COVID-19: Managing the Mental Mayhem

How to Connect in Times of Isolation and Uncertainty — June 29

As the experience of “social distancing” continues, it is natural to feel awkward or uncomfortable around other people. Between self-quarantine periods, isolation, and uncertainty about covid19, we may feel like we are losing a sense of socialization.

The fact is, we are still quite capable of feeling connected. We just need to recognize new ways to connect. Did you know that human culture has experienced social connection is a variety of ways throughout history? In some areas, a head nod and wave is considered a warm way of greeting someone. There was a time when curtsies and bows were the preferred method of demonstrating interest and respect for another person.

We are living through a period when we are called upon to develop ways of connecting and communicating with diminished facial expressions. Most of our communication is expressed through body language, for example, posture, eye contact, facial expression, tone and volume of voice. With the opportunity to see most of each other’s faces and touch each other restricted, we can intensify other methods of connecting and communicating.

So, let’s look at some ways to feel less awkward and instead feel more comfortable with social distancing:

1. Let’s rename “social distancing” to “physical distancing.” It is a more accurate phrase, because moving our bodies apart and covering our mouths and nose does not prevent us from socially interacting. For example, visiting via videoconference or singing with neighbors on our front porches can be very social.
2. Consider ways to acknowledge other people when in public besides smiling or hugging. Make your neighbors laugh by bowing or curtsying when you see them. Nod and wave to strangers when you are waiting in line or passing each other in public. Tell the grocery cashier that you are smiling under your mask (I do this regularly with people, and it usually brings positive responses). Say out loud what we are all probably thinking, for example, “Wow, isn’t it strange that we’re all standing in line on these 6-foot marks on the floor?” Say “hi” or “hello” to people and use an uplifting tone of voice.
3. If you have children (or just want to make this more fun and less restrictive for yourself), let them decorate their masks. They may want to pretend that they are a superhero. Draw smiles or other fun and pleasant facial expressions on your mask. Also help your children to practice wearing their mask before they go out. It can take getting used to breathing through the mask and having our faces covered. At the same time, be sure to breathe fresh air when you are in safe areas to take your mask off.
4. Remind yourself that following safe practices is an act of altruism. You are doing something actively to help prevent other people from getting infected. You are also helping others feel more comfortable if they are afraid of contracting the virus. This is a time when we can all benefit ourselves from thinking kindly of others. Altruism is a positive psychological trait, and it has been shown to reduce feelings of anxiety, depression, and loneliness.
5. Remind yourself that the distance may feel uncomfortable, yet when we are able to be close to someone or touch them again, it is even more meaningful.
6. If you are uncomfortable doing some usual public gestures, like holding a door for someone, let them know that you are apologetic for not holding the door. You can reinforce the fact that you are upholding 6-foot distancing for both of you, for example “sorry I’m not going to hold the door – I want to respect us keeping a safe distance”.
7. Create reasonable goals to practice connecting in new ways in public. For example, you may decide that you will make “small talk” with three people each time you are in public, while following distancing recommendations. Or you may decide to nod and wave to each person you pass.
8. Allow yourself and others to express thoughts and feelings without judgement. This experience is powerful to each of us in a variety of ways. We will have a variety of responses. At the same time, allow yourself to respectfully exit a conversation if it becomes anxiety-provoking or divisive. Acknowledgement of the challenges of these cultural changes from covid19 is healthy. It is also healthy for each of us to have clear boundaries regarding topics and direction of conversations. Be gentle with yourself and others. We are all striving to adjust and manage.

These are a few ideas to get you started. My next posting will continue discussion of this topic in hopes of helping all of us feel more comfortable and less awkward with the changes we are making to reduce the spread of covid19.

Wishing you good health, comfort, and connection, Dr. Lori Kleinman

Exercise & Restructured Thinking Can Energize You Toward Action & Solution — June 19

Have you ever found yourself feeling down or frustrated with or without apparent reason? If you have, you are a true normal human being. Our moods and feelings are naturally changeable, which can help us identify what is and is not acceptable to us. Another way to look at it is that feelings act as a barometer of the pressure we may be experiencing in our lives. That pressure may be external (work, finances, COVID-19 pandemic, etc.) or internal (self-expectations, fatigue, etc.). Once we learn to work with our feeling responses, those responses may seem less distracting and more helpful. For example, we may ask ourselves, “What is going on that needs my direct attention or different behavior to create a solution?”

In addition to feelings acting as a barometer of our perceived life pressure, some research suggests that feelings may change simply as a response to biological processes. In other words, sometimes a feeling is just a feeling. Give it some time, and it will pass. If it does not, then maybe something else is going on. The good news is that regardless of the cause of our feelings, we can act to increase or decrease the intensity of feeling as well as possibly change the feeling. If we feel happy, we most likely want to maintain or increase the feeling. If we feel “down-in-the-dumps,” we would likely want to change or decrease the feeling.

So, what do we do to influence our feelings in the direction of happiness, comfort, peace? First, we do things that have been shown to be effective in research and practice. Fortunately, we have a variety of interventions that have been experimentally and clinically (and practically) proven to improve mood and feelings. Two of those areas of intervention include exercise and restructuring our thinking.

Yes, once again, exercise shows itself to have tremendous benefits. Research in health psychology and medicine demonstrates the positive effects of exercise in reducing mild to moderate depression. We now know that exercise improves mood in a variety of ways. The act of exercising focuses our attention on something healthful to us rather than on negative thoughts. Our method of exercise may include stretching, weight training, or cardiovascular conditioning. Some specific examples include yoga, dance, push-ups, jumping jacks, biking, walking, running, or pilates.

Exercise also causes chemical changes in the brain. The most widely known of these is referred to as “runners’ high” or “endorphin rush.” We don’t have to be marathon runners to experience the benefits of chemical changes from exercise, however. Even moderate cardiovascular or weight-training activity has neurochemical benefits that can improve mood. We see the positive changes in our body in terms of appearance, energy and strength. We feel the positive changes as we feel relaxed with an uplifted mood.

Another way to improve our mood and feelings is by using our thoughts, or cognition. Whether or not we are aware of it, we are always thinking. Much of this thinking becomes automatic, like a recording running in the background of our lives. Some research suggests that many of us may have “negative” thoughts over 80% of the time. We may say horrible things to ourselves that we would never accept from a friend, stranger or loved one. These thoughts are not just psychological, they are also biological. Chemical changes occur in our brains in relation to our thoughts. Thoughts also can be affected by changes in our brain chemistry due to other causes, such as from certain illnesses.

We can be passive listeners, or we can learn to think actively. Here are some ways to think actively and improve your mood:

1. Focus on the facts of a situation and keep your thoughts oriented toward possible solutions. Create realistic, reassuring thoughts that are self-encouraging and help move you toward effective solutions.
2. When you recognize a negative thought about yourself or someone else, counteract it with three positive thoughts about yourself or that person. This helps reduce the intensity of frustration or disappointment, so you can process those thoughts more easily.
3. If you feel trapped in a problem without solution, think about a past problem that you solved and apply those strategies to your present situation. It is not about positive thinking alone; it is about identifying possible solutions.
4. Communicate with others directly rather than assuming what they mean or intended. Misunderstandings are natural, and we need to continue the conversation to seek better understanding. Use good communication strategies like clarification, summarizing, and asking for more information before drawing conclusions.

These methods are worth using if you experience yourself in a low mood. They are not a substitute for dealing with your problems, only a way to reduce possible interference toward finding solutions. Both exercise and restructured thinking can energize you toward action and solution. Also remember that some problems and persistent low moods may require additional intervention and/or professional help. Be open to possibilities that may enhance your life experience and let you enjoy each moment.

Wishing you good health and uplifting thoughts, Dr. Lori Kleinman

Managing Stress to Reduce the Intensity of Difficult Feelings — June 8

Did you know that stress can be experienced as many different feelings? Sometimes, we find ourselves angry, sad, frustrated, fearful, or lonely, and what is underneath those feelings is stress. Of course, there are other reasons why we may have many different feelings, but managing our stress level will help us reduce the intensity of difficult feelings. Managing our stress can also refocus us emotionally and prevent the stress from triggering difficult feelings.

So, here’s a basic refresher on stress management. I also encourage you to scroll down and read some of my previous blog postings about coping and managing life stressors, especially during the covid19 pandemic.

Become aware of your thoughts and adjust them as needed — Remember that you have control over your responses, even when the stressors seem out of your control. Stress results from the combination of “what is happening” and “how we respond.” You can immediately reduce your stress level by identifying a new perspective on the event or situation.

Strive to keep thoughts “realistic, reassuring, and solution-focused” — Pay attention to the way you talk to yourself. Be honest and kind.

Identify people in your life who focus more on solutions than problems — Become aware of interactions that “lift you up” and those that “bring you down.” Limit your time and/or change focus of conversations that result in interactions that leave you feeling drained or stressed. If you can’t leave the situation, remember we each see things from our own perspective and reframe it as a challenge for you to keep centered.

Focus on “fitness” rather than “exercise” — Fitness is about keeping your body and mind in optimal condition. Choose physical activities that you enjoy, such as a brisk walk in a beautiful park, neighborhood, or in the forest, or riding a bike, kayaking, dancing, etc.

Take control over what you eat by choosing healthier foods over empty calories – It’s not about depriving yourself, but rather about giving your body more of what it needs to feel good and function well. Eat fresh foods & drink plenty of water.

Actively commit to improving your sleep quality and to getting 7-8 hours of sleep most nights — Use your bedroom for sleep and sex only — no reading, tv, computers, eating, or working. Get up at the same time every morning, even on weekends, and get out of bed if you’ve not fallen asleep after 20-30 minutes until you are tired. If your mind is racing, journal or make a list of your thoughts or do a quick and quiet activity. Plan your day before you get out of bed in the morning. Reflect on positive experiences from your day before you go to sleep.

Utilize relaxation exercises daily and before sleep — The past has passed. “Be Here Now,” and focus on the moment and the future to help keep yourself calm and focused.

Wishing you good health and comfort, Dr. Lori Kleinman

Ways to Improve Your Mood During Uncertain Times — May 29

It is natural to experience mood changes during uncertain times. Usually, these mood changes resolve naturally as move through our day. However, there are times when a “low mood” or “funk” can linger, making it difficult for us to focus or do the things we want or need to do..

We have power to change our mood using best practices from the field of psychology. These best practices are based on both scientific research and clinical observation. There is a better chance of getting the outcomes we want when we use best practices.

So, let’s see what we can do to improve our mood and get back to the lifestyle and activities that bring us joy and comfort, using best practices from psychology.

1. Moderate exercise is a great way to reduce mild to moderate depression symptoms, especially with regard to low energy and low mood. Moderate means we are really moving our body but not to the point of getting winded or having any strain. Moderate exercise can include taking a brisk walk, jogging, riding a bike, jumping rope, marching in place, dancing, and many other forms of movement. Remember to also stretch gently after moderate exercise, and drink plenty of water to avoid dehydration. Moderate exercise has been found to help improve our energy and lift our mood. Check with your doctor if you may have any medical reasons to use caution when exercising.
2. Getting enough sleep seems like an obvious need because we feel fatigued when we have not slept. Did you know that getting enough sleep also improves our mood? Enough sleep means 7-8 hours for most adults, about 12 hours for toddlers, 10-12 hours for children up to the age of 12, and 8-9 hours for teenagers. When we sleep, our brain and nervous system reset, memories consolidate, and several other physical and mental processes take place. If you are having difficulty sleeping, check out my blog from April 23 “The Importance of Sleep” or look-up sleep hygiene guidelines on the Internet. If you continue to have difficulty sleeping, contact your healthcare provider.
3. Make a list of things you would do if your mood were improved. In fact, it is good to do this when you are already in a fairly good mood. List activities that bring you joy, happiness, interest, connection, creative expression. Then use this as a menu of activities when your mood drops. Often, we feel mildly depressed because we are not living purposefully and are just waiting for time to go by. We also can feel mildly depressed because our time is only spent on work and housework and we need a purposeful break. We may feel bored or we may be reacting to stressors in our environment. Many of us are frequently listening to news or reading updates about the Covid19 pandemic and we get compassion fatigued because we feel powerless. There is a clear difference between getting needed updates and information from Boulder County Public Health or the Centers for Disease Control versus listening to dramatic reports of other people’s pain over and over.
4. Recognize the difference between guilt and shame, and work to resolve the guilt and release the shame. Guilt means “I made a mistake”. So, if that is the case, choose what you will do to correct the mistake, if possible. Shame means “I am a mistake”. That has no room in our lives. There is no reason to feel shame. We all make mistakes, and some are quite impactful. Making restitution can ease our burdens and help to make-up for our transgressions, but shame only paralyzes us and can lead to unhealthy behaviors.
5. Set a clear schedule for your day that includes meaningful tasks and purposeful breaks. Then, follow your schedule. Structure in our day can help break-apart the depressed mood and give us a sense of variety and interest. It also helps us to focus and concentrate better. Making and following a daily schedule increases our opportunities to get things done, whether work or play, which helps us to feel like our time was well-spent.
6. Eat nutritious meals or snacks throughout the day. Often, our mood drops because we are not getting the protein, vitamins, minerals, and other nutrients that we need to stay energized, focused, interested, and uplifted. Minimize or eliminate the use of alcohol or other drugs, as they greatly contribute to depression and low mood..
7. Pay attention to your thoughts and adjust them as needed. Notice if you are spending more time on “negative” topics than those that are realistic and reassuring. Our thoughts and feelings are connected, so negative thoughts can create low mood. There is a difference between realistically recognizing a concern (for example, “Things are uncertain and I need to watch my spending”) versus negatively interpreting a situation (for example, “Everything’s falling apart and I can’t handle it”). Notice that the realistic thought includes something you can do (watch spending). The negative thought only includes extreme alarming statements, which can leave us feeling helpless and hopeless.
8. Utilize your support system and connect with others daily on a friendly level. Balance your conversation about troubles with talk about uplifting topics and pleasant memories. Allow your friends and loved ones to comfort you and provide suggestions. Also let them know what you need from them, within reason. Consider what you can offer to them as well. Helping others can also reduce mild to moderate depressive symptoms.
9. Seek additional assistance if your low mood is interfering with your ability to perform basic life functions and is causing impairment. Utilize your primary care provider or local mental health resources as needed, especially if you are having thoughts of hurting yourself or others. Some community resources include:

• • Colorado State Crisis Hotline (844-893-8255)
  • National Suicide Prevention Lifeline (800-784-2433)
  • National Domestic Violence Helpline (800-799-7233)
  • Sources of Strength (youth suicide prevention assistance)

Wishing you good health and uplifted mood, Dr. Lori Kleinman

An Activity to Help You Regain Balance & Control — May 15

Continuing to thrive in uncertain times is challenging for all of us. We may feel like we are continually having to adjust to new information and new experiences. That adjustment can be difficult because we lose our sense of balance and grounding.

There is a basic activity that can greatly help with this sense of balance and grounding. If we practice it consistently, we can begin to thrive again, even in uncertain times. Things may be different and changing, but we can have a better awareness of our position and how we will cope. It is important to remember that we do have control, or power, over our responses and behaviors. As we seize that power, we regain control over our lifestyle and can better adjust to changes.

So, here is what you can do – basic and useful – to regain control:

This activity is called “Grounding”. You can also think of it as a mindfulness exercise. It involves a series of questions that you will ask yourself and answer. Those questions are:

1. Where am I at this moment?
2. Am I safe at this moment?
3. What am I doing?
4. What is happening around me at this moment?
5. What do I see?
6. What do I hear?
7. What do I smell?
8. What do I taste?
9. What am I touching?

Next, take some slow deep breaths, really recognize this moment, and then ask yourself

10. What do I want to do from here?

If you really are unsafe in the moment, it is essential to get yourself to a safe place, either on your own or by utilizing resources in your environment. Most often, we are safe, but we are feeling overwhelmed by the larger problems outside of our immediate environment. For example, we know the numbers of COVID-19 cases, but we may not know anyone in our immediate environment who has been infected by the virus. The more we focus on our immediate experience, the more grounded we will feel. Then we can better cope with the larger problems.

As you ask yourself the sensing questions (what do I see, hear, smell, taste, & touch), you can use items in your immediate environment to activate those senses. For example, smell some cologne or a fresh cut orange, take a sip of tea or lemonade, or listen to a favorite song. This will help you to better experience the moment and get more grounded.

This is a simple and basic activity, yet it can have great effect in bringing us to a place of calm. From that place of calm, we can access our best resources to problem-solve.

Wishing you good health, comfort, and grounding, Dr. Lori Kleinman

Staying Safe & Healthy as Our Communities Start to Reopen — May 5

Here we are getting ready to reopen our County. It’s exciting to see people going back out into the community — to work and interact more publicly than we have been for the past numerous weeks. At the same time, we are still developing solutions to the COVID-19 virus outbreak.

As we prepare to be around more people, there are strategies that will help keep us safe and healthy. Following are some tips to help you safely transition as our communities reopen.

1. Continue to follow Centers for Disease Control and Boulder County Public Health guidelines. Check for updates regularly as we adjust to the changes.
2. Keep your masks, gloves, and hand sanitizer close and clean. If you have multiples of those items, keep them in various convenient places. For example, keep a set in your car, near your front or garage door, in your desk at work, etc. Put a note on your steering wheel or doorknob as a reminder.
3. Practice social distancing and consider what we psychologists call “successive approximations.” That means we don’t jump to a complete change; we do so gradually, in successive steps, until we reach our final goal. Since we are still in the process of reopening, it is important to move in steps, following expert guidelines. Successive approximations is what elite athletes, professional musicians, ballerinas, and others use to get to their performance goals. It is a way to work gradually towards sinking a basketball from center court, playing a difficult musical phrase, turning multiple pirouettes, or in our case, reopening the County and our communities. We move in stages, check our progress, adjust and adapt, and continue to move forward while staying safe.
4. Encourage your friends and family to follow CDC and BCPH guidelines. Help them to understand the concepts in this posting and support each other through this process.
5. Review the previous blog postings, and continue to utilize the ideas in them to maintain a healthy lifestyle. Much of what is in these postings are concepts that are good for us whether we are in a pandemic or not.
6. Add a few fun and safe activities to your lifestyle as we reopen. For example, since many of us are or will continue to work from home, consider some fun ways to let others in your household know you’d like to be left alone. You might pick an item in your home to wear or carry, such as a silly hat, to let others know you want to be “invisible” so they don’t disturb you. You also might want to put a large piece of paper somewhere in your house and start a gratitude list. Everyone can participate in adding to it and recognizing what you’ve all done to stay safe and healthy. If you live alone, your gratitude list might include supports in your environment and activities you enjoy and will continue or begin again.

Life brings moments of joy and of challenge. The key is to look at each phase as one part of a larger experience. We have come together as a community although we have been separated by social distancing. We are getting through this. Stay safe and healthy, and recognize those moments of joy as we all move forward.

Wishing you good health, comfort, and community, Dr. Lori Kleinman

Relaxation Exercises — May 1

As we begin to hear about our communities re-opening, we may experience a variety of responses. For some of us, the re-opening may be energizing, but others may begin feeling overwhelmed and stressed. The overwhelmed feeling is natural when we experience stressors that seem out of our control. However, it can interfere with our ability to manage those stressors. We can begin to feel anxious or depressed, and then our healthy behaviors and habits can go by the wayside. We can feel “frozen” instead of energized. In order to prevent or reduce these reactions, we need to mobilize our inner resources that help us to reduce the stress. That will help to give us a sense of reasonable control as things change in our environment and community.

So, how do we reduce feeling overwhelmed and instead feel energized?

We can gain the sense of reasonable control with a basic relaxation exercise that takes only minutes to do. Using the following relaxation exercise daily or as needed can help you refocus your energy and attention. It will also help your body to reduce stress hormones and create more balance, thereby improving your mood, energy, and even immunity.

First, sit or lay in a comfortable position.
If sitting, uncross your legs, put your feet flat on the floor, sit up straight with your back against the chair, shoulders back without strain, head up straight, hands resting in your lap. If laying down, lay on your back with legs uncrossed, arms at your side, and neck and head straight from your shoulders. You may want to use a small towel roll to support the base of your neck. Once you learn the breathing exercise, you may use it in any position and still receive benefits.

Next, close your eyes and clear your mind of any distractions.
One way to do this is to focus on an image that is pleasant and calming (e.g. a quiet beach or stream, a mountain view, a beautiful flower). Begin to focus on your breathing, allowing the muscles in your body to relax. Slow your breathing and allow even more air to enter and exit your lungs. Begin to expand your stomach and abdomen as you breathe, bringing the air even deeper into your lungs. As you exhale, breathe out all of the air and then inhale into your abdomen.

Breathe so that your stomach rises and falls.
You may place one hand on your abdomen as you practice this. You are moving the focus of breathing from your chest to your abdomen. As you fill your lungs with air, count to five, then count to two as you hold your breath, then count to seven as you exhale. Notice changes in your body as you do this; your breathing becomes slower and deeper, your shoulders release, your legs become loose and flexible, and your jaw and forehead relax.

As you continue to breathe deeply, repeat the word “calm” to yourself.
Use this word to recognize the relaxation flowing through your body; “c” for open chest, “a” for relaxed arms and shoulders, “l” for loose and flexible legs, and “m” for mouth slightly open and relaxed.

Relaxation through diaphragmatic breathing is a wonderful resource that is easy to access. It assists us in focusing our energy and mind on our priorities without distraction. You can easily and quickly incorporate this into your day; begin with ten minutes and expand or reduce the time as you choose. Even three or four deep breaths when something unexpected and stressful occurs can make a significant difference. You will be in a better position to address the unexpected as you better regulate your stress level.

Wishing you good health, comfort, and energy, Dr. Lori Kleinman

The Importance of Sleep — April 23

Today’s posting is about one of the most important lifestyle topics: sleep. Did you know that infants are experts in sleep? Think about it. We begin our life knowing one of the basics of good health and self-care without anyone telling us about it. Infants sleep when then need to, breathe deeply and slowly, rest without distractions, and wake when they are rested. Sometimes they wake up crying in the middle of the night. Their caregivers may not know why their infant is crying, but it’s clear that something is wrong, and it has disrupted the infant’s (and caregiver’s) sleep. By the time we reach adulthood, we have mostly forgotten what we already knew – that sleep is essential and important. It is often upsetting to wake up in the middle of the night. Plus, we simply feel better when we get enough good sleep.

Let’s review what experts know will assist us in getting good quality sleep.

Following are guidelines that were developed for people who have chronic sleep problems, such as insomnia. We have found that these guidelines are good for all of us, because they help the body and mind prepare for and maintain sleep. As adults, we may not wake up crying as infants do, but we can have trouble falling asleep or staying asleep. We also often stay up too late and press the snooze button too many times. As we continue to lose quality and quantity of sleep, we become “sleep deprived”. Since we want to focus on good self-care to support our health and well-being, the last thing we would want is to be “sleep deprived.” As you follow these guidelines, notice how you feel upon waking and how your energy is throughout your day. If you find you are continuing to have sleep difficulties even if following these guidelines, consider checking with your physician in case you need more assistance.

Good Sleep Guidelines

1. Actively commit to improving your sleep quality and to getting 7-8 hours sleep most nights. The number of hours we sleep actually does matter.
2. Use your bedroom for sleep and sex only – no reading, tv, computers, eating, working. This may be more challenging during self-quarantine, so be creative in transitioning between other activities in your bedroom and when you get in bed to sleep. I like to “put the house to bed”, meaning that I dim lights, pull down the bed covers, play soft music, etc. about 30-45 minutes before bedtime.
3. Get up at the same time every morning, even on weekends, as much as possible. It can help to have something to get up for, such as making a good breakfast, calling a friend, etc.
4. Get out of bed if you’ve not fallen asleep after 20-30 minutes. Do a quiet but uninteresting activity until you are tired. Then go back to bed. Keep cellphones, tablets, laptops out of your bedroom so you are not tempted to use them during sleep hours. If your mind is racing, journal or make a list of your thoughts. Remember, if you can’t do anything about a concern until morning, it’s better to get some rest and wake up ready to address the concern.
5. Plan your day before you get out of bed in the morning. Reflect on positive experiences from your day before you go to sleep
6. Utilize relaxation exercises daily and before sleep. This is a great way to transition to bedtime. Take some slow deep breaths like infants do when they are sleeping. Scan your body and release any tense muscles. Imagine some pleasant experiences, especially those in nature.

Wishing you good health, comfort, and quality sleep, Dr. Lori Kleinman

Remaining Optimistic and Hopeful – April 19

As we continue to deal with concerns about COVID-19, it is important that we remain optimistic. Optimism is not the same as positive thinking, though optimistic thoughts usually result in uplifted feelings. Optimism refers to hopefulness the outcome of something will be favorable and even pleasant. It is a mental attitude or way of thinking that looks at possibilities and solutions.

When we are in a stressful or uncertain situation, we may experience fear, worry, and think about the “bad” things that are happening or “bad” things that can happen. This is because our brain and entire nervous system is designed to focus on survival. When we perceive danger, our nervous system goes into survival mode. In that state, we can lose sight of those behaviors and resources that help us move toward solutions. When we are in imminent danger, meaning it’s happening right now, this survival system is fantastic. It really can save our life. But when the danger is “out there,” we’re better off if we remain optimistic.

So, what does optimism look like with regards to the COVID-19 pandemic?

Here are some specific examples for you. In addition, see if you can come up with your own optimistic thoughts. If you have children or others in your household, you could have a fun contest: who can come up with the most optimistic thoughts or sayings?

Optimistic Thoughts

• I’ve been through difficult times in life before and got through them. I will get through this too.
• I’m not sure how to get through this financially, so I’m going to access some resources in my community or nationally. It’s good to reach out for help when needed.
• There are things I can do right now to help reduce the spread of COVID-19 and reduce the chances of my contracting the virus. I will wear a mask in public. I will maintain at least six feet of social distancing. I will work and play from home as much as possible. When I do go outside for fresh air and to move my body, I’ll choose places where it’s easy to maintain distance.
• This is difficult. I know that. At the same time, there are lots of scientists, researchers, and health care professionals working to find global solutions to this pandemic. We’ve solved other pandemics and we can solve this one, too.
• While the uncertainty continues, I will participate in uplifting activities, even if I don’t feel like it, so that I keep my mind and body as healthy as possible. For example, I can listen to music I like, call a friend and share a happy memory, make a gratitude list, dance, watch a favorite movie, draw or paint, go for a walk in nature, or eat something nourishing that tastes good.”

I optimistically wish you good health and comfort, Dr. Lori Kleinman

Stress Hardiness – Bouncing Back from Difficulties — April 13

One of the challenges of the COVID19 pandemic is the continued stress that many of us are feeling. This stress, by definition, means that we may feel strain or pressure on our body, mind, and spirit that seems to be throwing us off balance. That stress is the result of stressors, or things that cause the strain or pressure, such as changes in work or home life. Stress management is a means of managing and relieving stressors so we can get back in balance.

There are many ways to manage stress. In fact, each of these “Managing the Mental Mayhem” blog posts address various ways to manage the stressors related to COVID19. There are also countless lists of stress management activities on the Internet and thousands of books and workbooks about managing stress. Stress is part of life, and the strain or pressure we feel gives us the message that something is off and needs our attention. The key is paying attention and taking effective action so you can reduce, or manage, the stress.

Bouncing Back

There are three basic concepts that will help you manage stress, no matter what specific stress management techniques you choose. These three concepts describe what experts call “stress-hardiness.” Stress-hardiness means that we believe that we can find ways to effectively manage stressors and be resilient, or ‘bounce back” from difficulties.

So, let’s identify the three concepts that help us to have stress-hardiness, and then I will get you started with some fun and helpful stress management techniques.

1. Control — We have an optimistic view, believing we can learn how to manage and solve problems. Also, we focus on things we can control and take responsibility for our part in the solution.
2. Challenge — We accept challenges as opportunities for us to use our own knowledge, skills, abilities, and talents to solve problems. We also see problems as puzzles and opportunities to grow and learn how to effectively ask for help.
3. Commitment — We believe that what we are doing in our life matters. We are aware of our values and strive to live accordingly, bringing meaning and purpose to our lifestyle.

These three concepts create a foundation, and from there we can choose stress management techniques to help us restore and refresh as we’re striving solve our problems. Below are some examples of stress management techniques to get you on your way to a joyful, healthy, balanced lifestyle.

Tips to Balance Body-Mind-Spirit and Enhance Well-Being

• Take some slow deep belly breaths, meditate and/or pray
• Look for multiple perspectives on a problem (and multiple solutions!)
• Select an easy to achieve task and do it!
• Listen to uplifting music and/or Read something inspiring
• Think about the “big picture” – What’s really important?
• Sing, Laugh, Dance, Draw, Play, Smile 
• Eat something nutritious and hydrate
• Call someone you like
• Ask for help and/or help someone else
• Practice Compassion, Empathy, and Tolerance; Forgive yourself & others
• Make a gratitude list
• Identify three supports – and use one now 
• Look at a picture of someone or something you love
• Rest, Sleep, Be Peaceful
• Write in a journal; keep the good stuff; dump the junk
• Pick a favorite activity you would do if feeling good – and do it!
• Recognize at least three wonderful qualities about yourself
• Visualize something that makes you smile
• Watch a funny movie
• Spend some time in nature… without your cell phone
• Be Proactive, Not Reactive

Remember – You are not your problems. Difficulties are just some of your many life experiences.

Wishing you good health and comfort, Dr. Lori Kleinman, Licensed Psychologist

Managing Stress and the Power of Music — April 10

As we continue learning to cope with the COVID-19 pandemic, you may find moments of increased stress. You may even find that you’re feeling continuous low-level stress while adjusting to this new, if temporary, lifestyle. Although we know that “This Too Shall Pass,” it hasn’t yet, so our stress responses are natural and even healthy. The natural part is that our body and mind is responding in-kind to our circumstances. The healthy part is that we can become aware of our level of stress, also known as physical and emotional tension, which puts us in position to decide how we will manage that stress.

We now have a lot of adjusting and managing to do. While we are problem-solving, creating new schedules, and following healthy lifestyle guidelines, there is something we can do that requires little to no effort yet gives us great stress relief. Did you know that simply listening to music can relieve stress without the pressure of learning an entirely new set of skills? We all know that music helps set the mood. Why else do gyms pulse with upbeat tunes and elegant restaurants favor soothing melodies? With just a moment of thought and attention, you can mobilize music into a powerful stress reliever and mood booster. In a previous posting I spoke about being your own superhero. Well, here’s another part of the superhero life; they usually have a theme song! There is power in music and we can use it to empower our own coping and relief during these uncertain times.

Music Therapy

Here’s a little background about music therapy, which is a field that focuses on music for healing. Music therapy began as a formal profession in the 1950’s with the discovery that music and music-based activities could help people with mental handicaps and psychiatric disorders. But the use of music in healing dates to ancient times. Ancient Egyptian and Greek artifacts depict music used in healing rituals. Music is embedded in cultural rituals around the world — in healing, celebration, transformation and spiritual and religious practice. Music therapy draws from this rich history, while also using modern science and psychology to improve physical, emotional, and mental health. But you don’t have to have a clinical diagnosis to enjoy the benefits of music therapy. The key is learning how to use music most effectively to improve our health and well-being.

So, let’s get started really listening to music.

Reducing the Intensity of Our Responses

Most of us can think of moments when a song has evoked memories and emotions. Pay attention to songs that bring feelings of joy, pleasure or hope. Listen to these songs when you are feeling stressed or in a low mood — or really, anytime. The songs you choose may be from any genre — popular, alternative, folk, jazz, classical, country, bluegrass or New Age music. Remember, it is not only the lyrics that matter; the energy or soothing nature of the music itself can bring comfort and relief.

Maybe you are feeling particularly angry or frustrated. These emotions are signals that we’re feeling threatened, vulnerable, fearful or possibly out of control. What if you can’t do anything about the source of the trouble? That’s when it’s crucial to reduce the intensity of our response. Music can be used to “vent” some of the overwhelming emotion and bring us to a more moderate emotional state. Then we’re in a better place to find solutions. Here’s where you put away the soothing New Age music and pull out tunes that match your anger and frustration in intensity. You will want to avoid songs with destructive or violent lyrics, as they can intensify rather than reduce your anger or frustration. As you listen to the music — it will probably have a fast beat, loud bass or percussion, heavier lyrics — really pay attention to how the music feels in your body. Focus your breathing and acknowledge the intense thoughts or body sensations you’re experiencing. Then start switching to songs that are a little less intense, gradually moving toward selections that are more and more soothing and upbeat. It may be helpful to create a playlist for yourself ahead of time, especially if you tend to experience frequent excess stress, anger or frustration.

Focus & Energy

Music also can help increase mental focus and concentration. In studies, classical Baroque music, such as chamber or orchestral pieces by Handel, have been found to help people focus on tasks even more than when those tasks are performed in silence. It seems that the ordered nature and pacing of this style of music are compatible with keeping attention to detail. Even if you are not a classical music fan, it may be helpful to play Baroque music at times when you seem distracted and need to concentrate.

Sometimes we want to increase or decrease our energy. Anyone who has cranked up their favorite music during exercise knows that rhythmic and percussive music is great for increasing energy. Conversely, non-melodic, slow-paced music, such as that in the New Age genre, can greatly enhance relaxation and meditation. Studies have also shown that listening to soothing music, even without practicing deep breathing or meditation, can bring about a relaxation response in the body.

Allow yourself to explore your own responses to the music you choose. Whether you are actively or passively listening to music, you can greatly benefit from the effects of the rhythms, melodies, lyrics, and instrumentation of the songs. Give yourself the opportunity to have moments of joy as you listen to songs that connect you to uplifting memories or hope for the future, along with enjoying the sounds in the present moment. Happy listening! (Please also refer to my previous posting for a song-list to get you started in your music listening adventure).

Wishing you good health and comfort, Dr. Lori Kleinman, Licensed Psychologist & Music Therapist

Music Soothes the Soul — April 6

“Music hath charms to soothe the savage breast, to soften rocks, or bend a knotted oak.” This phrase dates back a 1697 poem, “The Mourning Bride” by William Congreave. Fast forward to our current times, and we have abundant research in music therapy and the psychology of music to know that the phrase is true. Well, maybe we can’t soften rocks or bend a tree with a song, but we certainly can lift our mood and energize our body with music.

Rather than me “lecture-writing” you about the power of music, I am giving you a list of songs that are likely to bring a smile to your face, hopefulness to your mind and heart, and joy to your life. Explore these tunes or create your own playlist of songs that uplift you. I’m including songs that have lyrics, though there is a lot of instrumental music across all genres that uplifts, too.

So, enjoy the sounds of music and enjoy the joyful moments of your day.

Wishing you good health and comfort, Dr. Lori Kleinman, Licensed Psychologist & Music Therapist

Alphabetized Song list to bring you joy, hope, and vitality:

• Don’t Dream It’s Over – Crowded House
• Don’t Worry, Be Happy – Bobby McFerrin
• Drive – Incubus
• Forever Young – Bob Dylan or Rod Stewart
• Hold On – Shawn Mendes
• I Can See Clearly Now – Johnny Nash
• I Got You (I Feel Good) – James Brown
• I Hope You Dance – Lee Ann Womack
• I’ll Be There for You – The Rembrandts
• I’m Still Standing – Elton John
• I Won’t Back Down – Tom Petty
• Lean on Me – Bill Withers
• Somewhere Over the Rainbow – Judy Garland or Israel Kamakawiwo’ole
• Stand by Me – Ben E. King
• Three Little Birds – Bob Marley and the Wailers
• Twist and Shout – The Isley Brothers
• Unwritten – Natasha Bedingfield
• Walking on Sunshine – Katrina and the Waves
• We Are Family – Sister Sledge
• What a Wonderful World – Louis Armstrong

This Too Shall Pass — April 2

These are four simple words that can change the course of our lives right now. Let’s break it down:

This = The COVID-19 virus effects on our individual lives and society..

Too = There have been other large-scale difficulties in our individual lives and society. There will be again in varying ways. That is part of life and part of what brings us together to solve problems and build resilience.

Shall = We are designed to be resilient. Resilience means we can recover from difficulties and bounce back while becoming stronger through the process of recovery. Along with resilience, we have the capacity for stress hardiness. Stress hardiness means we utilize good coping skills during the difficult times to maximize our recovery and resilience. We, as individuals and as a society, can be realistically hopeful that we will survive and even grow stronger through this. In addition, we will cope with the sad and painful parts of this process by using our own strengths as well as reaching out for support and assistance with one another.

Pass = We will move through and beyond this. Stronger. More aware. Closer as individuals and as a society. There will be ease again, and in the meantime, we will actively look for and create moments of joy and relief as we soldier on toward solutions.

Managing Uncertainty

Now, on to the process of how we shall and will manage while times are uncertain:

1. Schedule your time and include breaks
2. Maintain healthy eating and limit sugar, saturated fats, empty calories
3. Keep alcohol use to one or less drinks per day (yes, really!)
4. Move your body and exercise at least an average of 30 minutes per day most days
5. Practice relaxation exercises including deep belly breathing and releasing muscles, especially jaw, shoulders, back, hands
6. Play and laugh, no matter your age, and schedule time for fun experiences into your day
7. Maintain personal hygiene with an attitude of appreciation for your body
8. Stay connected and reach out by voice to friends every day, even if only for a few minutes

Reach Out & Resources

These are challenging and uncertain times. Be gentle and compassionate with yourself and others. Sometimes the demands on us are greater than our existing resources to manage those demands. Please, if you need help, reach out. Below are some resources for you and your loved ones. Keep these numbers available, just in case.

• Colorado State Crisis Hotline: 844-493-8255 (844-493-TALK) or text “TALK” to 38255
• National Disaster Distress Hotline: 800-985-5990 (if emotional distress related to pandemic/disasters)
• Veterans Crisis Line: 800-273-8255, ext 1
• National Suicide Prevention Lifeline: 800-784-2433 (800-SUICIDE)
• National Domestic Violence Helpline: 800-799-7233 (800-799-SAFE)
• Safe 2 Tell: 877-542-7233 (877-542-SAFE) (anonymous reporting if someone in danger)
• Youth Suicide Prevention Assistance: www.sourcesofstrength.org
• Boulder County Public Health COVID-19 Information boco.org/COVID-19

Wishing you good health and comfort, Dr. Lori Kleinman

Organizing Your Time — March 27

Have you ever said to yourself, “If I had more time I would…?” Or have your ever thought, “Someday, I’ll…?” Dreaming about the future and wishing for things in life is perfectly natural. In fact, our psychological research tells us that optimism and future-focusing are healthy traits. Optimism can be thought of as realistic hopefulness. It can also be viewed as having expectations of successful outcomes. Future-focusing means we can see beyond the past and this moment, and are able to create a vision of the future. I like to think of it as. “the past has passed, the present is me in this exact moment, and the future is filled with possibilities that await my choices.” The choices I make and the behaviors I do will give me a sense of control of my future. Even when things are difficult and uncertain, making choices about how we will manage can make the difference between feeling in control or out of control. Another way to think of this is to think of feeling powerful. You know, like a superhero!

Be Your Own Superhero

Superheroes have to deal with a lot of danger and uncertainty. They usually win. And that’s because they are powerful. They keep moving forward even though things are difficult. They use their strengths and resources to solve problems. We humans don’t need special powers to do this. We just need to realize that we have strengths and resources. We need to recognize that we’ve coped with difficulties before and will do so again. We need to trust in ourselves and our resiliency. We need to ask for help when we need it. We need to remember that there is a future and our healthy choices today will make us more powerful. And let’s face it, we all want to feel more powerful – in a good way, like a superhero!

We are in a difficult and uncertain time. However, we still have power over many of the hours in our day and how we use them. We may even be able to start to do some of the things that complete the statements “If I had more time I would…? and “Someday, I’ll…”. We all have 24 hours in a day. Even if we can’t control all of those hours, we can choose our attitude and sense of optimism. Even if we feel uncertain or fearful, we can make choices to do healthy behaviors and think healthy thoughts to reduce the intensity and severity of that uncertainty and fear.

Powerful Tip — Make a Schedule

One of the things we can do that will help us feel more powerful in each 24-hour day is to make a daily schedule. It sounds so very simple: Make A Schedule. Yet, many of us let the day go by without intentional behavior. This is more likely when things are uncertain. Our motivation lessens and we feel helpless. Then we give in to those feelings, and before we know it, hours have gone by without anything enjoyable or purposeful. That cycle continues, and we can begin to feel mildly depressed. We can do something to prevent and change this cycle. We have power to change this cycle! The power comes from our behavior. Behavior is what we do. We can feel unmotivated and depressed while we get up and go for a walk. We can feel uncertain and fearful as we make ourselves a healthy snack. As we do behaviors that are good for us, we begin to feel some relief. As we feel relief, we continue to do behaviors that are good for us, and our day begins to have purpose. Our mood begins to improve, and we feel motivated to do more. We have used our own power to feel more powerful.

So, how do we make a daily schedule?

First, make a list of the things you have to do in a day. For example, work hours, personal hygiene, sleep, meals. Next, make a list of the things that support your health and wellbeing. For example, exercise, relaxation, social contact, learning something new, hobbies/interests, time in nature/fresh air, cleaning your home or car, etc. Then, use a calendar with half-hour increments to fill-in these activities. Start with the “have-tos” and then add from the second list. Also include open time – 15-20 minutes that is unscheduled at various times. It’s important that we have time to rest and reset between some of our activities in the day.

Although we may have restrictions like a Stay-at-Home order or the closing of some our usual hangouts, we still have a lot of power over our day. Following are ideas to get you started with some of the categories listed above. Be creative in your pursuit of a schedule that supports your health and wellbeing. Each day may be different and altogether they add up to a healthy lifestyle. Optimistic, Future-Focused, Powerful!

Where You Can Focus

Work hours

Follow your employment schedule. If you need to work but don’t have a set schedule, make one. Create a space in your home where you will work without distractions. (when I work at home, I often wear 30db construction headphones so I am not interrupted by other noise in my household).

Personal hygiene

Even if you’re staying home, clean your body, brush and floss your teeth, comb your hair, trim your nails. This shows respect and caring for yourself

Sleep

Experts recommend at least 6 hours and preferably 8 hours each night. Keep your bedroom for sleep and sex only – no tech or tv! If you must work in your bedroom, cover your desk with a sheet before you go to bed and turn off the computer. Put your phone in another room, do quiet tech-free activities 30 minutes before you go to bed to help you relax before sleep.

Meals

Experts recommend mostly vegetables, lean proteins, fruit, whole grains as tolerated. It’s important to limit alcohol and other drug intake and limit sugar and saturated fat.

Exercise

Three areas of fitness: stretching, cardio, strength training. Move your body everyday: take walks, use an online fitness video (many are free online), play upbeat music and dance, do pushups or sit-ups or jump rope or jog in place or whatever you are safely capable of (in agreement with your doctor’s recommendations).

Relaxation

Take breaks through the day, take slow and deep breaths, visualize images of comfort and peace, take a nap if you are tired, take tech breaks and news breaks

Social contact

Use your voice to connect with friends and family, tech platforms that let us see each other are great as well, smile at others as you pass one another or checkout at the grocery. If you are more isolated, look at photo albums and hold pictures in your hands if possible while enjoying memories

Learn something new

There are all kinds of free educational options online and possibly on your bookshelf. This can be a formal subject like science or astronomy. This can also be something fun, like music or cooking or a foreign language.

Hobbies/Interests

Hobbies and interests support our creativity, elevate our mood, distract us from life’s difficulties, give us purpose and meaning. Choose something that really interests you. It’s wonderful to get lost in something that makes us feel interested and uplifted.

Time in nature/fresh air

We benefit physically, psychologically, spiritually by spending time in nature. It can be as simple as going outside and breathing or looking at trees. Even passively sitting in a natural setting has benefits for us. Interacting with nature makes it even better.

Clean your home or car

Even if we don’t want to do it — we will feel better if we are in a clean and neat environment. Select one area of your home and get it clean or organized. Clear out the junk in your car, vacuum the seats and floor, wipe down the dashboard.

Enjoy this process as part of your powerful approach to coping with the COVID-19 pandemic. Recognize your strengths and resources and feel your resilience!

Wishing you good health, Dr. Lori Kleinman

Welcome & Dealing with Uncertainty — March 26

Welcome to the Boulder County Public Health mental and behavioral health blog for coping with COVID-19. Our purpose is to help our community members best manage the stress, anxiety, and uncertainty that is a natural part of our experience during this pandemic. Please know that although the current situation is “abnormal” for all of us, it is “normal” to be experiencing thoughts and feelings that are more alarming than usual. The posts on this page will utilize our best knowledge in psychology, medicine, science and even the arts to help you and your loved ones through the coming days and weeks. You will be able to learn about sound psychological principles that keep us healthy and thriving day-to-day. You will also be given ideas and activities that can help make each day feel more meaningful and purposeful to you. We are living under difficult circumstances, and we have the ability to choose how we will respond to those circumstances. Psychology gives us tools to respond in ways that are good for us – good mentally, good emotionally, good physically, good spiritually, good relationally.

So, let’s get started!

First, accurate knowledge helps to lessen our fear and anxiety. It’s important that we focus on accurate knowledge from reliable sources, for example the Boulder County Public Health and Centers for Disease Control websites about the disease. One of the initial things first responders do in an emergency is take account of the facts of a situation using the most accurate knowledge available. It is essential to know what we’re dealing with without distraction, so our emotional responses don’t get in the way of our thinking and coping responses.

Fear is a natural emotional response when we perceive that we are in immediate danger. That fear response leads us to fight the danger or flee from it. In fact, it is called the “fight-flight” response. It helps us to survive when we are in immediate danger. There is much we can do now to reduce any chance of personal danger from this virus, such as self-quarantine to reduce possible exposure and spread. Anxiety is also an emotional response. However, anxiety can interfere with our ability to respond to danger or choose how we will solve problems. The anxiety response can get in the way of our ability to manage a situation. An example of anxiety getting in the way is when we start worrying about what might happen. Instead of being able to recognize a problem, access resources, think about possible solutions, and take purposeful action, we can become emotionally distracted and nervous. Then we have even more difficulty finding a solution, and our anxiety increases.

It’s not unusual to worry when we are faced with ongoing uncertainty. The key is that we need to recognize it and take action to change the anxiety and worry into something productive. Fortunately, what we can do is rather simple. We need to ask ourselves one question: “Is there anything I can do about this thing I’m worried about?” If our answer is “yes”, we can plan what we can do and get started doing it. If our answer is “no”, then we need to start accessing accurate knowledge and resources to help us change the answer to “yes”. Or, we need to recognize that sometimes we can’t do anything, so we need to focus on something else. This takes practice, and the worrying may seep in, but we are starting to learn to self-regulate our responses and use our mental and emotional strength to feel more in control of our life.

Let’s look at the idea of self-quarantine or stay-at-home orders. For most of us, these ideas are in stark contrast to the ways we usually live. We can begin to worry about what might happen, or even what is happening. But if we want to feel more in control of our life, we can use the worry question. “Is there anything I can do about self-quarantine or a stay-at-home order?” Or even better, “What can I do about self-quarantine or stay-at-home order?” Now we’re getting somewhere. Whether it’s voluntary or mandated stay at home, I can choose to comply so that I keep myself and others as safe as possible at this time. Whew…Next, I need to problem solve how I will comply without losing quality of life. I will tell myself, “This is a time for prevention. That means I will do the things that experts say will help us. It also means I won’t do the things that experts say may likely hurt us.” In addition, I will plan for my days at home, including meals, exercise, activities, checking-in with reliable news for accurate knowledge, and social contact by phone, text, email, social media.

Remember, COVID-19 is real and important and is having a huge effect. We may feel uncertain and even scared. Yet we have the best scientists and medical researchers searching for solutions. We are in a country that has been resilient throughout our history. We are also resilient, and these situations remind us of that. This too shall pass, and in the meantime, we will help and support each other through. You have knowledge, skills, abilities, talents that will help you through. Be gentle with yourself and others as we move through this one day at a time.

Wishing you good health, Dr. Lori Kleinman