Continuing to Thrive: The New Normal

SURVIVORS AND THRIVERS

The events of the last many months have created survivors and thrivers of each of us. In our own way, we are each learning how to navigate a new world and new systems. We are creating a New Normal. We will not go back to "the way things were," and we will not return to "normal functioning." We will forge our pathway forward into a version of our world that includes shades of the old world, lessons learned from our current experience and brightness of the world that is yet to come.

For many of us, this is not an exciting or pleasant process. Creating a New Normal comes with painful experiences, loss and struggle. Many of us continue to be in that phase of loss and struggle. Each of us are weathing this storm and gaining new skills at our own pace. Be assured that on the other side of this storm, there most certainly is a New Normal with a new way of doing things that our human resliency and solution-finding nature have allowed us to design and implement.

As you work to thrive in this time of creation, consider the following ideas: 

1. FIND YOUR RHYTHM

You have likely already found new schedules and structures that work for you and your family. Continue to hone these schedules and find a rhythm that works for you. Each day might have variations, but you will eventually notice that you are following a pattern and a system that is of you own new creation. Consider writing it down, posting it or putting it in your calendar to further concrete this New Normal. 

2. DISTRESS TOLERANCE

A major overhaul of systems and daily life, as we are currently experiencing, can be distressing. As we work hard to create our New Normal, consider the following ideas that https://linehaninstitute.org/dbt/" target="_blank">Dialectical Behavioral Therapy teachers us: 

A. TIPP - Temperature Control, Intense Exercise, Paced Breathing, Paired Muscle Relaxation

Temperature - Cool your body down! Crisis and intense emotion can increase the heat in our body. Find an ice cube, splash your face or find some cool air - changing our body temperature can help re-regulate our system and give us an opportunity for fresh perspective.

Intense Exercise - Address your intense emotions with an intense response! Intense exercise could include a short sprint, 10 quick jumping jacks, or fast-paced game of "head-shoulders-knees and toes." Quickly increasing your heart rate will increase the oxegyn to the decision-making part of your brain and help to re-regulate your system for a fresh perspective.

Paced-Breathing - Remember your breathing exercises! This can be a simple breathing exercise or a more complicated breathing exercise, depending on the level of focus you can maintain in the moment.

Paired Muscle Relaxation - Practice exerting control over your body by tensing and relaxing different muscle groups as you cause your own body to relax and release.  

B. Self- Soothe - Use your five senses to re-regulate and re-focus on things you CAN control and being in the present moment. Pay attention to 5 things you can see, 4 things you can hear, 3 things you can touch, 2 things you can smell and 1 thing you can taste. Allow your own body to return to itself and open an opportunity for fresh perspective.

C. Radical Acceptance - We may find that once we have made every intervention available and made as many changes as possible, that we have to sit in the present moment and recognize that it is a product of all that has come before, of all our own efforts and of many things that we cannot control. We may need to choose to radically accept that our present moment exists in its pain and goodness while we survive until we can thrive.

Additional tools for Distress Tolerance can be found here: https://www.sunrisertc.com/distress-tolerance-skills/" target="_blank">SUNRISE: Real Life Change

3. HUNT FOR NEW NORMAL

Beginning training your mind today to hunt for the New Normal. Look around and see what is new that is working and embrace it. Look around for the new things that have been tried that didn't work and leave them on the side of the road. Track successful New Normal by writing it down, sharing with a friend or just choosing to stop and notice. 

I know that we are all using every ounce of energy we have left to create and navigate the New Normal. You are finding your systems. You are finding your rhythm. Keep working at it. I have faith in your strength. I have faith in your reslience! We are each making our way to New Normal. Just around the corner, New Normal will be NORMAL. 

Tips for Thriving at Home:

Our world is in crisis facing the current pandemic and mandates for social distancing. This amounts to our communities, our employment and our families being in crisis. As we shelter in our homes and learn how to be web-based in most everything that we do, we are not only distancing, we are isolating. We are vulnerable to symptoms of depression and anxiety. We need to reorganize the way we take care of our families and the way we take care of ourselves. And, we need to do it sooner than later. Here are some ways you can begin today: 

1. Structure
2. Move
3. Communicate
4. Water and Sun
5. Recharge

1. STRUCTURE

Creating structure and schedule has always been helfpul, but when we are facing crisis and so much uncertainty, schedule and structure become more imperative. Consider implementing structure that is manageable and sustainable for you. There are many sample daily schedules for children and families online, but not many for the single person. Even if you find a schedule, it may not be the one that works for you. So, consider what your day usually looks like a pick a general structure to follow. You can pick definitive times, or a range of times, such as "Wake up at 8am" or "Wake up between 8am and 9am." Start with the following: 

A. Wake Up Time 
B. Meal Times
C. Work Time
D. Bed Time

Waking up and going to bed at the same time will allow your body to follow a rythym, which is important for regulating ourselves. Making sure you have fuel to keep your brain and body working is valuable as we attempt to process new information and manage strong emotions every day. Everyone has some work they can do every day. This helps us feel productive and allows us to make contribution, which fights depression.

Your work might be a web-based version of what you have previously been doing every day, it may be working with your children on their classwork, or it may be learning a new skill online, such as a language or finger knitting. Be sure you find some meaningful work every day. 

Once  you create this basic framework, you can fill in other structure as it suits you. Find time to plan daily human connection. Find time to plan for movement, for getting outside and for taking breaks. Only you know how detailed and strict the schedule needs to be. Be sure to create a schedule that fits your personal style of need for flexibility and structure. 

2. MOVEMENT

Our bodies need to move for countless reasons related to health and well-being of the physical, emotional and cognitive selves. Find a way to incorporate movement into every day. Consider YouTube videoes that lead you in a movement pattern. Consider creating your own stretching routine. Consider talking a walk around the outside of your house. Consider putting on your favorite music and dancing in the living room. Be sure to include movement in your every day routine. 

3. COMMUNICATE

Many people are not used to being around their family members as often as will happen when you are completely home-based. Many people are not used to be out of connection with other humans as much as will happen when you are completely home-based. So, we need a new system for communication and connection. Incorporate the following reminders for navigating daily and ongoing communication: 

A. Kindness - start with kind words, even if you are frustrated
B. I Statements - speak from your personal feelings and experience
C. Soften - take a breath before you speak and soften strong emotions
D. Plan - set aside a daily time to check in with one another and schedule a family meeting
E. Reach Out - utilitze the resources you have to reach out to folks outside your home via video chat, email, text and social media

4. WATER AND SUN

Our bodies love and require water. Remember to stay hydrated, as a well-lubricated brain manages stress much better! Your body function better and you will navigate this path more effectively if you remember to drink plenty of water every day. Start with one large full glass right when you wake up and consider including a large glass of water with each meal of the day. Keep a water bottle filled and carry it around with you so you can sip on water throughout the day. 

Staying indoors with deprive us of direct sunlight, which our bodies also require. Try to get outside at least once a day. Breathe fresh air, feel the sun on your skin and change your view a bit. Consider sitting near a window while indoors to experience the sunlight indirectly as well. 

5. RECHARGE

All that time paying attention to structure, trying to get in some movement, tyring to get outside and working on  your communication skills may leave you depleted and in need of some recharge. Remember to take time each day for yourself to be alone, to mentally check out and to relax. This will look different for each person as you reflect on what helps you recharge. For folks that normally recharge by being with other humans, this may be the time where you dip into your social media more or engage in video chats. For other folks, this may be the time when you retreat to your bedroom, your closet, the garage or the backseat of your vehicle for some alone time. 

Take a break from exposure. Remember that we can increase our anxiety by continuing to expose ourselves to traumatic information and visual stimulus without a break. There is information being disseminated every minute of every day and we need to moderate how much we allow it into our life. Set times when you will not be on social media, the television and will not discuss current events. Let your mind check out from processing this crisis every second of every day and allow for a recharge. 

I am sure that each of you is working to manage and navigate this new and different way that we are living. You will find your system. You will find your rythmn. Keep working at it. You might not be great at it yet, but you'll get there. We all will. 

Here comes Spring!

April is our opportunity to focus on Being Active! 

The idea of starting an exercise plan can be exciting and also overwhelming. If you are bursting with energy to get out into the sunshine or onto the treadmill, feel free to follow that momentum and go forth! This month's article will be focused on a range of levels from starting slow, to jumping in at full-speed ahead.

Hopefully you have experienced the benefits of exercise for yourself. Perhaps you can remember a day when you felt especially anxious and all your body wanted to do was move. If you were able to move, you likely felt the release of energy and subsequent increased calmness that came with following that instinct to move. Perhaps you can remember a day when you felt especially depressed and your body did NOT want to move at all, but maybe you found that small part of you that was inspired to go for a walk. If you were able to move, you likely felt the release of some of that built-up sadness or maybe the light at the end of the tunnel became visible or a little brighter.

While exercise is not the magical and sole solution to any problem, including mental health, it sure can be a support and get things moving in a more functional direction. Article after article talks about the benefits of being active on our overall sense of well-being. There is also ample research demonstrating the positive affects of exercise (as little as 10-15 minutes) on memory, depression, anxiety, focus and learning. Increases in levels of glutamate, cortisol, dopamine, norepinephrine and serotonin contribute to better management of stress and sadness. Some exciting studies have even shown an increase in hormones that impact neurogenesis, the process by which our brain continues to grow and create new neurons. (Basso, J.C. & Suzuki, W.A. The Effects of Acute Exercise on Mood, Cognition, Neurophysiology, and Neurochemical Pathways: A Review.) 

(Before we get started, please be sure to check with your primary care provider and any other health providers invovled in your care to be certain which interventions are right for you. Only you and your providers know your body and your health needs best, so be certain to avoid any recommendations on this page that contradict information provided to you by your doctor, nurse practitioner, physical therapist, dietician, mental health specialist or other providers.) 

Now that you know what you have to gain, let's get going!

Week 1: Take a Walk

That's right. Walk. This week we are focusing on walking. You may love to run (and you are welcome to do so!), but this week's focus will be the value of walking. I found the great thing about walking is that you can go at a slow pace or a super speedy pace and obtain benefits from either one. In fact, my speediest pace of walking is sometimes faster than a jog with less impact on my joints. For folks that are concerned about physical abilities and the attempt at movement, walking can be a more comfortable and reasonable place to start. 

Beyond your pace, you also want to consider location. Walking is great because you can step outside your front door and walk, you can drive to the mall and walk the length of it over and again, you can find a local track (indoor or outdoor) and walk, you can access a trail system, you can find a flat walking path or a steep walking path, you can walk on a treadmill and you can even walk in the pool. Our local community pool has a great lazy river in which you will find people walking either with or against the current, around and around. 

Lastly, consider the length of time you walk. Time magazine recently published an article on the value of just 10 minutes of exercise (check it out here). You may need to start with 5 minutes and work your way up. Maybe you walk 4 minutes on Monday and increase by one minute for each day that goes by. As you reach the end of the week you will have achieved a 10 minute walk that you will be proud of and most certainly benefitting from.

Remember that eventhough exercise has other physical health benefits, this week we are focused on the mental health benefits. A 10 minute brisk walk will absolutely produce the neurochemistry necessary to start combatting stress and sadness. It will also change your mental perspective by providing a distraction and causing you to focus on your walk. Pair the walk with a friend and you will even add in some valuable social support! 

Week 2: Use the Living Room

Getting outside can be so wonderful, but you might have lots of reasons why you need to stay home. Some folks have physical limitations that make a walk out the front door difficult. Others have small children or aging parents that require arranging for a caregiver while they are outside their home. Depending on the time of year and location of your home, the weather may not be super cooperative for getting outside easily. For some folks, there are mental health barriers to leaving the house, such as fears of public places or groups of people. In short, maybe leaving the house is not the answer. 

Exercising at home may be necessary or may be a choice you make. There are so many options for staying right in your own living room, so why not? YouTube is full of just about any type of exercise routine you can think of, with instructors coming from a wide range of backgrounds and experience. Pull up some videos and choose something that fits with your interests, personality and style. You might even get some of your family members engaged in the activity as they are motivated by your efforts! Check out the following videos as a start to your discovery of what fits your needs best: 

POPSUGAR Fitness: 10 Minutes - No Equipment

Fitness Blender: Low-Impact Cardio

Walk at Home: Interval Training

Depression and Exercise

Adriene: 10 Minute Yoga

Keep looking! There are so many videos out there; you are sure to find one that suits your needs. 

Beyond YouTube vidoes, there are great lists of online workouts you can do at home: check some out at Health.com or Fitness Magazine. Dr. Axe has some fun ideas and tips on "micro workouts." Check out his 10-minute workouts here.

I know you can carve out 10 minutes between activities at home to squeeze in some exercise. Let's get going!

Week 3: Join a Group

The value of social support is immeasurable. With the advent of meet-up groups becoming more and more popular, you can easily join a group of people to participate in like-minded exercise endeavors. Beyond meet-ups, there are also clubs and organizations in every community that cater to being physically active. You might try joining a bicycling group or a mall-walkers club. You may find a group in a class setting, such as a yoga or tai chi class. You might choose to join an athletic club and participate in group activities, such as zumba, spin or other fitness classes.

Group dynamics are an impressive force. Humans are much more engaged in an activity when we have a partner or a group of poeople to help motivate us. The group dynamic produces a sense of community, but also a sense of committment that encourages us to follow through and remain on task. Groups provide structure and direction. A class has a specific time limit and identified goals and activities for the time allotted. A walking group has a destination and a pace. Larger groups allow us to break into smaller groups, identifying ourselves with folks among the group that are at our same level. Speaking of identifying with folks in the group, remember that group activities also give us an opportunity to connect with other humans, make friends, not feel so alone in our endeavors and normalize our level of ability. 

Want more information on the benefits of exercising with a crowd? Take a look at this article published by NBC, citing several studies that support the value of working out in numbers as it increased motivation and success. 

I'm definately trying to make a case for joining a group activity this week, but I know that some of you are thinking its too much trouble, too embarrassing, you're too shy, you won't know anyone or any other number of social barriers. Consider some of the following options for providing yourself with some encouragement:

1. Think of an activity you know you already like and bring your own group together.

2. Ask some other parents during pick-up or drop-off if they want to go for a walk after picking the kids up from school one day.

3. Plan a group activity for coworkers over the weekend and post your plan in the breakroom.

4. Tell your best friend that you need a group activity for this week and ask them to plan it for you.

5. Grab your siblings or parents and make it a family outing.

6. Use an online live-streaming group activity option, such as one found at Shape.com

Remember that a group activity can be as little as 3 people, so don't push yourself to go to a big jazzercise class if it will ramp your social anxiety up beyond the benefits of the exercise. Also remember that being social is part of being human and encouraging ourselves to engage in one group activity may be something we have to talk ourselves through, but will be worth the effort. This month, try to be creative with your solution-finding to prioritize a little exercise. This means thinking about all the ways you CAN make it work instead of focusing on why it will not. You can do this!

Read this article at Active.com for more information and ideas on the benefits of group exerices, as well as overcoming challenges. 

Week 4: Try Something New

Sometimes we need a change of scenary to prod our motivation. A start to this week might be to re-read the January Balance Blog on creativity. Check out Week 3 for some ideas on Creativity and Movement. I'm certain there is at least one option on the list that you have yet to try. Start with ones that sound interesting or ones that you have always been wanting to try, but don't shy away from ones that you might not have considered. Those might be the very activities that keep you interested, motivated and committed!

There are all kind of exercise ideas, including stretching, cardio and weight-training. Within these categories you can find a wide variety of options. This week you may decide to try something new for the whole week, or try something new each and every day. 

Need more convincing to get moving? Try this article by the American Psychological Association on the amazing benefits of exercise on the brain and mood.

THANKS FOR BEING ACTIVE WITH ME THIS MONTH!

HAPPY SPRING!

A note about building habits: There has been varying research about making habits and how long this might take. While we are undertaking a month focused on different areas of wellness, my hope is that the habit you are creating is one of seeking health and well-being in your life. By creating this habit over the course of a year, you will undoubtedly have oriented yourself to this goal to the degree necessary to make it habitual. The contents of each month, including this exercise month, may not specifically become habits without more focused effort. My hope for you in this regard is that you will find something during at least one week each month that connects with you. That week should be the buliding block for future endeavors and habit-forming behaviors as you identify throughout each and every month the activities that motivate and encourage your health and wellness plan.

Disclaimer: Speak with your primary care provider about any health concerns your may have and the level of exercise appropriate to your physical health needs. Do not engage in any of the activities mentioned above if your primary care provider or any specialist invovled in your care has advised against it. Speak with your mental health provider about the benefits of the above-mentioned activities and follow their recommendations on any necessary modifications or additions to the ideas shared here. You and your health providers know your body best, so make sure you are incorporating everything you read with the wisdom they are providing and your own internal source of wisdom. Remain in contact with your providers through any and all activity endeavors to be certain you are continuing on the path that is best for you. If you experience light-headedness, dizziness, sharp pain, chest pain, leg cramps, an inability to breathe or irregular heartbeats, STOP IMMEDIATELY and consult your provider for further activity recommendations. 

March is for restfulness.

This month, let's focus on

SLEEP

So, why choose sleep? Sleep deprivation is known to be associated with anxiety disorders, depression and attention-deficit-hyperactivity disorder. In fact, sleep disorders affect as much as 50%-80% of persons diagnosed with mental health concerns (Check it out at Neurocore). Even if you are not suffering from a mental health concern or diagnosed with a mood disorder, sleep deprivation results in decreased focus, impairment in judgement and clarity and difficulty learning new material. Additionally, the Division of Sleep Medicine at Harvard Medical School tells us that sleep plays a critical role in a healthy immune system and metabolism.

The benefits of sleep are obvious to every one of us. We know what it feels like to get a good night's sleep and we know what it feels like to wake up after a terrible night's sleep and try to function the following day. Sleep is one of the basic necessities of health and well-being. We may know how vital sleep is, but we don't always know how to make the good sleep happen.

For the next four weeks, let's try some ways to increase the amount of sleep and the quality of sleep we can create for ourselves.

Of course, I'm hoping you will find something in the next four weeks that works for you, but this is by no means an exhaustive list. Follow the links included below for countless more recommendations regarding increasing both the quanitity and quality of sleep you are achieving. As we continue our journey of 12 Months of Wellness, I've chosen four components of healthy sleep habits that I am going to try out in my own life. Follow along and try some out! They might just lead you a little deeper, help you sleep a little longer, or accelerate you drifting off a little sooner. 

Week 1: Bed = Sleep

We tend to use our beds for all kinds of activities other than sleep. We read in bed, watch TV in bed, check emails and social media, play puzzles, eat snacks and get after-hours work done. It is time to protect the bed! (Note that sex is not on the list, so feel free to keep on having sex in your bed).

Associating your bed with sleep is part of training our brains. We want our brain to see the bed and automatically think about sleep. In this way, we are setting ourselves up for sleep right from the first sight. You will find that your brain is already trained to associate other household items with physical responses. Walk into the bathroom and stare at the toilet. I expect that you will notice your bladder pressing on your mind and telling you it is time to pee!

Decide on another place in your home to complete activities that you have been doing in your bed. Make sure you open your computer at the desk or the kitchen table. Turn your phone upside down and complete your scrolling and texting prior to entering the bedroom. What do you do in bed that could be done elsewhere? What items might you move away from your bed or out of the bedroom that will signal your brain that your bed is for sleeping? I myself have coloring books, sodoku and young adult paranormal novels at my bedside, which I will be moving to the bookshelf in the living room.

Need a little convincing? Read this article on why some folks feel wide awake when they lay down to sleep. Or try this article that outlines cognitive-behavioral therapy interventions for improving sleep, starting with the importance of training our brain and body to associate the bed with sleep. 

Week 2: Prepping

Routines, schedule and predictability are part of what make our lives boring, but also efficient. Our brains are always working to make habits and create patterns that will allow us to refocus on more pressing issues. We commonly have a routine for leaving the bed in the morning. Routines such as turning on the light, brushing the teeth, jumping in the shower, brushing the hair and getting dressed. It is time to create or refine the bedtime routine.

This week we will focus on the bedtime routine that already exists in each of our homes. Just as we worked to train our brains in week one to associate the bed with sleeping, now we will work on the associations we create for transitioning to the bed. I encourage you to add at least one component to your bedtime routine and try to stick with it. Let's work on cueing our brains for sleep!

Some ideas to create or add to a bedtime routine are as follows: 

1. Empty your bladder - we have all experienced the pressing bladder that wakes us in the middle of the night. Avoid this distraction by emptying your bladder an hour before you plan to go to bed and then right again before bedtime. To be certain you bladder is as empty as possible, choose not to drink any liquid during the last hour before sleep. If you like, place a full container of water next to your bed to drink first thing in the morning (Consider choosing a container with a lid so you don't accidentally knock it over in the night). Do not take sips in the night if you wake, as you will undermine you determination to create an empty bladder.

2. Light a candle - candles have many benefits in preparing ourselves for sleep. First of all, there are many scented candles you can choose that will include a component of aromatherapy in your night-time routine. Consider choosing lavender or chammomile scents to send a clear message to your brain that it is time to settle down (check out this great article at Develop Good Habits for more tips on improving sleep with a specific focus on essential oils). Candle light also helps create an ambient light that sends a signal to your brain to calm down and rest. The flicker from the candle provides a slow rythm for your body to mimic as it prepares to relax into sleep (check out this article by Canyon Ranch in Tucson that expands on the benefits of candlelight, or this article at Mark's Daily Apple that expands on the impact of blue light versus red light on our sleep patterns). Don't forget to blow the candle out before laying down to bed!

3. Play a soothing and monotonous melody - Music can serve as a wonderful distraction or re-focus for our busy brains. It also provides a rythmn for our body to attend to and sync with. Our bodies have been trained since before we were born to respond to the rythmn of the beating heart. It is natural that we would continue to respond to rythmns throuhgout our lifetime (check out this article on the impact of music on the brain). Choosing a soothing rythmn can help your brain transition from active state to relaxed and restorative state. It can provide a sense of security that allows you to shed the stressors of the day (check out this PsychCentral article that details some of the benefits of music on decreasing stress).

You may have your own music that helps create a calming environment, or you may wish to review some podcasts or YouTube vidoes that have been created for just this purpose. Given everyone's personal preferences when it comes to music, make sure you pick one that feels and sounds right to you!

Calming Music (personal favorite)

Relaxing Music 

Water and Nature

Instrumental 

Spa Music

Nature/Instrumental

Piano

Ocean/Jungle

Rain

4. Meditate/Guided Imagery - we lead busy and full lives and our brains know it! Most of us have had the experience of laying down to bed and not being able to shut off the brain spin. We know we need to sleep, but our mind is racing with thoughts of the day, to-do lists for the next day, problems to resolve and on and on and on. Meditation can be a great way to power-down your brain after a long day of working hard. Since your brain wants to be thinking about something, give it something to focus on that will create a bridge to relaxation and calmness, thereby allowing your brain to transition into sleep. There are so many meditations available, so you may want to click through a few before you find one that works for you! Try listening to some of the following while you are making your choice, or pick several to change it up each night:

UCLA Guided Meditations

The Chopra Center Meditations

Koru Mindfulness

5. Write in your journal - just like evening meditation, journaling can give a direction to our activated brains and allow us to dump all of those spinning thoughts into a constructive and contained place. Journals come in all shapes, colors and sizes, just like their owners. Choosing a journal can be a fun, exciting and very personal experience. There is no right or wrong way to journal. Some people journal in lists. Some journal like a letter. Others journal in prose or poetry. Some journals have lines for neatness and others are completely blank pages. Some people follow the lines and others like to write diagnally across them. Maybe your brain thinks in pictures and you might find yourself wanting to doodle or draw in your journal. Whatever your style or need, you can make great use of journaling by letting go of journal-judgement and letting your pen do some walking across the page. 

Week 3: Sleep Cave

Consider the components of your sleep environment. Scan through your five senses and pay attention to what is affecting each. What is the temperature in your bedroom? How much light exposure is there? How much noise distraction? How comfortable is your bed? What does your room smell like? 

When setting up your idea sleep environment, consider the following components:

1. Darkness/Dim Lighting: Keep the lights low - darkness signals all kinds of changes in our brain. This includes the general signal that it is time to go to sleep, but also that it is time to start the healing process as well as chemical changes such as time to decrease cortisol and increase melatonin production. The Power of Positivity shares some interesting research and insight into how sleeping in darkness can affect our physical and mental health. Start waking up more rested and less stressed by turning down those lights!

2. Temperature: Keep it Cool  - the best temperature for sleep is right around 65 degrees Farenheit. Since our bodies naturally decrease in temperature as we fall into a deeper sleep, we can help this process along by starting the temperature in the room at a lower setting. The National Sleep Foundation shares some ideas about how temperature affects our transition to sleep in this short article.

3. Noise Pollution: Keep it Quiet - noises can startle us during the day, but add even a tiny unexpected noise at night and there are those of us who will jolt out of our sleep. Consider using a white noise machine to act as a consistent background and block out those pesky bumps in the night. Take a look at this article that outlines some research and more detailed infromation on those noises that steal our rest. 

4. Comfortable/Snug: Consider firmness, softness and pressure when thinking about comfortability of your bed. Different folks respond to different levesl of firmness or softness, often depending on their medical needs. Some folks need the extra pressure that a weighted blanket can provide. Weighted blankets can increase production of serotonin, help you get to sleep faster and move into a deeper sleep. Consider this article, at Medical Daily, that discusses Deep Touch Pressure, achieved through weighted blankets. 

5. Scent: There are many smells associated with sleep. Stinky feet and cat poop are not among them. What smells are coming from your bedroom or maybe the bathroom adjoining your bedroom? Do they help or hinder your sleep? You may need to remove some smells, or you may choose to add smells that enhance sleep. Consider this article when including new smells in your bedroom. A linen spray may be just what you need to ease into sleepy-time.

Week 4: Quality over Quantity

Try focusing on relaxation instead of sleep. While we are definately focusing on sleep this month, we all know that there are times when sleep just remains elusive. You may have tried the tips in weeks 1, 2 and 3. You may have tried a whole host of other tips and tricks, but sleep is still evading you. In these moments, we may need to shift our focus away from the pressure of "I need to sleep!"

The pressure we put on ourselves to get to sleep (because we know its healthy for us to sleep and we've read all these articles that remind us) can be the very thing that undermines our ability to fall asleep, as we sink into a worry spiral around not being able to sleep and the resulting struggles we expect to have as a product of lack of sleep. So, let's try taking the pressure off. Perhaps if we are focusing on relaxation, we might trick our brains into shutting down long enough to drift into sleep. 

As we choose to focus on relaxation, this means that we may lay quietly in bed and continue a relaxation exercise over and again, as we find ourselves bored, but calm. Keeping the lights low and the room quiet will continue to produce an environment that allows our body to relax. Focusing our brain on a relaxing activity will keep it occupied and in the direction of powering down. You may eventually bore yourself to sleep. If nothing else, you will be intentionally moving into a deeper and deeper state of relaxation. Try employing a Breathing exercise from February, a Visualization exercise from Week 2 or a Progressive Muscle Relaxation. 

Some of us struggle with falling alseep, while others struggle with remaining asleep. You may find that you wake at midnight each night or around 3am. You still need more sleep, but your brain has woken up and will not return to a restful state. During these times, we want to also focus on relaxation instead of sleep. Employ a relaxation exercise while you remain quiet, still and in your dimly lit room. Do not reach for your phone or computer to "help go back to sleep." Try to use the skills you have been practicing remain calm and turn your mind away from fears about lack of sleep and toward restfulness. If you find that you have worked at this for more than 15 minutes, let yourself get up. Your brain wants to be awake and it may need to be active for a bit before it will give up and return to sleep. Instead of watching a show or scrolling through social media, try grabbing a novel, writing in your journal or pulling out your coloring book. Let yourself engage in a peaceful activity for 30 minutes before trying to return to bed and settle back into deeper relaxation mode. 

End of the Month Thoughts: Struggling with sleep can be so very frustrating. I know that you may have already tried every idea on this list and find that sleep is still hard to come by. My hope is that at least one item might aid in your sleep transition and produce a deeper more productive sleep pattern for you. However, harnessing sleep is not always as easy as a 4 week plan and, for some, it can be a lifelong endeavor to find the right recipe. If you find yourself in need of additional support, consider seeking profesional supports. Find extensive information, referrals and resources at the National Sleep Foundation.

GOOD NIGHT!

Disclaimer: This article is provided for informational purposes and your consideration only. You are not required to engage in any of the ideas presented here. If you are suffering from a sleep disorder, or think you might be suffering from a sleep disorder, please contact your primary care provider. Do not attempt to engage in sleep modifying practices that have not been cleared by your primary care provider. If at any time you find that the practices shared here increase distress in your body or mind, discontinue the practice and check in with your provider for modifications or alternate recommendations.  

Here Comes February 2018!

We made it through the first month of 2018! I hope you found last month's ideas related to creativity inspiring in some way and were able to express some of your creative self, expand some of your previous endeavors or remember old skills. I will be writing a blog every month to provide some direction in continuing to hone and enhance wellness in your life over the remainder of 2018. There are many months left, so let's get going!

February we will be focusing on The Breath. 

You read that right. A whole month devoted to breathing. You  might be surprised how many beneftis come from harnessing something as simple as the air around us. In fact, you are already doing it right now. Moving forward, we will examine ways to further exert our control over the breath. In fact, there are so many breathing exercises available, you will find that one month is not nearly long enough!

Belisa Vranich, author of the book, "Breathe," asserts that breathing exercises are "massively practical." You can read a New York Times article in which research (printed in the August 2017 edition of BMC Complementary and Alternative Medicine) on the benefits of breathing is referenced, as well as some ideas for practicing easy breathing exerices. The article first references Coherent Breathing, which is very similar to what we will review in Week 1. 

You might be surprised to know that practicing a breathing exercise daily will reduce your stress levels enough to produce measurable effects in blood pressure, immune system response, heart rate, metabolism, circulation and detoxification. 

Week 1:

Simple Breathing - Start this exercise by finding a quiet place to sit or lay down on your back. If sitting, rest your back against the chair back. Rest your hands in your lap, or down at your side. Place your feet flat on the floor, or allow your feet to fall softly outward, if laying down.

Since you have been breathing all along, this exercise is meant to draw attention to your ongoing breathing.

*Pay attention to your breathe.

*Notice how it is filling your lungs and exiting your lungs.

*Be mindful of how your body responds to being filled with air, such as your shoulders lifting or your belly feeling full.

*Start exerting some control over your breathe by drawing a slower and deeper breathe with each inhale. 

*Exert control over your exhale by breathing slowly and evenly

*Notice that your breathe begins to find a rythmn that coincides with your efforts to create a slow, deep and even breathing pattern

Do this simple breathing exerise for two minutes. Most people breathe between 15-25 times in a minute. You will find that by slowing your breathes you will begin to take between 5-10 breathes per minute. Two minutes of breathing will allow you to take the minimum breathes necessary to create an impact on your mental well-being. 

Week 2:

The American Institute of Stress has created some relaxation techniques and has some wonderful resources available on their website. This week, try one of their certified techniques called "Quieting Response"

"Quieting Response– utilizes visualization and deep breathing (a powerful combination) to stop an acute stress response in its tracks. The entire exercise only takes 6 seconds! First “smile inwardly” with your eyes and mouth and release the tension in your shoulders. This is a powerful muscle release in the places where most people hold their muscles tense. Then imagine holes in the soles of your feet. As you take a deep breath in, visualize hot air flowing through these holes moving slowly up your legs, through your abdomen and filling your lungs. Relax your muscles sequentially as the hot air moves through them up your body. When you exhale reverse the visualization so you “see” hot air coming out the same holes in your feet. Repeat throughout the day whenever you need to feel calm and relaxed."

Week 3:

Peace Breathing - much like valuing the use of visualization, we can also harness the power infused in words. Hearing the words, peace, calm or relax can tune our mind to the desired results and produce an intention that creates a sense of peacefulness or calmness. In this exercise, you will start with the Simple Breathing from week one and add words to each inhale and exhale. 

As you breathe in, you will say to yourself one word that sets your intention for relaxation. This can be "Peace", "Calm", "Relax" or any other word that produces an increased sense of relaxation. The word will take on life as you visualize the breathe being infused with peacefulness and spreading throughout your body, starting at your core and seeping through every limb, out toward your fingertips and toes. 

As you breathe out, you will two words that focus your mind on stress leaving your body. These words can be "Stress Leaving," "Worries Leaving," "Fear Releasing," or any other combination of words that signifies to your brain that you are controlling the flow of your stress. As the breathe leaves your body, so will the stress, worry, nervousness, fear and concern. You will feel it blow out of you with every exhale and float away with the wind. 

Continue for two to five minutes of Simple Breathing, as you use both imagery and words to infuse your body with calmness and expell the tension from your body. 

“I know nothing in the world that has as much power as a word. Sometimes I write one, and I look at it until it begins to shine.” Emily Dickinson

Week 4:

Child Breathing Techniques - children can easily get bored with exercises that are meant to help them feel calm and relaxed, but so can adults! Whether you are using these techniques for yourself, or teaching them to your children, you may find that putting a creative spin on a breathing exericse can re-direct your mind and allow for the exercise to be more effective. Take a look at these 8 breathing exercises designed with children in mind. Christie Burnett, of Childhood 101, shares some of her wisdom as an educator and presenter and even makes them printer-friendly! This week, let's focus on what she calls Bumble Bee Breathing. You will find that this is also called Bhramari Pranayama Breathing and can read a great article about it here.

Bee Breathing - Start by sitting up straight and tall in a quiet place. Close your eyes to decrease distractions and encourage your mind to focus on your breathing exercise.

*Place the index finger of each hand in each ear and press very lightly on the cartilage (not into the ear canal).

*Take a deep breathe inward (do not hold it)

*As you exhale, keep your mouth closed and begin to hum (or buzz like a bee!)

Continue this pattern for 2 minutes as you reap the benefits of creating a distraction for the mind, drowning out the endless anxiety-chatter that can produce our stress to begin with and engage in mindful and focused breathes that have a positive impact on your physical and mental well-being. 

Beyond February: There are so many different versions of breathing techniques. You can  use the Simple Breathing to build with imagery, words, counting and body movements. I'm posting one more bonus link below and for more breathing exercises, please visit my FaceBook for links to various articles. Happy Breathing!

Feel free to visit the following website for instructions and ideas related to counting your breathes. 

BONUS: For my friends with Attention Deficits, you will likely find yourself bored, distracted or mentally wandering before you are halfway through some of these exercises. Try starting your breathing exercise in the most simplisitc manner (See Week 1) and then add another component at breathe 4 or 5. My favorite is to do the Simple Breathe until breathe 5 and then start "Breathing Colors." Choose the color that means calmness to you and visualize that color filling your body as you breathe in (I like blue or purple). Choose a color that means stress to you and visualize that color leaving your body as your exhale (I usually choose red or black). Visualize the places in which the stressful color is stuck and pull it out of you with your exhale. Make sure you fill those places with the calming color as you take your next inhale. Happy Breathing!

Disclaimer: This article is provided for informational purposes and your consideration only. You are not required to engage in any of the ideas presented here. If at any time you find yourself becoming light-headed, stop immediately. You can attempt the breathing exercise at a later time, but should not continue if it is producing light-headedness. You may also choose to discuss light-headedness with your primary care provider or practice the breathing exercise with a provider, instead of attempting on your own. 

Welcome to 2018!

This year I am writing a series of blogs related to creating wellness in a variety of ways in your life. By no means do I think that wellness is as simple as a short blog once a month. However, I am hopeful that the ideas shared each month might provoke you to make small and meaningful changes in your life. I am also hopeful that these changes, spread out over a year, may lead to increased health and wellness for you in an effective and sustainable manner. 

January will be our month to focus on:

Creativity

Each person reading this will likely find a different way of expressing their creative selves. I encourage you to consider ways in which you have been creative in the past and ways that you might like to try out new creative expression. You might choose to pull out the paints and work on a painting for 30 minutes each week. Maybe you are able to finish one painting each week and will have four paintings by the end of the month. Maybe you will try something different each week. It's up to you! For inspiration, please consider the following possibilities for creative expression: 

Week 1: Creative Expression via Music

You do not have to be a musician to creatively express yourself via music. You might choose to make a playlist of songs that inspires you to feel more relaxed, more joyful, more motivated or just generally distracts you. Maybe you are able to attend a live performance to experience the creativity of music. Many coffee shops or local venues have free and low cost performances. Maybe you have been wishing to identify yourself as a musician and now is the time to pick up a new instrument or practice your singing or song-writing. Speaking of singing, only you can decide if you are musical in this way. Perhaps your shower-ballads are just the thing to incorporate more of this week. 

If you are a musician, but have not played in a while, dig out that instrument from the closet or the garage and play some notes. Remind yourself how good it feels to create and express yourself. If you are a musician that already regularly plays, pull out your instrument and play something just for fun. Play something that speaks just to you or play something from long ago that has positively associated memories. If your instrument is your voice, you may choose to write a song, sing a new song, or sing an old set of favorite songs. Spend time with your music this week, even if only for 30 minutes, to check in with the creativity you experience through sound and song.

Week 2: Creative Expression via Art

With the advent of adult coloring books, there are so many new and easy ways to engage your artistic proclivities. There are detailed adult colroing books, wide-spaced adult coloring books and all manner of designs. Being creative this month is much more about self-expression than being "good at it." So, let yourself scribble, draw stick figures, or color outside the lines. 

You may have a particular artistic medium that calls to you. Consider exploring drawing, painting or coloring. Consider all types of artistic tools, such as chalk, acrylic, water color, pencil, marker or crayon. I recently found a set of sparkle markers that are just wonderful for coloring. You may choose to leave behind paper medium altogether and set yourself to graphic designs, wielding a stylus, your finger or a mouse pad. Consider all types of art subjects, such as abstract, shapes and swirls, people or landscapes. You may choose to doodle your next tattoo or maybe your friend's next tatoo. Perhaps there is a wall in your home that needs a mural. There is no artistic expression too small or too large to satisfy this month's endeavor.

Consider that art includes photographic representations. Try your hand at black and white photography. Try photographing items at very close range to capture the small details of life. Try photographing people, nature, animals or items.

Finally, consider that the written word is also a form of art. Maybe you haven't written poetry since high school, or maybe you've never tried writing poetry, but now is the time. Perhaps it's time to purchase a journal, or pull out the one you had been meaning to work on. Writing can be nonsensical, one-word, lists of words, letters to an unknown or stories. Stories can be short, comical, fictional, non-fictional and more. Let your mind wander and write whatever comes to you. For inspiration, review the following list of ideas: Daring to Live Fully: Journal Promtps. 

Do not put pressure on yourself to have a finished product, but just to allow yourself to experience creation. This month you are setting yourself to the task of creative expression and the only goal is just to begin. If you snap one photo, draw one line or write one word, you have been successful.

Week 3: Creative Expression via Movement

Our bodies love to move. One reason our bodies love movement is the positive effects on mental health. The following article outlines the effects of movement related to decreased anxiety and depression as well as increased self-esteem (Harvard Health: How Simply Moving Benefits your Mental Health). Some people's bodies love to move more than others. Some people's brains would love their bodies to move, but physical barriers make movement difficult. Remember to attend to your own level of ability, including medical indications for movement and include as much or as little movement in this month as possible.

There are so many ways we can move our bodies. You might have fun dancing. This would be my own favorite form of movement and I have found that there is so much variety in dance. What excites or engages one person will certainly not speak to another. Try out couples dancing, such as tango, two-step, waltz or swing. There is solo dancing, such as hip hop, ballet, jazz, modern or line dancing. You can free-style dance in the club or in your own home. Turn on pandora, shake your groove thing in the living room kind of dancing. Turn up the radio, wiggle in your seat, bob your head in the car kind of dancing. Whatever moves you, whether it is to song, beats, spoken word or silence, move that body!

Dance may not be the movement that inspires you. Maybe you enjoy yoga. Just as with dance, there are so many types of yoga to choose from. You can choose a grounding yoga or an invigorating yoga. You can choose to engage in yoga at home on your own or with a youtube video. You can join a class that is upbeat and fast paced or slow, focused and meditative. You can do muscle-building yoga or restorative yoga. For every personality and need, there is a yoga. If you have physical limitations, there are ways to modify yoga - just ask your teacher! If you are not connected to a studio or class, consider the following article that relates to pose modification and listening to your body (Yoga District: Be Safe in the Wild World of Yoga: Modifying for Injury/Conditions and Knowing When NOT to listen to Your Yoga Teacher.) If you choose yoga this month, consider trying a new style or returning to one that has worked for you before. Either way, move that body!

At this point, maybe you are thinking, "I'm not a yogi and I do not dance." Perhaps you have considered the martial arts? I myself have not explored martial arts in great detail, but I am aware of the many benefits related to body movement and control as well as meditative and mindfulness to be gained from the practice of martial arts. Of course, as I have already noted, there is variety within each area of interest. Martial Arts is no different! From Tai Chi and Kung Fu to Jui Jitsu and Karate, you can find a practice that will inspire movement and engagement. While you can certainly sign up for one-on-one instruction or join a dojo or take a class, you can also watch YouTube videos at home and get a taste of whatever you might like to try. Consider the following recommendations for choosing which practice might be right for you: WikiHow: Choose-a-Martial-Art.  

Whatever your choice is, remember to move that body!

Week 4: Creative Expression via Craft

Some people hear the word craft and think of preschool arts and crafts projects with paper and glue. If this speaks to you, then go for it! However, keep in mind that craft can mean so many different things! You may enjoy wood working activities. If you haven't tried working with wood, it can be very satisying to take a block and turn it into something fun or useful. If this level of wood working isn't for you (maybe you don't have the tools required), your local craft supply store has a variety of wooden objects ready to be sanded, painted or decorated.

You may find yourself inclined toward textiles, such as quilting, crocheting or knitting. In terms of cost, this craft is a little easier on the budget. Purchasing a crochet needle and some yarn does not have to be a huge investment. The libarary and the interent are also full of books and articles ready to help you learn the trade from the beginning or hone your skill with a new stitch. If you choose to puruse this type of craft, consider making something for yourself or a friend/family member. You might also make something decorative to remind yourself of your creative endeavors this month.

Other people may find themselves more crafty in the kitchen. You can try your hand at crafting a new recipe or making personal care items, such as, lip balms, lotions or bath salts and scrubs. There are many easy recipes available that take as little as 3 ingredients, a microwave and 10 minutes. My go-to craft right now is lip balm. I found some small containers at the dollar store and set to melting the ingredients any evening that I need a little creative boost. About 1 cup of ingredients can make 10 pots of lip balm. Great for putting one in each coat pocket, one in my purse, one on the sink, one at the office and a few left over to hand out to friends.

Craft ideas are really endless. Take a trip to your local craft supply store and you will see aisles and aisles of options. You might choose to make some new home or office decorations. You might decide to make some new jewelry or re-purpose some old jewelry into new items. Jewelry can be made from twine, fibers, chain, stones, beads and more. You might choose to try your hand at clay work, pottery or figurines. These are great ways to create something that will remind you of your endeavors this month.

A final note about creativity:

You may not have found something on the lists this month that speaks to you. This is by no means an exhaustive list of all creative opportunities and options. If you have thought of another creative outlet, please share in the comments! I would love to hear from you! I do hope that you have found at least one creative outlet this month to speak to that part of ourselves that benefits from self-expression. Please feel free to share your experiences in the comments!

Disclaimer:  This article is provided for informational purposes and your consideration only. You are not required to engage in any of the ideas presented here.

Grief can put us on the outside, looking in; stuck in a monochrome world of grays.
From the outside, the holidays appear joyful, life-giving and full of family and friends. Many people experience the holidays just as they appear. For others, that joyfulness is witnessed, not experienced.

The holidays increase the intensity of grief via reminders of our loved ones or reminders of holidays gone by that were different, better. Our communities continue to celebrate with little acknowledgement of who and what is missing for us. Finding ourselves in the position of observer, the heightened focus on joy and happiness produces an opposite emotional experience for the outsider. While grief will require of us an enormous amount of energy to function in day-to-day activities, holiday grief requires so much more effort.
An added struggle is the lack of understanding around the needs of grieving people at the holidays. There is an expectation that grieving people will continue on in the same manner they have done in prior years. This expectation can be experienced from family members, friends and the community. However, this expectation is also internalized. We often put expectations on ourselves related to holiday celebrations and fight our bodies natural desire to grief our loss. 

Whether it is your first holiday season or your tenth, you may find yourself feeling like you are on the outside looking in. You may need something extra at this holiday season. if you are feeling the intensity of your grief more acutely this time of year, if you are wishing there was a fast-forward button for the holiday seasons, consider softening the experience by focusing on permission-giving. 

Give yourself permission to grieve more fully, more acutely. You may want to punch me for saying that. You may be saying, "I don't need permission, grief takes me when it wants to." This is absolutely true. Grief will have its way in the middle of the night, first thing in the morning, in the middle of an important meeting or when we are stopped at a red light. Riding the waves of grief is exhausting, but is a skill that is slowly learned through the years of experiencing grief in its varying forms. When we refuse grief, push it down, turn the other way, attempt to block the waves, it will only continue to come, but we will be more exahusted for the effort of fighting it. 

So, let the grief come. Let it come with its re-newed holiday sharpness. Let it come with its surprise attack. Let it come as it washes over and around us, filling our eyes, ears and nose, as it drowns out holiday joy. 

Let us use our energy to weather the storm. Let us use our energy to brave the endless tears and deep sobs. Let us use our energy to feel the aching of our losses. Let use our energy to resist thoughts like, "I should be happy this time of year." 

Let us give ourselves permission to: 

1. Cry as much and as often as we need
2. Not go to the party
3. Not put out the decorations
4. Only put out some of the decorations
5. Not plan a big dinner
6. Not go to the service
7. Try a new tradition
8. Skip an old tradition
9. Set out an empty plate or chair
10. Sit at home and comfort ourselves

Whatever you decide to do or not to do, give yourself permission to not judge yourself for your need. And, since we still need to function at the holidays, do not leave out #10. Comforting ourselves is invaluable as we try to wade through daily routines and holiday expectations. Consider some of the following comforts as you put one foot in front of the other and make it to Spring. 

1. Take a hot bath
2. Soak your feet 
3. Light a candle (preferrable lavendar or peppermint for calming properties)
4. Mindfully lotion your feet/hands
5. Purposefully meditate or pray
6. Wrap up in a soft, warm blanket
7. Have a hot drink, like hot chocolate, cider or tea
8. Observe nature
9. Take a short walk
10. Start a small project that you can easily finish (clean a drawer, make a small craft, fix something that's broken, etc)

I am certain that these lists are only a fraction of the ideas you can come up with, as you allow you mind to wander over what specifically feels comforting and caregiving to you. Choose something small and do-able because we both know there is not much more energy left to give this time of year. 

Web-Based Psychotherapy is a great option for many people seeking mental health services in rural communities, like those around Flagstaff, AZ, or folks with limited ability to leave their homes. I have recently found that it is also a wonderful way to survive the occasional snow storm. 

Practicing in mental health for over a decade in a community that enjoys snowy winters means that there are days when both client and thearpist have a hard time leaving the house to get to the office. The snow may be clogging up the visibility on the roads, it may be making the roads themselves impassable, or it may have lead to closing of schools. Even if the roads are technically drive-able, some clients may feel safer staying at home during the snowfall. 

This year I have been fortunate to team up with WeCounsel to provide web-based services to folks living outside a comfortable driving distance to my office. As the winter continues to bring forth the snow, I have found that even clients living within the city or county limits, who would regularly drive in for session, are able to benefit from the WeCounsel platform. Since the first snow of the season, I have signed up most clients in my practice as a precautionary measure, in case of snow storm. 

Now, when the weather station is calling for snowfall and the schools are threatening to close, my clients don't have to worry about missing a session. They can log in from a comfortable, private and warm spot in their own home. With everything else that is shutting down on snow days, there is no reason to have to miss out on therapy!

I recently had the opportunity to speak at the NARBHA 50th Anniversary Conference for Health and Well-Being. It was a humbling honor to be asked to be a voice for the LGBTQ Community of Northern Arizona and not one I take lightly. I chose to use my limited time and opportunity to focus on the needs of LGBTQ Youth and the impact of bullying behaviors, particularly as it increases risk of suicidality in an already very vulnerable population. Below are eight ideas of how to increase safety for the LGBTQ youth in your own community. This is by no means an exhaustive list, but should be seen as a place to start making positive interventions and changes throughout agencies. Where you take it from there is up to you and your own advocacy endeavors as I encourage each of you to be embassadors for change, health and well-being. 

1. Send a message to all clients that you/your agency are/is inclusive by changing forms to be reflective of gender non-conformity and gender transition options

2. Send a message to all clients that you/your agency are/is inclusive by making LGBTQ lives visible in posters, art and signage throughout hallways, lobbies and offices

3. Be an advocate and an educator with colleagues and staff for inclusive and supportive use of language when discussing client needs/concerns and when interacting with clients

4. Do not tolerate abusive or derogatory statements made to or about LGBTQ youth by regularly redirecting colleagues and staff

5. Be mindful of lobby and hallway conversations that could be abusive or offensive - be aware and be present. Physically stand with LGBTQ youth to send a message that you support them and will not tolerate abuse toward them.

6. Be an Educator in your community, at schools, at community centers, at places of religious and spiritual gathering and any other venue in which human gather and therefore may experience bullying. 

7. Teach, build and encourage skills related to self-worth, assertiveness and advocacy to your clients. Do NOT blame the victims. DO help build resiliency and an ability to surivive and thrive. 

8. Recognize that bullying breeds symptoms of depression and anxiety and can be experienced as trauma. Intervene within your scope of practice and make referrals where necessary.