How to Create a Sleep Hygiene Routine

How to Create a Sleep Hygiene Routine

Sleep can be somewhat of an elusive goal for many of us.  There are many factors that contribute to the, frankly, abysmal state of rest in our current society.  Lack of quality sleep contributes to a multitude of negative outcomes for individuals, employers, and cultures, yet many factors about our modern society also contribute to unhealthy sleep habits.

For many of us, lack of good quality sleep contributes to an overall lack of a good quality of life. While there may be some things that are out of your control, like your work schedule or your children’s schedules, most of us can make a few small changes to work towards getting a better night’s sleep and a more restful morning.

I will be the first to say that creating a healthy sleep routine is hard. There are many factors that work against me when I’m trying to get a good night’s sleep.  I don’t like to hop in the bed and go right to sleep.  I have difficulty getting to sleep in perfect silence. I, too, sometimes want to veg out in front of a screen. My mind sometimes races with thoughts of all the crazy stuff happening in the world today. I like my glass of wine in the evenings. I’m tired but I can’t get comfortable. I’m naturally a night person but still have to get up early in the mornings. And on, and on, and on.  I get it.

I also know that I feel so much better mentally and physically when I am well-rested. I manage my stress better, I make better food choices, I have more energy for exercise, my mood is better, and I’m more efficient with the tasks I need to accomplish.  But don’t just take my word for it that sleep makes you a more healthy and happy individual.

Sleep is a biological need. We need sleep to pay attention, think clearly, perform physical activities accurately, and many other things.  Evidence has been building for decades that sleep disruption contributes to weight gain, obesity and associated disorders, and hypertension.

Research also indicate that up to 40 percent of the adult US population sleeps less than 7 hours on weekdays, which has been shown to result in lower levels of alertness and attention.  Chronic sleep deprivation may also contribute to excessive use of stimulants like caffeine.

Sleep deprivation is also linked to increased feelings of irritability, anger, hostility, and depression.  The good news, though, is that getting quality sleep is also associated with positive effects on mood.

Many people know that they feel better when they get good sleep, but knowing exactly how to exchange poor habits for better ones can be daunting. Here’s a few tips for starting to make some changes that will improve your quality of sleep, even if you can’t always increase the number of hours you actually sleep.

  1. Assess your habits:
    • Do you have a (relatively) regular bed time?
      • You don’t have to adhere strictly to a regular bed time every single night, but have a general idea of what time you should be winding down in order to get adequate shut-eye for your specific schedule. If you have more flexibility on the weekends, it’s fine to stay up later and sleep in the next morning, just know how your body reacts to those changes and pay attention to what works for you
    • Do you usually fall asleep with some kind of technology (tablet, TV, phone)?
      • The evidence shows that blue light in particular, which is the light that comes from your tech, disrupts your sleep and contributes to sleep deprivation. If this is something you’ve made a habit of, it’s going to have to change if you want better sleep. Don’t worry, I’ll give you some strategies for shifting this habit.
    • Do you budget enough hours a night for your sleep needs?
      • Understandably, you may not always have control of your sleeping and waking hours due to work schedules or other obligations. While we’re all busy these days, you know if there’s some room for adjustment here or not.  Yes, you should aim for 8 hours a night most nights, but if 6 or even 5 is what you’ve got, it’s even more important to make sure those hours are quality sleep hours. If you can adjust your schedule to budget a little more time for rest, then try to commit to making that change.  Your mind and body will thank you in the long run.
    • Do you drink too much alcohol in the evenings?
      • Alcohol might help you relax a little in the evenings, but too much can disrupt your sleep. You may find yourself waking up in the middle of the night after the alcohol has metabolized in your system, which is a good indicator that you were actually passed out, not getting good quality sleep. You may also find yourself feeling hungover in the mornings, which is never fun.
  2. Define your problem areas:
    • Do you have difficulty getting to sleep?
      • Are you staying up late watching shows or using tech? Or are you struggling with negative thoughts at this time, re-living past traumas or overthinking mistakes you may have made? If this is what is happening, it’s so important to start practicing some mindfulness techniques during this time to calm your mind and prepare your brain for a restful sleep.
    • Staying asleep?
      • Are you waking up during the night? Is this because of nightmares, or physical discomfort? Can you identify potential sources of mental distress? If there are specific fears or stressors you can identify, journaling before bedtime can help you process and let go of these thoughts before bedtime. If you have recurrent nightmares because of past trauma or emotional factors, please consider going to see a professional counselor or psychiatrist. Processing through your feelings and distress with a therapist may help you release the fears that may be the source of the nightmares.
    • Quieting your mind?
      • Is your mind racing at night? Are you thinking about every little thing you need to do tomorrow? This is another area where mindfulness practices can help. Try making a list of what you need to do so you can know that you won’t forget anything. Or practice quieting your mind by using meditation apps that you can download and play from your phone
    • Becoming tired?
      • If you just naturally are a night person due to your personal circadian rhythm, plan to do something that will exhaust you or make you sleepy. For some people, exercise in the evenings helps them relax, for others it is too stimulating so listen to your body to determine whether this will work for you.  Alternatively, pick out some reading material that will get your eyelids heavy.
  3. Find your strategies:
    • Personal Hygiene
      • Some people are nighttime shower people, other people are morning shower people. Whichever you are, you can still benefit from a little hygiene routine to set you up for a good night’s sleep. Let’s be honest: a nice warm bath with Epsom salt and essential oils is the gold standard.  Epsom salt helps you absorb magnesium through your skin, and magnesium helps you sleep at night.  But we don’t all have time or ability to take a luxurious bath every night, so we can do some adjusting to compensate.  If you are a nighttime shower person, try using aromatherapy in your shower by dropping a few drops of essential oils on your shower floor before you get in. Good oils for night showers are lavender and eucalyptus. If you’re not a nighttime shower person, you can still benefit from using lotions with essential oils, and taking time to wash your face and take care of your skin. All the attention to your body will help your mind feel better when you climb into bed.
    • Relaxation tools
      • Try a little self-massage. You can get a little hand massager and give yourself a neck rub, or just use a hand-towel that you’ve gotten damp, and then pop it in the microwave for 20 seconds or until it is warm but not super-hot. Be smart here and check the temp before you use the towel on your neck so you don’t scald yourself, but just a little warmth around the back of your neck can help you get into sleep-mode by relaxing those muscles a little. Also, those head massager tools that look like spiders give a really sweet head massage and makes your head feel warm and tingly.
    • Meditation Apps
      • There are plenty of different kinds of meditation apps out there. Just check out your app store on your phone and search for “meditation apps” and you will find lots of options. Some are free and others cost just a few dollars. There are apps that can specifically guide you to fall asleep, and others that just guide you through mindfulness exercises to quiet your mind.
    • Journaling
      • Journaling is a great strategy to use if you have trouble with thoughts running through your mind at night or are working through trauma or other emotional stressors. Getting your thoughts out on paper allows you to process and move past difficult emotions, and can provide a sense of relief through releasing difficult thoughts and feelings.  You can keep a journal by your bedside, and when you find your mind or thoughts racing, grab it and start writing until you get it all out.
    • Essential oils/Aromatherapy
      • Aromatherapy is great for preparing for bed. You can use a diffuser to scent your bedroom, starting 30 minutes or so before you get in bed, so that your bedroom smells relaxing and fresh.   Good oils for relaxation include lavender, chamomile, and peppermint. There are lots of recipes for diffuser blends on Pinterest and common oils are available in some grocery stores and even Target in the cosmetics section.
    • Reading Guidelines
      • In general, bedtime reading is something you want to aim to do from a physical book or magazine, rather than on an E-reader like a Nook or Kindle. This is only because of the blue light that emanates from our screens, which can stimulate our brains to think it’s daytime. Again, listen to your body.  If your Nook doesn’t keep you up, and reading from it helps get you sleepy, go ahead and use it.  But if you find it to be too stimulating, try reading from a good old-fashioned book with a lamp. Also, be mindful of content. If murder mysteries don’t bother you but help you get sleepy, go right ahead.  But if you think they might be contributing to those nightmares you’re waking up with, maybe find something less prone to keeping you up.
  4. Make new habits:
    • Decide what strategies you need to use based on your specific barriers to a good night’s rest and then set yourself up for success. Maybe you need to pick up a new journal or some aromatherapy supplies, or check out your app store to find some guided meditation apps.
    • Remember that it take 30 days to really build a new habit, so give yourself a chance by committing to try these new strategies for at least 30 days and see if your sleep improves.
    • Don’t beat yourself up if you miss a day, or if changes don’t happen immediately. Your brain needs time to adjust to new habits and get the full benefit of your efforts.  Just keep trying, and listening to your body to find what works for you.

Sleep is essential to good mental health.  In fact, for many of my clients, poor sleep is one of the most palpable and immediate ways in which their mental health manifests in their bodies.  Stress and anxiety, overwhelming expectations at work, depression and trauma; all of these concerns can affect our quality of sleep and leave us feeling burnt out and exhausted.  Sometimes, we avoid dealing with these other mental health concerns until our bodies just shut down and say “Enough! You are going to pay attention to me or you will be sick!”  Our bodies frequently give us messages, but we need to pay attention to hear what our bodies are demanding of us.  Sleep is an integral part of taking care of your mental health.  Use these tips to create a strategy that works for you so that your sleep is restorative enough to help you feel your best, physically and mentally.

Mindfulness: Whack or Worth It?

Mindfulness: Whack or Worth It?

Mindfulness has become sort of a catchall term for general self-help advice that focuses on using different practices to attune better to your mind and actions with the hopes of decreasing stress or associated symptoms.  Take time to meditate in the morning.  Pay attention to your food when you’re eating. Do a gratitude practice every night.  Self-care your stress away.  It all sounds good in theory, and certainly won’t do you any harm, but what does the term mindfulness really encompass, and is it really something that could change your life? Or it is just another fad and buzzword in the self-improvement culture of today?

As a therapist, I frequently encourage different types of mindfulness practices to encourage my clients to be intentional about their own lives.  Attuning to our bodies and our minds and our habits is an important part of both gaining control over our lives as well as our mentality.  I often work with people who have had something terrible, or heartbreaking, or unexpected happen to them, and they are struggling for a sense of control.  In those times I am often reminded that sometimes the only thing you have control over is your mentality.  Sometimes I get pushback from people who don’t necessarily believe that their mentality is within their own power.  Their thoughts are stuck in places that leave them thinking:

  • How can I help the way I feel?
  • What I believe is what I believe, there’s no changing it.
  • How can changing my mentality change my circumstances?
  • Thinking about my mentality doesn’t change the problems I’m facing.

I can understand why it might sound like a load of new age fluff when people start talking about mindfulness.  We have become accustomed to solutions that start and end with well-defined explanations and prescriptions.  We like to be able to have a blood test tell us exactly what’s wrong and what treatment is needed to fix the issue.  Unfortunately, our minds can be even more mysterious than our bodies are, at least in this day and age.  The good news is that our minds are also a lot more powerful than we might believe, and that means that we can use our mentality to improve our overall sense of wellbeing.

I wanted to find out what we really know about mindfulness, and what the evidence says about whether or not it works. Researchers have been studying mindfulness based practices for over 30 years now, and studies have investigated mindfulness as a treatment for conditions such as addiction, trauma recovery, stress, chronic pain, eating disorders, depression, anxiety, and more.  There was no shortage of research to comb through devoted to mindfulness and it’s various applications, but the results were pretty consistent.  Of course, with large bodies of research on a topic as broad as mindfulness, there are going to be variations in the results that studies present.  I found the results optimistic, though.  There is consistent evidence that when people are introduced to mindfulness based practices as a way to improve symptoms related to various stressors, they report good outcomes when they apply that knowledge.

Because mindfulness practices can be broad in terms of the actual strategies they refer to, here’s a few ideas about what people are referring to when they use that term:

  • Deep-breathing practices
  • Meditation (guided or self)
  • Attuning to senses
  • Intentional gratitude practices
  • Night-time de-stressing rituals
  • Conscious attention to mentality
  • Intentional eating practices

Much of the research out there on mindfulness focuses on using one or more of these practices in a specific setting with a specific group of people.  So the ways in which this area has been studied lends itself to a lot of different outcomes for a lot of different kinds of people with different kinds of problems.  Nevertheless, I found a lot of examples of some really great ways that mindfulness practices are having a positive impact on people.

A study on mindfulness and addiction published this year found that mindfulness based interventions (MBIs) had a significant effect on cravings and substance misuse in treatment for addictions.  This is a great example of how mindfulness practices can function as an auxiliary treatment for people.  The goal of a mindfulness practices is not necessarily to serve as a replacement for other therapies, but it can be a good asset to use in addition to other treatment, and can function as a sort of enhancer.  It may just give people an extra boost when they are seeking help for addictions or other mental health conditions.

Another encouraging example includes this study from PLOS One, which found that over a 6 year period in which medical and psychology students were introduced to mindfulness practices, the students reported significant increases in measures of their wellbeing.  This is especially important given the high rates of mental distress, burnout, and suicide amongst medical professionals.  As a person in a caregiving profession myself, I know how important it is to maintain a healthy mentality and how overwhelming the stress can get.  It’s good to know more evidence is showing how important it is for caregivers to be given the resources and support to incorporate these practices themselves.

Another study from the International Journal of Occupational and Environmental Health found more evidence that introducing mindfulness in the workplace decreased burnout and reduced stress.  This research supports my personal belief that employers should do more to help mitigate stress in the workplace and support the health of their employees by taking it upon themselves to bring stress reduction into the workplace environment.  Not only do I believe this will improve employee health and help workers be happier in their work environments, I think it will make workplaces more efficient as well.

There is a lot more research out there on the topic, which I will be working on delving into more this month.  However, these studies are a few examples of the research support out there for bringing mindfulness practices into our lives.  Our lives have gotten so much more harried and complicated, and sometimes our choices seem out of our control.  That’s why mindfulness is helpful in bringing a sense of focus and calm to your mentality, so that you feel more capable of handling whatever life happens to be throwing at you at the moment.

Mindfulness alone cannot solve every problem that you may have, but becoming more intentional about taking care of your mind and staying tuned in to how your mentality impacts your overall mood could help you stick to your goals and keep negativity at bay.

How to Use Sensory Distraction to Stop Panic and Anxiety

How to Use Sensory Distraction to Stop Panic and Anxiety

When you are experiencing overwhelming anxiety, or even having a panic attack, sensory distraction can help you re-focus your energy somewhere other than the distress you are feeling.  It’s a technique that involves using your senses to distract you long enough for you to calm down or regain your composure.  I’m going to discuss a few ways to utilize these techniques and give you some examples so that you can have some extra skills for self-soothing.

You have 5 senses: sight, sound, smell, taste, and touch, all of which can be used to help you re-focus and calm down when you are having high stress moments.  For each of these there are at least a few ways that you can stimulate your senses to help you distract during high moments of stress or anxiety.  I often recommend these techniques for my clients who are trying to find non-medical ways of coping with anxiety and panic attacks.


There are a couple ways you can use sight as a sensory distraction.  You can walk outside and start looking around you and focusing on what you see, preferably natural objects, like branches swaying in the wind or clouds moving through the sky.  Start to really look for details and try to absorb as much information through your visual observations as possible.  Trying to concentrate and store information will challenge your brain to focus it’s energy on something else besides the distress you are feeling at the moment.  You could also choose a photograph, piece of artwork or another type of image or object that you find to be symbolic to you.  This could be a picture of a relative or family member you love, or something with religious or spiritual significance to you.  Just find something that you can look at to remind yourself to center and shift your focus outside of the current moment.


Music is an excellent way to use sensory distraction.  However, choose your music wisely.  If you are feeling depressed and you go turn on your sad music, you’re not going to feel better.  With music we want to think about using opposites.  If you are angry or anxious, listen to something uplifting or calming.  If you are feeling depressed, turn up your favorite feel good music.  Another way to use sound is through the use of meditation apps, audiobooks, or podcasts.  Again, think about your choices here.  Don’t exacerbate your current distress by listening to something that will further your feelings of anger, anxiety, or sadness.  Use an app to calm down with guided meditation, listen to a motivational audiobook, or subscribe to a podcast with a positive theme.


Using smell as a sensory distraction can be very beneficial.  Essential oils are great for this part.  Good essential oils to use for calming include lavender, frankincense, and black spruce.  You can actually just grab the bottle and inhale the scents from there, or you could use them in a diffuser.  You can apply on your skin too, but you may need to dilute it with a carrier oil like coconut oil before rubbing directly on your skin.  Carry a small bottle of lavender with you for quick aromatherapy whenever you need it.


For this sense, you can think of it in terms of temperature, and focus on either drinking a very cold glass of water or a hot cup of tea.  Alternatively, you could suck or chew on a piece of ice.  Cooling your body temperature may help calm you down some.  You could also try chewing gum or bubble gum, to get more sensation on your tongue and again bring your energy to a different place of focus.


For touch, you could always just grab a stress ball and squeeze away.  However, one technique I’ve found can be useful is running your wrists under cold water.  Just turn on the faucet and let cool water run over your pulse points, and it may help calm you down by lowering  your body temperature slightly and giving you a peaceful sensation on your wrists.  You could also use ice for this, either by rubbing ice on your wrist or perhaps your neck and chest.  If you have a history of self-harming behaviors, using ice as an alternative to cutting is a good strategy, or you can also use the rubber-band snap method.  That just involves wearing a rubber-band on your wrist and snapping it occasionally or when needed to provide an instantaneous re-direction of your focus towards the snapping sensation on your skin.  As always, be mindful of what works for you as an individual.  With a history of self-harm, you want to make sure this is going to be helpful rather than triggering, so use your own best judgement as to what techniques might be most helpful to you and follow your instincts.

Using these techniques may help you pull some energy away from the feelings of anxiety or panic you are experiencing.  By focusing attention to our senses, we give our bodies a chance to let go of that anxiety and re-direct our energy towards something more positive or healing.  When managing anxiety, you will benefit from having multiple resources to pull from in order to build your set of coping skills.  These techniques can be part of your overall strategy to help manage your symptoms.

Cognitive Distortions 4.0:  Emotional Reasoning

Cognitive Distortions 4.0: Emotional Reasoning

As part of my ongoing series about cognitive distortions, I’m going address Emotional Reasoning in this post.  Emotional reasoning refers to the mistaken belief that everything you feel must be true.  In this way, we can sometimes trick ourselves into believing that our feelings are facts.  To the contrary, sometimes our emotions cloud our judgement, and we don’t always read the situation correctly when we allow our emotions to affect our interpretation of the situation we are in.  Sometimes we need to step back from our emotional response to a situation and try to see if our emotions are taking us to a conclusion that may not be really true.

Here are some examples of emotional reasoning and thoughts that may occur when you might need to think twice about whether or not what you feel is really true:


  1. “ I feel rejected and hurt, and therefore you have rejected me”
  • In this case, someone may or may not have rejected you. A person may have been trying to set boundaries with you by telling you not to call repeatedly when they are unavailable.  Your feelings of rejection may be due to insecurities you have, but you also need to respect the boundaries other people set in their own lives and relationships.  Or perhaps you were passed over for a job offer, and you were one qualified candidate in a competitive position, but fell short of the final cut.  This doesn’t mean the company didn’t think you would have done a good job or that your skill set wasn’t valuable.
  1. “I feel like a bad friend, therefore I must be a bad friend.”
  • Sometimes you may judge yourself too harshly for making a mistake. Being human, you’re bound to do things you regret from time to time, but this doesn’t make you a terrible person.  When you do make mistakes, try to own up to them and repair the damage when you can, but don’t believe that you are defined by every mistake you’ve ever made.
  1. “I feel lonely, therefore no one cares about me”
  • It’s hard to face problems on your own when you don’t have much support from others. However, sometimes we can get to feeling overwhelmed with the prospect of reaching out to others when we feel vulnerable and need support.  Oftentimes, it’s easier to sit with our feelings by ourselves than acknowledge that we need help.  However it’s important to reach out to your support system when you can.  Sometimes, your friends and family may not know that you are struggling, but would want to be there for you if they could.  It’s important when you feel this way to step back from your emotions and try to account for the support that you DO have, even if it’s not in the most likely places.
  1. “I’m angry with you, therefore you must have done something wrong.”
  • Anger is difficult to step back from, but it’s very important that you understand where your anger is coming from and how much control you have over it. Sometimes we get angry with others for things that cause us distress, but often times anger is really a reflection of how we’re feelings about ourselves. For example, you may feel angry at your partner for not doing something you expected from them, but you never actually verbalized what you needed.  You feel angry that your partner didn’t anticipate your needs, but you may not recognize that it was your responsibility to communicate your needs to your partner.
  1. “I feel worthless, therefore I am worthless.”
  • Self-esteem can be a struggle if you have been suffering from a mental illness or have experienced trauma in your life. It can be hard to separate your feelings of low self-worth from your outlook on life, but this is where it’s important to take stock in what your values are.  Sometimes we give other people more courtesy than we give ourselves.  Whenever you find yourself struggling with negative thoughts about yourself, ask yourself who gave you those messages about yourself and if you would say those things to someone that you cared about.  If you wouldn’t tell someone you care about that they are worthless, than you shouldn’t say those things to yourself.  Feeling down or struggling with the situation you are in at this moment doesn’t mean that you have to listen to thoughts that make you feel worse about yourself.


Sometimes we get so caught up in our emotions that we choose to ignore evidence that goes against how we feel. So maybe your friend sent you an invitation to an event on Facebook, but because she didn’t reach out personally to make sure you were coming you still choose to believe she doesn’t really care if you come hang out or not.  Or perhaps  you become overwhelmed with a presentation you have to give at work, and take this to mean that you must be in over your head and you’re not cut out for the job, despite the fact that your supervisor picked you for the project.

If you think you might be engaging in emotional reasoning and you want to make sure you are not letting your emotions cloud your judgment of the situation, ask yourself a few questions:

  1. Am I overlooking my strengths?
  2. Am I discounting evidence that would lead me to reach a different conclusion?
  3. Am I basing my conclusions on my emotions or facts?
  4. What would you say to a friend that was in your situation?
  5. Am I struggling to give myself the same advice that I would give to my friend?

These questions will help you evaluate your situation with more clarity and determine if emotional reasoning is getting in the way of your progress.  Emotions are important, and we shouldn’t just ignore them.  But keep in mind that relying on our emotions to guide us doesn’t always give us the full picture of what’s happening and what all of our options are.  Don’t forget that you are in charge of your mentality, even when it gets overwhelming.

For more on Cognitive Distortions, check out the other posts in this series:

Cognitive Distortions 3.0: Personalization

Cognitive Distortions 2.0: Disqualifying the Positive

Coping with Cognitive Distortions: Catastrophizing

The Problem with AA and why Harm Reduction Helps

The Problem with AA and why Harm Reduction Helps

As a therapist, I have worked with countless individuals who fall somewhere on the spectrum of having a serious substance addiction problem, to those who have problematic substance use or drinking habits, but who haven’t hit the proverbial “rock-bottom” we so often hear about. I spent a few years as a case manager in an inpatient substance abuse facility at the beginning of my career, and later I worked as a therapist in an inpatient center treating substance abuse, mental health, and eating disorders. Since then I’ve also worked with clients in individual therapy with problematic drinking habits, those who have significant substance abuse histories, or who use other substances recreationally. The history behind substance abuse treatment has been until recently almost exclusively focused on getting people to commit to and practice abstinence and total sobriety. AA (Alcoholics Anonymous) and NA (Narcotics Anonymous) have been the go-to referral for many people seeking help with sobriety and are considered pre-requisites in any recovery treatment model. Unfortunately, there’s one big glaring problem with these models… they don’t work. At least not for everyone.

There’s several reasons why they don’t work for everyone, and there’s other reasons why we blame individuals for “treatment failure” instead of recognizing that there is a range of ways to measure improvement, and another way to help people improve their lives and weaken the grip of addiction. I’m talking about Harm Reduction, and it is a growing movement in the field of substance abuse treatment that is giving more people hope for a future free from addiction. First, though, let’s look at why AA/NA programs are not working for everyone.

What’s wrong with AA and NA?

It’s not that AA and NA are terrible models for recovery, or that they haven’t helped many, many people achieve sobriety. I always tell my clients that if they find something that works for them, and if it is helping them achieve their goals, they should keep doing it. I have no qualms with people using AA or NA as a support and structure system that helps them gain freedom from alcohol or substance abuse. The problem is that they simply don’t work for everyone, for a variety of reasons. Here’s a few:

  1. Powerlessness: The first “step” in the 12-step AA model is that you need to admit that you are powerless over alcohol and/or drugs and that you are unable to stop using on your own. This is useful to some people, because it helps them get into the mindset that they do really need help. For others though, it feels, well, disempowering. Some people want power OVER their addiction, they don’t want to give the alcohol/drugs all the power. From the outset, telling people that they are powerless over substances gets them in a mind-frame that they are not capable of controlling their own choices and behaviors.
  2. Total Sobriety/Failure model: Another part of the AA/NA model is the “chip” system”. When you walk in to a 12-step program on your first day of sobriety, you get a “chip” that serves to commemorate your sobriety. Then you get more chips as you work the program and make progress, achieving markers such as 30-days sober, a year sober, et cetera. If you pick up a drink, or use again, you’re back to day one, and typically you’re expected to come into the group and pick up a 1-day chip, which basically announces to the group that you “relapsed”. Again, for some people, this model of accountability helps them stay on track with their goals; for others, it’s a humiliating exercise that points to them as being a failure and can ultimately cause people to not come back to the group at all because they don’t want to be seen by their peer group as having failed at sobriety. A different approach is needed for some people, who don’t want one drink to mean that their previous efforts at sobriety cease to matter and they’re starting over at square one. Another problem with this total sobriety model is that in all honesty, some people don’t want total sobriety. Some people want to be able to enjoy a few beers at a BBQ, or be able to toast on NYE, but they recognize that they don’t want or need to be getting blackout drunk every weekend. Or perhaps they’ve been on some really hard drugs, and want sobriety from those drugs, but want to be able to go out to dinner and feel like a normal person capable of having a couple drinks without being labeled as an “addict”. AA and NA do not provide any framework for a person who wants this, and thus they leave out people who want to change their habits, but don’t want total sobriety.
  3. The Higher Power part: The 12-step model requires members to submit to a higher power. While the 12-step program originated with Christianity as its structure for recognizing a higher power, it has since evolved to be more inclusive as to how people interpret their higher power but the requirement to subscribe to a higher power remains. Needless to say, this leaves out everyone who considers themselves agnostic or atheist. Once again, we find that there is part of this model that works for some people, particularly those who want their faith to be a major factor in their road to recovery, but it just doesn’t resonate for others. This aspect of the AA/NA program also relates to the concept of powerlessness. The idea is to turn your power over to a “higher power”, who will presumably help you stay sober. For those who want to feel that THEY control their use, not the other way around, the concept of turning it all over to your higher power doesn’t fit with their idea of being in control of their drinking or use.

There are other criticisms of the 12-step/AA model of recovery, but these are some of the main points that I have found that turn people off from working a 12-step program. Luckily, the concept of Harm Reduction is gaining traction in the recovery industry and helping to provide more options for those people who either have found AA/NA doesn’t work for them, or who are interested in another way.

What is Harm Reduction?

Harm reduction is the concept that people who are abusing alcohol and drugs CAN reduce their overall use of substances without committing to total sobriety, CAN reduce the negative effects that substance abuse has on their lives and the people in their lives, and CAN lower the risky behaviors associated with their substance abuse that ultimately can cause them to experience more severe consequences of their use. It is the concept that one solution does not fit every individual’s needs, and that someone who drinks or uses should have access to a variety of choices when they are seeking help. Harm reduction also includes advocating for policies that do not punish people for being addicted, but seeks to help them find the help they need to have healthier lives, without insisting that people conform to our expectations. Further, harm reduction posits that we should meet people where they are on the road to recovery, and stop insisting that they commit to 100% sobriety before we give them any help. Harm Reduction can encourage people to make the following changes in their lives and habits:

  1. Going from someone who drinks and drives regularly to someone who still drinks heavily, but no longer gets in the car and drives and is able to choose to get a ride home when needed, no longer risking their own life and the lives of others by being on the road while intoxicated.
  2. Going from someone who shares needles with others in order to get high to someone who still uses but accesses clean needles and no longer has to worry about contracting or transferring a disease or infection from dirty needles.
  3. Going from someone who drinks heavily on a regular basis and then verbally or physically abuses others during blackouts to someone who is able to set a limit on the number of drinks they have and eliminates the abusive behaviors associated with their drinking.
  4. Going from someone who uses high addiction-risk substances such as cocaine, meth, or heroin to someone who smokes marijuana and no longer experiences the damaging physical and addictive effects of those harsher drugs.

As you can see, there are ways that someone who struggles with substances can find ways to reduce the harm and associated risks that using substances or abusing alcohol has in their lives, without requiring that the person be completely sober in order to recognize those achievements. Harm Reduction advocates recognize that we don’t have to require people to be 100% sober before we can call their efforts a success. For one things, it is not our place to tell people what their goals should be. Some people want to be 100% sober and the truth is that some people don’t. As a clinician, I have always been trained to start where my clients are and to let them define their goals, rather than defining what I think their goals should be. Harm reduction fits into that concept as a best practice, because whether I think someone should stop drinking/using is irrelevant if they don’t want to stop drinking. However, if they want to reduce their drinking, feel empowered to make better choices about their drinking and while they’re drinking, or minimize the negative effects that drinking has on their life, then as a clinician I should support them in those efforts however I can.

Some people really do want and need total sobriety, because their behaviors surrounding their addiction have gotten so dangerous and harmful to themselves and to others, and because their efforts at moderation have not worked after multiple attempts. I think this is why most inpatient treatment centers use a 12-step model, because once you are at the point where you need inpatient treatment, your behaviors are probably pretty out of control and dangerous. However, as with all treatment, what one individual needs is not going to be the same across the board. In the meantime, we need to redefine what recovery means, because it doesn’t look the same for everyone. At this time, when I have clients that want to learn more about harm reduction and learn strategies that focus on that goal, I refer them to Smart Recovery. Smart Recovery does focus on abstinence, but it does so without some of the trappings of AA that have been problematic that I mentioned earlier. They also have groups and online meetings, which may be helpful to some people depending on their location and/or comfort with the group setting. Individually, finding a therapist or provider that is familiar with the concepts of harm reduction can be an important step in the recovery process as well.

To learn more about harm reduction, visit

To learn more about Smart Recovery, visit

When is the Right Time for Hospice Care?

When is the Right Time for Hospice Care?

I spent 4 years working as a hospice social worker, which was an invaluable experience for me.  I spent most of my time with hospice care in long-term care facilities.  Hospice patients can receive care in any setting that they reside in.  Many hospice patients receive hospice services in their homes, others at in-patient hospice facilities, and still others in assisted living or nursing care facilities.  I was fortunate enough to work with a wonderful network of facilities that by and large took very good care of their patients.  This is unfortunately not always the case, and because the goal of hospice care is to ensure the comfort of the patient, hospice services can be a wonderful addition to the care of the patient, but hospice care is not for everyone.  There are some important considerations to think about if you have a family member or loved one that may benefit from hospice services.  Overall you want to make sure that you know what hospice care is all about, who qualifies for hospice services, and when the right time is to ask about hospice services.

What Is Hospice For?

First and foremost, hospice care is about ensuring the comfort of a patient who has a terminally ill condition.  Hospice is not intended to provide aggressive treatment, and thus if someone has a medical condition that they are pursuing treatment for, such as chemotherapy or other cancer treatments, they wouldn’t be appropriate for hospice services while they are in treatment.  Hospice comes in to help ensure that patients who are approaching death but who are no longer pursuing treatments for their conditions are comfortable and are able to pass away peacefully under the conditions that are closest to the wishes of the patient and family.  A nurse will regularly evaluate the patient’s needs and condition, a doctor will oversee the care of the patient, and the hospice care organization will provide most of the patient’s care and supplies needed.  This means that a hospice care team will typically provide any pain medications needed to keep the patient comfortable, medical equipment like hospital beds, and hygiene care supplies like shower seats or incontinence supplies.  They can also provide hygiene related care, such as CNA assistance with bathing and changing clothing.  A hospice team will also usually include a social worker to support the patient and family emotionally and help advocate for the patient’s needs, and a chaplain to provide spiritual support to the family if desired.  These services are provided in addition to care that the patient may already be receiving from family members or the staff in an inpatient or nursing care facility.  There is a wide range of options for care, based on how much support a patient has and what their own capabilities are as they begin to decline.

Who Pays for Hospice?

Hospice services are primarily funded by Medicare, which means that most patients who need hospice care qualify under Medicare’s definitions.  Many community-based hospices have other donors and funders who help to fill in the gaps for funding needs.  In order to qualify for hospice services, a doctor needs to certify that the patient’s prognosis for a terminal condition is 6 months or less.  Typically, this will be done by the doctor at the hospice organization based on their evaluation of the patient’s condition and prognosis.  Hospice services can generally step in and provide support to the patient and family once the patient and family have decided to stop aggressive treatment of their terminal condition and focus on comfort care.

It is important to note that Medicare and Medicaid are different and pay for different things when it comes to end of life care.  Medicare is not the funder when it comes to nursing home care.  For example, if a person is no longer able to be cared for in their own home, and they need to go into a nursing care facility due to their level of care needs, Medicare does NOT pay for this.  Each patient is responsible for paying their own room and board expenses in a nursing care facility.  This is why there is a HUGE disparity in the type of accommodations people receive in nursing care or assisted living facilities.  Just like with private housing, you will be able to get into a much nicer facility if you have the money to pay for it, and nursing home care can cost upwards of $10,000 a month or more.  However, Medicaid DOES pay for nursing home services, but you must qualify for Medicaid in order to receive that benefit.  This means that you will either be indigent, or you will have already spent all or most of your money on your own care before Medicaid will kick in and start paying for nursing home care.  Again though, just because Medicaid is paying for the nursing home care, doesn’t mean that you can go to any nursing care facility you want.  Most of those really nice facilities that cost $10,000 + a month are going to be private facilities that do not accept Medicaid.  Therefore, if Medicaid is the only option to pay for care, the patient will only be able to get into a facility that accepts Medicaid for payment.  This is not to say that facilities who accept Medicaid give poor care.  There is just going to be some variations in the quality of care you receive no matter who is paying for the care.  I have been to facilities who reserved some beds for Medicaid patients and the rest were for private pay, but it just depends on the facility.

When is it Time for Hospice Care?

There are many reasons why a patient and family may choose to stop treatment, and every circumstance is unique.  In my particular experience, I worked with a lot of patients who were elderly and had been in nursing care for quite a while, and their health was more rapidly declining.  Some of my patients had been living with dementia, ALS, heart disease, or COPD for years, and they and their families were tired of taking medication and going to therapies and struggling to complete everyday tasks.  Many of them were ready to die, and just wanted to be comfortable and spend time with their families before they passed away.  Often it was harder on the families who were losing a loved one and experiencing grief than it was for the patients themselves.  Many were just tired.  Tired of fighting, tired of struggling.

This was not always the case.  When someone is dying of cancer in their 40’s, it’s not the same as someone who is dying of heart disease in their 90’s.  Every patient’s circumstances are unique and thus so is their outlook.  As human beings we tend to have an easier time accepting that a very elderly person who has been suffering for years with their decline is ready to come to the end of their life than it is to accept that a person in the middle of their life who still has young children at home will not recover from their illness.  This of course, also will be much different for a family who is facing the impending death of their own child due to a terminal condition.  Even the parents of terminally ill children sometimes have to make the decision that ongoing treatment may cause more harm than good in the quality of the remaining life of their child.  No one can decide for a patient and their family when the right time to stop treatment and move into hospice care is.  That decision needs to be made by the patient, to the extent that are able to communicate their wishes, or by their health care surrogate, who should be given all the information and options available in order to make an informed decision about the best care for the patient moving forward.

Hospice care workers are a special class of caregivers.  I was endlessly impressed with the compassion and fortitude of the nurses, doctors, social workers, chaplains, and CNAs that I worked with during my employment in hospice care.  When the time is right, and the patient and family have decided that comfort care is the top priority, hospice can be an amazing asset.  If your family is considering hospice care for a loved one with a terminally ill condition, think about what your goals are at this time in their care plan, and reach out to the hospice providers in your area to learn more about their particular services and your options for care.

Cognitive Distortions 3.0: Personalization

Cognitive Distortions 3.0: Personalization

This is the 3rd post in my series about Cognitive Distortions, and I am going to cover Personalization.  This is a distortion that can include believing that you are responsible for things outside of your control, or it could also mean interpreting things in a way that always reflects back on you.  As with all cognitive distortions, this may be something that we have all done once in a while, but if you find that you get in the habit of taking things personally when you don’t really need to, you may want to reflect on how you’re thinking about events that happen around you.

On the first part, believing that you are responsible for things that are actually out of your control, you might feel a sense of guilt or shame about things that are not your fault or that you couldn’t have controlled.  For example, if your partner is struggling with a health condition, but isn’t following their treatment recommendations, and you then feel responsible for not doing enough to help when their health declines.  Supporting your partner doesn’t mean that you have to take responsibility for things that are out of your control.  It’s always important to understand what you do have control over, because we all need to be able to take responsibility for our own actions and choices when we can.  Yet we also need to understand when something is out of our control, and recognize our own limitations.

The second part of Personalization is when you turn things around to reflect on you when an event or situation may not be about you at all. Sometimes this comes from a sense of insecurity or anxiety.  For example, if you walk into the break room at work, and everyone stops talking, and you mistakenly start to believe that everyone must be talking about you behind your back.  In reality, that could have happened for any number of reasons.  Maybe they were discussing something private, or maybe it was just one of those weird moments when the room goes quiet.  Regardless, if you don’t know for certain what’s going on, you don’t have to waste your energy worrying about it.  Sometimes we think situaitons are about us when they really are not.  One thing to consider is that most of the time, other people are worried about themselves and thinking about themselves.  This just means that most of the time they’re not thinking or worrying about you.  Of course there are people who spend their time focused on other people, and in general you don’t want to spend too much time involved with people who gossip or are just snarky in general.  Even when someone is treating you poorly, their behavior is about them, not you.  It’s easier to handle difficult people when you realize that the way they treat others is actually a reflection of how they feel about themselves.  Most of the time, you won’t be able to do anything to change those kinds of people, so you just need to focus on being the kind of person you want be.

If you find that you are often personalizing situations at times when you don’t need to, reflect on why you think this has become a pattern.  You may need to ask yourself why you feel responsible for things that you cannot control, or if you are holding yourself to a high standard that no one could realistically meet.  Sometimes you may need to ask yourself “is this really about me?” to get a better understanding of a situation and understand how much control you really have.  Try to practice asking yourself some of these questions when you are thinking about a situation and believe that it is about you or something you did.  If you think that insecurity or anxiety is playing a role in how you are interpreting a situation, you can practice reminding yourself that you are working on not personalizing situations.  This is one of those times when I will often recommend developing a personal mantra.  A mantra can be any simple phrase that you use to center your thoughts and help clear your mind of negativity.  It could be as simple as something like “Peace,”  or it could be something more specific.  For more on developing a personal mantra, see this post:

The Power of a Personal Mantra

Changing patterns of thinking can be challenging, but the good news is that with practice it becomes easier.  Once you are used to reflecting on your thoughts and taking more control over your own mindset, you will be building your emotional intelligence and you will feel more in control over your mentality and your moods.

For more about cognitive distortions, see my other posts in this series:

Coping with Cognitive Distortions: Catastrophizing

Cognitive Distortions 2.0: Disqualifying the Positive

The Power of a Personal Mantra

The Power of a Personal Mantra

Having a personal mantra is something that everyone can benefit from. When I work with people who have struggled with self-esteem, feelings of anxiety or even feelings of grief or depression, I have often encouraged clients to develop a personal mantra as a way of staying centered, focused, and calm in the face of difficult emotions. Having a personal mantra can help you when you begin to feel overwhelmed, anxious, frustrated or defeated. One great thing about personal mantras is that you don’t have to have just one, and you don’t even have to make it up yourself.

Take, for example, the Serenity Prayer. This is a common mantra that is used in addiction recovery circles and elsewhere, and it basically says: “God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference” [original credit from the American theologian Reinhold Niebuhr]. Your mantra can be something like this, an inspirational quote with a spiritual focus, or it can be completely different. You could use a song lyric that particularly speaks to you, or something your mother told you frequently when you were growing up that still resonates with you today. The power of a mantra is in its ability to help you focus your mental energy in a positive direction when you need to transition out of negative thought patterns. People often turn to inspirational quotes or wise old sayings in order to provide some comfort and hope during times of struggle (i.e: “this too, shall pass”).

Creating a personal mantra is just about using the messages that resonate most with you and provide you with encouragement and hope when you need a mental re-set. It serves as a source of positive affirmation and directs you to put your energy in a more productive direction. Whatever words you decide to use for your personal mantra, claim them! Decide that this is your new mantra and you are going to use that positive affirmation to help you through your current struggles or to keep you inspired. You don’t have to go around telling everyone, just make sure you internalize that message and use it when you need to.

Tips for creating and using a personal mantra:

– Think about your favorite inspirational quotes, song lyrics from your favorite artists, or words of wisdom you have heard or picked up on from other people you know, OR just make something up and inspire yourself

– Make your mantra short and easy to remember

– Make sure your mantra reflects something you actually BELIEVE

– Ensure that the mantras you will use are positive, uplifting, and encouraging (avoid picking something like “Life sucks and then you die”)

– Post visual images of your mantra in places where you will see it (in your wallet, on your bedroom mirror, on the wallpaper of your computer screen)

– Set a daily reminder to reflect on your mantra at a useful time such as when you first get up in the morning, or before you step into that dreaded Monday meeting that always sours your mood

– Keep repeating the mantra to yourself silently when you are struggling

– Pick more than one if needed

– You can use one for times when you are overwhelmed (“Serenity Now!”), and another for times you need to be inspired (“I can create the life that I want”)

I have several mantras that I use a various times in my life, but just to share, one that I use is “Get out of the Pool”. This phrase is connected to an analogy I use with my clients sometimes, referring to drowning in a pool of self-doubt or negative self-talk. It means that when I feel like I am lingering too long in self-doubt or negative thoughts, I need to get out of that pool before I drown. Sometimes I have to remind myself to get out of the pool, because I’m wasting my times there and it’s not helping me in any positive or tangible way to keep marinating in that self-doubt.

Once you start intentionally incorporating your personal mantra in your life, you will find that its power will grow. Changing our thought patterns and our limiting beliefs can be done, but you must make a conscious decision that you will actively work to re-focus your energy in a positive direction. You do not have to change everything in your life overnight but starting to use a personal mantra will help you shift your energy and focus in a way that will feel more empowering and will help you get through those times when your thoughts feel like they are controlling you instead of the other way around.


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Why Gardening is Great for your Mental Health

Why Gardening is Great for your Mental Health

I love it when science backs up things we already know to be true.  I’ve known for years that gardening is good for my own mental health; it’s one of my favorite forms of self-care.  I garden for many reasons.  I think the main reason I love it is because it helps feed my need for creativity, by which I mean creating something that gives me a sense of satisfaction.  I love planting seeds and sets and caring for them and watching them grow.  I love seeing the beauty of nature in my own space, and how just having a garden invites other little critters and birds, and bees into my home.  I love seeing the fruits of my labor, and the best part, harvesting what I’ve grown.  In some ways it’s like being a therapist, when you nurture someone and watch them grow and change and become the best version of themselves and really blossom.  That’s the best part of therapy, too.

Gardening is an easy recommendation for self-care for those who are so inclined.  Getting outside and connecting with nature helps remind us that we are part of something bigger than ourselves, as anyone who has gardened knows that if you neglect your garden, it will wither and die and get eaten by bugs.  Humans are the same way.  If we do not tend to ourselves, if we do not pay attention to what we need, we will not thrive; we will wilt and fail to bear fruit, and any fruit we do bear will be weak and possibly infested.  Exposure to the sun also helps us absorb more Vitamin D, and Vitamin D deficiency has been linked to increased rates of depression.  So yes, let the sunshine in if you want to boost your mood.  When I work with clients who are struggling with depression or just low threshold moodiness, I often encourage them to get outside and take a daily walk.  Just being out in the sunshine and moving around can be enough to get your mind out of a rut and clear your head a little.

The good news is that tending to our gardens, both physical and metaphorical, is excellent for our mental health.  Science is increasingly finding support for the connection between our gut health and our mental health.  Emerging evidence indicates that our gut bacteria impacts our immunes systems AND our moods, amongst other things.  Research also supports letting your kids play outside in the mud, as the exposure to outdoor microbes improves their immune systems.  Scientists are just now starting to understand the connection between gut health and specifically Soil-Based Organisms, or the bacteria found in dirt.  The preliminary research being done on rodents indicates that a specific strand of bacteria found in soil, M. Vaccae, reduces anxiety and helps mice be less submissive in relationships with other dominant mice.  (Improved assertiveness? Can I get a vitamin for that?)  Studies on humans have focused on the use of this particular strand of bacteria in the use of probiotics with PTSD patients.  Research in humans is ongoing and we don’t have any hard evidence to suggest that probiotics alone can help reduce anxiety or depression in humans.  There are a lot of mitigating individual factors, such as how severe the mental health conditions are, the amount of probiotics taken, and the method of introduction.  Science is always looking for a way to makes pills out of something, so it’s not surprising that the research has focused on giving people probiotics orally, rather than having them absorb them naturally by actually getting their hands dirty.  The strands of bacteria also make a difference, so just because there’s probiotics in your yogurt doesn’t mean that you’re getting the same effects as playing in the dirt.  Another strain, Bifidobacteria longum, has been found to help people cope with mild anxiety and memory problems, as well as lowering their levels of the stress hormone cortisol.  Research also has found that seniors who garden have lower risks of dementia.

You don’t have to wait for science to make happy-dirt-pills for you, though.  You can benefit from gardening now, without eating any yogurt.  You also don’t need a lot of space for your garden, as container gardening is a great option for those without a big yard or much outdoor space.  Some places also have community gardens that you can rent a plot in and plant whatever you want there.  In my town there is a community garden at a neighborhood park, and I’ve heard of some apartment complexes doing the same thing.  Whether you decide to go with flowers that attract butterflies and hummingbirds, vegetables or herbs for your own dinner table, or just landscaping your outdoor space to create a tranquil spot for rest and relaxation, getting your hands dirty can help boost your mood and give you a sense of serenity and control in a mad, mad world.

Last year, my family moved from a house where we had a huge yard that I had built a big garden in to a townhome where I have considerably less outdoor space.  The downsizing was good in many ways, but I do miss my big garden.  However, I switched strategies, and decided to just focus on a couple containers and edible landscaping to feed my need for a Zen outdoor space.  Now, I just have a couple barrels, one for cherry tomatoes and one for herbs that has rosemary, mint, and parsley.  I planted Lavender along my fence borders and we put some banana trees along the back fence, which gives us both green privacy, and, as of this year, bananas!  The lavender is mostly getting munched on by my bunnies, but I don’t care, it’s not like I was going to make that lavender cupcake recipe I had pinned anytime soon anyways because let’s face it, I don’t bake.  They also ate all my basil and dill, but I’d rather see them eat it than have the bugs get to it before I remember to make pesto.  Luckily, rabbits don’t eat tomato leaves, so they’ve left that barrel alone for now.  For me, the combination of the sunshine, the physical exertion, the sense of accomplishment when I’ve finished planting, and the reward of seeing that tiny, tiny eggplant my hard work bear fruit probably does more for my mood that the bacteria I might be getting under my fingernails.  Yet it’s nice to know that making gardening a prolonged habit will likely boost my overall immune system and improve my mental health at a biological level as well as a psychological level.