Cognitive-Behavior Therapy, Mindfulness, CBIT, ERP, CBT-I, Behavior Consultation, and Treatment for Anxiety and Insomnia

Laura Van Schaick-Harman, Psy.D., BC-TMH


Dr. Laura's Meaningful Psychological Services

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Can You Escape in Time?

Posted on April 11, 2018 at 5:10 PM Comments comments (5)


Picture this: You are locked in a room with no windows and can't get out until you solve a series of challenging clues, riddles, or simple math problems. If you are starting to get very anxious by this imagery, then going to an escape room might be a good exposure for you.



When we are anxious, our natural fight or flight reaction kicks in gear. As we have learned before, this response changes our physiological experience. We may experience shallow breathing, faster heart rate, sweaty palms, or tingling in our arms or legs. Because these sensations are uncomfortable or just plain scary, we tend to avoid situations that trigger our anxiety. While this seems like a great idea since the feelings seems to go away or dissipate and we feel better. However, this is only a short-term temporary fix. The next time we are faced with the situation or something similar, we are likely to feel the same level or even increased anxiety. Then we avoid, feel better, then worse again. The cycle continues.



Once we assess the true danger of a situation, we can work towards no longer avoiding situations that trigger anxiety when they are in fact safe.



Recently, I was locked in that room I described earlier as part of an escape room game. We had 1 hour to complete a series of puzzles, challenges, and questions in order to get the keys to be let out of the room. The puzzles were harder than I expected. We didn’t get out in time! Does that mean I am writing this now in the corner of that very room since I have been trapped there for several weeks? No. We were not truly trapped. Once the hour was up, an employee came in and explained the remaining answers to us and let us go.



This experience, while anxiety provoking, is a fun way of exposing us to a fear and worry. There are many types and levels of rooms and challenges. The themes vary too- from light and fun (we did one where you are stuck in a bakery) to scary (themes from horror movies).



If you worry about being in closed spaces, consider an escape room exposure. Grab some friends, challenge yourself, and have some fun! I suspect that you will grow and you will be able to cope with being "trapped." Remember, we are rarely every truly trapped in any situation. Anxiety can make us feel that way. Let's test anxiety and see if it is telling the truth or not. Good luck!

Dealing with Test Anxiety

Posted on April 11, 2016 at 1:35 PM Comments comments (5)

It's April, and for many of you college students you are preparing for finals in a few weeks. For those of you not in college, this post still applies for any type of test or work presentation. If you suffer from worry, anxiety, or panic symptoms before, during, or after an evaluation, continue reading for some helpful strategies to get you through.

 

 

Five Ways To Cope With Test Anxiety

 

 

Deep Abdominal Breathing

 

When we take deep breaths, it is important to make sure the air is getting deep enough. To know if you are bringing the air to the right spot, place one hand on your belly and one hand on your chest. Both should be rising and falling as you breathe, but your belly should be rising higher. Picture a balloon inside your belly slowly filling with air and then slowly deflating when you breath out. Focus on the way the air feels or how your body feels taking in this nourishment as you inhale and exhale.

 

 

Effective Preparation

 

This may seem like a no-brainer, but it is still important to cover. Our mind and body give us feedback about our environment. This is necessary for survival and healthy functioning. It is why we become fearful in dangerous situations. If we do not prepare for the test/evaluation, our mind says "uh, wait a minute here. I don't know how to process this situation. Alarm, alarm, alarm!" And our body feels the corresponding anxiety symptoms. While taking a test is not necessarily a dangerous situation, there are negative consequences for not performing well on a test. Hence, our mind will react accordingly. Note that this is unlikely to occur if you do not care about the negative consequences or the outcome of the test.

 

 

Healthy, Realistic, and Optimistic Thoughts

 

The way we think affects the way we feel which in turn impacts our behavior. We can be responsible for the thoughts we have about a test. If we interpret studying for a test as boring and a waste of time, we are less likely to prepare. If we interpret the test as a challenge that provides a stepping stone to our career, we are more likely to prepare. Our thoughts about the test while taking it also matter and can influence our performance. It is important to be realistic. If you haven’t studied at all and really never had a good handle on the material, thinking you are going to ace it is unrealistic. Thinking that you will do your best with what you have is more effective. Thinking that one test will make or break your life is also unhelpful and most likely not true.

 

 

Mindfulness-Focus on Here and Now When Taking the Test

 

Every second you have an opportunity to be mindful- to be fully aware of your experience taking the test. This means getting comfortable with being uncomfortable, focusing on the test itself, and being aware of any distracting thoughts with non-judgment and acceptance. This is a skill that takes practice. It is a good thing that we can practice any time we want because there is always the current moment available to us. Why not live in it?

 

 

Awareness of Cycle of Anxiety and Panic

 

Sometimes we get so anxious preparing or taking a test that we experience feelings of panic or a full-blown panic attack. While incredibly uncomfortable and terrifying, panic attacks on their own are not usually dangerous. It is important to understand the cycle of panic to stop it before it starts. We may feel anxious and start to notice our breathing and heart rate increase. Once we have had panic attacks diagnosed, we can understand that our body is falsely alarming us to a danger that is not real. Using healthy coping skills (some of them are mentioned above) can make a big difference.

 

I hope you apply these skills and have some great performances on your upcoming tests!

What's Your Movie Theater?

Posted on July 10, 2015 at 9:00 AM Comments comments (2)

Several years ago, I experienced a panic attack (yes, psychologists can get them too). I was sitting in the middle of a packed movie theater with friends when another movie goer had a medical emergency that was very scary and yucky (I'll spare you the details) and involved 911 and several medical professionals. The scene played out in the theater and blocked the only non-emergency exit. Faced with sights and sounds of the other person as well as being in the middle of a row with people on either side of me, I panicked.

 

Panic attacks occur very suddenly and sometimes can feel as if they come out of nowhere. Other times, we are able to identify an event that sets it into motion. Let's break this down using my panic attack example. The trigger was the medical emergency. The way that I interpreted this event ("I'm trapped," "are they going to be ok?" "why hasn't the theater stopped the movie and gotten us out of here?" "what's wrong with that person?") affected the way that I felt (nervous, sweaty, breathing rate increased, dizzy, tingling). The cycle of panic continued. I then interpreted the feelings as being more severe or dangerous ("I'm going to be sick," "why do I feel like this?") and then the feelings intensified (sense of derealization, heart rate increases, lose feeling in hands, stomach upset). Thankfully, I recognized the symptoms as a panic attack and was able to utilize coping skills to break the cycle and prevent symptoms from getting worse. I was able to stay for the remainder of the movie, rather than leave once the scene was cleared. If I left, I would have reinforced my anxiety by escaping the situation.

 

For a long time after this experience, I struggled with returning to that theater. This is called avoidance. The problem with avoidance is that you feel better in the short term (e.g., "good thing I didn’t go to that mean and scary movie theater because I feel better now") but the longer we avoid, the harder it is to go back. Family and friends would invite me to go, but I would work hard to get everyone to choose a different theater so I could avoid going back. This was the wrong thing to do!

 

Once I finally decided that this was ridiculous and unhealthy, I went back. This is called exposure. The first time was pretty uncomfortable. Over time, it became easier and easier to go to this theater. This is because I had to actively work on breaking the connection between the movie theater and having a panic attack and/or witnessing a scary medical emergency. The more I went and nothing scary happened, the easier it was to go. I also paired the exposure with relaxation techniques. This is to help replace the scary environment with a relaxing one.

 

If you are avoiding a situation that has an uncomfortable memory for you and is a place where you should be otherwise safe in, I invite you to decide to change this. A psychologist can assist you with the necessary tools and skills to regain the courage and the strength to return to your movie theater, wherever that may be for you.

 

It feels great to be able to see movies in this theater again, and to be able to share this story with you (which is another form of exposure, by the way).

 

"Hakuna Matata"

Posted on April 1, 2015 at 7:55 PM Comments comments (1)

"Hakuna Matata- it means no worries" (from The Lion King). This is a phrase I often sing to my baby. We even put a picture of the phrase on his nursery wall. As a Mommy, I never want my son to feel anything but happy and I don't want him to ever feel anxious. As a Psychologist, I actually do want him to experience worry and anxiety at certain points in his life, within reason. Why?


It is unrealistic and unhelpful to be happy and carefree all of the time. Negative emotions such as anxiety, sadness, and anger serve as motivation to make changes in our life. These feelings provide feedback to us that something is not quite right, very wrong, unsafe, dangerous, or not the right fit for us. It can also be an indicator that we need to develop better coping skills or seek professional help.


As parents, we might want to rescue or save our children from worries and anxious feelings. I believe this is a natural parental reaction. But attempts to save your child from anxiety can actually be making anxiety stronger.


Picture this. A child we will call Bobby is looking at a group of peers playing at a birthday party. Mom and Dad know that Bobby has concerns about playing with new people and is nervous to initiate play. Mom and Dad want him to have fun and end his anxiety so they bring him over to the group of peers and the parents initiate the play for him. They might say, "Bobby wants to play with you. Can he join in?" Sounds ok enough, right? Sure, Bobby can now play with his peers. But let's suppose there is a problem during the play such as a peer takes a toy away from him. Bobby becomes nervous and looks for parental support to solve the problem for him. In fact, Bobby learns to wait for his parents to initiate play for him in the future too. Bobby has just given his anxiety and worries a big reward by allowing his parents to speak for him. Bobby learns that he is not strong enough to deal with his worries, so he is likely to avoid situations on his own unless a parent is there to speak and solve problems for him.


This is one example of how anxiety can be reinforced. There are other ways anxiety can be reinforced and other circumstances when it is totally appropriate and helpful for parents to help their children initiate play and solve problems as described above. My goal in this month's post is to challenge parents to take a deeper look into their child's behavior and see if anxiety has been reinforced accidentally. You can discuss your observations and concerns with a mental health professional who can help you with managing your child's behavior.


I hope you and your children do not have too many worries and that you can recognize anxious feelings as providing you with valuable

information.


And maybe sing a song of "Hakuna Matata" to someone today.

Live Meaningfully With Anxiety

Posted on February 12, 2015 at 7:05 PM Comments comments (0)

Living with anxiety can be overwhelming, smothering, and in some cases, debilitating. Living with anxiety can also be meaningful, purposeful, and embraced. Yes, that is what you just read. For those of you reading this post who suffer from anxiety, you may think I am kidding. I'm not.


The truth is that we all experience anxiety in one form or another. There are many purposes for the experience of this uncomfortable, yucky, and scary feeling. Anxiety is necessary for survival. Our bodies and brain provide feedback to us when we are in a potentially dangerous situation. Anxiety can motivate us to change our current situation. Anxiety prepares us for novel experiences and difficult tasks such as a job interview or test.


We know from research that a little bit of anxiety can be helpful, but too much or too little could hurt our performance. This is explained by the Yerkes-Dodson Law. A simple diagram can be found on this website.


Basically, anxiety can be used for helpful and purposeful activities, when in moderation. Too much anxiety is what leads to feelings of being smothered and wanting to avoid the world around us. Many students describe this feeling as their mind "going blank" when taking a test. Too little anxiety can lead to being unprepared for new and difficult tasks.


It is important to remember that anxiety has a purpose. We can check in to our surroundings, environment, habits, activities, and lifestyle. Is there a change that needs to be made?


This information is one of the reasons I created the Live Meaningfully With Anxiety Room. There are several recordings available that explain how to live with anxiety in a healthy way. These resources are completely and totally free. You can access them on my website under Anxiety Resources.


Please seek the support of a mental health professional if you experience increased anxiety.

Halloween and Anxiety: A Good Treat or a Bad Trick?

Posted on October 17, 2013 at 9:40 PM Comments comments (0)


It's October, which means that school has been in session for a while, the leaves are changing beautiful colors, the temperature is cooling, and the holidays seem to be just around the corner. October is also a month during which many children and families (and some grown-ups too) are getting ready for Halloween. They are shopping for costumes, candy, and decorations. Many kids like to do the decorating themselves, allowing them to express independence and creativity.


 

Some homes are decorated with spider webs and pumpkins. Others are grounds for mock cemeteries with RIP stones on the lawn or have elaborate haunted houses available. Some homes have human size fake bodies covered in blood or with missing body parts stationed in front. Many people will enjoy these decorations in the spirit of Halloween. Many will not.


 

What about people who suffer from anxiety? What about children who have nightmares at the first look of a scary cartoon? What about adults with a fear of dying, getting injured in some way, or getting lost where they can't escape? How are these individuals affected?


 

People with anxiety may experience Halloween differently. We are all individuals and can tolerate different types of stimuli. Some will have nightmares (yes, even grown-ups), want to avoid certain settings (trick or treating at certain houses, parties at school, scary movies), or become fearful.


 

This is important to remember as you decide how you will celebrate. If you are a parent and your child suffers from anxiety, you know your child best. If you are an adult, you know yourself best. It is OK and healthy to decide which festive activities to participate in.


 

There are many programs designed for children that are actually very scary. Many "kid friendly" shows and movies can present concepts that may be difficult to understand such as kidnapping, death, illness, witchcraft, and ghosts. As a parent it is important to be sure that you are permitting your child to experience material that is appropriate developmentally and emotionally.


 

Now, let's not be confused with exposure treatment for anxiety. A general rule of thumb is that when we avoid something we are anxious about, it reinforces our anxiety, making it more difficult to face that situation in the future. This is true. Within the context of Halloween, however, I believe it is OK to avoid certain stimuli that are not needed for healthy development or functioning. If your child cannot attend school during the season because he/she is afraid of the parties, decorations, or costumes, it is important for him/her to attend school anyway. This would be a case when anxiety can be inadvertently reinforced if the child is permitted to stay home. A talk with the teacher may help to modify classroom stimuli to make it safer for your child to be there. Working with your child on coping skills can also help him/her feel safe in school. If your child wants to avoid scary movies, then this is OK. Let them. One does not need to be exposed to scary or horror films in order to develop appropriately. One does, however, need to be educated. See the difference?


 

And for you grown-ups out there who love horror films and Halloween parties, have fun! For those of you who want to crawl into a hole instead of watching the "however many nights of Halloween" specials on TV, then read on. It is OK that you do not like this material. We all have different tastes, interests, and levels of tolerance. Decide how you would like the next few weeks to be for you and make a plan.


 

Trick or treating is another interesting activity for people with anxiety. Think about it. You dress up in a costume, walk up to a stranger's door (or hopefully someone you know and have determined is safe to trick or treat from), knock, wait for someone to answer, say "Trick or Treat," hold open your bag or bucket, say "thank you," walk away, and repeat. Also, you have to stay with your friends and family, possibly walk a long distance in unusual clothing, and accept whatever treat has been given to you. Not such a simple process, right? Trick or treating can be a great way to practice social skills, follow a routine, and be exposed to new and unpredictable situations. However, how important a life skill is it to knock on people's doors and ask for treats? You decide.


 

Consider all of this information as you decide, either for yourself or your children, how to participate in Halloween. You can choose the specific activities to join, consumes to wear, stores to shop in, parties to attend, houses to trick or treat at, movies to watch, or candy to eat. Utilizing your power to choose is a great skill to practice for healthy development and functioning.


 

So, what is Halloween for you? A good treat or a bad trick?


 

#Halloween #Anxiety

How to Have a Fun, Meaningful, Successful, and Memorable College Experience

Posted on September 13, 2013 at 9:45 PM Comments comments (0)


College-what an exciting and terrifying time! It's exciting and terrifying for both students and parents. It’s the start of a brand new learning experience. It's an opportunity to shed old reputations and try on new ones. It's a time to challenge yourself and reach goals you never thought you could. It's a time to form lasting relationships and friendships. It's a time to learn and practice stress and time management skills. It's also a time when independence and autonomy gets tested. It's when "all nighters" might be pulled, parties are attended, and anxiety experienced.


Many people describe college as life changing and feeling as if they have grown tremendously during the years they spent in school. College can be a truly amazing and fantastic experience that can impact your life in a healthy and positive way. For some, however, ineffective management of college life can impede on personal growth and can even be hurtful.


What kind of college student are you? What kind of college student do you hope to be? If you are a parent of a college student, what kinds of hopes and dreams do you have for your "all grown up" child?


If you want to have a fun, meaningful, successful, and memorable college experience, then please read on!


This is an exclusive sneak peak into my brand new initiative, the College Suite. This will be open to students, parents, and teachers. Details coming soon. I can't wait to share this opportunity with you!


In the meantime, I have included a selection of helpful strategies from the College Suite that I have learned, taught, and practiced for having a super college experience.


Get Involved!

Getting involved in college activities, clubs, and events can change a boring and stressful college experience into a fulfilling one. This is true even if you feel like you can't possibly fit another minute into your day. Joining a club or attending an event can actually help refresh your mind and make those classes and homework time more productive.


Reevaluate

What worked in high school might not work in college. What works in one class might not work with another class. What works with one professor might not work with another. This means that it is important for you reevaluate your study techniques (flash cards, highlighting, groups, etc.), test taking strategies, workload management, etc.


Be Here Now

One can be in attendance in class but not be present. This means mindfully being in the room with your attention and awareness focused in the present moment. Really hear and see what the professor is teaching. You can text and Facebook surf later. You can daydream later. Your messages will be waiting for you. What was taught in class may not be repeated and you may miss an important piece of information.


Take Care of Test Anxiety

Many college students struggle with test anxiety, even if they have never experienced anxiety before. Learning effective study strategies, preparing adequately (not too much and not too little) for exams, practicing deep breathing, managing stress, and learning effective test taking techniques can really help alleviate discomfort and enhance performance. The counseling center on campus and a therapist in the community can help too.


Check my website and Facebook page for updates in the next few weeks about how to join the College Suite. You can also sign up for my newsletter on the website and you will be the first to know!


 

#collegesuccess #collegeexperience

Back to School: Is it REALLY Time Now to Get Ready?

Posted on July 29, 2013 at 9:50 PM Comments comments (0)


Recently I was in a bagel shop enjoying a delicious meal when I looked up and saw on the menu that they had an entire board devoted to "Back to School Savings." What? Why does a bagel shop need to have back to school savings and especially why is this even an option in July. This is an example of a huge movement in retail and other public arenas to start preparing for transitions way too early. I have been seeing back to school sales in all of the major chains and smaller stores as well for weeks. Now, you must know that I actually LOVE shopping in these sections and purchasing school and office supplies and I always have. Growing up (and I actually still do), I considered myself to be a nerd. I loved school from my very first day of preschool and was always eager to learn, and of course, get ready for my next school year. I don't remember, however, how early my parents felt the pressure needed to prepare me for a big transition between grades and even bigger--between schools. Having some anxiety myself, even for a kid who loved school, getting ready for and talking about this transition definitely heightened nervousness.


Fast forward to today, working as a psychologist and seeing so many children becoming anxious about going to school, I became so interested in the retail phenomena of back to school savings. Working with schools and families, I have learned about the work and stress that goes into planning big graduations, especially for preschoolers. While these events are important to have and it is great to celebrate accomplishments, it is still necessary to balance the excitement between one school year ending and another one beginning. There are two months (typically) between these two milestones. Parents-enjoy the summer and time off with your kids. There are plenty of books and professionals you can access to help prepare your children for the next transition when the time is right.


How do you know when the time is right? The answer is (as I learned in graduate school that this is usually the correct answer) it depends. For some children, they may be eager to start talking about and visiting their new school or anxiously awaiting at the mailbox in late August for the name of their teacher or class schedule. Other children may be more nervous (whether they are verbally communicating this to their parents or not) about beginning a new year. This may be especially true when the summer marks a transition between two levels of school (such as between preschool and Kindergarten, and Junior high and high school). It is normal to experience a certain level of anxiety about starting a new school year. After all, it is a chance to learn new things, meet new people, and challenge yourself with a new curriculum. But let it be that. And let it stop there. No need to talk repeatedly about transitioning to Kindergarten by practicing graduation songs in March. No need to purchase 6 different books to start reading them to your child in June. You know your child the best and you know what they need. Listen and pay attention to your child's words and behaviors. They are communicating to you. If you know that you have told your child they are going to Disney World two months before you are actually leaving and they can’t stop talking about it or asking you when you are leaving multiple times a day, you may have learned that they transition better when told about something new a few days prior to the change. If you child does better with slowly processing new information and upcoming changes, he/she may need to be prepared a bit earlier in slow increments.


There are some helpful ideas for preparing your child to start a new school year. Some parents have shared that reading books (and you can buy them easily at any bookstore or online) about going back to school have been helpful. Others have found it helpful (and this is one of my favorite and often recommended ideas) to have a special trip to the store with your child to choose his/her school supplies and give input into the materials that work best for them (and are required by the school). Some parents choose to bring their child to the playground of the new school and let them get used to the scenery. There are many ideas that can be used. The most important things to remember are to know your child, listen to what they are communicating to you, let them know they will be safe at school, and you will be there every step of the way to help them transition.


Some children may need a little extra support to talk about, prepare for, or make the transition to a new school year. This is ok and there is lots of support out there. I love working with children and families and helping with this transition. Call me, write me an e-mail, or visit me online and I will be happy to help. You can also post on my Facebook page. I love to hear your thoughts!


So now, go and enjoy the rest of summer with your kids.


#DrLauraVSH #BacktoSchoolAnxiety