Productive Purposeful Pleasant


Productive – Purposeful – Pleasant


After ending last week’s blog, I realized I haven’t ever posted about this little language-based motivation/behavioral activation technique that I sometimes use with clients. Probably because I really don’t like it when people make (or especially seem to force) alliteration or acronyms, and I don’t want you to think I did that! Haha! This actually just popped up in a session one day, fully formed (fully P’d!) and it has been useful several times. 

This little technique seems to be sometimes beneficial with clients who have mild/moderate depression, the kind of anxiety that keeps them sort of paralyzed (not catatonically paralyzed! Just keeps them from moving forward effectively), and some who deal with procrastination. (Although straight mindfulness is good for all of these, too, especially procrastination.) 

The technique is really simple – it just involves (Step 1) taking the things on the client’s to-do list (whether that is take a shower and check the mail in the case of depression or the long list of household chores or whatever), and dividing them into these categories, or labelling them… is the task Productive, Purposeful, or Pleasant? (or some combo?)

*Wouldn’t it be nice to have lots of things on the list that are all three?!*

Step 2: Just take anything else off the list! What’s it doing on there, anyway?! This can sometimes bring a sense of relief and permission to clients who need it. 

Step 3: Make sure there are items in every category, especially the pleasant category! (This is a kind of sneaky way to measure anhedonia and sometimes to figure out distress tolerance ideas!) 

Step 4: Invite clients, in session if it’s possible or as homework, to choose items from anywhere on the list.

I often start with Productive… is there anything on there that they have the motivation/energy/etc. to do right now? If they can, they often feel a sense of accomplishment and also relief from “checking something off the list.” It’s ok to make use of session time to get this started! Do they need to make a dr’s appointment – just have them call, right now! Do they need to update their credit card information on their bill pay? OK, do it! 

If not, how about something purposeful (meaning tied to values, even if it doesn’t “get things done”)? Is there a value of relationships or being a kind person – choose text a friend from the list (add it right in the moment if it comes up!) Is there a religious/spiritual value – choose read a scripture verse. Is there a value of being a good parent – write a sticky note for your kid and put it in their room. Is there a value on making progress in therapy? Listen to your affirmations, read a few pages in the homework book, etc. Make sure that plenty of these are easy, low energy, low cost options. (This is a kind of sneaky way to get to identification of values, as well, which can be helpful in most cases.)

Nothing doing there, either? Well, no problem! Because you have a list of activities that are for nothing but pleasure! Encourage clients that choosing something from the pleasure list is OK! (There might be a little bit of cognitive work to do here, about being “allowed” to do something for pleasure when there are things on the productive list. And one of these days I need to do a post on how “laziness” is just a really good energy management strategy! HA!) But remember – doing something is better than doing nothing, and often increases motivation and productivity in the long run. Even if the pleasant thing is doing “nothing,” like taking a nap, sitting quietly, etc., doing it mindfully is a positive step! 

Comment below: What do you do to help clients with behavioral activation? 

 

 

 

 

Best Quick Tips Ever Volume 2


Best Quick Tips Ever (Volume 2)


Here are some more super quick, highly accessible techniques that we could be teaching clients! (Remember, don’t use these if the underlying theory isn’t already part of your clinical repertoire, please!) If you haven’t seen Volume 1, see those here

 

  • Imagine Yourself on a Hot Air Balloon (or Better Yet, Sitting on a Satellite) – This is an old Stoic notion, “Plato’s View” (more about that here) that current research also suggest can quickly reduce distress. This visualization exercise allows you to change perspective, throwing even the deepest, most overwhelming pains into relief against all the rest of what’s happening in the world.     
  • Half Smile – A DBT classic, this is possible the quickest and most available emotion regulation technique of all! The brain and body work both ways, you know! 
  • Sunlight – 5-15 minutes in the sun is enough to boost serotonin and improve mood. Add to that the fact that you’re probably removing yourself from a less pleasant situation to a more relaxed/pleasant situation by going outside (yay, behaviorism works!) and getting a little nature fix (bonus mood enhancer!), and it’s even better. 
    • Also, as a reminder, regular moderate sun exposure helps prevent depression, and if you do it in the morning, helps to improve sleep! Oh, and cognitive function! And work satisfaction!
  • Jumping Jacks (any kind of intense exercise immediately) – Even five minutes of intense exercise can improve mood in several ways – by “using up” stress hormones if they’re present (yes, that’s a gross oversimplification), by getting you out of a stressful or uncomfortable situation (unless you’re going to bust out some crunches right in the middle of the stressful work meeting), and/or providing an intense enough distraction to act as a distress tolerance skill.
    • And, over time, a really excellent treatment and prevention strategy for depression! (WAY better than antidepressants) 
  • Say the Thing, Out Loud. Even to Yourself. Especially to Yourself. – That icky feeling is more tolerable once it has words that go along with it (especially if it has accurate words that go with it). But, emotional labeling acts as an implicit emotion regulation strategy, and it’s relatively effortless. Plus, the benefits of expressive writing (decreased anxiety, depression, negative rumination, and improved mental and physical health, including enhanced immune functioning) extends to speaking aloud as well!  
  • Drink a Whole Glass of Water – not only does this just give you a tiny break from whatever stressor you’re in, it’s an opportunity to engage in basic self care and possibly to engage in a mindfulness practice. But there’s also research showing that being even a little dehydrated can contribute to fatigue, low alertness, and negative mood. So a simple glass of water might help you feel better, and help you gear up for more active coping! (Also, many of us work in environments where this is something we could even offer clients in session.)

Comment below: Your ideas for super cool, underutilized quick tips? Or have you ever used any of these with clients? 

 

 

 

Best Quick Tips Ever (Vol 1)

 


Best Quick Tips Ever


 

There are a bunch of super effective, super-fast, super-easy techniques for stress reduction, emotion regulation, and more that therapists just aren’t teaching clients! Why?! I think it might be because people don’t know about them? Here’s a list of a few of my favorites, each with a little video. Well, except for the really self-explanatory ones. For those, I’m attaching some research because it’s hard to imagine these commonplace little tactics are actually effective! 

(Ethics moment – definitely don’t use these if the underlying theory isn’t already part of your clinical repertoire, please!)

 

  • The Dive Reflex – If you’re a mammal (and you are), and you’re stressed, put your face into cold water for 30 seconds. Instant changes in the stress response, thus calming anxiety and other dysregulated emotions. 
  • The Physiological Sigh – You do this, unwittingly. It’s that sobbing sort of thing you sometimes do in the middle or near the end of a big cry, or you at least do it in your sleep! It’s like taking 2.5 inhales and then a long exhale, repeat 3-5x. The end. Really good for quick emotional calming. (Side note: In real life, when your body does this naturally, it’s more like 1.5 inhales, but when I’ve taught it in therapy, clients are usually breathing very shallowly, and teaching them to do this consciously, 2.5 seems to work better – the first inhale to baseline, the second to what feels like “capacity” or a “deep breath,” and then that last little bit that “overinflates.”)
  • List 3 Things You’re Grateful For – Lots of research about this, but here’s a fun study about how gratitude reduces Repetitive Negative Thinking and thus reduces depression and anxiety. Even a single, small intervention, like listing 3 things you’re grateful for in the moment can change perspective and improve mood. 
  • If you already do EMDR, consider the Flash Technique – it’s like a quickie version of reducing SUDS, without processing the actual trauma (but has some limitations, of course). Remind me one day to do a post on what actually makes EMDR work (which isn’t bilateral stimulation).
  • Call a Thought a Thought – the simplest  of cognitive defusion strategies. Notice you’re thinking thoughts. Then say it to yourself, “I’m noticing I’m thinking XYZ,” or even “That’s just a thought.” Crazy powerful, quick, and accessible anytime. 
  • Controversial but interesting…. Take a Tylenol – Acetaminophen (paracetamol) reduces the pain of social rejection and of making tough decisions. Careful, though – it may also increase risk taking, reduce empathy, and decrease the intensity of positive experiences, as well. (And, of course, mind the risk of overdose!) 

Comment below: Share your favorite, research-based “quick tips” for clients!  

 

 

 

Post Concussion Syndrome

 

 


Post Concussion Syndrome


Diagnostics is always more complicated then it seems – more like a DND roll than a simple symptom checklist or binary “has it” or “doesn’t have it” question. Here’s a great example:

 

Post concussion syndrome (PCS, or postconcussional syndrome) is a relatively vague set of symptoms that can continue to occur well after someone has had a head injury. The symptoms are wide and many of them are mental health symptoms, which is why it’s especially important for us to know about it. A headache is usually accompanied by symptoms like:

  • sleep problems
  • depressed mood
  • irritability
  • anxiety
  • trouble concentrating
  • difficulty with memory

Sound familiar?! YIKES! 

In fact, it’s so closely associated with other mental health conditions that 10-20% of student athletes meet criteria for it… even if they haven’t had a head injury – just because they’re stressed and somewhat sleep deprived! So, it’s important to consider all facets of this diagnostic mess!

 

 

PCS codes in ICD-10 as F07.81. Now, we probably wouldn’t want to diagnose Postconcussional Syndrome…. but we very well might want to put it in as a Rule Out or make a referral for additional testing/diagnosis with a physician or neuro specialist. 

 

We definitely want to have a question on our intakes that helps us keep this possibility in mind. For example, on my regular intake I have this question:

Have you experienced:
– chronic headache, migraine, vision changes, loss of consciousness, or dizziness?
– changes in your vision, hearing, other senses, or movement? (e.g., blurry vision, ringing in your ears, difficulty swallowing, trouble speaking, weakness or paralysis)
– difficulties with your memory, planning ability, or thinking clearly?

If so, when did you experience these symptoms and for how long?

That allows me to consider PCS, along with some other potential issues such as mild neurocognitive disorder and functional neurological symptom disorder (formerly conversion disorder). These answers can also “flesh out” other conditions, such as chronic headache associated with generalized anxiety disorder or difficulty concentrating as part of a depressive disorder. Loss of consciousness sometimes maps onto a substance use disorder. It’s a big question, but it gives lots of data and paths to follow-up on during the actual intake. 

Comment below: What are some of the diagnostically oriented questions you have on your intake?