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At The Center for Stress and Anxiety Management, our psychologists have years of experience. Unlike many other providers, our clinicians truly specialize in the diagnosis and treatment of anxiety and related problems. Our mission is to apply only the most effective short-term psychological treatments supported by extensive scientific research. We are located in Rancho Bernardo, Carlsbad, and Mission Valley.

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Read our award-winning blogs for useful information and tips about anxiety, stress, and related disorders.

 

Mental Health Awareness Month

Jill Stoddard

by Annabelle Parr

Since 1949, May has been designated as Mental Health Awareness Month. Given that 20% of U.S. adults will experience a mental health condition in their lifetime, having conversations about mental health and the resources available for those who are struggling is incredibly important.

Risky Business

This year’s mental health theme focuses on “Risky Business.” Mental Health America is working to start a conversation around risky behaviors that may increase the chance of developing mental illness or that may accompany an existing mental health issue. The specific behaviors they are focusing on are: marijuana use, risky sex, prescription drug misuse, internet addiction, compulsive buying, and exercise extremes.

Our State of Mind Impacts Our Emotions and Our Behavior

It’s important to understand that mental illness consists not only of difficult emotions, but also includes behavior changes or an impairment of functioning in day to day life. Such behavior changes can manifest as either avoidance of certain situations and/or engaging in new behaviors to attempt to numb or escape the pain that accompanies the mental health problem. Neither avoidance nor risky/numbing behaviors will resolve the mental health concern; they provide short term relief, but actually serve to maintain and worsen the situation in the long run.

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Evidence Based Therapy

If you are concerned that you are struggling with a mental health problem or if you are overwhelmed with feelings of stress, anxiety, or depression and aren’t sure how to cope, seeking professional help can be a good place to start. A therapist can offer support and help you to work through those things that you are struggling with. He or she can also help you address any behaviors that may be impairing your ability to function in life, work, or your relationships.

Evidence based therapies including Cognitive Behavioral Therapy and Acceptance and Commitment Therapy have been scientifically demonstrated to effectively treat anxiety, depression, and many other emotional and physical difficulties.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) involves helping clients learn to identify and modify unhealthy, unhelpful, or inaccurate thoughts and unhealthy or unhelpful behaviors that serve to maintain emotional difficulties. Gradual, repeated exposures to feared situations also help clients learn to face that which they may have avoided previously. CBT challenges clients to face difficulty in the context of a warm, safe, therapeutic environment.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) also involves reducing experiential avoidance behaviors, but differs from CBT in that it focuses on accepting difficult thoughts and feelings in order to live a meaningful, values-based life. ACT challenges clients to embrace difficulty in the context of a warm, safe, therapeutic environment.

The Human Condition

Whether or not you find yourself in the 1 of 5 adults struggling with mental health, all of us will face pain, difficulty, and struggle at some point or another. Asking for help in the midst of struggle is a sign of strength, not weakness. One of the beautiful things about suffering is that it can lead to connection when we let those we trust in on our pain. While it can be tempting to turn to those risky behaviors listed above, we only exacerbate our problems by doing so. In turning to a trusted loved one or a professional, we can begin to find meaning and healing in the midst of pain and suffering.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

Don’t Believe Everything You Think: Cognitive Distortions

Jill Stoddard

by Annabelle Parr

Whether you recognize the term or not, at some point you have dealt with a cognitive distortion. These are thoughts that feel like the truth, but they describe an emotional reality rather than an objective one. For those struggling with stress, anxiety, or depression, often chronic and significant cognitive distortions play a big role in the struggle.

Dr. David Burns (1980) outlined 12 of the most common cognitive distortions in his book, Feeling Good: The New Mood Therapy. Dr. Burns’ list is adapted below with examples. As you read through the list, see if you recognize examples of any of these distortions in your life.

1. All-Or-Nothing (Black and White) Thinking: You see things in black and white terms, refusing to see any gray area.
Distortion: If I’m not nice to everyone all the time, I’m a jerk.
Reframe: I’m allowed to be assertive and set boundaries. I don’t have to be nice to someone who is being disrespectful to me. Standing up for myself doesn’t make me a jerk.

2. Overgeneralization: You see one or several negative events as a sign of an endless pattern of defeat.
Distortion: I got a bad grade on this math test, so I will never get a good grade on a math test.
Reframe: I got a bad grade on this math test. Maybe I didn’t understand the material or studied wrong. I will talk to my teacher to better understand my mistakes, and hopefully I will do better next time.

3. Mental Filter: You exclusively notice the negative aspects of a situation and magnify them out of proportion. At the same time, you filter out/fail to notice the positive aspects.
Distortion: My presentation went terribly. I lost my train of thought because I got nervous, and I forgot a key point I wanted to make.
Reframe: I stumbled over my words a little bit, but no one besides me seemed to notice. I also forgot a key point I wanted to make. But I got good feedback and everyone seemed engaged during my presentation. Next time I will practice a little bit more, but overall it went pretty well.

4. Minimizing/Disqualifying/Overlooking the Positive: You turn positive experiences or comments into negative ones by deciding that they don’t count for some reason. You overlook positive things about yourself or your environment. You don’t just filter out positive things; you actually turn them into negatives.
Distortion: He only invited me to come to his party because he feels sorry for me and knows I’m a loner.
Reframe: He invited me to come to his party because he wants me to come.

5. Mind Reading: You assume that someone is thinking or reacting negatively to you even though you do not know what they’re thinking.
Distortion: She didn’t wave at me because she doesn’t like me.
Reframe: She didn’t wave at me. She probably didn’t see me, or maybe she had something on her mind.

6. Fortune Telling: You think that something bad is going to happen even though you do not yet know what the outcome will be. This causes you to worry, overreact, or give up too soon.
Distortion: Even though things are going well now, I think he will eventually break up with me and I am afraid I will get hurt. Maybe I should just break up with him now to avoid getting hurt.
Reframe: Things are going well now. I’m not sure what will happen in the future. But for now I will try to be present and enjoy what is.

7. Magnifying/Catastrophizing: You exaggerate the importance of something, or you imagine that something that might happen would be terrible or earth shattering, when it would not actually be as bad as you imagine or you could cope despite it being difficult.
Distortion: I can’t accept the promotion because then I will have to give presentations. I’m terrified of public speaking, and I will get too scared and embarrass myself in front of everyone and then probably lose the job anyway.
Reframe: If I accept the promotion, I will have to give presentations. Lots of people are scared of public speaking. I might make a mistake and I might feel embarrassed or scared, but that’s part of being human. It won’t be the end of the world.

8. Emotional Reasoning: You assume that your feelings reflect the truth, even though your feelings are based on erroneous thinking.
Distortion: I feel like a failure, which means I am a failure.
Reframe: I may feel like a failure right now because I am still looking for a job, but job hunting takes time. I am not a failure.

9. Should Statements: You have a list of rules set in stone about how you or others “should” behave, but these rules are arbitrary or unrealistic. You feel guilty or inadequate when you “break” a rule, or get angry or frustrated when others do so.
Distortion: I should have enough time and energy after work to play with the kids. I feel guilty if I let them watch TV while I finish up some work instead, and I feel frustrated with my spouse when he/she does the same. 
Reframe: I want to have enough time and energy after work to play with the kids. But sometimes I will be too busy or tired. I will do my best to spend quality time with them, even if sometimes that means cuddling on the couch watching TV while I finish up some emails. On those nights when I really can’t find the time, I will give myself (and my spouse) grace.

10. Labeling: When someone makes a mistake, you don’t objectively evaluate the mistake. Instead you label the person – “I’m a failure” or “They’re an idiot.”
Distortion: He forgot to lift the toilet seat again! He is so inconsiderate. Or I forgot my kids had a half day today. I’m a terrible parent!
Reframe: He forgot to lift the toilet seat again. He must have had something else on his mind. Or I forgot my kids had a half day today. Today was really busy and I had too much on my mind. Maybe I need to write down half days on my calendar from now on.

11. Personalization: You think that things that others do or things that happen to you are personalized reactions to you, even if this is not the case.
Distortion: My friend didn’t return my text because she thinks I’m annoying.
Reframe: My friend didn’t return my text. Maybe she is really busy or has something going on in her life I don’t know about. Sometimes I forget to return texts too.

12. Probability Overestimation: You overestimate the likelihood of something bad happening.
Distortion: If I drive, I will get in a car accident, so I am not going to get my driver’s license.
Reframe: Accidents can happen anytime, but the odds are not high. Most people drive every day and nothing bad happens.

Cognitive distortions are not constructive, but experiencing a distortion every now and again is simply part of being human. However, when you are not able to reframe your distortions, or when cognitive distortions begin driving your behavior, they can become a problem.

Cognitive Behavioral Therapy (CBT) works to help clients notice, address, and alter these destructive thoughts. When you believe your own destructive thoughts, you may also tend to avoid certain situations on the basis of a false belief. CBT also works to help clients slowly learn to approach rather than avoid such situations. Having a warm, empathic therapist come alongside you throughout this process is healing. She can model compassion for you, helping you learn to have compassion for yourself, while still challenging you to see things in a new and healthier way.

If you find yourself feeling overwhelmed by cognitive distortions, stress, anxiety, and/or depression, you do not have to struggle alone.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

5 Myths About Anxiety

Jill Stoddard

By Trevor McDonald
edited by Annabelle Parr

People are talking about mental illnesses, like anxiety disorders, more often and more openly. Social media and access to digital content has helped facilitate the conversation. However, there is still a stigma surrounding mental illness, and while easy access to content can help reduce shame, stigma and misunderstandings about mental illness, it can also spread mistruths and foster outdated myths. This hurts those who suffer from mental illnesses as well as those trying to understand and support them. So let’s clarify some things about anxiety.

According to the National Institute of Mental Health (NIMH), anxiety disorders are the most common American mental illness, affecting 40 million adults – 18% of the population. Despite this substantial figure, the Anxiety and Depression Association of America (ADAA) estimates that only 33 percent of those suffering will receive treatment.

Anxiety is a blanket term. We all know what it feels like to feel anxious. But when we talk about anxiety as a mental illness, we may be referring to any number of disorders, from generalized anxiety disorder to social anxiety disorder to panic disorder to a specific phobia. Though all of these things fall under “anxiety,” each manifestation looks and feels a bit different.

Fortunately, anxiety disorders can be treated. Having a supportive network that includes mental health professionals and ideally, understanding loved ones, is critical. The first step toward encouraging and facilitating treatment is dispelling myths and providing education for both those struggling with anxiety and the people around them. Here are five of the biggest myths about anxiety disorders:

1. “You don’t really have anxiety. Everyone gets anxious/nervous!” Of course, everyone feels anxious or stressed sometimes. But according to the DSM V, when someone has an anxiety disorder, they feel excessively anxious about a number of things more often than not, and it significantly impairs their ability to function in a major area of their life. We must understand that there is a big difference between feeling anxious about a particular event or challenge, and feeling the chronic anxiety that comes with an anxiety disorder. Furthermore, it’s important not to toss around statements such as “I’m so OCD” when all we mean is that we like our desk organized. Minimizing an anxiety disorder in these ways undermines the challenge that something like generalized anxiety disorder or OCD can pose to people who are struggling with them.

2.  “You can get over anxiety with yoga, taking a walk, or meditation.” While taking a holistic approach to wellness is smart, and such activities can help with the symptoms of anxiety, taking a yoga class won’t “cure” an anxiety disorder any more than it will spina bifida. Though it can be tempting to offer advice to try to help those struggling with anxiety, it’s important not to minimize their experience or assume that you have a solution to offer them. Only a mental health professional should be offering any kind of “prescription” or suggestion for treatment.

3. “Anxiety means a person is weak, or they must have had a really bad childhood.” The former is never true; the latter could be part of the foundation for an anxiety disorder, though this is certainly not always the case. Trauma can kick start an anxiety disorder, but it’s not the only source. A big reason people with mental illnesses don’t talk about their condition is because they don’t want to be seen as weak or feeble, even though they’re not. It takes tremendous strength to live with any disorder. Invisible disabilities can be especially trying because people can’t “see” the disorder a person is battling.

4. “Anxiety isn’t that big of a deal.” Everything is relative. Anxiety disorders exist on a spectrum. If you know someone with anxiety, you can’t gauge how severe their disorder is. But unless you are a therapist, psychiatrist, or doctor, it’s not your job to gauge the severity of someone else’s anxiety. What you need to know is that anxiety is a big deal to the person suffering from it, no matter where they fall on the spectrum. Further, unlike a broken leg, anxiety can’t be seen on the outside.  So someone may appear perfectly put together on the outside, but is suffering in silence on the inside.

5. “I won’t be able to relate to someone with anxiety.” This myth is usually based on a person’s fear that they won’t know what to say when someone is struggling with anxiety. It’s human nature to want to “fix” things, but anxiety can’t be fixed that easily, especially by a non-professional. Remember that it’s not your job to “fix” someone’s anxiety or make it go away. All they really need from you is empathy. And listening well is far more important than knowing what to say. So when talking to someone with anxiety, let them lead the conversation, don’t judge them, and don’t try to fix it. Let them know that you want to understand and that you hear that they are struggling.  You might also offer to help them connect with professional help.

We’ve come a long way in our understanding of anxiety disorders. Psychological research has given us a solid understanding of anxiety and how to treat it effectively. Of course, there is always more to learn, but now the bulk of our work lies in sharing our understanding with the community and eliminating the damaging and unnecessary stigma that still surrounds mental illness. Working to un-learn false claims and myths of the past is a big step in the right direction. Doing your part to educate yourself and others will make a big difference in the lives of everyone with an anxiety disorder.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

Most Americans Are Stressed About the Future of Our Nation

Jill Stoddard

by Annabelle Parr

Have you found yourself feeling especially anxious or stressed out in the current political climate? You’re not alone. This particular election and transition of power is unique for many reasons, not least of which is the widespread stress it is creating in Americans across the political spectrum.

According to the American Psychological Association’s most recent Stress in America survey, two-thirds of Americans report feeling stress regarding the future of our nation.

This stress is bipartisan.

Prior to the election, stress may have been divided more along party lines. Back in August, Democrats were significantly more likely than Republicans (72 percent vs 26 percent) to feel stress regarding the outcome of the presidential election. However, according to the most recent study conducted in January, 59 percent of Republicans and 76 percent of Democrats reported that the future of the nation was a significant source of stress.

Overall stress levels have increased since the election.

In the ten years since the inception of the Stress in America survey, Americans’ stress levels had been gradually decreasing. However, between August 2016 and January 2017, Americans’ average reported stress level increased from 4.8 to 5.1, on a scale where 1 represents no stress and 10 represents enormous stress. This was the first statistically significant increase in stress since the survey began 10 years ago.

We are not the first cohort to feel stressed about the future of our country.

It is important to remember that this APA survey has only been conducted for the last decade, and to keep in perspective that our country has been through numerous tumultuous and stressful times. We are not the first group of citizens to be very stressed and concerned for America’s future. History shows us that we have inevitably and cyclically encountered dark times as a nation, and that hopefully, after each struggle, we emerge stronger and maybe a little bit wiser and more just.

However, currently we are very much in the midst of the anxiety and uncertainty. We are deeply stressed, and we are not alone in that experience. There is comfort to be found in the “me too,” but it is also important that together we learn to find balance during this time.

How do we manage our stress?

Engaging in democracy.

One of the beautiful things about our country is that we are part of a democracy, where we are empowered to use our voices to speak up regarding those things that do concern us. In order to properly voice our concerns, it is important that we use our access to information to stay informed about what is going on. (However, we must also recognize when we need to disconnect. More on the importance of limiting our information intake below).

One way to try to assuage the stress we feel is to use it as fuel for action. We can spend a few minutes calling our local representatives and communicating our concerns. We can get involved volunteering for or donating to an organization whose efforts are in line with our values. We can participate in protests or marches to literally stand up for the things that are important to us. There is something very empowering about engaging in community and collective action with other Americans who share our views.

Regardless of our political views and beliefs, our stress seems to be collective. The details of our concerns may differ, but we all have the opportunity to use our voices and engage in the future of the nation.

Finding a balance between staying engaged and allowing ourselves to disconnect.

However, as much as it is important to stay engaged, we must also recognize the limits as to what we can do to help foster change. When we come together, we are strong. But individually, we cannot carry the weight of the nation on our shoulders. And as we work to remain informed, it is also important that we allow ourselves the time and space away from news.

Limiting technology and news consumption.

Between all of our technological devices, 24-hour news cycles, and politically saturated Facebook news feeds, we could allow our eyes and minds to be occupied all day long by the constant, stress-inducing updates. We need to limit our news consumption in order to allow our minds and bodies to rest. Allowing ourselves to be overwhelmed by the news will leave us feeling powerless.

Practicing self-care.

Maybe the most important thing that we can do at this time of great national stress is to take care of ourselves. Self-care is vital to our mental, physical, spiritual, and emotional well-being. And if you have felt that your nation (or perhaps its commander in chief) has failed to care for you, or sent you the message that you are unworthy of care, maybe your greatest act of protest and defiance will be to choose to take care of yourself in spite of this.

Self-care will not fix the national situation, of course. However, wouldn’t it be powerful to have a nation filled with citizens who know how to care for their own well-being, and as a result they have the energy to stay engaged in their democracy?

How can we practice self-care?

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Good self-care is unique to each individual. What is relaxing and healing for one person may not be as helpful to another. It’s important to pay attention to those things, those rituals, that calm and center us. That signal to our psyche a time of rest or peace. Here are some ideas to help inspire you:

  1. Set aside some time to walk each day and focus on breathing the fresh air in your lungs and feeling the ground under your feet with each step.
  2. Practice yoga.
  3. Find a mindfulness meditation to practice every day. This doesn’t have to take more than five minutes. Check out this link for some suggestions: http://marc.ucla.edu/mindful-meditations
  4. Not a fan of meditation? Try focusing on your breathing. Take a minute to practice some mindful breaths. Check out our blog post on breathing for some tips: http://www.anxietytherapysandiego.com/blog/2016/6/8/the-power-of-breathing
  5. Turn off your devices. Allow yourself to unplug entirely. Maybe consider deactivating your automatic news updates, or deleting the Facebook app from your phone. Set limits on your news consumption by mapping out a given time to check the news each day.
  6. Find time for humor. Is there a show that makes you smile or laugh? Laughter is healing and helps relieve stress.
  7. Spend time with loved ones. Share your experiences and your feelings, but also make sure to find time to talk about things unrelated to the current political situation. It’s healing to talk with others who feel the same way that we do and to know that we are not alone. But it is also important to have fun and to remember that we can still enjoy the sweet things in life even when there are reasons to be concerned.

In conclusion,

In order to manage the stress that so many of us are feeling, seek balance. This means finding ways to be proactive about the things that you can change or that you have control over, but also accepting the things that are beyond your control. And in the midst of it all, remember to take care of yourself in the ways that work best for you.

Source URL: https://fundingforgood.org/fundraising-and-the-serenity-prayer/

Source URL: https://fundingforgood.org/fundraising-and-the-serenity-prayer/

If you find yourself feeling overwhelmed by the stress or anxiety that you feel, and you need some extra help, a therapist can help you to process your feelings. They can give you a space to feel heard, which in itself can be healing and empowering. They can help give you tools to manage your stress so that it doesn’t leak into other areas of your life or prevent you from leading a healthy day-to-day. Sometimes the best form of self-care is knowing when we need to reach out for external support.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

(2017, Feb. 15). Many Americans stress about future of our nation, new APA Stress in American survey reveals. Retreived from: http://apa.org/news/press/releases/2017/02/stressed-nation.aspx

Misophonia: A “Rarely Known” Conditioned Aversive Reflex Disorder

Jill Stoddard

by Annabelle Parr

Most of us can probably agree that it’s very unpleasant to hear nails scraping a chalkboard. Other sounds that tend to make us cringe include a woman’s scream, a disc grinder (think construction site), and a baby crying. This is because we are genetically wired to respond to a baby’s cry, so any other sound similar in frequency tends to be upsetting (Dozier, 2015).

There are sounds that are almost universally annoying, and then there are those sounds that get to each of us individually. But for some of us, a specific sound can be more than simply annoying or unpleasant; it can be intolerable. Do you find yourself experiencing a particularly extreme or adverse reaction to a sound or stimulus that seems strange or out of proportion? If so, you may be encountering a misophonic reaction.

What is misophonia?

Misophonia is a condition characterized by an extreme, immediate, involuntary emotional response accompanied by a reflexive physiological reaction to a specific, commonly occurring sound or visual stimulus (Dozier, 2015).

Tom Dozier, director of the Misophonia Institute, describes misophonia as a Conditioned Aversive Reflex Disorder. Though misophonia is most commonly identified by the emotional response – typically anger, rage, disgust and even hatred - there is almost always a physiological response that occurs as well. Tom’s research suggests that it is actually the physical response that lies at the heart of misophonia. When a person hears (or sees) their trigger, the autonomic nervous system elicits a reflexive physical reaction. It could be contracting of a particular muscle group or it could be an internal reaction, varying from nausea to a numbing sensation to constriction of the esophagus. Because the intense emotional reaction follows so quickly, the physical response often goes unnoticed. But it appears that the emotional reaction is directly related to the physical reaction. In individuals with misophonia, the connection between the autonomic nervous system and the limbic system (emotional center) becomes hypersensitized (Bernstein, Angell, & Dehle, 2013), such that the trigger stimulus elicits the physical reflex which then elicits the extreme emotions and fight or flight response.

What misophonia is NOT.

Misophonia is not a sensitivity to the volume of the sound; it is not a fear of a sound; it is not becoming upset by a continuous, loud, intrusive, irritating sound; and it is not a logical response to the meaning behind a sound (for example, responding to a baby’s cry is a natural response to address the infant’s distress). It IS the emotional and physiological response to a single occurrence of the trigger, regardless of how loud or noticeable the trigger is.

What are some common triggers?

There is an enormous range regarding potential trigger stimuli. However, some common examples include the eating or chewing sound, breathing sounds, coughing, swallowing, pen clicking, whistling, typing, and a dog barking. A trigger can be any repeating sound or sight. Triggers tend to be most strongly associated with one particular person, but they do have the ability to generalize. For example, the original trigger might be the sound of a sibling chewing. This will likely remain the strongest trigger, but it could also generalize to the sound of any person chewing.

How common is misophonia?

Not very many people know about misophonia, doctors and therapists included. Many people with misophonia struggle with feelings of guilt for their reaction, as they are aware that it is both out of proportion and irrational. They may also feel isolated in their experience. But if you struggle with a misophonic reaction, you are far from alone. It is not a rare disorder, but rather a “rarely known” disorder. Based on several studies and surveys, it is estimated that misophonia affects about 15% of the population (Dozier, 2015), compared with Major Depressive Disorder which, according to the Anxiety and Depression Association of America (2016), affects about 6.7% of the population above the age of 18 in a given year.

How does misophonia affect people?

Misophonia can range from manageable to debilitating. If a person’s trigger is fairly uncommon, it may hardly affect him or her at all. However, if a trigger is very common and the reaction is severe, it can lead to avoidance of situations and serious strains on relationships.

Can I get help for misophonia?

If you think that you may be struggling with misophonia, you don’t have to continue to try to handle it alone, particularly if it is something that has begun to impair your day-to-day functioning or affect your relationships. Misophonia can continue to increase in severity if it is left unaddressed, so it is important to know that help is available.  However, because there is not a widespread awareness of misophonia, it can often be misdiagnosed as anything from oppositional defiant disorder to ADHD to anxiety or OCD. So if you are struggling with what sounds like misophonia, it is important to find a professional who understands what you are experiencing and knows how to help.

For more information about misophonia, how it is treated, and related resources, please visit http://misophoniainstitute.org. If you think you or someone you love may be struggling with misophonia, CSAM’s Dr. Michelle Lopez offers specialized treatment at our Rancho Bernardo office. If you would like more information…

CSAM IS HERE TO HELP

Please contact us at (858) 354-4077 or at csamsandiego@gmail.com if you or someone you love might benefit from treatment for misophonia. We also offer acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, and would be happy to provide more information about our therapy services.

References:

Anxiety and Depression Association of America. (2016). Facts & statistics. Retrieved from: https://www.adaa.org/about-adaa/press-room/facts-statistics

Bernstein, R. E., Angell, K. L., & Dehle, C. M. (2013). A brief course of cognitive behavioural therapy for the treatment of misophonia: A case example. The Cognitive Behaviour Therapist, 6(10), 1-13. doi:10.1017/S1754470X13000172

Dozier, T. H. (2015). Understanding and overcoming misophonia: A conditioned aversive reflex disorder. Livermore, CA: Misophonia Treatment Institute.

HOW TO SLEEP BETTER WITHOUT SPENDING ANY $$$ ON SLEEP MEDICATION

Jill Stoddard

a guest blog repost by Alisa Palioni

Do you often find yourself lying awake at night, staring at your alarm clock as it ticks away the time? Or, do you wake regularly during the night, leaving you feeling as if you haven’t slept at all?

According to the National Sleep Foundation, nearly half the population reports suffering from at least one symptom of insomnia (difficulty falling asleep, frequent nighttime awakenings, waking up too early, and waking up feeling unrested).

Many of your daily habits likely play a bigger role in your nightly struggles than you think. Both our ability to fall asleep, and the quality of sleep we have are highly dependent on a variety of external and internal stimuli.

Learning about how each activity impacts your sleep patterns can help you make changes and finally get a good night’s rest.

1. Exercise

Why An Exercise Routine Helps Regulate Sleep

Body heat: Part of the natural changes our circadian rhythm brings about over the day are changes in body temperature.

The rise and fall of our body temperature associated with exercise mimics the natural fluctuations which lead up to sleep.

This can be enough to gently nudge your circadian rhythms back into ideal synchronization if exercise is performed at the right time of day. 1

Beneficial stressor: Exercise is a “beneficial stressor” in that it activates sympathetic nervous system (our flight-or-fight response). Your body compensates by increasing the time spent in deep sleep - leaving you feeling more rested. 

Decrease stress, anxiety and depression: Many of us experience difficulty falling asleep due to ruminating thoughts related to real or perceived stress.

Exercise has been scientifically proven to reduce reactivity to stressors, so that we are better able to manage stressful situations when they come our way.

It has likewise proven itself to be effective in reducing the symptoms of anxiety and depression. 2

What Kind Of Exercise Should I Do?

When it comes to improving your quality of sleep, aerobic exercise wins. Numerous studies have documented the efficacy of regular aerobic exercise programs for treating chronic insomnia. 

Aerobic exercises (“with oxygen”) include any that involve sustained activity which requires the body to consume large amounts of oxygen, such as walking, swimming and biking.

Whereas, weight training and sprinting are anaerobic exercises. While an important component of a healthy lifestyle, these activities are not effective for promoting sleep. 3

What Time Of Day Should I Exercise?

While fitting in exercise whenever feasible for your lifestyle can go a long way towards improving your sleep, studies have shown that exercising in the late afternoon or early evening has the greatest impact.

The reason for this relates back to how exercise promotes better sleep: In order to take advantage of the drop in body temperature you’ll want to complete your workout approximately 3-5 hours before bedtime.

How Long Should I Exercise?

While exercising for 15-45 minutes daily is the optimal duration; however studies have shown that 150 mins/week is sufficient to see improvements in quality of sleep up to 60%.

2. Diet

Your diet impacts your sleep through more means than just providing calories: What we eat and when we eat it can enhance or inhibit our sleep.

Foods That Inhibit Sleep

While some foods are well known for their ability to interfere with sleep, other dietary staples are equally responsible for keeping you up at night.

1. Coffee: Caffeine has a half-life of 5 hours: which means that 10 hours after drinking your coffee, 25% left in your system; and 20 hours later 12.5% of the caffeine still remains.10

So, while an early afternoon coffee as a post-lunch pick-me-up may seem like a good idea, it might be what is keeping you up at night.

2. Alcohol: Alcohol is a little more tricky in how it affects sleep; because it causes drowsiness many mistakenly believe that a drink can serve as a sleep-aid.

However, research has shown that while alcohol increases slow-wave sleep during the first half of the night, it actually leads to an increase in sleep disruptions during the second half. 4

3. Chocolate: Chocolate, particularly dark chocolate, can contain high levels of caffeine and thus needs to be treated similarly to coffee and other caffeinated beverages. 

In general try to avoid any kind of sweets in the evening though since it will not only improve your sleep but your overall health as well.

4. Spicy Foods: Capsaicin - the molecule which gives your spicy foods that kick - can causes changes in body temperature that can cause a disturbance in your circadian rhythms if consumed late at night.

5. High-Fat Foods: We all know that certain unhealthy fats negatively impact our health; but there’s also evidence that they may be keeping you up at night.

Animal studies have shown that high-fat diets are associated with more fragmented sleep, along with excessive daytime sleepiness.

Researchers speculate that this may be linked to the neuro-chemical orexin -- which plays an integral role in our sleep-wake cycles. Rats who were fed high-fat diets showed a decrease in orexin-sensitivity. 5

Foods That Promote Sleep

There are many foods that are lauded for their ability to promote a better, more restful sleep. These are the key components you want to be on the lookout for when planning your bedtime snack:

1. Magnesium and potassium: One of the symptoms of magnesium deficiency is insomnia, so you’ll want to load up on healthy sources of this mineral such as leafy greens, beans and lentils, and bananas. 6

Magnesium and potassium promote muscle relaxation, and thus not only help you feel more comfortable but can help deal with nighttime leg cramps.

2. Tryptophan: Tryptophan is an amino-acid found in both animal and plant proteins. Our bodies use tryptophan to create serotonin -- a neurotransmitter involved in both mood regulation and sleep cycles.15

Many foods are great natural sources of tryptophan, such as milk, bananas, peanut butter and walnuts.

3. B Vitamins: B vitamins are essential for both the synthesis and release of certain neurotransmitters and hormones that are part of the sleep-wake cycle: such as serotonin and melatonin.

Supplements are often prescribed to treat restless-leg-syndrome - a nighttime movement disorder which significantly disrupts sleep.

However, there’s no need to take a supplement. You can get your fill from legumes (chick peas), dark green vegetables, whole grains and fish. 7

4. Theanine: Theanine is yet another useful amino acid when it comes to treating sleep disorders. Research has shown that administering a theanine supplement improves sleep quality and increases sleep efficiency, while decreasing nighttime awakenings.

There is one superfood packed with theanine: Green tea. However, while green tea has significantly less caffeine than a cup of joe, it is recommended to opt for the decaffeinated kind if your goal is a good night’s sleep. 8

5. Melatonin: Melatonin is naturally produced by your pineal gland under direction of your circadian rhythms and is what makes us feel sleepy as we near bedtime.

It usually begins to release around 9 p.m. and remains at a high level for the next 12 hours, throughout the night into the next morning.

While there are certain foods that contain melatonin, you can also purchase this essential sleep-inducing hormone in capsules at your local pharmacy or health food store.

Taken at the right time of day, and in the right dosage, melatonin supplements can help reset your biological clock to optimal levels and is often used as a natural treatment for sleep disorders.19

However, you don’t need to take supplements: simply add tart fruits, like cherries and pineapples, to your diet. Oats, walnuts and bananas are likewise great natural sources of melatonin.

Here are some more foods that will help you to sleep better.

via Well+Good

Timing Your Meals

It’s not just what you eat, when you eat also counts.

Research at Yale’s School of Medicine has revealed just how vital the timing of our meals is to maintaining optimal circadian rhythms.

For instance, when we wake in the morning and our central clock is being stimulated by the light of day, but we decide to skip breakfast we have just given our body conflicting information that can in turn disrupt our circadian rhythms. 9

The main takeaway from this study and similar research is that you should not be eating close to your intended bedtime; but the recommendations for how long before bed you should refrain from eating vary: some saying not to eat after 7 pm, while others suggest 5 hours before lights-out and still others indicate a minimum of 12 hours before you eat breakfast. 

It’s also recommended to reserve large meals for the first half of your day, and consuming lighter snacks in the evening.

3. Environment

Mattress & Pillows

When it comes to choosing a mattress and pillows, there’s no universal rule for everyone to follow. Whether you should opt for firm or soft, memory foam or pocket coil all depends on your personal preferences, particularly the position you sleep in.

Back SleepersSleeping on your back is often the sleep position recommended by doctors, since it allows the body to lay relatively straight.

However, that does not mean there is no pressure being put on your spine as you sleep.

You should have a mattress which is both able to support the spine -- and not allow the exaggeration of any curves -- but is also plush enough to not cause painful compression.

  • Opt for a medium to firm mattress
  • Memory foam is more ideal since conforms to natural curves while maintaining support
  • May substitute for a pocket coil with pillow top.

Side Sleepers: Sleeping on your side has its own benefits: It can help reduce acid reflux, reduces the pressure on the lungs, and promotes better blood circulation.

The main complaints of side-sleepers are achiness in the shoulder and hip area. The way to circumvent this is to ensure your mattress adequately cradles these parts.

  • Medium to soft mattress
  • Memory foam is ideal for reducing number of pressure points

Front Sleepers: Sleeping on your front is by far the worst for your health: Not only does it put pressure on your stomach, but the spine is the least supported in this position.

While it is recommended you switch sleeping positions, there are certain considerations when choosing a mattress that can help alleviate some of the negative side-effects.

Opt for a firmer mattressPocket-coil mattresses are a big no-no, as the entire front side of your body is exposed to the pressure points and they will not support your spine.

Bed Sharing

There’s no doubt that sharing beds can add to your difficulty getting a good night’s sleep.

It’s unlikely that both people with have identical wants and needs when it comes to their sleep position and mattress preferences; and when one partner is uncomfortable their tossing and turning can quickly cause problems for the other.

Upsize to a Queen: A Full-sized bed will leave you and your partner with only 27 inches of space -- which amounts to the size of a baby’s crib.

Opt for memory foam, or ditch your box spring: While memory foam is the optimal choice for reducing the transfer for movements, replacing your box spring with slats can serve as a quick fix.

Invest in a mattress designed for couples: The Sleep Number mattress let’s you and your partner select your ideal level of firmness, comfort and support so you don’t have to compromise.23

Colors

Research has shown that people who sleep in blue rooms tend to sleep longer than when compared to other colors. Blue toned walls can serve as yet another signal telling your brain it’s time to sleep.24

It’s important that your bedroom makes you feel comfortable and relaxed. It’s less important to follow a strict guide than to follow your own intuition.

Light

Light is one of the most powerful cues for your body’s internal clock, it’s thus important to ensure that you are exposing yourself to light and dark during the optimal times.

Try to keep your bedroom as dark as possible while you sleep by using black-out curtains.

However, lighting is not just important when you are sleeping. It’s recommended to dim the lights one hour before heading to bed to cue your brain it’s time for sleep.

For this reason it’s also best not to stare at bright screens (TVs, computers, and smartphones) during this time period, although many phones do offer a “night-mode” setting that can help.

In fact, the blue light -- in the 460-nanometer range -- emitted by electronics and energy-efficient lightbulbs has been shown to delay the release of melatonin.25

Temperature

Generally speaking, the optimal temperature for sleep is between 60-70 degrees Fahrenheit (15.5-19 degrees Celsius).

This, yet again, links back to the natural changes that occur as part of your circadian rhythms: your body temperature drops during the night, and thus maintaining a cooler room will help maintain this.

Setting your thermostat far below or above this ideal point can make it more difficult to fall asleep, lead restlessness and even affect the time you spend in REM sleep.26

The material of your mattress, pillows, bed linens and pajamas can significantly impact your temperature while sleeping. Look for fabrics that are breathable and won’t trap heat such as cotton; likewise choose pillows made of natural materials over synthetic.

As for mattresses, memory foam is the best option when it comes to temperature control.

Noise

Your brain continues to register noises while you sleep, which although unknown to you may be causing you to toss-and-turn or wake briefly.

It’s more likely for a noise to wake you up while in stages 1 and 2 of sleep, than while in 3 and 4. Additionally noise tends to cause more sleep disruptions in the second half of the night.

There’s also evidence that you’re more likely to respond to a sound while sleeping if it is emotionally significant to you: Such as when a mother hears her baby crying.27

If noises outside of your control are keeping you up at night, white noise can be used to “drown” them out. White noise works by reducing the difference between the ambient noise and a sudden, “peak” sound -- like a toilet being flushed -- lowering the chances your sleep will be disturbed.

There are many white noise generators you can purchase, and now there are even phone apps that can do the trick. However, a simple fan or air purifier may be sufficient to help you sleep through the night.

4. Meditation

Fifty percent of people who experience difficulty sleeping blame stress and worry for their troubles.

Meditation, in relieving feelings of stress and anxiety, and - over time - improving our overall response to stressful situations, has been proven to improve both the duration and quality of sleep, with the effect increasing with prolonged practice.

Researchers at the Stanford Medical Center conducted a pilot study to investigate the effectiveness of meditation in treating insomnia. 10

Following a six-week mindfulness meditation training program, 60% of the participants no longer fit the qualifications for the diagnosis - falling asleep twice as quickly as they had previously.

A 12-month follow-up revealed that the majority of the benefits were long lasting.28 Similarly, experienced meditators show enhancement in both REM and non-REM sleep; as well as experiencing fewer awakenings when transitioning between cycles. 11

Meditating at any time of day helps to reduce stress and improve sleep; however, incorporating meditation into your bedtime routine can be especially effective in preparing your body and mind for sleep.

5. Structuring Your Bedtime Routine

Sleep is a behavior: You can teach yourself to sleep well, but you can equally teach yourself to sleep poorly. Our habits surrounding our bedroom routines have a much more significant impact on the quality of our sleep than many of us believe.

Children often have bedtime routines to encourage the onset of sleep, but this is just as important for adults.

Our body needs time to adjust and cool down after a busy day: Just as sleep inertia affects our ability to feel alert after being abruptly roused from a nap we need to allow our body and mind time to transition into a state of relaxation and finally sleep.

When structuring your bedtime routine the main goal is to reinforce your natural circadian rhythms. By developing a scheduled routine of activities at bedtime we can form habits that promote sleep, while avoiding those that impede it.

General Guidelines:

  • Follow a scheduled pre-sleep routine
  • Avoid stimulating activities and all screens for 30-60 minutes before bedtime
  • Reserve your bed for sleep and intimacy
  • Get rid of your alarm cloc

Rituals

Maintain a regular sleep/wake schedule (even on weekends): While it may seem like a treat to sleep in way past your usual waking time on the weekends, altering your sleep-wake schedule for just one night is sufficient to cause disruptions in your circadian rhythms that will affect you for days following.

Choose a favorite relaxing activity to wind down: Close off your day with a period of relaxation by incorporating one of your favorite calming activities into your bedtime routine.

Choose what works for you -- while one person may find reading relaxing, if you aren’t a bookworm yourself this will be counterproductive.

Some suggestions include:

  • Reading
  • Listening to music
  • Stretching (yoga)
  • Meditating

Prepare your room for sleep:

  • Dim the lights
  • Lower the temperature

Make your bed: A recent poll conducted by the National Sleep Foundation revealed that making your bed may be more than just a morning nuisance.

Those who reported they made their bed every morning had a 19% higher chance of getting a good night’s sleep than those who skipped this chore.

While the reason behind this is still unknown, researchers speculate that it’s related to feeling good about where you sleep.

Decluttering and maintaining a tidy bedroom can go a long way towards promoting better, more restful sleep.31

6. Tools And Resources

Nowadays there are many helpful tools to help you sleep better available at the click of a mouse -- or the swipe of a finger.

Sleep Cycle

Sleep Cycle Alarm Clock will revolutionize the way you wake up. This innovative app actually tracks your sleep patterns, and uses this information to gently rouse you when you’re in a light stage of sleep -- preventing sleep inertia.

The app achieves this by monitoring your movements throughout the night, as these vary depending on what stage of sleep you’re in.

There are two modes: Either using your phone’s microphone which “hears” your movements, or the accelerometer, which is placed on your mattress to detect your movements throughout the night.

At only $0.99 on iTunes it’s a small price to pay for waking up feeling refreshed.

F.lux

F.lux began as a software which adapts the colors of your computer’s display for different times of the day: Not only optimizing your viewing experience, but reducing your exposure to blue light - which inhibits the release of melatonin, a hormone essential for sleep.

While the app is still under construction, there are plenty of similar ones to choose from on iTunes and Google Play Store, so you can enjoy your devices in the evening without disrupting your sleep.

For iOS you can also use the built-in Nightshift mode to adjust white balance of your screen based on time of day.

White Noise

White Noise by TM Soft allows you to choose from a library of sound loops including beach waves, air conditioner and running water.

The app comes in three versions: Free, Full and Pro; with even the freebie coming with 40 sound loops as well as additional alarm sounds.

Whether you are looking for a way to drown out nighttime noise disturbances, or need a substitute for your favorite fan while traveling, White Noise’s variety will suit any preference.

Headspace

For those interested in experiencing how meditation can transform your sleep, Headspace is a great place to start.

With short guided meditations readily available on both desktop and mobile devices Headspace makes it easy to incorporate meditation into your bedtime routine.

You can try their Take 10 program for free, or choose from a variety of subscription options to get started today.

GoodnighT

While lying awake at night staring at your alarm clock waiting for sleep to come may make you feel powerless, there are a lot of concrete actions you can take to conquer your sleeping problems once and for all.

It’s not necessary to undergo a total life overhaul in order to enhance the quality of your sleep. Start by experimenting with the tips that are most appealing to you and see how they impact your sleep.

Keeping a journal can help you track what works and what doesn’t. Once you’ve felt the effects of a good night’s sleep you’ll wonder how you ever got by without it.

Originally posted on NestMaven.com.