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Resilience

Resilience

What is resilience? Resilience is something we all want, few of us practice and most of us have little idea as to what it is. We go through our lives in lock-step dealing with life’s numerous pitfalls and challenges without an understanding of the impact that stress has on our bodies and psyche. Resilience represents an individual’s ability to effectively tolerate life’s stressors, to more effectively “go with the flow” so to speak. To be resilient means that even though we cannot avoid stress we have the capability of actively managing it.

So it becomes quite clear that there is value in better understanding this concept. More importantly, we need to develop the capacity of resilience. For some, resilience may be an inborn trait. These individuals are lucky enough to be born with nervous systems that automatically foster resilience while others may be born with nervous systems that overreact to stress. The pathological worrier when faced with a life challenge may intensify the stress reaction by catastrophic thinking that leads to unhealthy emotional and physiologic reactivity. Those of us with resilience traits should learn how to enhance them while those with limited stress-control capabilities need to find ways to develop such traits.

Simply speaking, resilience is multifaceted. It requires first that we make ourselves aware of how we journey through life. When we are stuck in traffic and find ourselves being late for a meeting or activity, how do we react to this potential stress. We have a choice of fretting over it to the point that our heart rate goes up, stomach acid gets released in larger quantities and our brain fires off alarm reactions. This type of stress further releases unhealthy bodily chemicals like free radicals, brain chemicals that signal danger. It is not uncommon for this to result in back and head musculature contraction leading to tension headaches and backaches. But we also have the choice of placing this stress in a more appropriate perspective by consciously acknowledging that we truly may have no control over the traffic situation, did not cause it and certainly have no way of clearing a path through bumper to bumper vehicles. This does not mean that we shouldn’t feel badly about being late for our appointment and apologize when we get to our destination, but at the same time we don’t need to get ourselves into a tizzy over this. We can further trouble shoot and adjust our departure time if this route is known for traffic jams. Just discuss highway travel strategy with anyone residing in the Los Angeles area!

Resilience is about reasserting locus of control in situations that appear to be beyond our control. A psychological term, locus of control refers to establishing a mindset of control despite the nature of the challenge facing us. This requires being cognizant of how we are dealing with the issue in front of us no matter how vexing it may be. It sounds so simple yet this concept is mastered by few of us. We tend to be engaged in a mindless dance through life without attending to the need to be “present”, to attend to how we are reacting to each step of our travels. The task at hand is to regain the locus of control, to get back into the captain’s seat of life and actively do the best we can under the circumstances.

In reality, resilience is multi-faceted. It is about balance and the conscious decision to attend to the myriad aspects of our daily life journey. There are some simple aspects to this balance. Attending to nutrition, adequate sleep, exercise, establishing a daily routine and maintaining social interactions comprise a core set of basics. Self awareness is an essential component of this balance. However, as indicated earlier in this discussion, self-awareness escapes many of us. For example, how many of us are aware of our breathing? How shallow or deep, rapid or slow? Do we breathe in or breath out through our nose or our mouth? Does it make a difference? Do we inhale by natural downward excursion of our abdominal diaphragm or through the expansion of our ribcage? Research decades ago revealed that diaphragmatic breathing is healthier because it allows for a more robust intake of air than that of ribcage breathing. In fact, a researcher identified what is called the Q reflex or Quieting reflex in response to diaphragmatic breathing. It is no accident that the ancients emphasized the importance of breath work and diaphragmatic respiration as the core of meditation that is today a critical component of Yoga meditation.

Healthy self-talk is another major aspect of resilience development. We all engage is self-talk. Unfortunately, much self-talk is negative and self critical. Becoming aware of this tendency is absolutely essential. It is one thing if the negativity is well earned. We should certainly own up to our mistakes and failures. However, it is more common for self critical thinking to not be based on the facts but emanate from a life of low self regard and confidence, much of it based on unhelpful childhood conditioning.

This brings us to the importance of pursuing mindfulness in our quest to develop resilience. Mindfulness requires attention to our present situation, not just a cursory approach but a comprehensive assessment of the here-and-now. It is much more than our motorist we previously discussed stuck in traffic reacting to being late by getting upset and wallowing in this negative state. It requires an active participation in the event, acknowledging the problem, recognizing the absence of realistic control over the traffic jam, the need to call ahead and alert our destination of the unfortunate circumstance while appropriately apologizing for this situation. Mindfulness also involves taking active responsibility for our self-talk and learning how to develop more effective filters for the negativity that invades much of our personal internal banter. This ability can be learned and must be practiced regularly to become more of an automatic process. The ability to clear one’s mind of negativity becomes one of the finest gifts that we can provide for ourselves. Successful meditators will tell you about the bliss they encounter when they are able to empty their minds of non-essential thoughts.

Finally, we cannot have a discussion about resiliency without understanding the concept of emotional dysregulation. It turns out that the human psyche is composed of two operating systems. We are all aware of the two popular computer operating systems, one that runs Apple software and the other Microsoft software. The human operating system that we are most aware of is composed of words that result in language based communication. This particular system is based on logic. It is what this article utilizes as you read it. However, parallel to this operating system is one that is based on emotions. Emotions are not easily defined using words or language. Emotional expression is by its nature illogical. It is most important to understand that the operating system that governs emotions is extremely powerful and often gains control over our logical language-based operating system. Abusive relationships, addictive behaviors, impulsive and rash life decisions are examples of the dominance of emotions over logic.

Our challenge becomes one of regaining control over our emotional being. The first step in this process is to becoming mindful of our emotional production and not allowing emotions to run amok without conscious awareness. Once we can recognize problematic emotions we have the ability to modify and channel them in a more helpful manner. One can actually learn the skillsets necessary to control the emotional operating system and with practice incorporate them into our daily existence. Dialectical behavior therapy (DBT) a component of cognitive behavior therapy (CBT) has been a major advance in addressing the painful human toll of emotional dysregulation.

The twenty-first century has its own unique challenges and stressors to say the least. World events, internet connectedness, social media pressures and information explosiveness make our reality more complex than ever before. Fear not, for even though one may not be born with innate resilience it is possible to nurture this capability. However, this is not a passive process. It requires hard work and introspection often involving the assistance of a trained mental health professional. The benefits of resilience are immeasurable and certainly worthy of our efforts and hard work. Good luck!

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ADAA Session Recording -Treatment Resistant Panic Disorder

Our team presented at the 2018 ADAA Conference on Treatment Resistant Panic Disorder: A Multidisciplinary Multimodality Approach. You can access the audio recording of our session here with the below login credentials.

Username: arosen1980@aol.com

Password: 1667947

We hope you find the recording of our presentation helpful and informative!

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Treatment Resistant Panic Disorder: A Multidisciplinary Multimodality Approach

Treatment Resistant Panic Disorder: A Multidisciplinary Multimodality Approach

Panic Disorder is one of the most common anxiety disorders. Its impact on quality of life can be significant and incapacitating. One third to one half of panic patients demonstrate incomplete or absent remission after treatment. This Roundtable addressed the importance of the bio-psycho-social components of the evaluation and treatment of the resistant panic disorder patient.
The clinical team is challenged with determining what rendered the individual patient treatment resistant. Examples of complicating variables in such patients include medical mimics of panic disorder, occult substance use disorders, co-morbid psychiatric disorders like trauma syndromes, obsessive compulsive and pediatric spectrum disorders.
Treatment often entails a multi-modality approach that identifies the critical variables discovered during the evaluation phase. At our center the presence of multi-disciplinary clinicians in one location allows for ongoing case discussion and most importantly reassures the patient that they are being supported by an interactive treatment team.
This Roundtable reviewed the appropriate psychopharmacological interventions during the course of treatment that can provide a synergistic addition to the cognitive behavioral treatment plan. The CBT plan must be individually tailored to the patient since not all panic disorders are alike. When possible, we have found that a manualized workbook approach can be invaluable and supports greater patient adherence.
Recent technological advances have allowed for the development of state of the art clinical tools that incorporate specific biofeedback and virtual reality protocols. We will present examples of both and discuss the importance of a multi-pronged approach to the difficult to treat patient. Prevention is the core goal of mental healthcare and early childhood detection of panic disorder has become a major goal. This Roundtable will review early warnings of future panic disorder and importance of interventions that foster resilience and stress control capabilities in children.

Learning Objectives

1. Recognize the seriousness and frequency of treatment resistant panic disorder.
2. Apply the contents of this Roundtable to develop a multimodality treatment plan.
3. Demonstrate an effective systems approach to the evaluation of the treatment resistant panic disorder patient .

Chair(s)

David Gross, MD, Center for the Treatment of Anxiety and Mood Disorders
Dr. Andrew Rosen, PHD, Center for the Treatment of Anxiety and Mood Disorders

Discussant(s)

David Gross, MD, Center for the Treatment of Anxiety and Mood Disorders
Dr. Andrew Rosen, PHD, Center for the Treatment of Anxiety and Mood Disorders

Presenter(s)

Dr. Christiane Blanco-Oilar, PhD, Center for the Treatment of Anxiety and Mood Disorders
Joseph Brand, PhD, Center for the Treatment of Anxiety and Mood Disorder
Ryan Seidman, PsyD, Center for the Treatment of Anxiety and Mood Disorders
Dr. Andrew Rosen, PHD, Center for the Treatment of Anxiety and Mood Disorders

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Boca Raton Psychologist Discusses Fear Of Flying

Millions of people across the country suffer from a variety of anxiety disorders. The typical disorder is characterized by extreme fear, nervousness, or worry that leads a person to avoid specific places or activities. Dr. Andrew Rosen, a Boca Raton psychologist, notes that one of the most commonly known fears is a fear of flying. He says that, as with any anxiety, there is an irrational exaggeration of the possibility of something bad happening even though the risk of being hurt or killed in a plane crash is one in many millions. Additionally, a fear of flying can involve several components of anxiety that are not specific to airplanes. These components can include:

  • Not understanding the reasons for strange sounds and sights around you
  • Being dependent on the judgment of an unknown person (in this case, the pilot)
  • Fear of heights
  • Dislike or fear of enclosed spaces or crowded conditions
  • Sitting in hot, stale air
  • The possibility of terrorism

The physical and emotional symptoms associated with a fear of flying are similar to those seen in most anxiety disorders. The physiological symptoms can include:

  • Muscle tension and labored breathing
  • Chest pain and/or heart palpitations
  • Abdominal discomfort
  • Sweating
  • Dizziness
  • Flushed or pale face

The psychological symptoms can include:

  • Impaired memory
  • Narrowed perceptions
  • Poor or clouded judgment
  • Negative expectancies

The Boca Raton psychologist says there are many coping strategies that can be effective when working through a fear of flying, such as:

  • Expanding your awareness beyond the unpleasant situation. Realize that being paralyzed with fear will not make you any safer.
  • Understanding that your anxiety won’t disappear overnight. Celebrate even the smallest successes you have, such as making it to the airport, then making it on to the plane, then getting through the takeoff. Take one thing at a time.
  • Focusing on what you can do to relax instead of focusing on your fear. Many people bring books, puzzle books, music, or computers with them while they travel. Having something like this gives you something else to focus your energy on.

The fear of flying can be a debilitating anxiety but it can certainly be treated and overcome. For more information on this or other anxiety disorders and their treatment methods, contact Boca Raton psychologist, Dr. Andrew Rosen at 561-496-1094 or email Dr. Rosen today.

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