Emotion Regulation Skills

Having the tools to help regulate your emotions is crucial in maintaining a good quality of life. These tools help you stay grounded in your day to day functioning, even if things aren’t looking like they are going to improve. Emotion regulation skills are also helpful in that they help you respond to life events rather than react to them.

Here are some effective ways to start practicing some of these skills to assist you in regulating emotions:

-Build an awareness of the parts that you like about yourself and about the parts you don’t like about yourself. Acknowledge that there are certain things that you will not be able to change about yourself, but by being aware of these parts you can lessen the distress on yourself.

-Practice Acceptance: realize that you cannot change/control people or things around you- you can only control how you react.

-Make changes in your life so that positive events will occur more often (i.e. going for a walk, going to the movies, calling a friend, etc).

Distract yourself from unnecessary worries such as:

– thinking about when the positive/good experience will end

-thinking about whether you really deserve this positive experience

-thinking about if the experience will occur again

Get to know your feelings

 -Learn to identify and label your emotions

 

-Learn about the accompanying body sensations that come with these feelings

 

 -Describe the thoughts that come along with these feelings

 

By being simply noticing and acknowledging these feelings (rather than pushing them away), the intensity tends to dissipate on its own.

Know that Feelings are just feelings- you don’t need to act upon them. You can choose to engage in them or tolerate them while doing nothing.

 

 

 

 

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Managing Panic Attacks

What is a Panic Attack?

A panic attack is a fear response that is out of proportion for the given situation. It involves an intense anxiety that causes much discomfort. A panic disorder comes into play with the person is constantly living in fear of having another panic attack.  This could really affect a person’s daily functioning. Therefore, it is important to shed light on how to manage these panic attacks, so that they do not take over.

Christian had his first panic attach when he visited his father in the hospital, after a car accident. Christian saw his father asleep in the hospital bed, looking pale, with a cast on his leg. Christian felt himself trembling. He also had difficulty breathing and felt faint. He began to perspire and felt like he was going to die. His mother, who had experiences with panic attacks, helped Christian take long, deep breathes, until his panicky feelings subsided. After a couple of minutes, Christian felt better, but was confused as to what just happened with his body.

Symptoms of A Panic Attack

Difficulty breathing             Trembling or shaking           Pounding/racing heart

Feeling of terror                     Numbness                                Feeling Choked

Sweating/chills                       Feeling Dizzy                          Nausea/ stomachache

Tingling                                  Chest Pain                             Feeling like you’re dying

  Managing Panic Attacks

Using Your Mind:

  • Remind yourself that you are not in actual danger. You are having an exaggerated response to a reaction to stress.
  • Tell yourself that you can help yourself manage these feelings.
  • If you are worried that you can’t breathe, remember that if you are able to talk, you are able to breathe.
  • Seek help to get an understanding of what is causing your panic attacks.

Using Your Body:

  • Find a place you could sit and feel safe (for instance, if you are driving, pull over to the side of the road to let your body relax).
  • Begin to do some deep breathing exercises: breathe in through your nose, take a long deep breathe in, and then exhale slowly through your mouth. The oxygen will help calm your body, stop your heart from racing, etc.
  • Do other things that feel comforting to you (such as listening to soothing music, sipping cool water, calling a friend, yoga, going for a walk, etc).

Cristina Mardirossian, LMFT
Licensed Marriage and Family Therapist
(818)434-6051

Website: www.cristinamardirossiantherapy.com

Follow me on Facebook: http://www.facebook.com/TraumaTherapy

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Connecting to Emotions

In walks Mark, a 37 year old man who looks tougher than nails. Mark sits down and tells me that he doesn’t think he needs to be in therapy. He is strictly coming to therapy at his partner’s request. In slowly building rapport with him, I realized that he has difficulty in connecting to his feelings. Instead, he would put on this mask that made him appear like a “macho man,” as he would call himself. Many people who have suffered with pain have either never learned how to recognize and connect to their feelings or experience their feelings in a disconnected way. This typically begins as a defense mechanism. However, this disconnection eventually can decrease one’s ability to regulate stressful feelings, increase arousal in the body, and impairs decision making. Mark’s task in the beginning stages of therapy was to just learn how to recognize and understand his feelings along with the accompanying sensations he has in his body.

 In this process, Mark began to slowly trust me and eventually shared with me that he was severely emotionally abused and neglected in his childhood. According to Mark, his parents were always working and when they were actually home, they would degrade him consistently. He frequently was called an idiot, a failure, and a piece of shit. What Mark also remembers being very traumatic for him was never being touched.  Mark stated that he never received hugs or any form of intimacy with his parents.  When he attempted to sit close to one of his parents, he would be told to move away or go to his room. Now, as an adult, Mark has moments in which he is intimate, but then quickly withdraws (hence why his partner sent him to therapy). The “macho man” was just a cover up for Mark’s fear to connect.

Treatment

I helped Mark begin to learn how to listen to his body. For instance, he learned how to feel the “no” in his gut when he didn’t want to do something or when he felt uncomfortable. He also learned to notice what his body feels like when he is tired. As a result of Mark being more able to read his own body and express his needs, he became more able to increase his emotional connectedness. Mindfulness is the ability to be aware of what is happening in the present moment without judging yourself. It also includes noticing what is going on in your body, including physical sensations and emotions. As Mark learned to incorporate these mindfulness skills in his everyday life, he was able to tolerate slowly removing the “macho” facade without getting too overwhelmed.

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Sally’s Childhood Abuse

Sally, age 32, initially came to therapy to deal with her anxieties and fears. She talked about her phobia of being in the dark, being in environments that were unfamiliar to her (especially in the evening/night time), and avoidance of certain men. Sally described how her anxiety had been getting in the way of her relationships. One concern in particular that she shared was her fear of being in the dark with her boyfriend. She also stated that she’s had nightmares since she was 7 years old, but that they intensified when her boyfriend would sleep over. Sally also stated that she has a lot of anxiety around sex- She reports that her body shuts down and freezes when she attempts to have sex. Sally eventually revealed to me that she was sexually abused by a family relative at the age of 7.

In therapy, I initially spent the first part of treatment building trust and rapport with Sally. Although I had known about her childhood sexual abuse early in treatment, Sally first needed coping skills and grounding techniques prior to dealing with her trauma memories. She learned skills in how to deal with her anxieties, such as learning to relax her body when in fearful situations. Part of this first phase of therapy involved assisting Sally in identifying and verbalizing body sensations- helping her find the words to describe sensations i.e. tingling, twitching, burning, tight, numb, etc. and helping her get connected to them. She also learned to connect with sensory experienceshere-and-now experiences of what she smells, sees, tastes, hears, and feels in the present moment. I also helped Sally in developing a list of coping skills. One of the skills she favored most was keeping her eyes open and feet planted to the floor as a means to keep herself grounded when anxious. She also started to play calming music at night when her boyfriend would sleep over, which helped her sleep more peacefully.

Once Sally had the tools to deal with her anxieties trauma triggers, she was able to use the therapeutic space to talk about her sexual abuse. While Sally described her sexual abuse, I would ask her about emerging thoughts, emotions, body sensations, movements, five senses, etc. Through mindfulness of her present-moment experiences, she was able to shift from being caught up in the trauma to becoming curious about her sensations. This was very beneficial for Sally- she began to differentiate between traumatic memories/sensations from her abuse to her present reality of feeling safe.

Cristina Mardirossian, MA., LMFT

Licensed Marriage and Family Therapist

Lic. # MFC 49234

  (818)434-6051

Cnm.therapy@gmail.com

http://www.PasadenaTraumaTherapy.com

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TIPS FOR TAKING CARE OF YOURSELF FOR THE NEW YEAR

Take responsibility for your life: get to know yourself, your thoughts/feelings, and your motivations so that you can make choices that fit you.

Know your limits – saying “no” is okay. Don’t accept added responsibilities when you don’t have time for them.

Get adequate sleep and rest

Exercise: Get involved in an activity you enjoy i.e. hiking, yoga, dancing etc.

Good hygiene and grooming

Get organized: getting into a routine could help decrease stressors.

Smile and have laughter in your life

Allow yourself to “play”-if that means sitting down and doodling, going to Disneyland, or scrapbooking, do it!

Learn to Relax:  try to give yourself breaks during your day. If that means stepping out of your office to take a 5 minute walk, do it! Or sit down and take a couple of deep breaths.

Practice Acceptance: realize that you cannot change/control people or things around you- you can only control how you react.

Start a journal: instead of keeping your thoughts and feelings inside, give them space on paper. Writing and drawing both allow for venting!

Review your social support system: talking things out with those you trust can offer relief.

Set goals: and reward yourself when you have accomplished them!

 

 Cristina Mardirossian, MA., LMFT

Licensed Marriage and Family Therapist

Lic. # MFC 49234

(818)434-6051

Cnm.therapy@gmail.com

http://www.cristinamardirossiantherapy.com

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Effective Communication Skills

Conflicts are always going to come up in your relationships. However, the conflict isn’t the problem; it’s how you deal with it! Instead of communication your needs, you may by driving people away with your complaints, attacks, or lectures. To really have people understand you and get what you want, you have to take the attention off others and focus on yourself. Next time you’re dealing with conflict, keep these communication skills in mind!

 

  • State your feelings using “I statements:” This means, instead of saying “you have no consideration for others” you might say “I feel frustrated when you don’t ask me how my day went.” You can see that this latter statement identifies a “feeling word,” which could help the other person understand your point of view rather than feeling attacked.  It is a more constructive way to express feelings that sparks less defensiveness.
  • Make requests by asking rather than telling: For instance, instead of saying “go get me my laptop from the office” you might say “Would you mind bringing in my laptop from the office?” The latter statement comes off less authoritarian.
  • Ask questions to clarify anything you might not understand or might have misinterpreted.
  • Show you understand the person’s statements by validating feelings and rephrasing. For example: “You must feel…” or “It makes sense that you feel……”
  • Be open to tears: they are a sign that you are really listening by drawing out deep levels of pain.
  • Set limits: this means knowing what you are willing and not willing to tolerate. For instance, you might not allow someone to yell at you. You can say “If you continue to yell, I will leave until you have relaxed.”
  • Make eye contact, nods, and listening noises like “uh huh.”
  • Offer physical comfort if appropriate such as a hug or a shoulder to cry on.
  • Before offering solutions, ask if the person just wants to be heard.
  • Don’t agree to just pacify the person. You don’t need to agree to understand!!
  • When you don’t have the attention to listen, give yourself space and inform the person that it’s not a good time to talk. Set up another time to talk when you can be more attentive.
  • Listen to what the person is saying thoroughly before you disagree with them.
  • Respond to criticism with empathy: Instead of getting defensive, try to listen what the other person is trying to tell you. It’s important to validate the other person’s pain and also look for what’s true in what they are saying.
  • Compromise, compromise, compromise: try to come up with a solution that is going to meet everyone’s needs.  
  • Time Out: if the argument is getting heated, it is perfectly fine to take a time out from each other. Once both parties involved have calmed down, communication can start up again.

 

 

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Daisy’s Depression

Daisy, a 16 year old high school student, was referred to me by her school. According to her school counselor, Daisy was hospitalized recently for suicidal ideation and needed to be seen for her depression. When Daisy walked into my office, the first thing I noticed was all of her piercing. She had a few piercing in her arms, a few on her cheek, and two on her chest. I also noticed the cuts on her wrists and shoulders. I put my observations to the side and decided to come back to them later. I had to build rapport with Daisy first. I asked her about her hobbies, her friends, her boyfriend, etc. Daisy and I were able to build a positive therapeutic relationship fairly quickly. In the middle of our first session, I assessed Daisy for current suicidal ideation. Daisy shared with me that she does not currently want to die, but a few weeks ago was really contemplating killing herself. Daisy stated that she was happy that she was hospitalized because she is getting support and is now taking anti-depressants. She also stated that she is looking forward to continuing therapy with me, feeling like I can really help her. Therapy with Daisy really focused initially on stabilizing and creating safety for her. Daisy’s triggers of depression were discussed, along with her triggers for cutting and self-harming behaviors. A safety plan was put together for Daisy, in which she could utilize a list of alternate coping skills instead of cutting. Daisy and I put together a “Feel Good Menu,” which lists the things that make her feel good. We used her 5 senses to put this list together. For example, things that she sees that makes her feel good (such as seeing her boyfriend), or things she can hear (such as her favorite music), or things she can taste (such as her favorite ice cream flavor), etc. Daisy carries her “Feel Good Menu” with her wherever she goes, as a reminder that she has alternative ways to take care of her emotions.

Every session I assess Daisy for suicidal ideation. We also go over her coping skills as a means to reinforce them. Currently, Daisy is keeping herself safe and putting to use other coping skills to deal with her emotions. We have started to talk about her depression and where it stems from. Daisy has been raised by a single mother who has verbally/emotionally abused her. I am also assessing Daisy for possible sexual abuse, which up to this point she has denied. (The reason for me assessing her for sexual abuse is because one of her siblings was abused by a family member and Daisy whole-heartedly protects this family member from anything negative spoken about them).

 A big part of my treatment has also included Daisy’s mother. I have met with her to discuss parenting skills and deal with mother’s own abuse history. Daisy’s mother is starting to see how her unresolved abuse is getting in the way of her parenting. Daisy’s mother is now receiving her own therapeutic services with another therapist in efforts to work on her abuse history. Family sessions have been held to work on communication skills. Initially, Daisy and her mother would talk over each other, interrupting one another, and not listen to what the other is expressing. Now, Daisy and her mother are learning how to listen to each other and wait for their turn to speak. They are finally able to talk and build a strong relationship with each other. Daisy even showed her mother her “Feel Good Menu,” as a way to share her coping skills with her mother. This also allows for Daisy’s mother to know how to help soothe her daughter. Therapy with Daisy and her mother is a work in progress!

Signs of Cutting Behaviors

-Scars, from cuts or burns, found on different parts of the body (for example, on the stomach, arms, or thighs).

-Having sharp objects in possession

-Covering up the body with long pants or long sleeves, even if it’s hot

-Having fresh scratches or burns

-Having a lot of “accidents”

-A lot of isolation

For more information on cutting, please visit http://helpguide.org/mental/self_injury.htm.

 Suicide warning signs:

  • Risk taking behaviors such as reckless driving
  • Becoming suddenly cheerful after a period of depression
  • Saying things like, “I’d be better off dead” or “I wish I could die.”
  • Looking for a means to kill themselves, such as weapons or pills
  • Writing stories, notes, or poems about death, dying, or suicide.
  • Giving away favorite belongings or promising items to friends/family
  • Saying goodbye to friends and family as if for good.

24-hour suicide prevention & support:         1-800-273-TALK.

Helpful Websites:

http://kidshealth.org/teen/your_mind/feeling_sad/cutting.html

http://teens.webmd.com/cutting-self-injury

http://eqi.org/cutting1.htm

 

 

 

 

 

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Helping Teens with Anger

Recognizing Anger

Non Physical Signs

  • Controlling decisions
  • Isolating from friends, school, family
  • Having extreme standards
  • Blaming, insulting, name calling, threatening, questioning or checking up

 

Violent- No Contact

  • Reckless driving
  • Throwing things, punching things, destroying objects
  • Cruelty to animals or children

 

Violent Contact:

  • Holding down, pushing, shoving, twisting arms, grabbing, etc.
  • Slapping, spanking, punching, burning
  • Choking, banging head, hair pulling
  • Using weapons
  • Forced sex

Megan’s Story

In walks Megan, age 17, into my office. Megan is brought to therapy by her parents. Recently, Megan’s best friend died in a car accident. Her friend happened to be at the wrong place at the wrong time. Megan’s parents have informed me that Megan has been having a really hard time showing her sadness and instead has been relying on her anger.

According to Megan’s parents, Megan has been showing a lot of anger, both at home and at school. Megan started off by isolating from her friends. She then began to give attitude to her friends, teachers, and parents. Megan’s parents thought that this was just a phase and that she would get out of it. However, Megan instead began shoving her peers at school and slapping her younger brother. She also began to blame her personal problems on everyone around her. Megan’s parents realized that they needed help on how to assist their daughter through his difficult time, while also learning how to deal with her anger.

Helping Megan with her anger

 Some teens deny feelings of anger until they explode or turn anger against themselves. With Megan, it was important for me to first assess any risk of safety (such as having suicidal thoughts herself or having thoughts of hurting someone else). Once safety was established with Megan, I helped her in processing her anger. I personally believe anger is good, IF it is dealt with properly. Shoving people at school and slapping her brother is not an appropriate way for Megan to deal with her anger because she is placing others in danger. Instead, I assisted Megan in coming up with coping strategies that could allow her to express her anger in a healthy way, such as writing her feelings down in a journal. I also encouraged Megan’s parents to enroll Megan in a boxing class at her gym, as a way to release the anger pent up in her body.

Once Megan was able to use her coping strategies effectively, I assisted her in processing the death of her best friend, which was at the root of her anger. Part of Megan’s anger was also at her friend for leaving her. Megan needed to blame others for the injustice that was done to her. When I assisted Megan in facing her feelings, what began to show up in therapy with Megan was her sadness. Behind all that anger, Megan was holding a lot of sadness for her best friend’s death. I helped Megan talk about her memories of her best friend, remembering all the times that they had spent together, in a tangible and creative way. Megan decided to create a little ceremony for her friend, which included pictures, a necklace, and a goodbye letter. Megan also processed her feelings regarding the changes that have come about since her friend’s death, such as the changes in her weekend plans, changes in studying habits (since they used to study together every day after school), etc.  I helped Megan learn new ways to deal with these changes.

While helping Megan in processing her anger and sadness over her friend’s death, I also assisted Megan’s parents in dealing with Megan’s anger. For instance, I assisted her parents in coming up with their own relaxation techniques, as a means to help themselves calm down when Megan would give them attitude. I also provided psycho-education on the changes that could come about when someone looses a loved one, as Megan did. This information helped Megan’s parents understand where she was coming from and how to assist her better during this difficult time.

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Trauma in the Body

Marco* first came to therapy to help manage his anger. Marco stated that he has been angry for a long time now. He stated that he has a very bad temper, snaps at everything, and gets into physical fights at least three times a month. When asked where he learned to be angry, Marco had no problem talking frankly about his father.  Marco was a victim of child physical abuse from the ages of 7-14. Depending on his father’s mood when he walked into the home, Marco knew if he was going to get to sleep peacefully or if he was going to have another bruise on his body. Marco learned very quickly how to protect his younger siblings from being hit by placing himself at his father’s mercy. Marco thought that instead of his brother and sister being hurt, he will take the brunt of it. His mother, who was also scared of Marco’s father, stayed quiet and stood back while Marco got hit. Now as an adult, Marco has realized that anger has taken over.

As Marco’s therapist, the initial task at hand for me was to build rapport with him while creating safety. I provided Marco with a safe space for him to express his thoughts and feelings.  Creating safety for Marco also included helping him gain self-care resources. For Marco this meant regulating his emotions and body sensations, along with getting regular sleep and eating habits. Marco was not in touch with his body. He knew he felt tense, but wasn’t able to describe or connect with his tension. Marco early in therapy looked like he was always on edge, being very careful of what he would say and not say, had tension in his shoulders, and had a right leg that wouldn’t stop shaking up and down (when talking about his abuse). One of the first tasks in therapy was to help Marco learn to calm himself down by also learning how to connect with his body sensations. I helped him focus in on his body sensations in the present moment in our sessions, describing what his sensations felt and looked like. Marco started to understand how his sensations and past trauma are connected.

Since anger was a familiar and comfortable feeling for Marco to express, I helped him learn about anger in his body. By focusing on the sensations he experienced in his body, Marco was able to know when he was going to get angry, giving him the opportunity to think before he acts. In session, when Marco would talk about his father’s physical abuse towards him, I would check in with him and see how he is feeling inside. One session that really stands out to me is when I noticed Marco’s fists getting tighter and tighter in session when talking about a past memory. I asked Marco to temporarily stop talking about his memory of being hit and to shift his focus on his hands. Marco noticed the tension in his hands and said he felt like hitting something. At that point, I asked Marco to follow his body’s sensations (in a safe way). I engaged Marco in muscle relaxation exercises (tensing and releasing his hands over and over) until he got the tension out! He was able to release that pent up anger he had been carrying with him all these years. I then encouraged him to return back to his trauma memory when his body was relaxed.

My work with Marco is a work in progress. He has come a long way in his therapy process and is learning to self regulate more effectively as time goes on. He is also no longer getting into fights and is handling his anger better. He continues to attend therapy once a week and has also joined a group therapy specifically for men with trauma.

*Marco’s name has been changed to maintain confidentiality.

http://www.PasadenaTraumaTherapy.com

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Managing Insomnia

What is Insomnia?

Insomnia is difficulty initiating and/or maintaining sleep, or the perception of poor sleep. Insomnia could include: difficulty falling asleep, waking up too early in the morning, or waking up often during the night time. If you or someone that you know suffers from insomnia, make sure to see a physician to see if there is a physiological cause that needs to be ruled out.

Causes of Insomnia

Acute insomnia includes:

  • New stress ( such as a death of a loved one or changes in work)
  • Jet lag
  • Drug or alcohol use
  • Emotional or physical discomfort.
  • Uncomfortable room temperature
  • Excessive or unpleased noise in the room
  • Some medications (such as anti-depressants) may interfere with sleep.

Causes of Chronic or Long-Term Insomnia

Other Causes of Insomnia

  • Stimulants associated with poor sleep include caffeine and nicotine used prior to bedtime.
  • Some people use alcohol as a way to help them to sleep. This just disrupts sleeps patterns.

 

Insomnia Treatment

Treatment for chronic insomnia involves first treating any primary states/triggers or health conditions that are causing the insomnia.

GOOD SLEEP HABITS INCLUDE:

  • Try not to take naps during the day, unless directed by your doctor
  • Learn to relax. Do some deep breathing or muscle relaxation. Soothing music could be useful as well
  • Avoid stimulants like caffeine, nicotine, chocolate, and alcohol late in the day.
  •  Create a routine. For example, read a book prior to going to bed. Try to go to sleep at the same time each night and get up at the same time each morning.
  • Use your bed for sleep or sex only
  • Reduce fluids after dinner time
  • If you’re having ruminating thoughts in bed, get up and journal so that it gets off your mind and goes down on paper. You could also try writing a “to do list” so you don’t have to worry about those things.
  • Don’t force yourself to sleep. Go to bed when you are sleepy
  • Make sure you make your bedroom as relaxed as you can for yourself. For example, make sure the room temperature is comfortable.
  • Get regular exercise. Refrain from exercising a couple hours before bedtime since exercise is stimulating.

 

 

 

 

 

 

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