Two Stories of PTSD

By Harold Cohen, Ph.D.

Maria was only 15 when she was attacked by a group of men on the way home from school. They took turns screaming abuse at her and then they each raped her. Finally, they tried to stab her to death and would almost certainly have succeeded had the police not arrived on the scene. For months after this horrifying event, Maria was not herself. She was unable to keep the memories of the attack out of her mind. At night she would have terrible dreams of rape, and would wake up screaming. She had difficulty walking back from school because the route took her past the site of the attack, so she would have to go the long way home. She felt as though her emotions were numbed, and as though she had no real future. At home she was anxious, tense, and easily startled. She felt "dirty" and somehow shamed by the event, and she resolved not to tell close friends about the event, in case they too rejected her.

Joe saw a good deal of active combat during his time in the military. Some incidents in particular had never left his mind – like the horrifying sight of Gary, a close comrade and friend, being blown-up by a land-mine. Even when he returned to civilian life, these images haunted him. Scenes from battle would run repeatedly through his mind and disrupt his focus on work. Filing up at the gas station, for example, the smell of diesel immediately rekindled certain horrific memories. At other times, he had difficulty remembering the past — as if some events were too painful to allow back in his mind. He found himself avoiding socializing with old military buddies, as this would inevitably trigger a new round of memories. His girlfriend complained that he was always pent-up and irritable – as if he were on guard, and Joe noticed that at night he had difficulty relaxing and falling asleep. When he heard loud noises, such as a truck back-firing he literally jumped, as if he were readying himself for combat. He began to drink heavily.

Both Joe and Maria suffered from PTSD and, with time, both were able to control their symptoms. The first step in this process was for each of them to find someone they could trust – for Maria it was her art teacher, and for Joe it was his girlfriend. It was important for them to share how they were feeling, but it was also helpful for them to have someone who would listen. To Maria's surprize her art teacher reacted very supportively, seeing her not as "soiled", but as very hurt, and in need of help and comfort. Joe's girlfriend also expressed her willingness to help him cope with his intrusive memories, but she insisted that he find a way other than alcohol.

Maria and Joe both decided to participate in therapy. Maria worked with a therapist and then began group therapy where she was able to discuss the rape and her reaction to it with other people who had been sexually assaulted. She found that the support of others who had been in similar situations made her feel less alone. She learned that feeling "dirty" and somehow guilty after being raped is a very common experience, and after that she was better able to express her anger towards the man who had raped her. Working with this group also allowed her to begin to re-connect with and trust others.

Joe was not comfortable working with a group of people and chose to work with a therapist one-on-one. His first step was making the decision to stop drowning out his memories by using alcohol. He and his therapist then began to discuss his combat experiences, identifying the activities, people, sounds, and smells that could trigger these symptoms, and working on ways to manage his symptoms. Although he was initially reluctant to deliberately expose himself to such cues, he eventually agreed to an exercise of seeing old war movies. Over time, he learned to watch such movies and continue to remain reasonably calm.

In addition to therapy, medications helped Maria and Joe relieve some of their symptoms. The anti-depressant that Maria took helped to decrease the intrusive memories and her levels of anxiety. For Joe, the medication made him less irritable, less jumpy, and also helped with the problems he had falling asleep. Joe developed sexual side effects on his first medication, and although he wanted to discontinue all medications, his therapist succeeded in encouraging him to switch to a different agent.

Maria's symptoms ended within three months, while Joe's lasted longer. Both were eventually able to control their symptoms through a combination of therapy, medication, and the support of family and friends.

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Green Spaces Reduce Stress Levels

Green Spaces Reduce Stress Levels

By Janice Wood Associate News Editor
Reviewed by John M. Grohol, Psy.D. on February 16, 2012

The presence of parks and woodland in economically deprived areas may help people cope better with job losses, post-traumatic stress disorder, chronic fatigue and anxiety, according to a new study.

The study found that people's stress levels are directly related to the amount of green space in their surrounding areas — the more green space, the less stressed a person is likely to be.

Researchers measured stress by taking saliva samples from a group of 35- to 55-year-olds and measuring levels of cortisol, a hormone released in response to stress. They found that if less than 30 percent of a surrounding area was green space, its population showed unhealthy levels of cortisol.

The study shows that for every one percent increase in green space there was a corresponding — and steeper — decline in stress levels. Where there is more green space, people tend to respond better to disruptive events, either by not getting as stressed in the first place or by coping better, researchers said.

Participants were also asked to rate their stress levels and these results directly related to the percentage of local green space, the researchers note. People with more green space had lower levels of self-reported stress.

Exercise was another factor found to reduce stress, but it may not be related to exercising in park land, researchers added. People reported feeling less stressed if they lived in areas with more green space, regardless of how much exercise they did.

The research was led by the University of Edinburgh and Heriot-Watt's OPENspace research center, working with the Universities of Glasgow and Westminster. The findings were published in the journal Landscape and Urban Planning.

Source: University of Edinburgh

 

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Secrets, Shame, And Guilt

By Nanette Burton Mongelluzzo

A secret is something that is kept hidden.
We all know about secrets. There are quite a variety. There are good secrets; those we keep about the surprise birthday party or the special gift you have for someone you love. Good secrets can also be the confidences we keep for others that will not cause harm.
Therapists keep secrets, siblings keep secrets, employees keep secrets, friends keep secrets, and there are secrets about the past that one or two people may know, but they keep this private out of respect for you.
There are bad secrets as well. Bad secrets are those things that usually mean someone is getting hurt. In counseling teens ask me to keep things secret that sometimes cannot or really should not be a secret. Sometimes these are secrets that are about child abuse, sexual abuse, or other harm that has come to the young person or someone they know.
Let’s take a look at secrets; the good and not so good. Let’s take a look at the significance of shame and the difference between shame and guilt. All of these involve anxiety, worry and fear.
The origin of secrets dates back to the beginning of human interpersonal communication. The soon as human beings began living in groups it became necessary to have secrets. Somewhere along the way, usually through an unfortunate circumstance, a human discovered the dire consequences involved in not keeping a secret. It may have been taking a rock from a pile a neighboring tribe had used as a collection site for eventual tools. It may have been hunger related. It may have been part of a strategy to have kept a secret. We have had secrets as long as we have lived in groups.
Secrets have a long history. There are secret societies, secret rituals, secrets involved in Shamanism, and secrets used in Game Theory. There are secret cults, secrets in government, secrets with regard to spies and spying, and secrets in nature. Animals often build their den or nest in a concealed, or secret place in order to protect their home from intruders. Animals bury their food or hide it, as in the example of dogs burying a bone, squirrels hiding nuts, or pack rats hiding just about anything they find including bright pieces of aluminum and candy wrappers.
People consciously keep secrets about themselves due to shame, or perhaps guilt. We don’t want others to know everything about us for fear of being judged, harmed, ridiculed, embarrassed, or even exiled in some fashion. Sometimes people keep secrets from themselves concerning something they cannot accept and therefore cannot fully incorporate into their knowing about self. We keep secrets about harmful or bad things we have done to others. Families keep secrets and often these are secrets with dire psychological consequences for everyone.
There is a difference between shame and guilt.
Shame is when you feel like you’ve done something wrong but you don’t know what it is that you’ve done wrong.
Guilt is when you feel you’ve done something wrong and you have. You can feel guilty about breaking into Marlowe’s Department Store when you were 13, because you really did do this.
You can feel shame about the way someone talks to you, looks at you, or when someone shows disapproval. Shame is formless, ethereal, floating, and penetrating. It is hard to wrap one’s hands around shame.
The origin of shame is believed to be in early childhood. It is a technique used by many, if not most, families to obtain obedience to authority. Remember being told not to do something because of how it would make your mother, father, brother, sister, or someone feel? Do you recall hearing that you needed a certain behavior because, ‘What would the neighbors think.’ Shame is a secondary feeling related to the primary feeling of fear. Shame always involves fear.
It may not be possible to have a world without secrets. It may be that too much information is shared. Do we really need to know everything about everyone? Couples often ask me if I think it is healthier for them to disclose everything to one another. My response is, “Absolutely not, please don’t.” I believe in keeping secrets as long as the motivation for keeping them is one of good intentions. I believe secrets can keep us safe and secrets can hurt. Again, it depends on the motivation behind the secret.
More importantly it is essential to look at shame. Shame usually involves something that wasn’t said and wasn’t done. When parents use shame as a form of corrective discipline they are not thinking about the secret they are keeping. When mother says, “You should feel really bad that you made noise and your dad couldn’t sleep. He works hard for this family.” The secret is that mother is not telling something about her. Perhaps she is afraid of father’s anger. Perhaps she is just afraid. Likely she doesn’t know a better way to ask you to keep down the noise and so she resorts to shame.
In the end I think we want to make an earnest attempt at being honest with ourselves. Embrace the dark sides, the errors, the horrible mistakes and costly miscalculations. This releases shame and with it the secrets we may no longer need to keep.

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A View of PTSD Symptoms as Healthy by Athena H. Phillips, MSW, LCSW, Post Traumatic Stress / Trauma Topic Expert Contributor

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Trauma symptoms are often experienced and viewed as invasive and malevolent.  Helplessness, hopelessness, confusion and a condemnation of self for their existence also appear thematic.  The initial layer of trauma treatment is frequently the unraveling of self-loathing for the expression of symptoms themselves; survivor and therapist collude in their endorsement of them as being inherently destructive and are to be eradicated.  A divergent perspective could be that symptoms are an expression of health versus illness.  Viewing the manifestation of PTSD (Post-traumatic stress disorder) as having utility may offer an alternative understanding of the client’s presentation as offering direction to treatment, internal compassion, decreasing fear of symptoms and can foster a relationship between survivor, therapist and Trauma.  Additionally, the externalization and personification of Trauma may illuminate the individual functions of client presentation while offering precise direction for treatment.
In the embodiment of Trauma we view it as something that has characteristics and ways of being in the world that are consistent over time and place (and in this case it’s interaction with people).  Defining PTSD according the DSM IV is a means of detecting  its’ presence in the life of a survivor while establishing a foundation for this discussion. According to the DSM IV(American Psychiatric Association (1994). Diagnostic and statistical manual of mental health disorders (4th ed). Washington DC: Author), diagnostic criteria include intrusive memories, thoughts, or dreams of an event, a sense of reliving it,  and intense distress in response to both internal and external cues that resemble an event(s).  Individuals may thus become avoidance of triggers or cues, increase isolation, may have a sense of waiting for the other shoe to drop (a foreshortened future) and of being detached.  Sleep difficulties are common; mood labiality, and hyper vigilance are also common (American Psychiatric Association (1994). Diagnostic and statistical manual of mental health disorders (4th ed). Washington DC: Author).
Drawing from the concepts of narrative therapy and the externalization of a problem (the person is not the problem the problem is the problem) allows us to develop a relationship with Trauma and to begin to evaluate its’motivations (Playful approaches to serious problems: Narrative therapy with children and their families. Freeman, Jennifer C.; Epston, David; Lobovits, Dean New York, NY, US: W W Norton & Co. (1997). xvii, 321 pp.).  Symptoms could be conceptualized as tools utilized by Trauma on our behalf in order to protect us, remind us of our core values, and to ensure that what happened before won’t happen again. It could be argued that the trauma response corresponds to the level of violation on self and values; a profoundly disturbing event calls for a profoundly disturbing response (from Trauma’s perspective).  Analogous to the concept of stuck points in Trauma-Focused Cognitive Behavior Therapy (Akin-Little, Angeleque (Ed); Little, Steven G. (Ed); Bray, Melissa A. (Ed); Kehle, Thomas J. (Ed), (2009). Behavioral interventions in schools: Evidence-based positive strategies, School Psychology (pp. 325-333). Washington, DC, US: American Psychological Association, xi, 350 pp.) flashbacks, dreams, invasive thoughts and triggers provide specific information about the violation the client’s event(s) infringed upon them.
The appraisal of an individual who is “symptomatic” of PTSD could render the view that they are sick, crazy or irrational.  They might appear dissociative, clinically depressed, anxious, highly reactive or rageful (or all of the above).  Both therapist and survivor may be in agreement that these symptoms are a mark of disease, which connotes that alleviation of symptoms is the obvious goal.  An alternative view may be that Trauma will relax once there is a degree of trust in self to clearly identify one’s core values, to reflect his/her significance in the world, and in one’s ability to maintain safety. It will refrain from presenting images (flashbacks and dreams) when the stuck point has been identified (will cease making statements that the individual is culpable for what happened once there is a demonstration of mastery over the event, and it will hold back on invasive, persistent thoughts once the survivor is able to look at the event rather than avoiding it.  The way in which the symptoms manifest reflect individual values and provide explicit guidance for healing; if therapist and client are willing to work with trauma, listen and absorb the information it has to offer, it will not compelled to invade with such rigor.
In working with survivors, the aspect of their event that is troublesome can be quite specific and idiosyncratic.  Additionally, groups of people exposed to the same event often are disturbed by different parts of it. Trauma may be providing images to the survivor in the form of flashbacks, invasive thoughts or dreams to vehemently demonstrate the specific violation imposed by the event(s).  Interpersonal trauma such as child abuse, domestic violence, or sexual assault may render someone feeling responsible for what happened to them, feeling dirty or shameful, betrayed, feeling duped or foolish, unimportant or completely exposed.  Trauma might be conveying to someone that they are at fault for an assault because it wants the individual to have a sense of mastery or agency.  Helplessness is not acceptable to that particular individual and thus blaming the self is an acceptable tone to assume. Repetitive images of betrayal in the context of trauma and the associated feeling of foolishness would reflect Trauma’s attempt to ensure you do not trust people you shouldn’t. Feeling foolish is unpleasant enough to deter us from repeating the same mistake, and from the perspective of Trauma, will maintain inner safety.
The way in which a survivor expresses their PTSD can vary widely and presentations can be very complex and oppressive.  Survivors blame themselves for what happened and often enter into treatment with a great deal of shame because they should have “gotten over it” without help. Viewing their presentation as useful, even critical to their treatment trajectory as well as providing specific insight to their core values may offer some relief from shame. Entertaining the possibility that one does not respond to catastrophic events highlights the conceptualization of symptoms as healthy; a non-response would likely be more problematic than the manifestation of PTSD.  In other words, Trauma isn’t irrational in it’s assumptions; its’ response is proportionate to the event experienced by the survivor and is working toward rebuilding that which was lost to tragedy.

Athena H. Phillips, MSW, LCSW, therapist in Portland, OR. All Rights Reserved.

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Medication helps some with mild depression

By Genevra Pittman

NEW YORK (Reuters Health) - People with mild depression may benefit from taking antidepressants, suggests a new analysis of past studies that compared symptoms in people on the drugs to those given drug-free placebo pills.

Some earlier reports had suggested that antidepressants generally only improve mood in people with severe depression.

But that might be because those studies weren't precise enough to pick up on smaller changes in symptoms that can still make a difference for people with milder forms of the disease, researchers said.

"I think there's a valid concern... that if someone has not-that-severe depression that hasn't lasted that long, maybe it will get better itself or with therapy," said Dr. David Hellerstein, from the New York State Psychiatric Institute and Columbia University, who worked on the study.

Still, he said the question of whether or not to prescribe medication shouldn't necessarily come down to how severe the depression is, but how long symptoms have lasted.

People with "transient depression" that will improve with diet or exercise or after a few weeks of therapy "shouldn't be taking the risk of being on meds," he told Reuters Health.

"But people who have more persistent depression should be evaluated for treatment and medicine should be one of the options," even when the depression is more modest.

Hellerstein and his colleagues collected data from six studies done at the state's psychiatric institute between 1985 and 2000. Those included 825 people with non-severe, long-lasting depression enrolled in trials that compared symptoms with antidepressant treatment versus a placebo.

In three of the six studies, patients taking an antidepressant improved more on a widely-used scale of depression symptoms and severity than those taking a placebo, and in four studies, a higher percentage of patients taking antidepressants went into remission, meaning they were no longer considered to have clinically-significant depression.

Depending on the particular drug and study, the researchers calculated that between three and eight people with non-severe depression would have to be treated with an antidepressant for one to benefit substantially from it.

That, they wrote in the Journal of Clinical Psychiatry, is "a range considered by researchers as sufficiently robust to recommend treatment."

The drugs tested in those studies included Prozac, as well as older and now less-popular medications known as monoamine oxidase inhibitors and tricyclic and tetracyclic antidepressants. It's hard to know how well the findings would apply for newer antidepressants, the researchers said.

The results don't mean that everyone with mild depression should be on an antidepressant, a psychiatrist not involved in the study pointed out.

"People with these milder depressions also respond well to counseling and psychotherapy and can respond well to exercise," said Dr. Michael Thase, from the University of Pennsylvania School of Medicine in Philadelphia.

"This is basically saying, these antidepressants aren't that good, and you should also consider other treatment options and don't just focus on the thing that's the easiest," he told Reuters Health.

The researchers said that some combination of antidepressants and talk therapy is considered most effective in depression treatment -- but getting therapy is often more expensive and time-consuming than medication.

Talk therapy can run $100 or more per session, while generic brands of antidepressants usually cost about $20 per month. Drugs may come with side effects, including insomnia and stomach aches, but they're usually minor, according to Hellerstein.

Still, people on antidepressants should be followed closely by a doctor to see how they're responding to treatment, he said.

Several of the authors of the current study reported having received funding for other research projects from drug companies that make antidepressants.

One recent study found that some depressed people on the antidepressant Cymbalta did worse than the comparison placebo group -- but the majority got some benefit (see Reuters Health story of December 9, 2011).

"I believe the basic finding that drugs are more effective than placebo," Thase said.

But, "The benefits of antidepressants may not be that dramatic in patients with milder depressions for whom many other (non-drug) strategies can also be considered."

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Ending Nightmares Caused By PTSD

by

Amy Standen, KQED

Everyone has nightmares sometimes. But for people with PTSD, it's different.

Sam Brace doesn't want to talk about what he saw when he was a soldier in Iraq eight years ago. In fact, it's something he's actively trying not to dwell on. But what he can't control are his dreams.

They're almost always about the same explosion. "When I was overseas, we'd hit an IED," Brace says. "When I have a nightmare, normally it's something related to that."

Healthy dreams seem kind of random, according to Steven Woodward, a psychologist with the National Center for PTSD at the VA Medical Center in Menlo Park, Calif. "They're wacky," he says. "They associate lots of things that are not normally associated."

PTSD dreams are the same real-life event played over and over again like a broken record. "Replicative nightmares of traumatic events ... repeat for years," Woodward says. "Sometimes 20 years."

Scientists wanted to find out the reason why people with PTSD can't sleep and dream normally. One theory comes from Matthew Walker, a psychology researcher at the University of California, Berkeley. His particular interest lies in rapid eye movement, or REM. It's the time during sleep when a lot of dreaming occurs.

It's also a time when the chemistry of the brain actually changes. Levels of norepinephrine — a kind of adrenaline — drop out completely. REM sleep is the only time of day when this happens. That struck Walker as a mystery. "Why would rapid eye movement sleep suppress this neurochemical?" he asks. "Is there any function to that?"

Walker found that in healthy people, REM sleep is kind of like therapy. It's an adrenaline-free environment where the brain can process its memories while sort of stripping off their sharp, emotional edges. "You come back the next day, and it doesn't trigger that same visceral reaction that you had at the time of learning."

Emotions are useful, he says. They show us what really matters to us. "But I don't think it's adaptive to hold onto that emotional blanket around those memories forever," he says. "They've done their job at the time of learning, then it's time to hold on to the information of that memory, but let go of the emotion."

Walker's theory suggests that in people with PTSD, REM sleep is broken. The adrenaline doesn't go away like it's supposed to. The brain can't process tough memories, so it just cycles through them, again and again.

So, what if you could make the adrenaline just go away? Enter prazosin.

Pfizer Inc. introduced the drug under the brand name Minipress in the 1970s to treat high blood pressure. Dr. Murray Raskind, a VA psychiatrist in Seattle, says the drug, now generic, can cost anywhere between 5 and 15 cents. And, actually, it's not terribly effective as a blood pressure medication, he says.

But what prazosin does do is make people less sensitive to adrenaline. About a decade ago, Raskind starting giving prazosin to some of his PTSD patients, including one Vietnam War veteran.

"He had this recurrent nightmare of being trapped by the Vietcong forces in a landing zone and having his best friend killed in front of his eyes by a mortar round," Raskind says.

After a few weeks of treatment with prazosin, the veteran came in for a follow-up appointment. Raskind says the veteran told him that he wasn't sure the medication was working. He was still having the same dream over and over — just about something else. He told Raskind that in the new dream he was in his fifth grade classroom and there was a test. If he didn't pass the test, he wasn't going to be promoted to the next grade. But he never even got the assignment.

"I said, 'That's my nightmare!' " Raskind says.

Indeed, the veteran's new dream was the stress dream of a healthy brain trying to work things out, Raskind says.

This year, the VA is expected to finish up its trial for prazosin. It's already prescribing the drug to about 15 percent of its PTSD patients. Raskind, of course, would like to see that number rise.

"To us, it's a simple thing that works," he says.

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How to Train Your Brain to Alleviate Anxiety

By Margarita Tartakovsky, M.S.

Our thoughts affect our brains. More specifically, “… what you pay attention to, what you think and feel and want, and how you work with your reactions to things sculpt your brain in multiple ways,” according to neuropsychologist Rick Hanson, Ph.D, in his newest book Just One Thing: Developing A Buddha Brain One Simple Practice at a Time. In other words, how you use your mind can change your brain.

According to Canadian scientist Donald Hebb, “Neurons that fire together, wire together.” If your thoughts focus on worrying and self-criticism, you’ll develop neural structures of anxiety and a negative sense of self, says Hanson.

For instance, individuals who are constantly stressed (such as acute or traumatic stress) release cortisol, which in another article Hanson says eats away at the memory-focused hippocampus. People with a history of stress have lost up to 25 percent of the volume of their hippocampus and have more difficulty forming new memories.

The opposite also is true. Engaging in relaxing activities regularly can wire your brain for calm. Research has shown that people who routinely relax have “improved expression of genes that calm down stress reactions, making them more resilient,” Hanson writes.

Also, over time, people who engage in mindfulness meditation develop thicker layers of neurons in the attention-focused parts of the prefrontal cortex and in the insula, an area that’s triggered when we tune into our feelings and bodies.

Other research has shown that being mindful boosts activation of the left prefrontal cortex, which suppresses negative emotions, and minimizes the activation of the amygdala, which Hanson refers to as the “alarm bell of the brain.”

Hanson’s book gives readers a variety of exercises to cultivate calm and self-confidence and to enjoy life. Here are three anxiety-alleviating practices to try.

1. “Notice you’re all right right now.” For many of us sitting still is a joke — as in, it’s impossible. According to Hanson, “To keep our ancestors alive, the brain evolved an ongoing internal trickle of unease. This little whisper of worry keeps you scanning your inner and outer world for signs of trouble.”

Being on high alert is adaptive. It’s meant to protect us. But this isn’t so helpful when we’re trying to soothe our stress and keep calm. Some of us — me included — even worry that if we relax for a few minutes, something bad will happen. (Of course, this isn’t true.)

Hanson encourages readers to focus on the present and to realize that right now in this moment, you’re probably OK. He says that focusing on the future forces us to worry and focusing on the past leads to regret. Whatever activity you’re engaged in, whether it’s driving, cooking dinner or replying to email, Hanson suggests saying, “I’m all right right now.”

Of course, there will be moments when you won’t be all right. In these times, Hanson suggests that after you ride out the storm, “… as soon as possible, notice that the core of your being is okay, like the quiet place fifty feet underwater, beneath a hurricane howling above the sea.”

2. “Feel safer.” “Evolution has given us an anxious brain,” Hanson writes. So, whether there’s a tiger in the bushes doesn’t matter, because staying away in both cases keeps us alive. But, again, this also keeps us hyper-focused on avoiding danger day to day. And depending on our temperaments and life experiences, we might be even more anxious.

Most people overestimate threats. This leads to excessive worrying, anxiety, stress-related aliments, less patience and generosity with others and a shorter fuse, according to Hanson.

Are you more guarded or anxious than you need to be? If so, Hanson suggests the following for feeling safer:

• Think of how it feels to be with a person who cares about you and connect to those feelings and sensations.
• Remember a time when you felt strong.
• List some of the resources at your disposal to cope with life’s curveballs.
• Take several long, deep breaths.
• Become more in tune with what it feels like to feel safer. “Let those good feelings sink in, so you can remember them in your body and find your way back to them in the future.”

3. “Let go.” Letting go is hard. Even though clinging to clutter, regrets, resentment, unrealistic expectations or unfulfilling relationships is painful, we might be afraid that letting go makes us weak, shows we don’t care or lets someone off the hook. What holds you back in letting go?

Letting go is liberating. Hanson says that letting go might mean releasing pain or damaging thoughts or deeds or yielding instead of breaking. He offers a great analogy:

“When you let go, you’re like a supple and resilient willow tree that bends before the storm, still here in the morning — rather than a stiff oak that ends up broken and toppled over.”

Here are some of Hanson’s suggestions for letting go:

• Be aware of how you let go naturally every day, whether it’s sending an email, taking out the trash, going from one thought or feeling to another or saying goodbye to a friend.
• Let go of tension in your body. Take long and slow exhalations, and relax your shoulders, jaw and eyes.
• Let go of things you don’t need or use.
• Resolve to let go of a certain grudge or resentment. “This does not necessarily mean letting other people off the moral hook, just that you are letting yourself off the hotplate of staying upset about whatever happened,” Hanson writes. If you still feel hurt, he suggests recognizing your feelings, being kind to yourself and gently releasing them.
• Let go of painful emotions. Hanson recommends several books on this topic: Focusing by Eugene Gendlin and What We May Be by Piero Ferrucci. In his book, Hanson summarizes his favorite methods: “relax your body;” “imagine that the feelings are flowing out of you like water’” express your feelings in a letter that you won’t send or vent aloud; talk to a good friend; and be open to positive feelings and let them replace the negative ones.

Margarita Tartakovsky, M.S. is an Associate Editor at Psych Central and blogs regularly about eating and self-image issues on her own blog, Weightless.

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