a Bye Baby or Did you Ever see a Lassie)
o Place baby on her belly a stability ball or a large rolled towel lengthwise to her body and gently rock forward and back

Beach Ball Balance (Excellent song is Rock around the Clock)
o Using a stability ball or a 12” Beach Ball (slightly deflated) rock baby in all directions pretending to mark each hour on the clock. Only rock baby as far as she is comfortable

Baby Cycle
o With baby lying on back or in front carrier, “cycle” her legs to the beat of the music

Swat the Balloon or Toy
 Hold a balloon or toy about 6 inches from baby and let her try to catch it

Baby Push Up
o Start with baby on her belly and bringing her arms in under her so she is resting on her forearms
o As her neck strength increases, move a towel under her armpits so she can arch up at more of an angle to look around
o Eventually she will not need the roll and can push up by herself.

Supported Baby March (The Ants go Marching)
o Hold baby securely under arms
o Lower until her feet touch the ground
o Encourage her to march in place, bear weight—whatever she wants to do
o Also hold her in this position to help her learn to bounce to the beat of the music

Trampoline bounce with baby (5 Little Monkeys)
o Sit on the trampoline or on Tumble Track
o Rest babies on tumble track or 1 at a time on mini trampoline lying or sitting with your support
o Gently bounce to move the trampoline and assist baby in maintaining balance (You move the trampoline, baby is just along for the ride, but do it GENTLY)

Baby Kickboxer (using a stability ball)
o Put ball at baby’s feet.
o When she kicks it, pop up and make a sound

Chicken Flap Arms (Old MacDonald, Chicken Dance or Ducks Dance Too)
o With baby in front pack help her flap her arms like a chicken

Balloon toss
o Gently drop a balloon down for your baby to kick/hit etc. As he starts to sit up on his own he will delight in trying to bat it, eventually, actually trying to bat it back at you.

On floor or ball flutter kick
o Lying on stomach lift slightly one leg at a time as if swimming being sure not to raise hips off ground. Hold for 1 count take a break and assist baby doing the same on the floor

Aerobic
This is best for songs with narration (Wheels On The Bus, Clap Clap, Bunny Hop, Ring Around The Rosey, Mexican Hat Dance) Helps teach baby rhythm and to enjoy exercising—

Variations –Have parents face a mirror or pair off and face another baby while doing the activities in the song.
o Level 0: sit on the floor with baby
o Level 1: Stand or get on your knees with good posture, tummy tight, shoulders back with baby (no sitting)
o Level 2: Stand or kneel and lightly bounce with baby (use the thighs and glutes) With baby in front pack, bounce lightly to the beat
o Level 3: Side step with baby (standing or on knees) With baby in front pack step side to side to the beat of the music
o Level 4: March with baby in front pack, hold her feet to march or hands to clap
o Level 5: Squats legs hip distance apart or plie legs slightly more than shoulder distance apart, baby in front pack. No more than 1/2 squats/plies to beat of music

More for Parents
Calesthenic Music should be between 90 and 110 beats per minute…use what your class likes
These exercises help parents get in shape, model fun fitness, bond with baby, reduce fatigue and improve posture. Additionally they help baby gain a sense of trust with parent, muscle memory as they are helped to clap, march and identify body parts and rhythm as parent at least helps baby clap to the beat or holds baby while she/he bounces to the beat.

Sitting
Baby Bicep Curls
o Sit in a chair or on a stability ball with baby resting on your forearms facing you
o Gently Curl Baby Up and Give her a kiss then lower

o Advanced: Put Baby on a blanket. Gather the excess until you are holding right by her head. Supporting her so her head does not flop back, assist her to sitting

o Super Advanced: Assist baby to sitting by holding her hands and gently guiding her to sitting. Do not do this if baby’s head starts to flop back)

Leg Extensions with baby on for the ride (Froggy went a Courtin)
o Sit in a chair with your feet on the floor, baby sitting on your feet and leaning her belly on to your shins
o Hold her hands as you raise her slowly up and down

Lying
Push Ups/Cat Curls Over Baby (Everybody Wants to Be a Cat)
o Place baby on her back
o Get face-down with your shoulders directly over baby’s shoulders, legs on the floor
o Push up so your upper body curls up until your arms are straight
o Lower down over baby and give her a kiss
o (This can be done with full or modified push-ups as well if you are strong enough)

Baby Crunches
o Lie on your back, knees bent, feet about 12” from your rump
o Set baby on your pelvis, leaning against your knees, holding securely around ribs
o Curl up until your shoulders leave the ground, say boo and tickle tummy

Pelvic Tilts/Glute squeeze (She’ll Be Comin’ Around the Mountain)
o Lie on your back, knees bent, feet about 12” from your rump
o Set baby on your pelvis, leaning against your knees, holding securely around her ribs
o Tighten your glutes and your pelvic floor muscles (Kegles) then tighten your lower stomach muscles to tilt your pelvis in further. Hold and repeat

Baby Bench Press (2 months and later)
o Lie on your back with baby on his stomach facing you
o Grasp around his ribs and slowly lift/press into the air
o If baby starts to show fatigue or cannot hold his head still, wait to do this exercise

Standing
Upright Row
o Hold baby under arms and lower until your arms are extended
o Raise, bending your arms to chest height, elbows pointing out like chicken wings

Bent Over Row (Helps mom with posture and preventing back injury)
o Baby in carrier bend over, tummy tight and raise baby until elbows are at your sides

Overhead Press
o Hold baby around his ribs raise him up and push out at a 20 degree angle
o Lower and zerbert his belly

Shoulder blade squeeze (Reduces upper back strain in parent)
 Baby in front pack, legs shoulder distance apart, knees slightly bent, abs in squeeze shoulder blades together like holding a pencil

Dead lifts
o Place baby in her carrier or on the floor
o Stand with feet hip distance apart, knees slightly bent (“soft”), tummy in
o Bend over at the hips until your body is parallel with the floor
o Keeping your knees bent and tummy tight, slowly straighten up
o (Advanced) hold the handle to baby’s carrier and lift and lower her with each repetition

RECOMMENDED READING
Baby Play (Gymboree)

Filed Under: Infants, Parenting, Preemies, Uncategorized Tagged With: kids fitness

Self-Esteem

February 20, 2007 By Dr. Dawn-Elise Snipes

Self-esteem is simply the way we feel about ourselves. It is the product of people’s evaluation of their real-selves compared with their ideal-selves. Everyone has an ideal-self. This is who they believe they should be. (remember, “shoulds” almost always add unnecessary stress). People form this idea of the ideal-self at an early age based upon conditions of worth. That is, as children, praise was given not for who they were, but what they were able to do or how they were able to act. As a result, they formed ideas about what a “good girl” or “good boy” should be. Due to children’s immature reasoning, many things are overgeneralized and made into global, stable and internal attributions. This tends to create an unrealistic ideal-self. For instance, many girls grow up to believe that they must be successful: partners, mothers and business-women. This is called the superwoman stereotype. Little boys believe they must always be: strong, successful, good partners and primary providers. In reality, that is nearly impossible for either gender to do. People’s real-selves are who they are with all of their inherent imperfections. To improve self-esteem, people must change the way they feel about a situation (i.e. change their feelings about their self-evaluation) or change themselves (either the real-self or the ideal-self).

Suggestions for Improving Self-Esteem

Describe your ideal self. (If you were the perfect person emotionally, mentally, physically, in relationships, in your job)
Describe your real self in those same areas.
Identify the differences between your real and ideal self. Pick 2 that you want to change and go for it.

Filed Under: Mental Health, Self Esteem, Self Help, Self-Improvement Tagged With: Counseling, Depression, recovery, self esteem, self image, therapy

Aromatherapy

February 19, 2007 By Dr. Dawn-Elise Snipes

Just like colors, textures and virtually anything else, scents hold special meaning for people based upon their previous association. The following are several examples of different scents and what they are purported to do. 90% of reality is what we do with our perceptions, so if you believe that scents and fragrances have no effect, then they will probably fail to work on you. Likewise, your previous associations with these smells may alter the effects, for instance, you may have previously associated ginger with negative feelings or exhaustion due to the fact that most people eat ginger-based foods around the holidays. Therefore, ginger may not work for you.

Application of aromatherapy involves either the use of a humidifier, atomizer or combining “essential” oils with a base oil or lotion and applying it to the skin. (You can also put essential oil in melted candle wax, re-solidify the wax around a new wick and have an aromatherapy candle). There are many contraindications, especially when applying essential oils to the body, so make sure you do your research. There are many websites and books that can help you discover fragrance combinations and mixing instructions.

Purchasing and mixing essential oils is often cost-prohibitive, messy and time consuming. A cheaper, less messy way is to try pre-mixed combinations of the essential oils (such as Healing Garden), or, for the more common fragrances like ginger, cedar and pine find them in their natural form, smell it and see what you think. When I was pregnant, the smell of a little ginger or lemon in heated ginger ale was the only thing that (besides eating jalepenos) that would stop my nausea. A friend of mine swears by the Sleepytime spray they sell at Target for relaxation. Smell is tightly linked to memory. Even if the smell is not here, think of a smell that reminds you of happier times (the cologne of your first love, your Grandma’s house…whatever). Recreate it for yourself.

Scents
Many spices can be found in most grocery stores. Add about a tablespoon to 8 oz. of boiling water and inhale the steam and/or wait until the water cools to a tolerable temperature and dampen a towel to apply to your chest or face. Some, like rosemary, become very aromatic when combined with lotion or hair conditioners and used as an exfoliant/circulation stimulant. When dealing with fragrances other than essential oils which are often 400 times more powerful than the natural source, experiment. Place fresh rose petals in a zipped, mesh sack in the dryer with your darks (just in case there is any color bleed). You will dry the flowers and freshen your laundry at the same time. Use pine cones to absorb essential oils and place them in a decorative basket on your counter (Make sure to cover it with lace, or mesh if you have animals or children, because ingesting essential oils can be deadly). Add cloves and ginger to salt dough before you play with it and bake it. Some scents are only easily available in “essential oil” form, other scents can be easily found in gardening departments, dry-oils sprays in the perfume department or ordinary foods.

Angelica Root: relieves fatigue, migraines, anxiety,
Sweet Basil: brighten mood, strengthen nervous system, improve mental clarity and memory, relieve headache and sinusitis
Bay Leaf: relieve depression and burnout/exhaustion
Bergamot: balances nervous system, relieves anxiety, improves quality of sleep, relieves hopelessness/helplessness
Black Pepper: increases circulation, relieves stiffness
Cardamon: relieves mental strain and fatigue, aphrodisiac, mood elevator
Carrot Seed: eases anxiety and stress
Cedar: calm emotions (try smelling cedar chips in the gardening department)
Chamomile: sedative, relieves anxiety, improves quality of sleep (tea)
Clary Sage: relieves stress and tension, improves quality of sleep, aphrodisiac
Clove: aphrodisiac, relieve tension, worry, guilt and hostility
Coriander: helps improve sleep, helps remove feelings of self-doubt, weariness and irritability
Cypress: immune stimulant, increases circulation, relieves grief, jealousy
Fennel: deals with mental, creative and emotional blocks as well as resistance to change and fear of failure.
Fir (Balsam): relieves anxiety and stress through helping ground one mentally (especially common at Christmas as this is one kind of pine tree)
Frankincense: elevates mind and spirit, helps with reconnection with repressed feelings
Geranium: relieves fatigue, nervous tension, discontentment, heartache, fear. Can be found in most gardening departments, smell the flower. (P.S. They are not that easy to grow)
Ginger: stimulates appetite, helps relieve confusion and lonliness (and nausea) Try heating 6oz of ginger ale and adding 1/4 teaspoon of ginger. Drink while warm. Also investigate ginger lillies and pinecone lillies…They are amazing–and easy to grow.
Helichrysum: helps people with addictions, grief, panic, burnout and emotional sensitivity find a sense of calm
Jasmine: relieves depression, labor pains, and provides a sense of calm when dealing with bitterness, guilt and repressed feelings. (common in dry oil sprays in perfume department)
Juniper Berry: improves mental clarity, and improves empathy
Lavender: promotes restful sleep, calming influence (common in dry oil sprays in perfume department)
Lemon: uplifting, helps energize and relieve apathy
Lemongrass: helps releive stress related exhaustion
Lime: uplifting and cheering
Marjoram: promote restful sleep, help ease migraines, calms and helps relieve anger. Use as the moisture on a moist-heat heating pad.
Myrrh: helps relieve lack of spiritual connection and emotional blocks.
Neroli: good for anxiety relief
Nutmeg: invigorates and stimulates the mind and helps regain focus.
Sweet Orange: brightens mood, relieves apathy and bunout
Oregano: energizes mind and body and helps relieve headaches
Peppermint: improves energy, mood and relieves exhaustion (mints)
Pine: increases energy and repels fleas
Rosemary: improves mental clarity and memory, relieves headache
Sanadalwood: relieves apathy and melancholy
Spearmint: eases nausea and headaches; energizes and relieves fatigue (gum)
Thyme: relieves fatigue and may help with bronchitis
Ylang-Ylang: aphrodisiac, mood brightener, promotes restful sleep, relieves anxiety. Very “flowery” sweet smell

Filed Under: Environmental Tagged With: aromatherapy

Nurture Your Creativity

February 19, 2007 By Dr. Dawn-Elise Snipes

50 Ways to Challenge Your Mind and Express Your Creativity
1 Play a board-game: Clue, Scrabble, Trivial Pursuit, Mind Trap, Chess
2 Cook a new meal
3 Creatively frost a cake or bake it in a special cake form (heart, bunny, race car, sorority letters)
4 Go hiking in a new park: find your way in and out
5 Create greeting cards on you computer
6 Create a new web page
7 Get the Book of Questions by Gregory Stock and discuss with friends
8 Plan a party for children
9 Find a social problem and create a plan on how to improve the situation
10 Write a grant
11 Surf the Internet and learn as much about a single topic as you can
12 Use a class assignment to increase your knowledge or proficiency at something important to you
13 Start taking leisure classes
14 Turn one of your hobbies into a business
15 Tutor children at the Boys and Girls Club
16 Sewing: cross-stitch, needle point, quilting, sew a sweater, knitting, cruel, embroidery
17 Decorate something ordinary: bulletin board, photo album,
18 Paint your room (or use wall paper which you attach to the wall with push pins)
19 Learn reflexology or massage
20 Choreograph an aerobics, dance or exercise routine
21 Listen to a book on tape while you run
22 Learn about something which your best friend is interested in
23 Each night at dinner, discuss one current event
24 Plan the most romantic date you can think of down to the last detail (then do it)
25 Hang-out at the bookstore and read books which represent your different interests
26 Start a “coffee club” to gather and discuss books, ideas
27 Plan a scavenger hunt for you and your friends
28 Teach your dog a new trick
29 Collages
30 Pottery, creating or painting
31 Flower arranging
32 Invent something to solve your most nagging problem
33 Plan a party for your friends
34 Make soaps with your favorite scent
35 Paint/color/draw
36 Help a civic organization decorate for an event
37 Make up a bedtime story
38 Write poetry, short stories
39 Create a new recipe
40 Make a coupon book for your significant other: hugs, house cleaning, car washes, dinner, etc. . .
41 Find a new way to do a routine task at work
42 Join an acting/drama club
43 Join a choir
44 Take pictures of nature, weddings, parties etc.
45 Redecorate a room in your house
46 Gardening, landscaping–make your patio a sight to behold
47 Create a new game and teach your friends/kids how to play
48 Crossword puzzles
49 Be a freelance writer for the newspaper
50 Spend time with a 3 year old…Just today I was a Queen, a snake, Mother Bear and a Goblin.

Now make a list of your own and get creative.

Filed Under: Uncategorized

50 Ways to De-Stress Your Life

February 19, 2007 By Dr. Dawn-Elise Snipes

1. Keep your house clutter free
2. Allow “wiggle-room” in your schedule
3. Get a pet
4. Maintain clear communication with house-members
5. Get up 15 minutes earlier for extra time
6. Lay out your clothes and book bag/brief case the night before
7. Set 2 alarms (one on the other side of the room) and have one with a battery back-up
8. Set one day aside to run errands etc. . .
9. Listen to “happy music” on your way to work
10. Get your least favorite task out of the way first
11. Make a resolution for the day to practice acceptance
12. Use only one credit card so you only have one bill/grand total to keep track of
13. Enlist the help of others when possible
14. Make an office buddy. You can give each other pick-me-ups when stress hits.
15. Try not to gossip
16. The more difficult someone is, the more stressed s/he is. Try and do something nice for them. It may be just what they need to get out of their funk.
17. Bring happy pictures to work. Even if you don’t have a desk, you can keep it in your pocket.
18. Take a time-out and go for a walk
19. Moderate caffeine and sugar as they mimic the stress reaction
20. Keep a humor page book marked on the internet. Go to it when you need a laugh.
21. Wear comfortable clothes
22. Practice affirmations and Stress Inoculation Training
23. Find something to look forward to every hour
24. Try to find something positive or redeeming about every task
25. Check to make sure your life is in balance: Do you feel overwhelmed by a particular area?
26. Do something nice for someone every day
27. Overcome one resentment or regret to free up some energy
28. Practice a relaxation strategy
29. Eliminate one stressor from every area of your life
30. When you get up, wake up with an aromatic bubble bath and your favorite morning drink
31. Reward yourself for a job well-done at the end of each day
32. Leave little notes with affirmations or jokes throughout your house/office: cabinets, drawers, books
33. Express your frustration through something creative
34. Spend the day with a child learning to appreciate what s/he appreciates: swings, clouds, merry-go-rounds, slides, scampering little ants. . .
35. Turn off all forms of external communication for a day: pager, telephone, cell phone, answering machines (or at least turn the volume all the way down–check it tomorrow)
36. If you died tomorrow, what would you like to spend the day doing today??? Do it (or as close as you can get)
37. Keep a running list of everything you run out of/need at the store
38. See about shopping from the internet.
39. Evaluate to see if you are giving too much
40. Contact at least 1 positive person per day
41. Describe your perfect day: what would you do (or not do) where are you (somewhere feasible) and make it happen at least once a month
42. Create a personal space where you can go and relax without interruption
43. Be honest with yourself about what is stressful then modify small parts of it
44. Volunteer for something in your profession (make it a tax write off–see your accountant for specifics)
45. Find a social cause to work for: saving stray animals, curing disease etc. . .
46. Cross things off your to do list for a sense of accomplishment
47. Learn how to play just as hard as you work
48. Don’t watch the news in the evening if it is going to stress you out
49. Spend 10 minutes a day being silly with someone else or an animal
50. Ask yourself, Is it worth time out of my life to get upset about this

Filed Under: Counseling Techniques, Depression, Stress Management Tagged With: Anxiety, Counseling, Depression, quick fix, stress, treatment

70 Ways to (Painlessly) Improve Nutrition

February 19, 2007 By Dr. Dawn-Elise Snipes

The key to lasting behavior change is making small changes, gradually. Try adding one or two of these things to your routine each week and see how you feel at the end of the year.

1. Use applesauce, pureed bananas or sweet juices, instead of oil, when baking (When my son was little I used prune juice—for obvious reasons—instead of oil when I made brownies)
2. Use cooking spray instead of oil for frying
3. Limit meals eaten out to 1 per week and/or order lower-fat options such as grilled or broiled meats, especially chicken and fish
4. Eat meats which are low in fat–Top round instead of chuck roast
5. Try to eat at least once every three to four hours. This helps keep your metabolism up and reduce sugar munching.
6. Before snacking, ask yourself if you are hungry, or just bored, stressed, sleepy etceteras. This is one of the biggest traps of students and shift workers, because the cues for stress and hunger are so similar, often their body is too tired to accurately differentiate.
7. Be aware that fat-free substitutions often have just as many calories as their whole-fat counterparts, the calories just come from carbohydrates
8. Rinse and blot the fat from meats before adding to recipes
9. Cut excess fat off of meat before cooking
10. When cooking a turkey, skin it, cut off all excess fat (especially from the back) then cook in a baking bag
11. Combine meat with cooked lentils in a ratio of 3 parts meat to 1 part lentils. This increases fiber as well as helping your budget.
12. Use oatmeal, potato flakes, cornmeal for fillers in ground meat
13. Ground turkey is often higher in fat than lean ground beef, so read the label
14. Use 1% buttermilk instead of heavy cream in recipes
15. Use butter substitute or chicken broth in vegetable dishes instead of real butter
16. Blot pizza and other high fat meals with a napkin
17. Use skim milk instead of water in low-fat brownie recipes
18. Keep fresh fruit in the house
19. Keep chocolate, cookies etc. out of the house or in a locked cabinet
20. Do not use food to reward good behavior or comfort yourself when stressed or depressed
21. Add only half of your normal amount of butter or fats to your food
22. Use cooking spray instead of oil to sauté your food
23. Instead of oil in baking recipes, use the same amount of unsweetened applesauce
24. Keep water extra cold and try to drink from a larger cup or bottle
25. Add oats, dehydrated potato flakes, chopped onions or tomato paste to beef for a filler
26. Mix 1/4 c. Soy flour with regular flour
27. Make casseroles with vegetables in them
28. Make italian dishes “primavera” with carrots, zucchini and green peppers
29. Constantly have a water bottle with you
30. Limit fried food to only one meal per week
31. Find out exactly what your meals are made from (1/4 c. Oil is used to coat the pan for every small pizza + oil in the dough) EEEW! That will stop you dead in your tracks much of the time.
32. Try and eat at least one balanced meal each day with every food group represented
33. Don’t get in a rut eating the same thing every day
34. Get a dinner group together. One person cooks a healthy meal for everyone each night and everyone takes a turn.
35. Learn about a new food and three recipes for it: lentils for instance
36. Challenge yourself to eat as many different colors each day as you can (yellow, orange, brown, white, green, blue, red, purple )
37. Try eating vegetarian for a day–and getting all of your food groups represented.
38. Pack snacks like trail mix, dried fruit, 1/2 peanut butter & jelly, cereal bars etc.
39. Don’t buy in bulk if you tend to eat the whole package of whatever it is.
40. Get a microwave popcorn popper and make your own popcorn so you can control the salt and fat
41. Try and drink a 32 oz. glass of water with lunch and dinner, more if you tend to consume caffeine or alcohol
42. Drinking 1 gallon of ice-cold water burns 200 calories …just do not do it right after exercising
43. If you want to eat junk-food, split it with a friend
44. Keep fresh vegetable salads in the refrigerator: cucumbers, carrots, mushrooms, sliced bell peppers in fat free dressing or red wine vinegar and a few packets of sweetener.
45. List your favorite foods and find healthier alternatives: either reduced in fat or sugar
46. Dress-up vegetables with melted low-fat cheese, lemon juice or 2 tablespoons of a “sauce” made from fat free or reduced fat cream soups heated with only 1/4 the required water
47. Use plain yogurt instead of sour cream
48. Watch condiment use, they are high in salt
49. When cooking meat, rinse the fat off of it half-way through the cooking process
50. Read the labels to find out how much sugar and fat is in your food
51. Do not cook vegetables until they are limp and dull in color. Vitamins are gone then.
52. When you are served food with butter patches in the “juice” you know it is high in fat
53. Red sauces are much lower in fat than white or cream sauces
54. Avoid breaded, fried or sautéed foods. Opt for boiled, broiled or baked in own juice.
55. Be careful how much butter and sour cream you use on baked potatoes–it adds up fast
56. If you can set a muffin, role, piece of pizza or brownie on a napkin for 20 seconds and it forms a grease stain, it is probably extremely fat laden–approach modestly.
57. Too much protein actually prevents bones from absorbing calcium. The average person needs roughtly 1/2gram of protein per pound of body weight per day. The average American eats 1 1/2grams per pound per day…overkill
58. Caffeine inhibits the absorption of iron
59. Make foods you like–if that is limited, find creative ways to prepare them–add soy protein powder in a ratio of 1:4 to baking mix, use egg whites only and use apple sauce instead of oil to make healthy muffins or pancakes.
60. Vegetarian does not mean low fat., Low fat means less than 5 grams of fat per serving
61. Take a cooking class to improve your culinary skills
62. Take a multi-vitamin
63. Keep a food diary to see exactly what you eat
64. Make index cards representing each one serving for all servings from every food group (i.e. 11 grain cards, 4 vegetable cards, 4 fruit cards etc.) Each time you eat a food group, take a card from the pile. This is also a good way to help kids learn to eat balanced meals.
65. Use colored cards representing different foods, select one of every color for each meal
66. Green = vegetables, brown = grains, white = dairy etc.. For meals with multiple types of foods, like lasagna, the card should be multiply coded.
67. Vitamins and antioxidants in foods work synergistically, so they need to be eaten in combination. Eating all of your vegetables for the week in one day just won’t cut it.
68. Excessive amounts of protein can prevent the proper absorption of calcium
69. Eat in color! The darker the food, the more nutrient dense. Try to have at least 3 different colors on your plate at each meal.
70. Too much simple sugar on one day can leave you feeling sluggish throughout the next day, so try to satisfy that sweet tooth with a piece of fruit. It is higher in fiber so you will feel full and you will not “crash” as hard.

Filed Under: Quick Nutrition Fixes Tagged With: fix, healthy, Nutrition, quick

Bipolar Disorder

February 19, 2007 By Dr. Dawn-Elise Snipes

1.2 to 1.7 percent (or approximately 2.3 million) of Americans over 18 and approximately 1% of children 14-18 (National Institutes of Health) experience bipolar disorder. Another 1% of the population experiences a condition called Cyclothymia. Cyclothymia’s manic and depressive episodes are less intense and shorter than that of full-blown Bipolar disorder and are referred to as “hypomania” and “dysthymia.” People with Cyclothymia often go untreated and are perceived as just having extreme and frequent mood swings. Think of it on a continuum:

Bipolar/Clinical Depression—>Dysthymia—>Nonclinical Depression—>Normal—>Elated—> Hypomanic—>Manic

Bipolar disorder often gets a bad reputation because people often lump it in with psychotic disorders like schizophrenia. The term “bipolar disorders” actually represents a cluster of mood disorders in which people alternately feel periods of “mania” and “depression” with shorter or longer periods of remission. People with Bipolar experience extremes in their mood. Their “highs” are really high and their “lows” are unbearable. A manic episode can be diagnosed when three or more of the following qualities are present at the same time:

Manic Symptoms in Adults
Inflated self-esteem or grandiosity
Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
More talkative than usual or pressure to keep talking
Flight of ideas or subjective experience that thoughts are racing
Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

Manic Symptoms in Children
Severe changes in mood, either extremely irritable or overly silly and elated
Overly-inflated self-esteem; grandiosity
Increased energy
Decreased need for sleep, ability to go with very little or no sleep for days without tiring
Increased talking, talks too much, too fast; changes topics too quickly; cannot be interrupted
Distractibility, attention moves constantly from one thing to the next
Hypersexuality, increased sexual thoughts, feelings, or behaviors; use of explicit sexual language
Increased goal-directed activity or physical agitation
Disregard of risk, excessive involvement in risky behaviors or activities
*Note: In children Bipolar Disorder, ADD/ADHD and Oppositional Defiant Disorder are often difficult to differentiate and misdiagnosed. Make sure to tell your doctor if treatment starts making your child’s behavior worse. Many ADD/ADHD medications can make symptoms worse if the child actually is Bipolar.
**Note: Hypomanic symptoms are the same as manic ones, but their intensity and the degree to which they disrupt a persons life is less than that of mania.

People often mistake simple mania for psychotic behavior. This is a crucial mistake. As you can see in the symptoms above, most people in a manic episode are hyper and possibly annoying, but very rarely dangerous to others. Psychosis, on the other hand is a generic term indicating that a person’s thought and perception are severely impaired sometimes referred to as a “loss of contact with reality”. During a psychotic episode, people may experience hallucinations, delusional beliefs (e.g., paranoid delusions), demonstrate personality changes and exhibit disorganized thinking. The person in a psychotic episode lacks insight into the unusual or bizarre nature of such behavior, and has difficulties with social interaction and impairments in carrying out the activities of daily living.

Again, people with psychotic disorders are often misunderstood. We center on television shows like “Criminal Minds” and think that psychosis=danger. This is rarely true. Although their behavior may be bizarre, they, like the person in the manic episode, are usually more of a threat to themselves (i.e. because they fear their food is contaminated so they won’t eat or think they are All-Powerful and antagonize the wrong person and get into a bar-room brawl). If you are dealing with someone in a psychotic episode, it is vital to remember that their reality is not yours (and may never be). Just like the child who truly believes there are monsters under his bed, it is futile to try to convince them that their hallucinations are not there or their delusions are “crazy.” Instead, help them solve what they perceive as the problem. At the very least, make them understand that you “believe” them and you will try to help them with their problem as they see it.

The depressive side of Bipolar disorder is often the most dangerous for people, and for law enforcement. Since people with Bipolar disorder experience such extremes of mood, their depression can quickly plummet to the level of suicide or suicide-by-cop.

Between 30% and 60% of people with Bipolar disorder also have a substance abuse disorder and patients with bipolar are notorious for not taking their medications. (Why? Because although the lows are really low, the highs are incredible—some would say addictive and the side effects of some medications are less than appealing.)

What does this mean for you? Well, probably more often than not the people you interact with who are substance abusers and “acting out” have a bipolar diagnosis or some other mental health diagnosis. Additionally, the medication they are taking (of failing to take) may interact with any substances they are taking which makes neither produce the anticipated effect. Finally, although they are usually not dangerous, the impulsivity and agitation inherent in a manic or hypomanic episode may lead them to make poor decisions or act “hinky” which could easily make you feel threatened. In the throes of a depressive episode, they may also intentionally act to provoke you. It is important to remember, that many—most—people with Bipolar Disorder or Cyclothymia never come into contact with the police. The persons you encounter often are the most severe. Be careful but compassionate. Bipolar disorders are very treatable, but require a combination of medication and lifestyle changes.

Bipolar Self-Assessment
http://www.blackdoginstitute.org.au/bipolar/howtotell/selftest.cfm
http://www.dbsalliance.org/questionnaire/screening_intro.asp

CEUs for professionals

Filed Under: Depression, Mental Health Tagged With: bipolar, Counseling, symptoms, therapy, treatment

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Bipolar Disorder

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