Anxiety

Psychological flexibility: What is it and how does it help us?

Like many of you, I have spent much of the last month watching Olympians contort their bodies into some pretty stunning shapes. Seeing such incredible physical limberness on display has also got me thinking about one concept in particular: “psychological flexibility.” Whereas an Olympic gymnast’s flexibility is measured by looking at how their body bends during a floor or vault event, psychological flexibility is “scored” in terms of how far we are able to “stretch” our thoughts and actions during everyday life events. 

Let’s say that during any social event you attend, your mind automatically convinces you that others are going to negatively judge you, no matter what you say or do. Unfortunately, because your mind is unwilling to “bend” towards multiple possibilities (e.g., that others may also judge you positively), it would not receive very high flexibility scores. And instead of winning you a gold medal, this rigid mindset only offers you added worry, anxiety, and apprehension.

The good news is, just like our physical flexibility can be enhanced by routinely stretching our limbs, there are a couple different “exercise” approaches we can use to improve our psychological flexibility as well. While the cognitive approach involves switching up our thinking strategies or shifting our belief systems, the behavioral approach involves switching up our actions or shifting the way we conduct ourselves in a given situation.

For example, let’s say our manager at work provides us with constructive (albeit negative) feedback. Rather than rigidly assume that this feedback means they hate us and are going to fire us, the psychologically flexible method of response would be to fully flesh out the facts and adjust our beliefs to better reflect them. Here, the facts indicate that while yes, we have indeed made an upsetting error at work, we are not being let go. Instead, our manager has actually given us the opportunity to correct our mistakes and learn from this incident. 

Having “stretched” our thoughts in this way, we can then decide what actions are best for us to take. While rigidly assuming that our job is doomed might rigidly cause us to react defensively (e.g., telling our manager “you can’t fire me, I quit”), adopting a more flexible mindset will lead us to develop a more flexible action plan. Perhaps instead of impulsively quitting or arguing back to our manager, we decide to hear their suggestions, apologize for our oversights, and heed their advice in order to prevent this error from happening again in the future.

Behavioral flexibility in this case may also involve “manually” bringing down the physical activation and tension that come with the anxiety we often feel in moments of conflict like this. For example, we could momentarily distract ourselves from this distressing situation by engaging our five senses (e.g., intensely focusing on the sounds, smells, or visual details of our surroundings). Or, we do some square breathing exercises to bring our heart rate down. We could also methodically relax the tense muscles in our body one by one. Regardless of which option we select, all of these actions listed will help reduce the physical symptoms of anxiety and ultimately allow us to manage the situation more adaptively.

Engaging flexibly with our own beliefs, bodies, and behaviors will help us more effectively tackle the challenges that we inevitably encounter in life. When we are better able to change things up and strategically adapt to the demands of the situation, we drastically increase the odds that our own “gold medal” goals will be achieved. 

If you or someone you know would like to become more psychologically flexible and adaptive, our team of CTW clinicians are here to help you get started. Reach out and speak with us today!

Context Is Everything

Many of us are traveling more since COVID.  I recently returned from a trip to Japan to visit my in-laws.  While the trip was nourishing and long overdue, I noticed a significant dip in my mood upon my return.

I gave myself recovery days prior to returning to work, but nevertheless I struggled with upside-down jetlag this week which definitely impacted my sleep, appetite, energy, and mood.  Thankfully, I have experienced this frequently before, and so simplified my week in preparation.

This reminded me of the importance of  context when interpreting our moods. 

There are so many external and internal influences on our moods - travel, illness, hormones, work ramp ups, family demands, nutrition (the list is endless).  But it’s a core skill to assess whether these influences are likely temporary and/or changeable.   For me, I understood that the source of my low mood was  jetlag, and so I was not concerned as I understood jetlag to be a temporary biological phenomenon. This helped me cope; I simplified my week, ate nutritiously, lowered socializing, and was patient with the transition back to my normal circadian rhythm.

The ability to have some meta-awareness about our moods is critical in mood management.  When we notice our lowered mood, we can check the context for our mood shift by asking ourselves a few questions:  1)  Is there something external or internal that is known and influencing my mood?  2) Has anything changed biologically for me this week? 3)  Can I expect this to be temporary?  3) What can I do to anchor or soothe myself today?  4)  Am I willing to ask for support from my friends/family/coworkers?

Here at CTWPS, we are always trying to help our clients expand their self-care repertoire.  Getting curious about the context of our moods is key.

Pillow Talk: Women's Sleep and Mental Wellbeing

Ever tell someone they "woke up on the wrong side of the bed"? While this is just a saying (and the side of the bed we find ourselves on in the morning has little to do with our mood!), sleep, in general, greatly impacts our mental health. This is especially true for women. 

Sleep and mental health have a bidirectional relationship: poor sleep affects the mood and can exacerbate mental health disorders, and an existing mental health condition can affect sleep quality. 

Traditionally, sleep troubles were viewed as an outcome of depression. Yet, increasing evidence suggests that poor sleep could also trigger or worsen depression. Sleep problems and depressive symptoms seem to mutually amplify each other, forming a reinforcing loop. For those struggling with anxiety, the hyperarousal, or "racing mind," associated with an anxiety disorder is a key contributor to insomnia. 

During the night, the body enters the rapid eye movement (REM) stage of sleep. Here, the brain is given the opportunity to process emotional information, analyzing thoughts and memories from the day. Without enough sleep, the body misses out on crucial REM time and the synthesizing of important positive emotional content (Suni & Dimitriu, 2023). 

Women are more likely than men to have insomnia disorder and sleep disturbances. In a survey conducted by the National Sleep Foundation, 71% of women said menstrual symptoms like bloating, headaches, and cramps impacted their sleep. In another study, sleep quality and efficiency tended to be poorer during the menstrual and premenstrual phases than other phases of the cycle. This is attributed to the fluctuating levels of steroid hormones (like progesterone) released during the premenstrual and menstrual phases. Progesterone is the hormone that facilitates pregnancy and has a slight sedative effect. Following a woman's luteal phase, progesterone levels drop dramatically during menstruation, hence the reason for sleep difficulties (Baker & Driver, 2004). 

Cognitive-behavioral therapy (CBT) can prove beneficial if you're struggling with sleep disturbances or insomnia. CBT can help you manage your mood and the thinking processes that impact sleep, as well as providing concrete strategies to support your sleep.   

Hidden In Plain Sight: The Female ADHD Experience

Between 2020 and 2022, the population of adult women diagnosed with ADHD nearly doubled.  Often considered a “boys disorder,” girls are significantly less likely than boys to be diagnosed with ADHD. But this is by no means saying there is a lower prevalence of attention disorder in girls or women. Instead, girls with ADHD tend to present differently than boys and teachers and practitioners often overlook their symptoms. 

From a young age, women face difficulties receiving a diagnosis of ADHD. Disorders that go hand-in-hand with ADHD in girls, like anxiety and depression, can overshadow ADHD symptoms and lead physicians to misdiagnose their young female patients. Inward behaviors, like inattentiveness, are more common in girls with ADHD than outward behaviors, such as hyperactivity. In the classroom, hyperactive boys are noticed and dealt with by teachers, while inattentive female students remain ignored because their behavior is manageable. As a result, women learn strategic coping skills for their ADHD throughout their lives, further mitigating the external appearance of their disorder. Researchers Arcia and Conners (1998) determined that the self-perception of adult women with ADHD is poorer than that of men with ADHD or women without an ADHD diagnosis.  Learn more

Studies have shown differences in dopamine release, cognitive function, and sensation seeking between men and women in response to stimulant drugs like amphetamine, often used to treat ADHD (Quinn & Madhoo, 2014). The effects of amphetamine in women vary based on their menstrual cycle, with greater euphoric and stimulating effects observed during the follicular phase, when estrogen levels are higher, compared to the luteal phase. This research suggests that the response to ADHD medications might need to be adjusted throughout the menstrual cycle for better symptom control for women.

Cognitive therapy can be a helpful tool in your ADHD arsenal. Some cognitive therapists specialize in working behaviorally with clients to improve executive functioning skills which may be helpful for aspects of ADHD. While we here at CTWPS do not specialize in executive functioning coaching, we do support our clients in managing the anxiety and isolation that often surrounds their ADHD experience.  If that is something that you’d like to explore more in depth, reach out to us to learn more!

References

Arcia, E., & Conners, K. C. (1998). Gender Differences in ADHD? Journal of Developmental & Behavioral Pediatrics, 19(2), 77. https://journals.lww.com/jrnldbp/Abstract/1998/04000/Gender_Differences_in_ADHD_.3.aspx

Quinn, P. O., & Madhoo, M. (2014). A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls. The Primary Care Companion for CNS Disorders, 16(3). https://doi.org/10.4088/pcc.13r01596

Russell, J., Franklin, B., Piff, A., Allen, S., & Barkley , E. (2023). Number of ADHD Patients Rising, Especially Among Women. Epic Research.


The Sex-Mind Connection

Understanding how your sexual and mental health are interconnected is integral to taking care of your well-being.  Research has shown that sexual activity has a direct impact on mental well-being. A healthy sex life can improve the way you feel and express emotions. But what happens when menopause, illness, pain, or other factors get in the way? 

Sexual dysfunction and other issues related to sexual health can often lead to common mood disturbances in women. Many women may experience feelings of anxiety, low self-esteem, or depression. These symptoms usually appear in a cycle; sexual dysfunction impacts the mood, and mood disturbances further impact sexual health. Link here

Common sexual health concerns in women include a low sex drive (aka hypoactive sexual desire disorder), painful intercourse, difficulty reaching orgasm, and menopausal changes. Women facing these concerns should speak with their healthcare provider or gynecologist. Many of these issues are treatable, but can still be frustrating.  

Stress and anxiety even have a biological impact on the body that can affect one’s sexual health. Your body is programmed to react to stressful environments by producing a hormone called cortisol. Usually, it provides you with a short burst of energy to tackle an immediate problem in front of you. But, importantly, when your body is producing cortisol, it cannot release the essential hormones needed for sexual arousal. In a population study conducted by researchers Dunn et al. (1999), sexual concerns were affected by psychological issues in women more than men. Problems with arousal, inhibited enjoyment, and painful sex were strongly related to anxiety and depression measures in women. For men, sexual health concerns were connected to age and physical health more significantly than emotional issues. 

Your gynecologist, a sex therapist, and a cognitive behavioral therapist can each be critical   resources for women experiencing sexual dysfunction. The role of cognitive therapy can be to promote a healthy change in attitude around sex, reduce anxiety relating to sex, and improve a woman’s self-image in the context of dysfunction.  

We are not separate from our bodies.  Sexual health is crucial to your overall health. Despite the stigma surrounding sexual dysfunction, please don’t go it alone.

About Those New Beginnings

In the Northeast, we are pretty much programmed to anticipate new beginnings in September.  We may feel a surge of inspiration and energy that catapults us out of the last vestiges of summer.  

Changes in season often reflect in our mood, at least temporarily.  A key aspect of managing our moods is recognizing the transience of mood.  Everything - including our mood - changes. And while external factors, like a seasonal shift, might impact us briefly, we don’t always have to make a larger negative story out of it.  Sometimes our meta-story about our mood is the culprit in worsening it.   For example, a client might say “Every winter I get depressed”, and the result of that belief is that she feels anticipatory anxiety and dread as the winter approaches.  But a further examination of that statement reveals that most winters (not all) she feels a brief but significant drop in her mood that signals her to then anchor herself in her coping skills, and shift herself out of that low mood.   So a reframe of that statement could be “I typically feel a significant mood drop in late November. I am going to try to get ahead of that by being proactive and practicing my repertoire of coping skills to either prevent, or move more quickly out of a depressed mood if it arises.”  

Changes in mood are inevitable.  But our power lies in our willingness to directly influence the meaning we give to those changes.  If you would like support in doing just that, we’d love to help!

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