Sadly, there's been a lot of trauma this month:  college rape, accidental deaths and mass shootings.  Today, June 27th, is National PTSD Awareness Day, so it’s a perfect time to discuss PTSD, a mental health disorder that can develop after trauma.  As a PTSD psychologist, I’ve heard quite a few inaccurate beliefs about PTSD from patients and others over the years.  It’s time we cleared some of that up so that we can best support those who are suffering from symptoms related to trauma.  First, it’s important to understand what PTSD is...then proceed with checking your facts:

DIAGNOSTIC CRITERIA FOR PTSD (DSM-5):

1. A traumatic experience occurred (threat of death or serious injury to self or others) 
2. Experience of each of the following symptom clusters:
   1. Intrusions/re-experiencing = thoughts that pop up about it, flashbacks, nightmares, feeling as if it is happening again
   2. Avoidance = avoiding people, places and things that are reminders of it; avoiding thoughts and emotions about it
   3. Negative changes in thoughts & mood = changes in the way the person thinks about themselves, others and the world; persistent negative mood states
   4. Hyperarousal = feeling hyperalert/on-guard; difficulty sleeping; irritability; inability to relax
3. Symptoms are around for more than a month after the trauma
4. Symptoms cause significant distress or impairment
5. Symptoms are not caused by medication, substance abuse or other illness

10 MYTHS of PTSD

        1.  “PTSD is untreatable.  You have it forever.”
NOT TRUE.  PTSD is very responsive to treatment if it’s the right kind of treatment.  To find the right kind, you need to look at what the research says.  Cognitive processing therapy and prolonged exposure (both related to cognitive-behavioral therapy) have been shown to work very well in 12 sessions or less and are the gold-standard of treatment.  In these treatments, a therapist helps a patient face the reality of a situation, process difficult emotions, examine unrealistic thoughts that maintain difficult emotions, and make adjustments to be more realistic, balanced and healthy. 

        2.  “It’s all in their head / they just need to relax.”
WELL…..  Yes, it is in the head because the brain is in the head, and inside the brain, you can find the amygdala (previous blog post all about this), which drives the fear response.  And yes, relaxation helps but the fear response is not directly in your control.  So it’s not that simple.  The brain is stuck in looping physiological/emotional/behavioral automatic responses to reminders of the trauma.  These responses reinforce unrealistic thinking and avoidance behavior, which reinforce the fear response, and the cycle continues.  Therapy intervenes to reverse what’s happening and recalibrate the brain. 

        3.  "Those who are weak get PTSD / PTSD means you’re weak or less than a person.”
NOPE.  This one is surprisingly common along with other stigma related to mental health issues.  If you fall in a way that breaks your arm, no one will deny that the arm is broken and it would be ridiculous to judge/blame someone for that or not see a doctor.  Mental health issues are similar:  things in our environment or physiology can trigger responses that change the way the brain works and we suffer problems because of that.  Posttraumatic stress is a normal response to an abnormal event (trauma).  We have to acknowledge that process and apply the correct treatment so that things can get back in line again. 

        4.  “People with PTSD are dangerous/will lose control.”
NOPE AGAIN.  This stereotype has been perpetuated by the media and sensationalized in movies.  It is true that people with PTSD may have difficulty managing their emotions, might be quick to get irritable because the nervous system is on edge, and might have a strong reaction to reminders of the trauma, but violence and psychosis is rarely present in PTSD.  Someone with PTSD might fear losing control because the fight-or-flight reaction can be very automatic and overwhelming, but the reality is that they are still in control in ways they may not realize and the scariest part is simply the idea of losing control. 

        5.  “PTSD happens immediately after a trauma. If it doesn’t, you won’t get it.”
NOT TRUE.  It can sometimes take months or years before symptoms of PTSD appear.  There are many reasons for this.  Sometimes people move forward quickly and keep themselves busy…when things slow down and they become less distracted later on, symptoms may pop up.  Or, an additional stressful event may cause shifts in the way you think about a previous trauma, which then might bring about distress.  PTSD can only be diagnosed if symptoms are still sticking around one month after the trauma so immediate posttraumatic stress reactions are considered normal and not yet PTSD. 

        6.  “If too much time has passed, there’s nothing you can do about it.”
DEFINITELY NOT TRUE.  Because PTSD is maintained by certain thoughts and behaviors, it can be worked on at anytime.  The biggest problem with allowing PTSD to stick around over time is the effects that it has on parts of life.  PTSD can have a negative impact on relationships and other roles, which can really get someone off-track over time.  It can also have a negative impact on physical health because it puts chronic stress on the body.  It’s best to get treatment early so that those things don’t become more of an issue, but treatment has been shown to be effective at any point. 

        7.  “The only way to get better is to erase what happened.” 
IMPOSSIBLE.  We cannot erase memories.  If we’re able to push them down, it’s probably for a limited amount of time.  Then they start popping up again and become more out of our control.  Therefore, we have to face them, really look at them, feel all the feelings associated with them, and then move through them.  The memory will never go away, but how you feel about the memory and how you relate to it will change.  That’s how to gain control over the memory rather than it having control over you.

        8.  “PTSD is just a military thing / All vets come back with PTSD.”
NEGATIVE.  PTSD happens as a result of trauma, and trauma can happen anywhere to anyone.  In addition to combat and war, trauma can be things like accidents, assaults, violence, rape, bodily injury, neglect, and natural disasters.  In fact, most of the research on PTSD has been conducted in civilian populations.  The lifetime prevalence of PTSD might be lower than you think as well:  it’s about 14% for those in the military and 7% for the general population (10% in women; 4% in men).

        9.  “Getting treatment will damage my career.”
HMMM….  We know that stigma does exist...that's why this blog post exists.  However, it is entirely possible to see a professional outside of the system if you don’t want people to know about it.  Mental health treatment is confidential, and no one has to know you’re in it, not even your insurance company.  Also, you may not know for sure what your employer’s perceptions actually are.  Maybe they would view seeking treatment as a positive, proactive move to prevent personal and career problems down the road.  If the concern is about damage to career, it’s important to realize that letting PTSD or other mental health issues stick around might cause the most damage in the long run. 

        10.  “Anything can be traumatic & cause PTSD.”
AND…..NO. Many events can be stressful, but there are specific factors that need to be met for a trauma in PTSD.  Actual or threatened death, serious injury or sexual violence all fall under “trauma” if they were directly experienced, witnessed in person, or in some cases, witnessed through indirect exposure.  If there was not a threat of serious injury to yourself or others, then it’s likely the event wasn’t a trauma but just a highly stressful event.  Anxiety symptoms can absolutely arise after a stressful event.  Like PTSD, anxiety and phobias have symptoms that are very difficult to manage AND are very responsive to cognitive behavioral therapy.  
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Looking for treatment?  If you’re military:  San Antonio is home to the world’s largest PTSD research consortium, STRONG STAR, at UT Health Science Center.  Leading PTSD researchers and clinicians provide free treatment to active duty military and veterans.  Patients can be seen outside of the system so there is no concern about how the diagnosis will affect their record.  Top-of-the-line care is provided in 12 sessions.  People outside the military can find a therapist who offers PTSD treatment by entering your zip code in the Therapist Finder tool on Psychology Today.  I also offer completely confidential individual treatment for PTSD and other things, and can see clients over video if you're in another part of Texas.  Contact me for more info. 

​As the holidays are approaching, inebriated driving is going to happen and people will die as a result.  Is the drunk driver to blame?  Yes…but there’s more to the picture than simply someone who made one bad decision, and it’s important to understand why people get behind the wheel to drive. 

In psychology, we have a term called desensitization, which describes the loss of an emotional response after repeated exposure to a stimulus.  Usually, what we target in psychology is the fear response seen disorders like phobias or PTSD.  In fact, short term exposure therapy works very well for these disorders – if you gradually and safely expose someone to the thing that produces fear, the brain learns that it’s not that dangerous, the body’s physiological reaction calms down quickly, and the fear response is drastically reduced in a small amount of time.  It’s biology and psychology in a neat little package.  The effectiveness of this approach is reflected in colloquialisms such as “face your fears” and “what doesn’t kill you makes you stronger.” 

However, there’s another side of desensitization that can prove damaging.  Although fear can and often does hold us back from good things in our lives, fear has a very important purpose.  Fear is a basic emotion that humans evolved to have because, simply, it keeps us alive.  At a low level, fear can be considered part of our moral compass or even intuition, and at a higher level, it leads to our fast-acting survival response.  Fear serves to protect us from danger and keep us safe, but this emotion can be dulled or desensitized if we repeatedly put ourselves in dangerous situations but don’t experience a negative outcome. 

It is easy to feel that we are fine to drive after a couple drinks, and, given our BAC, we very well may be.  However, if we get used to driving after a couple drinks and nothing bad happens, we may be more likely to make the decision to drive after 3-4 drinks.  If we’re used to driving after 3 drinks and one night we have a 5+, it is more likely that we will decide to drive, because we are used to driving, nothing bad has happened in the past, and we are unaware of how we are impaired.  Repeatedly driving under the influence, even if minimal, desensitizes us to the act of driving under the influence.  If the fear response is gone, someone is much more likely to get behind the wheel out of habit.  Essentially, people train themselves to lose fear of something they should fear, and intuition and judgment become skewed.

Is driving after a few drinks one time going to lead to something bad? Maybe not. Is making the decision to drive after a few drinks dangerous?  Yes, not necessarily because our driving is deemed as unsafe (the BAC may be at a legal level), but because we are forming a bad habit and increasing the chance that we will drive in the future. 

So, if you see someone making the decision to drive after a few drinks, saying “it might not be safe to drive” is accurate, but for more than one reason.  There is the risk of something bad happening immediately, and the risk of allowing a bad habit to form that increases risk in the future.  Sometimes people respond with “I’ll be fine!” and there’s not much of a wiggle room if they’re desensitized to the risk.  This season, try saying “I believe you, but it’s a bad habit to get used to, so let me call you an Uber.”

***Note:  it is always important to consider BAC and drinks/time when calculating if you are "ok" to drive.  Click here for a BAC calculator and be aware of your state's laws.  Also, keep yourself sensitized to the risk of inebriated driving by not driving after a couple drinks, ever.  

December is "National Impaired Driving Prevention Month."  See more info at the DUI Foundation.
 

A personal story told by guest blogger and registered dietitian, Shannon Garcia.

In honor of WORLD MENTAL HEALTH DAY (10/10/15), my friend and colleague, Shannon Garcia, wanted to share her experience in therapyland.  I've found that the biggest barrier to seeking therapy seems to be fear of stigma and unfamiliarity about the process.  Shannon shares her personal experience with therapy and 5 reasons why it just makes sense!  Read it here:

"Have you ever had something happen that generated a knee- jerk reaction of “I can’t wait to share this on Facebook!”?  That was me recently. I found myself wanting to scream from the mountain tops, “I AM SO GRATEFUL I HAVE A THERAPIST!” No, I didn’t end up posting that. Not because I’m embarrassed, but because I knew the post would be way too long to be appreciated in the world of social media status updates. So here I am in the blogosphere, with a hopefully more captive audience.
 
I’ve always had a huge appreciation for mental health services. In 2010, my father passed away after 5 long years of congestive heart failure. When he passed, the relief and loss were equally tangible. I didn’t know the first thing about grieving, but because I’m a Type-A perfectionist, I knew I needed to get this whole “grief thing” done right the first time. As a student at The University of Texas Health Science Center, I was incredibly fortunate to have psychology services available free of charge.
 
I still remember my first session as if it were yesterday. In a few words, it was 50 minutes of tears (okay- really more like 50 minutes of ugly crying) with many words most humans would not be able to discern.  Much to my relief, my therapist and I quickly built rapport and worked together for a year until he took a job in another city. By that time, I was quite pleased with my grief process and chose to not pursue a different mental health provider.
 
Fast forward to 2015.  After a year into launching a small business, burning the candle at both ends and struggling with work-life-balance, I found myself on a comfy sofa once again.  The sofa was different, but lucky for me, the counselor was the same. I have no idea if others have had similar experiences, but I feel so blessed that we picked right back up where we left off (but much less ugly crying this first session).  This quickly became a safe place for me to unwind and regroup. Little did I know how much I would need this refuge just a few short months later.
 
Earlier this year, I found myself very much immersed in another end of life care scenario. This time around, I had the privilege and honor of caring for my stepdad in his finals weeks on this earth. For various reasons, and much to my surprise, this process proved to actually be more challenging than previous experiences with my dad.  In fact, it was so difficult that I increased the frequency of visits with my therapist and even requested an urgent session to help me make it through a particularly hard day at my stepdad’s bedside.  After that session, came my moment of wanting to announce to everyone on social media that I’m bursting with gratitude that I have a therapist - a safe space to go to clear my head, share my thoughts and even ugly cry.
 
So, for those that like less babble, and more organizational lists, here are the top 5 reasons you should hire a therapist:

1. We hire professionals for everything else. Need a toilet fixed? Call a plumber. Need a tooth pulled? Call a dentist. Need to improve healthy eating habits? Call a dietitian (www.LSNutritionTX.com). Need to improve your fitness? Call a trainer (Rick Garcia). Need to confide in someone? Call a friend. Perhaps…but check out reason #2.
   
   
2. Friends are well meaning, but not professionals. Some friends are fantastic listeners. Some friends give great advice, but there’s always a BUT. We want to and are capable of confiding in friends, but we often hold back because the BUT. “I want to tell her that he did or said this, BUT then she’ll think poorly of him….,” etc. Face it - there’s always going to be a “but,” even with the most stellar and supportive people in your circle.
   
   
3. Preservation of relationships. Just like there are BUTs when wanting to confide in friends, there is also a need to keep friend time sacred. Whether it’s a happy hour, a jog or a shopping trip- even the kindest of friends don’t want to hear about an issue ALL the time. I’m not suggesting bottling up emotions, but if there are personal issues that require more than a month’s time of attention, consider working with a therapist or health coach (www.DrLindsayBira.com).
   
   
4. They’re on the clock. This is a good thing. We tend to feel guilty or limited when talking with a friend or family member about our struggles. That’s normal and that’s also healthy to be respectful of other’s time. However, a therapist’s job is to listen, to coach, to help you think and process - and you’re paying them to do just that. So you can ramble or you can just sit there in silence; either way, you’re paying for it and shouldn’t feel guilty about taking their time. You bought it.
   
   
5. Bias is a non-issue.  This is tremendously important. A therapist isn’t biased and is trained to stay that way while employing strategies that have been shown by research to really help. Your friends and family want what’s best for you, BUT (see - there’s another BUT) they also think they know exactly what that is. They are emotionally involved in your circumstances and are predisposed to guiding you in a certain direction. A therapist wants what’s best for you, but helps you figure out exactly what you believe that to be. Now that’s powerful stuff, folks.

 
A huge thank you for those that hung in there with my ramblings and appreciation for therapy. This post could have been summed up with “I AM SO GRATEFUL I HAVE A THERAPIST!”, but that just wouldn’t cut it. Lastly, I didn’t address the stigmas surrounding mental health services. Personally, I think it’s ridiculous that psychological services are not more accepted by society. I’m happy to disclose to friends, family and even my clients that I see a therapist regularly, and I hope my transparency of this inspires others to do the same."

Thank you, Shannon, for sharing your story!  Please share this post in support of World Mental Health Awareness Day.  For those of you who have a friend who is hurting, check out my previous post on 5 Tips for Mental Illness Support.  
​

MENTAL ILLNESS....scary?  It's something no one wants, just like diabetes, high blood pressure, or cancer.  The truth is that some people do experience it, and the prevalence is about 1/3 of the population when looking at some disorders specifically.

According to the National Institute of Mental Health (NIMH), 18.6% of the population experienced mental illness in 2012 and this prevalence is higher in females compared to males.  28.8% of all people will experience some type of anxiety in their lifetime and the age group at highest risk is those from 30-44 years.  This age group is again at the highest risk when considering mood disorders, which 20.8% of the population experience in their lifetime.  

A mix of genetics and environment is often what causes symptoms to appear.  It may be you, your friend, or a member of your family.  That's ok.  Here's what to do to help if someone you know is struggling with their mental health:

1. Be supportive.  This may seem obvious, but often it's hard to figure out what to do to help someone who is hurting.  We get nervous and uncomfortable, and jump to try to fix the problem or tell them to "think positive."  Both of these approaches can be harmful, as they invalidate the person's experience and make them feel unsupported and alone.  A good statement to use is "This sounds so hard.  I'm so sorry you're struggling right now.  How can I help?"
2. Keep the focus on the person.  Don't take things personally.  Self-care is important, and it's good to draw boundaries around sources of stress, even if the source is a friend who is struggling with their mental health.  However, we can often take things too personally and add fuel to emotional fire.  If a friend is struggling and they don't want to talk, that's ok.  Don't make it about you because it most likely isn't.  See #1 and try support them in other ways: send an email, leave them a gift, or just take a few moments to send them good thoughts.  
3. Acknowledge severity without shaming.  It's easy to brush symptoms under the rug because they make us nervous or we think it's not a big deal.  On the other hand, it's also easy to have a big reaction when someone discloses heavy emotions, because it's shocking and upsetting to us.  We need to find the middle ground.  Try to strike the balance of accepting the person's experience as it is while communicating supportively that this is not the norm and it should be proactively addressed.  Change "Oh you'll be fine - it just takes time" or "Oh this is bad!  You're worrying me and you need to get that figured out now!" to "This is so hard, and may stick around for a while or get worse.  It's how it is right now, but not how has to be forever, so let's figure out what to do to address this and take action."  If that doesn't work well, maybe they just need to be sad for a while, so allowing then to sit with that while staying connected to them in a caring way can help. 
4. Ask directly about suicidal thoughts. Sometimes with depression, these thoughts are already happening, but the person may feel too uncomfortable to bring it up or bring it up again if they have already.  If we bring this to the table and accept it as a symptom that may be happening whether we like it or not (clearly not), we can discuss it and address it, without letting it slide too far (to where we can't be of help anymore).  Ask directly:  "Are you thinking about hurting yourself?"  If the answer is yes, see #1 & 2, and consider calling the Suicide Prevention Hotline together at 1-800-273-TALK.  
5. GET TREATMENT.  Years of solid mental health research have led to effective evidence-based practice delivered in short-term therapy that yields good results.  See my article "What is Psychotherapy Today?" to understand a bit more about what therapy is and how a change in perspective may help people seek it. 

Need to find a therapist?  Go to Psychology Today Therapist Finder to enter your zip code and search through profiles of professionals that may meet exactly what you're looking for.  

May is Mental Health Awareness Month.  To deny we have stigma is to deny the opportunity for growth.  We all hold stigma about many things in the form of very automatic thoughts, which often occur under our awareness.  The only way we can develop awareness is to talk about it and be willing to face discomfort in order to examine ourselves.  

UT Health Science Center found me on Twitter (how ironic) and asked me to write an article for their graduate students about professional social media and self-branding.  I didn't know much about social media before I self-branded, but I threw myself in and have learned a lot by doing so.  

I knew that to connect with my community and build professional relationships I needed to utilize several platforms of social media.  If you don't have a Facebook page, you almost don't exist, and Twitter is a great way to find out who is talking about your interests.  Despite all my hours distributing paper flyers throughout my community, Meetup.com and Craigslist (and some word-of-mouth) are still the outlets that bring people to my meditation groups.  

As soon as I self-branded and dove into social media, things began to happen and they happened quickly.  I'm not gloating here, nor am I claiming to know a lot!  In reality, I feel like the more I learn about social media, the less I know...I'm still extremely small in the social media world and business-wise, but I have seen benefits quickly, and my purpose is to highlight and discuss the power that professional social media can have.  In fact, I'd like this to be an open and ongoing discussion so that we can learn from each other -- who will be the first to comment on this post??!  I digress...

Through my Twitter activity, I was found and featured on UTHSCSA's Standout (see this article at Dr. Lindsay Bira's UTHSCSA Spotlight), I was retweeted by some big organizations (e.g., Wounded Warriers, American Psychological Association, Psychology Today, KSAT, Military Officer Magazine), and my following grew accordingly.  I was picked up and featured by Humans of San Antonio (see my thoughts on that here:  HOSA Dr. Lindsay Bira overcoming barriers), which was unexpected and fun, increasing my exposure in San Antonio. Simultaneously, I was working in the background on my blog and other content that I was actively promoting on my platforms.  [[Side note:  self-promotion feels weird -- some people may read it as self-absorption (if they don't understand professional social media), but I simply remind myself of my professional goals and reasons for doing so and that's really all that matters.]]  

As time went on, I found and connected with other professionals in my field on the same path, which helped align my vision.  Most recently, as mentioned, UTHSCSA invited me to be a featured writer for a piece on professional social media tips for graduate students (see below for infographic), which was a great opportunity.  I hope that my social media presence will continue to grow and offer more surprising connections and opportunities, as I'm sure it will.  The possibilities with social media are endless, and ceilings do not exist.  You create your content based on your interests and goals, and make connections that wouldn't have been possible otherwise.  

In sum, social media provides effective space for creativity and personal expression within your profession (if used correctly), and can help you connect with people you may not have come across otherwise.  My passion is related to distributing psychology-related information in a digestible and inspiring way to those who may not normally access it. I've discovered ways in which to do so effectively while trying to walk the line between professional and personal disclosures (a hard line to walk).  I will continue to learn how to become more effective, as social media is an evolving world and our interactions with it evolve as well.  

Now, in 2015, social media is a powerful and necessary business tool, regardless of your career path or stage of training.  It's interesting that we don't get more training about how to use it well, professionally, as the world depends on it.  There's often fear related to social media exposure, but that fear (like all fear) is focused on extreme negative outcomes and failing to face it may keep us from growing in important ways.  

Read more in my Professional Social Media & Self-Branding Tips article, leave comments about your thoughts, and share my infographic, below:

Shannon Garcia of Lone Star Nutrition (an expert registered dietitian and a good friend of mine) is a great example of successful professional social media and has been an inspiration for me along my path.  She's used social media to build her business and get sponsors for her now-regular segments on the news!  

So, how might you use social media help your professional goals come together or simply build credibility in an area of interest?

CONFESSION:   I do not spend time every single day in quiet room with a perfect meditation pose and a lit candle.  I do not have a go-to mantra.  Although I consider myself an always-learning-meditator, I don't fit neatly inside the box of what some people consider to be 'meditation.'  Test yourself:

           Mindfulness.  Meditation.  When you hear these buzz words, what comes to mind?  You may                envision something similar to the photo above:  A specific meditation stance, possibly with a                    mantra, probably from a Buddhist perspective, that opens the door to mind expansion beyond the            realms of our small imaginations.  I'm here to challenge that... Meditation and mindfulness are                skills that anyone can do in almost any kind of way, with unlimited possibilities.  And I think a              good way to approach meditation is through MINDFULNESS.  

WHAT IS MINDFULNESS?
Mindfulness is a skill that you can practice while not even "meditating."  It can literally change the way you view the world.  You may have heard about it on NPR or ABC, and whether you're familiar with the term or it's brand new to you, one thing is clear:  mindfulness is a hot topic right now.  There are very good reasons as to why.  I won't go into the abundance of research on the health benefits of mindfulness here (take a look at this, this & this) but I will explain the practice of mindfulness.  

Present Moment...
Mindfulness is about creating more awareness of the present moment while letting go of judgments, rather than getting entangled in the ups and downs of life.  It's about slowing things down to get to know yourself, others and the world in a deeper, more meaningful way.  We often live life on autopilot, zipping around to our next responsibility and doing it all over again the next day.  Sure, it would be nice to drop it all and move to Hawaii, but that's most likely not going to happen (and our problems would still find us, even there), so we have to figure out how to live well, HERE and NOW.  

Tap in...
There's an easy way to understand mindfulness...think of a time where you were consumed in an activity you enjoy (e.g., art, music, sports, another hobby, watching a child, etc.).  During this activity, it's likely that you lost sense of time, were intensely aware of the present moment, and experienced a sense of restorative energy.  Some might call this being in a state of "flow" but what you are also experiencing is a naturally-driven mindfulness.  Now the challenge is this:  How can you create that same feeling while doing something you don't enjoy?  How can you take it to the moments where you are overburdened at work, to waiting in a line when you don't have time, to dealing with someone difficult or to moments of boredom???  

Train Your Brain...
Our brains are hard-wired to spend time 1) regretting the past & 2) worrying about the future.  The act of being in the present moment and not regretting or worrying goes against our very nature (read more in my blog about the amygdala response) and that's why we so much enjoy activities that force us to be in the moment (e.g., hobbies, sports, social time).  It feels good, and is hard to re-create ourselves.  However, we can do it if we attempt to re-train our brain by slowing down and practicing the mindful approach to life.  When we're mindful, we awaken to experience (good AND bad) with a new point of view.  Mindfulness increases our capacity for feeling fulfilled, experiencing gratitude, compassion, and more.  This new perspective changes the way we feel, which changes the way we behave, which changes how others behave toward us, which further changes our perspective, and so on and so on.  

So, how do you begin to do this?  Start with your breath.  Then you can focus on sound.  You might scan your body to notice all present sensations that come and go.  You may even begin to create distance between yourself and your thoughts/emotions, just observing them (this takes more work & practice). Whatever you choose to do, take time and space to slow down, anchor yourself in the moment, and challenge yourself to stay there.  

What I Do...
I work hard to make mindfulness a part of my daily life.  How?  While driving, I try to notice the trees.  While walking, I try to notice what's in the sky and how my feet feel each time they land firmly on the ground.  While doing work, I often take breaks to check in on my stress level and body tension, listen to the noises around me and practice deep breathing to let go of judgment.  While I'm eating my macaroni-and-cheese, I really try to take it slow to savor every single dollop of goo and contemplate how it came to be.  Every time I lead my community meditation group or write something about mindfulness, I become more mindful. AND I do personal meditation, by taking quiet time for myself with no distractions to clear my head.  It's a skill that requires practice -- I've gotten a lot better at it over the past 6 years, and will continue to grow into it.  I define my meditative practice and my life with mindfulness.  I have shaped my personal meditations into what I feel best suits me, and I truly enjoy helping others find their own approach through individual sessions and through Meditation @ Pearl.  

Now You...
Mindfulness is not just a meditation or a practice, it's a way of being...a way of living.  It can lead to limitless growth if we allow ourselves time to explore it, and a good way to get started is by joining a group or a program with someone who will lead you through it.  Sticking with that program can keep you on track, and will show you ways of thinking and being that you haven't even considered yet.  

Rarely do we give ourselves time and space to examine our existences.  We tend to spend our time passively living with lack-of-attention, rather than actively living with intention, regardless of what we're doing.  It's the way the world pushes us.  But.....we can push back.  So, how can you get started?  

Have you heard about this?!  Artist Nelson Shanks, who painted Bill Clinton's official presidential portrait in 2005, just confessed:  He painted a shadow to the left of the portrait that represents Monica Lewinsky (he actually had a mannequin in a blue dress when painting alone) and also purposefully did not paint on Clinton's wedding ring.  Ha!  

Now, I had a lot of different thoughts when I first read this article in People Magazine and then in CNN this morning:
      1) How can a presidential artist get away with that?!  
      2) That is wrong...his client trusted him...  
      3) What an interesting way to represent real life events and freeze a bit of history...   
      4) Nelson Shanks has guts!  

...How many times since then do you think Mr. Shanks drank wine and laughed hysterically about his secret?! 

And as I arrived at the last couple of thoughts, something else struck me.  I began thinking about the career of a presidential artist and how boring that must be at times.  Making someone stand still in front of stiff decor, painting for hours....?  I mean, of course there is passion behind the painting but let's face it:  All jobs become mundane regardless of the passion that got you there. 
  
This all led me to one simple conclusion:  Nelson Shank's portrait of Clinton should be a metaphor for our lives.  Now just follow me here.....

You have a painter, an artist, who has found his niche painting prominent societal figures over and over and over in stuffy rooms while dealing with even stuffier personalities, I'm sure.  This artist has a choice:  Stay inside the box by conforming to the structure of "presidential painting," follow the path carved by all presidential artists before him, and let the idea of acting like a "proper" professional dictate exactly what he does; OR, let his personality and interests bleed into his work, shape his own path and give himself something meaningful and true to himself by which to feel fulfilled, while also not giving a significant thought about what others may or may not think.  This is a delicate balance and something we all have to make decisions about from time to time...How do we even walk that line effectively???

There is a meditation I often do called the "deathbed meditation."  This sounds very depressing but it's actually quite uplifting and helps you get in touch with the values that should be dictating your actions here and now.  It's a process, but basically you envision yourself at the end of your life, and look back over all your life chapters, seeing everything you did or didn't do, and taking note of things you regret, things you long for, and things you would have handled differently.  Do you think Nelson Shanks will be on his deathbed, regretting that he took artistic license/risk to secretly add something controversial but representative of the reality he viewed into his work?  This is a quote from Nelson Shanks himself, so I'll let you decide:

My answer is NO!  He will not regret it.  Rather, he will feel accomplished and whole in that he stayed true to himself, mixing his values, personality, and brand into his career as a political painter.  

Now, I am absolutely NOT condoning the act of hiding things that may hurt other people or generally being sneaky.  I highly value and promote transparency in myself and others, especially when working with other people in any capacity.  But, there's a stronger message here...a message we can all learn from and apply to every role we fill.

My point in this post is simple:  In order to live happy fulfilled lives, we need to make whatever we do in life OUR OWN.  Society's structure will constantly funnel us into a mold, and on some level, we must conform to that mold in order to fit in, make a living, and get by.  It is easy to lose yourself in this process.  We too often settle into the mundane, and accept the unenjoyable, because it's safe and predictable.  But, we do have some control over how much of this we sit with and we ARE allowed to break the mold....because when we do break it, the ceiling of possibilities just gets higher and higher.  There are risks in breaking the mold, of course, and that is scary, but isn't the biggest risk taken when you don't create and live a life that is true to yourself and your values?

Ivanka Trump is currently leading an initiative focused on cherishing your career without being defined by it. It's about having courage to break the molds of whatever you are doing especially when you don't have a role model that has paved the path for you.  It's about finding yourself, staying true to yourself (regardless of the perception of others), and using this vision to forge your own path, exploring possibilities once viewed as impossible and achieving fulfillment with no regrets.  

And so, I ask:  What risks are you not taking?  How is this keeping you from living a fulfilling life?  How are you allowing yourself to be pigeon-holed in a stale structure formed by someone else?  

The ball is in your court.  Catch it, and a challenge yourself to make a riskier next-move.  And, feel free to contact me for brainstorming.  :)

We all face barriers throughout life.  Often, we just settle because we forget about the power of fighting for something better.  Other times, we remember, and it changes our lives.  

Last Saturday, I had the honor of being captured by Humans of San Antonio (HOSA), an artistic and humanistic initiative with roots in NYC.  I had just finished leading my weekly meditation group at The Historic Pearl and was about to continue my typical Saturday morning dance by grabbing some fresh veggies and goods at the Pearl Farmers Market.  That's when Michael Cirlos III, founder of HOSA, caught up with me.  He had great questions:  What do you do?  What did you just come from?  What inspires you?  What is one hardship you feel great about overcoming?  

He really made me think. 

I talked mostly about my professional life, my recent adventures in self-branding, the benefits of meditation, and my fantasy of becoming an off-grid mango farmer in Hawaii.  There was one experience I also talked about, though, that since he published I've been thinking a lot about.  

When I was in band in high school, I was told that I couldn't make the drum line because I was too weak, as a girl.  I don't think a girl had been on the drum line previously in our small town and it does take a lot of forearm and hand muscles to control the sticks and carry the drum.  The boys so naturally made the drum line because of their build.  I, on the other hand, was really bad at controlling the sticks and could barely lift the drum because I had no meat on my bones.  It seemed pretty bleak, but I felt angry-inspired.  Why can't I be the first?  Why should a gender-based limitation prevent me from doing something I feel passionate about?  

Besides my normal self-doubt and the discouragement from my peers, the real barrier was just one thing:  muscle tone.  Part of that is genetic and part was under my control.  The solution, then?  Toning up.  I borrowed my mom's 3lb weights and used them in place of drumsticks for an entire summer.  My paradiddles were on point! When drum line tryouts happened, I impressed a lot of boys by making my way onto the snare line, where I stayed.  It was consistently more difficult for me than it was for the guys; I tripped a lot, was sore and bruised all the time, struggled much more with everything...but I made it and that's what mattered.  This showed me that if you're motivated, creative, willing to drop the self-doubt and face the struggle, you can find effective ways around almost all barriers.

This experience changed the way I looked at other challenges in later stages of my life.  I had more faith that if I just worked hard, even when it was not fun, something good would eventually come. In fact, figures of authority told me I wasn't good enough for the following things so "don't try" (but I did):

      1) Getting into University of Miami:  Well, after a struggle, I did get in and received amazing                     training. It led to getting the chance to live in Miami & Boston, a Harvard fellowship, a Ph.D. and             interesting areas of focus in which I never imagined I would have the opportunity to be involved.
      2) Modeling:  Well, I did take the plunge on this too after lots of work in the beginning. I had the                experience of being an agency-represented runway model in Miami for 5 years, which taught me            lots about myself, the world of fashion, women in general, and the discrepancy between real life              and what we see in magazines (stay tuned for a blog entry on this soon...).

I had to work hard to get to both of those points and and stay there because I wasn't as competitive or didn't have the training some others did, but I embraced the hurdles, leaned on my support system, worked hard, and eventually succeeded. In reflecting on my personal challenges, I realize my barriers have been very small compared to what some people face and overcome.  Intellectual and physical disability come to mind, which remind me of these people making recent news for overcoming their specific barriers:

• Jamie Brewer - The first model with Down Syndrome walking New York Fashion Week 2015
  
• Viktoria Modesta - Pop star with a below-knee amputation and accessories for it (watch the vid)
  
• Combat Wounded Veteran Challenge - taking injured vets on big adventures (Mt. Kilimanjaro?!)
  

Can we just take a second for Viktoria Modesta...Go girl!  What a great example of how you can redefine your life and change the way others think at the same time.  This goes for the other two as well.  Hack your mind, hack your life, y'all.  Changing your perspective not only changes the way we see the world, but also how we behave in the world, and consequently, how others behave toward us. 

So how do you overcome your specific barriers?  It's pretty simple to create a focused plan if you're willing to face it and try. And if you're willing to try, anything is possible. Take a look at the following and apply it to your life:

   1) What is your goal?  And are you passionate about it?  (Passion means you will work hard...)
   2) What is keeping you from your goal?  Why haven't you achieved it yet? (Find the specific barrier)
   3) What kind of barrier is it?

• Is it mental?
  
• Is it physical? gender, orientation, body-related
  
• Is it placed on you by someone else?
  
• Is it time-related?
  

   4) Figure out what you need to do to overcome it & create a plan.  
   5) Take action, even if small.

We all have limitations.  This doesn't mean we can't excel, it just means we have to identify what exactly we need to work harder at and then keep doing it.  Struggle is necessary.  My dad has always said "you grow the most when things are the hardest" and I've really come to understand and believe that.  I believe we too often lose faith in ourselves and settle for something less or something safe, when what we could do to achieve our dreams is waiting just around the corner.  Look for that, find it, harness it, and don't fear the struggle....because often our weaknesses, if faced and worked through, open doors to strengths we could not have imagined.

>>>Want some help in working through barriers to achieve your goals?  That's one of the things I help clients do in 1:1 sessions via Skype or in person.  Email me & mention this blog for a free consultation:  DrLB@drlindsaybira.com

Chronically stressed at work? Too much going on outside of work to concentrate?  Or just having a rough day? Here are 6 common workplace dilemmas with solutions that will alleviate distress, increase motivation, and improve health (if practiced):

Problem 1:  High demands & deadlines are making you feel overwhelmed

• You get to work and already you are slammed with that task you didn't finish yesterday as well as 3 more dinging in your inbox.....and you wanted to make happy hour tonight.  

     Solution:  Take intentional breaks to breathe & focus on the moment at hand.  

• Simple techniques such as these fall under the umbrella of "mindfulness" practice. Mindfulness is about reorienting yourself to the present moment instead of letting your mind dwell in the past or worry about the future (which is unfortunately how we spend most of our time). Engaging in mindfulness practice has been shown to lead to many benefits, physiological and psychological, and can even improve productivity. See if you can make intentional efforts to reorient your attention, calm your mind & body, and tackle one piece of one task at one time. Then on to the next!
  

Problem 2:  Facebook is just too interesting and look! There's a bird outside and oops, you've gotten nothing done.

• Distractions are everywhere and suddenly they’re even more interesting when you have a really painful task to complete.  

     Solution:  Plan incremental rewards for yourself.  

• Instead of mindlessly eating all day, mindfully plan to have that handful of chocolate covered coffee beans at your 11am & 3pm slumps after ACTUALLY getting 2 solid hours of work done!  Then you can take a break and relax. Not to mention, getting something done will make you feel good, which will increase your motivation to get more stuff done.  And so the cycle continues (and it now includes chocolate!).  
  

Problem 3:  It all feels pointless and you feel unmotivated.  Time drags on.  Why are you even there?!

• It’s easy to lose track of your goals, especially if they are more long-term in nature and work is boring.  That makes motivation is almost non-existent. 

    Solution:  Get back in touch with your goals & plans. Re-evaluate them to make sure you're           working toward them.  

• Maybe you’re at your job strictly to make money for the other parts of your life.  Maybe this job is just a stepping-stone to a job you actually want later down the road.  Maybe you don’t even know what you want.  Regardless, remind yourself of why you are there.  Envision something you want down to small details and connect what you are doing now to that image.  Use that as motivation and mindfully bring yourself back to the task with the intention of getting it done.  
  

 Problem 4:  Annoying Co-workers 

• “If he makes that noise one more time…”
  
• “She’s seriously at my desk again?”
  
• “That thing he said was actually really offensive…”
  

    Solution:  Consider context to stop taking things personally

• Usually when we allow little things build up, we’re looking at them only from our favorite perspective:  ours.  We forget to consider the big picture and we are easily irritated.  Maybe he’s having high anxiety today (thus, the tapping); maybe she needs some extra support; maybe he actually didn't mean it the way you took it.  And even if it is the worse case scenario (e.g., he taps carelessly all the time; she doesn't understand boundaries; he actually meant to hurt you) actively communicate your needs in an open, honest, and caring way to be understood and effectively influence co-worker behavior without the close-quarters drama!  

 
Problem 5:  You didn't get time for breakfast, you don't like your outfit, & you got mean-mugged by your co-worker because you were 20-minutes late.  

• All of these things go back to one problem:  Not enough time in the morning.  Is there ever enough time?!

    Solution:  Get up 15 minutes early to make your morning a positive, calm part of the rest of           your day.  

• This simple trick will set you up for success.  You can plan your outfit better, get time for breakfast and coffee, and you are more likely to be on time (which will make you feel better about yourself).  You can even use some extra time in the morning to exercise (imagine having that checked off your list for the day!) or have a quiet morning meditation.  Stress is very related to mental health, so giving yourself the opportunity to feel more grounded will lead to feeling better overall and to more success during your day.  Try it!

 
Problem 6:  Your view is ugly.  You’re staring at a wall.  

• Why are you inside when outside exists?!
  

    Solution:  Bring life into your office.  

• Adopt a plant.  A fish.  Move your body.  Stretch.  Turn your desk in to a stand-up desk, even it if means pulling boxes & books out of the supply room until you get the right height (I have a colleague who has done this twice!).  Researchers have found that having plants in the workplace increases concentration and focus, improves workplace satisfaction, and makes the air seem more refreshing (Nieuwenhuis, Knight, Postmus & Haslam, 2014).  In addition, too much sedentary time has been found to be related to health problems in the long-term, so activity breaks are always a good idea.  
  

The Key??  Focus on things you CAN control: Deal effectively with your own mind, consider context to adjust your reactions to others, and manipulate your environment to make it more rewarding!

After being asked "Are you psychoanalyzing me right now? Can you read my mind?" from the 5,000th stranger who learned about my career path in psychology, I was frustrated.  I realized that the very dated and extreme idea of therapy (lying on a couch...talking about your childhood...being deeply & secretly analyzed) is still held by many and needs to officially be clarified. So, I'm taking it to The Internets.  

Today, the focus of psychological treatment, therapy, or psychotherapy if you'd prefer that term, is much different than it once was. We've come a long way since Freud swaggered through the scene -- Now, a very large body of research has established evidence-based treatments using interventions that are regulated and have been shown to work. Often, these treatment approaches have nothing to do with your childhood. Sure, your therapist will take some basic background history just to get a sense of who you are, but rarely do we explore deeper than that. Now, treatment is brief (~12 sessions or less), collaborative, focused on the present, and directed at giving you tools you can use for the rest of your life.  Also, psychologists are not psychics; the words sound similar, but no, they can't read minds!  It's up to you to be open and honest while at the same time willing to explore possibilities so that the therapist can best help you make changes.  

In addition, therapy is not only focused on ameliorating disorder or preventing disease; therapy also focuses on helping overall healthy people live healthier and better by fostering self-discovery, self-growth and working with them to adjust behaviors and reach goals. Therefore, yes, you can see a therapist if you are depressed or have anxiety so that you can get the help you need to recover. You can also see a therapist if you need some help, say, losing weight, or to stop smoking. You can even see a therapist to simply identify career goals, get your values back in line, and increase your feelings of fulfillment and overall happiness. Many therapists now approach therapy from a cognitive-behavioral perspective, meaning they work with you to identify and adjust thoughts (cognitive) as well as behaviors that may be holding you back. This gives you the perspective and tools you need to better yourself and improve your life, for the rest of your life. It's an approach that is very present-focused, skill-based, and effective.  

One last point:  Mental health professionals now are focused on being transparent and communicative, not necessarily secretive or forming opinions of which you will never be made aware. Therapy is about helping you learn about yourself, resolve any issues you may have, and recover a well-balanced & rewarding life. The relationship you have with your therapist is an important one, as trust has to be established, so it is often harder to find a therapist you feel comfortable with than it is to find a good primary care physician. This means if you're seeking one and having trouble, don't give up.

So, how might you benefit from therapy? What kind of ideas about therapy might you have previously held that have prevented you from ever pursuing it before?  And, what can you explore about yourself to begin to improve your life? 

Get involved in your own self-betterment initiative, whether that be through therapy, or simply working with yourself to adjust your perspective and reach your goals. Surround yourself with people who build you up (another blog post on this is coming...), seek resources that help open your mind, and aspire to never become too comfortable with the status quo of an unfulfilled life. 

So, how does that make you feel? ;)