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

Online and Office Based Cognitive-Behavioral Therapy

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Permanent Decisions and Temporary Feelings

Posted on April 17, 2017 at 1:00 PM Comments comments (25)

Have you ever said something and then almost immediately regretted it? Most, if not all, of us have been there are at one point or another in our lives. When we get down to the basics of this experience, we learn that we let our feelings dictate our actions. In other words, we let a temporary state make a permanent decision for us.


Our emotions can be experienced so intensely at times. We feel so angry at our spouse for forgetting to take out the garbage again. We feel scared that the darkness while driving will be too much to handle. We feel sad that our friend cancelled plans on us. And so we yell at our spouse, or avoid driving at night, or mope around the house the entire weekend.


These actions are hard to undo or take back, and often leave a permanent mark on ourselves or someone else. Handled a different way, the feeling would have passed and our choices would have been much less detrimental to those around us.


We have more power than we think. Our feelings are temporary. They will go away. Why make a permanent decision based on a temporary feeling?


This month, I am challenging you to respond with grace, respect, love, hope, and self-care. Use your problem solving skills and think of an alternate solution. Remember, all feelings are ok. What you do with them is what matters.

Why I Love My Role

Posted on September 12, 2016 at 2:30 PM Comments comments (4)

I love my job. I love that I get to learn from others. I love that I get to share the happy moments and the sad moments. I love that I get to help someone work through a hurt or anger. I love seeing the world through multiple perspectives.

 

Being a psychologist is such an awesome job. It isn’t an easy one, of course.

 

I love that I can feel what others feel. I love that I can share knowledge imparted on to me to give to you. I love that you’re reading this right now. How amazing is it that we can share information together? How wonderful that we can work together to change a family system, a classroom, a marriage, a workplace, or a relationship.

 

I love that when a client makes a decision to seek therapy and put in intense effort and energy, they are not only feeling better, but getting better. They are not only helping themselves but helping others. They are not only improving one situation but others.

 

Have you heard about the 6 degrees of separation theory? You can read a little about it here- https://www.psychologytoday.com/articles/200311/six-degrees-separation

 

The world is small. Our connections are strong. We may be more connected than you think. If you choose to make a healthy change in yourself, you may be inspiring a healthy change in someone across the country. Amazing.

 

I love psychology. I love our brains. I love that people work to make healthy choices. I love being a psychologist.

 

I am in awe when I think about someone somewhere at this moment is experiencing the worst moment of their life and that moment will lead them to contact a psychologist for help. I am in awe that my role can help that person (and others) through that moment. What a wonderful role to have- because of you.

 

And for that, I thank you.

How Are You Sleeping?

Posted on June 14, 2016 at 12:15 AM Comments comments (6)

How are you sleeping? This is a question that may not be often asked, yet the answer certainly weighs on our mind and affects our daily life. Sleep is an important component of wellness. When we feel that we don't get enough of good quality sleep, we may be tired, in a bad mood, lack energy, or make poor decisions.

 

Understanding the components of sleep is essential to getting adequate rest. Did you know that you may be spending too much time in bed? Did you know that you might actually be trying too hard to sleep or that wearing sunglasses during the day could affect how well you sleep?

 

There are multiple factors that contribute to sleeping habits and problems. These include medical, psychological, emotional, behavioral, and cognitive components.

 

Learn how to change habits and explore options for improving your sleep. There is a life without sleeping pills available to you.

 

In my practice, I am now offering treatment for insomnia using the preferred method for treating this sleeping problem- Cognitive-Behavior Therapy for insomnia (CBT-I).

 

This can be used as part of therapy, or as a stand alone service (5 sessions over 6 weeks). For more information about this program, head on over to my service's page and start on the path to a good night's sleep.

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).

 

Focus on Mental Health

Posted on May 11, 2015 at 3:30 PM Comments comments (1)

 

May is National Mental Health Awareness Month. It is my hope in this month's post to reduce stigma around mental health concerns and utilizing therapy. There is great need for psychological services in our communities. It is an area ever evolving, changing, and growing.

 

Notice May is Mental Health not Mental Illness Awareness Month. As mental health professionals, our commitment to our work involves not only reducing symptoms, but also identifying and building strengths and abilities. Mental health is so much more than not having mental illness. It is not the absence of symptoms. Many mental health professionals will be able to help people not only get better but to also enhance strengths, skills, and abilities. A favorite Twitter bio of mine by NY Psychiatrist Dr. Samantha Boardman (@sambmd) includes the phrase "Fix what's wrong AND build what's strong." I love this sentence and I am on board.

 

Early in my training, I was introduced to the concept of looking at what goes right and not always just what is wrong. I am forever grateful for this. It is easy to get caught up in worry, anxiety, stress, and negative thinking patterns. It is not so easy to climb out from under these powerful thoughts and feelings, but it is possible. Therapy can help you dig out, breathe, and keep growing. This is the same concept as the saying "April showers bring May flowers."

 

In my practice, I utilize cognitive-behavior therapy and positive psychology. These styles of treatment have lots of research behind them and have been shown to help. The American Psychological Association has developed several brief animated videos to demonstrate how psychologists can help. You can watch them here.

 

Think you don't have time to go to therapy? No problem. With advancing technology, we can offer online therapy services. You can dig out and grow from your own home, office, car, playground, etc. There are options available so that your mental health can be nourished.

 

If you have questions or would like to learn more about how therapy can help you, I'm happy to talk with you for a free 15 minute consultation. All you have to do is schedule a time.

"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.

Am I An Effective Problem Solver?

Posted on May 1, 2014 at 9:20 PM Comments comments (0)


Should I move out of my parents house? Should my child repeat Kindergarten? Should I get married? Should I accept the new job? Should I get divorced? Should I make-up with my friend? Should I go away to college? These are only a few of the big life questions many of us are faced with at some point in our lives.


 

What about some other, more common questions we ask ourselves on a daily basis? What should I make for dinner? Who should I ask to go to the movies tonight? Where should I park my car? What time should I wake up tomorrow?


 

Opportunities for making choices are all around us. How effective are you at making choices? This may sound like a simple or minor question, but it is more important than you might think. One of the most common reasons people seek therapy is trouble with decision making. Either they are not sure about a major life decision or they experience daily distress regarding making choices.


 

What do we know? Problem solving is key. Effective problem solving starts with specifically identifying and describing the problem (e.g., "I want a raise at work but I don't know how to ask for one"). This gives us a clear picture of what we are dealing with and helps to focus our thinking. Next, consider all of the possible solutions to the problem without evaluating whether or not it is a good choice or a bad choice. It is good to list even the outlandish options (e.g., "push my boss down the stairs and demand he gives me a raise"), since this is an option you could feasibly choose (but hopefully won't!). This step is important to keep your mind open to various choices and not become limited by crossing off choices before effectively considering them. Third, consider each option individually. List the advantages and disadvantages of each one. Try to predict the outcome of each option. Note-you will never be able to predict every possible outcome! Fourth, choose the best option for you and try it out. Fifth, evaluate your choice and re-evaluate as needed.


 

During this process, work on accepting the outcome and avoid punishing yourself if the choice turns out to not be the best one. Try again. Good problem solving takes practice.


 

This process may seem time consuming, and it can be. But I challenge you to this. How much time are we spending with our problems anyway? Why not use the time more effectively?


 

If you find that you are struggling with daily decision making, please seek the support of a mental health professional.


 

How effective are you at solving problems and making choices?

Spring Cleaning

Posted on April 8, 2014 at 9:25 PM Comments comments (0)


Spring is here! Finally! I love seeing flowers bloom, the sun shining, and daylight lasting longer. The air feels warmer, the grass will start to feel thicker, and outside activities are more popular. It's also when we clean our homes, schools, offices, parks, yards, and cars. Some of us will see beautiful weather and exciting opportunities for growth and renewal, while others may see bugs, weeds, and work to do.


 

 

What do you see? What do you want to see? While two people may physically experience the same spring event, they may emotionally experience it differently. You have the power to choose how you will view your spring cleaning.


 

 

Based on years of research in the field of cognition, we know that events (the physical experience) do not directly cause us to feel the emotion we experience. There is space and time during which we interpret the event (how we think) and it is that interpretation that is directly related to the feeling we experience. If we see that it is raining (the physical experience) and think "ugh, more rain. What a dreary day" then we will likely feel a negative emotion such as sad or angry. On the other hand, if we see that it is raining and think "more rain. At least I don't have to water the flowers today" we may feel more positive about the physical experience and feel relieved or even happy.


 

 

 

Our interpretations matter. If you are mindful about how you interpret events, you will be able to observe habits and patterns in your thinking. You will be able to practice changing or modifying your interpretations to be optimistic, realistic, and helpful.


 

When you are cleaning your office, room, home, or yard, remember to spend some time "spring cleaning" your thoughts.


 

 

Happy Spring!


 

Change

Posted on March 10, 2014 at 9:30 PM Comments comments (0)


As I am writing this blog, I am reflecting on the childhood rhyme, "March comes in like a lion and out like a lamb." Since we just had another snowstorm here in NY, I am especially hoping this to be true this year. Why am I talking about weather? I am thinking about change. Change that happens as seasons transition. Change that happens when you have 60 degree days over the weekend and then 20 degree days during the week. Change that happens when you see snow falling, then melting, then falling again.


 

 

While I prefer the warmer weather, being able to cozy up with a blanket, a book or a movie, and family is appealing as well during these cold winter months. But sometimes I wonder- what will the new season bring? Rain? Sunshine? Heat? Flowers? More snow? So often, we spend time wondering about what's next and don't spend enough time in the what is. Spending time in the now is being mindful.


 

 

 

 

Life is like the seasons changing. We wonder when there is a problem we are experiencing (the "lion") if it will ever get resolved. Will we ever experience the calm days (the "lamb") again? Just as it is hard to picture beautiful flowers sprouting from a nutritious rich soil in the middle of winter, it is also hard to picture getting along with the family, being successful at work, getting a good grade in class, feeling happy in a relationship, making a new friend, and achieving a goal. While I would love to say that it always gets better and people always experience the calm, I can't. I can't because it is not always true. The seasons are generally predictable. Winter will not last forever (even though it may feel that way sometimes!). Spring will come. But, how meaningful, wonderful, difficult, messy, or fun the next season will be depends on many factors.


 

To get the benefits out of new seasons and to effectively transition into preferred weather conditions, we need to support the seasonal change. Flowers need water and food in addition to the springtime sunshine to grow. They also need attention. They need someone to problem solve to try different areas in the yard (more shade or more sun) to grow effectively.


 

 

 

 

Why do clients enter therapy? Change. To change themselves. To change someone else. To change a situation. To get more comfortable with change. It all has to do with change.


 

 

I invite you to accept change. To deal with it. To struggle with it. To accept it. To embrace it.


 

 

 

 

What areas do you want to change as we transition into a new season?

How Do We Actually Keep Our New Year's Resolutions?

Posted on January 8, 2014 at 8:35 PM Comments comments (0)


How do we actually keep our New Year's Resolutions? This is a question that is asked each year, usually by the end of January. New Year's Resolutions are essentially goals that we set for ourselves to accomplish during the year. These goals, however, may not be met and are set to be the following year's resolutions. Why does this happen? How can we achieve our resolutions?


In my practice, we spend the first session or two, and then as often as needed, discussing long term and short term goals/objectives. These are different terms, to be discussed below. Often, a New Year's Resolution is a long term goal (e.g., "I want to loose weight," "I want to have a good bathing suit body," "I want to get a new job," "I want to quit smoking") and it does not reflect the certain attributes that are needed to actually be successful in attaining this goal.


If we want our resolutions to be kept, we need to have an understanding of what healthy goal setting looks like. Long term goals are the broad aspirations that we would like to achieve later in the future. They are the end destination in a particular area of our lives. Long term goals may be large or small. Short term goals or objectives are the steps on the ladder to get you there. We don't jump on the roof of a three story building from the ground without climbing each step on the way up (unless we are Spider Man or another superhero-which is highly unlikely). For example, a long term goal may be for a child to learn how to wash their hands independently. Now, this may seem like a simple task and too simple to be a long term goal. However, take a moment and think of all of the objectives that need to be accomplished before the child achieves the long term goal of washing their hands independently. If you need some help, here are just a few of the steps on the ladder: walk to appropriate sink, turn water on, wet hands, pump soap, lather hands (both hands, between fingers, palm and outer hand), rinse soap off, turn water off, and dry hands. The child needs to be able to complete each of the objectives in order to achieve the long term goal.


Why am I writing about hand washing steps? If we have a resolution to go to the gym and loose weight and we have never been to the gym before, we are not likely to start going 4 times a week and maintain this schedule for long. If we haven't been looking for a new job, we are not likely to get hired by a company with a 50% salary increase by January 15th. There are objectives and short term goals that need to be accomplished first.


Goals need to be measurable (go to the gym 2 times/week for 30min each time), attainable (look for a new job to earn more money, not win the lottery), specific (target one behavior-eating, drinking, or exercising, not "be healthier") and realistic (learn 2 new healthy dinner recipes, not become a famous gourmet health chef on TV within 1 month).


When we set long term and short term goals, it can be helpful to make sure that we have enough steps on the ladder (objectives), a realistic long term goal, and that we make sure each goal is measurable, attainable, specific, and realistic.


Let's not confuse goals with dreams. You can dream about winning the lottery or becoming famous. These just don’t make for good resolutions or goals.


Consider revising your resolutions so they have enough short term goals and are measurable, attainable, specific, and realistic. It's never too late. If you noticed, I noted earlier that goals are discussed as often as needed throughout treatment in my practice. Goals can and should be revised whenever needed. Circumstances, desires, feelings, and finances change. Be flexible with your goal setting and enjoy climbing the ladder!


What are your revised New Year's Resolutions?