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There are a lot of different methods and theories of couples therapy. One of the best ones for treating couples, is the Gottman method. John Gottman, PhD and his wife Julie Schwartz Gottman, PhD have been studying couples’ behavior in Washington State, teaching clinical and direct workshops for therapists and clients, writing books, and providing couples’ therapy for over 40 years. They are internationally recognized for their contributions to what can be a very tricky area for therapists and clients. If you want to know more about them or the Gottman Institute, please check out https://www.gottman.com/.

The Gottman Method

Since becoming a Gottman Certified Educator in 2015, I have been running workshops and working with couples using their methods (as well as all of my other clinical experience). This method takes you beyond active listening and conflict resolution to focus on friendship, respect, and acceptance that not all problems can be solved – but they can be managed.

This is a very difficult thing for a lot of people to process – that problems need to be managed and compromised on, that they cannot always be solved. And it is just one of the seven principles of a “Sound Relationship House” that form the core of their treatment philosophy.

Why Couples Come to Therapy

Couples come to therapy for a myriad of reasons. It is a difficult and stressful thing to do – to recognize that your relationship needs work and that you cannot solve all of the problems in your relationship between the two of you.

Some couples come because they don’t really interact with each other anymore – maybe they are empty nesters, maybe they have had family crisis(es) that leave them having to put out fires all the time instead of nurturing their relationship. Whatever the case, a lot of couples who come into my office do not know each other very well anymore – sometimes after only a few years of marriage! It takes energy to keep up with people – in our busy lives, we all know how difficult it is to keep in touch with friends and relatives – but you also need to keep up with your spouse, your partner, the person who you (hopefully) have some downtime with.

“Love maps” are the Gottman method’s way of getting to know each other again – drawing a map of what makes your significant other tick and keeping up with it as it changes. I also like Table Topics to generate discussions in couples or families.

Couples also come to therapy when there has been infidelity. There are a lot of potential reasons for this, but infidelity (emotional or physical) is the opposite of “Turning Towards” your relationship. When one partner is unfaithful, they have turned away from their partner and towards someone else. A “sound relationship” is one where each party can rely on and trust the other. That means that if one person is struggling with something, they turn to the other for support, guidance, opinions, or a port in their storm.

If you love, respect, and admire someone and you have a disagreement, you try to see their side and validate their point of view even when you don’t agree. You do not give in (which will just cause resentment), you do not turn away, and you do not blame the other person. Forgiveness is an aspect of “fondness and admiration” as well as “turning towards” and the “positive perspective.” You do not always have to forgive, but if you want to stay in a relationship after infidelity, you both have to forgive each other for whatever transgressions have brought you to that point.

Another reason couples come to therapy is that they argue all the time – I call it “kitchen sink” arguing when you start arguing about one thing (usually something minor in the scheme of things) and end up throwing all your other resentments, hurts, problems, and unhappiness into the argument. There is no way to win that kind of argument. You know that you are there when you do one of the “Four Horseman” of relationships. These are criticism, defensiveness, contempt, and stonewalling (see left). Whenever you get to the point of complaining about unrelated things, arguing about semantics, name calling or just not talking at all, you have done one of these.

There are a lot of other behaviors that you do with each of these, but it is important that every time you do one, you have to do at least five positive things to counter the damage to the relationship. With contempt, it is 20 to 1! Relationships cannot survive constant arguments like this. There are a lot of things – Gottman calls them “repair attempts” – that you can do to try to fix it, but it is MUCH easier not to do these in the first place. No one wins in these situations.

The average couple comes to counseling six years after the problem begins in their relationship – that is a lot of negativity to counter. There is no quick fix or shortcut to building a healthy relationship. Everyone argues, everyone disagrees, and everyone has to figure out the best way to manage their relationship. It is a puzzle that requires both partners be interested in change. It requires that both people be willing to learn and grow to make a relationship healthy. There is no shortcut to learning to listen, argue well, compromise, and value each other.  But sometimes, there is help along the way.

 

Kendra Wilson, LCSW, CEDS

Kendra is a Gottman Certified Educator and teaches Couples Enrichment Seminars at Chrysalis Center periodically. If you are interested in attending a seminar, please email Chrysalis and we will let you know when the next set of seminars will be scheduled.


22/Sep/2017

 

A Tale of Two Changes (ish)

A couple of months ago, I was talking to a friend about my yoga practice. I am hardly an aficionado, but I really enjoy practicing yoga, and when I regularly do yoga, I notice my mood is so much better, I feel better in my body, and my distress tolerance increases significantly. And yet, I think the last time I did yoga was at least a month ago with the previous time being a month or two before that.

On the other hand, I used to be someone who was chronically late. I used to joke that it was in my DNA to be late because I was even born late. Then, one day, someone said something to me, and it stuck with me in just such a way, that over time, I have shifted out of the pattern of being late to being on time (I do think I should clarify, though, that I’m still not an early person).

How can I enjoy doing something so much and still not follow through with actually doing it? How was I able to make the change with becoming more on time even though doing so was physically painful at times?

Breaking It Down

Both of these questions have to do with the question of motivation and sustainability. Why are we sometimes able to make change and keep it going, and other times, it feels like a constant struggle or something that we try and fail to follow through with?

In brief, it is our motivation to change and how we approach the change process that makes a difference.

Next Steps

Starting in September, there will be a Motivation to Change group that explores the change process, strategies to make and maintain change, and focuses on goal setting and follow through to meet goals.

By breaking down the steps it takes to make change, becoming aware of our individual values, and increasing our skills and supports, each of us has the capacity to make significant changes.

To be fair, though, it’s both exactly what I said and also more complex. I still am not doing yoga the way I wanted to several months ago, but I also have shifted my focus towards being more flexible with the activities I am incorporating and being less rigid about it necessarily being yoga where I find my peace and tranquility. As a result, I have made change, continue to make efforts at change, and also have further clarified my values to better match up with my goals for change.

Putting It Together

Clearly, as outlined above, I am still human- just a person who is able to make some changes but struggles with others. However, through this group, I am confident that you can gain better understanding of what motivates you in the moment, keeps you motivated over time, and helps you maintain progress towards your goals.

Wishing everyone wellness, flexibility, and motivation during this season and moving forward!

 

For Follow Up

If you are struggling to make change, or if you just want to know more about the process, please reach out, and I am happy to follow up with you. Also, if you would like to work through a group focused on change (and flexibility and self-care and all the things), then please let me know, and I am happy to discuss options for that, as well!

 

 

Rachel Hendricks, LCSW is a new addition to the clinical team at Chrysalis and has been working on the topic of motivation to change for the entirety of her clinical practice. She also specializes in working with clients who have had their eating disorder for ten or more years, clients with co-occurring substance use behaviors, as well as working with couples and families. She is excited to be making the transition to Wilmington from the Center for Eating Disorders in Baltimore, Maryland and looks forward to becoming more familiar with the area as well as continuing her reputation for providing excellent clinical care in the field of eating disorders.



This posts shares some information about a supportive, evidence based treatment for trauma and PTSD symptoms: Prolonged Exposure.

What is PTSD?

Post traumatic stress disorder is a common mental health problem following trauma. Individuals with PTSD often have difficulties with emotion regulation, managing symptoms of arousal, and other related symptoms. Co-occurring problems such as eating disorders, substance use disorders, depression, and self-injury are also common. You can read more about PTSD in my prior Chrysalis blog about PTSD.

What is prolonged exposure?

Prolonged exposure (PE) is a well established evidence based treatment for PTSD. It has been shown to yield long term improvement in PTSD symptoms.  PE can be applied with individuals who have co-occurring problems as part of a comprehensive treatment plan.

PE s a form of Cognitive-Behavioral Therapy (CBT) for PTSD, developed by Edna Foa, PhD. PE typically takes 8-12 sessions with at home practice in between sessions. Before working on traumatic memories, the PE therapist teaches the patient various safe techniques for relaxation from anxiety and arousal.  After the patient learns theses techniques, the PE therapist helps the client begin to work on traumatic memories. As part of this process, the trauma survivor intentionally recalls a traumatic memory that is contributing to PTSD symptoms. This is done through the use of verbal or written narratives while under the careful supervision of the PE therapist. These memories are recalled and then the safe relaxation techniques are employed. This is done long enough and often enough to experience a reduction in PTSD symptoms.

Working in this careful manner with a PE therapist, the patient learns new ways for the brain and body to respond to traumatic reminders. This allows the traumatic memories to lose their power to elicit PTSD symptoms. To be successful, PE needs to target the traumatic memories that are most related to PTSD symptoms. However, individuals can experience improvement  without discussing every trauma or all aspects of their trauma.

How does prolonged exposure work?

PTSD can be seen the inability of the brain to stop the fight-or-flight response. Reminders of the trauma trigger distressing thoughts, feelings, and harmful behaviors, even when there is no current danger. Escape and avoidance behaviors develop to provide temporary relief; unfortunately, over time they can lead to PTSD and co-occurring problems.

By intentionally approaching traumatic reminders safely under the therapeutic guidance of a PE trained therapist, new learning can happen to decrease PTSD symptoms. Over the course of PE, the brain starts to learn that traumatic memories and reminders are not dangerous, that anxiety does not last forever and that it is possible to have some power and control over traumatic memories.

What if I feel too afraid to start prolonged exposure?

It is natural to feel afraid at the start of PE. It is common not to feel quite to start PE or even feel afraid. All of that is totally okay. In fact, the first steps of PE address these concerns and give patients tools to decrease these anxious feelings, relax and regain control before working on traumatic memories.

PE should only be done in the context of a strong therapeutic relationship with a licensed clinician who has received formal training in PE. PE is a gradual process where the patient is in control and works collaboratively with the PE therapist. As part of this collaboration, fears about PE should be discussed about openly with your PE clinician throughout the process. This should help decrease initial fears and keep later fears manageable. It is okay to feel afraid and PE will help you gain strength and confidence.

What if I am ready to start prolonged exposure?

If you think you may have PTSD and that PE might be helpful, talk with your primary clinician or  contact Chrysalis to set up an initial evaluation. PE is compatible with ongoing therapy for other difficulties. PE can be added for 8-12 weeks in conjunction with your primary therapist in a collaborative approach to your treatment. At Chrysalis, we offer PE by a licensed psychologist who has been intensively trained in PE.  You can contact Chrysalis for more information about getting started. Recovery from PTSD is possible and within reach!

Dr. Kate Brody Nooner is a licensed clinical psychologist and associate professor of psychology at UNCW. She also holds an adjunct appointment at Duke University and is the principal investigator of NIH-funded grants aimed at reducing child and adolescent trauma and preventing alcoholism.


11/Sep/2017

Chrysalis Center will be hosting Wilmington’s 5th Walk From Obesity and Fitness Fun Run on Saturday, October 14 at our office in the Burnt Mill Business Park. This event benefits the American Society for Metabolic & Bariatric Surgery (ASMBS), an organization that is committed to improving public health and well-being. This is done through research and education, awareness, and access to care. Chrysalis Center is a member of the ASMBS and an advocate of these initiatives as we strive to help clients both physically and psychologically become healthy.

This year, our theme for the Walk is “Fight the Stigma”. Today in America, there are many types of discrimination and stigma against specific populations of people. We see this in many scenarios for children and adults who are obese. While any healthcare provider wants to help individuals become healthy and avoid risks associated with obesity, it is very important to fight weight based discrimination. In the workplace, it is becoming one of the top reasons why candidates are passed over. In fact, “it has become a leading cause of either discrimination or termination from jobs for the female population, representing the third most common form of discrimination for women in the workplace, after sex discrimination and age discrimination.” (HG.org)

The ASMBS and Obesity Action Coalition (OAC) are committed to raising awareness for employers and law makers about the dangers of weight based discrimination. By participating in the Walk From Obesity as an individual or as an organization, you are helping to advance this issue so that fewer Americans will be treated unfairly because of their weight. It is important for people who are obese to feel confident in participating in activities (for work or pleasure) despite their weight. We can raise awareness for this by encouraging business to consider thinking outside the box in their marketing efforts. We are already seeing this in some national advertising campaigns who are committed to including plus sized models. Through our fundraising, the ASMBS and OAC can continue to fight the stigma, raise awareness, and provide access to care to those struggling with obesity.

Are you ready to show your support and participate this year? Sign up as a participant here and use the code EARLYBIRD at checkout for a discount by 9/14/17! We’ll have a silent auction, prizes and fun on the day of the event. If you have a business that would like to participate, please email me at alexis@chrysaliscenter-nc.com for more information on those opportunities.

If you are struggling with obesity and you are ready to make a change, contact our office. We have a team of mental health therapists and registered dietitians who want to help you reach your personal and professional goals. We’re here and we believe in you.

 

Alexis is the Director of Professional Relations at Chrysalis Center and oversees all Marketing and Human Resource efforts. 



Michael*, a 52-year-old man who has recently reconciled with his wife, walks in his front door shortly after 9:00pm on a Monday evening. His wife is sitting on the sofa watching Law & Order on Netflix. She looks over at him suspiciously, “Did you work late today?” “No,” he says,” I went to a meeting.” “You go to your meetings on Tuesdays and Thursdays…” she says with a “gotcha” tone.  Michael, fighting becoming exasperated, looks her in the eye and says, “I’m going to have to work late tomorrow and I’ll end up missing that meeting, so I went today to keep up my routine of two meetings a week.”  Michael’s wife still looks discontented. Looking away, she says, “Fine.” Then she mutters, “Are you going to go to two of those meetings a week for the rest of your life? And, aren’t you still doing therapy too? I thought we’d eventually get our life back.”

Michael is an alcoholic and has been attending AA meetings for about nine months now, and has been in therapy for just as long. Why does he do both? How long will this go on?  First, AA or Alcoholics Anonymous is a self help group, and it’s not the only self help group out there for individuals struggling with an addiction. Let’s start by looking at what self help groups are and then we can look at what role therapy plays in a person’s recovery.

Here, in the Wilmington, NC area, we have a few different self-help/self-empowerment groups for those seeking self help for addiction. I’m going to talk about AA (Alcoholics Anonymous), NA (Narcotics Anonymous), CR (Celebrate Recovery), and SMART Recovery (Self Management And Recovery Training).  Most people have at least heard of AA and NA. These two groups are aimed at helping people in similar ways. The major difference is that AA is specifically geared toward alcoholics and NA is open to a variety of chemical dependency addictions. These two groups provide a support network and guidance for individuals who have a desire to live a clean and sober lifestyle. Individuals are encouraged to get a sponsor, someone who has experience in recovery and the AA/NA “program,” otherwise known as the 12-step program.  A sponsor guides the addict through working the steps and provides support for recovery and a lifestyle free of addictive behaviors. This program asks members to acknowledge a “higher power” to whom they will give over their will and in whom they trust to help them with their addiction. Although this program originally began based on biblical principles and Christianity, currently the wording is changed to include all forms of belief in a power greater than yourself.

Celebrate Recovery, on the other hand, is strictly a Christian self help group. This group covers all addictions, habits, and hang-ups that a person wants to change and can include everything from alcohol to sex, co-dependency and gambling. This program is similar to AA/NA in many other ways including a 12-step program and sponsorship.

SMART Recovery is not based in any form of spiritual belief system. It is specifically based on scientific research and the principles of cognitive-behavioral therapy. They teach the “4-Points” which include working on motivation, learning how to deal with urges, managing thoughts, feelings and behaviors, and living a balanced life. In SMART Recovery, there are usually fewer meetings offered in a community, and there is not as broad of a community of support as tends to be available through AA/NA and CR. Which one should you choose? Anecdotally, I know of success stories from individuals who have used each of these programs. I’m a firm believer in doing what works for you!

Why should a person do therapy and engage in self help? Self-help groups offer a level of support that is just not available through meeting with a therapist. However, a trained professional is able to identify and treat problematic behaviors and mental health issues. This is not something that self help groups are truly able to do. For example, individuals who have survived a trauma are especially vulnerable in a way that is best addressed by someone who is trained to do so. I have seen many trauma survivors relapse because someone well meaning addressed the individual’s trauma in a way that triggered nightmares or flashbacks that the trauma survivor was not skilled enough to handle yet. Issues related to mental health and trauma frequently rise to the surface once the addiction isn’t masking them. This is why many of the individuals who are successful at managing an addiction often attend therapy in addition to participating in self-help groups. It allows an individual to benefit from the strengths of both methods and increase the likelihood of success in reaching recovery goals.

Michael, mentioned in the outset, is a trauma survivor. He attends AA meetings to address his addiction, develop a new lifestyle, and gain support from those who understand his journey. He participates in therapy for all of those reasons and also to address his trauma and develop the skills he needs to deal with trauma symptoms without drinking. He will attend some kind of 12-step meeting for the rest of his life as part of his program of recovery. When his sponsor agrees that he is ready, he will sponsor those who need help and request his guidance. He will provide support for other members of AA and for “new comers” for years to come. Michael attended 90 meetings in the first 90 days of his sobriety, as suggested by his sponsor, and has now reduced down to twice per week. His personal goal is to always attend at least one meeting per week. However, if he finds himself struggling for whatever reason, he will attend as many meetings as he can, and he will call members of his support system for help. As far as therapy goes, when he started nine months ago, he attended intensive outpatient therapy for the first 90 days of his sobriety. This means that he attended nine hours of group therapy and one session of individual therapy per week. Upon completion of intensive outpatient therapy, he began attending two individual therapy sessions per week and is still doing so six months later. As he accomplishes therapy goals related to addiction and trauma, he will reduce down to attending one session per week, then one session every other week, then once per month, and then at some point, he will no longer need to participate in therapy. In the mean time, he also faces the challenge of helping his loved ones understand what he needs to do to be a healthy person. He will probably discuss this with his therapist and his sponsor before addressing the issue with family members who are struggling to understand how he spends his time and what it takes for him to stay in recovery. With support and the application of what he learns through AA and therapy, he has a good chance of succeeding!

*Michael is a fictional character used to demonstrate the real experience that individuals under these circumstances tend to face.

Lillian Hood, LPA, LCAS
Psychologist and Clinical Addictions Specialist
At the Chrysalis Center, I specialize in treating individuals with co-occurring disorders. This includes working with individuals who have trauma, depression, bipolar, anxiety, and/or eating disorders along with an addiction. I use evidence-based practices to help patients develop skills for successfully facing this unique challenge.

References:

Alcoholics Anonymous  www.aa.org

Celebrate Recovery       www.cr-inside.com

Narcotics Anonymous   www.na.org

SMART Recovery  http://www.smartrecovery.org


25/Aug/2017

Pregnancy can be a lovely and exciting time for many women. It is a momentous, life changing event, where the woman’s body will now become a vessel for another life to grow and flourish. This can feel empowering for many women and they take on the changes necessary for nourishing this new life without much effort or thought. For others, it is not that easy. Pregnancy (and motherhood) require a great deal of strength, both physically as well as psychologically and emotionally, even when moving into this space as an overall healthy woman. What if you are struggling with an eating disorder when you become pregnant? Or are in recovery from an eating disorder when you become pregnant? This is the case for many women- in American and worldwide. Consider the following statistics to better understand why this is an issue that needs to be attended to, rather than ignored.

  • Eating disorders affect approximately seven million American women each year and tend to peak during childbearing years
  • Pregnant women with active eating disorders are at a much higher risk for delivering preterm and low birth weight babies
  • Pregnant women with an active eating disorder appear to be at greater risk for having a Cesarean section and developing postpartum depression
  • Pregnant women with active eating disorders are at increased risk of hyperemesis, delivering infants with significantly lower birth weights and smaller head circumferences

For many women, a healthy weight gain during pregnancy is approximately 25-35lbs. The necessary gain can be higher for women who have been struggling with an eating disorder, as their pre-pregnancy weight may be dangerously low. This can be extremely triggering for some women, and close supervision and guidance from a trained eating disorder specialist is usually necessary. Other maternal issues that can occur are psychological upset, perinatal depression, anemia, increased risk of hyperemesis gravidarum, and more problems with episiotomy repair. While studies regarding the risk to the baby vary greatly it is possible for women with a history of an eating disorder had a higher rate of miscarriage, small for gestational age babies, low birth weight babies, babies with microcephaly, intrauterine growth restriction, and premature labor (especially if the mother’s body mass index was <20). History of an eating disorder or struggling while in pregnancy with an eating disorder can also adversely affect the breastfeeding relationship between mother and baby.

Women who struggle with an eating disorder previous to or during a pregnancy are at a higher risk for perinatal distress and are more likely to indicate postpartum mood issues, anxiety, panic attacks, self-esteem and body image issues, and other mental health concerns. These issues have negatively affect not only the new mother, but the infant, and the significant other/partner of the woman suffering.

Woman suffering from an eating disorder while pregnant will show many different symptoms and signs that are as varying and different as woman themselves. Some common factors for health care providers and loved ones to be aware of are:

  • Little to no weight gain throughout pregnancy
  • Fear of weight gain during pregnancy
  • Excessive exercise to avoid normal pregnancy weight gain
  • Induced vomiting (sometimes hidden as morning sickness)
  • Fainting, dizziness, dehydration, chronic fatigue
  • Social isolation
  • Avoiding meal times with others
  • Increased depression or anxiety symptoms

Effective treatment throughout the pregnancy and postpartum period are important in order to promote a healthy outcome for both mother and baby. There are several supports that should be in place, with the two most important being an OB that is somewhat knowledgeable about eating disorders and an eating disorder specialist for therapy. Meeting with a nutritionist that is trained in treating eating disorders will also be very important for a healthy outcome. Medication may be necessary during pregnancy or in the postpartum period, especially if co-morbid psychological issues are present. Group therapy, support groups and peer and peer support along with birth and parenting classes are also great ways to supplement the support that is necessary during this time.

At the Chrysalis Center, many of these services are offered by trained eating disorder specialists, which can help achieve a healthy pregnancy and postpartum period, both physically and emotionally.

Megan Schlude, MA, LPA facilitates the Motherhood Matters program, which offers specialty services to women in pregnancy and the postpartum period, including women suffering from an eating disorder during the perinatal period.

 

 



Imagine for a moment the most intense itch you have ever had. The burning sensation of discomfort screaming at you to just scratch for sweet relief. For whatever reason, you are unable to scratch this itch. Maybe you can’t reach it or maybe it is in a less-than-conspicuous spot. But you are forced to sit with that powerful fiery itch. Nobody can know that you have this itch. If you touch it, you won’t be able to stop yourself. Soon, you’ll spend countless time and energy on taking care of all the itching that ensues. It seems like there is no other way to take care of this itch than to just suffer in silence. This is the closest comparison to what it feels like to have a body-focused repetitive behavior such as hair-pulling (Trichotillomania) or skin-picking (Excoriation).
Body focused repetitive behavior (BFRB) is a term that describes any type of compulsive grooming behavior that results in damage to the body. Trichotillomania is a disorder characterized by the behavior of pulling one’s hair from the scalp, eyelashes, eyebrows, or any other parts of the body. People with excoriation repetitively touch, rub, scratch, or dig at their skin often in attempt to improve it. Despite efforts and devastating consequences, these individuals cannot stop their behaviors. Avoiding common activities such as haircuts or beach days is commonplace for those with body-focused repetitive behaviors. It is rare as a clinician that somebody enters my office and asks for help with the seemingly uncommon problem of pulling their hair or picking their skin. Often, individuals who suffer from these disorders do not seek treatment out of shame or embarrassment.
What is surprising is how common these disorders are. The best research suggests that over 3% of the population live with a BRFB. They typically come about around puberty and affect both males and females, although it is estimated that females outnumber males 9 to 1. There are several theories about what causes hair pulling or skin picking. What has been established is that there is an inherited predisposition that in combination with other factors—such as environment or temperament—lead to people engaging in these behaviors. While some may think that this is a form of self-harm or self-mutilation, the reality is that the behaviors are more to relieve stress or receive gratification (much like your insatiable itch).
There is a lot left to be understood about these disorders, the TLC Foundation for Body Focused Repetitive Behaviors (www.brfb.org) offers the most up to date information and research from experts working in the field. Treatment entails a combination of Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Dialectical Behavioral Therapy, Habit Reversal Training, or most recently the Comprehensive Behavioral Therapy Model.
If you are suffering from a Body Focused Repetitive Behavior, you do not need to suffer in silence. Change is possible! Please feel free to reach out to schedule an appointment with one of our clinicians.

 

Leanne Christian is a Licensed Professional Counselor with continuing education training in the treatment of Body Focused Repetitive Behaviors.


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So what’s the big deal about having  a cocktail after WLS?    WLS has been shown to drastically lower alcohol tolerance – to the point that some post-surgery patients have a blood alcohol content above the legal driving limit after just one drink.  Alcohol is absorbed more rapidly into the blood and small intestines due to the reduction of hydrochloric acid in addition to the alteration of shape & size of the stomach.  Bariatric patients will be more sensitive to the affects due to their low caloric intake, metabolic changes and hypoglycemia is more likely to occur.

As far as cooking with alcohol, people believe once heat is added all the alcohol burns off and only the flavor is left.  This is a myth.  The US Dept of Agriculture shares that if alcohol is added to boiling water and quickly removed from a flame, 85% of the alcohol is retained in that dish.  Simmering a meal with alcohol can take as long as 2 hours or more to burn off.

The American Society of Metabolic and Bariatric Surgery recommends high-risk groups (those with any history of psychiatric illness, substance abuse or addiction) who have had gastric bypass should completely eliminate alcohol consumption due to impaired alcohol metabolism and risk of alcohol abuse post-operatively.

Remember you’ve had a surgery that puts you at risk for malnutrition.  Alcohol inhibits the absorption of thiamin which is a vitamin that can already be deficient in many bariatric patients due to malabsorption. B1 depletes quickly with chronic vomiting or increased alcohol intake because B1 is essential for glucose metabolism.  Regular alcohol consumption is strongly correlated with thiamine deficiency.  Symptoms of thiamine deficiency may include headaches, brain fog, nausea, muscle aches and pains.  It can progress to worse symptoms such as depression, amnesia, unstable gait, motor weakness, peripheral edema, hallucinations and even congestive heart failure.  If anyone is experiencing these symptoms, please check that your multivitamin includes at least 1.2 mg of thiamine.  Share your symptoms with your doctor immediately.  Early diagnosis is extremely important.

If you still choose to consume alcohol after WLS, wait until after the first year during the most rapid weight loss period.  Find a designated driver. It is apparent that alcohol affects people very quickly after their procedure. Be cautious and keep your low sugar drinks to a minimum as you learn how alcohol will affect you and to prevent dumping syndrome. If you are drinking to cope with emotions and feel it may be an issue, seek professional support to address the underlying issues.  The Chrysalis Center offers a Bariatric Recovery Group if you are struggling with alcohol addiction or dependency.


04/Aug/2017

Anger in its’ proper form is a healthy emotion despite all of the bad press it has been getting. Healthy anger helps to mobilize our internal resources in order to respond to external threats and injustices. The key term in that statement is “healthy.” Many however struggle to determine what constitutes healthy anger and how to properly express it or manage it.

In order to better understand anger, we need to first know where anger comes from. From the perspective of Cognitive Therapy, anger occurs when we perceive a violation to our Personal Domain. Our Personal Domain consists of our values, our rules about the world, our needs, our wants and our expectations of others. Our physical being is also an element of our Personal Domain. An example of how anger is triggered from this perspective might be the anger most of us feel when a child or some innocent person is terribly harmed. For many of us, when we see a news story depicting someone being unjustifiably harmed-we become angry. We were not personally harmed, yet we still feel angry. The reason is because our value or our rule about the world that innocent people should not be harmed was violated. In order to determine if we are experiencing healthy anger, we need to evaluate our anger using the following criteria:

Are you making something out of nothing?

1. What did we “perceive” to have happened? We need to determine what did we see or “perceive” to have happened. We need to determine if what we “think” occurred actually did occur as we saw it by reviewing facts or using sound logic. If our perception is supported by facts or sound logic-then we are probably experiencing healthy anger.

2. What aspect of our Personal Domain was violated. We need to determine what value, rule, need, want or expectation was not met. Once we are able to identify this, we need to evaluate if this element of our Personal Domain is reasonable. Just because we feel things “should” be a certain way, does not mean is has to be that way. Objectively, if we are able to determine that our value, rule… is valid-then we are experiencing healthy anger.

Are you making a mountain out of a molehill?

1. Does the severity of our anger equal the situation that occurred? Now that we have determined that our anger is justified, we now need to make sure the level of anger we are feeling is equal to the situation. We need to make sure that our anger does not supersede what occurred. If our anger is proportional to the situation-then we are experiencing healthy anger.

Healthy anger consists of ensuring that you are “not making something out of nothing” and “not making a mountain out of a molehill.” Now, if you are reasonably able to determine that you are experiencing healthy anger, there is still one very important final step. You still need to express your anger in a healthy and productive manner that helps to resolve whatever issues triggered your anger in the first place. Healthy anger also warrants a healthy expression.

If you are interested in learning more about healthy anger and how to manage anger in a healthy manner, please feel free to contact our clinic and schedule an appointment with one of our clinicians.


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“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.

 

 

 


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