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4 days ago · Wrap up: Creating your Resiliency Roadmap in Living with Mild Cognitive Impairment (MCI)

@danceswithhooves Thank you! I hope you'll comment along the way with your thoughts and suggestions!

6 days ago · Wrap up: Creating your Resiliency Roadmap in Living with Mild Cognitive Impairment (MCI)

Road to Resilience

Resiliency roadmap wrap up!

Thank you so much for joining me on this resiliency roadmap journey! I hope you’ve been reminded of your strength and perhaps added a few more tools to your coping toolbox. With this one last post, I want to bring all the components together one final time. Remember, everyone’s roadmap will look different–the goal of this series was to give you coaching so that you develop the roadmap that is most likely to work for you. Each day you reflected on one component and hopefully made some notes. Now, lets bring them all together here so you have one more moment of reflection. You can use this Resiliency Roadmap to bring your plan together.

Day 1: Identify your own personal signs of stress.

You learned that there a number of different signs of stress that can include physical symptoms (e.g., back pain, fatigue), emotional symptoms (e.g., worry, irritability), cognitive symptoms (e.g., trouble concentrating, catastrophizing thought patterns), and behavioral symptoms (e.g., snapping at others, withdrawing from activities). Identifying your constellation of symptoms (and hopefully sharing that pattern with loved ones) will help you (and them) recognize stress as soon as possible so that you can go to your coping toolbox for support.

Day 2: What aspects of a stressful situation are most likely to be challenging for you?

We all find different aspects of a stressful situation difficult. For some, it may be the loss of control of a situation. For others, it may be when a situation separates us from family. And for yet others, it may be disruptions in a routine or financial pressure. Being able anticipate what features of a challenge are most likely to be the highest stress for you will allow you to plan some coping techniques to mitigate that impact.

Day 3: Identify stress coping techniques that already work for you and some tips from me.

Next you brainstormed all the positive coping techniques you already use! Being sure to identify and commit to those existing resiliency-building strategies helps you give more intentional time to these strategies (and not letting them fall by the way-side when challenges arise). I gave a few additional tips including: Be sure to take breaks, limit your media consumption, remind yourself what gives you a sense of meaning and purpose, and get some time outdoors.

Day 4: Part 1 of relaxation techniques–Focus on diaphragmatic breathing.

I’d encouraged you to try this website for the free breath pacer (http://www.xhalr.com) and discover the inhale, pause, exhale timing settings your body likes best for use in your Resiliency Roadmap summary for easy reference. Then remind yourself to practice your paced breathing daily so that you’ll be able to lean on it more robustly in times of stress.

Day 5: Part 2 of relaxation techniques–Mindfulness and meditation.

In this post, I gave you resources to try progressive muscle relaxation, guided imagery, mindfulness, and meditation. Were there specific techniques you liked best?  Did you try any of the apps I suggested?  Summarize the tools you’ve added to your tool box from this post on the Resiliency Roadmap.

Day 6: Healthy thinking by reframing unhelpful thinking patterns.

My favorite! “Our greatest weapon against stress is our ability to choose one thought over another.” So often we do not even realize the negative self-talk we have running in our thinking patterns. I gave you some broad types of unhelpful thinking patterns (Overgeneralizing, Catastrophizing, Maybe it is true, but…) and some challenges questions to ask yourself with the goal of shifting your thinking into a more helpful frame. Which challenge questions resonated with you? And, what helpful and healthy thinking patterns resonated with you (e.g., acceptance, self-compassion, humor, optimism, belief in your abilities).

Day 7: Intentional focus on positive emotions and experiences.

“Every day may not be good, but there is something good in every day!” In this section of your Resiliency Roadmap I encouraged you to describe your plan for giving intentional attention daily to times of joy and gratitude. Also, a reminder that this is not about denying those things in life that are a challenge and pretending everything is “fine”, but really about being sure that our positive emotions get equal (or more) attention during those times.

Day 8: Social support (and keeping those connections in this time of physical distancing!).

And finally-this section was about identifying what social support means to you. Who is your support network, and what types of support are most valuable to you (e.g., emotional comfort, encouragement, acts of service, advice, companionship)? And, do you feel that cultivating new supports would be a good idea for you?  If so, what’s your plan for that?

My Resiliency Roadmap

Using the Resiliency Roadmap from the link here, here is my completed roadmap! Each of ours will be unique even as we have some similar content and features!

Road to ResilienceRoad to Resilience

It’s OK to ask for more help.

Although this resiliency workshop can help you feel confident and empowered, many of us may still need to reach out and ask for professional help. I want to be the first (but I hope not the last) to encourage you to do this if you feel at all like you need more help. If you are experiencing daily distress and having trouble finding joy and getting things done, please start with talking to your primary care doctor about what’s going on. He or she may recommend some additional tests or some medical therapies. He or she may also suggest professional therapy with a psychologist or licensed counselor. They may already have specific mental health providers they recommend. You can search for a psychologist or mental health professional by looking at providers in your area on your insurance panel, asking your primary care physician for a recommendation, or searching Psychology Today.

I’d love to see your Resliency Roadmap!  Please share them here!

 

Fri, May 15 11:43am · Day 8: Creating your Resiliency Roadmap in Living with Mild Cognitive Impairment (MCI)

Road to Resilience

Happy Friday! This is the last topic in our resiliency roadmap series. I’m grateful for all the positive feedback we’ve gotten along the way and for all the comments and suggestions you all have made about each topic. I want to encourage our new readers to take a look at our Introduction to the series and then work your way through the other pieces of the roadmap (recognizing your personal signs of stress, recognizing situational factors that cause stress, identifying positive coping techniques you already use, learning diaphragmatic breathing, learning other formal relaxation techniques, cultivating helpful and healthy thinking patterns, and giving attention to positive emotions) before coming back to this topic. Today is our final topic-social support.

We all need support

In this session, I want to remind us all that we do not have to get through anything alone. The rest of the roadmap series until now is, admittedly, very focused on building YOUR toolbox. This is important because the more you believe you have the tools to handle challenges, the more you will be able to adapt to or bounce back from those challenges. But, that doesn’t mean we always MUST go it alone. Sometimes the tool we need is leaning on others.

The relationship between social support and health has been studied in many populations (e.g., patients with cancer, weight loss, maternal health, caregivers) and in many cultures (e.g., American, Turkish. For example, this meta-analysis found that higher perceived social support was related to lower subjective burden in caregivers of adults or older adults. And this meta-analysis found a positive relationship between social support and mental health.

You are probably thinking, this is obvious, what’s the catch?  The catch is that many of us neglect our social support networks or tell ourselves we “shouldn’t” reach out to them in times of challenge (take a look back at our Day 6 topic on unhelpful vs. helpful thinking for a reminder of the dangers of “should”).

What does social support mean to you?

First, who makes up your social support?  Taking a step back a moment, this question is important. For some of us, having a robust network of friends and family with whom we communicate often. For others of us, it is a smaller network you may talk to less often, but you know you can always rely on one another when needed. . For some, our faith community is an important part of that support network. Some of us may be in formal support groups, on-line discussion groups like Mayo Clinic Connect, or other social groups like a men’s group, quilting circle, book club, etc. So, what does social support mean to you? Who and what groups do you feel you can really rely on in times of challenge (and who do you support when they are challenged)?

The other part of social support beyond the who is the what. Social support can be emotional comfort, encouragement, services to one another (like helping get things done or giving a ride), problem-solving support or advice, or just comfortable companionship. Just like the who, the what can vary based on individual preferences and needs of the situation. It is important to recognize that the same whos may not do the same whats for you, but that you need a mix of both. Knowing what whos do what whats (and when) for you specifically is important. (Is it just me or did that end up sounding like Dr. Seuss wrote it? I’m ok with that, he was amazing!).

So, are you someone who has a smaller network and really appreciates having someone in that network who will let you express those strong emotions and provide comfort? Are you someone who appreciates a large network of family, friends, co-workers, etc who are willing to pitch in with “service” support when needed? Or, you may be a mixture of all of this (many of us are). I encourage you to spend a moment answering these two questions:

  1. WHO is my social support network? Name names here. My husband, my dad, my 2 sisters, my brother-in-law, my friend Kam, My friend Kim, My co-workers and friends Melanie and Anni, etc. What about you?
  2. WHAT types of supports do you find most helpful? This can really range for me depending on the situation. My husband really provides all the versions of support at times, thankfully, but I find that with my family, I usually appreciate services to one another (i.e., physical help getting things done) and problem-solving most. My friends Melanie and Anni are part of my network who I know I can process my strong emotions. My friend Kam has also provided help getting things done and companionship.

How do you maintain those connections?

Before COVID and social distancing (physical distancing really) you probably had a routine that allowed you to maintain those connections. You went to services in whatever faith is important to you, you attended your support group, you got together for dinners, lunches, brunches, etc. with those important to you. Now, most of that has been on pause. So, how do we maintain those connections in the time of this physical distancing? In our presentations to the staff at Mayo Clinic in Arizona, we’ve heard lots of innovative suggestions–group fitness challenges, group text messages, FaceTime/Duo calls, Zoom happy hours, Virtual book clubs, trading photographs each day, sending around jokes for a laugh, getting back to being pen pals through letters and cards, etc.  I’d love to hear the ways you are doing this!

How do you cultivate supports?

All of the above assumes you feel you have all the social supports you need, which I hope is true for all of you. However, the reality is that some of us felt like we didn’t have the social support we needed even before COVID changed our lives. So, if you need to start cultivating some support networks, I hope this series gives you the opportunity to reflect on that and get started. I’ll offer a few recommendations here, but this is where I also welcome comments from you!  What would you, our readers, say to one another in terms of ideas for cultivating that support network? Here are mine:

  1. Start with family. Family support is not an option for all of us, but sometimes we THINK it isn’t because of distance. Is this a time to intentionally create some family chats or Facetime/Duo or Zoom calls?
  2.  What do you like?  Is there a community for you related to something you like?  For example, getting involved in a faith activity, volunteering, joining a book club, etc.?  The challenge here is often identifying the unhelpful thinking that may be stopping you from joining these activities: “I probably won’t like anyone there.” “They probably won’t like me.” And, many of these activities are on pause or moving to a virtual format at this time. Nevertheless, I hope you’ll look around for opportunities.
  3.  Consider joining a Mayo Clinic Connect discussion group. There are groups here on just about every topic you can think of, but there is also this “Just Want to Talk” group where you can start a discussion about just about anything!  Just looking right now, and I see conversations about gardening, distancing at home, gratitude, recipes, and humor as a coping tool. And that is just a small drop in the bucket of the conversations going there.
  4. Consider the people you already know. Are there people in your life who maybe ARE supports to you, but you didn’t necessarily think of them that way?  Or, are they individuals who really could become those supports with just a little effort?  For example, do you have neighbors that you talk to regularly that could really become that support circle?  Co-workers? Faith-community partners?  For me, I had an “ah-ha” moment when I realized that the parents of my kids’ friends were also people I liked and were my friends. This was really a mental shift on my part that allowed me to realize these parents are also my supports. Do you have an existing resource like that around you?

What are your ideas?!

Wrap up Tuesday

On Tuesday, I’ll post one more entry on this topic, bringing us around again to the full roadmap.  I’m hoping you’ve made some notes for yourself along the way, and Tuesday we’ll be able to put them all together. I can’t wait to hear what you’ve put together!

Wed, May 13 11:42am · Day 7: Creating your Resiliency Roadmap in Living with Mild Cognitive Impairment (MCI)

Road to Resilience

Attending to positive emotions

We are nearing the end of our resiliency roadmap journey. I hope you’re seeing all the tools you already had available and are adding to your toolbox. Welcome back for those of you who have been following the series all along. If you are just finding us–Welcome!  I’m so glad you’ve found us. As always, I want to encourage our new readers to take a look at our Introduction to the series and then work you way through the other pieces of the roadmap (recognizing your personal signs of stress, recognizing situational factors that cause stress, identifying positive coping techniques you already use, learning diaphragmatic breathing, learning other formal relaxation techniques, and cultivating helpful and healthy thinking patterns) before coming back to this topic.

Every day may not be good, but there is something good in every day.

This quote by Alice Morse Earle is perfect for this topic. However, I said this last time, and I want to emphasis it again today: sometimes bad things happen to us or we make a mistake (sometimes a big one). It is important to acknowledge that. But, it is also important to acknowledge in everyday there is always something (big or small) that brings us joy or for which we are thankful. On days that are full of joy, it is easy to bathe in the emotional aftermath of a day of positive experiences: joy, thankfulness, and  happiness. With all that lovely serotonin (a neurotransmitter related to mood) flooding our system, we feel great!  But what about those days filled with stress? How do we get a serotonin dose on those days?

Gratitude

Fairly recently on this newsfeed, I discussed some research into gratitude and experiments related to the impact of gratitude practice. I encourage you to review that full post for all the details.  To summarize, the results showed that when people focused on and recorded all the frustrations they experienced during the day, they had much higher negative emotion ratings and much lower positive emotion ratings ratings than when people focused on and recorded things they are grateful for. The impact of this practice is stronger if done on a daily basis (as opposed to weekly). Beginning a daily gratitude practice overall improved satisfaction with life, optimism, feeling connected to others, and improved sleep in comparison to a group that was not instructed to start a gratitude practice.

I wish to emphasize that gratitude is not a practice of ignoring the negative or stressful aspects of life–those are real, often very serious, and acknowledging those emotions is important. However, gratitude is about acknowledging the positive even as we process the negative.

Homework

If you’ve followed along in the resiliency roadmap series so far, it won’t surprise you that I’m giving you homework. Just like other tools we’re recommending, using the tools regularly and building them into your routines means you’ll be more likely to use them in times of stress and be less distressed by stress when it happens.

With that, I hope you’ll try to join me as I fight my own tendency to focus on my frustrations and hassles and instead focus on those things I’m grateful for or have brought me joy. Here’s my two step homework assignment for us to do together.

  1. Try it out here. I’d like to start with having you comment below with 1-3 things you can identify today that bring you joy or for which you are thankful. Try to be as specific as possible so that your daily reflections can be unique. My entries for today are: 1) Remembering the chuckle I had when I heard my son singing to himself in his room. 2) My colleagues had a wonderful success in implementing a new follow-up service for patients who are COVID survivors; I’m so grateful I get to be a part of of this team and help. 3) I’m watching the moon each night (really afternoon as the moon is already visible then!) and enjoyed just recently seeing the full moon again. How about you?
  2. Make it a habit. Now, how can you do this regularly?  For me, I have an “appointment” with myself set for 7pm each evening. When that reminder pops up on my smart phone, I just enter a couple reflections right there on the appointment. Other people prefer to actually to keep a written journal. I have a colleague who keeps a photography version of a gratitude journal where she takes a photo everyday of something she is thankful for or brings her joy. What are the ways you can think of to begin building this habit?  What reminders and techniques can you use to get started and keep that record?

I look forward to hearing from you on the above. If you are interested in continuing a gratitude discussion, I’d encourage you to join in the gratitude discussion group here on Mayo Clinic Connect!

On Friday, we’ll meet again and discuss the importance of social support and brainstorm ways to reinforce our social support networks in the time of COVID social distancing.

Tue, May 12 10:33am · Day 6: Creating your Resiliency Roadmap in Living with Mild Cognitive Impairment (MCI)

@hopeful33250 Thank you so much. I'm glad this topic has been helpful. It has definitely been an honor and a pleasure to write this series. It has been wonderful hearing everyone's positive comments, but I also got my own refresher! I hope those in the mental health group would also find this helpful. If there are any other topics you or they have for suggestions, I'm all ears!

Tue, May 12 10:31am · Day 6: Creating your Resiliency Roadmap in Living with Mild Cognitive Impairment (MCI)

@debbraw I'm so glad to hear this! It sounds like you see why this topic is my favorite! I have to be sure can give shared credit to @drmelaniechandler as she helped me tweak the content of this one. I think the "Maybe its true, but…." language came from her and it is SOOO needed. So many things that happen are true and awful, but it I think you've seen that even when that is the case there are some helpful thinking patterns you can lean on for making it through it.

Mon, May 11 11:37am · Day 6: Creating your Resiliency Roadmap in Living with Mild Cognitive Impairment (MCI)

Road to Resilience

Healthy and helpful thinking vs. unhelpful thinking

Today is one of my favorite topics in our resiliency roadmap series! Thank you so much for joining me again. If today is the first day you are finding this series, I’d encourage you to go back and take a look at our Introduction to the series and then work you way through the other pieces of the roadmap (recognizing your personal signs of stress, recognizing situational factors that cause stress, identifying positive coping techniques you already use, learning diaphragmatic breathing, and learning other formal relaxation techniques) before coming back to this topic.

Heading into today’s topic, I want you to keep in mind two difficult, but true facts of life: 1) there just is so much about the world that we CANNOT CHANGE and 2) WE ALL MAKE MISTAKES. Yes, you can use some relaxation strategies in these situations, but if you are diagnosed with a chronic illness or feel the depth of shame of something you wish you hadn’t done, practicing relaxation will only go so far if you keep thinking how “awful, terrible, horrible” the situation is.

This is is why this is one of my favorite pieces of this whole series: Paying attention to the thoughts we tell ourselves is very helpful. Sometimes, we get stuck in the idea that something shouldn’t be what it is.  For me, I tell myself that if I can just plan or problem solve enough, I’ll fix it. Thinking we have more control than we do can lead to some unhealthy thinking patterns (“I’m a failure”), unhelpful behaviors (keep trying to plan/control the situation when it is not possible), and negative emotions (demoralization, guilt, anger, worry). Whew!

Our thinking affects our emotions and behaviors

“Our greatest weapon against stress is our ability to choose one thought over another.” – William James

We all have a constant self-talk narration happening about the events around us. The narrative we tell ourselves affects how we feel and how we act. A simple, but easy to recognize example is traffic. How do you feel when you are stuck in traffic?  Nobody likes traffic, but there usually isn’t anything you can do when it happens.  So, how can our thoughts impact our emotions when we are stuck in traffic? Here are two possible narratives we may say to ourselves:

  1. “All these people are idiots. Nobody can drive right in this town. I’m an idiot for not going another route or leaving earlier. I’m going to be late for dinner, and my friend will all think I’m a jerk and not want to be friends with me.” Ok, that may be an exaggeration, but you can imagine even just one or two pieces of this thought chain would drive feelings of anger, anxiety, worry, fear, etc. OR
  2. “Oh man. Look at this traffic!  I’m going to be late for dinner, but I’ll be sure to give my friends a big apology and explain what happened. I’d certainly understand if the shoe were on the other foot. Now, is there a song on the radio I really like?” Again, that may be an exaggeration, but I hope you can imagine that just one or two pieces of this thought chain would be more calming on the emotional state.

As another example, one of my coping techniques is planning ahead. Let’s say I plan for a given situation, but there is something about a situation that I didn’t anticipate and something doesn’t go quite like I’d hoped. I can give myself two thought messages about that:

  1. “You are an idiot. You should have seen that could happen and be ready for it. You failed in your job as a parent/partner/psychologist”. What emotions might I have after that thought chain?  Sadness? Guilt? Anxiety?  Defeat? And then, how might I act in the next situation?  I might tell myself I have to plan more, plan more in detail, think ahead to all the details and spend so much time planning and anticipating all possible outcomes that I’m just consumed and stressed and anxious.
  2. “Ah man, I would have liked that to go better. I didn’t think of that possibility, but I know I did all I could with the information I had at the time. Nobody is perfect, but I know I’m doing my best to be a good parent/partner/psychologist. I’ll do the best I can to move forward in the situation from here.” What emotions might I have after that thought chain? Disappointment but with self-reassurance? Self-compassion?

shutterstock_1105605224

 

This visual helps to lay out these inter-relationships between events–>our thoughts about those events–>our emotions–>actions or behaviors we take in response to that event.

With some practice, we can learn to recognize and change our thought patterns.

 

Watch out for and challenge distorted thinking

It can be difficult to get used to paying attention to your internal self-talk. You maybe never paid attention to it before. Right now, it just happens automatically. It feels like the event happens, so we have emotions. It can take some time and practice becoming aware of the thoughts that occur between the two events. In general, look out for messages (either in your head, or when you share with a friend) that include words such as “should”, “shouldn’t”, “never”, and “always”. Two common helpful thinking patterns that often include these words are overgeneralizing and catastrophizing.

Overgeneralizing:

Overgeneralizing is exactly what it sounds like–taking one example of a negative outcome and generalizing that to a never-ending pattern of defeat.  Maybe you or your family member makes a mistake, and you think, “I never get things right.” or “Things never work out for us.” or “He/she never listens to me.” or “He/she can’t/won’t do anything.”  Something went wrong, but does that really mean you or your loved one can’t do anything or get anything right?

Catastrophizing:

Catastrophizing is a thought pattern where we believe something is far worse than it really is and/or believing that you cannot cope with something. “Everything is falling apart.” or “I can’t live this way.” or “My life will never be normal again.” How likely is it that everything in your life is falling a part? Maybe your health has changed, but do you have family that loves you?  are you financially OK?  still have a roof over your head and something to eat? You can interchange those items, as some may be good and others bad for you, but is EVERYTHING so awful that you will cease to survive?

I also think of catastrophizing as being unable to turn off or reign in “what if” thinking. Being prepared is good, but sometimes the “what if” train of thought can lead to some pretty unlikely scenarios that would be hard to prepare for anyway. Or we have unnecessary worry because the thought message we’re unwittingly giving ourselves is “I’ll never be able to handle it if [fill in the blank] happens.”  or “This will never work out.”

Maybe It’s true, but:

So maybe what you are thinking is accurate; it’s not an over-generalization or catastrophizing. “I feel sad that I can’t move about like I used to because of my illness.” or “I have lost a lot of money, and it will be difficult to pay the bills.” or “My husband would know what to say to cheer me up if he was still here.” But, ask yourself, what good does it do keep telling yourself this?

I said in the beginning that bad things happen that are often out of our control, and we make mistakes (sometimes big ones). Having negative emotions about that is perfectly reasonable and normal. I definitely do not want you to practice saying “oh well, that doesn’t matter” and pretending like everything is fine. That also isn’t healthy. What I’d like to you aim for is some balance, focus on the situation at hand, self-compassion, and reminding yourself of your resiliency.  When something is awful, how kind is it to yourself to keep repeating the narrative or story in your head?

Ways to challenge those thought patterns:

Just recognizing that our brains have taken an unhealthy thinking turn is really half the battle, so just that may be a great start to your resilience practice for now. When you have a strong negative emotion see if you can put up a stop sign for a moment and reflect internally on what thought pattern might be related to that situation and driving some emotion. Then, ask yourself:

  • How accurate is xxxx? (could it be an exaggeration?  over-generalization?)
  • Do I know for certain that xxxx will happen? (could it be catastrophizing?)
  • Is my thinking helpful to me right now? (would it be better to let that fact go for now, and think about something else?)

Once you’ve gotten this far, see if you can turn the pattern of your thoughts to something more useful (and kind) to yourself:

  • If xxxx does happen, how can I handle it?
  • What can I actually control in this situation?
  • What would I say to a friend that messed up, or was experiencing this situation?

Homework.

For homework, I’d like you to practice putting up that stop sign when you get upset, and consider what you are thinking/telling yourself. Then, try some of the challenge questions. For me, I typically fall back on “what can I actually control in this situation” as I’m prone to worry about things that are outside of my control. This simple challenge question often helps me back into a healthy thinking pattern, rather than worry and negative emotion about what I wish was different. I also like “Is my thinking helpful to me right now?”

Please feel free to add your own challenge questions to the list if you have others that you like.

COVID-19 Resiliency Training 4

Then, practice turning those thoughts around.

healthy

I look forward to hearing about your homework and whether you are able to detect those unhelpful thinking patterns and actively counter them. When I’m able to do this myself, it makes me feel really great! I feel less stressed, more confident, and more centered in the moment. I wish that for all of you. Please join me on Wednesday where I wish to focus more on ways to give attention to positive emotions on a daily basis even in the midst of such dramatic stressors (like all the changes we are experiencing due to COVID-19). I look forward to talking again on Wednesday!

 

 

 

 

 

Sun, May 10 1:22pm · Day 5: Creating your Resiliency Roadmap in Living with Mild Cognitive Impairment (MCI)

@lioness thank you so much! She has several meditations on her page if you scroll down. Which one did you try? @paulinehlucas thanks for making these meditations available for everyone!