Blog

By: Eric Kruse 

A Thanksgiving Exercise to do with Family and Friends

We all take things for granted. It’s easy for us to forget about the things in our life that we are lucky to have. For example, if you are able-bodied, you probably forget to be grateful for you ability to walk. Often, we take our relationships for granted. We forget to tell our family, friends, and loved ones how much we appreciate them. Thanksgiving is the perfect opportunity to tell your loved ones how much you appreciate them, and you can do it with the following exercise that I call The Gratitude Hot Seat.
Setup
Add an empty chair to the thanksgiving dinner table. This will be the Gratitude Hot Seat.
Exercise
Each person at thanksgiving table will take turns sitting in the gratitude hotseat. The person sitting in the gratitude hot seat will listen to the others express what they appreciate about them. Going around the table, every person takes a turn saying what they appreciate about the person in the hot seat. 
Conclusion
I came up with this exercise for a thanksgiving dinner with my family a few years ago. I learned things about my family that I had not considered before. It’s amazing what happens at a family dinner when only one person speaks at a time and the focus of the dinner is about expressing what you appreciate about one another. 

By: Eric Kruse

​Dialectical Behavioral Therapy uses a concept called “The Wise Mind.” The Wise Mind is where your emotions and your intellect come together to create a balanced perspective.
The Emotional Mind
Emotions are beneficial because they help us feel things. We cry when we are sad. We smile when se are happy. It provides opportunities for us to cultivate relationships with others because others can relate to our emotional responses. Emotions are the catalyst for empathy and empathy is greatest tool in developing deep emotional bonds with others. 
The Reasonable Mind
Intellect helps us solve problems and think about the world around using knowledge and information. We use it to cook or meals, fix our cars, drive technological advancements, study medicine, and to write blog articles such as this one.
Knowing when to use each state of mind
Being overly emotional or overly intellectual at the wrong time can cause problems. For example, sometimes people in your life want you to empathize with their situation when they are struggling rather than trying to “fix it” with intellectual problem solving. Sometimes, it’s better to keep your emotions under control, such as when you make a mistake at work and you start to feel defensive. You don’t want to act impulsively. 
The Wise Mind – Finding balance
The Wise Mind strikes a healthy balance between intellect and emotions. It allows you to understand others by reading their emotional cues and allows you to process what you want to say and how you want to proceed without impulsively acting on your emotions.
 
The following website link shows a Venn Diagram of The Wise Mind, The Emotional Mind, and The Reasonable (intellectual) Mind:
https://www.therapistaid.com/worksheets/wise-mind.pdf
The bottom of the sheet asks you to list an example of an experience that you have had with each of the three states of mind. I encourage you to apply the knowledge from this by describing your own experience with each state of mind so that you can be more aware of when you are using each state of mind.

By: Eric Kruse

​It has been estimated that humans have anywhere from 30,000 to 70,000 thoughts per day and that up to 80% of these thoughts can be negative. It should be no wonder why so many members of the population struggle with anxiety and depression. It’s impossible to stop ourselves from having negative thoughts, which is why we call them “automatic thoughts,” but we do have control over the thoughts that follow our “automatic thoughts.” 
An effective tool for doing this is to treat our automatic thoughts as guesses. For example, you see people in your office whispering and looking at you and your automatic thought is, “they must be making fun of me.” Instead, try framing that thought as question by altering it to, “Are they making fun of me?” Then follow it with another question, “Are they saying nice things about me? Are they talking about someone or something else and just looking in my general direction?” There are so many conclusions that are positive or neutral that we often miss the chance to consider.
The next step is to write down all the guesses and arrange them into a pie chart. Consider the evidence that supports each guess (i.e., hypothesis) and then assign probability percentage to each guess. For example, the fact that you cannot hear what your colleagues are saying about you and the fact that you don’t know if they are actually looking at you is evidence to support the guess that “they are talking about something or someone else and looking in your general direction” so you can assign I high percentage of the pie chart to that guess. Furthermore, the fact that up to 80% of our daily thoughts can be negative is evidence against the possibility that your colleagues are making fun of you because you now know that statistically there is a high chance that your first automatic thought will be negative. 
Your pie chart can be drawn out by hand our done as a mental image if writing things down is not your thing. The purpose of this exercise is to slow down and consider that your thoughts may not always been accurate, especially when they are tainted by a smoke-colored lens. Treat your thoughts as guesses and make an active effort to follow your negative guesses with neutral and positive guesses. 

By: Eric Kruse

"Great stories happen to those who can tell them." --Ira Glass

“Storytelling is the most powerful way to put ideas into the world today” – Robert McKee
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What is Narrative Therapy?
Narrative therapy is a medium for self-reflection and growth through stories or narratives (hence the name). The general idea is to change your perspective on your life by the way you tell your story. Every event that happens can be told from a positive, negative, or neutral lens. For example, let’s say you are suffering from depression. What is the story you are telling yourself about your depression? Are you telling yourself that there is something wrong with you and that you will feel depressed for the rest of your life? How does that story make you feel? Typing that out made me feel hopeless and sad. This is how the stories we tell ourselves about our life impact how we feel. 
Externalizing our Problem
What if I told myself a different story about my depression? What if my depression was not a part of me, but instead an evil entity that dwells inside me. I can even give it a name, such as The Dark Voyager. Sometimes The Dark Voyageris not inside me. Those are my good days. Whether The Dark Voyageris with me today or not, there is definitely nothing wrong with me. If anything, I am strong person for endearing The Dark Voyager’s poison. This is strength-based narrative that allows me to feel proud of my level of resilience to the depression I am facing. 
Life Stories
The story that you tell about your life does not have to be clever. You are not trying to win a creative writing contest. You don’t need characters, such as The Dark Voyager. You can start with a very simple template, such as “my past, my present, my future.” Here is a link to a free template online:
https://www.therapistaid.com/worksheets/life-story.pdf
Everyone has a story so don’t tell yourself that you don’t. If you tell yourself that your story is dull and boring, then you are formulating a negative narrative, which once again, will make you feel sad about your life. Regardless of how much you believe your life is mediocre and not worth telling a story about, the truth is, it’s not! We have all had formative experiences that have shaped us into the people we are today and those experiences are worth sharing and talking about from a strength-based perspective. 

​What does it mean to be mindful? This is a question I come back to a lot on my own, and also one that my clients ask me often. There are so many ways to be mindful and to meditate, and there is not a one size fits all for any person. The key to living in the moment and learning to be more present can come from starting with the little things. Enjoying your coffee in the morning, taking a ten-minute walk after work, combing your hair and washing your face before bed. It is easy to go through the motions- it is harder to do these things with intention. Taking five extra minutes to sit down when drinking your coffee and not sipping it as you rush out the door. Taking a walk without your phone and paying attention to the beauty and nature around you, instead of making an internal list of what you need to do when you are back. Combing your hair and washing your face and recognizing that this is a way you care for yourself, instead of rushing through it because you feel its another thing that needs to be done. 
 
We can so easily live out of habit instead of out of intent. Being able to stay in the present and make changes requires this intention, and being able to live in the present (or be more mindful!) is what leads us to feeling happier and more content with our life. It can feel overwhelming to feel like we have to be mindful all of the time. When clients come to me and want to start being more present, I always remind them to start small. Form habits and create the time in your day to enjoy what is and just be. Being able to implement this will lead to more lasting change and present moment awareness. Even as a therapist, being mindful is something I am always trying to work at and implement into my life more. Paying attention to what I need and what feels right is important as well and has helped me to take more time for myself and think about what I want for my life in a more intentional way. “The Mindfulness Journal” by S.J. Scott and Barrie Davenport is a great way to help with the process of becoming more mindful and can help with beginning to create that habit into your daily life and practice. I highly recommend this to anyone who is wanting to be more present, aware, grateful and intentional. 

By: Eric Kruse

​Just like the most loaded questions with complex answers, the simple answer to this question is “yes and no” or “it depends.” Let’s start with why video games are stigmatized and how they can be unhealthy and then we will circle back around to the benefits of gaming.
Sitting for Extended Periods of Time
First, when you play video games you are sitting in a chair and staring at a screen. Doing this for extended periods takes its toll on your physical health. Furthermore, majority of individuals have jobs where they sit and stare at screens. Students sit at desks at stare at their laptops. Sitting for long durations contributes to lumbar and hip pain. It is important for us to get up and exercise, which is why there is a huge market for standing desks. Gaming is time consuming. There is a finite number of hours in the day and many of our daily activities involve sitting for extended periods of time (work, school, transportation, etc.). To make this problem even worse, time flies when you are having fun and a three-hour gaming session feels more like fifteen minutes.
Instant Gratification and Dopamine Abuse
Video games are an audio and visual explosion on your senses. Everything that happens in a game taps into the reward center of your brain. Gaming hits this reward center at faster rate and frequency than the average activity in everyday life, which is why gamers play for extended periods of time. It feels good. The downside is that it makes real life feel less stimulating and exciting. Reality hits the reward center at a slower rate. Thus, gamers feel less motivated to accomplish goals in real life and more motivated to achieve goals in gaming.  They prioritize gaming over workplace or academic accomplishment. Activities outside of gaming feel dreadfully slow and unfulfilling. Real life accomplishments don’t trigger bright colored animations and cool sound effects.
Benefits of Gaming
Video games are very challenging. They increase hand eye coordination, problem solving skills, and spatial reasoning skills. Many games require the user to solve complicated puzzles and navigate complex menus for resource management.  Timing and precision are integral components of being successful. These tasks require active engagement and focus, which exercises the brain in a positive way.
Community
Gaming can promote a sense of community. Sometimes these communities are toxic, but other times they are supportive. Gamer’s should seek out the latter. Many gamers suffer from social anxiety, which is why they hide behind their screens and play games alone. However, there a massive world of online gaming that can help with social anxiety. Fore example, twitch streaming has become incredibly popular over the years. Many gamers who suffer from social anxiety have stepped out of their comfort zone by broadcasting their gameplay while being filmed with a webcam. They essentially put on a live show for people, which is a form of exposure to their fears. Negative attention is a concern here, but gamers have the power to ban people from their channel who are not being supportive to the type of environment they are trying to promote. Gamers suffering from social anxiety should not stop there though. They should also expose themselves in face-to-face interactions with others in order to continue working on their social anxiety. A great way to do this is by meeting up with people to play board games in-person.
Putting It All Together
Gaming has a lot of benefits. However, time disappears while gaming because it is overly stimulating. Balance is the key here. If you are noticing that real life is starting to feel less meaningful than your gaming habit, then you may want to decrease the amount of time that you play video games to boost the pleasure you get out of non-gaming life. In addition, real life responsibilities should never take a back seat to your gaming habit. Make sure you are living a balanced life and be mindful of potential side effects from over indulging in gaming (i.e., feeling fatigued, depressed, anxious, unfilled, etc.). Furthermore, because gaming is not a physical activity (unless your playing virtual reality while standing up and swinging your arms around) it is essential that you have an exercise routine in your schedule (at least 30 minutes 3x per week, I suggest more than that).  Set a time limit to your gaming sessions and pay close attention to how you feel after you log off. 

By Eric Kruse

​When I was doing my training as a marriage and family therapist in Graduate School I worked at a community mental health center called The Relational Center. I will never forget the day that my supervisor told me that studies have shown that social isolation can be deadlier than smoking cigarettes. Naturally, being the skeptical person that I am, I researched the topic to see if she was correct, and to my surprise I found the same results.
I was shocked, but after thinking about it further, it started to make sense. We are social creatures. Even if you are an introvert, you still need social contact to some degree. Having no one to share your thoughts or feelings with can lead to dark thoughts and negative ruminations. It’s no wonder the most punitive punishment in prison is solitary confinement. We need to share our thoughts with others to stay sane.
This is where the community plays a huge role. You can be around people and still feel alone. The presence of people is not enough. You must find those who are relatable to you; those who will understand you and be interested in what you have to say. Sometimes these people are not the in closest proximity to you and you will have to go out into the world and find them. This can include going to meetups or attending social gatherings for things you may be interested in, (cosplay events, board game meetups, recovery meetings, group hikes, soccer games in the park, etc.)
The next barrier tends to be social anxiety, and this is where it gets tough. The only way to overcome social anxiety is to expose yourself to the anxiety provoking situation.  I know that is not want you want to hear, but unfortunately it is true. The more you avoid the thing that makes you anxious, the worse the anxiety gets. Every time you lean into the avoidance, you make the anxiety (the thing you want to get rid of) more powerful. Embrace the messiness that is social awkwardness. Remember, there is strong probability that the person you are speaking to is also anxious, which should hopefully be comforting.
Many of us doubt ourselves and fear social rejection to a certain degree. It hurts to feel rejected. It’s normal to feel that pain. However, the pain of social rejection is not as dangerous as the chronic, long lasting, slow burn of loneliness and social isolation. And now that you know that social isolation is deadlier than smoking cigarettes, that should scare you. It’s time to get out there and find your community of people. They exist. You must find them. There is a community out there for everyone.
As a final thought, don’t be afraid to show your emotions. Emotions are how we relate to one another. If you feel nervous, then own it. Say, “sorry I am feeling nervous.” Sometimes saying that simple sentence will help you feel less nervous. The person you are speaking with (if they are not a mean person) will have a better understanding of how you are feelings and may know what to say to relate to you. Give it a try. Get comfortable feeling uncomfortable. 

​Shame is a word that we have all heard before, but rarely hear talked about. Oftentimes shame gets mistaken or used in place of the word guilt. I think it is important to first make a significant distinction between these two. I once read in a book called “Shame and Grace” that guilt is when we feel bad about something we have done, and shame is when we feel bad about who we are. The emotion of guilt can actually be of service to us. If I say something or do something that hurts someone and I feel bad about it or feel guilty, it is a cue to myself that I was possibly wrong and perhaps need to apologize or make peace with that person whom I hurt. In other words, guilt signals that I may be feeling bad for a reason. Guilt is more short-lived than shame, and often dissipates once we have apologized or made peace with something that we have done.
 
This is where shame is different. Shame does not serve us one bit, but instead often lives deep inside of us, rearing its ugly head right below our level of awareness. We can feel guilty about something we have done, but that can turn into shame when we start to use our actions to define our character- for example, I have done something bad, therefore I am bad. We can also be shamed throughout our lives in many ways- by parents, teachers, significant others, friends, etc., but since shame is so rarely talked about in an open way, it gets easy to bury these feelings deep down and avoid dealing with them. Shame can be very difficult to talk about, contributing to why we may not do it often.
 
Therapy is a perfect place to start to explore and unpack this shame so many of us feel. I believe that shame is something that most of us deal with in solitude, often leaving us feeling unworthy and undeserving of so many things in our lives. How powerful it would be if we were able to acknowledge our own shame and talk about it with others who feel it as well. In order to first begin to deal with it, we need to admit that it exists in us. 

By Eric Kruse

Understanding our emotional triggers and learning how to communicate our emotions to others when we feel triggered is an essential part of building and maintaining healthy relationships. We all have emotional triggers and sensitivities and they are different for each person. One person may be triggered by a friend canceling their plans last minute whereas a different person may not mind at all. The person who does feel triggered by this event may have grown up with an absent parent who made empty promises and never delivered. The incident of their friend canceling their plans triggers this past emotional sensitivity, which results in disappointment, frustration, and sadness. Often time the person who feels triggered does not even recognize that the present event is linked to their past, which is why it is important to bring awareness to these processes.
Once you begin to understand how and why certain emotions get kicked up for you, then you can use self-regulation techniques to manage these emotional disturbances. You can look at the situation described above and say, “My friend is not trying to hurt me by cancelling last minute. This is just a sensitive topic for me.” You can take the next step by communicating that to your friend by saying, “It really hurt me when you cancelled last minute on me, but I recognize that is an emotional sensitivity of mine.” Depending on how comfortable you are with your friend, you may even go into how your parent made repeated empty promises to you as a kid and how that is a sensitive subject for you. This can be an advanced style of communication that is very vulnerable and may not work with all your relationships. The relationships that do support this type of communication will be stronger as a result. This is especially true with couples.
Therapy is a place where couples and individuals can explore these emotional sensitivities and gain more awareness into what triggers these emotional disturbances. When we are emotionally dysregulated, we often are impulsive with our responses. We say things such as, “My friend is such an inconsiderate and rude person for cancelling on me last minute. Who does that?” This is negative interpretation of their behavior and only creates a further divide in the relationship. It also lacks the step of inwardly reflecting on how this action made you feel. You can end the relationship with the person who made you feel this way, but chances are that your emotional sensitivities and triggers will rearise in future relationships. The only way to improve the situation is to begin understanding what triggers you and why.  

By Becky White
Cognitive Behavioral Therapy(CBT) is an evidenced- based treatment that has been shown to significantly reduce depression and anxiety which may be contributing to problems in your relationships.  Frequently, couples come in to session making broad generalizations about one another: “You never listen!” “You always forget to take out the trash”, “Your work is more important to you than I am!”  We then infer meaning from such generalizations such as “You don't love me enough,”  “You are losing interest or,  “You don't understand me.”

Using CBT, together we can explore the relationships between our thoughts, feelings and actions.  According to CBT, every single one of us engages in what are called automatic thought patterns ordistorted thinking patterns, which then have a direct effect on the way we FEEL and therefore the way we ACT.  CBT states that our thoughts affect our feelings which then affect our actions/behaviors.  Examples of common automatic thinking patterns include catastrophizing (If I don't pass this test I’m going to fail college and will never get a job), black & white thinking (perfect/worthless; success/failure), and personalizing (he ignored me when he walked by so he must hate me versus he didn't see me or he was distracted).  
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Through uncovering, identifying, and then owning our own automatic thinking patterns, we are then able to track what emotions these thoughts trigger in us (hopelessness, helplessness, fear, anger ) and then observe how these feelings affect our behavior (withdraw, isolate, become aggressive, demanding, violent, etc). Through identifying our thoughts, feelings, and behaviors, we are then able to create more balanced thinking patterns, which then affects our feelings and subsequently may lead us to taking different, new actions (engaging, increasing compassion, connecting, applying for your dream job, etc.)