There's More to Time Outs Than "Go to Your Room!"

“Lately I've been having issues with my almost 2-year-old son being aggressive towards me and his dad. He hits me and pushes me. He doesn't see behavior like that in our household, and doesn't really play with a lot of other kids yet so I don't know where he's getting it. What is the best way for me to react? I've been pretend crying LOL.”

Points for creativity on the pretend crying technique! However, this response may do more harm than good in that it may give your son at least a taste of the reaction he’s after: he wants your attention, and he probably doesn’t mind that he’s getting it by “pushing your buttons.” The appropriate parental response in this situation is not to simply ignore his behavior. When he behaves aggressively, a time out is warranted.

Behavioral psychologists classify time outs as “negative punishment” because a child placed in time out is being removed from the stimulus that was reinforcing his or her behavior. Allow me to translate: time outs are a form of punishment because your son, while in time out, will not receive the attention he was previously getting (or wanting) for the way he was acting. Many parents think sending the child to his or her room is sufficient, but an effective time out looks much different than this. “Go to your room!” may give the parent a time out from the kid, but most kids get to enjoy playing with toys or even watching T.V. in their rooms. Wrong answer! Here’s what to do instead:

There’s no need to yell, but firmly say “We don’t hit” (or push or whatever the “naughty” behavior is) and walk your son to the designated time out spot. Ideally, this will be a chair facing a bare wall.

Without saying anything else for the duration of the time-out, set your son on the chair watch the clock. You don’t need to have a timer for him to watch; keeping track of the time is your responsibility. Stand near him the entire time he’s on the chair but do not give in to any efforts on his part to engage you—pretend you are a guard outside Buckingham Palace if you have to.

If he gets off the chair, calmly and gently set him back on it. Do this as many times as necessary until he gets the idea this is not a game and you really do mean business. After the allotted time is up (I like one minute per year but it’s up to you; just be consistent and don’t let it go on too long), remove him from the chair but only if he’s sitting calmly. Say, “Since you’re sitting quietly you may get up now.” If he’s still throwing a fit he’s not ready to come out of time out. Wait for him to settle and as soon as he does for a few seconds, remove him from the chair.

That’s it. There’s no need to “discuss” or “process” with him because your actions have already spoken louder than your words possibly could. Use time outs effectively for a few days and you should see his aggressive behaviors decrease. At that point give him some positive feedback such as “Thank you for not hitting.” Even at this young age, he’ll come to realize that getting attention for being good feels much, much better than getting attention for being naughty.

Dump Others As You Would Be Dumped

"After seven months, my girlfriend and I are no longer 'clicking,' I guess you might say. I think we both know this but neither one of us wants to be the one to break it off.  So what’s your advice for breaking up without hurting her feelings?"

Breaking off a relationship, like so many things in life, tends to get easier with practice.  Many people get to experience both sides—getting dumped and dumping someone else. The good news about that is it paves the way for the Golden Rule; in this case, “Break up with others as you would have others break up with you.”

I wish someone would have given me this advice when I was an insensitive jerk of a boyfriend in high school. I broke up with my girlfriend, more out of boredom than anything, through a note I gave her during passing time. Sure, that was a fairly common way to dump someone in the days before text messaging, but the worst part was that I told her to wait until after her Spanish test next hour to read the note. She, of course, didn’t, and bombed the test. Would I have wanted someone to break up with me in that fashion? If I had stopped to think about what it would be like to be on the receiving end of that note, I would have done things much differently.

Karma being the force of equity that it is, I later got to experience the hurt of being blindsided by an unforeseen breakup. My fiancé (same girl I broke up with via the note back in high school!) dumped me by packing up her things while I was out of the apartment one night. When I got home I was essentially told, “We’re through; I’m outta here.” Later, when I tried the “Let’s work on this together” approach, she would hear nothing of it. I remember feeling very frustrated because I really believed we could get past what had driven us apart, but I did not have the sense that my ex-fiancé was really hearing me out.

My advice for breaking up amicably is to dump the other person as you would want to be dumped. For me, with my fiancé, that would have meant a little more warning about what was coming my way and an opportunity to talk it out. Keep in mind that “talking it out” doesn’t mean giving the person false hope, but it does mean that you give them a chance to be heard. Sit down with your girlfriend and tell it to her straight—explain to her how you feel and what you want to happen next. Let her respond and make sure she knows you hear and understand what she is saying, especially if she’s not quite ready to call it quits.

Breaking up with someone as considerately as possible is a sign of real maturity. As an aside, a difficult breakup can be a great opportunity for growth. I know how clichéd that might sound, but it’s true. My high school girlfriend/ex-fiancé is now my wife, and we wouldn’t have the relationship we enjoy today without having experienced our share of breakups. If done right, the cycle of dating and breaking up, whether it’s with one person or several, is all about growth.

Don't Panic!

"I have been having anxiety and panic attacks for years now. My symptoms became worse after I gave birth (compounded by postpartum depression). I was reading your previous post about thinking positive and I try really hard everyday to do so, but I still continue to have horrible panic attacks! My doctor said she could put me on Xanax but I don’t want to be a zombie. Do you have any other advice?"

Positive thinking is very important when it comes to defeating irrational/self-defeating thoughts and self-talk (e.g. “I can’t handle this” or “I’m a horrible mom”). These thought patterns often contribute to symptoms of depression and anxiety, but monitoring and combating your thoughts using positive thinking is only one piece of the puzzle. Here are some other things to try that, if used consistently, should help you get a handle on your anxiety and panic attacks:

Exercise. “One of the most powerful and effective methods for reducing generalized anxiety and overcoming a predisposition to panic attacks is a program of regular, vigorous exercise” writes Dr. Edmund J. Bourne in his “Anxiety and Phobia Workbook” (New Harbinger: 2005). Exercise is also a great way to “blow off steam,” reducing your overall level of stress and anxiety. The type of exercise you engage in is really up to you—anything that gets your heart rate up on an almost daily basis will help (but talk to your doctor first if you have health concerns). Choose something you enjoy doing so exercising does not feel like a chore.

Diet. Soda, tea, sugar, and nicotine are all stimulants and will cause you to feel more jittery and on-edge, putting you that much closer to “panic mode.” Consume any stimulant sparingly.

Breathe. This is probably the most commonly given advice for stress, anxiety, and panic attacks—commonly offered because deep breathing really does help.  The increased amount of oxygen you inhale by taking slow, deep breaths using your abdomen signals the brain that “everything’s okay” and helps the body to calm. 

• Inhale slowly through your nostrils until your lungs are full (you should see your chest rise and feel your abs tighten). 
• Hold your breath while you repeat a calming phrase to yourself such as “Relax” or “I’m okay.” 
• Slowly push the air out through your mouth, counting backwards from 10. Repeat this process a few times (as many as it takes to calm yourself). 
• Use this technique as part of your morning routine,  before you go to bed, or as needed to curb your anxiety before a full-blown panic attack develops.

Accept. Emotions have meaning; some are helpful, others are not. They come and they go, washing over us like waves on a beach. We cannot control our feelings, and this is a major “sticking point” for many people with anxiety issues who tend to want to control as much as possible (and who may become even more anxious when faced with a loss of control). 

What you can control is how you handle your emotions. For example, if you are sad for any reason—perhaps even no reason in particular—you can choose to ignore the sadness by pretending it doesn’t exist. Many people who attempt to do this end up channeling their actual emotion (sadness) into something else (usually anger). This, clearly, is not helpful. The alternative is to acknowledge and accept the emotion for what it is by sharing your feelings with someone you trust, journaling, or even just admitting to yourself “I am sad today.” You might add, “I don’t know why, but it will pass” or “I am sad today because ______, and this is what I can do about it.” Perhaps there is nothing you can do about the source of your emotion, but acknowledging its existence in your life at that very moment is much more helpful than stuffing your feelings away, letting them pile up and pile up until they eventually burst out of you in a full-on episode of panic. 

Sorting through emotions can be difficult work that is best accomplished in the safety and comfort of a counselor’s office, especially if there are unpleasant incidents from the past or unresolved issues that commonly contribute to your feelings and overall functioning in the present. With determination and perseverance, your hard work will pay off; you can overcome panic.

Disclaimer: Although the advice contained in this Web site frequently makes mention of diagnostic criteria and treatment options, it is not intended to replace the opinion of a qualified mental health professional who could directly and more specifically address the issues and concerns at hand; nor is the advice contained herein offered as substitution for psychotherapy or other professional mental health services. Individuals with mental health concerns are advised to seek treatment in person through a licensed professional. The author of the content on this Web site, Bryan J. Hall, LMHC, makes no guarantees regarding the advice offered and reminds readers to use personal discretion when deciding what, if any, advice or suggestions to accept and implement.

Love, Loss, & The Worrywart

"I consider myself a chronic worrier, and I could really use some advice or suggestions about how to deal with my fear of the unknown."

Worry exists as a means of self-preservation. When we sense danger, our old friend the “fight or flight” response is activated, physically preparing the body to protect itself or, as conditions warrant, to get the heck out of Dodge. Maybe it’s due to genetics or previous life experiences or a nasty combination of the two, but some people are simply more susceptible to over-interpreting or misinterpreting situations in their lives through a lens clouded by worry and fear. You may be one of those people; you may even meet diagnostic criteria for “Generalized Anxiety Disorder,” a condition characterized by the predominant symptoms of chronic and excessive worry.

There are many techniques you can engage in to combat anxiety. I’ll go over some of them, including exercise and deep breathing, in a post this Friday about the “granddaddy” of worry and fear: panic attacks. Please check back for those tips, but in today’s post I want to focus instead on the philosophical “big picture.”

There is one school of thought that holds all anxiety is rooted in the fear of death. I think there is some truth to this notion, but I also believe this statement is more accurate when “death” is interpreted as a symbolic representation of loss. This could mean loss of one’s own life, loss of a loved one, loss of a job, loss of innocence, etc. The list goes on and on, because throughout the span of life we will face loss. We will face it repeatedly, and it will hurt, at times tremendously. Anxiety comes into play because loss (including the possibility of loss) poses an enormous threat to our psychological comfort and safety. Recall from the first paragraph that worry, as a component of anxiety, is a response to danger (real or imagined) designed to promote self-preservation (decrease chances of loss) through activation of “fight or flight.”

But here’s the thing: at the end of the day, we can neither fight nor flee from loss (yes, we can work hard to keep a job or stop a foreclosure, but those are examples of working to stop loss at the micro/specific level. Remember this particular blog entry is focused on the“big picture”). As mentioned, losing what we cherish is a key element of the human experience; some even go so far as to say that loss defines the human experience and gives life meaning. I think this is true to the extent that loss is a part of love. Logically, if we had no love then loss would be a moot point. 

On the other hand, love—according to many, from poets to Popes, is never ending. “All you need is love,” sing the Beatles. “Better to have loved and lost than never to have loved at all” writes Alfred, Lord Tennyson. “There is no fear in love,” proclaims the sign outside a business near my home. We have medication to treat anxiety and helpful techniques to combat its effects, all of which have their proper place. But to truly overcome worry and fear of the unknown, I recommend making a choice each day to focus on gratitude for what, or whom, you have in your life that you love. The alternative is to spend your energy worrying about the day that will eventually come in which loss will occur.

Choose love as the ultimate antidote for anxiety. It really does conquer all.

Disclaimer: Although the advice contained in this Web site frequently makes mention of diagnostic criteria and treatment options, it is not intended to replace the opinion of a qualified mental health professional who could directly and more specifically address the issues and concerns at hand; nor is the advice contained herein offered as substitution for psychotherapy or other professional mental health services. Individuals with mental health concerns are advised to seek treatment in person through a licensed professional. The author of the content on this Web site, Bryan J. Hall, LMHC, makes no guarantees regarding the advice offered and reminds readers to use personal discretion when deciding what, if any, advice or suggestions to accept and implement.

Mental Health Monday: "Accentuate the Positive"

Psychologists who work with people and their concerns have developed a reputation as “problem focused.” Rather than concentrating energy and effort on what’s going well in someone’s life, psychotherapy often deals primarily with what’s wrong. A newer movement in the field called positive psychology is working to change just that.

Noted psychologist Dr. Martin Seligman launched positive psychology in the late 1990s as an alternative to mainstream therapies, which Seligman felt overemphasized the negative at the cost of deemphasizing the good. For instance, a review of the literature published between 1973 and 2003 found more than 54,000 articles containing the word depression and more than 41,000 including the word anxiety, but a mere 400 mentio ned the word joy.

Instead of depression and anxiety, positive psychology focuses on aspects such as personal well-being and fulfillment, with particular attention paid to “authentic happiness.” Positive psychologists teach that anyone can reach this pinnacle; in many cases authentic happiness is a matter of changing one’s outlook on life in order to change one’s life.

Not long ago (but before the recent recession), Dr. David Myers, another well-known positive psychologist, commented on the economic success of our country. Myers said, “We have big houses and broken homes, high incomes and low morale. We celebrate prosperity but yearn for purpose.” Today, that sense of prosperity has been shattered for millions of Americans personally impacted by the economic downturn. Foreclosures, bankruptcies, and jobs lost to layoffs have left many people with a less-than positive outlook, but this means now is the time for positive psychology to intercede—working to fill an emotional void in the lives of many.

By accentuating the positive, psychology stands to progress from helping people overcome their problems to helping people find greater purpose in life.

Stormy Weather

"I think my seven year old son has a phobia of storms. The last time it thundered and lighteninged he began to cry and he screamed “I don’t want to die!” What can I do to help him with his phobia?"

Your son may have astraphobia, an irrational fear of thunder and lightning, or he may simply be experiencing an age-appropriate worry related to his safety during threatening weather conditions. In the case of the latter, his fear should subside with age, but in the meantime there are things you can do to help lessen his storm-related anxieties (these tips apply whether he has an actual phobia or age-appropriate fear).

For starters, he probably doesn't understand what is happening during a thunderstorm. Although he’s not yet old enough to grasp the exact science behind a thunderstorm, he is at an age in which “feeding his mind” should help to ease his thunderstorm fears. Get him some children’s books on the topic, visit a science museum, or talk to his teacher about the possibility of having a meteorologist visit the class. There is power in knowledge, and becoming more knowledgeable about thunder and lightning may help your son to feel less vulnerable during storms.

Another important point in helping him through this is to monitor your own reaction, both to the storm itself and to his reaction to the storm. If your son sees you “freaking out,” he’s likely to do the same. Remain calm and don’t belittle or dismiss his fear; nor should you shame him for crying. Instead reassure him in a quiet and loving manner that he is safe inside your home. You might also inform him that you will monitor the weather and move to shelter if necessary. Then, get him distracted by listening to music, playing a game, reading a story, etc. Do what you can to keep him busy until the worst of the storm (and his fear) passes.

Mental Health Monday: "Addicted to Lust"

Tiger Woods’ apparent sexual addiction and subsequent treatment brought much media attention to the matter, with news reporters asking the inane question “Are you a sex addict?” (Inane because if you are addicted to sex, you probably don’t need a news report to tell you so, and if you aren’t addicted to sex, you definitely don’t need a news report to tell you so, but I digress). It’s often argued that human beings, as so-called “sexual creatures,” are all addicted to sex to some extent. From an evolutionary perspective, our species would obviously cease to exist without it, so it would make sense that we are genetically programmed to desire sexual contact and satisfaction. There is a good reason sex is pleasurable; it is designed to be physically and emotionally reinforcing.

So what separates a normal or healthy sexual appetite from sex addiction? I think it boils down to two key considerations: What psychological factors (if any) are contributing to the preoccupation with sex, and what are the effects of such a preoccupation on the person’s life?

Perhaps the clearest sign of addiction is the amount or intensity of disruption the behavior creates. For many, sex addiction involves pleasuring oneself to pornographic images rather than having multiple sexual partners. Either way, if an individual’s efforts to satisfy his or her sexual impulses have created additional issues in the person’s relationships or professional pursuits, then the behavior is more likely a true addiction in the sense that it is problematic (as was clearly the case with Tiger Woods, whose power and prestige were probably instrumental in helping him to act out his fantasies with many partners, ultimately ruining his marriage and disrupting his game of golf as well as his endorsement career).

Another important consideration in distinguishing between normal sex drive and addiction is the underlying cause or causes which ultimately feed the behavior. For someone with a healthy interest in sex, the desire for sexual pleasure is based purely on normal interest in sexual activities…sex for the sake of sex. However, when sex is used in an effort to medicate or suppress feelings, addiction is more likely the case (as also happens with drugs and alcohol, gambling, shopping, and eating—all of which stimulate the brain’s reward centers). Naturally, the individual may not be aware that his or her behaviors are an attempt to meet otherwise unmet emotional needs, but work with a psychotherapist can help bring such insights to light.

According to the American Psychiatric Association’s DSM-IV, sexual addiction is not currently a diagnosable disorder, although there’s been much talk about adding hypersexual disorder to the next edition of the widely used manual, due out in 2013. Regardless of this status, there are many skilled mental health professionals who can help you or a loved one overcome an addiction to lust.

When it Comes to Bullies: Ignore, Ignore, Ignore

“My son is in the fourth grade. Lately he’s been coming home from school upset because some older boys have been teasing him and giving him a hard time by calling him nasty names. I told him to tell his teacher about their bullying but he doesn’t want to do that. What else should I tell him to do?”

If your son won’t tell his teacher about the teasing he’s enduring at school, then you should. It’s not that the teacher should be expected to babysit your son, but he or she should be aware of what’s going on and keep an eye on everyone when your son is around these other kids.

As for what your son can do, I would tell him to ignore the bullies as much as possible (unless they are threatening to harm him physically, in which case he should definitely tell a nearby adult). No doubt their words to your son are unpleasant and hurt his feelings, but engaging the bullies by fighting with them or hurling insults back only serves to give them what they want—the satisfaction of seeing that they are “getting" to your son. Most responses other than ignoring bullies or telling an adult only serve to reinforce the bullies’ behavior, making them that much more likely to continue picking on their target.

For ignoring to work, your son is going to have to be consistent. Bullies, like most people, don’t appreciate it when their efforts go unnoticed. Forewarn your son that the teasing may actually intensify--at least initially-- after the bullies see he’s no longer responding to them like they want. However, when they see he’s serious about blowing them off, they should get bored and move on. If they’re still after your son in a couple weeks, call the school and ask for a meeting with the principal or dean of students to address your concerns. That individual should agree to monitor the suspected bullies and get their parents involved if necessary.

Bullies are as much a part of childhood as loose teeth. For better or worse, learning how to handle them appropriately is an important rite of passage. Equip your son with a strategy to ignore the bullies, and in the meantime do your parental duty by letting the teacher and school administrators know what’s going on.

Disclaimer: Although the advice contained in this Web site frequently makes mention of diagnostic criteria and treatment options, it is not intended to replace the opinion of a qualified mental health professional who could directly and more specifically address the issues and concerns at hand; nor is the advice contained herein offered as substitution for psychotherapy or other professional mental health services. Individuals with mental health concerns are advised to seek treatment in person through a licensed professional. The author of the content on this Web site, Bryan J. Hall, LMHC, makes no guarantees regarding the advice offered and reminds readers to use personal discretion when deciding what, if any, advice or suggestions to accept and implement.

Mental Health Monday: "Chronic Illness & Depression"

For thousands of years, philosophers and more recently psychologists have discussed and studied “mind-body” dualism, the notion that what happens in the mind affects the body and what happens in the body affects the mind. You may have already noticed that even a common cold can have a detrimental impact on your psychological well-being.

People who suffer from long-lasting illnesses with little or no relief in sight are at an increased risk of also struggling with related emotional concerns, primarily depression. That’s because people diagnosed with chronic illness must cope not only with the illness itself, but also with significant lifestyle changes including treatment for their condition and social adjustment to things like professional disability and long-term care. Depressive symptoms including fatigue, irritability, and social isolation occur in 40 percent of people diagnosed with Parkinson’s disease or multiple sclerosis and 25 percent among cancer patients and diabetics. After all, chronic illnesses may change the way a person lives, relates with others, and views him or herself.

Here’s some good news: depression is highly treatable. Often just sharing your feelings with someone who cares will help greatly. In some cases prescription medication is helpful in alleviating more severe symptoms of depression. Make sure you clearly communicate the psychological as well as physiological aspects that accompany your chronic illness with your doctor. Don’t be afraid to seek help for depression as soon as symptoms appear.