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The nature of death and dying from the perspective of those “left behind” remains steeped in tradition.  Some of these traditions can be traced back to our ancestors on the uncharted American frontier. Our modern day “wakes” were initiated at that time to allow for those unfortunate enough to be mistaken as “dead” to awake from, often, states of extreme drunkenness. Laying out individuals to ensure their death prevented the occasional and unfortunate act of burying loved ones while they were still alive.

Wakes were also used by individuals living in areas of voodoo practice. In these locations, voodoo practitioners might use tetrodo toxins as a tool to create the illusion of death, allowing the practitioner to be the saviors and wake the “dead”. Unfortunately for those poisoned, they, too, were at times buried alive…until they were finally dead. Instituting wakes allowed time for either the poison to wear off or to confirm actual death in the absence of modern medical science.

The tradition of mourning extended into the business of religious ceremonies.  There was, and continues to be, great profit surrounding the passing of one’s loved ones.  The most expensive caskets which are often perceived as a visual proclamation of the level of love for those who have passed can reach the cost of tens of thousands. To further the importance of the dead,  the practice of hiring professional mourners embellished the status and value of the deceased’s life and to help qualify the loss of the family for all to see and hear.  This calls to question just how much of our current practices in regard to death and grief are based on outdated concepts?

Kubler-Ross (1969) instructed us to conceptualize loss in five stages of emotional experience that end in a final acceptance of this reality – denial, anger, bargaining, depression, acceptance.  The theory is taught as the explanation of our role as witness and survivor of the death of those close to us. It qualifies the experience of grief and normalizes it, without raising the question of why it exists in the first place. The theory further chronicles the ceremonial traditions supported by divergent religious doctrines that all serve to ease the pain of loss. It does not however reflect on the causation of that emotional experience lying in the stage-based thought processes that trigger the emotional experience in the first place. The human concept of “loss” is an ordained, conditioned, emotional experience rather than a pre-determined reality.

The final moments of earthly existence are at times the result of accidents or medical conditions that are symptom-free until the final moment life ends.  Other times it is a prolonged “fight” that is “lost” due to debilitating illness.  Modern wakes cause us to become part of the experience of death and begin to examine the fear and fascination with a next existence we hope for.  Mourning becomes the idiosyncratic reflection of our loss as the theories of grief teach us.

Had the stages of grief moved into a sixth stage or allowed for an alternate trajectory, we may have an understanding that grief is a conditional factor.  In other words, our grief may well be as much a requirement of social norms as it is an inherent emotional outcome.  To move a step further, is it possible that the first five stages are a reflection of societal artifacts that do not ease the negative emotional experience of loss but instead reinforces it?

The sixth stage might be best reflected in the concept of celebration of life.  This is not a new term, but it is a relatively new concept to move the mourning cycle out of black veils and into the potential for rejoicing on memories of a life well lived. Rethinking death as a time for celebration is already a part of facets of the human collective.  The funeral processions in New Orleans depict the potential for moving beyond loss into a realm of gratitude for being part of the lives of the deceased – us in theirs, and them in ours. Maintaining the thought that our time with them was a gift results in a shift from the paradigm of loss to one of remembrance of gain.  Rather than looking about the room or sifting through the possessions of the deceased to latch onto an artifact of their life, we have the option of holding our conscious experience of them in the shining moments of their engagement with us.

Mourning, stages of grief, and the very process of death in our society may be an unnecessary burden we are taught to place on ourselves to qualify our connection to the person who died.  Within this new perspective, however, we have the alternate choice to qualify that connection by rejoicing in the most precious moments of their existence.  Over time our minds evolve our memories to this experience without our conscious effort, thus focusing on happiness and gratitude, rather than sadness and regret.  We hold onto fond memories of those no longer in our presence and relinquish any memories of “final days” and fading lives.  A way someone moves, a familiar smile, favorite quotes and their overall context replace the creation of loss imposed upon us in the funeral process.  Our minds become focused on the positive experiences of those who are done with the physical existence, and automatically reflects this perspective back to us if we are not hampered by the demands of societal grief.

Celebrations of life raise the question – are the original stages of grief within Kubler-Ross’ model potentially outdated, based upon historical traditions intended for other purposes and taking the assumption that we must be sad if we truly loved someone?  Reframing the experience of grief and death can offer a more beneficial experience based upon the ultimate goal of celebration. Denial, anger, bargaining, depression, and acceptance can be replaced by:

• Acceptance – Understanding the reality of finality of existence in physical form;
• Reflection – Contemplation of the connection experienced over your time together;
• Accommodation – Allowing for the emotional experience of others with grace;
• Joy – Appreciation for both the qualities and flaws of the person who moved on; and
• Celebration – Honoring their unique contributions to our lives and the lives of those around us.

In closing, I ask the question of why we subject ourselves and those closest to us to the requirement of mourning?  It is equally possible to join in celebration of the many contributions, shining moments, and tiny kindnesses the deceased leave behind as their legacies of existence in our lives.

Cheers to those who touched our lives. – Dr. Tom

Music ends at 5′ mark (fast forward)

“Do you think the school will have graduation for the seniors?”

“I can’t wait for summer and surfing and just being with my friends. Do you think the beaches will be open by then?”

“When do you think we’ll be able to stop doing social distancing?”

“What if the governor sticks with the May 4^th deadline of lifting the rule?”

These are questions in just the past 48 hours from one of my teenagers. At 17, with a boyfriend, and as an extreme extrovert, she wants answers regarding when life will be “normal” again. She doesn’t like feeling isolated, doesn’t like being restricted, and doesn’t like not knowing. And she’s not the only one. Friends, family members and patients are asking similar questions. Some are spending hours daily scouring websites and news sources for information, trying to get answers to their timeline questions. Essentially, they are trying to predict an unpredictable situation, one that our world’s best scientists are having a hard time predicting. Much like my teen, many people are playing the “what if” game and trying to come up with answers that are not available.

The reason why they do this is understandable. Uncertainty is not a comfortable place for most humans. From an evolutionary perspective, uncertainty from the earliest times of man equaled danger. When there is uncertainty, our brains respond, with anxiety or hypervigilance, to try and determine the danger and establish a safe protocol. We search for answers and patterns in an attempt to establish timelines. But when this is impossible, these dysfunctional responses worsen. Anxiety and hypervigilant behaviors grow, possibly overwhelming a person’s daily functioning, impacting sleep, and manifesting as physical symptoms. Instead of protecting us, our behaviors are now hurting us.

The solution may not be easy for some and it requires breaking habits that may very well be ingrained from our primitive beginnings. The solution is to live in the moment, with the current information. The challenge becomes harder when many of the questions don’t have answers like my conversation with my daughter:

“Do you think the school will have graduation for the seniors?”   I don’t know, but I’m sure they’ll do whatever they can for the seniors.

“I can’t wait for summer and surfing and just  being with my friends. Do you think the beaches will be open by then?”  I don’t know, hon. We’ll keep following the guidelines to stay safe.

“When do you think we’ll be able to stop  doing social distancing?”  I don’t know that, but I do know that social distancing is keeping us safe.

“What if the governor sticks with the May 4^th deadline of lifting the rule?”  Why don’t we focus on today and this week since those are what we know.

You can imagine how these responses were received by my daughter. She wanted definites and concrete answers about life returning to “normal”, and I couldn’t give her these. No amount of research, or charting, or scheduling provide the answers. Working to bring my daughter back into the moment was what I could control and could offer.

“What ideas do you have of what the school can do for the seniors?”

“Have you looked at any videos on surfing to get better at your skills, or have you thought about preparing your board so it’s ready to use?”

“What are some things you can do with your friends now with the social distancing?”

“What things are on your list to do while we are still staying safe at home?”

Keeping ourselves and our loved ones grounded in the moment, focused on current, factual information, and maintaining control over things that are actually within our control, are all important steps to maintain mental health during times of crisis and uncertainty. This requires a consistent practice of retraining our brains, and the brains around us, to stop the “what ifs”, reduce the future thinking, and replace those with alternate thoughts which meet the three criteria above. By doing so, we let go of the thoughts of what life “should” or “would” be like, and learn to be comfortable, or maybe even enjoy, the life we are currently in.

Just a little something for your insight. – Dr. Robin

MENTAL HEALTH WELLNESS TIPS FOR QUARANTINE

1. Stick to a routine. Go to sleep and wake up at a reasonable time, write a schedule that is varied and includes time for work as well as self-care.
2. Dress for the social life you want, not the social life you have. Get showered and dressed in comfortable clothes, wash your face, brush your teeth. Take the time to do a bath or a facial. Put on some bright colors. It is amazing how our dress can impact our mood.
3.  Get out at least once a day, for at least thirty minutes. If you are concerned of contact, try first thing in the morning, or later in the evening, and try less traveled streets and avenues. If you are high risk or living with those who are high risk, open the windows and blast the fan. It is amazing how much fresh air can do for spirits.
4.  Find some time to move each day, again daily for at least thirty minutes. If you don’t feel comfortable going outside, there are many YouTube videos that offer free movement classes, and if all else fails, turn on the music and have a dance party!
5. Reach out to others, you guessed it, at least once daily for thirty minutes. Try to do FaceTime, Skype, phone calls, texting—connect with other people to seek and provide support. Don’t forget to do this for your children as well. Set up virtual playdates with friends daily via FaceTime, Facebook Messenger Kids, Zoom, etc—your kids miss their friends, too!
6. Stay hydrated and eat well. This one may seem obvious, but stress and eating often don’t mix well, and we find ourselves over-indulging, forgetting to eat, and avoiding food. Drink plenty of water, eat some good and nutritious foods, and challenge yourself to learn how to cook something new!
7. Develop a self-care toolkit. This can look different for everyone. A lot of successful self-care strategies involve a sensory component (seven senses: touch, taste, sight, hearing, smell, vestibular (movement) and proprioceptive (comforting pressure). An idea for each: a soft blanket or stuffed animal, a hot chocolate, photos of vacations, comforting music, lavender or eucalyptus oil, a small swing or rocking chair, a weighted blanket. A journal, an inspirational book, or a mandala coloring book is wonderful, bubbles to blow or blowing watercolor on paper through a straw are visually appealing as well as work on controlled breath. Mint gum, Listerine strips, ginger ale, frozen Starburst, ice packs, and cold are also good for anxiety regulation. For children, it is great to help them create a self-regulation comfort box (often a shoe-box or bin they can decorate) that they can use on the ready for first-aid when overwhelmed.
8. Give everyone the benefit of the doubt, and a wide berth. A lot of cooped up time can bring out the worst in everyone. Each person will have moments when they will not be at their best. It is important to move with grace through blowups, to not show up to every argument you are invited to, and to not hold grudges and continue disagreements. Everyone is doing the best they can to make it through this.
9. Everyone find their own retreat space. Space is at a premium, particularly with city living. It is important that people think through their own separate space for work and for relaxation. For children, help them identify a place where they can go to retreat when stressed. You can make this place cozy by using blankets, pillows, cushions, scarves, beanbags, tents, and “forts”. It is good to know that even when we are on top of each other, we have our own special place to go to be alone.
10. Practice radical self-acceptance. We are doing too many things in this moment, under fear and stress. This does not make a formula for excellence. Instead, give yourself what psychologists call “radical self acceptance”: accepting everything about yourself, your current situation, and your life without question, blame, or pushback. You cannot fail at this—there is no roadmap, no precedent for this, and we are all truly doing the best we can in an impossible situation.
11. Limit social media and COVID conversation, especially around children. One can find tons of information on COVID-19 to consume, and it changes minute to minute. The information is often sensationalized, negatively skewed, and alarmist. Find a few trusted sources that you can check in with consistently, limit it to a few times a day, and set a time limit for yourself on how much you consume (again 30 minutes tops, 2-3 times daily). Keep news and alarming conversations out of earshot from children—they see and hear everything, and can become very frightened by what they hear.
12. Notice the good in the world, the helpers. There is a lot of scary, negative, and overwhelming information to take in regarding this pandemic. There are also a ton of stories of people sacrificing, donating, and supporting one another in miraculous ways. It is important to counter-balance the heavy information with the hopeful information.
13. Help others. Find ways, big and small, to give back to others. Support restaurants, offer to grocery shop, check in with elderly neighbors, write psychological wellness tips for others—helping others gives us a sense of agency when things seem out of control.
14. Find something you can control, and control the heck out of it. In moments of big uncertainty and overwhelm, control your little corner of the world. Organize your bookshelf, purge your closet, put together that furniture, group your toys. It helps to anchor and ground us when the bigger things are chaotic.
15. Find a long-term project to dive into. Now is the time to learn how to play the keyboard, put together a huge jigsaw puzzle, start a 15 hour game of Risk, paint a picture, read the Harry Potter series, binge watch an 8-season show, crochet a blanket, solve a Rubix cube, or develop a new town in Animal Crossing. Find something that will keep you busy, distracted, and engaged to take breaks from what is going on in the outside world.
16. Engage in repetitive movements and left-right movements. Research has shown that repetitive movement (knitting, coloring, painting, clay sculpting, jump roping etc) especially left-right movement (running, drumming, skating, hopping) can be effective at self-soothing and maintaining self-regulation in moments of distress.
17. Find an expressive art and go for it. Our emotional brain is very receptive to the creative arts, and it is a direct portal for release of feeling. Find something that is creative (sculpting, drawing, dancing, music, singing, playing) and give it your all. See how relieved you can feel. It is a very effective way of helping kids to emote and communicate as well!
18. Find lightness and humor in each day. There is a lot to be worried about, and with good reason. Counterbalance this heaviness with something funny each day: cat videos on YouTube, a stand-up show on Netflix, a funny movie—we all need a little comedic relief in our day, every day.
19. Reach out for help—your team is there for you. If you have a therapist or psychiatrist, they are available to you, even at a distance. Keep up your medications and your therapy sessions the best you can. If you are having difficulty coping, seek out help for the first time. There are mental health people on the ready to help you through this crisis. Your children’s teachers and related service providers will do anything within their power to help, especially for those parents tasked with the difficult task of being a whole treatment team to their child with special challenges. Seek support groups of fellow home-schoolers, parents, and neighbors to feel connected. There is help and support out there, any time of the day—although we are physically distant, we can always connect virtually.
20. “Chunk” your quarantine, take it moment by moment. We have no road map for this. We don’t know what this will look like in 1 day, 1 week, or 1 month from now. Often, when I work with patients who have anxiety around overwhelming issues, I suggest that they engage in a strategy called “chunking”—focusing on whatever bite-sized piece of a challenge that feels manageable. Whether that be 5 minutes, a day, or a week at a time—find what feels doable for you, and set a time stamp for how far ahead in the future you will let yourself worry. Take each chunk one at a time, and move through stress in pieces.
21. Remind yourself daily that this is temporary. It seems in the midst of this quarantine that it will never end. It is terrifying to think of the road stretching ahead of us. Please take time to remind yourself that although this is very scary and difficult, and will go on for an undetermined amount of time, it is a season of life and it will pass. We will return to feeing free, safe, busy, and connected in the days ahead.
22. Find the lesson. This whole crisis can seem sad, senseless, and at times, avoidable. When psychologists work with trauma, a key feature to helping someone work through said trauma is to help them find their agency, the potential positive outcomes they can effect, the meaning and construction that can come out of destruction. What can each of us learn here, in big and small ways, from this crisis? What needs to change in ourselves, our homes, our communities, our nation, and our world?

ADDITIONAL TIPS FOR PARENTS OF YOUNGER CHILDREN

Spend extra time playing with children. Children will rarely communicate how they are feeling, but will often make a bid for attention and communication through play. Don’t be surprised to see therapeutic themes of illness, doctor visits, and isolation play through. Understand that play is cathartic and helpful for children—it is how they process their world and problem solve, and there’s a lot they are seeing and experiencing in the now. This can be done via technology!

Be prepared for (but don’t expect) behavioral issues in children, and respond gently. We are all struggling with disruption in routine, none more than children, who rely on routines constructed by others to make them feel safe and to know what comes next. Expect increased anxiety, worries and fears, nightmares, difficulty separating or sleeping, testing limits, and meltdowns. Do not introduce major behavioral plans or consequences at this time—hold stable and focus on emotional connection.

Focus on safety and attachment. We are going to be living for a bit with the unprecedented demand of meeting all work deadlines, homeschooling children, running a sterile household, and making a whole lot of entertainment in confinement. We can get wrapped up in meeting expectations in all domains, but we must remember that these are scary and unpredictable times for children. Focus on strengthening the connection through time spent following their lead, through physical touch, through play, through therapeutic books, and via verbal reassurances that you will be there for them in this time.

-Adapted from Mike Cutler, PsyD

When the COVID-19 quarantine was first implemented, my thoughts immediately went to those members of society known as “extroverts”. In this category are people whose energy is charged by interaction with others. Their sense of well-being is fostered by in-person experiences with others and social connectedness. With the quarantine, the extroverts lost significant ways to charge their batteries. They have been forced into daily lives which deplete their batteries, draining them of energy and a sense of well-being. Essentially, the extroverts are now living the lives of their counterparts, the introverts.

Introverts are people whose energy is charged by alone time, or time with very limited, very close friends. In non-Corona times, introverts exist in a society which functions on social interaction. They leave their homes and have to function all day in environments which deplete their batteries. They have no way to avoid these social interactions and simply have to deal with our socially-based society to go to school, go to work, run errands. So while the introverts are now living their ideal social lives – by themselves or with limited numbers of people, in the security of their homes, choosing when and how to be social via technology, on their own terms – the extroverts are adjusting to a daily social environment that is contrary to what their batteries need.

So as a therapist, I was concerned about how the extroverts would manage and have the luxury of a sample population within my own home.

Our younger daughter is an introvert. Getting through an entire day of school, with non-stop social interactions and no opportunities to escape and re-charge, is exhausting for her. The societal expectation is for her to be social, particularly as a teenager; to be otherwise labels her as weird or “antisocial” or stuck up. So she pushes through the day, enjoying her friends and classmates, but drained of all resources by evening. The quarantine, however, lets her create her own schedule. She happily exists with limited social contact during the day, focusing on her online classes, working out, engaging in activities she loves, and then connecting with friends via technology at night. The perfect introvert world, right? Maybe, but the challenge introverts are having is that they never really get time alone. They are now constantly surrounded by people in what can seem like a smaller and smaller space. So helping my daughter and other like her to find a corner, a room, or a way to get the true alone time they require to recharge is important.

Our other daughter is an extrovert. In actuality, if there was an “uber-extrovert” category, that would be her label. Prior to social distancing, she would wake up excited to go to school, not because of her love of academics, but for the opportunities to be with other people. By the time she drove the 20 minutes home from school, she’d be thinking about the next opportunity to be with larger groups of people other than her limited family size. She will offer to run errands for me simply to get out of the house and be around other people. Her personality fits within society’s established standards, and it is extroverts like my daughter who are typically reinforced and rewarded for their outgoing natures. So when all that is taken away, and the extroverts are now in a world of limited social interaction and small group sizes, they are struggling. They are now experiencing what introverts have always dealt with – a social construct that works against their batteries rather than with.

Or so I thought. In the past few weeks, I’ve noticed an unexpected trend among some of my teenage patients who are extroverts. These are the kids I thought might need extra, online therapy sessions to manage the change to their social environments. While that is true for some, there is a larger group of extroverts whose mental health seems to have IMPROVED in this quarantine. They report being more relaxed and less stressed. They like not having to go to school and making their own daily schedule to get work done. Their parents have reported these kids are more productive than usual, demonstrating better focus and seemingly happier. Like their introverted peers, they are enjoying choosing when to be social, maintaining focus on academics without social distraction and then social interactions without academic pressures. The quarantine is allowing these extroverts to compartmentalize their lives to truly enjoy all parts, rather than having the parts overlap. It makes me wonder if for some extroverts, the continuous demand on their sociability overloads their social batteries in a similar way that too much sociability overloads the introverts’ social batteries. If then these extroverts present as overly stimulated, hyper, irritable, or unable to process information or make sound decisions due to the overload.

The quarantine is also allowing extroverts to determine true friendships versus extraneous relationships. A mom of an 8^th grader was exceptionally worried that her daughter wasn’t reporting the “painful” experience of some friends not responding via social media. Her daughter was close with these girls prior to the quarantine, but during, hadn’t heard back from most of them. When I asked my patient about the situation, she said she was relieved! She hadn’t felt close to the girls she had called friends for many weeks prior, and was glad not to have the pressure of interacting with them during school. She described these girls as “people I thought were friends, but who were really former friends that I just hung out with because I always had”. She shared with me that she didn’t want to continue friendships with them in high school, and was glad the quarantine made the timeline to be around them shorter.

Because of the quarantine, I am reminded not to assume how kids or adults will react in times of crisis or trauma. Some are finding value in the downtime, allowing themselves to learn about who they are and who the people they want in their lives to be. Others are discovering new interests, or re-discovering old interests, as they are confronted with boredom. And while there are some who are reacting with fear, or anxiety, or depression, the quarantine might provide those individuals time to take care of themselves, get the mental health support they need, and ultimately be stronger individuals once our society is healthy.

Just a little something for your insight. – Dr. Robin

One of the most common questions mental health providers get is whether they accept insurance. When the answer is “no”, the assumption is often related to the complicated nature of insurance payments for practitioners. While that may be true, there are two factors which are more significant to patients in the decision not to accept insurance by mental health practitioners: ethics and confidentiality.

Ethics

A new patient came to our practice a few years back. She had been dealing with a mild eating disorder for about 8 years. She decided to come for therapy when she noticed the eating disorder was getting worse, after the sudden death of her mother. Her health insurance company required pre-authorization for treatment and, when contacted by our office, the patient’s insurance approved a total of 10 visits. Now let’s do a quick math problem. The insurance company was essentially approving 1.25 sessions for each YEAR this young woman had experienced the eating disorder. It doesn’t take a doctoral degree in psychology to understand this is unrealistic for successful treatment.

By not being paneled for insurance, mental health providers can focus on effective and ethical treatment for each patient, whether it takes less or more time than dictated by the algorithms used by insurance companies. Less time is also spent on insurance paperwork, allowing the practitioner more time to determine strategies and approaches that will treat the symptoms and get the patient back to an appropriate level of functioning. The focus stays on data-driven mental health best practices, rather than a “one-size-fits-all” model of cost effectiveness.

Confidentiality

Private pay rather than insurance also allows for a higher level of confidentiality. Let me give you an example. A patient came in with severe depression. When asked how long he had been dealing with the depressive symptoms, he responded, “Nine months.” If you know what severe depression feels like, you can empathize with how hard the past nine months had been for this individual. The patient went on to explain that the depression had built over the nine months, but he had been afraid to get treatment because of his future plans. You see, this patient planned to apply for high-level jobs in the corporate world, and was worried what a psychological diagnosis might do to his acceptance. With insurance, a diagnosis would be required and would be documented in this individual’s records, and potentially discoverable in a future application process. Without insurance involved, however, a diagnosis did not have to be recorded. The patient’s mental health issue and treatment would remain completely confidential. This option for private pay rather than insurance allowed the patient’s stress level and anxiety to decrease, which only increased the successful treatment of his depression.

Without documentation, confidentiality can also be ensured from any potential technology breaches. It seems as if no organization is immune to the threat of data breaches. Target, Facebook, CapitalOne, Equifax, and others have all been hacked, leaving the personal information of their customers and clients exposed. Now imagine if your mental health history was exposed. At the least, this is a personal violation; at the worst, it could have negative ramifications on your professional and personal life. But if no diagnosis is recorded in insurance companies’ databases, there can be no information leak due to security breaches. Mental health information stays out of the hands of individuals who might exploit it.

Options

Of course having an ethical, completely confidential approach to mental health seems like it might be a more expensive approach, but there are two things to consider regarding this aspect. First, many practitioners offer a sliding fee scale for those individuals who can’t meet the private pay costs. Second, individuals do have the option of submitting receipts to insurance companies for reimbursement. While this might be contrary to the discussion we had about confidentiality, it puts the decision on what have documented with insurance companies in the hands of the patient, and this sense of control over your treatment can only benefit the overall process and prognosis of the individual.

Just a little something for your insight. – Dr. Robin

I had a dentist appointment this morning. I know, nothing too exciting about that, but the assistant got me in to exam room right away and then I had to wait for the doctor. I reached into my purse for my cell phone to kill time, only to realize I’d left my phone in the car. I felt vaguely annoyed that I had “nothing to do” while I waited – no social media to review, no work to check on, no emails to return, no book to read. I even debated excusing myself to go get my cell and then, thankfully, realized how ridiculous and rude that would be. So I sighed and stared out the window across from the exam chair. Outside the window was a winterscape since the area just got a fresh coating of snow a few days earlier. Snow clung to each branch and as the sun hit the branches, they sparkled with the layer of ice that had followed the snow. The dental team was also brilliant because they placed bird feeders outside the window. I got to see a cardinal, a blue jay, and a bunch of other birds that I didn’t recognize but which were filled with color and movement. As I watched, it occurred to me to practice the yoga breath that I did in the classes I attended, but somehow regularly forget to continue during my days. I incorporated my mantra – “inhale peace, exhale strife” – as I breathed, as I watched, as I stopped thinking. I’m not sure how long it was before the dentist came in, but I was a little disappointed when he did.

Can you relate to that initial reaction I had regarding my cell phone? We are so accustomed to having distraction with us at all times. According to a recent American Psychological Association’s annual Stress in America™ survey, 81 percent of Americans report they are constantly or often connected to at least one technological device, and 18 percent of adults describe technology as a very or somewhat significant source of stress. The challenge is that technology also provides us with the opportunities to be more flexible and more productive when it comes to getting things done. We excuse the amount of time we are “plugged in” by how much we accomplish, whether it is responding to work emails, keeping track of our ever-changing calendar, being accessible via text/call/email/social media at all times, submitting our shopping list for pick up later, recording our daily exercise, or any of the other ways we use our phones, laptops, or smart watches. So while the same Stress in America survey found that 65 percent of respondents somewhat or strongly agree for the need to “unplug” to maintain mental health, only 28 percent actually do this. We don’t allow ourselves to just be in the moment because we have “so much to do”, or we don’t want to be bored. But it is in those moments of being and boredom that our mind can relax, and in relaxing we can foster creativity, peace and psychological health.

Now if you are one of those 28 percent who disconnect, GOOD FOR YOU! You have taken a very deliberate and healthful step for your optimal functioning. But, if you are like me and trying to make better choices regarding technology, here are some things to consider in this process. I like to remember these as NOW HERE:

• Nondigital people. Have you ever noticed a group of people at a restaurant, sitting at the same table, some on their phones and the others with their phones lined up alongside their utensils, within reach? While social media and technology have made is easier to connect with others, they’ve also become barriers to our standing-right-in-front-of-you interpersonal experiences. For the 44 percent of Americans who state they check their devices “often” or “constantly”, they also report feelings of disconnect with their families, even when they are together. I know it is just a “quick email” to send off, or “what if the kids need us”, or “let me just get back to this person”, but what do our actions of staring at a device, communicating to someone else, while someone we care about or love is right in front of us say to that other person? You know because, very likely, you’ve had the same done to you.
  • Strategies: silence your devices when you are with others; find a location in your house to park your devices once you are home and only check them on schedules you’ve created (and which we’ll talk about in other points).

• Observation only. How many social media platforms are you on? Between Facebook, Instagram, Twitter, LinkedIn, and Snapchat (and there seem to be others developing monthly), you can lose hours each day scrolling and “liking”. Not only do you end up losing time, you might also begin to create unrealistic social comparisons between others’ lives and your own. Avoiding the “fakebook” trap is an essential part of positively utilizing social media.
  • Strategies: schedule specific timeframes to review social media; develop a perspective of appreciating others’ posts as isolated snapshots of their lives which do not reflect their entire lives nor offer comparisons to your own.

• Worship your bed. You train your brain with routines. By only using your bed for sleep (or, if you have a partner, sex), your brain will come to associate bed with those 1-2 activities. It will learn that when you go to bed, it is time to start winding down.  In addition, technology use before or in bed interferes with the quality of your sleep for two reasons. The first is the blue light from devices which interferes with the creation of melatonin, a hormone necessary for sleep. The second is your exposure to content which stimulates the brain. Whether an email, or a social media message, or the storyline of a show or movie, your thoughts can be triggered by the content and instead of beginning to relax, these activities rev the brain back up.

• • Strategies: set your cell phone to its blue light filter; stop use of technology one hour before bedtime; remove TV from your bedroom; do not use your cell phone in bed; if you use your cell phone as an alarm clock, turn your volume off (your alarm function should still work) and place the phone across the room; do not use laptops in bed; remove your smart watch or at least shut off all notifications at night.
• Hands free. Actually what I’m really saying is technology free. We all know the dangers of using cell phones when driving and to support that, many states have laws requiring hands-free use of technology behind the wheel. This is certainly good in terms of safety, but not quite helpful with our mental health. With hands free, you are still able to avoid being in the moment by telling your phone to send texts or emails, or by calling someone. While that distraction might lead to driving errors, it definitely leads to you not fully enjoying or appreciating two areas: those things around you and those things inside of you. In terms of the former, taking care of your to-do list as your drive means you might miss the beautiful sunrise as you drive to work, or the puppy in the car next to you licking the window, or your child singing in the backseat. Now what about those things inside of you? Those are your thoughts. Driving gives you time to connect with your thoughts and I don’t necessarily mean your mental to-do list. This time gives you the opportunity to just think which we’ll talk about in the next point. Sometimes the mundane nature of driving allows us to just be in the moment, paying attention to all around us for safety and appreciation.
  • Strategies: turn off the notifications on your phone and put your phone out of reach (the backseat or the trunk).

• Enjoy boredom. My sister, an incredible art teacher and future art director who has an intuitive sense about people, has a terrific saying, “It is only when you are bored that you truly figure out what you’re interested in.” In today’s world, there is little boredom. We always have access to games, or movies, or shows, or photos, or news, or music, or other people’s lives. We don’t want or take time to be bored and we are quickly becoming trained to avoid “doing nothing”. But without the down time, without quiet blocks of time, when do we allow ourselves time to truly breathe, to relax, to reflect? Without these moments, our brain doesn’t get to explore or imagine or create. We need time to let our thoughts wander and play, to consciously or subconsciously problem solve, create new ideas, imagine possibilities. None of this can happen if we constantly fill our brain with technologically-created content.
  • Strategy: schedule time, every day, to unplug.

• Reject Pavlov. Are you familiar with this classic study? The one where the researcher would ring a bell, and the dog would automatically salivate? Many of us are conditioned by the notifications on our phones in the same way Pavlov’s dogs were conditioned by the bell. We hear a notification and we immediately pick up our phone or tap on our watches, click on our email or flip to our social media. Research has shown that when cell users turn off their notifications, they report lower levels of inattention and hyperactivity, and higher levels of productivity, social connectedness and feelings of psychological well-being. Think of it this way. If you had a friend who constantly and randomly interrupted your work day, family time or time with friends, you’d likely establish better boundaries with that friend, or get rid of the friend altogether. The why do we let our devices do just that?
  • Strategies: selectively choose which notifications to leave on; create a schedule to determine what times during the day you will check your messages and for how long.

• Explain boundaries. If you plan to retrain yourself when it comes to technology, you likely will need to do the same for the people in your life. As a society, we have come to expect immediate gratification when it comes to communication. It always cracks me up when students will show frustration if I haven’t responded to their texts or emails within a few I don’t blame them; they’ve grown up in an “immediacy” world. What I can do is help them understand my boundaries: I don’t respond to messages after 5pm at night or on weekends, during the day I make every effort to respond to text messages within 24 hours and emails within 48 hours, and please be sure to sign your name to any communication so I know who I am talking to. The same is true for the people in your life. If your mom knows you will only respond to messages after work hours, then she won’t be texting you multiple times during the day to get a response. If your boss knows that you devote the weekends to your family, she won’t be waiting for your response to an email. And if your friends know that when you are with other people, their messages might remain on “red” because you are focusing on the people you are with, they won’t be offended. By sharing your plan, you manage expectations and reduce frustrations.
  • Strategy: share your technology response plan with family, friends, co-workers, employees.

These seven considerations might take time to set up, and even more time to establish as habits. Maybe take one a week or one a month to put into practice. Within 7 weeks a minimum or less than one year maximum, you will be giving the gift of presence to yourself and to those you love. I doubt there is a better present than that.

Just a little something for your insight. – Dr. Robin

Yea, the start of a new year! A time for resolutions and change, new beginnings and….pressure and stress to fulfill and maintain those plans. Usually the pressure comes with some very specific words:                      

These words – which I categorize as “nagging” verbs – have a powerful impact on how you view your shiny, new resolutions, and the impact isn’t positive. “Should”, “must”, “have to” and “need to” convey obligation or guilt, while “would” and “could” often imply a passive position with no specific control over the action.

Over time, these words can alter the resolution you originally made with optimism and excitement into a burden. It’s no wonder that less than 25% of people maintain their resolutions after 30 days, and only 8% of people achieve their new year’s resolutions (Prossack, 2018). These well-intentioned plans stop feeling like a choice because we “have to” go to the gym, or we “should” start journaling, or we “need to” start being more assertive. Instead of feeling empowered to take control over a change in our lives, it ends up that we “could” start doing more for ourselves or we “would” spend more time with friends. (You might also notice that with “could” and “would”, “but” tends to follow with an excuse of why it would be hard to accomplish the plan.)

Do these sound like choices to you? Not to me either. Instead, they sound like verbal weight being added onto our shoulders.

Now you might be thinking, “C’mon, they’re just words. How can words affect my feelings or my behaviors?” Great question! To answer it, try this. Stand in front of a mirror and think of your biggest new year’s resolution. Now choose one of the nagging verbs and apply this formula:

I  +  {nagging verb} + {resolution}.

Say this sentence at least five times to your reflection. Notice anything? Most of us won’t be smiling when we say our resolutions. You might even notice some physical responses to the pressure created by the word choice. Did you feel a weight on your shoulders? A tension in your neck? Tightness in your stomach? Did you start to slouch or did lines appear between your eyebrows? And how is your overall mood? Are you already dreading doing the activity?

Okay, shake that off and try it this way. Say the same sentence five times again but replace the nagging verb an active verb – “want” or “will”. Watch your appearance when you are saying your resolution as a choice, as something you desire. Typically, the tension leaves your face and body. Your thoughts about the activity become positive. You might even feel powerful in terms of accomplishing your goal.

The most interesting part about changing your nagging verbs to active verbs is that you will begin to hear just how often you use the nagging verbs in your thoughts and your statements. You will catch yourself when you say something like, “I need to go grocery shopping”, “I should get up early to workout”, or “I would see my friends more often but….”. Right at that moment, you can rephrase the statements using active verbs. “I want to have food in the house that is healthy and that I like so I will go grocery shopping.” Or “I want to get up early to workout and feel good.” Or “My friends are important to me so I will schedule time to see them.”

Take just one day to notice how often you use nagging verbs for yourself. See if you can change them, in the moment, to active verbs. Then acknowledge how you feel when you start to consider your goals in terms of wants, desires and active choices. When we allow ourselves to rephase our choices in active and desirable ways, we are more likely to succeed in achieving them.

Just a little something for your own insight. – Dr. Robin

Prossack, A. (2018, December 31). This year, don’t set New Year’s resolutions [Blog post]. Retrieved from https://www.forbes.com/sites/ashiraprossack1/2018/12/31/goals-not-resolutions/#1bf57bf3879a.

How’s your to-do list coming for December? You know the one – all your loved ones listed and the gifts you plan to buy each one. After them, you have all the service providers you plan to buy holiday thank-you’s for – teachers, stylists, postal workers, dog sitter. Add work colleagues after that. And any holiday party White Elephant gifts. And maybe gifts for charities you support during the holidays like Giving Trees or food pantries. And once you get through most of your list, and are starting to breathe a bit easier, you know someone {insert significant other, spouse, child, mother-in-law, sibling} will ask you if you’d mind picking up something for someone they need a gift for. It’s not even my list but I’m exhausted just thinking about your list!

But it seems like you forgot someone on your gift giving list. Can you think of who? (I’ll wait for you to scour your brain and your list in a desperate attempt to double check…)

YOU!

Where are you on your gift giving list?

Are you chuckling at this idea? Thinking that it’s silly or frivolous? That if you’re going to get a present, it should be from someone else? That you don’t have time to think about getting yourself something when your gift giving list could challenge Santa’s list? Or maybe you’re thinking you don’t deserve a present for whatever reason. If you’re putting time and energy to thinking about how to acknowledge those people in your life whom you love or appreciate for the things they do for you, why wouldn’t those two factors apply to you? Why wouldn’t you recognize the special person you are and show yourself appreciation for all you do?

Now I am not telling you to head out to your nearest jewelry store to buy a Rolex. Or to go buy the fun Jeep at the dealership you’ve been driving past each day on the way to work. Or to book a solo cruise to the Mediterranean. (Although if any of those are comfortably within your cash budget, you certainly don’t need my permission…) Giving yourself a gift this month can be simple as long as it is meaningful to you.

So what gift will you give to yourself? Maybe it’s to start that class at the gym that you’ve been wanting to try, but keep letting everyone else’s schedule get in your way. Maybe it’s to meet a friend for coffee once a month, starting this month. Maybe it’s setting aside 30 minutes a day to explore options for new changes – a job you’d really enjoy, a volunteer organization to get involved with, a hobby you’ve always wanted to try, a new hair style. Maybe it’s putting into your calendar 30 minutes a day to just breathe, meditate or read a book. It doesn’t matter what you choose as long as you choose the gift to yourself in the same way you choose gifts for the other special people in your life.

As the gift giver, my guess is you put thought into each gift, thinking about what each person would most love to receive and what best suits that person. You then give the gift unconditionally, with the basic idea of bringing happiness to that person. You can do the same for yourself.

And as the gift receiver, you accept the gift from yourself as you hope others accept the gifts you select for them – without guilt or feelings of obligation. You hope your recipients feel special and appreciated by the gifts you give them. It is not only okay, but wonderful, for you to create those same feelings in yourself from yourself.

So I dare you to add yourself to your gift giving list. (Yes, actually write your name on the list, in pen.) Then have as much fun thinking about what to give yourself as you have in thinking about what gifts would make other people in your life smile. Remember your gift to you can be anything you want that works within your life as long as it is in recognition of the amazing person you are. (Read those words again…and maybe again, slower.)

Merry Christmas, Happy Chanukah, Happy Kwanzaa, Happy Boxing Day, and any joyful holiday or celebration you have in December!

Just a little something for your insight. – Dr. Robin