Wednesday, October 19, 2011

What do I do when I think a friend or family member has an eating disorder?

If you are worried about the body image, weight, and/or eating patterns of someone you care about, this can be a very overwhelming and challenging time. We are glad you found this blog, as researching eating disorders is often one of the first steps in helping someone who is struggling with eating concerns. Below, find some effective guidelines on how to help. For additional information, please contact The Anxiety and Stress Center.

Continue to research as much information as possible regarding eating disorders and body image. We strongly recommend that you limit your information gathering to reputable sources such as the National Eating Disorder Association, books, scholarly articles, and treatment center brochures. Pay special attention to the difference between facts and fiction about weight, exercise, and food intake. Knowing these facts will help you inform your friend against any myths he or she might be using to reinforce the disordered eating.

Be Honest, Caring, and Firm
Ignoring the disordered eating patterns and body image concerns of your family member will not make it go away. Set a private time to talk to your loved one, away from other distractions. Being open and honest about your concerns will let your loved one know you care. However, it is important to be firm in helping your friend recognize they are responsible for their actions. Do not set unfair rules or expectations on your friend, i.e., “Eat or I won’t talk to you again.” Do not make promises that will only help your friend continue the disorder eating, i.e., “I won’t tell anyone.”

Be a Role Model
Demonstrate self-acceptance as well as healthy eating patterns and exercise habits. Compliment your friend on their personality and efforts and do not focus simply on appearance.

Tell Someone
If you are concerned about a friend, reach out to a trusted parent, teacher or coach. If you are a parent of a child who may struggle with disordered eating, it is important to seek professional help. Addressing body image and eating concerns during the initial stages of the disorder provides the best chance for recovery.

Avoid Shame, Control, or Guilt
When someone is struggling with disordered eating, avoid focusing immediately on food. Eating disorders involve complex emotional struggles, and cannot simply be “fixed” by forcing someone to eat. Statements like, “just eat” or “look what you’re doing to this family” only add to the guilt and shame surrounding disordered eating. Express continued support and understanding.

National Eating Disorder Association,

Sara M. Gruzlewski, Psy.D.
The Anxiety & Stress Center, P.C.

Thursday, September 29, 2011

Anxiety and Bullying

What is bullying?
Bullying is a repeated act that can be physically, verbally or socially aggressive and is intended to cause harm.
Types of Bullying:
a. Physical
• Hitting,
• Pushing,
• Kicking,
• Taking others personal belongings.
b. Verbal
• Threats,
• Putdowns
• Name-calling, nick names.
c. Relational Aggression-Behavior that is intended to harm someone by damaging or manipulating his or her relationships with others (Crick, N.R., & Nelson, DA, 2002)
• Indirect, hidden acts of aggression
• Social Isolation, exclusion
• Ignoring
• Spreading Rumors/Gossiping
• Cyber-Bullying-IM, E-mail, Web Pages/Blogs
• 18% of students in grades 6-8 said they had been cyber-bullied at least once in the last couple months (Kowalski et al., 2005).

Even if your child is not the target of bullying, they are still affected by the exposure of seeing others being bullied. Children often know who the bullies and their targets are. This can cause a child to feel worried about what might happen if they socialize or stick up for the target. They may not want to upset the bully in any way that could in turn; cause them to become a new target. This in itself can be anxiety provoking for your child simply by being in the presence of bullying.

Signs your child may be affected by bullying:

• Abrupt changes in mood/behavior
• Changes in school performance

• Changes in friend groups
• Frequent complaints of illness or wanting to leave school/Not attend school
• Lowered self-esteem

What can parents do to help their child if they are a victim of bullying?
Be proactive. Even if you are not sure your child has been a victim of bullying, talk with your child about bullying. Explain what bullying is and ask them what their school is doing to work with the issue. Discuss ways of handling situations where your child may be bullied and how to handle it. For instance, it is not uncommon for children to keep their worries about bullying to themselves, often due to fears of the bullying increasing and not wanting to look bad for “telling”. This shows the importance of finding your child supports they know they can trust. Your child should always tell an adult if he feels unsafe in any way and should have an adult in the school they are able to speak to about their issues with bullying, without having to fear their name would be used. Try to stay in pairs or groups and stick up for one another. Bullies tend to look for easy targets.
Role Playing. Another way to prepare your child is by running different scenarios and discussing the importance of trying to stand up to the person who is bullying you in a responsible manner. It is OK to let someone know they are making us uncomfortable. It is OK to let someone know they are being a bully. If he is being bullied on-line, let him know not to reply or stand up to the person doing the bullying. Instead, show an adult.

If your child is showing signs of distress from dealing with bullying, contact your child’s school to make sure they are aware of the situation and to discuss what actions are taken to deal with situations regarding bullying in the school. Because bullying can lead to issues such as low self-esteem, depression and anxiety, it may also be a good time to consider contacting a child therapist to discuss ways to help your child to cope and build skills to deal with the issues they are experiencing. Help for school refusal and social skills building can be attained through working with a Clinical Therapist.

Deanna Kozlowski, MSW, LCSW

Saturday, September 3, 2011

The Impact of Job Loss on Families

Losing a job certainly takes a toll on the person who lost the job. However, when a parent looses a job, everyone in the family is significantly affected.

One of the more obvious changes for families is the reduced income. When a parent looses a job, lifestyle changes are often required. Decisions have to be made about how to spend what money there is. Relied upon extras, such as childcare, extracurricular activities, and various forms of entertainment, often have to be cutoff.

Other, more drastic family changes may result from unemployment. The other family members may have to find employment or increase their hours at work. This change may lead to less family time together. Finding employment may necessitate relocating to a new city. The children may have difficulty and resentment leaving their schools, friends and routine.

Emotional responses from household family members may result from both the reactions to the unemployed parent as well as to the job loss itself. The unemployed parent may withdraw from family members and show signs of depression. There may be more conflict between the parents due to the increased stressors. These challenges increase the discomfort during this period of time, especially for the children. Job loss is frightening for children. They rely on their parents for emotional support. When parents are in distress, the children feel a loss of security.

There are several ways to reduce the negative emotional impact of job loss:
1. Inform the children of the job loss. It is scarier for them to be aware of negative changes and not know what they are. Their imaginations take over.
2. Maintain household routines and keep change to a minimum, as much as possible.
3. Help the children by helping yourself: eat balanced meals, recognize and address signs of stress such as headaches, sleeplessness, digestive problems, angry outbursts and appetite changes.
4. Be on the look out for these signs of stress in the children, too.
5. Have the family discuss their feelings, thoughts and concerns about the job loss situation.
6. Find low or no cost ways to spend family time together.
7. Focus on the positives like having good friends, a loving family, good health, etc.
8. Assure the kids (and yourself) that the job loss is a temporary condition that affects many other people.
9. Use this situation to role-model for the children how to handle a life-crises and use problem-solving skills. Children who see their parents handle stressful situations well are more likely to handle stressful situations successfully as adults.

Holly Houston, Ph.D.

Sunday, August 14, 2011

Childhood Sexual Abuse

Childhood sexual abuse is a commonly occurring negative life event.  One in four girls and one in six boys experience some form of sexual abuse before the age of 18.  Many time children don't tell their parents that they are being sexually abused.  There are many reasons why children don't tell.  Some children are afraid to tell because they think they are to blame for the abuse or they fear they won't be believed.  Other children are afraid to tell because they fear the perpetrator of the abuse may be punished.  Many times, the perpetrator of sexual abuse is someone the child knows and thus also has caring feelings towards.  Finally, children don't tell out of fear that their loved one will be harmed (many times they have been told this by their pepetrator). 

Childhood sexual abuse is a very frightening and shameful experience and as a result, parents or those close to the chid victim of sexual abuse many notice changes that should serve as "red flags."  Some "red flags" are changes in behaviors, appearance and functioning such as:
  • Not wanting to be left alone with a particular person
  • Sleep difficulties
  • Nightmares
  • Becoming more isolated/withdrawn
  • Disturbances in mood (i.e., depression, anxiety)
  • Disturbances in behaviors (i.e, oppositional and defiant behaviors, "angry outbursts")
  • Sexually reactive behaviors (i.e., excessive masturbation, acting out sexually with other children)
  • Decrease in grades
  • Loss in previously acquired developmental milestones (i.e., toilet trained but now having frequent toileting accidents)
  • Covering up (i.e., wearing baggy clothing)

It is normal for parents to have many feelings when their child begins to tell about their abuse.  However, regardless of their feelings, it is most important for parents to exhibit support to their child.  Parents should:

  • Try their best to remain calm
  • Don't interrogate their child
  • Never blame their child
  • Reassure their child
  • Call for help right away
A responsive and supportive parent is the best indicator for recovery in a child who has been the victim of abuse. 

Nicole A. Tefera, Psy.D.
Anxiety & Stress Center, P.C.

The Stress of Job Loss and Stages of Grief

Our jobs not only give us a way to earn a living, but they also define part of who we are and how others see us. When meeting someone for the first time, a typical question is "What do you do?" Our jobs are valuable. They provide: status, an entity that facilitates a sense of belonginess and opportunities for socialization. So, when a job is lost, many feel as if a part of themselves has been lost. Often, people report that loosing a job is like going through a divorce.

Job loss, like other forms of loss, brings about a variety of emotions. These emotional reactions are affected by many factors including age, personality, coping skills, financial condition, employment outlook, family situation and the length of job tenure. The longer the job was held, the more difficult the loss.  Concurrent financial stress, deep attachment to the job, unrelated emotional difficulties and other losses can make coping with job loss more difficult. The most common emotional reactions to job loss include: shock and disbelief, anxiety, depression, embarrassment, loss of control, distrust of employers, self-blame, loss of confidence and anger.

Job loss often brings about grief defined as the emotional, mental and behavioral reaction to the loss of something closely tied to one's identity.  Birkel and Miller (1998), Australian therapists, liken the emotional response to loosing a job to the Kubler-Ross stages of death and dying. Birkel and Miller refer to this process as the e wave or emotional wave.

The first stage of the e wave is shock and denial. "This can't be true ?","How can this be happening to me?" are common thoughts in the initial phases if job loss. This may be accompanied by an emotional numbing. Encouraging the person to talk about their experience and providing a listening ear is helpful. It is important to inform others about job loss and not hold this information in as it adds to the overall burden.

The second e wave stage is fear and panic. "I'll have to file bankruptcy", "My career is over" are typical responses. Here, anxiety-reduction coping techniques can be quite beneficial.  Relaxation techniques, calming self-talk and thought reframing exercises are recommended interventions.

The third e wave stage is the anger stage.  In this situation, anger is a natural response to the loss of power and influence.  It is essential to express the anger in positive and constructive ways.  Rather than responding to the boss in an angry or hostile fashion, anger may be channeled through physical means (exercise, punching bag), talking it out or through creative outlets (writing/journaling, art).

The fourth e wave stage is bargaining.  "If you give me another chance, I'll be the best employee this company has ever had", "I'll work harder and longer for the same pay and correct all my mistakes" are thoughts typical of this stage.  These thoughts represent an attempt to try to regain some control. However, this approach is not constructive or realistic. Looking for constructive ways to approach unemployment can help create a greater sense of control and direction. Examples include taking classes, seeking training opportunities and revising the resume.

The fifth e wave stage is depression which is characterized by guilt, feelings of worthlessness, lack of energy and motivation. Other physical symptoms may include insomnia and appetite disturbance.  Helpful interventions include tasks that provide structure and goal achievement. Unemployed individuals should get up and get dressed, exercise (studies have shown exercise reduces depression and anxiety) and make their daily job the process of looking for a job. Seeking help from a mental health professional can also be quite helpful, even necessary if the depression is severe or prolonged.

The sixth and final e wave stage is temporary acceptance. It is called "temporary" because most people continue to have sadness, disbelief, etc., originating from the other stages, that vacillates throughout the job loss experience. This stage is characterized by greater acceptance and integration of the job loss. Individuals are able to job seek more effectively by reflecting on where they have been and where they are going career-wise. This greater level of job loss acceptance is facilitated by the ability to create emotional distance from the job loss experience itself.

The emotional wave of job loss is not experienced by everyone in the same way. Some people may not go through all the stages and others may go through them in a different order. The presentation of the e wave is meant to help with the understanding of the significant emotional experiences associated with loss of employment and to provide some general guidelines for management.

Holly Houston, Ph.D.

Friday, July 22, 2011

Among Mental Health Professionals - What's the difference?

I am often asked about the difference between a psychologist and a psychiatrist or a social worker and a licensed counselor.  There are many different professionals who provide direct service to people seeking help from mental health professionals. The education, training and areas of expertise vary widely. This article will give a general explanation of the more prominent mental health professions, their educational and training backgrounds.

Psychologist (Ph.D.) - Doctorate of Philosophy, a clinical/research degree
The average length of a Ph.D. program is 6-7 years emphasizing psychological evaluations, theories and practice of psychotherapy, research and statistics, diagnosis and ethics, much more so than any other degree. Pre-internship training (practicum), internship and the completion of a dissertation are required for degree completion.  The differences between psychologists who graduated from a clinical program and those who graduated form a counseling program are minor. Clinical programs, which are greater in number, tend to focus more on serious mental illness such as depression, schizophrenia, anxiety, etc. Counseling programs tend to focus on change of life issues such as divorce, relationship problems, academic difficulties, etc.

Psychologist (Psy.D.) – Doctorate of Psychology, a professional degree
The Psy.D. was established in the late sixties and is more clinically oriented than the more traditional Ph.D. The average length of this degree program is 5-6 years. It requires more training and practicum experience instead of the research and statistic requirements of Ph.D. programs.  Most Psy.D. programs also require a dissertation, although some require an extensive research paper.  The degree focuses on psychological evaluations, theories and practice of psychotherapy, diagnosis and all forms of treatment delivery in a variety of clinical settings.

Social Worker (M.S.W.) – Master of Social Work
Social work programs generally last from 2-3 years. Degree attainment requires supervised clinical experience. Program emphasis is on psychotherapy and efforts to integrate people with available community resources.  Most social workers pursue careers as general psychotherapists, family therapists, case managers and/or EAP counselors.

Counselor/Therapist  (M.A., M.S.) – Master of Arts or Master of Science
The Master of Science is often a terminal degree meaning that the student plans to end their academic career with the Master’s degree, at which point they go on to become a general practitioner. The Master of Arts is a degree requirement necessary for admission to a doctorate program.  Both degrees are about 2 years in length, emphasize general psychotherapy techniques and require the completion of a thesis. There are few, if any, requirements for psychological assessments, theory and research.

Psychiatrist (M.D.) – Medical Degree
Psychiatrists begin their careers as general doctors and then complete a 3-4 year residency (training) in psychiatry. Residency training typically includes experience in medication management, diagnostic and crises evaluation in both inpatient and out patient settings.  Usually, psychiatrists receive no formal training in psychological assessment, research, or the practice and theory of psychotherapy.  Psychiatrists are the only mental health professionals that can prescribe medication and this is the mainstay of most who are in private practice.

Holly Houston, Ph.D.

Friday, July 8, 2011

Attention Deficit/Hyperactivity Disorder (ADHD) and Difficulties In The Classroom

What is ADHD?
Attention Deficit/Hyperactivity Disorder (ADHD), formerly known as ADD/ADHD, can be characterized as Inattentive Type, Hyperactive/Impulsive Type, or Combined Type (both).  Inattentive Type (formerly ADD), can affect a child by causing difficulty with staying organized, listening and/or concentrating for even short periods of time, and often leads to forgetting to do things such as chores and homework.  Children who are inattentive are often seen as daydreamers.  A child who is hyperactive often has trouble sitting still and remaining quiet, often causing disruption in the classroom.  They may seem fidgety or always on the go.  Impulsivity causes issues with taking turns with others.  Examples of this can be blurting out answers or not being able to wait their turn when playing a game.  This may be seen as annoying to other students and cause problems with peers.

Difficulties Associated with ADHD
Many daily demands can actually be unattainable for a child with ADHD, especially without the proper interventions in place.  Too often, a child with ADHD hears what they are doing wrong and what they need to change, without the child being given tools to make the necessary changes. The stressors that a child with ADHD face on a daily basis can be exhausting.  For instance, a child who is impulsive may have difficulty remaining quiet for any period of time, yet they consistently find themselves in trouble for talking out of turn.  It is not uncommon for the child who is hyperactive to become a disruption in the classroom by getting out of his seat without permission or by making noises by tapping their pen or speaking out of turn.  Impulsivity can make it difficult for a child with ADHD to wait his turn or follow rules that might otherwise seem simple for his peers.  Inattention can look like a child is lazy or does not care about what they are learning.  All of the above can lead to issues getting along with peers, and behavioral issues leading to disciplinary actions by your child’s school.

Undiagnosed and untreated, problems with ADHD can easily lead to your child feeling anxious, angry, and defeated. No matter how hard they try to do what is asked of them, they find themselves failing.  School can easily become a place where a child with ADHD feels they are seen as a “trouble maker.”  Difficulty with paying attention and remembering what assignments to complete often lead to academic underachievement and the belief that they are not smart enough to be successful academically.  All of the above can be very frustrating for a child with ADHD and can lead to low self-esteem and eventually lead to children giving up on themselves.

Ways To Start Helping Your Child
The good news is that there are ways to help your child if they are dealing with ADHD.   The first step is to take your child to a Child Psychiatrist or Child Psychologist/Mental Health Professional to get a proper diagnosis.  Once a diagnosis has been made, find out your child’s educational rights.  Contact your child’s school to discuss the possibility of what educational interventions and/or behavior plans can be put in place to assist your child’s learning in the classroom.  Work with school staff to find ways to help maximize your child’s academic success. Schedules and behavior management plans for school and home can help to keep your child on task and help your child to see the improvements they are making.  Seek professional assistance. Individual, Group, and Family Therapy can also be utilized to help you and your child learn about ADHD and how to build skills to deal with issues associated with ADHD.  Keeping yourself educated on ADHD and involved in your child’s education is a must.  Remember that you and your child are not alone and that there are effective supports.  The more advocates your child has, the greater their chances are of finding ways to help them become successful. 

Deanna Kozlowski, MSW, LCSW 

Thursday, March 3, 2011


It is normal to have some amount of anxiety in preparation for a test.  Different people have different levels of anxiety in this regard.  Some people have good coping strategies for their anxiety and don’t find test anxiety to be a significant problem.  In fact, an optimal amount of anxiety can actually give a revved up feeling that can enhance performance.  Other people have degrees of test anxiety that can interfere with their performance.  It may be hard for someone who does not experience test anxiety to understand just how incapacitating it can be.

Consider the following situation:

                You’ve done all your homework. You’ve listened in class and
                prepared well for the test.  While taking the test, you freeze...
                your mind goes blank.  The things you have learned, the
                material you have studied seems nowhere to be found.         

Test anxiety is actually a type of performance anxiety similar to stage fright.  It typically occurs when performance is important and the pressure is on. It is not the same as worrying about something (death of a loved one, or a romantic break-up) and becoming distracted. Emotional symptoms of test anxiety are fear, irritability, anger, and even depression. Physical symptoms include headache and stomach upset. Symptoms of severe test anxiety are similar to symptoms of generalized anxiety disorder (increased heart rate, rapid breathing, nausea, panic attack).  Sufferers of generalized anxiety disorder are more likely to experience test anxiety. 

Anxiety causes a kind of “clatter” in the brain that blocks the ability to retrieve what is stored in memory.  Several mental activities can be disrupted including: the ability to concentrate, the ability to understand what is read, and the ability to organize thoughts.  There are several practices that are beneficial in managing test anxiety:

 Neutral Tool -every time you have a negative thought that repeats itself (i.e. I’m not going to do well, this test is going to be so hard), stop the repetition by focusing on the area around your heart (a distraction).  Then, breathe normally but deeply, allowing the breath to flow in and out.  Spend five seconds on both the inhalation and the exhalation. While breathing, try to create an attitude of calm and peace in order to neutralize the anxiety.  You may imagine taking in calm or peace when you breath in and letting out stress and anxiety when you breath out. Do this before and during the test.

Address the What-If Questions - very often test anxiety takes the form of what-if questions such as, “What if I can’t remember the material?” or “What I run out of time?”.   Changing the what-if questions to a positive form can help reduce the anxiety.  Examples are, “What if I remember more than I have to for this test?” or “What if I can feel more calm than I ever have?”.

Think Good Thoughts –Studies show that focusing on positive feelings (i.e. gratitude, affection, etc.) actually helps the brain work better. So, when feeling anxious, try thinking of something that makes you feel good such as a hug from a loved one, your favorite pet or a good vacation. Focus on the positive thought for 10-20 seconds trying to fully experience the feeling. This can be done as often as needed, though not during the test itself.

Holly O. Houston, Ph.D.
Anxiety and Stress Center, P.C.

Thursday, February 10, 2011

Personality and Panic Attacks


Although panic disorder strikes people from wide and varied backgrounds, most sufferers have some personality and emotional characteristics in common.  People who eventually develop panic disorder very often have an overriding tenacity to “get the job done.” They put their personal concerns and needs side, sacrificing themselves for what is perceived to be the greater good. In time, this ongoing sacrifice takes its toll resulting for some in the mind and body imbalance of panic disorder.

Panic sufferers often report that panic seems to come out of nowhere – one day a panic attack just seemed to fall from the sky.  In truth, the building blocks for panic disorder accumulate for some time, often years.  Taking on large responsibilities while working to meet external (other people’s) needs, “panickers” delay or even deny their own need fulfillment.  In so doing, they drain their emotional, physical, and spiritual energy reserve without refilling it.  They tend to ignore the small and subtle signs of overload (inability to relax or slow down, sleep problems, intermittent heart palpitations) in favor of getting the job(s) done.  It is just a matter of time before the first panic attack occurs.

 Often self-described as independent, competent people to whom others turn to for help, many people are shocked when they develop panic. Having anxiety problems seem incongruous to the way some panickers see themselves. But, it is just this combination of spending massive amounts of energy on others and precious little in the service of oneself that makes one vulnerable to panic disorder.

Once panic becomes manifest, there are two strong and related perceptions reported by nearly all.  The first is an enduring sense that something crucial is out of control. Second, there is a sense of insecurity in some aspect of one’s life position – a sense that there is a job that one can’t handle.  These thoughts serve to fuel and maintain panic overtime.

The treatment of panic disorder focuses on all of these aspects of its presentation.  Common personality characteristics, thoughts, and emotions are taken into account in the treatment protocol.  The specifics of panic disorder treatment are presented on another blog.

Holly O. Houston, Ph.D.
Anxiety & Stress Center