Category Archives: Pyschotherapy

A Trip Through the Past: The Genogram

None of us were created out of the mist, but have generations of family members that came before us.  Even if we are no longer speaking to them, or know nothing about them, these people continue to  have an influence on us–even it’s unconscious.  How do we bring this influence into consciousness?  Enter the genogram!

A Geno-what?

Simply put, a genogram is a graphic representation of a family tree that displays detailed information about relationships among individuals. It is more complicated than a traditional family tree as it can include individuals’ characteristics, health history, cause of death, emigration patterns…basically anything that the therapist and/or client feel they would like to add to the document.

If you’re curious and want to discover more about the structure and history of genograms, you can check out this Wikipedia entry.

The Use of Genograms in Therapy

When I begin to work with a new client, one of the first things we often do is create a genogram. This is a joint process, and the document is created from the client’s perspective.  We start with the client and work outwards by adding partner(s), siblings, children, parents, etc.–going as far back as grandparents–though sometimes farther back if it will be useful.

Once we have the added the people, then we start to include ‘relationships’ between the client and key people on the chart.  Are they close or distant?  Who doesn’t speak to whom?  Who disappeared from the family never to be heard from again?

Often a useful component is the addition of a few words describing each person on the chart.  As a client tells their family history/personal story, additions are made to the chart. For example, perhaps emigration is a large part of a family  history, which effects the relationships between members that stay in the country or origin and those that leave.  It’s also interesting to track items such as divorce, suicide and drug/alcohol use over the generations.

While genograms follow a definite structure and use specific symbols, each chart is as individual as the person creating it.  In fact, their usefulness is due to their flexibility as we can include any information that feels important to the creators.

The genogram is a ‘living document’ and the product of an iterative process.  As more information comes to light during the course of therapy, it may be added to the chart.  We can also go back to the chart during sessions to confirm thoughts or perceptions when needed.

The Client Response to Creating a Genogram

Ideally, creating a genogram is an enjoyable activity. It can be interesting to look at our family history from this perspective.  When I ask clients what they think of the process, I often hear about how they never thought of their family in this way and are enlightened when they start to see the patterns that emerge.

Clients often apologize when they don’t know information for the chart.  However, it’s all good information–even not knowing is valuable.  Why don’t they know?  What does this say about their family system? It’s acceptable not to know as it’s all grist for the mill.

The Use Of Genograms In Couple Work

Genograms can also be completed when working with couples.  In this case, we complete a chart for both partners–‘marrying’ it into a whole picture.  It’s often fascinating to see how family of origin pieces affect their current relationship and how each person is being affected by family history.

The Benefits of Creating a Genogram

Besides showing multi-generational patterns, one of the benefits of completing a genogram is that it puts some distance between the clients and the current concern(s) that brings a couple or individual into therapy.  We can see the challenge from another, less-personal perspective.

Another benefit is the unveiling of family secrets.  Holes in family of origin information often point to family secrets.  Why don’t we know what happened to Great Uncle Ed?  Why did Cousin Louise disappear only to return suddenly?  How come no one talks about Aunt Nancy?  Family secrets are important as they are part of the rules that govern families. As these rules often affect our core beliefs and subsequent mental health, it’s important that we explore them.  A genogram is often the first hint that a secret exists.

A third benefit of a genogram is as a tool to encourage interactions between family members.  While in grad school I created a complex genogram as part of a family of origin course.  In order to fill in missing information, I had to initiate conversations with family members that wouldn’t have occurred otherwise.  While these talks were not always easy, the results were worth the effort, both for information gained and relationships renewed.

It’s Not Our Ancestors’ Fault–At Least Not Intentionally

One of the pitfalls of a genogram is the possibility of blaming our family for our current struggles. While they may have a part to play–especially as patterns are repeatedly acted out, at the end of the day it’s safe to say that parents desire to love their children unconditionally and attempting to do their best.  However, this doesn’t always seem to be the case.  Why?

Dr. Gabor Maté, in his book, When the Body Says No:  Exploring the Stress-Disease Connection, writes about how multi-generational stress and trauma affect the ability of parents to attach to their children.  It is well-documented that our attachment style (secure vs. insecure) is a key component of our mental health and the way we interact with others. Our ability to handle stress is deeply related to brain development, both before and post birth, as much of our brain development continues well into the first years of age. Therefore, if our grandparents were stressed and unable to attach securely to our parents, it affected our parent’s brain development and their ability to attach…and on it goes.

Dr. Maté states:

“Parenting styles do not reflect greater or lesser degrees of love in the heart of the mother and father; other, more mundane factors are at play.  Parental love is infinite and for a very practical reason:  the selfless nurturing of the young is embedded in the attachment apparatus of the mammalian brain…Where parenting fails to communicate unconditional acceptance to the child, it is because of the fact that the child receives the parent’s love not as the parent wishes but as it is refracted through the parent’s personality. … For better or worse, many of our parenting attitudes and responses have to do with our own experiences as children.  That modes of parenting reflect the parent’s early childhood conditioning is evident both from animal observations and from sophisticated psychological studies of humans.” (p. 211-212)

What Do We Do With The Information?

Once we have looked at and integrated the information from a genogram, what do we do with it?  Awareness is the key.  When we begin to notice patterns, both in ourselves and in our relationships with others, we have taken a big step in making things better.  We can choose to do something differently.  We can choose not to continue the pattern to our children and grandchildren.

The “7th generation” principle taught by Indigenous tribes and Native Americans say that in every decision, be it personal, governmental or corporate, we must consider how it will affect our descendants seven generations into the future.  This also relates to taking care of our mental health.  When we do the hard work of healing the results of multi-generational stress and trauma, we not only benefit ourselves and those we are currently in relationship with, but also generations to come.

Now for some vintage comedy…family dynamics from the Carol Burnett Show.  Enjoy!

 

 

 

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The Highly Sensitive Person in Therapy

Last week I posted a book review of The Highly Sensitive Person:  How to Thrive When the World Overwhelms You by Elaine N. Aron, Ph.D.

In this post, I’ll explore what taking part in therapy may look like for a highly sensitive person (HSP).

A Fictional Story

Jenny (age 23) had recently graduated,  with a certificate in Business Administration, from a small community college in her hometown .  Due to financial restrictions, she had chosen to live at home throughout her coursework.  After graduation, job prospects where she lived were in short supply, so she happily accepted a receptionist position at a busy company in a large city three hours away.  Jenny was looking forward to moving to ‘the big city’, making new friends and starting her ‘grown up’ life.

Jenny arrived in the city a few days before she was due to start her job.  She moved in with a young woman that she had found on Kijiji who was looking for a roommate.  The apartment was small, but she told herself that wouldn’t matter as she had her own room. Plus, her roommates was going to become a new friend.

Jenny’s first day at work was a whirlwind.  The subway ride from her apartment to the office was hot and crowded.  The reception area where she sat was in a busy lobby that echoed with the sound of hundreds of people rushing through the space.  If the phone wasn’t ringing, there was someone waiting to meet another employee or a courier asking her to sign for packages.

By the time Jenny ‘fought’ the subway to get home, she was exhausted and overwhelmed. She was looking forward to spending a quiet evening at home getting to know her roommate. However, when she arrived she was greeted by deafening noise!  Her roommate had invited work colleagues to the apartment for their usual “Thank Goodness Monday is Over” party.  They invited Jenny to join them, but she was so tired that she declined, promising to join them another time.

Jenny’s first day turned out to be the pattern for most work days–busy days, followed by some sort of social gathering taking place in her apartment at night.  Weekends were somewhat quieter as the office was closed, but her ‘home’ became pre-party central both Friday and Saturday nights as her roommate and her friends warmed up for their evening adventures. Jenny often spent her time at the apartment, curled up in her bed with her head under her pillow.  Jenny started to feel lonely and miserable.

After six months of living this ‘grown up’ life, Jenny was struggling to cope. On the advice of a friend from home, she decided to find a therapist.

The Therapy Experience

By the time individuals like Jenny start to meet with a therapist, they are often overwhelmed and doubting their abilities.  Many HSP’s think that they are failing at life and that there is something wrong with them.

As a therapist, once a client and I have talked about what is bringing them into therapy, if I suspect that the individual may be highly sensitive, I will talk to them about the concept of HSP’s.  We will explore the characteristics of high sensitivity–looking at past and present behaviours, situations and experiences.

I often suggest homework to my clients, and at this point will ask that they read The Highly Sensitive Person, not only as a way to gain more information, but also to discover some tools and coping strategies.

If the idea of high sensitivity rings true for them, this concept can provide a new lens for the client to look at their way of being in the world.  For the therapist, being aware that they are working with a client who is highly sensitive can help them to adjust their way of working with that client and the types of interventions they may recommend.

HSP’s and Types of Therapies

When working with clients, it’s helpful if a therapist has different ‘tools in their toolbox’ to help them.  The art of therapy involves matching specific therapeutic tools, from different types of therapies, to particular clients.  What are some common therapies and how can they be adapted to be the most beneficial with working with someone who is highly sensitive?

Cognitive Behaviour Therapy (CBT): 
CBT helps to relieve specific symptoms by exploring how our thoughts and beliefs affect our behaviour.  It’s fact-based, and involves keeping track of thoughts and behaviours. This type of therapy tends not to focus on feelings or motivations for actions.

When working with HSP’s, I like to use CBT not only as a way to explore symptoms (monitoring the thoughts and behaviours in the same way that we would a science experiment), but also as a way to gauge if the coping strategies learned in the Highly Sensitive Person are proving to be useful.

One of the skills possessed by highly sensitive people is an ability to focus on details.  This is very helpful when observing/tracking symptoms in CBT.

Dialectical Behaviour Therapy (DBT):
DBT takes Cognitive Behaviour Therapy  further by looking at the emotions that are not explored in CBT.

I find that there are two benefits of using DBT with highly sensitive people:  the first is that DBT teaches calming and distraction skills that can help HSP’s to cope with the sense of overwhelm they can feel in specific circumstances.  The second–DBT encourages acceptance of current situations, while at the same time realizing that there needs to be positive change.  This acceptance allows HSP’s to begin to feel comfortable with their way of being in the world, while learning new skills and making changes.

Narrative Therapies:
We usually equate therapy with talking, and talking is at the heart of the narrative group of therapies where feelings and motivations are explored.  HSP’s can feel very comfortable with this type of therapy as they tend to have a rich inner life and are sensitive not only to their relationships with others, but are intuitive regarding interpersonal dynamics. Their attention to detail and awareness help them to recognize patterns in behaviour and circumstances.

Medications:
As a psychotherapist, I don’t prescribe medications, though I sometimes suggest that a client consult with their doctor to explore if medications could be a useful addition to therapy.

For many highly sensitive people, their sensitivity includes their physical self.  They may have noticed that they are more sensitive to physical stimulation such as sounds, light, touch.  They may have discovered that they are more sensitive to alcohol, caffeine and over-the-counter medications.  They may react to prescription medications.

It’s important for people who feel that they are highly sensitive to let their health care providers know.  For many prescription medications, compounding pharmacists can create specific dosages for individuals that can be slowly increased over time–eventually arriving at the ideal dosage while minimizing side-effects.

The End of the Story

When Jenny learned about the possibility that she may be highly sensitive, she felt that a big piece of her personal puzzle fell into place.

With her therapist, Jenny explored her negative beliefs about her feelings of failure and that there was something wrong with her.  She looked at how her current living and working situations were affecting her health.  Jenny thought about whether she wanted to continue her current lifestyle  (using her new coping strategies and tools) or if she wanted to try something else.  Jenny gave herself permission to dream about what a new lifestyle could look like and used her therapist as an accountability partner as she planned for a change and set these plans in place.

By the end of therapy, Jenny had decided to fine-tune her lifestyle.  Using what she learned in therapy along with her past experiences, she decided look for a new job at a smaller company.  She updated her resume to help her obtain a specific position that didn’t involve working with the public in an open space.  She decided that she liked living in the big city, but wanted to do so on her terms. She found a bachelor apartment that allowed her to live alone at a rent she could afford.

Jenny  used the HSP coping strategies to travel to work on the subway and organize her social calendar.  Jenny found that when looking at her life though the HSP lens she was able to take care of herself and do so without embarrassment.

Let’s Take a Break

Now, for all of us who would like to take a break from the business and noise of life; here are two clips.  They both feature the famous cellist, Yo Yo Ma.  The first  is a clip of his 2015 concert at the Royal Albert Hall in London, England.  The second is of a seven-year old Yo Yo Ma (accompanied by his sister) at the his American debut performance at the Kennedy Center for the Performing Arts.  Enjoy!

 

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Experiential Learning Theory and Mental Health…Is There a Connection?

As a therapist, one of my professional goals is that the people I work with will leave therapy with a greater understanding of the issues that brought them to see me, as well as tools to cope if the challenge should occur in the future.  As a way to work towards this understanding and skill development, I often ask clients to complete homework assignments.  The assignments may be to reflect on part of our discussion, practice a new skill or write a letter (not to be sent) to a difficult person.   Over time, I have found that clients’ willingness to complete homework outside of our sessions has a positive influence on their therapeutic success.  Because of a presentation I recently heard on Experiential Learning Theory, I now have a clue as to why.

What Is Experiential Learning Theory (ELT)?

Simply put, the theory is based on the idea that people learn through “discovery and experience”.

Imagine that you want to learn how to ride a bike.  If someone told you how to ride a bike or you read “Bike Riding for First-timers”, you could gain theoretical knowledge about physical balance or types of bikes. You may even get an idea of how to fix a bike, but would this information be useful in fulfilling your desire to race through the neighbourhood on your own steam?

Instead, now imagine that you are standing beside your ‘new-to-you’ bike.  You are brimming with determination to start riding.  My guess is that you would be using a process of ‘trial and error’ to figure out how master this new skill.  Learning would involve finding ways to sit on the seat, pedal, turn and stop–while not falling off.  It would take time, and while a book or lecture could be helpful, their content may make more sense after your had the experience of actually playing with your bike.  This is experiential learning!

David Kolb and the Experiential Learning Cycle (Kolb Learning Cycle)

In 1984, David Kolb (social psychologist) coined the term “experiential learning” when he published Experiential Learning:  Experience as the Source of Learning and Development.

Kolb’s cycle has four parts:  experience (doing something), reflection (review what was experienced), conceptualization/generalization (making sense of what happened and the relationships between these elements, and experimentation (putting what was learned into practice).  When we see how what we learned is useful in our lives, we’re more likely to retain the knowledge.  The gift of this cycle is that it is a cycle–we can keep repeating the process as a way to fine-tune our knowledge when learning a new skill.

Let’s return to the bicycle example–you want to learn how to ride your bike.  To begin (experiential stage), you straddle the bike, sit on the seat and put a foot on a peddle.  So far, so good.  However, as soon as you start to lift your second foot off the ground, you feel a loss of balance and find yourself on the ground!  The reflective stage starts as you think about what just happened (one second sitting on your bike, the next lying on the ground).  As you make sense of this experience (conceptualization/generalization) you may be thinking about how unsteady you felt as you moved for the second peddle.  You may decide to go back to “Bike Riding for First-timers” and re-read the section on balance–this time with a new perspective.  Finally, after your bruises have healed, you will return to your bike and apply what you have learned (experimentation).  As you repeat this cycle, you will roaring around the streets in no time!

What Does ELT Have To Do With Mental Health?

As I was listening to the presentation, I was thinking not only about how this could explain the success of therapy homework, but also how it could affect the development of phobias and be used in their treatment.

Phobias are learned behaviours–based on previous experiences.  Common treatments for phobias are Exposure Therapy (treating the avoidance behaviour by helping individuals to slowly become acclimatized to the phobic trigger) and Cognitive Behaviour Therapy (CBT)(exploring thoughts around the feared object, as well as develop alternative beliefs about the phobia and its effects on their life).

If we bring in the Experiential Learning Cycle, can the Learning Cycle help to explain the creation of a phobia?  There was the original experience (for example being bitten by a small dog).  A time of reflection–“I was just bitten by a small dog!” followed by conceptualization/generalization–I put my hand out and a small dog bit me, so small dogs bite.  Finally, experimentation when we put what was learned into practice–“I’m staying away from small dogs!”… and a phobia may be born.

On the other side, does CBT and  Exposure Therapy use ELT concepts to help people explore and unlearn the basis of the phobia–especially when used together?

I’ll Keep Suggesting Homework

Experiential Learning Theory has confirmed for me the value of therapy homework, as the homework is assigned based on a specific client experience.

Let’s take the example an argument with a co-worker.  In therapy we would reflect on the argument, look at past incidents with the co-worker, and talk about emotions connected to this event.  We would explore possible ideas of what could be done differently in the future.  We may move into role-playing a specific communication skill or conversation.  The resulting homework would be to practice the skill, and perhaps, have the conversation with the co-worker.  The cycle continues at the following session when we debrief the homework, fine-tune and explore where to move from that point.

Experiential Learning Theory In Practice

Here’s a great example of experiential learning.  Thankfully, most people don’t have this experience on network television!  Warning…there are lots of bleeps due to language.  Enjoy!

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It’s Groundhog Day! Are you SAD?

We are a hardy people living in the northern hemisphere!  While we may enjoy snowy and cold activities–we also lust for spring–especially  after an especially cold, dark or wet winter.  Whether it’s a longing for spring or the desire for a distraction from the cold, enter Ground Hog Day!

First popular in 1956, February 2nd is set aside each year as a day to place our faith in the predictions of a ground hog to forecast the coming of spring.  While Wiarton Willie (an albino ground hog from Wiarton, Ontario) was the original weather-forecasting rodent, he has been joined by Shubenacadie Sam (Nova Scotia), Gary the Ground Hog (Ontario), Balzac Billy (Alberta) and Brandon Bob (Manitoba).

For those who are unaware of the process–people get up before dawn to wait for their groundhog of choice to come out of his den.  If the animal sees his shadow, he flees back into his den and we’re destined for six more weeks of winter.  If not, spring is on the way.

According to Willie’s website, he has been able to predict Spring with a 90% accuracy rate.

Seasonal Affective Disorder

All fun aside, some people need spring, and the longer hours of daylight, for bigger reasons than to get a break from the cold and dark.  These are people who suffer from Seasonal Affective Disorder (SAD).

SAD is a type of depression that is related to the change of season.  It is experienced by individuals who are not usually depressed at other times of the year.  It often begins, and ends, at the same time every year.  While most people who suffer from SAD do so in the winter, some may do so in the summer instead.

How Do I Know If I Have Seasonal Affective Disorder?

There are a variety of symptoms that people coping with SAD are dealing with.  These include:

  • Low energy
  • Moodiness
  • Irritability
  • Problems getting along with other people
  • Hypersensitivity to rejection
  • Heavy, “leaden” feeling in the arms or legs
  • Oversleeping
  • Appetite changes, especially a craving for foods high in carbohydrates
  • Weight gain
What Causes SAD?

While there are no known clear-cut causes, we do have some ideas of what may bring on SAD.

  • Your biological clock (circadian rhythm).The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body’s internal clock and lead to feelings of depression.
  • Serotonin levels.A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression.
  • Melatonin levels.The change in season can disrupt the balance of the body’s level of melatonin, which plays a role in sleep patterns and mood.
What Can I Do?

There are many ways that you can cope with SAD symptoms.   Depending on the severity of your symptoms, some or all may help.

Increase Your Exercise
While it’s easy to hunker down during the winter, especially when feeling depressed, increasing your level of exercise has been shown to improve negative effects of SAD. Exercise releases endorphins (the ‘feel good’)  hormone as well as improving seratonin levels.

Cut Back on Simple Carbs
During cold days, when we spend more time on the couch, we may also be spending more time with white pasta, candy, potato chips, cookies and other ‘comfort’ foods. Unfortunately, these foods cause sharp spikes in our glucose levels that play havoc with our moods.  If you’re suffering with Seasonal Affective Disorder, it’s a good idea to pay special attention to eating well.

Take Advantage of Natural Light
When possible open your drapes or shutters to let in the sun (when it makes an appearance!).  Spend time outside by going for a walk, shoveling the driveway, or inviting friends over for a snowball fight or snowman-building competition.  As long as you dress warmly, it can be fun.

Use a Natural Spectrum Energy Light
If Mother Nature doesn’t provide enough natural light, box light therapy is an alternative. Natural spectrum energy lights mimic the sun’s rays.  While data on the results of these lights is mixed, many people say that they are helpful.

Make a Point of Socializing
When we’re feeling depressed, often the last thing we want to do is be with other people. However, this is often what is needed.  If possible, plan a regular get-together with friends–even a coffee date will do.

Meet with a Therapist and/or Medical Professional
As with any form of depression, sometimes it becomes difficult to cope with.  If you are feeling unsafe, hopeless, attempting to self-soothe with self-harming behaviours, alcohol or drugs, feel that SAD is taking over life or are experiencing suicidal thoughts, reach out for professional help ASAP.  You don’t have to cope with this alone.

Spring, and with it warmer and longer days, will come again!  For laughter…here’s a clip from the iconic movie Ground Hog Day…featuring the famous Punxsutawney Phil (Pennsylvania’s Ground Hog)….and Bill Murray.  (Spoiler alert…contrary to what the ending looks like…they survive!).  Enjoy!

 

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It’s Friday the 13th…Are You Feeling Anxious?

Happy Friday the 13th!  Are you feeling anxious?  While some people find this a reason to celebrate, others spend the day in a state of fear and anxiety; suffering from either Triskaidekaphobia (the fear or avoidance of the number 13) or Paraskevidekatriaphobia (the fear of Friday the 13th).

If you are uncomfortable when Friday the 13th comes around, you’re not alone.  Popular culture supports your discomfort around the number 13.  Most buildings don’t have a 13th floor.  There is no 13th row on airplanes, and the entertainment industry has capitalized on our anxiety by creating horror movies such as Friday the 13th.  The effect is so wide-spread that businesses lose approximately $1 billion a year in sales as people chose not to do business on Friday the 13th.

At the end of the day, it’s a phobia.

Triskaidekaphobia and Paraskevidekatriaphobia are phobias.  A phobia can be defined as “an extreme or irrational fear or aversion to something or situations that pose little real danger, but provoke anxiety and avoidance”.  Phobias are linked to anxiety disorders and the fight or flight response in the brain.

Common categories of specific phobias are:

  • Situations: flying, enclosed spaces, going to certain locations (school, work)
  • Nature: extreme weather, heights
  • Animals or Insects: dogs, spiders
  • Medical: body fluids, needles
  • Others: loud noises, dolls, clowns, escalators.
Our mind and body knows.

When we’re under the influence of a phobia, we can experience a range of symptoms:  intense fear, anxiety, panic, racing heart, sweating, breathing difficulties, dry mouth, upset stomach, dizziness or shaking; just to name a few.  Not fun.

Reactions can range from mild to severe.  In some cases, a phobia can get in the way of our daily routines and even redirect our path in life.  For example, we may choose not to accept our dream job because it requires travel; and we’re afraid to fly.

Am I at Risk for Developing a Phobia?

Phobias can be developed at any time, and there are factors that make some people more susceptible than others.

  • Age: Phobias usually first appear under the age of 10, though they can start anytime in our lives.
  • Family History: Some phobias are like family heirlooms—passed down from one generation to the next–“Women in my family have always been afraid of spiders.”  It’s not clear if this is genetic or learned behaviour.
  • Temperment: Some people have developed a more sensitive ‘fight or flight’ response that makes them more sensitive to negative events.
  • Negative Experiences: I have a family member who was bitten by a small, white dog as a young child and has been afraid of small dogs ever since.
  • Learning about Negative Experiences: We live in a world that is so inundated with news and social media that we are more aware than ever before of negative events—either among our Facebook friends or world events.  If we pay attention to all of it, the world can seem like a very scary place–“I’m terrified of spiders after reading the Facebook post about the man in Australia that had to have his arm amputated after a spider bite!”.
When to Seek Help.

As with most things in life, it’s a matter of degree.  If your phobia is something that can be managed in a healthy way, and doesn’t affect your normal life, then you may choose not to look for support.  However, if you are experiencing any of the following behaviours, please speak to a therapist or your doctor.

Social Isolation

When we suffer with anxiety disorders, life can become smaller.  Anxiety is an ‘avoidance’ disorder—we become so afraid of being anxious that we avoid the triggers.  Eventually, our lives become an exercise of keeping ourselves safe.  We stop seeing our friends or family members because we’ve become afraid to take the bus, go into crowds or even leave the house.

Increased Anxiety or Depression

If you feel that a phobia is beyond your control and is running your live, increased anxiety and depression can set in.  If you are feeling that the anxiety/depression or your life isn’t going to get better, seek help.

Self-soothing with Addictive Substances

If you are attempting to ease the negative feelings that you are experiencing by using alcohol or drugs, this is not in your best interest.  In fact, using drugs or alcohol to cope is complicating the issue by adding addiction to the mix. As it is very difficult to improve mental health challenges when an addiction is fully active, you would need to be able to manage the addiction before working on the phobia and resulting anxiety or depression.

Suicidal Actions or Thoughts

Sometimes phobias can send us to such a dark place that suicide is seen as a way out.  I cannot say strongly enough—if you are feeling suicidal or having suicidal thoughts, go immediately to your nearest hospital emergency room.  It is important that you are safe.

Treatment

There are three recognized treatments for helping with phobias:  Exposure Therapy, Cognitive Behaviour Therapy (CBT) and medication.

Exposure Therapy
Exposure Therapy treats the avoidance behaviour by helping individuals to slowly become acclimatized to the phobic trigger.

For example; if my family member was undergoing Exposure Therapy for his fear of small dogs, a therapist would support him in his efforts to think about small dogs.  Once this becomes comfortable, he would move on to looking at pictures of small dogs, followed by watching a live small dog, getting closer to a small dog, talking to a small dog—all the way to petting a small dog.

My family member can move at his own pace, and stop when he reaches his goal.  He may decide that being symptom-free when seeing a small dog in the park is enough, and have no desire to ever touch a small dog.

Cognitive Behaviour Therapy (CBT):
During CBT, the therapist helps the individual to explore their thoughts around the feared object, as well as develop alternative beliefs about the phobia and its effects on their life.

Medication:
Depending on the severity of the effects of the phobia on an individual’s life, they may choose to use medication to lessen the mental and physical symptoms—especially while they take part in the other therapies.  If a phobia is situational and/or infrequent—such as a fear of flying—short-term medication is often an option.

You don’t have to let a phobia take control of your life.  It’s treatable.  If possible, enjoy the day.  For some people, Friday the 13th is very lucky!

Now, here’s some Exposure Therapy if you have a phobia about black cats.

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