During the first therapy session, I like to teach patients about the different styles of therapy that might help them depending on their specific problem or issue. Cognitive Behavior Therapy (CBT) is an orientation based on the Cognitive Triad, the connection between Thoughts, Feelings and Behaviors. Patients usually nod their heads at this psychology jargon stating that they grasp the basic concepts but in order to help connect it to their real lives, I introduce the following scenario:

Imagine you’re in high school and sitting in the front row of math class. There is one empty seat next to you and the minute before the bell rings for class to start, your best friend sits down next to you. You say “Hey, what’s up!” and your friend doesn’t respond and doesn’t even look at you. Class begins and the teacher is standing right in front of you so you can’t talk, text or pass notes until class is over. Why didn’t your friend respond? What are you thinking? What emotions are you feeling? What physical reactions occur in your body? How are you behaving in the moment? How will you act after class?

Your answer to all of these questions will depend on your specific personality characteristics, life experiences and perhaps on the psychological issues (anxiety, depression, PTSD, low self-esteem, relationship conflict) you may be struggling with. Your brain starts moving at a mile a minute to figure it all out.

Let’s break this math class situation down because it’s sometimes hard to differentiate between thoughts, feelings and behaviors.

Thoughts: Why didn’t my friend talk to me? What did I do wrong? Are they angry at me? Did I say or do something that made them angry or upset? Let’s replay every conversation I have had with them over the past week or month or year or decade. This may take a while. Was it that joke I told? Maybe they took it the wrong way? Did I forget their birthday or to call them back? Did they think I was trying to hit on someone they liked? Did I not wear pink on pink day last week? Are they still angry that I borrowed their favorite stuffed animal when we were 5 and I never gave it back? I always do these things, nobody will ever like me. Wait, maybe something terrible happened to my friend, maybe someone died, who could it be, oh this is terrible. Your mind will continue to jump from place to place struggling to figure out what might be occurring.

Wow, all of those intense thoughts have now led to a whirlwind of emotions.

Moods/Emotions/Feelings: I am so anxious about all of the things I might have done or might have happened. I feel super depressed because my friendship may be over. I am so angry at them for feeling this way about me.

These emotions are so strong, I can feel them physically.

Physical Reactions: I may throw up, my heart is racing, my lungs feel heavy, I am sweating, I am shaking.

Now that I am experiencing all of these physical changes, I can’t just let it go, I am going to do or say something at the end of class.

Behaviors/Actions: In the moment: Lack of focus on math. After class: I am too scared to talk to my friend, maybe I’ll just walk out of class without talking to them (this may lead to a rift in your relationship). I am going to yell at my friend or say the meanest things I can to them for not talking to me because I am certain that they are angry at me so I am going to attack first. Let me come up with that list of meanest things now so I will be ready. Perhaps you bad mouth your friend behind their back or tell others that you are angry or upset with this friend for what they did which could lead to the destruction of your friendship or their friendships with others. Some of these may seem like extreme reactions but they happen all the time.

Gosh, that’s a lot of stuff going on in terms of possible thoughts, feelings, physical reactions and behaviors! Now what if I told you that your friend was just super tired because they stayed up late watching a movie, they barely got any sleep and they didn’t even hear you say hello. You have just spent the last 45 minutes creating countless scenarios of what you may have done wrong, you are possibly highly anxious, super depressed or incredibly angry, you made yourself physically ill, you may hurt or destroy your friendship with your behaviors afterwards by separating or retaliating, oh and you didn’t learn any math so you might fail the next test all because you created a false reality in your head. Learning how to stop this spiral is crucial in learning how to better our relationships and also manage stress, anxiety and depression.

In part two we will discuss why this happens and what to do to stop ourselves from getting caught in negative thought spirals. Check it out here: Part Two

Be well,

Dr. Ben Alpert :-)

To discuss this and other issues or behaviors in detail, contact us at Hilber Psychological Services. To read more about cognitive distortion, feel free to click on this additional blog post.

Burns, D. D. (1999). The feeling good handbook. New York, N.Y., U.S.A: Plume.

Greenberger, D., & Padesky, C. A. (2016). Mind over mood: change how you feel by changing the way you think. Second edition. New York, NY: The Guilford Press.

Mark Hyman MD is the Director of Cleveland Clinic’s Center for Functional Medicine, the Founder of The UltraWellness Center, and a ten-time #1 New York Times Bestselling author. At the peak of his career, he suffered a broken brain, causing him to turn into someone he no longer recognized. He felt like he suffered from depression, ADD, and dementia all at once. 

The epidemic of the broken brain is something you feel, hide, and fear. It is the leading cause of disability and effects 1.1 billion people around the world. 1 in 6 children, 1 in 2 elderly, and 1 in 4 people during their lifetime are effected by this epidemic. Mark Hyman MD created a docuseries, Broken Brain, to help transform your understanding of brain health. It is a series describing everything he learned on his journey to curing his broken brain, as well as diving in to the top brain disorders and learning why they happen and how to address their main root causes. This docuseries reveals what conditions like Alzheimer's, Dementia, ADHD, Autism, Depression, Anxiety, and Brain Fog have in common. Many root causes of brain disorders are outside of the brain. The rest of the body can play a huge part on mood, memory, attention, and behavior problems. 

Of all the highlights and benefits learned from this eight episode series, here are the top 5 take aways Mark Hyman MD and his team learned from the Broken Brain docuseries. 

1. The Gut-Brain Connection
According to Dr. Raphael Kellman, gut and brain expert, "Embryologically, the gut and the brain start out at the same point, and then one goes up and one goes down. When two cells start from the same place, they always retain a memory for each other. They’re constantly speaking to each other in so many different ways. They’re communicating messages to each other. These messages are part of a communication system that really outshines any type of communication system that we know of today with our modern technology." The gut is considered your second brain. Therefore, a healthy gut leads to a healthy brain. By keeping our intestines and microbiome healthy and clean, our brain will remain healthy. 

2. Brain Health is Connected to Blood Sugar
Blood sugar is related to a healthy brain, especially memory loss. Experts are calling Alzheimer's type 3 diabetes. Dr. Ann Hathaway states, "When your blood sugar is high, it pumps your insulin high, and insulin is inflammatory. Inflammation is a major factor in cognitive impairment and Alzheimer’s disease. Also, high blood sugar causes something called glycation, where the proteins throughout your body, including in your brain, get a sugar molecule added to them. That addition of a sugar molecule to a protein is damaging—that’s actual damage to that particular molecule in your brain." It is important to keep your blood sugar low so that no additional sugar molecules damage your brain. 

3. The Thyroid and Your Brain
An unhealthy thyroid can cause anxiety, depression, brain fog, and many other mental health disorders. Dr. Izabella Wentz suggests, "For people with Hashimoto’s and for thyroid disease, focus on eating a whole-food-based diet that’s minimally processed. I’ve seen the most benefit from patients going on a Paleo diet, as well as the Autoimmune Paleo Diet. We see symptoms like headaches, panic attacks, palpitations, weight gain, fatigue, all these symptoms begin to melt away when we get rid of the reactive foods and focus on eating organic, wild-caught, and real foods." 

4. The Role of Fats in Brain Health
A low-fat diet is not always the answer. By avoiding all fats, we avoid the good fats. Dr. John Ratey states "omega-3 fatty acids are perhaps as good a treatment for things like bipolar illness as are some of our bipolar drugs. With that came a whole lot of research looking at omega-3s as a way to treat mood, anxiety, ADD, and autism. It has a positive effect on all of those pervasive problems. Plus, it’s great for the heart, skin, bones, the connections in our body, and also treats arthritis and the like.” Don't cheat yourself of the fats your body and brain need to stay healthy.

5. The Role of Community in Brain Health
One of the biggest take aways these experts had from this docuseries is the importance of community. According to John Ratey, "real connection is vital, and I call this vitamin O—vitamin oxytocin. Oxytocin is the thing that mammals get when they’re in a community, touching one another, hugging, and they’re sitting down eating together. That sharing, that social bonding that happens, that glue that cements us together is really important." As we grow older, it is important to remember to take our prescribed medicine, get exercise, but most importantly stay social and connected to your community. 

Watch the entire 8 episode docuseries for free to learn more about your brain health. Watch episode 4 to learn more about ADHD and autism. Watch episode 5 to learn more about anxiety and depression.

If you have questions about these services and how they can affect you or your child or would like to schedule an appointment, please contact us. For more information on therapy, visit FAQ at Hilber Psychological Services

Written by Allison Parker and Tanya L. Hilber, PsyD

Reference: Hyman, Mark. “5 Things We Learned from the Broken Brain Docuseries.” Dr. Mark Hyman, Hyman Digital, 5 Jan. 2018, drhyman.com/blog/2017/10/27/5-things-learned-broken-brain-docuseries/.

Emotions of children on the autism spectrum are often hard to comprehend. It is important to help children not only identify an emotion, but also connect that emotion to a specific event. According to Alice Kassotaki, speech language pathologist MSc, BSc, there are four steps to identifying emotions.

• -Step 1: Definition of the child’s emotion: “Nick, you look scared”.
• -Step 2: Connection of the emotion while it is being expressed: “Maybe you are scared because this is a new game”.  
• -Step 3: Confirmation that it is normal to have such an emotion: “It makes sense to be scared when you try something new for the first time”.
• -Step 4: Reassurance: “Let me help you. It will be easier and less scary if we do it together”.  

There are many simple games that can be played to help children identify emotions. Mirroring emotions and having children guess how you are feeling is a great way to have them practice recognizing emotions. One a child has accomplished this step, they will later learn how other people think, and then eventually be able to connect how their feeling in regard to what they are doing.

Children on the autism spectrum may have difficulties displaying empathy. However, during the transition period from early childhood to preschool age, children are able to gain some skills. For example:

• verbal and nom-verbal characterization of the emotional expressions
• use of emotional language to describe personal emotional experiences and to clarify others’ emotional experiences
• development of knowledge about the rules of emotional expression and how various emotions can occur at the same time
• gradual understanding of social emotions such as guilt

It is an important first step to understand one’s own emotions. Once this is achieved, identifying, understanding, and reacting to others’ emotions is crucial to building strong social skills. Misunderstanding social ques, such as non-verbal signs, can lead to miscommunication. A child may unknowingly misbehave because of the lack of understanding. This can often be avoided by teaching children specific emotions and reactions in the clearest way possible.

At a young age, 4 to 6, most children are able to understand the main emotions: joy, sadness, anger, and fear (think of the Disney movie, Inside Out). More complex emotions, such as pride, guilt, and shame, must be learned through the main emotions. Here are 7 ways to help children understand the complex emotions:

1.     Attention approach: some children must be taught to pay attention to social information. When you notice a child feeling a certain emotion, such as anger, state their emotion and why they are feeling that way while continuing to show nonverbal signals, such as crossed arms and stern voice.

2.     Naming the emotions: As a child begins to pay attention to social information, teach them the names of the emotions, starting with the main emotions. Using pictures of familiar faces with obvious emotions can help the child relate the name to the understanding of the emotion.

3.     Designation emotions: Once a child is able to look at a frown and identify that that person is sad, teach them how to designate each emotion. Ask questions such as “How does he feel?” to be able to designate different emotions

4.     Actions based on emotions: Now that the child is able to understand and designate each emotion, help them react based on emotions. Rather than looking at pictures, show them real life examples of emotion.

5.     Role-playing: Give the child different scenarios of receiving ice cream and feeling happy or losing a toy and feeling sad, allowing them to role-play and further identification and expression of emotions.

6.     Modeling (filming): When watching a movie or television show, point out characters’ emotions that the child will be able to relate to.

7.     Games and books: Playing board games and reading books are also great ways to help the child learn about others’ emotions in different situations. This is a way to turn learning into an interactive activity.

While this information is geared towards individuals on the autism spectrum, this same information about identifying and understanding emotions can be used to all children. 

 Contact us for more information on children on the autism spectrum, learning and expressing emotions, or for help with children who are struggling.

~Written by Allison Parker and Tanya L. Hilber, PsyD

Reference: Kassotaki, Alice. (2017). “Emotions of Children on the Autism Spectrum.” Upbility.

One of the best ways to continue living a balanced lifestyle is to reduce stress levels, especially during the holidays. Stress does not only ruin your holidays, but it's also bad for your health. Between shopping, baking, cleaning, and entertaining, we sometimes forget that the holidays are supposed to be a fun, relaxing time spent with family and friends. When stress reaches it's top peak, it can be hard to gather and regroup. Here are some practical tips to help you get through the holidays, stress free: 

1. Acknowledge your feelings- Just because it is holiday season, that does not mean you have to be jolly all the time. If you have lost a family member or are unable to be with loved ones this holiday, it is okay to feel sad and cry. Acknowledging how you are feeling and accepting it can make the hard times a little more bearable.

2. Reach out- If you are feeling lonely, reach out to your community. Volunteering is a great way to pass time while feeling better about yourself and broadening friendships amongst your community. 

3. Be realistic- As years go on and people grow older, it is hard to make holidays perfect and the same as last year. Although traditions are important, there is always room for change. If family members are unable to make it this year, reach out and celebrate in other was to continue the holiday festivities.  

4. Set aside differences-  Try to make the most out of the time you have to spend with people. Accept family and friends for who they are and pick a different time to talk about your problems. Remember that other people are suffering from holiday stress as well. 

5. Stick to a budget- Holidays are not about who spent the most money. Before you begin shopping,  decide on a realistic budget and stick to it. Use techniques such as homemade gifts or family gift exchanges to keep the cost low. 

6. Plan ahead- Set aside specific days for shopping, baking, and visiting friends. Plan out events first then make lists of what you need to avoid last minute scrambling. Reach out to friends and plan ahead for party prep and clean up. Through all the madness, don't forget to save time for yourself. 

7. Learn to say no- Saying yes to every event will only lead to more stress. Friends and family members will understand if you can't participate in everything. If you start to feel overwhelmed, prioritize and take something off of your list.  

8. Don't abandon healthy habits- Eating healthy, exercising, and appropriate amounts of sleeping are all still important even during the holidays. It's easy to get caught up in the sweets every now and then,  but don't forget to take care of yourself.   

9. Take a breather- Spending just 15 minutes alone without any distractions can make all the difference. Go for a walk, listen to music, or read a book are some healthy ways to distract yourself and help with self care.  

10. Seek professional help as needed-  Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, talk to your doctor or a mental health professional. 

Effects of too much stress or chronic stress can exacerbate current problems or create more problems in life. The healthier your family is, the less difficult holidays are and the more enjoyable the holidays are. The more dysfunctional your family, the more important it is to have a survival plan. Use these tips to not only get through the holidays, but to get through everyday. 

If you have questions about stress and how it can affect you or your family's health or would like to schedule an appointment, please contact us. For more information on therapy, visit FAQ at Hilber Psychological Services. 

Written by Allison Parker and Tanya L. Hilber, PsyD

Reference: Mayo Clinic Staff. “Tips for Coping with Holiday Stress.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 16 Sept. 2017.