Give Yourself a Break: The Power of Self-Compassion When people experience a setback at work whether it's a bad sales quarter, being overlooked for a promotion, or an interpersonal conflict with a colleague it's common to respond in one of two ways. Either we become defensive and blame others, or we berate ourselves. Unfortunately, neither response is especially helpful. Dodging responsibility by getting defensive may alleviate the sting of failure, but it comes at the expense of learning. Self-flagellation, on the other hand, may feel warranted in the moment, but it can lead to an inaccurately gloomy assessment of one's potential, which undermines personal development. What if instead we were to treat ourselves as we would a friend in a similar situation? More likely than not, we'd be kind, understanding, and encouraging. Directing that type of response internally, toward ourselves, is known as self-compassion, and it's been the focus of a good deal of research in recent years. Psychologists are discovering that selfcompassion is a useful tool for enhancing performance in a variety of settings, from healthy aging to athletics. For most, (self-compassion is a less familiar concept than self-esteem or self-confidence. Although it's true that people who engage in self-compassion tend to have higher self-esteem, the two concepts are distinct. Self-esteem tends to involve evaluating oneself in comparison with others. Self-compassion, on the other hand, doesn't involve judging the self or others. Instead, it creates a sense of self-worth because it leads people to genuinely care about their own well-being and recovery after a setback. People with high levels of self-compassion demonstrate three behaviors: First, they are kind) rather than judgmental about their own failures and mistakes; second, they recognize that failures are a shared human experience; and third, they take a balanced approach to negative emotions when they stumble or fall short -they allow themselves to feel bad, but they don't let negative emotions take over. A Growth Mindset Most organizations and people want to improve--and self-compassion is crucial for that. We tend to associate personal growth with determination, persistence, and hard work, but the process often starts with reflection.) One of the key requirements for self-improvement is having a realistic assessment of where we stand -of our strengths and our limitations. Convincing ourselves that we are better than we are leads to complacency, and thinking we're worse than we are leads to defeatism. When people treat themselves with compassion, they are better able to arrive at realistic self-appraisals, which is the foundation for improvement. They are also more motivated to work on their weaknesses rather than think "What's the point?" and to summon the grit required to enhance skills and change bad habits. Being True to the Self Self-compassion has benefits for the workplace beyond boosting employees' drive to improve. Over time, it can help people gravitate to roles that better fit their personality and values. Living in accord with one's true self -what psychologists term ("authenticity" results in increased motivation and drive (along with a host of other mental health benefits). Unfortunately, authenticity remains elusive for many in the workplace. People may feel stuck in jobs where they have to suppress their true self because of incongruent workplace norms around behavior, doubts about what they have to contribute, or fears about being judged negatively by colleagues and superiors. But self-compassion can help people assess their professional and personal trajectories and make course corrections when and where necessary. A self-compassionate sales executive who misses a quarterly target, for example, not only will focus on how she can make her numbers next quarter but also will be more likely to take stock of whether she is in the right sort of job for her temperament and disposition. Self-compassion can help people gravitate to roles/that better fit their personality. What's happening here? Treating oneself with kindness, understanding, and without judgment alleviates fears about social disapproval, paving the way for authenticity. Optimism also seems to play a role. Having a positive outlook on life makes people more willing to take chances -such as revealing their true selves. In fact, research shows that optimistic people are more likely to reveal negative things about themselves -such as distressing experiences they've endured or difficult medical challenges they face. In effect, optimism increases people's inclination to be authentic, despite the potential risks involved. I believe that the relative emotional calm and the balanced perspective that come with being self-compassionate can help people approach difficult experiences with a positive attitude. Turbocharged Leadership A self-compassionate mindset produces benefits that spread to others, too. This is especially the case for people in leadership roles. That's because self-compassion and compassion for others are linked: Practicing one boosts the other. Being kind and nonjudgmental toward the self is good practice for treating others compassionately, just as compassion for others can increase how compassionate people are toward themselves, creating an upward cycle of compassion -and an antidote to "incivility spirals" that too often plague work environments. The fact that self-compassion encourages a growth mindset is also relevant there. Research shows that when leaders adopt a growth mindset (that is, believe that change is possible), they're more likely to pay attention to changes in subordinates' performance and to give useful feedback on how to improve. Subordinates, in turn, can discern when their leaders have growth mindsets, which makes them more motivated and satisfied, not to mention more likely to adopt growth mindsets themselves. The old adage "lead by example" applies to self-compassion and the growth mindset it encourages. A similar link between leader and subordinates exists for authenticity, too. People can sense authenticity in others, and when leaders are seen as being true to themselves, it creates an atmosphere of authenticity throughout the workplace. There's also substantial evidence that stronger relationships are forged when people feel authentic in their interactions with others. When leaders respond to failures and setbacks with a self-compassionate attitude, they themselves benefit, being more likely to exhibit psychological and behavioral tendencies that bode well for their own professional development and success. And the benefits can trickle down to subordinates, making the practice of self-compassion a win-win for leaders and those they lead. Fostering Self-Compassion Fostering self-compassion is not complicated or difficult. It's a skill that can be learned and enhanced. For the analytically minded, I suggest using psychologists' definition of self compassion as a three-point checklist: Am I being kind and understanding to myself? Do l acknowledge shortcomings and failure as experiences shared by everyone? Am I keeping my negative feelings in perspective? If this doesn't work, a simple "trick" can also help: Sit down and write yourself a letter in the third person, as if you were a friend or loved one. Many of us are better at being a good friend to other people than to ourselves, so this can help avoid spirals of defensiveness or self-flagellation. The business community at large has done a good job of removing the stigma around failure in recent years at the organizational level -it's a natural byproduct of experimentation and, ultimately, innovation. But too many of us are not harnessing the redemptive power of failure in our own work lives. As more and more industries are disrupted and people's work lives are thrown into upheaval, this skill will become more important.

Sleep disturbances predict increased risk for suicidal symptoms, study finds FROM PSYCHIATRY RESEARCH Several features of sleep disturbance, including nightmares, sleep onset latency, and sleep quality, were associated with a significantly increased risk of suicidal ideation (SI), based on data from 102 individuals. Suicide remains the second leading cause of death in young adults, but factors that may predict increased suicide risk have not been characterized, wrote Rebecca C. Cox, PhD, of the University of Colorado Boulder, and colleagues. “Sleep disturbance is a promising modifiable risk factor for acute changes in suicide risk,” they noted. “Previous research has found multiple aspects of sleep disturbance are linked to elevated SI, including insomnia symptoms, both short and long sleep duration, nocturnal wakefulness, and nightmares.” However, data on the impact of nightly sleep disturbance on suicide risk are limited, the researchers said. They hypothesized that use of ecological momentary assessment (EMA) to assess daily variability in sleep might offer more insight into the relationship between various components of sleep disturbance and changes in suicide risk. In a study published in Psychiatry Research , the investigators recruited 102 young adults aged 18-35 years who had a history of suicidal behavior; 74.5% were female, 64.7% were White. Participants completed seven semi-random surveys per day for between wake and sleep schedules over 21 days. Each survey asked participants to report on whether they had experienced suicidal ideation (SI) since the last survey. The researchers examined within-person and between-person sleep variables including bedtime, sleep onset latency, sleep onset, number of awakenings, wake after sleep onset, sleep duration, sleep timing, sleep quality, and nightmares. Overall, nightmares had a significant, positive effect on passive SI at both within- and between-person levels, but no significant effect on active SI. Sleep latency showed a significant, positive effect on passive and active SI at the between-person level, meaning that “participants who took longer to fall asleep on average were more likely to experience passive and active SI during the sampling period,” the researchers noted. In addition, days following nights of more time awake between sleep onset and offset were days with increased likelihood of passive and active SI. Similarly, days following nights of worse sleep quality than normally reported for an individual were days with increased likelihood of passive and active SI. Sleep timing and duration had no significant effects on SI at the within- or between-person level. “Notably, tests of reverse models found no relation between daily passive or active SI and any component of the subsequent night’s sleep, suggesting a unidirectional relation between sleep disturbance and subsequent SI,” the researchers wrote in their discussion. If future research replicates the study findings, the results could support the inclusion of sleep difficulties on standard risk assessments as a way to identify risk for SI and initiate prevention approaches, they said. The findings were limited by several factors including the potential for unmeasured variables impacting the associations between sleep and SI, the researchers noted. Other limitations included the lack of data on more severe levels of SI such as planning and intent, and on suicidal behaviors such as preparatory behaviors, aborted attempts, and actual attempts. The findings also may not generalize to other age groups such as children, adolescents, or older adults, they said. More research is needed to determine which sleep disturbance components are acute risk factors for which suicide-related outcomes, the researchers said. However, the study is the first to provide evidence for daily sleep disturbances as a near-term predictor of SI in young adults, they concluded. The study was supported in part by the National Institutes of Health. The researchers had no financial conflicts to disclose.

Schizophrenia TOPLINE: Suicide is a main cause of death among people with schizophrenia, even years after diagnosis, and deaths from medical conditions and diseases also occur prematurely, results of a long-term study suggest. The results show "an urgent need for new efforts to improve the disparities in health that lead to this increased mortality," the researchers conclude. METHODOLOGY: The life expectancy of patients with schizophrenia is 10-12 years less than in the general population, and as the mortality gap seems to be worsening, it's important to learn more about the patterns behind it. The analysis included 578 participants in the OPUS study, a randomized controlled trial of patients in Denmark with a first-time diagnosis of a schizophrenia spectrum disorder who were assessed after 2, 5, 10, and 20 years. From linked databases, researchers collected clinical and sociodemographic data and information about time and cause of death and determined baseline predictors of mortality and predictors that remained significant during follow-up. The primary outcome was death, which researchers divided into death due to external causes, and death from medical conditions and diseases; secondary outcomes were cause-specific mortality rates. TAKEAWAY: During 20 years of follow-up, 82 participants (14.2%) died, compared to a mortality rate of 4.4% in a matched group from a background population. Mortality rates were higher among men, those aged 40 or older at baseline, and people with substance abuse at the time of diagnosis. About half the deaths were due to external causes, and half were from medical conditions and diseases. The most common external cause was suicide, which accounted for 27.5% of the total number of deaths. The most common medical causes were cardiovascular disease and cancer, both representing 8.3% of the total. At baseline, employment (hazard ratio [HR], 0.47; 95% CI, 0.22 – 0.1; P = .049), psychotic disorders other than schizophrenia (HR, 0.36; 95% CI, 0.15 – 0.83; P = .017), and longer duration of untreated psychosis (HR, 0.57, 95% CI, 0.33 – 0.98; P = .042) predicted lower mortality, while substance use predicted higher mortality (HR, 2.56; 95% CI, 1.50 – 4.36; P < .001). As for predictors of mortality later in the illness, symptom remission without use of antipsychotic medication was associated with a significantly decreased risk for mortality (HR, 0.08; 95% CI, 0.1 – 0.6; P = .013), as was being in recovery (HR, 0.21; 95% CI, 0.05 – 0.84; P = .028), whereas substance use (HR, 3.64; 95% CI, 2.36 – 5.61; P < .001), cancer (HR, 6.31; 95% CI, 3.12 – 12.77), cardiovascular disease (HR, 2.25; 95% CI, 1.36 – 3.71; P = .002), and pulmonary disease (HR, 2.15; 95% CI, 1.36 – 3.42; P = .001) predicted increased mortality. IN PRACTICE: That the rate of death due to suicide remained steady over time underlines the continuous need for suicide-preventive measures for people with schizophrenia, said the authors, adding more regular screening for suicide risk in aging patients with schizophrenia could help prevent some later suicides. SOURCE: The study was conducted by Marie Stefanie Kejser Starzer, Copenhagen Research Center for Mental Health, Copenhagen University Hospital, and the Department of Clinical Medicine, University of Copenhagen, Denmark, and colleagues. It was published online August 1, 2023, in the Schizophrenia Bulletin in the Journal of Psychoses and Related Disorders. LIMITATIONS: Although the cohort was large and follow-up lengthy, the number of deaths is still small. It's possible that those who were lost to follow-up represent a group with an increased risk of morality. The cohort was obtained from a clinical trial, and participants in this trial might not represent all patients with a first schizophrenia spectrum diagnosis. As all patients in Denmark have access to free, well-resourced healthcare, the findings are not representative of all patients. DISCLOSURES: The study was supported by the Tryg Foundation, the Lundbeck Foundation, and Helsefonden. The authors had no competing interests.

"By developing strategies that reduce both stigma and normalization, we can create a more supportive environment for those at risk and improve suicide prevention efforts." Suicide, a global public health issue, is often associated with stigma, which can exacerbate the problem and hinder prevention efforts. Stigma surrounding suicide can deter individuals from seeking help and can isolate those who are already vulnerable.1-5 Research shows that suicide stigma is multifaceted, encompassing public stigma, self-stigma, and label avoidance.4 Public stigma refers to the general population’s negative attitudes and beliefs about suicide, while self-stigma is the internalization of these negative attitudes by individuals who are suicidal. Label avoidance is the reluctance to seek help to avoid being labeled “suicidal.” These forms of stigma can lead to discrimination, social isolation, and a reluctance to seek help, which can further increase the risk of suicide.1-3 Moreover, a study by Sheehan, et al,4 revealed that suicide attempt survivors may be subject to double stigma, experiencing both the stigma associated with suicide and the stigma of mental illness. This double stigma can impede recovery and access to care. The study also found that individuals who attempted suicide were often stereotyped as attention-seeking, selfish, incompetent, emotionally weak, and immoral, further contributing to the stigma. However, stigma is not the only societal attitude that can impact suicide rates. A study by Oexle, et al,5 highlighted the concept of suicide normalization, defined as liberal attitudes toward suicide. The study found an inverse relationship between suicide stigma and suicide normalization, suggesting that efforts to reduce suicide stigma could inadvertently increase suicide normalization. This is concerning, as suicide normalization can act as a barrier to seeking help for suicidality. To address these issues, it is crucial to develop strategies that reduce both suicide stigma and suicide normalization. One potential approach is to promote interpersonal contact with individuals who have experienced suicidality and have a recovery story to share. This can help humanize the issue, reduce stigma, and counteract normalization by showing that recovery is possible.5 In conclusion, addressing the stigma associated with suicide is a complex task that requires a nuanced understanding of societal attitudes toward suicide. By developing strategies that reduce both stigma and normalization, we can create a more supportive environment for those at risk and improve suicide prevention efforts. Dr Ajluni is an assistant professor of psychiatry at Wayne State University in Livonia, Michigan. During the preparation of this work, the author used ChatGBT in order to synthesize and summarize information based on my ideas, input, and conclusions. After using this tool/service, the author reviewed and edited the content as needed and takes full responsibility for the content of the publication.

Hopefulness key to mental and physical health The woman arrived for her first therapy session distressed and depressed. Her husband of 20 years had just announced that he was in love with someone else. At 47, she was so upset she had a heart attack and then needed to go on disability from work. "She had her sense of self shaken at the core," said Dan Tomasulo, PhD, a counseling psychologist and academic director of the Spirituality Mind Body Institute at Teachers College of Columbia University, who treated her. "Within about 10 days, her whole life crumbled." Working with her regularly, Tomasulo helped her not just recover from depression and her sense that she had no future, but to thrive. The key? Teaching her how to be hopeful. Hopefulness can be learned, Tomasulo and many other mental health experts contend. Once we learn how to be more hopeful, that habit can help us overcome depression, suicidal thoughts, inertia, bad health habits, and other obstacles and ultimately move forward. Recent surveys suggest that our hopefulness is sorely lagging, and in some populations more than others. In February, the CDC reported that 57% of U.S. teen girls felt persistently sad or hopeless in 2021, double that of boys and the highest level reported since 2011. Overall, 32.3% of U.S. adults reported anxiety or depressive symptoms in 2023, according to an analysis of Census Bureau data by the Kaiser Family Foundation. Among adults 18 to 24, nearly half did. Experts disagree about how much hopelessness drives thoughts of suicide, but at least in depressed people, it's believed to be linked. Learning hopefulness is not only a good skill to have, but it could be lifesaving. Therapists like Tomasulo, who advocate an approach known as positive psychology, as well as educators who have launched hopefulness programs for youths and workers, say anyone can develop or reclaim their sense of hope — if they are willing to work at it. What Is Hope and Hopefulness? Crucial to boosting hopefulness is understanding what it is. Hope is a word we often use. "I hope I win the lottery." Or "I hope I get a better job soon. That hope is simply a wish, experts said. That's "squishy" hope, said Rick Miller, founder of a program at Arizona State University called Kids at Hope, which teaches the value and strategy of hope. "We are talking about cognitive hope," Miller said. That hope, according to the Kansas psychologist who developed the concept 30 years ago, requires having a goal, the ability to stay motivated to meet the goal, and having pathways to get there, even if obstacles occur. This is "learned hopefulness," Miller and others say. The Path From Hopelessness to Hopefulness "Hope is unique among all the positive emotions," Tomasulo said, "because it requires negativity to be activated. With all the other positive emotions, you don't need that. Hope is unique because it requires something [going] wrong." As he helps people discover the route to hopefulness, Tomasulo talks about pebbles and feathers — pebbles are the negative thoughts, feathers the positive. To cultivate hopefulness, the goal, of course, is to increase the feathers in relation to the pebbles. As you do that, the ratio of positive to negative emotions change, and the positive ones begin to carry more weight. In one of the first meetings, Tomasulo asked the woman with the heart attack and cheating husband to focus on gratitude -- the things she had in her life she was grateful for. Friends had dropped food to her after her hospital stay, she recalled, and then other friends took her out. She had a horse she loved, and while she couldn't ride him yet, she could go to the barn and hang out with him and with her nieces, who also loved the horse. Instead of being stuck in her pain, the woman's perception was changing as she realized more than one thing was happening in her life, not just depression and adultery. Receiving all that kindness allowed her to be kind. When she felt better but wasn't yet back to work, she started volunteering at a food pantry, which boosted her sense of self-worth. Then, very naturally, she started leaning into the future. The feathers were adding up. "Hope is the belief you can have a positive influence on the future and a desire to make that happen," Tomasulo said. Within 6 months, she was back to competitive horse riding, had a much better job, and got through the divorce. "It was not that she forgot about the pain or negativity, but realized she had a choice about what she could focus on," said Tomasulo, who wrote Learned Hopefulness and The Positivity Effect. After much effort, the woman had chosen hopefulness. What the Research Says "Hope is a lot of work," said Crystal Bryce, PhD, associate dean for student affairs and associate professor of medical education at the University of Texas at Tyler, who researches hope in youths and adults. (Researchers measure hope by adding up scores on adult and child hope scales.) Among her findings: Hope levels in children change over time. "We saw a decrease when kids went from seventh to eighth grade, and an increase in hope scores when they went from eighth to ninth." In her study of more than 1,000 youths in grades six to 10, she found that school performance stress may contribute to this decrease, and that fostering increases in hope skills (such as setting goals) before the high school transition might buffer stress and boost achievement. "If you have higher hope, you tend to have lower stress." In another study of 726 students in grades six to 12, those who had higher levels of hope before the pandemic felt more school connectedness during the pandemic, even when they were learning remotely. "Even during what one would call a hopeless time, they were able to find ways to feel connected," Bryce said. Feeling connected, Bryce said, decreases the risk of depression. In a small study of 41 teachers, Bryce found those who reported being emotionally exhausted before the pandemic had lower levels of hope during it. Those who got support from colleagues had higher levels of hope. Teaching Hope to Youth, Workers Others have launched programs to teach hopefulness to children and to adults in the workplace. One is Hopeful Minds, a project developed by iFred (the International Foundation for Research and Education on Hope). The aim is to give students, teachers, and parents the tools needed to develop a hopeful mindset. Its 16 lessons, 45 minutes each, have been downloaded more than 5,000 times in 47 countries, at no cost, according to Kathryn Goetzke, the founder of iFred. Goetzke also founded the Shine Hope Company, which reaches out to workplaces with courses and campaigns on how to foster more hope to improve workers' well-being. Goetzke knows well the journey from hopelessness to hopefulness. Her father died by suicide soon after she started college. In her grief, she said, she soon learned that the coping mechanisms she had were based on hopelessness, not hopefulness. Told she was at high risk of suicide, she began researching hope. On the 30th anniversary of her dad's death, Goetzke's book, The Biggest Little Book About Hope, was released. No one is hopeless at learning to be hopeful, she insisted. "I can teach anyone to be hopeful, but it's up to the person to do the work," she said. Miller, of Arizona State, founded the Kids at Hope program in 2000. The name, he said, is to eliminate the "youth at risk" stereotype for those viewed as disadvantaged. When children with fewer advantages are labeled as "at risk," he said, the expectation they will succeed is diminished. The program now operates in 24 states, in 475 schools and juvenile justice systems. It inspires schools and organizations to create a culture and environment where all kids experience success. "We introduced the science of hope through a series of training modules," Miller said. "We translate the research into simple yet powerful principles and practices that demonstrate how to create and activate hope for all, by all." The basics, Miller said, are that children need to know adults believe in them and are willing to connect with them. Another key is to introduce a concept called mental time travel, which activates hope. It's "the ability for the brain to imagine a future." To date, Kids at Hope has trained more than 125,000 adults and reached more than 1.1 million children, ages 3 to 18. With an "it takes a village" view, the organization has trained not only teachers, but social workers, bus drivers, custodians, superintendents, juvenile prosecuting attorneys, and others, Miller said. "Hopeful people seem to do better in life than people without hope," Miller said. "They do better socially, emotionally, economically, and live longer. "While squishy hope comes and goes, cognitive hope is a choice we get to make every day because it comes with a strategy." While definitions of hope vary, Miller likes this one: "If resilience is the ability to bounce back, hope is the ability to bounce forward."

Depression, Anxiety Do Not Increase Overall Risk for Cancer HealthDay News — Depression and anxiety are not related to an increased risk for most cancers, according to a study published online Aug. 7 in Cancer. Researchers observed no associations between depression or anxiety and overall or for breast, prostate, colorectal, and alcohol-related cancers. However, associations were seen for depression and anxiety (symptoms and diagnoses) with the incidence of lung cancer and smoking-related cancers (hazard ratios, 1.06 to 1.60), although these associations were substantially reduced when additionally adjusting for known risk factors, including smoking, alcohol use, and body mass index (hazard ratios, 1.04 to 1.23). “Our results may come as a relief to many patients with cancer who believe their diagnosis is attributed to previous anxiety or depression,” van Tuijl said in a statement. “However, further research is needed to understand exactly how depression, anxiety, health behaviors, and lung cancer are related.” Analysis: Depression, Anxiety Do Not Increase the Risk of Cancer Aug. 11, 2023 – While depression and anxiety have been linked to a wide range of other health problems, a new analysis shows there is no link between the two psychiatric disorders and the risk of most major cancers. The findings were published this week in Cancer, the journal of the American Cancer Society. The authors wrote that they undertook the study because depression and anxiety have long been thought to be linked to increased cancer risk, but previous research on the connection has been inconclusive. This latest analysis combined data from 18 previous studies and included 319,613 people, who among them had 25,803 cases of cancer. The follow-up period for some people was as much as 26 years. The researchers found no associations between depression or anxiety and overall cancer risk, nor did they find a link with breast cancer, prostate cancer, colorectal cancer, or alcohol-related cancers. They did find that depression and anxiety were associated with a 6% increased risk of developing lung cancer or smoking-related cancers, but the researchers concluded that behaviors like smoking and alcohol use were likely the driving factors, not depression and anxiety. The authors noted that previous studies have found that people who are depressed are more likely to be smokers. “Our results may come as a relief to many patients with cancer who believe their diagnosis is attributed to previous anxiety or depression,” said study author Lonneke A. van Tuijl, PhD, who studies anxiety and mood disorders, in a statement. She is a post-doctoral researcher at the University Medical Center Groningen in The Netherlands. “However,” she added, “further research is needed to understand exactly how depression, anxiety, health behaviors, and lung cancer are related.” SOURCES: Cancer: “Depression, anxiety, and the risk of cancer: An individual participant data meta-analysis.” Wiley: “Robust analysis challenges theory that depression and anxiety increase cancer risk.” Analysis: Depression, Anxiety Do Not Increase the Risk of Cancer Full Article

Correcting the Automatic Negative Thoughts That Steal Your Happiness and Rob Your Joy One of the most effective techniques we use with all patients at Amen Clinics is what we call (ANT Therapy, or learning how to kill the ANTs (automatic negative thoughts). I coined this term in the early 90s after a hard day at the office with many patients in crisis. After coming home that evening I found an ant infestation in my kitchen. Gross!! As I started to clean up the thousands of ants, the acronym came to me. I thought of my patients from that day--like my infested kitchen, my patients' brains were also infested by the negative thoughts that were robbing them of their joy and stealing their happiness. The next day brought a can of ant spray to a work as a visual aid and have been working diligently ever since to help my patients eradicate their ANTs. Automatic Negative Thoughts Here are the "ANT Killing" principles we use to help people feel better fast. 1. Every time you have a thought, your brain releases chemicals? That's how our brains work: you have a thought ... your brain releases chemicals . an electrical transmission goes across your brain and you become aware of what you're thinking. Thoughts are real and they have a direct impact on how you feel and how you behave. 2. Every time you have a mad thought, an unkind thought, a sad thought, or a cranky thought, your brain releases negative chemicals that make you feel bad. Think about the last time you were mad. How did you feel physically? When most people are mad, their muscles get tense, their heart beats faster, their hands start to sweat, and they may even begin to feel a little dizzy. Your body reacts to everynegative thought you have. 3. Every time you have a good thought, a happy thought, a hopeful thought, or a kind thought your brain releases chemicals that make your body feel good. Think about the last time you had really happy thought. What did you feel inside your body? When most people are happy their muscles relax, their heartbeat and breath slow. Your body also reacts to your good thoughts. 4. Thoughts are very powerful! They can make your mind and body feel good or they can make you feel bad. Every cell in your body is affected by every thought you have. That is why when people get emotionally upset they often develop physical symptoms, such as headaches or stomachaches. 5. Thoughts lie; they lie a lot, but it is your unquestioned or un-investigated thoughts that make us sad, mad, nervous, or out of control. Unfortunately, if you never challenge your thoughts you just "believe them." The negative thoughts invade your mind like ants at a picnic. One negative thought, like one ant at a picnic, is not a big deal. Two or three negative thoughts, like two or three ants at a picnic, become more irritating. And ten or twenty negative thoughts can cause real problems. 6. You can train your thoughts to be positive and hopeful or you can just allow them to be negative and upset you. Once you learn about your thoughts, you can chose to think good thoughts and feel good, or you can choose to think bad thoughts and feel lousy. That's right, it's up to you. Research has shown that positive emotionsespecially a sense of awe can reduce inflammation that will hurt your health. You can learn how to change your thoughts and change the way you feel. Nine Different Types of ANTs (10+) (or ways we distort reality to make it worse than it really is) 1. All or nothing thinking: thoughts that things are all good or all bad. 2. "Always" thinking thinking in words like always, never, no one, every one, every time, everything. 3. Focusing on the negative: only seeing the bad in a situation. (mental filtering) 4. Fortune telling: predicting the worst possible outcome to a situation with little or no evidence for it. ( catastrophing) 5. Mind reading: believing you know what another person is thinking even though they haven't told you. 6. Thinking with your feelings) believing negative feelings without ever questioning them. 7. Guilt beatings: thinking in words like "should, must, ought or have to." 8. Labeling: attaching a negative label to yourself or to someone else. 9. Blame: blaming someone else for the problems you have. ANT Killing Exercise: *Whenever you feel sad, mad, nervous or out of control, write down your automatic negative thoughts, label them, then talk back to them. Here are some ANT Killing examples: ANT Your thoughts matter. Kill the ANTs and train your thoughts to be positive and it will benefit your mind, mood, and body. Kill the ANTs Worksheet: When you notice an ANT: 1. Write it down. 2. Identify the type of ANT it is. 3. Kill the ANT by talking back to it - challenge the thought! What's your ANT? Identify the distortion - then challenge that thought with a more realistic perspective! Source: Amen Clinics/Dr. Aaron Beck (CBT)

The World Within - Carl Jung, MD in His Own Words - Documentary Who is Dr. Carl Jung? Carl Gustav Jung was a Swiss psychiatrist and psychoanalyst who founded analytical psychology. Jung's work has been influential in the fields of psychiatry, anthropology, archaeology, literature, philosophy, psychology, and religious studies. He worked as a research scientist at the Burghölzli psychiatric hospital, in Zurich, under Eugen Bleuler. Jung established himself as an influential mind, developing a friendship with Sigmund Freud, founder of psychoanalysis, conducting a lengthy correspondence, paramount to their joint vision of human psychology. Jung is widely regarded as one of the most influential psychologists in history. Freud saw the younger Jung not only as the heir he had been seeking to take forward his "new science" of psychoanalysis, but as a means to legitimize his own work: Freud and other contemporary psychoanalysts were Jews facing rising antisemitism in Europe, and Jung was Christian. Freud secured Jung's appointment as president of Freud's newly founded International Psychoanalytical Association. Jung's research and personal vision, however, made it difficult to follow his older colleague's doctrine and they parted ways. This division was painful for Jung and resulted in the establishment of Jung's analytical psychology, as a comprehensive system separate from psychoanalysis. Scholar Yosef Hayim Yerushalmi believed Jung's later antisemitic remarks may be a clue to the schism. Among the central concepts of analytical psychology is individuation—the lifelong psychological process of differentiation of the self out of each individual's conscious and unconscious elements. Jung considered it to be the main task of human development. He created some of the best known psychological concepts, including synchronicity, archetypal phenomena, the collective unconscious, the psychological complex and extra-version and introversion. Jung was also an artist, craftsman, builder and prolific writer. Many of his works were not published until after his death and some remain unpublished. The World Within - Carl Jung, MD in His Own Words Source: Wikipedia (2023)

Detaching from Emotional Pain (Grounding) "No feeling is final." -Rainer Maria Rilke (20th-century German poet) Using Grounding to Detach from Emotional Pain WHAT IS GROUNDING? Grounding is a set of simple strategies to detach from emotional pain (e.g., drug cravings, self-harm impulses, anger, sadness). Distraction works by focusing outward on the external world, rather than inward toward the self. You can also think of it as "distraction," "centering," "a safe place," "looking outward," or "healthy detachment." Grounding - to help control emotional volatility WHY DO GROUNDING? When you are overwhelmed with emotional pain, you a need a way to detach so that you can gain control over your feelings and stay safe. As long as you are grounding, you cannot possibly use substances or hurt yourself! Grounding "anchors" you to the present and to reality. Many people with PTSD and substance abuse struggle with feeling either too much (overwhelming emotions and memories) or too little (numbing and dissociation). In grounding, you a attain a balance between the two: conscious of reality and able to tolerate it. Remember that pain is a feeling; it is not who you are. When you get caught up in it, it feels like you are your pain, and that is all that exists. But it is only one part of your experience-the others are just hidden and can be found again through grounding. Guidelines Grounding can be done any time, any place, anywhere, and no one has to know. • Use grounding when you are faced with a trigger, enraged, dissociating, having a substance craving, or whenever your emotional pain goes above 6 (on a 0-10 scale). Grounding puts healthy distance between you and these negative feelings. Grounding - to help control emotional volatility Keep your eyes open, scan the room, and turn the light on to stay in touch with the present. Rate your mood before and after grounding, to test whether it worked. Before grounding, rate your level of emotional pain (0-10, where 10 means "extreme pain"). Then rerate it afterward. Has it gone down? No talking about negative feelings or journal writing-you want to distract away from negative feelings, not get in touch with them. Stay neutral-avoid judgments of "good" and "bad." For example, instead of "The walls are blue; I dislike blue because it reminds me of depression," simply say "The walls are blue" and move on. Focus on the present, not the past or future. • Note that grounding is not the same as relaxation training. Grounding is much more active, focuses on distraction strategies, and is intended to help extreme negative feelings. It is believed to be more effective than relaxation training for PTSD. WAYS OF GROUNDING Three major ways of grounding are described below-mental, physical, and soothing. "Mental" means focusing your mind; "physical" means focusing on your senses (e.g., touch, hearing); and "soothing" means talking to yourself in a very kind way. You may find that one type works better for you, or all types may be helpful. Mental Grounding Detaching from Emotional Pain (Grounding Describe your environment in detail, using all your senses-for example, "The walls are white; there are five pink chairs; there is a wooden bookshelf against the wall . . . Describe objects, sounds, textures, colors, smells, shapes, numbers, and temperature. You can do this anywhere. For example, on the subway: 'I'm on the subway. I'lI see the river soon. Those are the windows. This is the bench. The metal bar is silver. The subway map has four colors." Play a "categories" game with yourself. Try to think of "types of dogs," "jazz musicians," "states that begin with 'A' "cars," 'TV shows," "writers," "sports," "songs," or "cities." Do an age progression. If you have regressed to younger age (e.g., 8 years old), you can slowly work your way 80)back up (e.g., "I'm now 9; I'm now 10; I'm now 11 . ") until you are back to your current age. Describe an everyday activity in great detail. For example, describe a meal that you cook (e.g., "First l peel the potatoes and cut"). them into quarters; then I boil the water; then make an herb marinade of oregano, basil, garlic, and olive oil . Imagine. Use an image: Glide along on skates away from your pain; change the TV channel to get to a better show; think of a wall a as a buffer between you and your pain. Say a safety statement. "My name is located in the date is _; I am safe right now. I am in the present, not the past. am you focus on the letters and read not on something,the meaning, saying of each words. Use humor. Think of something funny to jolt yourself out of your mood. Count to 10 or say the alphabet, very s ... l... o . . . w... l... y. Physical Grounding * Run cool or warm water over your hands. * Grab tightly onto your chair as hard as you can. * Touch various objects around you: a pen, keys, your clothing, the table, the walls. Notice textures, colors, materials, weight, temperature. Compare objects you touch: s one colder? Lighter? * Dig your heels into the floor-literally "grounding" them! Notice the tension centered in your heels as you do this. Remind yourself that you are connected to the ground. * Carry a grounding object in your pocket-a small object (a small rock, clay, a ring, a a piece of cloth or yarn) that you can touch whenever you feel triggered. * Jump up and down. *Notice your body: the weight of your body in the chair; wiggling your toes in your socks; the feel of your back against the chair. You are connected to the world. * Stretch. Extend your fingers, arms, or legs as far as you can; roll your head around. * Clench and release your fists. * Walk slowly, noticing each footstep, saying "left" or "right" with each step. *Eat something, describing the flavors in detail to yourself. * Focus on your breathing, noticing each inhale and exhale (e.g., a favorite color, or a soothing word such as "safe" or "easy"). Soothing Grounding + Say kind statements, as if you were talking to a small child-forexample, "You are a good person going through~ a hard time. You'll get through this." +Think of favorites. Think of your favorite color, animal, season, food, time of day, TV show. + Picture people you care about (e.g., your children), and look at photographs of them. + Remember the words to an inspiring song, quotation, or poem that makes you feel better (e.g., the AA Serenity Prayer). + Remember a safe place. Describe a place that you find very soothing (perhaps the beach or mountains, or a favorite room); focus on everything about that place-the sounds, colors, shapes, objects, textures. + Say a coping statement: "I can handle this, "This feeling will pass." + Plan a safe treat for yourself, such as a piece of candy, a nice a dinner, or a warm bath. Think of things you are looking forward to in the next week-perhaps time with a friend, going to a movie, or going on a hike. WHAT IF GROUNDING DOES NOT WORK? Grounding does work! But, like any other skill, you need to practice to make it as powerful as possible. Below are suggestions to help make it work for you. * Practice as often as possible, even when you don't need it, SO that you'll know it by heart. * Practice faster. Speeding up the pace gets you focused on the outside world quickly. * Try grounding for a looooooonnnnngggg time (20-30 minutes). And repeat, repeat, repeat. * Try to notice which methods you like best-physical, mental, or soothing grounding methods, or some combination. * Create your own methods of grounding. Any method you make up may be worth much more than those you read here, because it is yours. * Start grounding early in a negative mood cycle. Start when a substance craving just starts or when you have just started having a flashback. Start before anger gets out of control. * Make up an index card on which you list your best grounding methods and how long to use them. * Have others assist you in grounding. Teach friends or family about grounding, so that they can help guide you with it if you become overwhelmed. * Prepare in advance. Locate places at home, in your car, and at work where you have materials and reminders for grounding. * Create a cassette tape of a grounding message that you can play when needed. Consider asking your therapist or someone close to you to record it if you want to hear someone else's voice. * Think about why grounding works. Why might it be that by focusing on the external world, you become more aware of an inner peacefulness? Notice the methods that work for you-why might those be more powerful for you than other methods? * Don't give up! From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press.

Too Much Distance: Learning to Say "Yes" in Relationships Why is it important to say "yes"? It means connecting with others. It is a way of recognizing that we are all human and all need social contact. It is a healthy way of respecting your role as part of a larger community. It means becoming known to others. Learning to Say "Yes" in Relationships SITUATIONS WHERE YOU CAN LEARN TO SAY "YES" Asking someone out for coffee. Telling your therapist how you really feel. Asking someone for a favor. Joining a club or organization. Calling a hotline. • Being vulnerable about your "weak" feelings. Letting people get to know you. Soothing "young" parts of yoursel * Any others that you notice? Write them on the back of the page. EXAMPLES: SAYING "YES" IN SUBSTANCE ABUSE AND PTSD With Others With Yourself Substance a "I am having a drug craving-please help talk Abuse me through it." can give myself treats that are healthy rather than destructive." "Please come with me to an AA meeting.' "I need your help-I am scared." "I will try speaking at an AA meeting." PTSD " need to reach out to people when I'm upset." would like you to call and check in on me "I can start creating healthy friendships step to see if I'm okay." by step.' HOW TO SAY "YES" * Try different ways: • Share an activity: "Would you like to go a to a movie with me?" Say how you feel: "I feel so alone; it is hard for me to talk about this." • Focus on the other person: "Tell me about your struggles with cocaine." Watch how others do it: Go to a gathering and a listen to others relate. * Plan for rejection. Everyone gets rejected at times. It is a normal part of life. Let go of that person and move on to someone else who might be available. * Practice in advance, if possible. Therapy may be safe place to rehearse. (cont.) From Seeking Safety by Lisa M. Najavits (2002). Copyright by The Guilford Press. Permission to photocopy this form is granted to purchasers of this book for personal use only (see copyright page for details). 276 HANDOUT 3 (page 2 of 2) Setting Boundaries in Relationships * Choose safe people. Select people who are friendly and supportive. * Know that it's normal to make mistakes along the way. It will feel uncomfortable to reach out to others at rst. Allow yourself room to grow-it will get easier over time. fi * Set goals. Keep yourself moving forward by making a clear plan, just as you would in other areas of your life. Decide to make one social call a week, or try one new meeting a week. * Recognize that you may feel very "young." Parts of you may feel vulnerable, like a child who a is just learn- ing how to relate to people. That is expected, as parts of you may not have had a chance a to develop due to PTSD or substance abuse. * Start small. Start with a simple event (e.g., saying hello or smiling) rather than a huge one (e.g., asking someone out on a date). a * Notice what you have in common rather than how you are different. Work hard to see your similarities with others; this can make it easier to connect. ROLE PLAYS FOR SAYING "YES" * Try rehearsing the following situations out loud. With Others ) You talk about your impulse to hurt yourself before doing it. -> You ask someone at work to go to lunch. -> You tell your therapist you missed her when she was away on vacation. > You call your sponsor when you feel like drinking. › You tell someone, "I love you." } You tell someone how alone you feel. - You admit a weakness to someone. - You talk to your friend honestly about your anger at him. - It is 4:00 A.M. and you are so depressed you can't sleep. Whom can you call? is The weekend is coming and you have no plans with anyone. What can you do? With Yourself You feel scared; how can you soothe yourself? You have worked hard; how can you give yourself a safe treat? a Part of you ("the child within") feels hurt. How can you talk to that part? -› You are angry at yourself for failing a test. How can you forgive yourself?

Learning to Say No - Setting Boundaries Too Much Closeness: Learning to Say "No" in Relationships Why is it important to say "no"? It means setting a limit to protect yourself in relationships. For example, "If you show up with coke, I'm leaving," or "Unless you stop yelling at me, I'm walking out." Saying "no" is an important skill for setting boundaries. At a deeper level, setting boundaries is a way of conveying that both people in relationship deserve care and attention. It is a healthy a way of respecting your separate identity. SITUATIONS WHERE YOU CAN LEARN TO SAY "NO" Refusing drugs and alcohol. Pressure to say more than you want to. Going along with things that you do not want to do. When you're taking care of everyone but you. When you do all the giving in a relationship. When you make promises to yourself that you do not keep. When you're doing things that take your focus away from recovery. EXAMPLES: SAYING "NO" IN SUBSTANCE ABUSE AND PTSD With Others; With Yourself Substance "No thanks; I don't want any now." Abuse "Drinking is not allowed on my diet." "I need you to stop talking to me like that." PTSD "Please don't call me again." "Self-respect means no substances today." "If anybody offers me drugs at the party, I need to leave." "Working as a prostitute is making my PTSD worse; I need to stop." "Seeing war movies is triggering my PTSD; need to stop." Learning to Say No - Setting Boundaries HOW TO SAY "NO" * Try different ways to set a boundary: Polite refusal: "No thanks, I'd rather not." Insistence: 'No, I really mean it, and I'd like to drop the subject." Partial honesty: "I cannot drink because I have to drive." Full honesty: "I cannot drink because I'm an alcoholic." Stating consequences: "If you keep bringing drugs home, will have to move out." * Remember that it is a sign of respect to say "no." Protecting yourself is part of developing self-respect. Rather than driving people away, it helps them value you more. You can be vulnerable without being exploited. You can enjoy relationships without fearing them. In healthy relationships, saying "no" appropriately promotes closeness. How Do Approach the Situation * How much or how little you say is up to you. if however, if you can comfortably provide an explanation, this can make it easier on the other person. * You will find the words if you are motivated to say "no." Once you commit to protecting your needs, the how will present itself. * Take care of yourself; let others take care of themselves. You can only live your life, not theirs. * If you are afraid of hurting the other person, it remember that it may take repeated work, both with the other person and within yourself. Over time, you will realize that healthy people can tolerate hearing what you think and feel. * You can set a boundary before, during, or after an interaction with someone. Try discussing a difficult topic beforehand (e.g., discuss safe sex before a sexual encounter), during an interaction (e.g., try saying "no" to alcohol when it is offered), or afterward (e.g., go back and tell someone you did not like being talked to abusively). *Be careful about how much you reveal. PTSD and substance abuse are sensitive topics, and discrimination against these disorders is very real and harmful. You can never take back a statement once it has been said. You do not need to be open with people you do not know well, people in work settings, or people who are abusive to you. **Be extremely careful if there is a possibility of physical harm. Seek professional guidance. ROLE PLAYS FOR SAYING "NO" * Try rehearsing the following situations out loud. What could you say? With Others You are at a holiday party and your boss says, "Let's celebrate! Have a drink!" - Your partner says you should "just get over your trauma already." A friend tells you not to take psychiatric medications because "that's substance abuse too." -* Your sister wants to know all about your trauma, but you don't feel ready to tell her. Your partner keeps drinking around you, saying "You need to learn to deal with it." - Your date says, "Let's go to my place," and you don't want to. -› Your boss gives you more and more work, and it's too much. You suspect that your uncle is abusing your daughter. With Yourself - You want to have "just one drink." - You keep taking care of others but not yourself. -You promised to stop bingeing on food but keep doing it. - You are working too many hours, with no time left for recovery activities. Source: Therapist Aid (2023)

Distress Tolerance Skills DBT Distraction (A.C.C.E.P.T.S.) Negative feelings will usually pass, or at least lessen in intensity over time. It can be valuable to distract yourself until the emotions subside. The acronym "A.C.C.E.P.T.S." serves as a reminder of this idea. Distress Tolerance Skills DBT Radical Acceptance Sometimes you'll run into a problem that's simply out of your control. It can be easy to think "This isn't fair" or "I shouldn't have this problem", even though those ways of thinking only make the pain worse. Radical acceptance refers to a healthier way of thinking during these situations. Instead of focusing on how you would like something to be different, you will recognize and accept the problem or situation as it is. Remember, accepting is not the same as liking or condoning something. Learning to accept the problems that are out of your control will lead to less anxiety, anger, and sadness when dealing with them. Situation You find out that you were not selected for a job where you felt that you were the best candidate. **Shift in way of thinking** Typical Thinking "This isn't fair - I did everything right! was the best one there. They can't do this to me." Radical Acceptance "It's frustrating that I didn't get the job, but I accept that they felt someone else would be a better fit." Self-Soothe with Senses Find a pleasurable way to engage each of your five senses. Doing so will help to soothe your negative emotions. 1) Vision - Go for a walk somewhere nice and pay attention to the sights. 2) Hearing - Listen to something enjoyable such as music or nature. 3) Touch - Take a warm bath or get a massage. 4) Taste - Have a small treat-it doesn't have to be a full meal. 5) Smell - Find some flowers or spray a perfume or cologne you like.