Tag Archives: handouts

Grounding

19 Thursday Dec 2019

Posted by in grounding, Handout, Health, mental health, Psychoeducation, Therapy

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Grounding Techniques are activities you use when you feel overwhelmed by feelings, thoughts, sensations. These techniques help a person move their focus away from what is overwhelming them to something else. That something else is preferable healthy and supportive to their wellbeing. Below is a list that clients and patients have mentioned over the years of things they do that help them ground.

  • Get ice or ice water
  • Breathe – slow and deep, like blowing up a balloon.
  • Take your shoes off and rub your feet on the ground.
  • Open your eyes and look around. See yourself in a different place than.
  • Move around. Feel your body. Stretch out your arms, hands, fingers.
  • Peel an orange or a lemon. Notice the smell. Take a bite. Focus on the taste.
  • Pet your cat, dog or rabbit.
  • Spray yourself with favorite perfume.
  • Eat ice cream! Or any favorite food. Pay attention to the taste.
  • Call a friend.
  • Take a shower.
  • Take a bath.
  • Go for a walk. Feel the sunshine (or rain, or snow!)
  • Count nice things.
  • Dig in the dirt in your garden.
  • Turn lights on.
  • Play your favorite music.
  • Hug a tree!
  • Touch things around you.
  • Frozen Orange – put your nails into it – the cold and the smell can bring you back
  • Pull up the daily newspaper on your browser. Notice the date and read a current article.
  • Stomp your feet to remind yourself where you are. Press your feet firmly into the ground.
  • Try to notice where you are, your surroundings including people, sounds like the t.v. or radio.
  • Concentrate on your breathing. Take a deep cleansing breath from your diaphragm. Count the breaths as you exhale. Make sure you breath slowly so you don’t hyperventilate.
  • Cross your legs and arms. Feel the sensations of you controlling your body.
  • Call a friend and ask them to talk with you about something you have recently done together.
  • Take a warm relaxing bubble bath or a warm shower. Feel the water touching your body.
  • Mentally remind yourself that the memory was then, and it is over. Give yourself permission to not think about it right now.
  • Realize that no matter how small you feel, you are an adult.
  • Go outside and sit against a tree. Feel the bark pressing against your body. Smell the outside aromas like the grass and the leaves. Run your fingers through the grass.
  • If you are sitting, stand. If you are standing sit. Pay attention to the movement change. Reminding yourself — you are in control.
  • Rub your palms, clap your hands. Listen to the sounds. Feel the sensation.
  • Speak out loud. Say your name or significant others name.
  • Hold something that you find comforting, for some it may be a stuffed animal or a blanket. Notice how it feels in your hands. Is it hard or soft?
  • Eat something. How does it taste, sweet or sour? Is it warm or cold?
  • If you have a pet use that moment to touch them. Feel their fur and speak the animals name out loud.
  • Visualize a bright red STOP sign to help you stop the flashback and/or memory
  • Step outside. If it’s warm, feel the sun shining down on your face. If it’s cold, feel the breeze. How does it make your body feel?
  • Take a walk outside and notice your neighborhood. Pay attention to houses and count them.
  • Listen to familiar music and sing along to it. Dance to it.
  • Write in your journal. Pay attention to yourself holding the pencil. Write about what you are remembering and visualize the memory traveling out of you into the pencil and onto the paper. Tear the paper up or seal it in an envelope. Give it to your therapist for safekeeping.
  • Go online and talk with an online friend. Write an email.
  • Imagine yourself in a safe place. Feel the safety and know it.
  • Watch a favorite t.v. program or video. Play a video game.
  • If you have a garden, work in it. Feel your hands running through the dirt.
  • Wash dishes or clean your house.
  • Meditate if you are comfortable with it.
  • Exercise. Ride a bike, stationary or otherwise. Lift weights. Do jumping jacks.

Honesty

30 Wednesday Oct 2019

Posted by in Handout, Honesty

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This is one of the handouts I use with groups when we talk about honesty.

  1. Figure out why you lie and who you lie to. We’ve all lied at one time or another, to different people, to ourselves, and for different reasons. But coming up with a systematic plan for becoming more honest will be difficult unless you try to define those reasons and those people for yourself.
    • Lies to make ourselves look better might include exaggerations, embellishments, and flat-out tall-tales we tell to others, and ourselves, to make ourselves feel better about our inadequacies. When you’re unhappy about something, it’s much easier to fill it in with lies than tell the truth.
    • We lie to peers we think are better than us, because we want them to respect us as we respect them. Unfortunately, being dishonest is disrespectful in the long run. Give people more credit for their ability to empathize and understand you on a deeper level.
    • Lies that avoid embarrassment might include lies told to cover up bad behaviors, transgressions, or any activity we’re not proud of. If your mom found a pack of cigarettes in your jacket, you might lie and say that they’re your friend’s to avoid punishment.
    • We lie to authoritative figures to avoid embarrassment and punishment, including ourselves. When we’ve done something we feel guilty about, lies are told to eliminate the guilt, avoid the punishments, and get back to the objectionable behavior we’re forced to lie about. It’s a vicious cycle.
  1. Anticipate behaviors that will make you feel guilty. To break the chain of embarrassment and lying, it’s important to learn to anticipate things that you’ll likely feel guilty about in the future, and avoid those behaviors. When you lie, you’re covering up some uncomfortable truth that’s more easily couched in a lie. You can either get comfortable with the truth, or abandon the behavior that makes you embarrassed.
    • If you smoke cigarettes, you won’t have to lie if everyone knows it’s true. Own up to it. If a behavior is un-own-upable, it’s probably best to avoid it. It would be humiliating for your wife to find out that you had an inappropriate relationship with a coworker, but you won’t have to lie if you don’t do it.
  1. Avoid situations in which you’ll have to lie for others. Be wary when someone tells you something in confidence that you know that you should share with someone else (e.g., knowledge of a crime, a lie, or a harmful act against another). Hearing such information puts you in a difficult position, especially when the truth eventually emerges and reveals to the affected person that you knew all along.
    • If someone begins a sentence with “Don’t tell so-and-so about this, okay?” be prepared to offer your own disclaimer: “If it’s something that I’d want to know about were I them, then please don’t tell me. I don’t want to be responsible for anyone’s secrets but my own.”

Thinking influences

28 Tuesday May 2019

Posted by in Anger, Handout, Uncategorized

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Thinking influences our feelings through the things that we say to ourselves. Unhelpful thoughts can add fuel to the fire and play a large role in keeping anger going after the event has passed. However, using helpful self-statements (or ‘cooling thoughts’) can be a good way to manage our anger and guide our behavior. brainmpExamples of these include:

  • Chill out
  • Calm down
  • Breathe away the anger
  • Don’t yell
  • Don’t give them the satisfaction of seeing you angry
  • It’s not worth it
  • Give them a chance to have a say

 To use this strategy we need to break anger into several stages:

  • Getting ready for provocation: when we know we are going to face something that will make us angry.
  • During the event: early signs of anger are cues to use coping strategies.
  • Coping with stress: early attempts at anger management may not be successful.
  • Reflecting on provocation: time to evaluate the effect of the experience on you, continue coping or give self praise.

feelings-07.jpg

Preparing for a provoking situations

  • This is going to upset me but I know how to deal with it
  • What is it that I have to do?
  • Stick to the issues and don’t take it personally
  • Try not to take this too seriously
  • Time for a few deep breaths of relaxation
  • Easy does it, remember to keep your sense of humor

During the event

  • Stay calm, just continue to relax
  • Think of what you want to get out of this
  • There is no point in getting mad
  • It’s really a shame that she has to act like this
  • If I start to get mad I’ll just be banging my head against the wall
  • What he says doesn’t matter. I’m on top of this situation and it’s under control

Coping with stress

  • My muscles are starting to feel tight, time to relax and slow things down
  • It’s just not worth it to get so angry
  • Time to take a deep breath
  • Try to reason it out. Treat each other with respect
  • He’d probably like me to get really angry. Well I’m going to disappoint him Leaving the anger and looking back
  • Try to shake it off. Don’t let it interfere with your job
  • Remember relaxation, it’s a lot better than anger
  • I handled that pretty well. It worked!
  • It could have been a lot worse
  • My pride can sure get me into trouble, but when I don’t take things too seriously, I’m better off

Evidence based Yoga 2

08 Wednesday May 2019

Posted by in Health, Wellness, Yoga

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Yoga is a mind and body practice in complementary medicine with origins in ancient Indian philosophy. Part two of evidence based Yoga:

Carpal tunnel syndrome A randomized, single-blind controlled trial of 42 patients with carpal tunnel syndrome assigned subjects to either a yoga treatment group or a wrist splint group, each 8 weeks in duration. Twice a week, the yoga group practiced postures specifically designed to strengthen and stretch each joint in the upper body. Yoga participants showed improvement in grip strength, pain levels, and Phalen’s sign when compared to the wrist splint group. Nerve conduction studies were not performed.15 A Cochrane review of 21 trials that evaluated the clinical outcome of nonsurgical treatment of carpal tunnel syndrome reported that 8 weeks of yoga practice significantly reduced pain as compared to wrist splinting. The yoga was described as having a “significant short-term benefit,” though the duration of this benefit is unknown.16

Depression A 2004 review of five RCTs that evaluated yoga-based interventions for depression and depressive disorders showed some positive outcomes and no adverse effects on patients’ mild to severe depressive disorders. However, poor study design and incomplete methodologic reporting makes this interpretation preliminary.17 An RCT studying 7 weeks of yoga training in a group of breast cancer survivors showed positive changes in emotional function, depression, and mood disturbance.18 “Yoga and stress management” (in the online version of this article) provides more information on this study and others involving the effects of yoga on stress.

Irritable bowel syndrome In an RCT, treatment with loperamide (Imodium) was compared to treatment with a series of 12 yoga postures practiced twice a day for 2 months in a small sample of patients with clinically diagnosed irritable bowel syndrome. Patients underwent measurement of surface electrogastrography, and trait and state anxiety tests were administered before, during, and up to 2 months after treatment. Both intervention groups demonstrated a decrease in bowel symptoms and state anxiety.19

Menopausal symptoms In a recent pilot study, 14 postmenopausal women reported via interview and questionnaire a decrease in the severity and frequency of hot flushes after 8 weeks of 90-minute “restorative yoga” classes. Although this initial finding sounds encouraging, this trial had no control group or objective parameter measurements.20 An RCT studying postmenopausal sleep quality divided 164 women into groups who participated in either 4 months of low-intensity yoga, a moderate-intensity walking program, or a wait-list control group. This study reported no statistically significant interventional effects of any treatment on total sleep quality or on any individual sleep quality domain.21

Multiple sclerosis An RCT of 57 subjects with clinically defined multiple sclerosis were assigned to weekly Iyengar yoga class plus home practice, a cycling program, or a wait-list control group for 6 months. Results showed that both active interventions produced significant improvement in perceived levels of energy and reduced fatigue; however, the specific effects of the yoga practice were not isolated.22 Osteoarthritis In a pilot study, 11 deconditioned, yoga naive subjects with a clinical diagnosis of knee osteoarthritis showed improvements in pain and knee stiffness after 8 weeks of yoga training. The group performed modified Iyengar yoga sessions once a week.23

 

Seizure disorders In 2000, a systematic review of the published literature revealed that only one study was able to meet the selection criteria for reliable research design. The reviewers concluded that no available evidence pointed to yoga therapy as an efficacious treatment for epilepsy.24

Strength and flexibility In a recent study on the fitness related effects of hatha yoga, 10 yoga-naïve and previously untrained subjects aged 18 to 27 years participated in 85 minutes of pranayama and hatha yoga practice twice a week for 8 weeks. These subjects showed significant improvement in upper and lower body muscular strength, endurance, and flexibility. No statistically significant change in body composition or pulmonary function was observed.13
In a partial RCT with a longer time frame, 54 subjects aged 20 to 25 years participated in either 5 months of yoga instruction or no activity. After that time period, both groups practiced yoga for an additional 5 months. The group practicing 10 months of yoga showed significant improvements in shoulder, trunk, hip, and neck flexibility, as well as a reported improved performance during submaximal exercise testing.25
A well-executed study compared subjects who underwent 24 hours of hatha yoga classes over 8 weeks with a control group. The yoga training group showed a 13% to 35% improvement in flexibility, balance, and muscular endurance. The authors concluded that hatha yoga practice has significant effects on balance and flexibility.26

 

REFERENCES

1. Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005;11(1):42-49.
2. Carrico M. Yoga Journal’s Yoga Basics: The Essential Beginner’s Guide to Yoga for a Lifetime of Health and Fitness. New York, NY: Henry Holt and Company; 1997.
3. Nayak NN, Shankar K. Yoga: a therapeutic approach. Phys Med Rehabil Clin N Am. 2004;15(4): 783-798, vi.
4. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a systematic review. J Am Board Fam Pract. 2005;18(6):491-519.
5. Raub JA. Psychophysiologic effects of Hatha yoga on musculoskeletal and cardiopulmonary function: a literature review. J Altern Complement Med. 2002;8(6):797-812.
6. Luskin FM, Newell KA, Griffith M, et al. A review of mind-body therapies in the treatment of musculoskeletal disorders with implications for the elderly. Altern Ther Health Med. 2000;6(2): 46-56.
7. Jensen PS, Kenny DT. The effects of yoga on the attention and behavior of boys with attentiondeficit/ hyperactivity disorder (ADHD). J Atten Disord. 2004;7(4):205-216.
8. Kirkwood G, Rampes H, Tuffrey V, et al. Yoga for anxiety: a systematic review of the research evidence. Br J Sports Med. 2005;39(12):884-891.
9. Krisanaprakornkit T, Krisanaprakornkit W, Piyavhatkul N, Laopaiboon M. Meditation therapy for anxiety disorders. Cochrane Database Syst Rev. 2006;(1):CD004998.
10. Sabina AB, Williams AL, Wall HK, et al. Yoga intervention for adults with mild-to-moderate asthma: a pilot study. Ann Allergy Asthma Immunol. 2005;94(5):543-548.
11. Vendanthan PK, Kesavalu LN, Murthy KC, et al. Clinical study of yoga techniques in university students with asthma: a controlled study. Allergy Asthma Proc. 1998;19(1):3-9.
12. Sherman KJ, Cherkin DC, Erro J, et al. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2005;143(12):849-856.
13. Tran MD, Holly RG, Lashbrook J, Amsterdam EA. Effects of Hatha yoga practice on the healthrelated aspects of physical fitness. Prev Cardiol. 2001;4(4):165-170.
14. Clay CC, Lloyd LK, Walker JL, et al. The metabolic cost of Hatha yoga. J Strength Cond Res. 2005;19(3):604-610.
15. Garfinkel MS, Singhal A, Katz WA, et al. Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA. 1998;280(18):1601-1603.
16. O’Connor D, Marshall S, Massy-Westropp N. Nonsurgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003(1):CD003219.
17. Pilkington K, Kirkwood G, Rampes H, Richardson J. Yoga for depression: the research evidence. J Affect Disord. 2005;89(1-3):13-24.
18. Culos-Reed SN, Carlson LE, Daroux LM, Hately-Aldous S. A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Psycho Oncol. 2006;15(10):891-897.
19. Taneja I, Deepak KK, Poojary G, et al. Yogic versus conventional treatment in diarrheapredominant irritable bowel syndrome: a randomized control study. Appl Psychophysiol Biofeedback. 2004;29(1):19-33.
20. Cohen BE, Kanaya AM, Macer JL, et al. Feasibility and acceptability of restorative yoga for treatment of hot flushes: a pilot trial. Maturitas. 2007;56(2):198-204.
21. Elavsky S, McAuley E. Lack of perceived sleep improvement after 4-month structured exercise programs. Menopause. 2007;14(3, pt 1):535-540.
22. Oken BS, Kishiyama S, Zajdel D, et al. Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology. 2004;62(11):2058-2064.
23. Kolasinski SL, Garfinkel M, Tsai AG, et al. Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot study. J Altern Complement Med. 2005;11(4):689-693.
24. Ramaratnam S, Sridharan K. Yoga for epilepsy. Cochrane Database Syst Rev. 2000(3):CD001524.
25. Ray US, Mukhopadhyaya S, Purkayastha SS, et al. Effect of yogic exercises on physical and mental health of young fellowship course trainees. Indian J Physiol Pharmacol. 2001;45(1):37-53.
26. Boehde D, Porcari JP, Greany J, et al. The physiological effects of 8 weeks of yoga training. J Cardiopulm Rehabil. 2005;25(5):290.

Honesty handout

16 Tuesday Apr 2019

Posted by in Handout, Honesty, Uncategorized

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This is a handout I use for groups that tend to be dishonest. 
  1. Figure out why you lie and who you lie to. We’ve all lied at one time or another, to different people, to ourselves, and for different reasons. But coming up with a systematic plan for becoming more honest will be difficult unless you try to define those reasons and those people for yourself.Transformation.jpg
    • Lies to make ourselves look better might include exaggerations, embellishments, and flat-out tall-tales we tell to others, and ourselves, to make ourselves feel better about our inadequacies. When you’re unhappy about something, it’s much easier to fill it in with lies than tell the truth.
    • We lie to peers we think are better than us, because we want them to respect us as we respect them. Unfortunately, being dishonest is disrespectful in the long run. Give people more credit for their ability to empathize and understand you on a deeper level.
    • Lies that avoid embarrassment might include lies told to cover up bad behaviors, transgressions, or any activity we’re not proud of. If your mom found a pack of cigarettes in your jacket, you might lie and say that they’re your friend’s to avoid punishment.
    • We lie to authoritative figures to avoid embarrassment and punishment, including ourselves. When we’ve done something we feel guilty about, lies are told to eliminate the guilt, avoid the punishments, and get back to the objectionable behavior we’re forced to lie about. It’s a vicious cycle.
  1. Anticipate behaviors that will make you feel guilty. To break the chain of embarrassment and lying, it’s important to learn to anticipate things that you’ll likely    feel guilty about in the future, and avoid those behaviors. When you lie, you’re covering up some uncomfortable truth that’s more easily couched in a lie. You can either get comfortable with the truth, or abandon the behavior that makes you embarrassed.
    • If you smoke cigarettes, you won’t have to lie if everyone knows it’s true. Own up to it. If a behavior is un-own-upable, it’s probably best to avoid it. It would be humiliating for your wife to find out that you had an inappropriate relationship with a coworker, but you won’t have to lie if you don’t do it.
  1. Avoid situations in which you’ll have to lie for others. Be wary when someone tells you something in confidence that you know that you should share with someone else (e.g., knowledge of a crime, a lie, or a harmful act against another). Hearing such information puts you in a difficult position, especially when the truth eventually emerges and reveals to the affected person that you knew all along.
    • If someone begins a sentence with “Don’t tell so-and-so about this, okay?” be prepared to offer your own disclaimer: “If it’s something that I’d want to know about were I them, then please don’t tell me. I don’t want to be responsible for anyone’s secrets but my own.”

Learning healthier ways to manage stress

03 Wednesday Apr 2019

Posted by in Anxiety, grounding, Handout, mental health, Psychoeducation, Relaxation, Stress, Wellness

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If your methods of coping with stress aren’t contributing to your greater emotional and physical health, it’s time to find healthier ones. There are many healthy ways to manage and cope with stress, but they all require change. You can either change the situation or change your reaction. When deciding which option to choose, it’s helpful to think of the four As: avoid, alter, adapt, or accept.

Since everyone has a unique response to stress, there is no “one size fits all” solution to managing it. No single method works for everyone or in every situation, so experiment with different techniques and strategies. Focus on what makes you feel calm and in control.

Dealing with Stressful Situations: The Four A’s

Change the situation:

Avoid the stressor.

Alter the stressor.

 Change your reaction:

Adapt to the stressor.

Accept the stressor.

1. Avoid unnecessary stress

Not all stress can be avoided, and it’s not healthy to avoid a situation that needs to be addressed.

Learn how to say “no” – Know your limits and stick to them.

Avoid people who stress you out –Limit the amount of time you spend with people that cause you stress.

Take control of your environment – If the evening news makes you anxious, turn the TV off.

Avoid hot-button topics –If you repeatedly argue about the same subject with the same people, stop bringing it up or excuse yourself when it’s the topic of discussion.

Pare down your to-do list –If you’ve got too much on your plate, distinguish between the “shoulds” and the “musts.”

2. Alter the situation

If you can’t avoid a stressful situation, try to alter it. Figure out what you can do to change things so the problem doesn’t present itself in the future.

Express your feelings instead of bottling them up. If something or someone is bothering you, communicate your concerns in an open and respectful way.
Be willing to compromise. When you ask someone to change their behavior, be willing to do the same.

Be more assertive. Deal with problems head on, doing your best to anticipate and prevent them.

Manage your time better. Plan ahead and make sure you don’t overextend yourself.

3. Adapt to the stressor

If you can’t change the stressor, change yourself. You can adapt to stressful situations and regain your sense of control by changing your expectations and attitude.

Reframe problems. Try to view stressful situations from a more positive perspective.

Look at the big picture. Will it matter in a month, or a year?

Adjust your standards. Set reasonable standards for yourself and others, and learn to be okay with “good enough.”

Focus on the positive. When stress is getting you down, take a moment to reflect on all the things you appreciate in your life, including your own positive qualities and gifts.

4. Accept what you can’t change

Some sources of stress are unavoidable, in such cases; the best way to cope with stress is to accept things as they are. Acceptance may be difficult, but in the long run, it’s easier than railing against a situation you can’t change.

Don’t try to control the uncontrollable. Focus on the things you can control such as the way you choose to react to problems.

Look for the upside. As the saying goes, “What doesn’t kill us makes us stronger.” When facing major challenges, try to look at them as opportunities for personal growth.

Share your feelings. Talk to a trusted friend or make an appointment with a therapist.

Learn to forgive. Accept the fact that we live in an imperfect world and that people make mistakes.

5. Make time for fun & relaxation

You can reduce stress in your life by nurturing yourself. If you regularly make time for healthy fun and relaxation, you’ll be in a better place to handle life’s stressors.

Healthy ways to relax and recharge

Go for a walk.

Spend time in nature.

Call a good friend.

Exercise.

Write in your journal.

Take a long bath.

Light scented candles

 Play with a pet.

Work in your garden.

Get a massage.

Curl up with a good book.

Listen to music.

Watch a comedy

Nurturing yourself is a necessity, not a luxury.

Set aside relaxation time. Include rest and relaxation in your daily schedule..

Connect with others. Spend time with positive people who enhance your life.

Do something you enjoy every day. Make time for leisure activities that bring you joy, whether it be stargazing, playing the piano, or working on your bike.

Keep your sense of humor. This includes the ability to laugh at yourself.

6. Adopt a healthy lifestyle

You can increase your resistance to stress by strengthening your physical health.

Exercise regularly. Physical activity plays a key role in reducing and preventing the effects of stress.

Eat a healthy diet. Well-nourished bodies are better prepared to cope with stress, so be mindful of what you eat.

Reduce caffeine and sugar. The temporary “highs” caffeine and sugar provide often end in with a crash in mood and energy. By reducing the amount of coffee, soft drinks, chocolate, and sugar snacks in your diet, you’ll feel more relaxed and you’ll sleep better.

Avoid alcohol, cigarettes, and drugs. Self-medicating with alcohol or drugs may provide an easy escape from stress, but the relief is only temporary.

Get enough sleep. Adequate sleep fuels your mind, as well as your body. Feeling tired will increase your stress because it may cause you to think irrationally.