Helping Diabetes Management in Teens | Identifying the barriers to achieving desired A1C

Share

Assisting people with improved diabetes management behaviors has been a specialty of mine in my psychotherapy practice since 2009. My Wife has a been a senior research coordinator at the Barbara Davis Center for Childhood Diabetes in Denver since 2006, and through bonding with her passion to assist in this area, I have developed my own modes of intervention.

There are a number of factors which make managing A1C particularly difficult for teens including: Social pressures and responsibilities, motivation, personality, nutrition, substance use, sleep habits, brain re-structuring, defence mechanisms (such as denial and avoidance), social justice issues (oppresion – racism), diabetes education, individuation, future-oriented culture, access to health services, family structure and dynamic issues, marital conflict between parents, family and friendship conflict with teen, mental health stigma, academic pressure and responsibility, limited mindfulness and somatic awareness, spirituality (especially concerning death), an under-developed ability to conceptualize long-term cause and effect (this is developmentally normal for teens), co-parenting discrepencies, emotional inteligence, individuation, hormonal changes, the tendency for co-morbidity (people with diabetes can be more prone to additional physical and mental health diagnosis), and many other life/environmental stressors (poverty, grief etc.) .

One of the most significant impediments to proper management is the reality that often times the variables which are most disruptive to diabetes management are outside of the control of the teen. 2 examples: (1) If the teen lives in a household with domestic violence the resulting stress can impede their ability to maintain attention on their management routine. In this instance the ‘cycle of abuse’ needs to be intervened upon – assistance to the teen alone may not render significant results. (2) If for financial reasons the teen does not have access to proper nutrition, diabetes education, insulin or testing strips, the ability to manage diabetes will be near impossible (again an intervention on the teen alone would not be particularly helpful – a social intervention is necessary).

Proper diabetes management requires an unbelievably high level of self-discipline, familial and social support, consistency, mindfulness, finances, education, and organizational skills. Imagine dedicating yourself to an exercise and nutrition regiment that was conducted exactly the same way every day of your life … a routine that was never to change despite the relative influences of changing social, emotional, and environmental conditions… yet, paradoxically… the specific intervention was always to change in response to changing social, emotional, and environmental conditions. (ex. you exercised at exactly the same time every day, but the way you exercised was different and in response to a large number of variables). Wow, this is hard…

In order to best assist an individual in achieving their A1C goals, we must first help in identifying the impediments or barriers to proper management. in other words-

“What are the factors or stressors which are most disruptive to proper management?” 

The answer to this question can then dictate the most effective mode of intervention, and to be realistic, there is most often a need for multiple forms of intervention. Social, emotional, cognitive, motivational, familial, and academic interventions have been the most abundant needs in my experience.

From answering this question we can come up with a treatment plan which is holistic and individualized. Of course, this can become a financial issue as it is rare to find an interventionist who is adept at all these different modes of intervention (many of these interventions come from different theoretical orientations and it is not uncommon for a psychotherapist to specialize in one).

To address this financial reality, perhaps it is helpful to subtly change the question so as to identify the one variable which is most disruptive to diabetes management for the given individual.

“What is the one variable or stressor, once removed, that will have the most positive impact on your ability to manage your diabetes?

note: answering this question will often take a minimum of a session or two with a highly trained psychotherapist (ideally other people who know the teen will collaborate) as it is very likely that the teen is not conscious of the answer… additionally, the answer that the teen initially offers is usually what they believe to be the ‘right’ answer or an answer someone already suggested (ex. I need to try harder) as opposed to the answer which would ultimately serve them most effectively (ex. I need my house hold to be a place of respite, which means I need my parents to stop fighting so much).

I will end with a short list of specific intervention types which have been used to address the ‘most significant stressor.’

Existential and Spiritual Intervention – Stressor = fear of death and resulting apathy. The intervention focuses on increasing tolerance of the fear surrounding death so that it can be contemplated with less stress. Reducing this stress can reduce avoidance behaviors to proper management.

Family Structure Intervention – Stressor = overinvolved and under-involved parent creating inconsistent and less useful assistance to teen. In any family system, there is always going to be a parent who is more adept at motivating a teen (this is no one’s fault and mostly has to do with personalities). In many family systems, there is one parent doing all the ‘reminding’ – this reminding often increases avoidance behaviors. The goal of the intervention is to create a family structure and interaction dynamic which motivates the teen towards better management and minimizes stress and avoidance behaviors. This involves getting the parents on ‘the same team’ and intelligently deducing who engages with the teen in what way (ie. who asks about blood sugars and who reminds or collaborates in reminding to give insulin and how they do that).

Motivation and Solution-Focused Intervention – Stressor or factor = lack of willpower, habit, momentum or hope that better management will positively impact a teens life. The collaborative method focuses on identifying what the teen believes that they can realistically accomplish and to ‘cheerlead’ them when successful. The intended result is for the teen to feel empowered to engage in solutions and to be more hopeful about the positive impacts of engaging in solution-oriented behaviors. On an unconscious level this also ‘re-trains’ the mind to focus more on solutions and less on cynicism or ‘problem-focused’ thinking.

Attachment-based Intervention – Stressor = Stress from Family conflict including an inability for the family to offer a supportive and regulating home environment to assist in mediating stress, promoting resiliency, and in offering validation. helping the family in developing the emotional intelligence aptitudes necessary to interact with other family members in a way which supports: bonding, authenticity, vulnerability, and compassionate empathy. Attachment intervention serves to mitigate stress by increasing the family systems ability to offer regulation through connection. In my experience, often it is marital counseling which ends up having the most positive impact on the teen’s stress level = the intervention is with the parents and not necessarily with the teen at all.

Academic Advocacy Intervention – Stressor = Inability to meet the responsibilities of school, which result in intolerable emotions (shame, fear, anger etc) that encourage apathetic behaviors in all areas of the teen’s life – including diabetes management. In my experience, constantly fluctuating blood sugar levels appear to create symptoms similar to ADHD – this makes it extremely difficult for certain teens to use the attention and organization skills necessary to complete tasks on time and independently. Additionally, because of medical leaves of absence, Teens often fall behind in school and find themselves completely overwhelmed by the task of ‘catching up’ (often it is mathematically impossible for them to ‘catch up’). In these instances, the intervention is to advocate for the teen to have an individualized education plan which accommodates their specific needs (ex. certain homework assignment being excused, tutors, un-timed testing etc.)

Education, behavioral and strategic Intervention – Stressor = a lack of understanding of the most effective form of management along with a lacking ability to create an implementation strategy that accommodates all the nuances of the teen. For this intervention, the psychotherapist takes both an expert and a collaborative position to create an individualized behavior plan that the teen can follow to best manage their diabetes. (the plan will include: times to check blood sugar, education about carb counting and taking insulin, and a daily time for the teen to report to his parents about management updates etc. – parents need updates or else they become overwhelmed with fear – often a structural intervention is necessary for the teen to feel comfortable in offering updates.

Cognitive Intervention – Stressor or Factor – thoughts, ruminations, and/or beliefs which negatively influence the teen’s management behaviors. The intention of this intervention is to both dispute unhelpful and possibly irrational beliefs while also allowing new narratives to positively impact the teen’s life. Some examples of an unhelpful belief could be: “if I can’t do it perfectly I shouldn’t do it at all” – or – “If I don’t think about my problems they will go away.”

Mindfulness intervention – Stressor or factor = an inability to observe physiological indicators which could help to inform the teen about current blood sugar levels or an inability to focus attention on the present moment so as to reduce anxiety and increase felt happiness. Mindfulness is the ability to keep your attention in the present moment as opposed to the future or the past. Body awareness mindfulness exercises help a teen to observe the sensations of the body in the present moment. I have found that teens with this ability are far superior at managing their diabetes as they take management action long before they are way ‘too- high’ or ‘too-low” This intervention generally also necessitate one of the above intervention as mindfulness facilitates increased ‘awareness’ and other interventions are often helpful in encouraging responsive action.

 

 

 

 

 

 

 

 

 

 

 

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.

Does laziness cause depression or does depression cause laziness?

Share

There will not be an answer to this question that is true for everyone – instead, I think that this is an interesting question to ask one’s self as the answer would lend itself to a different form of intervention.

“Is my depression the result of my being lazy… or does my depression cause me to be lazy?”

perhaps an additional variable could be “am I depressed because I don’t know the activities that could help my depression… or am I depressed because I know what would help my depression, but I am unable to motivate to take action?”

the purpose of bringing up this ‘chicken or the egg’ discussion is to assist people in identifying the most effective intervention strategy and to de-complicate depressions a bit

 

let’s look at this issue from an inverted perspective – what if you wanted to make yourself depressed – what could you do?

 

note: It is easier to make yourself depressed than to un-depress your self… It takes quite a lot of intentionality, dedication, motivation, and energy to avoid depression in today’s complicated world. Depression is a ruthless entity which encourages people to follow the rules below… inversely if you engage in all the behaviors below you can unintentionally allow depression into your life. 

Here are a few things that you could do to make yourself depressed:

1.) Eats lots of hard to digest foods (processed, fried, carbs, sugars etc)

2.) Don’t get enough sleep

3.) Find an addiction (electronic devices are particularly effective)

4.) Never exercise, stretch, or meditate

5.) Throw your fear circuitry into fight or flight mode by regularly watching 24-hour news stations

6.) Avoid hobbies and any form of recreation, activities, and entertainment that could leave you feeling stimulated

7.) Avoid contact with other people (especially emotionally intimate encounters) and avoid working on your boundaries

8.) Avoid having sex

9.) Work until you are exhausted

10.) Avoid all therapies (mental, relational, and physical)

11.) Never experience nature

12.) Choose comfort over an engaging, stimulating, or challenging experience whenever possible

13.) Stop learning, growing and challenging yourself

14.) Ensure your life has no structure, routine, or goals

15.) Avoid the Arts

16.) Never play. take everything too seriously

17.) Spend all your time thinking/planning for the future, and ruminating on the past … never enjoy the present moment (or spend no time planning in your life)

18.) Avoid being openminded, curious and flexible

19.) Avoid all spiritual and existential contemplations and practices

20.) Don’t listen to your emotions or intuitions… and don’t acknowledge or validate your emotional experience

 

For all 20 variables listed above, there is a unique solution for you – for example: not everyone needs to engage nature the same way, exercise the same, eat the same etc to avoid depression… but most of us, both intuitively and through contemplation of our life, have a basic idea of what we need to achieve ‘wellness’ relevant to all the above 20 variables.

Depression may have come from a biological source, a traumatic event, or from some other environmental variable… or depression may have arrived because the above 20 variables were not attended to…

For some, an outside helper such as a therapist or psychiatrist may be necessary to get the ball rolling… for others, the solution may be as simple (though ironically difficult) as addressing the 20 variables above with an intentional plan.

 

 

 

 

 

 

 

 

 

 

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.

Choice and quality of life | What choice, if removed, would most positively impact your well being?

Share

the United States is home to many many sub-cultures and there also exists a meta-culture which has a strong influence on all the diverse groups that make up the nation.

Perhaps the most prolific attributes of the meta-culture (the US culture) is our love for freedom and choice.

Choice is often looked at very dichotomously in our culture; we often conclude, without flexibility or relativity, that ‘more choice’ = good. Inversely we tend to have a hard time emotionally when we perceive that we, or someone else, are lacking in choice and again we can fall back to the dichotomy of ‘no choice’ = bad or oppressive.

as we apply dialectics to the topic we arrive at a plethora of examples of how choice is both the catalyst for oppression and for emancipation… choice can embolden our authentic self and allows us to embody and exercise our unique purpose while choice also oppresses the expression of our unique self and traps us from living a fulfilling and purposeful existence.

It can be relatively easy for most people to identify how choice facilitates a subjectively better and more fulfilling life, but what is often under-contemplated is how choice is our oppressor or impediment to living a ‘better’ or more fulfilling life.

Therefore I encourage you to ask yourself the following question:

What choice, if removed, would most positively impact your well being? What choice would you be better off not having? 

Again, notice that you may have an automatic negative emotional reaction to this question – If you live in the US (and many other countries) you have been primed your entire life into believing that no choice = bad… this creates anger or fear at the suggestion that you could remove choice.

One good example of a culture in which the removal of choice seems to positively impact the people is the Buddhist and Hindu cultures at temples. In many ways, routine, ritual, and a dedication to various practices are favored over choice. Additionally many cultures have removed the choice of isolating from family, or eating certain harmful foods or engaging in spiritual practices etc.

What choice would you remove?

Some examples:

  • the choice to exercise
  • the choice to meditate
  • the choice to eat certain types of food
  • the choice to read
  • the choice to engage with nature
  • the choice to take certain drugs
  • the choice to have what quantity of alcohol
  • the choice to act with aggression towards another
  • the choice to lie
  • the choice to avoid meeting the needs of a loved one
  • the choice to engage in art
  • the choice of when to go to sleep and wake up
  • the choice work what amount of hours
  • the choice to watch what amount of tv
  • the choice to always have your smartphone

 

etc

 

 

 

 

 

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.

Solutions and Causes of Anxiety

Share

For this post, I will outline all the different causes of anxiety. I will break my list into categories and sub-categories (note: there will be overlap – for example, emotional anxiety can cause cognitive anxiety. and ultimately every form of anxiety has biological manifestations).

1st we need to address the reality that Anxiety in 100% necessary for survival – it is impossible to have no anxiety, If you didn’t have anxiety you would not have an automatic system for avoiding danger. Anxiety is an effective mechanism which informs a person when change is necessary = Often it is not simply our job to ‘stop’ our anxiety… instead, it is our responsibility to listen to our anxiety to deduce a needed change.

note: for simplicity, I will be calling the complex neuro/biological network responsible for anxiety the – ‘anxiety system’.

The main sources of anxiety:

Health and Biological

Nutrition – What you ingest affects the neurotransmitters in your brain (both in creation and transmission) which impact the sensation of anxiety. Both your hormonal and neurological systems are impacted (and in many ways connected) to your digestive system = gut health directly impacts mental health. Studies have suggested that anti-oxidants and probiotics may impact anxiety. Many believe that in the process of human evolution our first neurological system was in our gut (intestines) – therefore, maintaining a healthy environment in our digestive system is crucial for our mental health. Additionally, what you eat can leave you more susceptible to other causes of anxiety listed below (example 1 – Ingesting too much caffeine can negatively impact your sleep = which is a major source of anxiety. Example 2, consuming food that is difficult for your digestive system to process can leave you lethargic, which can impact your social abilities and your motivation to engage in anxiety-reducing activities such as exercise). Lastly, having relatively stable blood sugar is correlated with reduced anxiety – this means that eating regularly and eating ‘easy to digest’ (not heavily processed) foods can help to manage anxiety.

Exercise – Exercise is necessary for the proper function of many biological systems including your cardiovascular system, respiratory system, and your central nervous system. Without exercise it is difficult to ‘reset’ your ‘fight or flight response’= this will leave you with more ‘alertness’ or ‘vigilance’ – When your system is in fight or flight mode – there are measurable effects such as shallow breath, increases heart rate, tense muscles and more adrenaline in your system. Exercise is one of the most effective mechanisms for 1.) a healthy central nervous system and 2.) helping your body to effectively transition between sympathetic (the ready for action state of being) and parasympathetic (the rest and digest state of being) systems. Additionally, Anxiety is a natural feedback mechanism for automatic bodily function – If you are having difficulty breathing or/and if you have an accelerated heart rate, you will experience anxiety as a biological notice for you to take reparative action – without proper respiratory and cardiovascular function, it is possible for you to feel anxiety from activities such as walking up the stairs. For many people, It is near impossible to not feel anxious without a regular exercise routine.

Sleep – Almost everything listed above under Exercise is also true for Sleep. It is relatively impossible to avoid feelings of anxiety without sufficient sleep (7 – 9 hours per night). To compensate for your fatigue, your body will utilize hormones to energize the body – this leaves you feeling anxious. Additionally, the proper function of most of your biological systems is impacted when you do not get enough sleep. Anxiety is your bodies natural way of letting you know that something isn’t right – If you don’t take care of your body it is natural for you to feel anxiety.

Breathing and Oxygen – The brain receives signals that we are drowning when it is not supplied with enough oxygen (with insufficient oxygen the sensation of anxiety occurs to inform your consciousness that there is a real problem. Often when people are having a panic attack, they exhale more than they inhale (unconsciously); this increases panic as they have too much CO2 and too little O2 in their system. During times of extreme emotions, it is common for people to engage in ineffective breathing patterns – this exacerbates our stress response and reduces our ability to engage rationally (with our cortex). Breathing impacts the central nervous system – certain breathing patterns can engage the ‘fight or flight’ system while other patterns can activate your parasympathetic (resting) system. In general, Breathing deeply into your abdomen (stomach area) reduces anxiety, while short quick breath into your chest increases anxiety (or vigilance – remember what we call ‘anxiety’ is not always a bad thing – If you are preparing for athletic competition you want to feel a little ‘anxious’).

Prolonged Stress – Stress Feedback Loop (burnout, unsafe environment, institutionalized oppression, abusive relationships etc.) – When a person is in a state of stress for a prolonged period of time, their stress creates a feedback loop, which begets more and more stress. In stressful situations, it is adaptive for our ‘anxious system’ (most notably the sympathetic nervous system and the amygdala) to activate in response to the stress to assist us in resolving the situation (fighting, running etc). During this time the body releases cortisol and other hormones such as adrenaline to 1.) assist us in taking action in the moment (increased blood flow to muscles and decreased blood flow to digestion etc) and 2.) to create and strengthen synaptic connections in the brain so that we are ‘faster’ at responding to the threat or stressor if it should come about again in the future. When the stress does not go away the body continues to release cortisol, which mylenates (makes more effective) synaptic connections which activate our ‘anxiety system’. If this continues for too long, basically anything in the environment can very quickly invoke an anxiety response = we are in a constant state of fight or flight = sympathetic activation. This type of anxiety requires a prolonged period of time in a safe environment with reduced stimulation to recover (this option is not available to all people – especially marginalized or oppressed group = community-wide social justice interventions are often necessary to reduce this form of anxiety). For other people, this means leaving an unhealthy relationship or quitting a job or creating better boundaries (turning off your electronics during rest time)etc.

Brain Hemispheric integration – when the left and the right hemisphere of the brains are well integrated – the synergistic relationship can help to manage anxiety. The left hemisphere is our logical and language center – the right hemisphere is our systemic, emotional and creative center. The left hemisphere requires the proper function of the right hemisphere to understand emotions (of the self and of another) the right hemisphere requires the language of the left hemisphere to narrate the emotions we experience. Studies have shown that the act of correctly identifying emotions reduces the felt impact of that emotion (ex. simple saying I feel guilty or embarrassed etc.). We need the right hemisphere to be aware of our anxiety, the left hemisphere to label the anxiety, the right hemisphere to create potential solutions to remedy the anxiety, and the left hemisphere to implement the details and linear strategies of the plan.

Trapped Tension or Energy – For centuries Eastern medicine has identified that the body stores anxiety and stress… many cultures believe that disease is caused by dis – ease or unresolved stress that is trapped in the body that needs assistance in being successfully released. Acupuncture and massage are two of the most well know and well-researched interventions for freeing trapped stress from the body. There are also somatic therapies (psychotherapies) which allow a person to re-experience traumatic events in a safe setting – this often involves mindfully noticing sensations in the body while allowing the body to ‘finish’ an action which was interrupted during the trauma (such as shaking uncontrollably).

Trauma – Some experiences in life are too extreme for the human condition to handle (this differs from person to person – some people might only require a slow car accident to experience trauma while others return from war zones without incident.) A traumatic event was never cataloged correctly in the brain – as such when there is an environmental trigger (‘reminder’) a person will feel as if the traumatic event is happening in the present moment. For most stressful incidents the memory of the event can still be anxiety provoking, but there is a felt sense that the stress was in the past. For a person who experienced trauma, the threat (stress) feels like it is happening in the now – this is emotionally very difficult and can be a source of constant anxiety (as you will always feel fear).

Relational Variables

Secure Relationships – Humans have evolved for millions of years to be a relational animal. As such, many of our systems (especially the systems utilized for emotional regulation) require positive and secure relationships (vulnerable, authentic, emotionally and physically nurturing, supportive, attuned, compassionate) to function ideally. The most effective way to stay regulated is to be in the presence of a secure partner or caregiver. Studies have demonstrated that pain and fear (both related to anxiety) are significantly reduced when a person has a secure relationship present.

  • There are 3 main methods of regulation: external regulation – when another person behaves in a way which offers you regulation (ex. a parent holding a child and swaying back and forth or when you receive empathy and compassion from your therapist). Self-regulation – When we engage in behaviors to regulate ourselves (ex. meditation, journaling or deep abdomen breathing), and inter-regulation -when we are regulated through a reciprocal emotionally intimate connection with another (this is often behavioral – such as having an emotionally connecting conversation, but inter-regulation will happen without additional action for people in a secure relationship. For example, simply sitting next to a loved one can have regulating effects). Humans have required secure bonds for survival for millions of years – because of this fact, relationships are thought by many (namely attachment theorist) to be basic needs for survival (like food water and shelter). If the body does not have access to a basic need it will activate the ‘anxiety’ system.

 

  • In a secure relationship, partners can use empathy to understand their partner’s emotional reality – they then can offer compassion to nurture their partner’s emotions. Both partners will benefit from emotional intelligence to assist them in knowing themselves and knowing the need of the other.

Sex and Physical Touch – prolonged nurturing physical touch and consensual sex with a loved one release oxytocin, which reduces cortisol (responsible for perpetuating the stress feedback loop – above) and makes you feel more ‘safe and bonded’. Without regular touch, our bodies are left to manage anxiety without the influx of really helpful hormones. Sex is unbelievably helpful in promoting health in almost every variable one can think of – the positive biological, existential, and relational impacts are really useful in controlling anxiety. When Anxious, a prolonged hug (about 8 seconds or more) can assist in regulation. As many of us know, babies and young children require nurturing hugs to regulate; Though adults have other methods of regulation, are systems still favor nurturing contact with a loved one.

Attachment Style – The way that we were nurtured and cared-for by our early caregivers impacts how we engage in relationships as adults. There are three main styles. Secure – “I am confident in myself and in my partner to meet my needs”. Avoidant – “I am only confident in myself to get my needs met”. Anxious – “I am unsure about how my needs will get met, but I want you to do something.” People with an avoidant style will feel anxious if they have to rely on another person, and people who are Anxious tend to feel nervous about whether someone can or is willing to help them.

Boundaries – The ability to say ‘yes’ and ‘no’ in a way which best meets your needs is paramount to controlling unnecessary anxiety. We all have different stress threshold and levels of tolerance for certain activities or emotions etc. – our inability to monitor our needs and to set boundaries with our environment is one of the major sources of anxiety. Very often we stretch ourselves way too thin and can benefit from reducing responsibility (saying no). Other times we prioritize comfort instead of engaging in activities which would promote existential, physiological, or relational health (not saying yes).

Consciousness and Congruence

Attention – Attention is one of the main sources of Anxiety. What we place our attention on directly impacts our emotional systems. At any given point there are millions of things in the present moment that you can attend to (all of which will elicit a different emotion), additionally, there are a seemingly infinite amount of things that have happened in the past or could happen in the future that you can place your attention on. Lastly, the human brain does have limits to the amount of stimulus that it can successfully process – Often we are so inundated with stimulation that we feel anxious in response to the reality that we can not adequately categorize our environment (for survival reasons, your brain is responsible for categorizing everything in your environment as a threat, a pleasure, or neutral – this is a largely unconscious process). Placing your attention on a positive stimulus (or thought) can help you to manage anxiety.

Mindfulness – Almost everything that we feel anxious about it out of our control, already happened or is purely hypothetical. Mindfulness is the ability to place your consciousness in the present moment. In the present moment, there is very rarely anything to be anxious about (quantitatively there are very few minutes in your life where stressors are actually present – the rest of the time our minds are reminding us about stressors that happened and stressors that could happen.) Developing your ability to immerse yourself in the present moment (mindfulness exercises, yoga, meditation) is one of the most effective means of mitigating anxiety. Mindfulness also, ironically, would help us to know and understand the physiological, emotional and cognitive reality of our anxiety.

Thoughts, Beliefs, and Schemas – Often our attention is placed on our thought processes and the quality of our thoughts along without our attachment to our thoughts (or, conversely, our differentiation from our thoughts) impacts our anxiety. Cognitive Behavioral Therapy CBT is interested in helping people to identify dysfunctional thought patterns and addressing them with ration. The theory is also concerned with identifying core schemas that impact a great majority of our behavioral patterns. Schemas are essentially universal and rigid truths that we unconsciously use to guide our decisions and behaviors (ex. “Conflict is bad, I need to be liked by everyone, emotions are weak, strong people don’t depend on anyone else etc.)

Existential – Are you living a life which is congruent with who you really are? are you acting like you – or – are you being you (or are you being someone that you believe you are supposed to be that isn’t actually the ‘real’ you?) Existential Anxiety is your body and minds way of reminding you to be your self – we are all unique and have different paths towards feeling fulfilled – we all have a different purpose. Anxiety is the result of not living a life which embodies your core values and sense of meaning. If your life feels subjectively meaningless, you likely will feel quite a lot of anxiety.

Emotions – put simply, anxiety is fear (fear of failure, fear of impermanence, fear of abandonment, fear of harm etc.)… so all anxiety is related to emotions. When we ignore, avoid, deny, repress, or otherwise disregard our emotions we tend to have a low underlying anxiety. Much of this can be attributed to the fact that something important is not being attended to – some emotion is not being honored. And again, anxiety then is your bodies way of saying – please respect and acknowledge your emotional truth. Anxiety tells us what needs to be changed – our intuition and emotions give us the data needed to arrive at what change needs to take place. Becoming more aware and connected to your emotions is a great way of managing your anxiety. On the other hand, it is also very possible to be too enmeshed with our emotions – we can feel as though we Are our emotions instead of living a life in which we are Experiencing our emotions (ex. there is a huge difference between “I am sad” and “I feel sad”).

Intuition – your intuition is your automatic and largely unconscious implicit decision-making system – It is extremely intelligent – this system has the ability to provide decision making information (usually in the form of an emotion) from a large amount of data. Your explicit system, largely manually and conscious, is considerably slower in comparison and does not have the ability to process as many variables. Your intuition is therefore very often correct and is a more robust decision-making tool. (note: the system can be fooled by trauma, other life events, and intentional psychological manipulation – ex. political adds target your implicit system to manipulate your feelings and resulting decisions about candidates – so do many marketing campaigns). Anxiety is often felt when we ignore our intuition. This is because your brain ‘knows’ something that you are not consciously aware of. for example, if someone is trying to sell you a counterfeit item – your explicit system may have no way of deducing this, but you have a ‘gut feeling’ that something is wrong. Often times we experience anxiety because we are not conscious of, or do not have proof, something we ‘know’ to be true (ex. your kids are doing drugs, your friend is lying, your partner is having an affair, your job is planning on letting you go etc – again, sometimes our intuition is wrong, but sometimes it is correct, and our anxiety is the result of ignoring or denying.)

Nature – We evolved for millions of years to live within nature – for reasons not totally understood, being in nature has dramatic impacts on anxiety. Simply being immersed in nature is a natural (yes a pun!) solution. This likely means that the opposite is true = lacking regular access to nature is likely a cause of anxiety and depression.

 

 

 

 

 

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.

Concrete vs Abstract responsibility for teenagers

Many Teenagers are struggling to complete the tasks that they are responsible for… often times their achievement is interrupted due to the fact that they view the tasks as meaningless or irrelevant to their life.
The “meaningless and irrelevant” assertion is often […]