Recently had a chance to talk with Devin Higgins on his new Skull Sessions Podcast.
We talked about how Covid has affected mental health, relationships, mental health stigma, anxiety, depression and Insomnia (47 minutes in).
The world is still reeling from the Coronavirus pandemic. Here in Oregon, we are a few weeks into social distancing and shelter-in-place. Businesses big and small have shut down, families are struggling with unemployment and an uncertain future. Couples and families are strained with living in close quarters while at the same time people are feeling isolated and disconnected from friends, church and other activities.
Parents and teachers are scrambling to learn how to do online school from home. Medical providers are racing to prepare for a surge of patients with a shortage of available beds and personal protection devices.
I’ve been working in the field of sleep for the past 24 years, working for the sleep labs at OHSU and Kaiser Permanente. The past two weeks reminded me of the morning of 9/11 when I drove into work with my coworker at the sleep lab and we listen to the radio report of the planes hitting the towers. Later that morning we sat with a group of patients after their overnight sleep studies and we set them up with CPAP machines and watched the towers fall together.
This pandemic may not be as sudden as the terrorist attacks of 9/11 but it is wreaking havoc on our lives in many ways.
We’re under a tremendous amount of stress because of the disruption to our normal rhythms and routine. It’s not only taking a toll on relationships and our emotional health, it’s also stealing our sleep.
Here are a few resources to help you, those you work with or your family get your sleep back on track and to manage the stress you may be experiencing.
The first is the CBT- Coach App by the US Dept of Veteran Affairs
I recently had a client increased their total sleep time from just under 5 hrs sleep to 7.5 hrs sleep per night in the last three weeks.
There are other apps that can help with stress and sleep at the VA site:
Mindfulness Coach, Mood Coach as well as apps for Acceptance and Commitment Therapy and Anger & Irritability Management Skills.
The second resource is the book the Insomnia Answer.
In this book, Paul Glovinsky and Dr. Arthur Spielman teach the Spielman 3-P Model of Insomnia.
The three P factors that can disrupt sleep are Predisposing, Precipitating and Perpetuating Factors. The Predisposing Factors are our tendency to having Insomnia. If you have a low predisposition you probably have always slept well, if you have a high predisposition you are sensitive or vulnerable to disrupted sleep. You may be sensitive to noise and light, struggle with worry or anxiety or have struggled with sleep since childhood.
Whether you have a low predisposition or high predisposition for insomnia at some point Life can happen to your sleep. The Precipitating Factors are changes in life that disrupt your sleep. They can be negative stressful changes like conflict and stress at work, divorce, unemployment or a 20 page term paper that you’ve waited till the last weekend to start. They can also be positive changes like a job promotion, moving to a new house, a vacation,
The impact of Covid 19 is a huge Precipitating Factor on the sleep of many people, even folks who usually have no problems sleeping.
The Perpetuating Factors are ways of coping with being sleep deprived that may help short-term but end up perpetuating the problem. Things like caffeine, napping, watching Netflix or scrolling through Instagram till 1am. It can also include eating in the middle of the night or sleeping in for hours on the weekend to try to catch up on sleep. These are the the things that get us caught in a viscious downward spiral; for example, “I didn’t sleep so I drink coffee. But I can’t sleep because I drank coffee.” Or “I didn’t sleep so I end up falling asleep on the couch but then I can’t sleep because I took a 2 hr nap after dinner.”
The 3rd resource is especially helpful if you have trouble turning your brain off at bedtime and struggle to get to sleep or in the middle of the night and have trouble getting back to sleep is Say Goodnight To Insomnia by Gregg Jacobs.
Dr. Jacobs uses the phrase Negative Sleep Thoughts or NSTs to describe thoughts that trigger more stress and physiologic arousal, squirt your brain with the stress hormones adrenaline and cortisol. Some authors call these “hot thoughts”. He teaches you how to reframe your Negative Sleep Thoughts into quieter or cooler thoughts that are soothing, calming and less alerting.
Besides sleeping better right now after a few weeks of Insomnia. These resources will help prevent this acute or situational Insomnia from becoming the start of a chronic problem. Psychophysiogic or “conditioned” insomnia is the type of insomnia that becomes like a bad habit. It’s when you are exhausted and tired and maybe feel drowsy or sleep in the living room or on the computer but as soon as you brush your teeth, put your pjs on, get in bed and turn out the lights you feel more wide awake. When you start to struggle with getting sleep or staying asleep your bed, bedroom and bedtime can start to become associated with frustration and trigger a stress reaction. It can get to the point where folks have a mini-stress attack and start to avoid going to bed, staying later and later because they start to believe that sleep just doesn’t work for them.
One more note on improving sleep at this time, good sleep habits or sleep hygiene doesn’t just start with your evening or bedtime routine. Good sleep hygiene starts with your morning routine and can be practiced throughout the day because one keep to sleep is managing your mental, emotional and physical arousal during the day. Starting out the day well, eating healthy, getting some physical activity during the day, practicing mindfulness or other spiritual disciples all contribute to keeping your stress level down. For a lot of us right now, we are both bored or idle at times or extremely busy and scrambling around figuring out how to respond and adapt to new realities. Deciding on a structure and schedule for the day is helpful, especially for kids home from school.
My next blog post will be of some resources to help with homeschool and time together as a family, working from home, exercise and routine.
(I wanted to include it in this post but it’s getting late and I need to get ready for bed a good night’s sleep.)
For more info here’s a video I did on sleep and stress on Facebook.
Feel free to let me know if you have any questions about sleep.
Having to wait for counseling can be really frustrating. A little more frustrating than waiting for your mocha at the coffee shop. This blog is on what you can do while waiting.
Don’t lose hope. Having to wait for counseling can be really stressful because often the situation that prompted you to email or call for counseling can be a crisis that is affecting your family or marriage. If you’ve been putting off going to counseling, struggling with emotions or behaviors or communication for a while, if you’re in pain and things feel out of control and unmanageable – not being able to be seen can make you feel even more desperate or upset.
Maybe you’ve just discovered porn on your husband’s laptop. Or your daughter’s started to cut herself and talk about suicide.
Things don’t have to get worse in the meantime, they can even get better while you wait.
I recorded a Periscope video on this. I missed a few key resources and ideas I wanted to share so here’s a blog that goes more in depth.
Here are a few reasons why you may have to wait for counseling and some suggestions for each.
1) You want to start counseling but your counselor isn’t available. Sometimes the counselor you’d like to see doesn’t have openings in their schedule or their appointment times don’t work your schedule.
2) You want to do counseling but it’s too expensive.
3) Your insurance won’t cover counseling at all, or it covers it but not as frequently as you’d like.
4) You don’t know who you want to see.
5) You aren’t sure if you want or need counseling.
6) You’re ready for counseling but your partner isn’t ready or they don’t want to go with you.
Here are a few suggestions for each situation. Try a few of these and by the time you meet with your counselor, you’ll be able to dive right in and hit the ground running.
1) Take action on what you can. (If you are in crisis or struggling with suicidal ideation – call the 800-SUICIDE crisis line, call 911, call your medical provider and ask for emergency psychiatric services or get someone to bring you to the local ER or urgent care. ) The situation doesn’t have to stay the same or get worse. You may already know what you need or want to do. If the counselor you would like to see isn’t available, you may be able to learn more about their approach to counseling by reading their website. I started this blog for clients and friends and try to post info to help with the topics and problems I meet with people about. Your counselor may have a blog or website where they share resources and info. Besides here, I post articles on relationships and mental health on the A New Day Counseling Center Facebook page.
You can also ask for a referral to another counselor. If the counselor you’d like to see isn’t available they may be willing to recommend a colleague or another counselor who could help. I recommend my friends at A New Day Counseling and the student interns who are training here. There are also several counselors in the Portland and Vancouver area who are doing good work that I recommend.
2) Consider low-cost counseling resources. At A New Day Counseling we have interns who can meet with folks for $25 a session. Sometimes asking your employer or human resources department about counseling resources may help, there may be an Employee Assistance Program available. Addendum: Sunnyside Counseling here in Portland also has interns who can provide care for $25 a session. If you know of other counselors who provide a sliding fee scale or discounted rates, feel free to comment below. Your church may also be willing to help defray the cost of counseling for a limited number of sessions, ask your pastor or church leader if that’s a possibility.
Consider pastoral or lay counseling or coaching. Some churches provide free or low-cost counseling and/or coaching and mentoring. You may not need counseling. I like to describe the difference between coaching and counseling this way. Coaching can be like a personal trainer at the gym. They help you set goals, encourage and push you to go from good to great or okay to good. Counselors use many of the same tools and techniques but they can be more like a physical therapist. They help you with goals and problem-solving but they also focus on repair, treatment, therapy, and healing a problem. Coaches tend to focus on the present and future. Counselors do that but they also explore the past more, as needed. I’ve been trained both as a counselor and a coach.
Consider peer and group support. I didn’t say enough about this in the Periscope video! Some insurance plans or medical groups may not provide counseling weekly or at all but they may have groups for treatment or support. Three A few other types of groups I didn’t mention are Celebrate Recovery, NAMI, Griefshare, DivorceCare, For Men Only, and Refuge groups locally. There are also groups for dealing with pornography and sexual addiction locally. There are twelve-step groups for alcoholism, codependency, drug addiction, overeating. All can be beneficial and offer support; one of the hardest things about making a change or struggling with emotional and relationship issues is feeling isolated and alone. Groups help and I often recommend groups for my clients who I meet with in addition to meeting with me.
Your insurance plan may also provide online resources that can help with mental health topics. If you are a Kaiser member, there are self-help resources to learn more about the Mind Body connection, the process of change, and improving communication. There are also support programs for Stress, Overcoming Depression, Overcoming Insomnia. There are guided imagery and relaxation podcasts that can help you with anxiety, pain, and insomnia. You can also call the Health Coach team to enroll in free coaching for stress management. Some Kaiser members use health coaching to supplement their counseling. They get additional support on the phone between their office appointments with their mental health providers. If you don’t have KP insurance may provide similar resources: groups, online resources, online coaching, or phone coaching.
4) Write down what you want counseling to change. Learn how to describe what you are experiencing. Write down what is happening: Inside you and outside of you. What are you hoping will be different? Different counselors have different approaches to therapy but they often involve changing how you feel, how you view yourself, your self-talk, how you are currently experiencing life, your patterns of behavior and communication, the way to relate to others. Investigate. Read a few counselor’s bios. Ask others who have been to counseling who they might recommend. Read more about mental health topics online and on social media.
5) Learn more about your problem. One way to take action is to start to learn more about what you are struggling with. Once you start articulating what you are going through you can start to narrow down defining the problem and solutions. There are online assessments that can help you narrow down the problem. You don’t want to get too locked in to a specific “diagnosis” until you meet with your counselor but you can start to learn and read about mood disorders like depression and anxiety, you can start to learn more about healthy conflict resolution and communication.
Gaining more understanding, awareness of your feelings, and insight about yourself and how you impact and relate to others are the skills of self-awareness and emotional and relational intelligence. You may be able to make improvements on your own. If the struggles are impairing your work, your relationships – if they are longstanding, pervasive, and perpetual – if they aren’t getting better on their own or if they get better for a while but then come back, it might be time to try counseling.
Start writing down your story. Start looking at who you are and what you’ve been through. If it’s too hard to this on your own, that’s okay. Go slow. Writing it down helps you get clarity, decreases how big the problems and the past are in your head and heart. What’s the script? What are your core beliefs and family rules? What is the metaphor, the word picture you have for life, or your image of yourself? After you learn how to describe what is happening see if you can make connections and identifying the patterns and triggers in your life. All of this work can be painful. It can also be a relief to start to face it. Writing down and facing your story can start to heal and free you up from any destructive patterns and the hold your past may have on you.
6) Give yourself permission to work on yourself. Often, getting counseling, working on your healing, boundaries, growth areas, mood, and stress – your stuff – can help your marriage or relationship because if you get healthier you influence and impact your partner. Marriages are a system, if you change you change the dynamics and the relationship. If you change your steps in the dance, if you change your lines in the script, you can change your interactions, your patterns, and vicious cycles.
I often recommend the books Boundaries, Boundaries in Marriage, Boundaries with Kids, and Love & Logic. Each of these books gives principles that can be helpful in communication and relationships. The authors’ website has video advice for a number of emotional and relationship topics.
I hope this blog will help you if you are in the gap of wanting to start counseling and starting.
I will blog soon more on how to explore your past, present, and future.
One of the best things about self-care is taking the time when it seems like you don’t have the time helps you realize you do.
You do when you make the right choices about what’s most important.
And not waiting until you have permission, giving it to yourself, is a great way of breaking free of feeling so out of control or controlled by circumstances and the expectations of others.
I get questions about counseling in my inbox sometimes.
Here are some local Christian counseling recommendations and resources.
First of all, I recommend my friends at A New Day Counseling Center which is on the campus of Western Seminary. We have a team of counselors and psychologists that work with a variety of concerns and also accept different types of insurance.
We also have student interns that receive excellent supervision and can see folks for $20 a session.
Here are a few counselors and counseling clinics I recommend.
Feel free to recommend others below. Apologies to anyone I’ve left off.
For marriage counseling:
Jason Wilkinson at Wellspace Counseling. This is an interview I did with Jason.
Alan Rutherford sees individuals and couples. My wife and I enjoyed and benefited from a Marriage class Alan did for Imago Dei Community.
Roxie Sprick at Gresham Family Counseling.
In town, Nate Bagley and Bridge City Counseling
In Sandy/Gresham Dave and Hollis at River Ridge Counseling
On the west side, Aaron at Discover Counseling
In Clackamas, Cornerstone Clinical and Connie at Partners in Hope
In Springfield, Scott Waters at Veritas Community Counseling. Here is an interview on marriage counseling with Scott.
In Vancouver, Charis Counseling and Fir Crest Behavioral Health.
Julia Garrison at Garrison Counseling Services. This is an interview I did with Julia.
In Battleground, Parkway Counseling.
When looking for a counselor, I recommend reading the info and bios at the counseling center’s website for the areas they specialize in, their experience, their description of their approach to counseling, and see if it resonates with you. You can also call their office usually to ask questions to help you decide.
These days many counselors do telehealth (online video) sessions so you can meet with counselors who are not in your immediate area or city. You will need to schedule with a counselor who is licensed in the state you live in.
Some folks ask me if there are counselors I recommend at Kaiser. Since I don’t work in the mental health department there I recommend folks with KP insurance make an intake appointment and ask to be assigned to a Christian counselor. Sometimes, KP members are able to get an external referral to clinics outside the KP offices. I think clinics like Western Psychological Services may take these referrals and you might be able to find a Christian provider there.
Briefly, I’ll say here, if you are a Christian you don’t always have to have a Christian counselor to benefit from counseling. I’ll probably blog more about why that’s true here. If you’ve found that to be true for you, I invite you to comment about your experience in the comments.
I often recommend support groups, they can be extremely helpful in recovery, healing, and making difficult changes.
Divorce Care has a website with good information and several support groups locally and nationally. It is also helpful for couples and families that are going through a separation.
Celebrate Recovery also has several groups that meet at churches in the area. It is helpful for a variety of issues.
Refuge at Imago Dei Community in Portland meets on Mon evenings. Their website also has a list of Christian counselors.
Pure Life Alliance has groups for men and women struggling with porn and sexual addiction. They also offer groups for spouses and significant others that have been hurt by their partner’s struggle.
Here’s a website I recommend frequently as well
Cloudtownsend.com – I recommend their books on Boundaries all the time, their video advice channels cover many topics related to relationships, emotional health, etc. They also have Q&A replies to many questions related to mental health. I really appreciate their perspectives on integrating faith and psychology.