Two Approaches to Dealing with your Fears

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I was born a little skittish. I get startled easily when I see and hear something I don’t expect. I had to tell my husband early on in our marriage to make noises as he enters the room. Otherwise, I’d scream bloody murder, which would freak him out. Oh, and I don’t like scary movies. Husband got into a kick recently and watched the three original Alien movies while I was out-of-town. Good, cuz it ain’t happening when I’m home.

The thing is, we’re all wired a certain way, along the continuum of higher versus lower threshold for fear. It’s not a right or wrong, good or bad. It just is. But, what’s the point of fear? Is it even necessary? Ever wondered where fear came from?

The origin of fear

Too many million years ago during the age of saber-tooth tigers, wonderful men hunted and awesome women gathered. Whether they were out in the fields or back at the shelter, they had to be on hyper alert for wildlife. They were either going to have lunch or be lunch. With that hard-wired alert for danger, those who were careful and watchful procreated and lived on. Those who had a low radar for fear and lived a carefree life did not.

What does this mean for us in 2017?

Real threats

Though we’re no longer living amongst saber-tooth tigers, some threats in our lives are very real. It could be a life threatening illness, an accident, any other traumatic events or threats to our dignity as people. During these moments, our fears make sense and fit the facts of the situation. These threats ought to make us have the automatic reactions of fight, flight or freeze. When our fears are justified, we should take action to effect change where we can. This is for our survival and the survival of people we care deeply about.

Perceived threats

There are real threats and then there are perceived threats. Perceived threats are when you’re no longer in the car accident, in the abusive relationship, in the situation that made you feel so threatened and yet, you live as though you’re still in that life-threatening event. Or, your fears are not tied to something that has happened, but a fear that something might happen. You then avoid places, people and activities that might remind you of your fears, examples being you do less because you fear failing or embarrassing yourself in public. When checking the facts of the situation, you realize the probability of something bad happening is very low, or your fears may be unpleasant, but they’re not life-threatening. What are you to do?

Facing perceived threats one of two ways

When your fears are not justified, it is important that you learn to face your fears. I share two approaches here:

1. Whatever you’re afraid of doing, do it over and over again.* Not kidding you. When there is little evidence for why you should be afraid of something that has occurred in the past or might occur in the future, the way to overcome that fear is to face it head on. Do the very things you want to avoid with consistency. Is it public speaking? Getting behind the steering wheel? Watching certain shows that might be triggering? Take baby steps to overcome your fears by approaching, rather than withdrawing. Overtime, you’ll feel more in control over your fears.
2. Harry Potter shows us another way to face our fears during a boggart lesson:

We can have a different relationship with our fears.** Put in its original context, Ron’s afraid of spiders, Harry Dementors, and Professor Lupin a full moon. When they cast the spell Riddikulus and envision something humorous, the shape-shifting boggart assumes a comical form. Followed by outright laughter, they had the power to make the boggart disappear!

While we don’t have this power at our disposal during current times, Professor Lupin’s lesson is for all of us. Can we see our fears differently, and therefore, relate with them differently? What if a natural disaster turned into a ribbon twirling performance, social humiliation took the form of people high fiving you, and the car accident transformed into a scene from Fantasia?

Facing your fears together

Don’t let the fears of your fears hold you back! If you need help facing your fears or otherwise make them ridiculous, well, you know where to find me.

* Borrowed from Cognitive Behavioral Therapy and Dialectical Behavior Therapy
** Borrowed from Acceptance Commitment Therapy

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Ada Pang is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She mostly helps unhappy couples and breast cancer patients. She also loves helping people address fears that hold them back in life. Her favorite Harry Potter films are the Order of the Phoenix and the Deathly Hallows: Part 2. Her worse fears are, well, she can identify with Ron. 

Why Valentine’s Day is not Always Happy for Couples and What you can Do about it

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Ordinary Tuesday

It was an ordinary Tuesday when I finished up with my last client. “You must be in a hurry to get home” and I was like, “No, you’re good.” I was still wrapping up my case notes when my husband sent me an emoji rose. Husband is not the romantic type and I was like, “What’s with the rose?” I was then reminded that today was Valentine’s Day. Husband implied that he brought home dinner and I was more excited about that! As I was leaving the building, I realized how unusually dead the office was. Valentine’s Day must be a thing.

Who took the happy out of Valentine’s Day?

If you’ve read one of my earlier posts, you’d know how deeply I feel about this “Show-love-to-your-partner-or-you’re-screwed” Day. This day is supposed to be happy. It is a celebration of love; often a narrow definition of love. For couples, this set date that comes on the 14th of every February is a reminder of where your relationship is, which is not always where you’d want it to be.

Situations change, patterns do not

Regardless of whether you had an amazing time with your partner, it was like any other day, or you had the hardest time, this Valentine’s Day is a reflection of where you already are in your relationship. A commercialized day filled with the expectation of card, sweets, expensive jewelry or flower exchange will not unearth a long standing pattern in your relationship. I often say to my clients, “Situations change, patterns do not,” unless you intentionally and consistently work at undoing the pattern. The situation could be a move, a vacation, an extravagant gift, _______________________. How you relate is still how you relate.

If your Valentine’s Day was indeed unhappy, what to do about that?

What makes for happy and close relationships?

As you can tell, I’m biased against any one day in the calendar deciding for us how we ought to be. If it’s a value or a desire we have, I believe we should strive for it everyday. If having a close, loving relationship with your partner is something you long for, consider how you can relate differently:

1. Speak to your perceptions – How you see your partner will affect how you feel and how you respond. If you think your partner doesn’t care about you, you might see the dirty dishes as proof, whereas if you think your partner got sidetracked, used pots and pans don’t rub you the same way.

2. Dig into your feelings – Anger is usually the emotion that bubbles onto the surface. What’s buried underneath are usually more vulnerable emotions such as hurt, humiliation, fear, and rejection. These deeper emotions, when shared, usually bring out a more tender part in our partner.

3. Clarify your intentions – Sometimes your intentions do not come out as perceived. When that happens, it’s important to clarify where you were coming from. “Wow, I was late in picking you up and you thought I didn’t care that your bladder was about to explode! If I had known you needed to go pee, I would’ve stepped on it!” (Officers reading this, I’m not encouraging speed limit violation. This is about the comfort we feel when we realize our partner is willing to go out of their way for us).

4. Notice and own your vulnerabilities – Are you sensitive to anger because your grew up in a home with an explosive parent? Is it hard when your husband shuts down because your previous partner frequently walked off without an explanation? Have you learned to keep stress to yourself, only to lash out when you’re at your wits end because you haven’t learned to cope any other way? These are examples of sensitivities that partners bring to the relationship. It helps to be aware of them.

5. Share your vulnerabilities with your partner – Let your partner know that particular words and behaviors are triggering for you, NOT because your partner is your enemy, but because we all come with a history. Ironically, we’re often attracted to partners who remind us of our family growing up. Awesome or not; it’s familiar to us.

6. Acknowledge your needs and wants in the relationship – The reason you get worked up in your relationship is because your partner matters to you. If you’re only doing life with a roommate, there’s less at stake. The weight of this relationship has you longing from your partner love, closeness, comfort, appreciation, and acceptance. It’s okay to ask for these things from your intimate partner.

7. Bring it all together – As you share your perceptions, deeper feelings, intentions, vulnerabilities, and relationship needs, let your partner have a turn. After all, it takes two to make love work.

Daily loving

Let’s not wait until the next event, the next anniversary, the next “situation” to show your partner she matters, you love her, and you have her back. You can practice daily loving as a part of living daily. If you need help nurturing a close, loving relationship with your partner, let me know!

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps unhappy couples and breast cancer patients. When she’s not working or thinking about work, she loves hanging out with her husband. On an ordinary day when they’re both working long hours from home, she likes to go give him a hug and a kiss and tell him, quite literally, “I’m here to connect with you.” 

The Great Divide. I’m not having it.

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Way to start the New Year’s

I woke up on Sat Jan 28, 2017 to the start of Jan 1, 2017 on the Chinese lunar calendar. I happened to be in Vancouver, BC, Canada for a two-day training prior to the festivities and stayed with my folks. I had a rather slow morning and came downstairs to my Mama’s homemade CNY brunch. My aunt came over, my sister and niece have spent the night and all was well until I got a text from my husband.

He was asking when I’d be home. Later in the eve, I conveyed, not knowing what’s the hurry. He then mentioned some executive order that Trump has signed that morning. I looked it up and it was f*cking unbelievable.

I am a Hong Kong-born Canadian citizen green card holder living in America and I was shocked. I cannot imagine what it is like for refugees and Muslim brothers and sisters around the world.

I felt very uneasy and after a late lunch, left for the border. For the first time, I didn’t know what to expect. While Canada and the US are allies and I have all my documentation, a “Muslim ban” from selective Muslim-majority countries has me wondering what’s next.

Back on US soil

The border was uneventful, as if nothing has happened. I almost wish that something was different because this is NOT okay. I’m now back on US soil. And for the first time in my 15.5 years of living in the US, I felt different, like I don’t belong here. My countries of origin and naturalization aren’t even on the blacklist. I’m not even Muslim. But to exclude immigrants and non-citizens is to exclude me and to exclude people like me. I realize to make America great again is make America white again.

Pulling away

During my 2-hour drive home, I became increasingly aware of my “other-ness”. I feel threatened by the future possibility of not being welcomed in this country. I find myself emotionally pulling away from my white community. I picture the faces of these people I have come to know and like, and already, I feel further from them.

Suddenly, I realize what was happening. There is a great divide in our country and around the world and to pull away is to concede. In Trump’s promotion of all people white, male, straight, Christian, middle and upper class, able bodied and Euro American, he is shutting down those who don’t fit the bill.

I’m not having it.

Leaning into America

When I realized this, I made a conscious decision to lean in, instead of pull away. It helped that when I got home, my husband, who is 4th-generation Japanese American, hugged me for a long time. It helped that protests rose up at airports and city streets around the country as we stand with each other. It helped that I connected with my community the next day and saw how they were also affected by this news.

It helped that this is not the end; rather, the beginning.

We CAN find safety and shelter in each other. Notice where this was filmed:

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond therapy practice in WA. At the heart of what she does, she’s about helping people flourish and live compassionate and vital lives. She can be found at PeopleBloomCounseling.com.

Creating Deep and Lasting Changes in your Marriage

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Shallow change

Last fall, husband and I had a chance to visit Kauai. We were there with family and we also got some time to ourselves. With little hesitation, we rented snorkel gear and stand up paddle boards on the first day. We ended up doing little of both because of the strong waves. Nonetheless, it didn’t stop us from trying.

We drove to Poipu Beach Park which is on the south end of the island. We saw some amazing sea creatures, but something else was bothering me: my goggles. It kept leaking water in. I’d be in the water for no more than 30 seconds and my astonishment would be put out by the gradual overflowing of salt water that threatened my eyes and I’d have to re-surface. My husband came and checked on me a few times and I kept trying to make it work: I tightened my goggles, I breathed in to suck the goggles to my face, I tried to remove every trace of hair that might have been in the way. Some of you reading this can come up with yet a 4th way I could’ve tried to make it work, but by now, my forehead was turning purple and I wasn’t having any fun. The changes I was making were not working.

Deeper change

We finally decided to cut the trip short and went back to Snorkel Bob’s to exchange for a new pair of goggles. The next day, we headed to Salt Pond Park. In the back of my mind, I couldn’t help but to wonder, “Are my goggles going to work?” I took a moment to adjust to the water temperature and dove in. I was expecting water to slowly fill up. Nothing. I paddled around for a bit longer and ta-da! My goggles were water proof, as goggles should be! We enjoyed the rest of our snorkeling experience and saw for the first time, trumpetfish!

Shallow changes in intimate relationships

So why am I telling you this story? I believe that we often try to make shallow changes in our intimate relationships, changes we call “first order change” in family systems theory. First order change is when patterns of interactions are changed at the surface level and they usually involve changes in behaviors. Let’s say you and your partner are not getting along. Well, you should learn to communicate better, use “I” statements, carve out time to go on date nights or address a fair share of household chores.

Now don’t get me wrong, I’m all for these changes, except I don’t believe that’s really the problem. These surface level changes will improve things momentarily, probably for longer than 30 seconds. But they don’t change the fact that something more is likely going on that’s causing the “leak” in your relationship. These problems might be surfacing because of deeper underlying issues in your marriage.

Deeper changes in couple relationships

So what is this deeper change and how is it possible? Yes, you guessed it: it’s called “second order change.” Second order change is when your relationship itself changes based on feedback from each other and hopefully, for the better. Underlying rules and beliefs about the relationship is called into question and altered. Let’s come back to your relationship.

Where you’re stuck in your relationship

Same problem: you’re not getting along. Your partner is super defensive when you bring something up and ends up hiding out at work. You become more frustrated every time you approach him and all he hears is your anger. You want to feel loved, accepted, important, and connected and it’s not happening. Your partner feels criticized, misunderstood, like he can’t do anything right. He also feels scared about rocking the boat, because he doesn’t want to make things worse. His feelings of inadequacy makes him withdraw even more. Sounds familiar? Are you tell me that this is just a communication problem and you can fix it by throwing solutions at it?

Want to feel close and connected with your partner?

The thing is, deeper changes lie in each of you recognizing that you have a part to play in the dance. As one of you pursues, often times out of desperation seen as anger, the other gets defensive and withdraws, often due to feelings of incompetence and shame. It’s not as simple as asking you to stop pursuing and the other to stop running away. After all, you have reasons for why you do what you do. Rather, it’s about recognizing that this dance is not working and it’s time to put on a different set of music. We’d still go snorkeling, but let’s switch out the goggles.

Emotionally Focused Couples Therapy (EFCT)

Emotionally Focused Couples Therapy (EFCT) is a heavily research-based model for the treatment of couples. It gets at the underlying needs for couples to feel close, desired, and accepted in their intimate relationship. It focuses on how each partner influences the other and whatever rules or beliefs you had about your relationship will naturally shift as you experience your partner in new ways.

This is hard work and it’s not for the faint of heart. Let me know when you’re ready to trade in your goggles. I'll be here. 

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That can also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not thinking about couples and cancer, she loves to go play with her husband! Her favorite sea creature while snorkeling in Hawaii will always be the Humuhumunukunukuapua’a. 

The Guide to Surviving Breast Cancer Screening and Diagnostic MRI

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Last month, I wrote about the guide to surviving mammograms. When your breasts* are temporarily smashed, to the point where you didn’t think they could be flattened any further, there is nothing fun about that. Breast cancer patients tend to talk about surviving cancer and not about getting through these imaging appointments. Today, I’d like to touch on ways to survive a diagnostic breast MRI, which is sometimes used in breast screening to supplement a mammogram.

Breast Magnetic Resonance Imaging (MRI)

Breast MRI uses powerful magnets to generate detailed pictures of your boobies. You’re to lie tummy down, hands over your head on a moveable flat table, with your boobs hanging into an opening. After you’ve been situated as comfortably as possible on this hard, narrow table, you, along with the table, will slide into a large cylinder-shaped tube. This procedure will last approximately 18 minutes, during which you’ll hear a constant sound of jack hammer, with some breaks in between. You’re to hold completely still to insure accuracy. Once inside the tube, you’ll feel alone in a tight space.

You might be given the choice of music to occupy your mind, but the music would have to be really loud to drown out the construction noise. Near the beginning of the scan, a contrast material will be injected into your arm through an IV to help outline breast tissue details. The technologist will speak to you through a speaker if any communication is to be had. These 18 minutes can feel like forever. How can you survive it?

Do’s and don’ts during a breast MRI

DO ask a friend or family member to come along. Even just knowing that your loved one is near can be comforting.

DON’T be afraid to ask questions or interrupt the process if something is really bothering you. The technologist can help you adjust your position or let you take a break as needed.

DO focus on your breathing. Notice the natural rising and falling of your body as you lay there. Come back to your breath over and over again.

DON’T scratch an itch or move around. If you pay close enough attention, you will feel some level of discomfort. Unless you're in pain or you're super uncomfortable, know that these feelings will pass.

DO close your eyes if it can help forget that you’re in a tube. Instead, imagine you’re in open space.

DON’T tense up your muscles. Notice when you feel tension in your body, from your face, arms, shoulders, torso, gluts to your legs. Invite relaxation into those muscles and let your body fall heavy on the table.

DO hum or speak softly to yourself. You can hardly hear yourself but you can feel what you’re saying. Soothe yourself with your own voice.

DON’T say to yourself, “I can’t wait for this to be over!” This will likely lead to further impatience and frustration. Your scan will take as long as it takes.

D0 think about what you plan to do to reward yourself after you leave the clinic. Perhaps it is a, “Jenny, you did it!” or a mocha waiting for you down the street.

DON’T try to calculate how long it has been. Chances are, it hasn’t been as long as you think.

Bonus tip on surviving a breast MRI: self-touch

No, I’m not asking you to think kinky thoughts as you lay inside an enclosed tube. Rather, remember your arms overhead? Your hands could be touching each other. In fact, before the machine starts, bring your hands to touch, one on top of the other. Feel the warmth of your hand, the texture of your skin. Notice what it is like to be touched, to be cared for, to be comforted, by you. Much like the touch of a loved one can help lower your cortisol level, so here you are, lowering your own stress level because you’re loving you.

Loving yourself through cancer

It’s hard enough going through cancer, your body does NOT need another, “Hurry up and get this over with!” moment. Instead, consider how you can love yourself through it all. If you need help getting through cancer care and life thereafter, let me know!

*Breasts are used in plural form with full awareness and respect that this might not be true for everyone

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That can also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not thinking about couples and cancer, she has found yoga to be a wonderful practice to nurture present moment, self-love and self-compassion. She has grown pretty fond of her toes recently. She says hi to them every time she passes them by.  

There is Hope – Trauma Therapies that Re-wire the Human Brain

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The word “trauma” on Google

When I google searched “trauma” the first definition that came up was “a deeply distressing or disturbing experience”. The word “trauma” is synonymous with “shock, upheaval, stress, pain, anguish, suffering, agony, misery” and the list goes on. The word has a Greek origin which literally means “wound”. When I pause to reflect on what these words actually mean, my heart becomes heavy.

Posttraumatic Stress Disorder re-triggered

I must say that while I’ve processed the trauma of my aunt’s death, watching an episode of Sherlock Holmes this past weekend was enough to trigger memories of her. I didn’t expect it; it just happened. Then I think about the many people who have been through a traumatic event and have not learned to process it and integrate it as a part of their life story. After all, it doesn’t take much to be triggered with the never ending information on social media, and to hide from triggers is to hide from life itself. If that’s your experience, I grieve with you. But, let’s not stay there.

A recap on CBT modalities for treating trauma

Last month, I wrote about Cognitive Behavioral Therapies (CBT) for the treatment of PTSD. CBT is about changing the way you think and feel about a traumatic experience. There is often an exposure component where you recall what happened in the safety of the therapist’s office and you learn to put the trauma behind you. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE) were amongst the treatments covered.

Trauma therapies that re-wire the brain

Today, I’m excited to call upon additional experts in the Seattle area to talk about other forms of PTSD treatment. They eloquently speak to modalities that use brain activation and body-mind integration to re-wire the brain and change the relationship you have with the traumatic event.

Without further ado, I give you Lorencita Villegas and Laura Moon Williams!

Eye Movement Desensitization and Reprocessing (EMDR)

Lorencita Villegas, LMHC, NCC is a certified EMDR psychotherapist. She writes, “Eye Movement Desensitization and Reprocessing (EMDR) is a therapy modality that helps process traumatic or disturbing life experiences or memories. It follows an eight-phase protocol where I’d ask you to recall the memory and the negative thoughts associated with it, as well as the positive thoughts you’d rather have about yourself. The goal is to replace the negative cognitions with the positive, and allow the trauma to move.

Trauma moves by allowing the brain to create new pathways that are more adaptive. To allow movement we will use eye movements (or other bilateral stimulation) to activate your brain. EMDR allows you to access your intellectual and emotional processes on your own, unlike talk therapy where the clinician would help interpret them.

It is important to note that EMDR will not change the memory of the particular event, but will change the thoughts and physical reactions associated with it. For example, a person who experienced a car accident may go from experiencing high levels of stress to having a more adaptive thought such as, “I can control my driving.” EMDR has been recognized by the World Health Organization and the Veterans Affair as a leading treatment for Posttraumatic Stress Disorder.“

Lifespan Integration Therapy (LI)

Laura Moon Williams, MA, LMHCA is a Lifespan Integration (LI) therapist. This is how she explains LI, “Those who have had a traumatic experience(s) often feel stuck reliving the event through intrusive memories, flashbacks, dreams or physical and emotional responses to reminders/triggers of the traumatic event. These PTSD symptoms occur because the person doesn’t fully and truly know that the traumatic event is over; the body-mind system is stuck in the experience and continues to respond to its current environment as if the event had just happened.

Lifespan Integration provides a safe, therapeutic way of re-experiencing the event and demonstrating that it is over, without re-traumatizing. This is done by viewing multiple timelines, beginning with the event and continuing with everyday memories that bring you into the present moment. Seeing what happened in the days, weeks, months, or years following the event proves to the body that the event is over and allows the traumatic experience to be integrated into one’s larger story. People are often surprised by how quickly they experience relief from PTSD symptoms with Lifespan Integration.“

There is hope for you

If you struggle with symptoms of posttraumatic stress disorder, you don’t have to go about it alone. PTSD affects you when you’re waking or sleeping, when you’re alone or in the company of others, when you’re at work or at play. It doesn’t have to be this way! Lorencita and Laura are here to help you put trauma in its place. Reach out to them! Lorencita is here and Laura is here.

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. She understands that she cannot be known for too many things, but yes, she also loves helping amazing but struggling people recover from trauma using CBT approaches. When she’s not seeing clients, she’s about working on her business and building relationships within the therapist community. 

The Guide to Surviving Breast Cancer Screening and Diagnostic Mammograms

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Surviving cancer

Let’s face it. When breast cancer patients are in the thick of their cancer diagnosis and treatment, they’re just trying to get by. Surgery, radiation and/or chemotherapy all require recovery periods. The side effects of treatment are very real and some of them lasting. Many breast cancer patients are simply taking it a day at a time, trying to survive.

Having survived cancer, it is then interesting to note that some of the patients I have spoken to have a hard time with the screening and diagnostic tools such as mammogram and breast MRI. While they might be grateful for the accessibility of screening and early detection of cancer recurrences, they dread going to those appointments. Since regular mammograms and in some cases MRI might be recommended as routine care, is there value in talking about how to survive not just the cancer, but also follow-up care?

Whether you’re walking into your second mammogram or your 20th, I present to you a two-part series on how to survive these screening and diagnostic imaging appointments. Please note I’ll be using breasts in the plural form; I understand we do not all have two breasts and I’m cognizant of that.

Mammogram

Mammo: I recently heard this term and I consider it a euphemism for mammogram. Call it whatever you want, but it is not pleasant. A technician cues you to stand against a large machine as she operates slides and squishes your boobies into pancakes from various angles. X-ray images are taken of your flattened boobies and checked for abnormalities. If you’re going in for a diagnostic mammogram, more images will be taken and magnified for accuracy. In other words, more pancakes.  

While cancer patients tell me they’ve been instructed with all kinds of creative things to do as they bare their boobs against the mammography machine, you don’t hear this one very much: “Lean in(to the machine) like you love it!” That would be quite difficult to do considering the circumstances. However, there are ways to get through that moment of pain and discomfort. Let’s call it mindfulness, distress tolerance and self-compassion.

The mindful way through a mammogram

Mindfulness is about making space for the experience you’re about to enter into, paying attention to it, moment-by-moment. Usually when the experience is pleasant, we have no problem jumping in. However, when you’re about to get your chest temporarily flattened, it’s harder to accept the experience without resisting it and being with it as it is. Here are some ways you can practice staying present during a mammogram.

Feel the Robe

First of all, let’s backup and see if you can ask for a warm robe. Whether you’re getting a mammogram in the middle winter or the heat of the summer, a warm robe feels nice. We often associate warmth with comfort. Why not take a moment and feel into that warmth? The robe is there to keep you from the cold air in the room. Let’s take a moment to acknowledge what it’s doing for you.

Experience your breath

As the technician is setting up the machine and pulling up your record, take the time to ground yourself by focusing on your breath. Your breath is your anchor. Feel the rising and the falling of your chest. Perhaps notice the cold air coming into your nostrils and the warm air as it leaves you. No one breath is the same. Take some time with your breath. You’re alive because of it.

Sense your pain

This may seem contrary but as your breasts are being flattened, feel into those sensations. Your body is experiencing pain for good reasons and it’s sending you signals. The technician will often use a dial to tighten the slides together and you will experience an increase in pain with every turn. See if you can notice where you’re feeling the pain. Take it all in. Feel the tension, then feel the release when the slides separate again. Notice how when you enter into your pain rather than avoid it, it still hurts, but you learn to not be afraid of it. You are co-existing with it and watching the sensations come and go, come and go.

Tolerating the distress of a mammogram

Borrowing from Dialectical Behavior Therapy (DBT) tradition, when you cannot change difficult circumstances, it’s about getting through it without making things worse. After all, you wouldn’t want to have to reschedule your mammogram or have additional images taken because you couldn’t hold still. Within DBT there’s a set of skills designed specifically to help you tolerate your distress and survive the moment.

Here are some additional ways to get through a mammogram:

• Think of a comforting, safe image - some mammo technicians suggests your kids, grandkids or pets. Others mention butterflies and unicorns. Whatever floats your boat.
• Conjure up soothing sounds and play them in your head
• Say a prayer to your Higher Power
• Count to 10 and back – if this is too easy, count by 3’s. That should grab your attention
• Focus on touch – as you hug the machine, notice the texture, color, shape, etc.
• Notice what you hear – be curious and name the different sounds you hear. Can you notice a new sound every time the machine moves?
• Remind yourself this will soon be over - “Beth, you’re doing it. You’re here and this will pass.”
• Be grateful for medical access - “Beth, this hurts like heck but I’m glad you can access this kind of care.”
• Affirm yourself – “Beth, you’ve been through harder things and I’m with you and I love you.”

If the latter sounds a lot like self-compassion, that’s where we’re heading.

Extending compassion to yourself

Kristin Neff is a guru when it comes to all things self-compassion. Unlike mindfulness where you enter into the experience of pain without escaping, self-compassion is about seeing yourself in pain and wishing it wasn’t so. While compassion does not make the pain go away, it does ask the questions, “What do I need right now? Can I give that to myself? What can I do to hold myself with more tenderness?”

Self-reassurance and self-advocacy

Would it reassure you to tell yourself you’re well loved and cared for? Would you want to close your eyes and focus inward? Would it soothe you to think about your partner? If the technician is turning the dial too tight, would you love yourself enough to say something about it? I ask that because I once had a patient tell me her breasts were bruised for two weeks after her mammogram. She said the technician made the slides too tight and she didn’t want to speak up. You’re important to speak up for. Would you do that for yourself?

Life after cancer

While you may no longer be in cancer survival mode, follow-up appointments and regular diagnostic images are and will be a part of your life. You don’t have to white knuckle through these tests “just to get them over with”! You also don’t have to wish your cancer experience away. Let me know if you can use some help staying present, tolerating distress and loving yourself as you are. I’m here!

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That can also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not thinking about couples and cancer, she has found yoga to be a wonderful practice to nurture mindfulness, distress tolerance and self-compassion. She has grown pretty fond of her toes recently. She says hi to them every time she passes them by.  

There is Hope – Cognitive Behavioral Therapies for Treating Trauma

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Trauma is prevalent in our society. Turn on the TV or go on any social media and there’s no shortage of natural disasters, accidents and injuries, abuse, threats of violence, violence itself, and sudden deaths. Sadly, this does not include traumatic events that have happened to you or to those you know. In my previous post, I gave an overview on trauma. In this post and next, I’ll be covering treatments for trauma.

Evidence-based treatments for Posttraumatic Stress Disorder (PTSD)

In the field of psychotherapy, “evidence-based treatments” are treatment modalities that have been proven by scientific research to be effective for treating a particular set of symptoms. In the case of PTSD, a subset of Cognitive Behavioral Therapies (CBT) have shown to significantly decrease PTSD symptoms and related conditions, and these benefits are sustained well after treatment is over. I’ll be writing about two types of CBT approaches that I practice at my Redmond office. I’ll also be calling on trauma experts in the larger Seattle community to comment on other approaches that they specialize in.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is designed to help children, adolescents and their families recover from trauma and related symptoms. Over the course of 12-16 sessions, children and their caregivers will learn about the particular trauma the child has experienced, common trauma symptoms, as well as the roadmap for treatment. Caregivers will also get support around parenting and learn ways to manage the child’s emotional and behavioral difficulties related to the trauma. Children will develop and practice relaxation techniques, ways to regulate their emotions, and skills to begin thinking about their trauma differently. They will also be asked to tell/write about their trauma experience in a safe environment, share it with a special person and learn ways to safely navigate the world going forward. At the end of treatment, many kids feel really empowered and their caregivers proud! And, the tools gained from treatment can be easily adapted to cope with other life stressors.

Cognitive Processing Therapy (CPT)

First developed for use with veterans who have experienced PTSD symptoms, Cognitive Processing Therapy (CPT) has been shown effective in treating other types of trauma. As in traditional CBT, CPT sees a strong connection between your thoughts, feelings, actions, and body sensations. And, to the extent that you have some unhelpful ways of seeing the world before and/or after the traumatic event, those beliefs will keep you “stuck in non-recovery”. When you’re “stuck,” you tend to be hard on yourself and others, mistrustful of the world, and feel numbed out and angry. The ultimate goals of CPT are to help you: 1) accept the reality that the traumatic event happened, 2) fully experience the emotions about the event in a safe environment, and 3) develop more balanced, realistic views about the event, yourself, and others. Clients who have completed 12-20 sessions of CPT have shown a decrease in PTSD and trauma-related symptoms such as depression, anxiety, shame or guilt. They have also reported feeling more present in their everyday life.

Now, calling my first expert! *Drumroll*

Prolonged Exposure Therapy (PE)

For years, Caitlin Vincent, MS, LMFT, CDP provided therapy at the King County Sexual Assault Resource Center. She writes, “I find people struggle most with the re-experiencing symptoms of PTSD (flashbacks, nightmares, intrusive memories and strong physical and emotional reactions when reminded of their experience). They often say that they feel haunted and raw, like the event just happened, even if it didn't. Prolonged Exposure (PE) is a form of therapy that is especially helpful for alleviating these symptoms of PTSD by safely revisiting painful memories in detail, from start to finish, in a process called Imaginal Exposure. Just as a once-scary movie becomes less shocking if you watch it several times, this process can allow someone to regain more control over their minds and bodies. By facing these memories thoroughly and directly, and then talking about the thoughts and feelings that arise, people can start to put the experience behind them, because finally allowing the brain to process the memory relieves its instinct to replay details over and over. PE is best for someone who has a clear and identifiable 'worst' traumatic incident that they can refer to and focus on, but can easily also be used for multiple traumas.”

There is hope for you

If you suffer from trauma symptoms and these CBT approaches to treatment resonate with you, there is hope. Yes, it is scary. Caitlin and I hear you. We’ve been there with countless clients and have walked them through this painful and frightening journey into hope and recovery. We'd want to do the same for you. Let us know how we can help. I’m here and Caitlin is here.

Up ahead

Stay tune for other evidence-based approaches to treating trauma that I cannot even begin to describe! I’ll leave it to the experts.

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. She understands that she cannot be known for too many things, but yes, she loves helping amazing but struggling people recover from trauma as well. When she’s not working or thinking about work, she’s eating or thinking about food. 

How to be with the 2016 US Election Results

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Unexpected results

Wow! What a week and it’s not over yet. Tuesday seems like eons ago. The election results shocked the whole world, leaving some celebrating, others protesting. On the one hand, as an immigrant and a woman of color, I hear and identify with the concerned voices of my fellow brothers and sisters as they face an amplified fear to the already prevalent racism, xenophobia, islamophobia, homophobia and sexism in our society. On the other hand, republican voters speak to the hopelessness and oppression they felt under the Obama administration. Each has a story to tell.

Narrowing the great divide

Our country is facing unprecedented polarization. That leaves a “we” versus “them” mentality with little room to hear the other. Whether you are a distraught Clinton voter who has taken to the streets, a victorious Trump supporter beaming with pride or a secretive Republican supporter afraid to come out of the closet, here are some ways to be post election.

1. Come together – be with those who share your viewpoint. Find company. Look around you and know that you’re not alone.
2. Express yourself – silence is dangerous. Speak to your hopes, fears, frustration and disappointment. Use words, art, music, anything.
3. Let your feelings come and go, come again and go again – if you’re experiencing shock, denial, anguish, sadness, fear, anxiety, anger, joy, thrill or whatever else, acknowledge them. Pushing away unpleasant feelings will only make them stronger; prolonging pleasant feelings will make you miss out on the here and now.
4. Revisit your values – remind yourself what you’re about and how you want life to be for you, your family, your neighbors, your community, the environment, animal life, and human kind.
5. Know your impact – your beliefs and thoughts carried out in words and actions will affect another. Your choices have consequences, positive or negative. Imagine the effect of those same choices when done to YOUR father, mother, brother, sister, son, daughter, best friend and those your love.
6. Listen closely – you come with your worldviews, life experiences and biases as you encounter another’s worldviews, life experiences and biases. Listen and understand another’s perspective even though that has and might never be your reality.
7. Stand up for justice – give voice to those who are silenced or are afraid to speak up. Stand with those who are treated less than because of their race, gender, sexual orientation, age, religion, class, abilities, looks or ethnicity. Pause to reflect on what each of these even mean. 
8. Teach the next generation – when your children, grandchildren, nieces and nephews inherit this earth, what do you want them to know about caring for ourselves and each other?
9. See our humanity – we are first human beings BEFORE our differences divided us. Strip us to the core, we have the same needs for safety, love and connection:

I might not know your story, but let me hear it. 

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond therapy practice in WA. At the heart of what she does, she’s about helping people flourish and live compassionate and vital lives. She can be found at PeopleBloomCounseling.com.

Body Image after Breast Cancer – What is Visible to the World

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In my last blog post, I gave an overview on body image after breast surgery and radiation. I invited you to befriend your breasts and come to accept them as they are. This takes time. When you’ve reconciled this loss, breast prostheses, mastectomy bras or reconstruction is the icing on the cake, rather than the cake itself.

Now, while it is devastating to lose a boobie or two, it is something private and can be covered up. What about the body changes that scream, “Cancer!” to the rest of the world? Treatment will lead to body changes that are visible to all. How do you involuntarily give yourself away?

Hair on your head

A study done by Dove in Dec 2015 found that only 11% of women love their hair as is. The rest of us wish that it was less wavy, more fine, less grey, more thick or, just fill in the blank. You never come to appreciate your hair as much as you do, until it starts falling off in clumps. In the shower, as you’re brushing it, while you’re going about your life: you’re shedding everywhere.

Some women choose to shave their heads early on to avoid the pain and the clean up of such a visible loss. Others choose to keep every strand of their hair until chemo is over and then get the shave to ready for new hair growth. Often times, patients speak to how difficult it is to face hair loss: there is no hiding that you have cancer and you’re going through treatment. A scarf or a wig simply don’t do the job of your own hair.

Overtime, if you are able to adorn beautiful head scarves, find a wig (or two) that lets you be yourself or wear your bald cut with pride, kudos to you sister! Whatever you choose, women can look amazing without long, thick, and shiny Pantene hair! But, what about other facial hair you had taken for granted?

Hair on your face

Brows look better thick and lashes long and thick, so says society. Regardless of whether you’ve totally bought into that message, we can’t argue the fact that your brows do help to shape your face and your lashes emphasize your eyes. When you’re going through chemo, your brows will likely thin out and your lashes fall out. These small changes can make you look and feel more vulnerable.

Let’s take a step back from these aesthetic features. Did you know that brows and lashes have actual functions? Brows help keep sweat and moisture out of your eyes while lashes protect your eyes from debris. Sensitive to the touch, lashes will also trigger the eyes to shut when there’s a foreign object near the eye. In light of that, can you imagine coming to appreciate why we have these hairy facial features? And, the next time you look into the mirror, remind yourself that these features have a purpose before the definition of beauty find them lacking and needing “modifications”.

Weight gain

Aside from hair loss, the other most noticeable change to the body during breast cancer treatment is weight gain. Perhaps you used to be active and lived a busy life. You might not have been training for a triathlon (or maybe you have been), but your schedule was full. During chemo, you inevitably experience early menopause and a drop in metabolism. Feeling tired and nauseated, you become less physically active and your previous lifestyle seems miles away. Side effects of meds can also cause increase in appetite and weight gain.

What to do about visible body changes

What would be giving and nurturing to you? Would you enjoy going for a makeover? Donning ginormous earrings? Loving your beret turban? Going for a head massage? Whatever it is, I invite you to be gentle with yourself. Your body needs A LOT of comfort and care, not a focus to return to status quo. Just as treatment is for a period of time, so some of the side effects of treatment will also be.

There is no returning to what is normal; rather, it’s about establishing a new normal. While it’s wise to have less on your schedule, you might try to slowly phase in a physical activity or two while on hormone therapy. Start with short walks and lengthen them with time. Be around good company for accountability sake. Above all, listen to your body; it has a lot to tell you.

If you need help reconciling these changes during and post treatment, let me know!

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Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That can also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not at work, she has found yoga to be a wonderful practice to nurture self-compassion.