This summer marks the 30th Anniversary of the Discovery Channel’s Shark Week, affirming its continued popularity as a televised underwater exploration on the creatures of the deep blue. This is not surprising as sharks tend to provoke strong emotional reactions. Personally, I am fascinated by all species of sharks. I have been an avid fan of Shark Week since I was a little girl, attempting to spot one off the coast of Cape Cod, Massachusetts during the summer months. Marine research shows that a shark’s role in the marine ecosystem is vital. They maintain equilibrium in the ecosystem by keeping other fish from overpopulating the ocean. Overfishing or arbitrarily slaughtering sharks could throw the entire marine food chain off balance.

However, there are those who don’t watch Shark Week. The reason may be tied to fear. Fear is complex; it is both instinctual (survival-based) and learned (by experience) or taught (through societal/cultural norms or beliefs).

Anything associated with danger can trigger the brain to pay attention in the name of survival. “The psychological characteristics of pain and suffering, uncertainty and powerlessness, make the idea of being attacked by a shark way scarier than the statistics show.” Shark-attack stories get a lot of coverage and exposure through the media, which can contribute and amplify the fear. This can cause the “flight” (avoidance) response to watching Shark Week, because of the perceived threat to the emotional state. If fear is primed, the more scared you feel, the scarier things will seem. That is why it is best to learn adaptive ways to address rational and irrational fears as they swim (I mean, come) along.

To help debunk some misunderstandings about sharks, I wanted to share some therapeutic insight from Shark Week!

• Keep moving forward. Ever notice sharks seem to be constantly moving? Well, they have no other choice. If most sharks stop moving even for a short period of time, they can drown and die. Just like sharks, we need to keep moving forward in our lives. Experiencing adversity and difficulties can be a road block for growth. To increase resiliency, we must keep progressing forward, even if its small steps at first.
• Be opportunistic. Sharks have six senses and they use all of them to their advantage. As a bonus to sight, sound, taste, touch and smell, they can detect electrical currents through their heads to find prey effectively. Humans may have one less sense compared to sharks, but tuning into all five senses can create an increase in self-awareness, thus more opportunities for emotional, mental and spiritual growth and development.
• Sense of Mastery. Sharks are well equipped for their role as the top apex predator. They know how to use their abilities and capabilities to its full potential.  As humans, its best we operate from our most authentic, highest sense of self to life a value-driven life. Are you working in your areas of strength? What creates a sense of mastery/competence? How are you best equipped to handle life’s circumstances?

References:
Bracha, H., Ralston, T. C., Matsukawa, J. M., Matsunaga, S., Williams, A. E., & Bracha, A. S. (2004). Does “fight or flight” need updating? Psychosomatics, 45, 448-449.
Lang, P., Davis, M., & Ohman, A. (2000). Fear and anxiety: animal models and human cognitive psychophysiology. Journal of Affective Disorders, 61, 137-159.
Lerner, J. & Keltner, D. (2001). Fear, anger, and risk. Journal of Personality and Social Psychology 2001. 81:1, 146-159.
Sylvers, P. Lilienfeld, S., & LaPrairie, J. (2011). Differences between trait fear and trait anxiety: Implications for psychopathology. Clinical Psychology Review, 31, 122-137.

Many college institutions and universities offer the opportunity for students to study a semester abroad in a foreign country. This is an invaluable experience for a young person to learn and grow both academically and personally. This topic of discussion has come up in my sessions working alongside college-aged students in eating disorder recovery. The decision to study abroad is a commitment that requires an extended amount of time away from family, friends, and other sources of support. I utilize these evaluative questions to explore with my client their readiness to travel abroad in recovery:

• Are my symptoms managed well? Am I able to regulate using healthy coping skills? Do I have a relapse-prevention plan in place?
• Is my physical and mental health stabilized?
• Have I been making progress in recovery for a continual amount of time?
• Do I feel properly supported?
• Does the thought of travel bring joy and excitement (not fear or anxiety)?

How Do I Know I Am Ready to Study Abroad?
From traveling long hours on a plane, exposure to different foods, adjustments to time zones, experiencing a new culture and way of daily living – the choice to study abroad would be carefully considered and discussed with a treatment team (primary therapist, registered dietician, medical provider, etc). Considering the costs and benefits of the timing of the trip abroad is also important – a person should ideally be at an outpatient level of care, medically and psychologically stable and solidly in recovery. With guidance from a treatment team, realistic expectations and goals can be met if planned out accordingly.

Maintaining Mental and Physical Health Abroad:
Choose with recovery in mind. Traveling abroad for the first time in recovery is not the time to push or challenge too much. I encourage clients to be mindful in choosing a location and/or program type that will be aligned with maintaining recovery (i.e. access to appropriate dietary needs, ability to maintain contact with support network) – reminding them that there will be other opportunities to explore different destinations in trips to come.

Engage in self-care. Ah, the infamous s-word. Taking care of basic health needs is a fundamental way to preserve any type of recovery. Upholding a regular sleep schedule, proper nutrition, limiting alcohol, taking daily medications, journaling before bed or beginning the day with a meditation; whatever works in day-to-day life in America should be translated abroad to incorporate stability into the new and potentially changing environment.

Stay connected. Traveling or studying abroad can feel isolating at times, especially when navigating a different culture. Staying connected to various sources of support is important. This can be met through an online eating disorder support group, emails from a treatment team member or regular scheduled FaceTime or phone calls with a loved one.

Cassy Taverna, MSW, LCSW-A currently sees individual clients and facilitates S.O.A.R (Staying Open about Recovery), a support group for college-aged women who are making strides to positively stay on track with eating disorder recovery. Her clinical interests include the treatment of eating disorders, trauma, anxiety/mood disorders and LGBTQIA issues. Cassy loves to travel as she presented her research on Disordered Eating Among Newly Bereaved Spouses at the International Conference on Community Mental Health in Bangalore, India during her graduate studies at the University of North Carolina at Wilmington.

“Your body cannot heal without play. Your mind cannot heal without laughter. Your soul cannot heal without joy.” – Catherine Rippenger Fenwick

Sure, it’s fun to have a good laugh, but did you know it can improve your health? I’m not joking! Laughter can “strengthen the immune system, improve mood, reduce pain, and protect from the damaging effects of stress.” As children, we used to laugh on average over 200 times daily, but as we age into adulthood, life tends to be more serious and laughter more infrequent. To counteract this barrier, it is important to intentionally seek out more opportunities for humor and laughter in everyday life, and that includes in the therapy setting. Mental health professionals can safely incorporate tools such as psychodrama and other experiential exercises in session that extract humor to address the mental, physical and emotional needs of clients.

The Science Behind Laughter & Humor

When a person is depressed, neurotransmitters in the brain [dopamine and serotonin] are reduced and the ‘mood control circuit of the brain’ is impaired. Laughter can repair malfunction by fluctuating dopamine and serotonin activity. Laughter can also alleviate the effects of stress by decreasing stress-making hormones and serum levels of cortisol and epinephrine found in the blood steam. Humor and laughter can shift perspective and change the way the mind views or experiences an event. Looking at a problem from a different perspective can create psychological distance. help diffuse conflict, feelings of being overwhelmed and even increase objectivity and insight.

Laughter & Humor in the Therapeutic Environment

Laughter Yoga

Laughter Yoga was created by Indian physician Dr. Madan Kataria in collaboration with his wife Madhuri, a yoga teacher in 1995. Its principle follows a “body-mind approach” to laughter by inviting participants to “laugh for no reason”, which sometimes entails faking a laugh until it becomes real. This is possible since the body can functionally laugh regardless of what the mind has to say. A few studies have examined the effects of laughter yoga applied in the workplace and nursing home facilities, and the results show that engaging in exercises that simulate laughter can “increase self-efficacy in employees and reduce depression in the elderly.”

Click this link to hear more from Dr. Kataria and join in on some laughing exercises! https://www.youtube.com/watch?v=5hf2umYCKr8

Improvisation

Improvisation, or improv, has more recently been applied to group therapy for the treatment of psychological issues and provide opportunities for personal growth and exploration. The benefits of practicing aspects of improv comedy in group therapy include, “active listening,” “risk-taking,” and “group-mind” (Steitzer, 2011). Comedic improv therapy (CIT) a group therapy model inspired by the practice of improv comedy, provides the therapeutic elements of “group cohesiveness, play, exposure, and humor.” Operating in collaboration with The Second City Training Center in Chicago, Mark Pfeffer and Becca Barish have facilitated a program known as Improv for Anxiety for the treatment of social anxiety disorder in adults and adolescents. Improv for Anxiety involves participants meeting twice a week for a period of 8 weeks. Each weekly session provides an opportunity for participants to engage in a traditional improv comedy class led by skilled improvisers at The Second City Training Center and mental health professionals experienced in group facilitation that utilize the proposed CIT model, in combination with other empirically-based models of therapy. They also provide psycho-education about unhelpful thinking styles and discuss methods of restricting negative cognitions. The response from the program’s participants has been positive, and is currently being empirically evaluated by the University of Chicago using the Liebowitz Social Anxiety Scale.

References:

Phillips Sheesley, A., Pfeffer, M., & Barish, B. (2016). Comedic Improv Therapy for the Treatment of Social Anxiety Disorder. Journal of Creativity in Mental Health, 11(2), 157-169.

Panksepp, J. (2000). The riddle of laughter: Neural and psychoevolutionary underpinnings of joy. Current Directions in Psychological Science, 9(6), 183-186.

Steitzer, C. (2011). The brilliant genius: Using improv comedy in social work groups. Social Work with Groups, 34(3-4), 270282.

Yim, J. (2016). Therapeutic Benefits of Laughter in Mental Health: A Theoretical Review. The Tohoku journal of experimental medicine, 239(3), 243-249.