A key tool in improving communication within a couples relationship is providing opportunities for healthy conflict. In John Gottman’s research examining thousands of couples, he found that some couples were masters at having difficult conversations around issues that distressed them. The common thread was these couples sought to understand and validate their partner before problem-solving the issue. Regardless of whether the couple ultimately found a solution that worked for both parties, the ability to let the other person feel heard and understood was valuable to the relationship’s overall success.

He created a structured conversation for couples nicknamed the “State of the Union" where couples would spend one hour per week discussing difficult topics in a way that allowed both parties to feel understood and valued. When couples followed this structure, they were more likely to have a successful discussion of the issues in their relationship rather than an intense conflict. This is how he suggests conducting your own State of the Union meeting.

The Preparation Stage
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It’s crucial to find a time where both parties will show up fully present and able to engage with the conversation. Try to find a time that can work on a weekly basis and doesn’t need to be moved from week to week. Remaining consistent is key to making the State of the Union conversations work. Both parties know that it’s a time where they will be heard and they can confront more difficult aspects of the relationship so it’s important to treat that time as sacred.

Before starting, make sure each partner has paper and a pen to take notes while they are being the active listener. You want to find an hour of the day that will be uninterrupted by outside intrusions (no cell phones!) and where your partner has your full attention.

The opening remarks should be focused on what has been going well in the relationship over the past week. Gottman found that 5 positive interactions balanced out every 1 negative interaction within the relationship. So try coming up with 5 examples of positive
things your partner has done for you or the family over the last week. Be as specific as possible! Starting off on a positive note sets the tone for the entire conversation. 

Sometimes couples will come to the meeting with a conflict that occurred earlier in the week that they wish to discuss in greater depth. Otherwise, it’s important to determine what issues are open for discussion so the other partner doesn’t feel blindsided or defensive. Once everyone is on the same page, it’s time to get started!

The Main Discussion

Each partner will get an opportunity as the speaker and the active listener. Typically, the first speaker is the one who is bringing up the issue that needs to be addressed. The speaker’s goal is simply to communicate their emotional experience to the other party. Not to ask for solutions or cast blame but to explain to their partner what it feels like to experience this issue from their perspective. Gottman recommends using a softened start-up which centers “I feel” statements rather than “You did” statements. Here are some examples:

I feel overwhelmed lately by the amount of housework and I really need more support.

I feel so lonely with how little we’ve been spending time together and I need us to prioritize more date nights.

I feel hurt when we end up shouting at each other over money and I want to find a better way to have these discussions.

Focusing on what the experience feels like for the speaker might seem unnatural at first. Most people hear statements like these and immediately jump into problem solving but allowing space for your partner’s discomfort is a key component of emotional validation. The active listener is encouraged to take notes so they can accurately report back what they heard the speaker explaining about their perspective.

Once the speaker has expressed their full experience, the active listener can provide validating responses like these:

I hear you saying how overwhelmed and frustrated you are by the housework. That you don’t feel supported in that area.

What I’m hearing is that you’ve been feeling lonely in our relationship. We haven’t been prioritizing time as a couple and you’d like to have more date nights.

I understand that you’re feeling hurt when we start to yell at each other during money discussions. From your perspective, we need to find a more constructive way to have those conversations.

Notice how none of the validating responses are meant to defend the listening partner or dismiss the speaking partner’s concerns as silly or trivial. Having an emotionally open conversation requires safe and non-judgmental communication. While it might seem like a minor issue to one partner, it has been causing distress for the other and improving the emotional connection requires that level of vulnerability.

The active listener can ask follow up questions like: Did I hear you correctly? Is there more you wanted to share? Have we covered all aspects of the issue? until the speaker agrees that their perspective has been understood. Then it’s time to switch roles.

It’s important to clarify that this is not an opportunity for the active listener to defend themselves or make a case for why they did something that upset the other person. This is simply the listener’s chance to share their own emotional experience with this particular issue. With the speaker now in the active listening role, their job is to take notes to understand their partner’s view of the issue. Responses might look like:

I feel frustrated that the housework has become so overwhelming for you. I’ve noticed we’re fighting a lot more lately and I didn’t know that was the reason. 

I feel helpless and scared when I hear that you’re feeling alone in this relationship and I think I have been letting my work schedule get in the way of our time together.

I feel so angry and stressed when we have conversations about money. I don’t realize how upset I am until I’m already yelling.

Sometimes, the speaker or the listener will start to get emotionally overwhelmed or “flooded” during this process. They might feel guilt and shame coming up when their partner shares what an emotional experience has been like for them. If they feel flooded, it’s important to call a time-out and take a 20 minute break. Allowing 20 minutes of self-regulation (taking a walk, having a snack, watching a funny video) takes both partners out of fight or flight and allows them to continue the conversation in a more calm manner. It also keeps the conversation from escalating into a confrontation.

It’s essential to resume the conversation after 20 minutes. Allowing an opportunity to connect and repair after a setback strengthens the outcome of the conversation. Once both parties have regulated and returned to the conversation, it’s time to ask the same clarifying questions from the new speaker then ensure both parties have been heard and their perspective validated.

Problem Solving and Finding a Compromise

Couples are often surprised that problem solving is so late in the process. Typically, we learn that to make another person feel better we must present them a list of solutions to their problem. But the solution is less important than how the conversation has created a greater sense of unity and connection. When you feel like you’re collaborating with your partner, you’re much more open to finding a compromise that feels good to both sides.

Now that the issue is fully understood, Gottman suggests making a list of areas you can be flexible and areas that are inflexible or non-negotiable. Leading with the areas in which we are willing to accommodate our partner allows them to feel special and important. This might look like:

I am not able to adjust my work schedule during the week but I can dedicate time on Saturdays to tackle some of the weekly housework so it won’t be on your to-do list.

I am able to come home early 2 nights per week so we’re able to have dinner together. Or I can plan some dates for us that work with your travel schedule for work.

We can meet with a financial planner and get a better understanding of our money situation in a neutral setting.

Following this blueprint helps the majority of couples come to a more peaceful agreement however, Gottman considers certain issues “perpetual, unsolvable problems”. While some of these problems may lead to ending the relationship (wanting kids vs wanting to be childfree, wanting to live in Hawaii vs wanting to live in Alaska),Gottman found that master couples were able to offer some flexibility and agree to temporary compromises even if it meant revisiting the issue a short time later and trying again.

After agreeing to a compromise, you’ll want to end the meeting on a high note! Try to name one or two things you’ll do to make the other person’s upcoming week better. Improving your partner’s day-to-day life makes even hard conversations like these feel less intimidating.

Making the State of the Union meeting a regular part of your weekly routine might not prevent every conflict but it’s a productive way to get ahead of challenges and maintain a sense of teamwork when tackling difficult subjects. The more you and your partner are on the same team, the more likely you are to be successful in the long-term.

​If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

The Latinx population is rapidly growing in the United States (Valdivieso-Mora et al., 2016). The Latinx population makes up about 16.3% of the total population in the United States (Mendoza et al., 2015). As a fast-growing population, mental health in the Latinx community has been studied more in recent years, and new findings are coming out about what individuals in the Latinx community face. There are many barriers that impact individuals in minority communities when it comes to mental health. From stigma, feelings surrounding treatment, and systemic barriers, it is important to be able to have an understanding of what individuals in the Latinx community face to understand what it is that mental health professionals and individuals can do to help support someone seeking services. This blog post will help break down some common questions that come along with mental health stigma and treatment in the Latinx community. 

What is mental health stigma?
First, it is important to understand what mental health stigma is. Mental health stigma is defined as negative thoughts and beliefs a person has associated with mental health illnesses and treatment (DeFreitas et al., 2018). This impacts individuals because people will find themselves resisting getting help due to biases related to what it means to receive services for mental health. Mental health stigma may increase the risk of navigating a mental health disorder alone or waiting a long time before receiving treatment, which can impact quality of life. 

How does mental health stigma impact the Latinx Community?
Mental health stigma impacts those in the Latinx community because it is estimated that only 1 out of every 11 Latinx American navigating a mental health disorder will seek treatment (Valdivieso-Mora et al., 2016). This is less than 10%! There can be many reasons why an individual in the Latinx community may be impacted by mental health stigma, but there are common feelings associated with mental health stigma.

What are some common feelings that someone from the Latinx Community may feel when seeking mental health services?
There are common feelings associated with seeking mental health treatment. The following are some of the most common.

1. Shame/Vergüenza: Those in the Latinx community may have a stigma around receiving help due to worry about bringing shame or embarrassment to the family (vergüenza). Due to family being a core value for many in the Latinx community, the feeling of shame can keep people from receiving treatment due to the impact it could have on the family unit. 
2. Guilt/Culpabilidad: How many people have thought to themselves “My life isn’t that bad. Why do I feel this way?” This can bring up feelings of guilt, or culpabilidad. Individuals in the Latinx community can feel guilty for feeling down or impacted by mental health disorders and this may create hesitation in receiving mental health services. This thought may come from themselves or their family. Individuals in the Latinx community often minimize their experiences, which is often a survival tactic when in distress. 
3. Fear/Miedo: There is often fear, or miedo, associated with the unknown. Because mental health is an emerging topic in the Latinx community, one may find themselves feeling fear when thinking about receiving treatment. What will it look like? Where do I even start? All of these questions can impact reaching out for help. 

What are barriers to treatment in the Latinx Community? 
When a person in the Latinx community finds themselves breaking away from the barrier of mental health stigma, there may be other barriers that they have to face. One of the biggest barriers present is accessibility with providers and finances.  

1. Accessibility (Providers): Due to the mental health field continuously growing and changing, there has been a lot of positive change with providers. However, there are still gaps in treatment as far as providers go. Some people may only feel comfortable speaking to a Latinx provider due to feeling worried about providers not understanding their experiences. There is a gap in the amount of Spanish-speaking and Latinx mental health providers in many areas. 
2. Accessibility (Financial): Mental health treatment is becoming more accessible, but there still are barriers. It is estimated that about 37% of those in the Latinx population do not have access to health insurance (Valdivieso-Mora et al., 2016). It is estimated that 22% of Latinx-American adults are living in financial hardship (Valdivieso-Mora et al., 2016). This can significantly impact someone's ability to obtain mental health services. 

How can I combat mental health stigma and barriers to treatment? 

1. Offer an understanding and safe space where there is compassion and empathy.
2. Prioritize accessibility and advocate for accessibility. 
3. Work to break stigmas by not being afraid to talk about mental health.
4. Know what to do if someone asks for help and have readily available resources.
5. Stay educated on current events and topics that impact the Latinx community.

I am in the Latinx community and am seeking services. Where do I start?
You are brave and you are not alone. Many organizations are willing to help. It may help to review the article by Dr. Kat Harris titled “HOW TO FIND THE RIGHT THERAPIST FOR YOU”. Other than this, you can look for Latinx-specific organizations or use a search engine designed to help find providers that meet what you are looking for. Below, you will find a list of Latinx-serving organizations. It is okay to not be okay and reach out for help.

​If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

Resources

Latinx Talk Therapy
Therapy,  Immigration Evaluations
155 N. Michigan Ave. Suite 500 C
Chicago, IL 60601
312-620-7551

Latino Treatment Center
Substance Use
54 S. Grove Ave.
Elgin, IL 60120
847-695-9155

Latinx Therapy: Find a Latinx Therapist near you
https://latinxtherapy.com/

References

DeFreitas, S. C., Crone, T., DeLeon, M., & Ajayi, A. (2018). Perceived and personal mental health stigma in Latino and African American college students. Frontier Public Health 49(6), 1-10. https://doi.org/10.3389/fpubh.2018.00049 

Mendoza, H., Masuda, A., & Swartout, K. M. (2015). Mental health stigma and self-concealment as predictors of help-seeking attitudes among Latina/o college students in the United States. International Journal for the Advancement of Counseling, 37(3), 207-222. https://doi.org/10.1007/s10447-015-9237-4

Valdivieso-Mora, E., Peet, C. L., Garnier-Villarreal, M., Salazar-Villanea, M., & Johnson, D. K. (2016). A systematic review of the relationship between familism and mental health outcomes in Latino population. Frontier Psychology, 1632(7), 1-13. https://doi.org/10.3389/fpsyg.2016.01632

As a provider who works with many individuals with Obsessive Compulsive Disorder (OCD), I see the impact this disorder has on my clients, especially the profound shame it creates. For those of you who are reading this blog to better understand OCD, individuals with OCD have intrusive thoughts about taboo, inappropriate, bizarre, and/or distressing things followed by behaviors intended to neutralize the thoughts or prevent the fear from coming true. Throughout the day, many individuals with OCD are bombarded with disturbing images, distressing thoughts, and scary impulses that they fear they will act on; many of these individuals try to hide the fact that they are thinking such thoughts, believing their intrusions mean they are terrible people who want to do terrible things. However, what individuals with OCD do not often understand, is that everyone has intrusive and inappropriate thoughts throughout the day. Of course, we cannot read everyone’s mind for a reason. It would be overwhelming to hear everyone’s intrusive thoughts throughout the day and we would all feel some level of shame and embarrassment if all of our thoughts were displayed to the world. However, many of my clients describe that their extreme shame is related to a fear of being ‘found out’ that they too are having intrusive thoughts. They tell me they live in fear of being labeled a ‘monster,’ or of being a terrible person who will do terrible things due to their intrusive, unwanted thoughts. They even experience this in the therapy space, as many of my clients even fear sharing with me, their therapist, due to fear of judgment, hospitalization, or even imprisonment. 

While this blog is intended to serve as a reminder that no one with OCD chooses to have the intrusive thoughts that they do, I also hope to address the shame and fear of being a ‘monster’ that many of my clients live with. If individuals with OCD are monsters for having odd and taboo, intrusive thoughts, then we all are monsters because EVERYONE has intrusive thoughts. However, not everyone gets stuck in and judgmental about their intrusive thoughts the way someone with OCD does. Although the exact genetic or biological cause of OCD remains unknown, we do know that no one would choose to experience and get stuck thinking about scary, intrusive thoughts. In my years of experience treating OCD, never once did I have a patient inform me that they enjoy these thoughts or that they hope to act on them some day. In fact, everyone says the exact opposite. If a thought is intrusive, it is quite literally intruding into conscious awareness and is not a thought of desire or a thought that someone wishes to have or act on. Whatever an individual with OCD is thinking about is actually the exact opposite of what they want to do; often the intrusion represents the greatest fear an individual has or the thing they want to prevent at all costs. A thought someone wishes to act on will alternatively be welcomed by someone and it will not create distress; a non-intrusive thought is a thought that is intentionally created by someone and is aligned with their true desires, wishes, and values.  

Clearly then, if everyone has intrusive thoughts and intrusive thoughts are not chosen or desired thoughts, then there must be biological abnormalities in individuals with OCD that contribute to their distinct reaction to intrusive thoughts, as someone with OCD reacts to intrusive thoughts with extreme anxiety, whereas someone without OCD reacts with “huh, that was a strange thought” and moves on with their day. As discussed in previous blogs (see the Oakheart Blogs: OCD and “Unacceptable” Intrusive Thoughts - You are Not Alone - and The Role of Thought-Action Fusion in the Development and Maintenance of OCD), it has been identified that individuals with and without OCD have the same intrusive thoughts (Moulding et al., 2014). However, something in the brain of an individual with OCD is hypothesized to be different (Yang et al., 2024). As identified by Yang and colleagues (2024) in their meta analysis (a meta analysis examines the combined results of many studies), many research studies suggest neurobiological differences in individuals with OCD. Specifically, Yang and colleagues (2024) found that individuals with OCD exhibit abnormal functioning and structural differences in the bilateral medial prefrontal cortex/ anterior cingulate cortex (mPFC/ACC), insula, and inferior frontal gyrus (IFG). Therefore, overcoming OCD, a biological condition, is not a matter of will power. Instead, overcoming OCD requires structured, evidence-based treatment often in combination with medication management, in which the neurobiological abnormalities are considered and addressed. 

With this said, I believe it is important that we start discussing OCD as what is it: A medical condition, like any other medical condition. A medical condition is by definition “a disease, illness or injury; any physiologic, mental or psychological condition or disorder. A biological or psychological state which is within the range of normal human variation is not a medical condition” (Medical condition, n.d.). Should one feel shame due to having a medical condition? Most individuals would say no. Most people would not shame someone who has cancer or autoimmune disorders. Why? Because we cannot control our biological abnormalities or challenges. We cannot choose to stop having such differences. No one chooses to have intrusive thoughts about running over pedestrians or giving someone a deadly disease or causing harm to their loved ones. 

Alternatively, an individual with OCD desires nothing more than to stop having their intrusive thoughts, as they experience intrusive thoughts about their greatest fears in life. If someone is afraid of hurting others, they will have intrusive thoughts about harming others. Others are afraid of dying and leaving their loved ones behind so they have intrusive thoughts about deadly diseases. Others fear losing control over their environment and thus they have intrusive thoughts about order, symmetry, or contamination. Because OCD is a biological/ medical condition that reflects someone’s greatest fear in life and is a product of abnormal brain biology, as a provider, it is clear that individuals with OCD should not be ashamed of their intrusive thoughts or related compulsions. Instead, we should recognize that individuals with OCD simply have strong desires to engage in the world in a way that aligns with their values. They have a strong desire to keep others safe. They have a strong desire to stay healthy or to control their environment so that everything will be ok. 

So to anyone reading this who has OCD, it is time to let go of the shame of having this medical condition. It is time to find compassion for yourself and to attribute your intrusive thoughts and your reactions to them to the differences in your brain that cause you suffering. It is time to start believing that it is because of your moral integrity or value of safety and stability that these intrusive thoughts impact you.

If you would like help overcoming your reaction to your intrusive thoughts, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

References

Medical condition. (n.d.) Segen's Medical Dictionary. (2011). Retrieved April 24 2024 from https://medical-dictionary.thefreedictionary.com/medical+condition

Moulding, R., Coles, M. E., Abramowitz, J. S., Alcolado. G. M., et al. (2014). Part 2. They scare because we care: The relationship between obsessive intrusive thoughts and appraisals and control strategies across 15 cities. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 280-291. https://doi.org/10.1016/j.jocrd.2014.02.006

Yang, Z., Xiao, S., Su, T., Gong, J., Qi, Z., Chen, G., Chen, P., Tang, G., Fu, S., Yan, H., Huang, L., & Wang, Y. (2024). A multimodal meta-analysis of regional functional and structural brain abnormalities in obsessive-compulsive disorder. European Archives of Psychiatry and Clinical Neuroscience, 274(1), 165-180. doi: 10.1007/s00406-023-01594-x

June is Men’s Health Month and as such, I thought this would be a great opportunity to bring continued awareness to the topic. Health includes a multitude of factors in one’s life, including but not limited to: physical health, social health, mental health, spiritual health, and financial health. I have noticed both throughout my personal and professional life that men tend to neglect their health in more than one of these categories more often than women, sometimes with dire consequences, and that is why I am intentional about providing therapy to our male population in the areas of treating and working with depression, anxiety, trauma and grief. 

Here is one way I like to help my male clients visually assess their health journey to-date and work together to find ways to experience growth and encouragement along the way. 

When you have an eating disorder, learning how to interact and make room for those pesky and uncomfortable internal experiences, such as thoughts and feelings, can be difficult. The eating disorder usually jumps into the "rescue," leaving the person feeling a massive sense of relief, control, and maybe even comfort. The truth is that when someone is chronically "rescued" from their own internal experiences, they lose their sense of self-efficacy, and their tolerance for those uncomfortable thoughts, sensations, and feelings reduces dramatically. Self-efficacy is a person's belief in their own capabilities to navigate situations and perform specific tasks. As you can imagine, if you already have it in your head that you won't be successful or that you can't handle the situation or internal experience, it could be easy to give in to the directives of the eating disorder, earning a huge sigh of relief.  

The bad news is that the relief of being "rescued" is fleeting. While there is undoubtedly a short-term benefit to feeling the relief wash over you, the cost is most concerning, as the price has a long-term effect of reducing a person's window of tolerance to everyday stressors. A person who is "rescued" by an eating disorder, which I like to refer to as their frenemy, starts to notice the symptoms of the eating disorder getting worse with more minor stressors or internal experiences. Their world gets smaller. Usually, a person doesn't realize the severity of their symptoms until the disorder overtakes them. This can be particularly difficult because, as you remember, the eating disorder damages self-efficacy, so recovery can feel too uncomfortable even to consider. 

There are several treatment approaches that are focused on re-building self-efficacy, increasing psychological flexibility, and violating the beliefs that hold people captive to eating disorders. I firmly believe it is easier to engage in therapeutic services when you know what you may be working on. Below, I am sharing 3 of my favorite therapy tools that I often utilize with my clients who are learning to live without being "rescued."

The Personification of the Eating Disorder: The personification of the eating disorder is an excellent way to help a client disentangle themselves from the disorder. Often, it can feel like you ARE the eating disorder. When we personify the eating disorder, it creates distance and allows clients to start to challenge and question the information that the eating disorder is presenting as truth. I often encourage my clients to give the eating disorder, their frenemy, a name. Some stick with Ed and others develop a whole new name. The trick is to ensure that the client knows that they are not the eating disorder and they still have a voice and can take action against the disorder that they have distanced themselves from.  

Defusion and Function Management: Defusion from an eating disorder involves learning to allow thoughts, sensations, urges, and feelings to be present without needing to take action or give them a lot of attention. I help my clients identify which internal experiences are important to defuse from and which are legitimately helpful and deserve more of their time and energy. My clients learn to ask themselves, "Is this thought helpful for me to spend my time and energy on right now, or can I let it be and move forward?" There are many defusion techniques that we use in treatment, but the one I start clients with is putting the phrase "I am aware of (the feeling of), (the sensation of), (the urge of), (the thought of)" and then communicating those feelings, sensations, urges, and thoughts. Generally speaking, acceptance and tolerance of discomfort follow when someone identifies and communicates their internal experiences accurately and makes room for them without willing them to stay longer with more energy and attention than they deserve. 

Once clients become skilled at implementing their favorite defusion techniques, they are more equipped to identify the function of eating disorder behaviors that present as urges. Learning the function can help clients identify other methods for meeting those needs without engaging in harmful behaviors. Every behavior has a function, and when clients discover their triggers, they can manage the function in more productive ways that align with recovery. 

Exposure and Behavioral Experiments: What we know is that the eating disorder tends to put an obsessive focus on food and, sometimes, the body. For instance, in Anorexia Nervosa (AN), we notice that most clients have rigid rules about food consumption and their bodies. The eating disorder cultivates deeply feared consequences that are maintained by compensatory behaviors (restriction, self-induced vomiting, over-exercising, misuse of laxatives, etc.) the client engages in. The feared consequences never get challenged, and data that violates those belief sets are never internalized because the person is usually really good at compliance with the directives of the eating disorder. In my opinion, exposure is one of the most important therapeutic tools. 

Exposure starts by collecting data from the client on triggering internal and external situations, specific feared consequences, and compensatory behaviors used to obtain temporary relief. Once the information is collected, the client collaboratively develops an exposure action plan. Together with their therapist, they can determine what triggers they are willing to face AND what compensatory behaviors they are willing to withhold. A willingness to test their feared consequences allows them to gather evidence of their self-efficacy. Usually, it also provides them evidence that the eating disorder has not been honest about their ability to cope effectively and/or that the outcomes are different than what was initially hypothesized by the eating disorder. More often than not, exposures become easier with time and practice, allowing clients to tackle the most difficult items on their action plan list. 

Eating disorder treatment is hard work, but it is good work! Most people are apprehensive and scared when they start, and with the eating disorder buzzing in their ears, they have likely gone back and forth over treatment. Luckily, the real self outside of the eating disorder is still capable and present, and seeking out a qualified therapist and registered dietitian who has expertise in the area of eating disorder treatment is possible. I like to remind my clients that the determination and will that got them into the disorder is the same determination and will that will get them out of it, just refocused.  

If you are interested in counseling for Eating Disorders or in general, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

Exposure and response prevention (ERP) has historically encouraged using what is called habituation as a tool for and marker of symptom reduction in anxiety disorders (as cited in Abramowitz et al., 2019). Habituation generally entails repeated exposure to a feared situation or stimuli until the anxiety eventually subsides (i.e., getting habituated to the situation). In other words, overcoming a fear has generally been determined by how little anxiety someone feels at the end of treatment when engaging with the feared situation or stimuli.

For example, if someone is afraid of having panic attacks in the grocery store, successful treatment would look like having little anxiety (and elimination of panic attacks) in the grocery stores by the end of treatment. However, Craske and colleagues (2014) have suggested that habituation is not the most important factor in the extinction of fears in the long term. Specifically, Craske expresses concern regarding the goal of habituation, or anxiety reduction, claiming that it reinforces a problematic belief that anxiety is intolerable and that it must be eliminated. Instead, researchers like Abamowitz (n.d.), emphasize what is referred to as the inhibitory learning perspective, which suggests that the goal of exposure and response prevention should be to learn that, even if a trigger/stimuli makes us anxious or is slightly dangerous/distressing, we can also develop beliefs that the stimuli are not dangerous enough to be avoided or that the stimuli are generally safe. 

The inhibitory learning perspective suggests that the goal of ERP should be to learn to tune out or inhibit the idea that a stimuli is dangerous while allowing development of the the belief that the stimuli is generally safe, despite any anxiety and/or distress that arises (Abramowitz; n.d.). This perspective also emphasizes that learning new information/new safety associations that supersede or combat previous fear associations is critical to overcoming a fear. In other words, part of exposure therapy requires sitting with a feared stimuli long enough to develop new beliefs about it, mainly that it is not as dangerous as it seemed.

This perspective also emphasizes that overcoming a fear requires new learning to take place that supersedes or combats previous fear associations (Abramowitz; n.d.). In other words, part of exposure therapy requires sitting with a feared stimuli long enough to develop new beliefs about it, mainly that it is not as dangerous as it originally seemed. For instance, in the example above, if someone fears going into a store due to fear of having a panic attack and being unable to escape, exposure therapy using habituation would entail repeatedly going into the store and seeing that the panic will subside if they stay in the store long enough and that they always could escape because no one is permanently trapped in a store. Per the inhibitory learning perspective, successful treatment would entail learning that the individual can in fact still function even when experiencing panic, as panic is not a harmful emotion. Conversely, panic is an emotion that naturally protects us. 

Although repeated exposure to a grocery store will teach the person referenced above that they can handle grocery stores and that they are safe, research suggests that fears/danger associations can’t be unlearned (as cited in Abramowitz et al., 2019). According to certain theories and researchers, the fear of grocery stores may remain and in the future may resurface even after exposure therapy. However, if we collect enough new safety information, which allows us to see that whatever we were afraid of is actually not as dangerous as we thought, then we will be able to overcome our fears in the future if or when they resurface. This is supported by the inhibitory learning perspective, in which the goal of treatment is to learn new and more accurate safety associations so that the old threat associations are no longer controlling thoughts and behavior. 

From this perspective, it is not as critical that one habituates to a feared situation or object (becomes less anxious or triggered). Instead, the exposure should be repeated until a new belief related to general safety of the situation is believable, and what the person expects to have happen (e.g., disastrous consequences) does not happen. For instance, if you are starting treatment with a fear that you will contract or spread a deadly disease if you do not wash your hands with bleach before cooking meals, the goal of exposure and response prevention therapy would be to refrain from hand washing with bleach and to cook a meal anyway until you start to learn that a deadly disease will likely not spread through cooking dinner. The updated model of exposure therapy using inhibitory learning suggests that, during this exposure work, additional learning takes place: that the originally feared stimuli, the possibility of spreading a deadly disease without washing with bleach, is actually unlikely, that the act of cooking using standard non-bleach handwashing methods is safe, and that the fear/thought/possibility itself is tolerable. 

If a new belief has not formed during exposure therapy, Craske and colleagues (2014) suggest that a future relapse is likely. Craske and colleagues (2014) therefore suggest that a new non-threatening cognition must be developed during therapy and the patient must be able to easily access the safety-based cognitions in a variety of contexts after gathering an abundance of evidence in opposition to the original fear. They believe that anxiety should not be controlled or resisted but instead exposure therapy should prioritize fear tolerance, because anxiety is universal, inevitable, and critical for our survival.

Exposure therapy using the inhibitory learning model therefore does not encourage the use of a hierarchy, or slowly facing fears in a progressive way, from easiest to most difficult feared situation. Instead, it suggests that the patient commit to “desirable difficulties” (Bjork, 1994) in exposure therapy, or random choosing of exposure stimuli instead of utilizing a hierarchy. Craske and colleagues (2014) and Bjork (1994) believe that this approach assists with managing real life challenges because they will be able to retrieve newly learned information during surprise exposures in the future and learn that desirable difficulties aid in fear tolerance.

They hope patients can start to see that when they feel fear, they can manage the distress. In other words, the end goal, according to the inhibitory learning perspective, is to learn that you did not increase the likelihood of developing or spreading a deadly disease because you refrained from bleach use. If your family survives the meal, you have gathered information that is inconsistent with your original belief and you may start to see that bleach is an unnecessary protection (even though it technically does kill germs). Every time you repeat this exposure, you will build up stronger and stronger new associations which suggest your old belief was inaccurate.

​Of note, we can never be 100% certain. The goal of therapy is also to be able to tolerate uncertainty and to let new information gathered during exposure work drive future behavior patterns, which thereby allows you to live life and welcome anxiety along the way.  

If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

References

Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2019). Exposure therapy for anxiety: Principles and practice (2nd Ed.). The Guilford Press.

Bjork, R. A. (1994). Memory and metamemory considerations in the training of human beings. In J. Metcalfe & A. P. Shimamura (Eds.), Metacognition: Knowing about knowing (pp. 185-205). Cambridge MA: MIT Press. 

Cras ke, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behavior Research and Therapy, 58, 10-23. 

Abramowitz, J. S. (n.d.). The Inhibitory Learning Approach to Exposure and Response Prevention (iocdf.org). Retrieved April 11, 2024 from https://iocdf.org/expert-opinions/the-inhibitory-learning-approach-to-exposure-and-response-prevention/

April kicks off alcohol awareness month for the Substance Abuse and Mental Health Services Administration (SAMHSA). I wanted to take some time to review information related to alcohol and bring awareness and understanding to alcohol use and misuse.
  
According to data from the 2022 National Survey on Drug Use and Health, among the 137.4 million respondents aged 12 and older self-reporting current use of alcohol, 44.5% reported binge drinking, with the most prevalent age category being 18-25 years old (29.5%). Among people 12-20 years old, 15.1% used alcohol in the past month. Estimates of binge alcohol use and heavy alcohol use in the past month among underage people were 8.2% and 1.7%, respectively. The Centers for Disease Control and Prevention estimate about 178,000 people die from excessive alcohol use in the U.S. each year (SAMHSA, 2024).

Let's review how SAMHSA classifies a standard drink of alcohol:

• 12 ounces of beer (5% alcohol content)
• 8 ounces of malt liquor (7% alcohol content)
• 5 ounces of wine (12% alcohol content)
• 1.5 ounces or a "shot" of 80-proof (40% alcohol content) distilled liquor (gin, rum, vodka, whiskey, etc). (SAMHSA, 2024) Increasing awareness of how much alcohol is consumed can aid in assessing if an individual is using alcohol in excess. 

Signs of Using Too Much Alcohol:

• You drink more or longer than intended 
• You try and cut down or stop drinking but aren't able to 
• You continue to drink even though it adds to other mental or physical health problems 
• Individuals you love and trust have commented about your usage of alcohol 
• You spend a lot of time thinking about or drinking alcohol
• Usage of alcohol impacts your ability to complete daily activities with work, friends, family, or recreational activities 
• You may experience legal problems related to alcohol
• You have experienced symptoms of withdrawal (increased sweating, tremors, headache, decreased anxiety/irritability, and/or insomnia) when you do not use alcohol. (SAMHSA, 2024).

If reading the information provided above resonated with you and you may be struggling with alcohol use, reach out. I’d like to connect and find out more about how I can support you on your journey.

References

Alcohol Awareness Month. (n.d.). Alcohol Awareness Month. SAMHSA. Retrieved April 17, 2024, https://www.samhsa.gov/newsroom/observances/alcohol-awareness-month

​​If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

The concept of boundaries has seemed to take off in the social media realm and in therapy offices alike. The Merriam-Webster Dictionary defines a boundary as “something that indicates or fixes a limit or extent.”  Boundaries apply to things like property lines and city limits, and they also apply to both intrapersonal and interpersonal relationships. Boundaries are an opportunity to determine how and when we will utilize our innate and external resources such as emotional capacity, verbal and non verbal communication, time, and money, to name a few things, when we relate to ourselves and other people in our lives, for the purpose of creating and maintaining safe and satisfying relationships. 

As a recovering people pleaser, I can attest that setting healthy boundaries is hard, but it’s not selfish. The furthest thing could be from the truth - boundaries are actually kind. Merriam-Webster defines kind as being “of a sympathetic or helpful nature.” Boundaries are also helpful. Here’s an exercise: Consider someone you personally know who you would describe as having healthy boundaries, and as being kind and helpful - ask them if they believe it is selfish to have and maintain boundaries. 

In regard to continuing to unlearn some misconceptions about boundaries, I like to envision them as a “gate” instead of a “fence.” This means that there is a pathway, an opportunity for the boundary to be responsive, to allow others in and out when appropriate, but it does not mean shutting the world out forever. A barrier I’ve also noticed for so many individuals in setting healthy boundaries is the fear of coming across as “mean” or “selfish.” This fear of negative perception maintains the boundaryless behavioral pattern until it’s no longer sustainable. What usually happens over time is that resentment will set in and all of a sudden, it’s “boundaries for everyone!” as an attempt to regain some peace. The only problem with this is that when boundaries are coming from a place of burnout and resentment, and it becomes tempting to isolate, they’re usually less effective.

However, regardless if someone is setting a boundary proactively or somewhat reactively, they are still so important to have. Without them, we risk enabling poor behavior in ourselves and in others. 

Here are some signs and questions to ask to determine if boundaries are needed with self or others:

• Becoming aware of feelings that may point to a need for boundaries: irritability, frustration, tiredness, stress, bitterness, resentment
• Becoming curious if the feelings are chronic or sudden. If chronic, boundaries are necessary

I hope you’re now wondering how to get ahead of burnout and resentment, and how to learn to set boundaries from a place of health and peace. One of my favorite ideas to think on is that instead of being responsible for other grown people, we are instead responsible to them; to do no harm. This distinction can help shift away from the tendency to engage in people-pleasing tendencies at the expense of one’s own needs and desires. 

How to set and communicate boundaries:

• Pick an area of life where having a boundary would be helpful - ex: work, school, marriage, dating relationship, friendship, relationship with a parent, relationship with a child, with yourself 
• Identify the need the boundary will address - ex: need for more support, less micromanagement, more help with the chores or the kids, more time together, less time together, more privacy, more independence
• Pick a date and time to have this conversation, or time of reflection if with yourself
• Communicate in a calm, respectful, and firm tone

Lastly, I want to expand a bit more on this idea of having healthy boundaries with ourselves. The relationship we have with ourselves is one of the most, if not the most, important relationship we have, and yet I find this to be an area that often gets overlooked. Some examples of this could be forgetting to eat or sleep well, not advocating for what we need in our homes or relationships or workplaces, not doing what we say we will do, etc.

Here are some examples of boundaries that someone can have with themselves:

• Fill your car w/ gas the night before instead of rushing in the morning the next day
• Pack a lunch for the day instead of wasting that time checking social media
• Limit social media consumption and comparison
• Listen to your body: take a nap if you’re physically tired
• Listen to your body: go outside/sit/walk in nature if you’re mentally tired
• Be mindful of spending habits/start a budget
• Regularly do something for the sake of fun

If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

When we think of what it is to be defiant or to display a level of defiance in our everyday lives, more times than not, this isn’t exactly viewed from the lens of being a desirable trait that one would possess in their arsenal. After all, when’s the last time a friend got back from a social engagement, perhaps a first date of sorts, and when pressed for details on what their counterpart was like, jubilantly exclaimed, “Oh, it was magical! They were so defiant!” Yeah, not so much *shrug emoji*

To take this a step further, according to the upstanding, grade A humans at Merriam Webster, of both dictionary and thesaurus notoriety, defiance and/or defy can be defined as:

A.) The act or insistence of defying
B.) Disposition to resist and/or a willingness to contend or fight
C.) To confront with assured power of resistance
D.) To resist attempts at
E.) To challenge to do something impossible
F.) To combat

Well, yikes! Not an overflowing, overabundant amount of positivity in this term defiance, yet, what if I were to spill all sorts of tea everywhere, whether it be chamomile, jasmine, or hibiscus, and shared that there’s actually a defiance that’s, well, positive? What if I were to also be brazen enough to take it a step further and speculate that perhaps this level of, what we’ll call from here on out as positive defiance, is something that can be leveraged fully in your life to use as the very vehicle to guide you from the disappointments of the past and perhaps even present, towards the hope that emerges in the future? All sorts of outlandish, I know, but hear me out on this as there’s more to it than might meet the eye.

I’m going to go rogue for a bit here, and make the perhaps emboldened claim, that at some point in your life, dearest and most beloved blog reader on the world wide web, there have been points in your life where negative thing have occurred. Chances are, they weren’t simply negative things, but heavy, emotionally dense things that dragged you to figurative waters that were so deep it was almost impossible to swim within.

So what gives? You were dragged to the figurative deep waters but you didn’t drown; neck deep in hardship and circumstances yet still able to carry on, all the same. Chances are, at some level, there was an aspect of positive defiance that emerged against the hardship, where you made a determination that you simply weren’t going to give in. Think about every aspect of your life to this point, whether it was the hardships of an upbringing that saw a level of neglect, abuse or trauma, a situation that happened where something or someone you deeply cared for was ripped away from you, or even just the perpetual disappointments that happen day to day.

You got through it. Take a moment to acknowledge that and receive that. You! Got! Through! It! As if that wasn’t enough, this is the potential that positive defiance has in this process, as it allows you to not just get through difficult things, but to actually use the very things that sought to overwhelm and destroy, as the very foundations for continued growth for yourself and others.

So let’s take this negative upbringing example that was previously referenced; chances are very high that level of pain and discomfort shaped you, illustrating thoroughly what you’re not seeking for your life or the lives of those significant people that are around you. Positive defiance therein takes this experience, and makes a commitment to not pass along those hurts to others in a way that’s inconceivable, because you yourself can identify the pain, the brokenness and the hurt that emerged from that and couldn’t possibly fathom inflicted that on another.

Think of this as the bizarro version of a generational curse, where one generation of a family experiences a particular behavioral pattern and passes it along to other generations in a vicious cycle that leaves a path of dysfunction and brokenness in its aftermath. Positive defiance ends that, all of it. Positive defiance plants a flag and makes the proclamation that one won’t be held to the hurts of the past, but instead will confront them head on, ensuring that others within their relational sphere will not have to encounter them personally.

There’s a crux to all of this that’s a vital piece of this positive defiance puzzle: before any positive defiance can be exhibited, there has to be the understanding in place that everything that’s happened in your life has been necessary, as you don’t get the current version of yourself without first walking through the past versions, each & every past version.

All of your experiences matter. Not just the ones we proudly speak to, even the ones we’d rather forget, bury deeply within ourselves and attempt to forge ahead in spite of them. Your past can be a prison or a pathway, the decision is yours to make and yours alone. On that pathway though, positive defiance awaits, with the ambition to reshape and repurpose those negative situations into something that stops the harm cycle and ushers in a healing cycle that’s beyond comprehension. So get after it, let’s get defiant with our past!

​If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

​Everyone has ‘intrusive’ thoughts that are odd and even disturbing, inappropriate, or taboo, at times (Grayson, 2014). Individuals without obsessive-compulsive disorder (OCD) recognize that intrusive thoughts, or thoughts we are not consciously producing that just pop into our heads, are not anything to be alarmed by and don’t need to be interpreted as potentially dangerous. They might think to themselves, “well that was a strange thought” and move on with their day. However, someone with OCD will be inclined to react to an intrusive thought with fear, panic, and shame and interpret the thoughts as potentially meaningful and dangerous. They might alternatively say “Oh my, that is awful, I need to get that out of my head, would I act on this thought? Why am I having this terrible thought? I must be a monster.” They then may assume that having this terrible thought MUST mean that they will act on the thought and that every thought will lead to action, and therefore they must do something to prevent the terrible thing from happening (i.e., compulsive behavior). 

As referenced in a previous blog written by Johanna Younce, MA (see OCD and “Unacceptable” Intrusive Thoughts - You are Not Alone - OakHeart, Center for Counseling (oakheartcenter.com)), a study conducted on 777 students from 6 continents (13 different countries), found that 94 percent of people without OCD have the same of intrusive and unwanted thoughts, images and/or impulses that someone with OCD has (Moulding et al., 2014). So why is it that individuals with OCD have such a strong reaction to these intrusive thoughts when someone without OCD does not react really at all? 

Well, OCD is sometimes referred to as a thought phobia. In other words, individuals with OCD believe that their thoughts are very powerful and they fear having certain thoughts due to the belief that every thought is significant. Most of us tend to believe that thinking positively will result in positive outcomes and thinking negatively will result in negative outcomes. However, we do not think this in a literal sense. We believe that negative thinking isn’t great for our well-being. Conversely, someone with OCD might believe that negative, intrusive and disturbing thoughts (that are highly normative) will likely result in negative outcomes. In this sense, individuals with OCD tend to believe that whatever thought comes to mind will result in action or result in very real consequences. I think we all sometimes wish our thoughts were that powerful. Wishing for a billion dollars would then result in financial prosperity. Wishing for world peace would result in world peace. Unfortunately, individuals with OCD don’t just believe positive thoughts will result in positive outcomes. They also believe the alternative. I think we can all recognize that this belief would be challenging and quite distressing. If every intrusive thought that pops into someone’s head could lead to an actual outcome in the world, our world would be a scary place! For example, when we are running late and the car in front of us fails to see that the light turned green, many people likely experience anger followed by intrusive thoughts about the person in that car. Individuals with OCD tend to believe, because they had that bad thought, there is an increased likelihood that the person in the car ahead will actually experience harm.

Thought-action fusion reflects the distorted thinking described above that is often characteristic of OCD: This distortion suggests, because I think it, it must be so (Grayson, 2014). Because we think many ridiculous thoughts throughout the day, this psychological phenomenon causes significant distress in individuals with OCD. For this reason, the most effective treatment for OCD is exposure and response prevention (ERP), which entails exposing someone to a scary thought (ones that they are already having) and then refraining from trying to undo the thought via a compulsion. 

Studies have been conducted to understand the neurobiology of thought-action fusion. Researchers have identified areas of the brain that are likely involved, including the inferior orbitofrontal gyrus, several prefrontal cortex regions, the insula, and the globus pallidus (Lee et al., 2021). Lee and colleagues (2021) found that the superior and middle frontal gyri (dlPFC), medial prefrontal cortex (PFC), and inferior parietal lobule were correlated with OCD symptoms. A recent meta-analysis showed that all of these regions were associated with OCD in functional imaging studies (Rasgon et al., 2017). For instance, individuals with OCD were found to have abnormalities in the insula (associated with disgust) and the unacceptable thought dimension of the dorsolateral and dorsomedial prefrontal cortex (PFC; associated with cognitive control; Rasgon et al., 2017; as cited in Lee et al., 2021). This neurobiology of thought-action fusion exhibits that OCD is a medical/ biological condition and therefore requires treatment that will assist with training the brain, which is the goal of exposure and response prevention treatment. 

ERP treatment aims to help you either reduce the frequency of intrusive thoughts or learn to recognize that most thoughts are just thoughts without much or any meaning. By intentionally provoking or “sitting with” your scary or distressing thoughts in exposure-based therapy, you can start to learn that intrusive thoughts do not lead to action and that thought-action fusion is simply a thinking error. This is a major goal of treatment. An additional goal in treatment is to realize that a thought is just a thought; it means nothing without intentional action. For instance, one exercise that I sometimes have my patients participate in is to have the thought “stand up” for one minute. I then tell them, “now actually stand up.” To actually stand up, requires intention. Intended action requires more than a thought. The goal of treatment is to see that you are more than your thoughts. We are here to help you too start to believe this. 

If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

References

Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2019). Exposure therapy for anxiety: Principles and practice (2nd Ed.). The Guilford Press.

Foa, E. B., Steketee, G. S., & Rothbaum, B. O. (1989). Behavioral/cognitive conceptualizations of posttraumatic stress disorder. Behavior Therapy, 20, 155–176. https://doi.org/10.1016/S0005-7894(89)80067-X

Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.

Krypotos, A-M., Effting, M., Kindt, M., & Beckers, T. (2015). Avoidance learning: A review of theoretical models and recent developments. Frontiers of Behavioral Neuroscience, 9(189), 1-16. https://doi.org/10.3389/fnbeh.2015.00189   

Lee, S. W., Cha, H., Jang, T. Y., Kim, E., Song, H., Chang, Y., & Lee., S. J. (2021). The neural correlates of positive versus negative thought-action fusion in healthy young adults. Clinical Psychopharmacology and Neuroscience, 19(4): 628-639.  https://doi.org/10.9758/cpn.2021.19.4.628

Moulding, R., Coles, M. E., Abramowitz, J. S., Alcolado. G. M., et al. (2014). Part 2. They scare because we care: The relationship between obsessive intrusive thoughts and appraisals and control strategies across 15 cities. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 280-291. https://doi.org/10.1016/j.jocrd.2014.02.006

Rasgon, A., Lee, W.H., Leibu, E., Laird, A., Glahn, D., Goodman, W., et al. (2017). Neural correlates of affective and non-affective cognition in obsessive compulsive disorder: a meta-analysis of functional imaging studies. Eur Psychiatry, 46, 25–32. https://doi.org/10.1016/j.eurpsy.2017.08.001.

Resick, P. A., Monson, C. M., & Chard, K. M. (2014). Cognitive processing therapy: Veteran/military version: Therapist’s manual. Department of Veterans Affairs.