Meaningful Time With a Family Member Who Has a Terminal Illness

I have worked with many patients who are terminally ill and one of the common themes that I hear from them is: “My family and friends won’t talk to me about my terminal illness! It’s like I’m contagious!”

I believe that you need to just ask!

Ask what? “Are you comfortable talking about your diagnosis?”

If the answer is a “No” don’t just drop the question, turn it into an empathic comment, “If you ever want to talk, please know that I am here for you and if you don’t mind I may periodically check in with you.”

If they are open to talking about their terminal illness you can once again ask an open-ended question. “What were you feeling when you heard the diagnosis?” “Can you tell me how I can best support you?”

To focus on a more specific answer to your question, keep some of the following things in mind. Folks with a terminal illness have good days and bad days. If they are receiving chemotherapy for the treatment of CA, the first week of the Chemo may be a week of bad days. Bad day may mean nausea, vomiting, diarrhea, weakness, or lack of appetite.

It’s O.K. to ask if this is a good day or a bad day? Your definition of meaningful may be much different than his or her definition of meaningful.

Doing the laundry, ironing your brother-in-laws shirts, picking up the dry cleaning, tiding up the house, or running errands may have more meaning that sitting with your relative and having deep conversations.

The latter sans the deep conversations can also make meaningful memories especially if you live miles apart. Ram Dass in his book How Can I Help wrote that one of the most meaningful things that we can do for someone with a terminal illness is to “just be there!”

Again it is important to take your cues from your family member and the best way to get those cues is to ask for them.

Be Well!

Lawrence J. Schulte, Ph.D., C.Ht.

Ph.D. Clinical Health Psychology 1990-Present

C.Ht. Certified Hypnotherapist 2016-Present

Please visit my website: https://www.centerforadultdevelopment.com

Are You Suffering From Pandemic Panic? Here are some Tips to Help You Control Your Anxiety

Are You Experiencing Pandemic Panic? These Tips Can Help You Reduce Your Anxiety.

It is normal to have some anxiety about this relatively unknown virus. You may experience some anticipatory anxiety not knowing if "You are at risk" or if you could contract the virus from a co-worker or pushing an elevator button. Because so many events, colleges, schools, and businesses are shutting down, we are in a period of national uncertainty. Years ago, two psychologists came up with the notion of  "Locus of Control." Moos and Tsu suggested that we have an "External Locus of Control" and an "Internal Locus of Control." With the level of unpredictability of the Coronavirus, it may feel that we do not have any control over it, and it has the potential to control us. The latter is a perfect example of an External Locus of Control. An Internal Locus of Control is an internal felt sense that I am in control of a particular situation and that it is not controlling me. Washing my hands and not touching my face are examples of Internal Locus of Control.

Increased stress from the Coronavirus can weaken our immune system and thus make us more vulnerable to infections and getting the flu. So what's a Pandemic Panicked Person to do? See that little 🍎symbol in the left-hand corner of your Mac? Scroll up to it and put your computer or tablet "to sleep!" If you have a cell phone in your hand, turn it off, the same with the TV. Repeated checking about the latest newsbreak from NPR, CNN, and MSNBC keeps you stimulated in a place of fear and anxiety. If you are obsessed with reading everything you can about the Coronavirus, it does nothing to decrease the possibility of you contracting the virus!

There are a few other reasons to disconnect from all electronic devices at least one hour before you go to bed. The blue light emitted from our cell phones and computers stimulates our brains and our whole nervous system. The blue light mimics daylight causing us to be more alert making it difficult to shut down our minds. Blue light also decreases Melatonin, which helps us sleep, and messes with our Circadian Rhythm so that we don't fully experience REM sleep or rest-filled sleep.  You can turn off your cell phone and then go a mindfulness meditation app like Headspace or Mindfulness.

Between November and the end of January, I was in Urgent Care four times, once with walking pneumonia and three times with an Upper Respiratory Viral Infection. In the first week, the doctor told me not to go to work because I was contagious, and she ordered me on bed rest. She told me that I needed sleep and lots of it. Well, if you know me spending 12 hours in bed is not my forte. During that week, I found that the more I slept, the better I felt. She also told me that when I started to get my strength back that I should go on short brisk walks. Increasing my heart rate would help reduce my risk of a reoccurring chronic condition. Getting out in the sun can increase the Vitamin D in your system, which is an immunity booster, and taking a walk; especially with a loved one or your dog can also help with any Coronavirus anxiety.

Should you wear a mask? Not unless you have a cough, the flu, or sneezing a lot. The Coronavirus is transmitted from one person to another via respiratory droplets. If you are standing within three feet of the person, there is a chance that you could become infected. The new Federal Guidelines suggest that people keep six feet of separation from each other. Droplets can land on doorknobs, elevator buttons, stairway handles, and any shared workspace. Use a pen or a piece of Kleenex to push elevator buttons, Kleenex when touching shared public spaces.

Please be kind and think about others. Don't hoard, pick up the used paper towel you dropped in the restroom, flush the toilet. Practice agape love, the selfless going out to meet the needs of another. If you have elderly family members or neighbors (60+), go grocery shopping for them, take them to doctor's appointments, and check in on them frequently. Isolation and loneliness exacerbate anxiety.  

Remember to wash your hands with soap and water for at least 30 seconds and leave the soap on for enough time for it to penetrate your skin. Another option is to use hand sanitizers with at least 60% alcohol. Don't touch your face if you have contacted a contaminated surface.

Be Well!

Lawrence J. Schulte, Ph.D., C.Ht.

Ph.D. Clinical Health Psychology (1990-Present)

Certified Hypnotherapist (2016-Present)

www.centerforadultdevelopment.com

How can you stop a panic attack if you're asleep?

Most people who have a panic attack if they are asleep are having a spontaneous panic attack. These come out of the blue and may be related some trauma from the past. Most spontaneous panic attacks come from a cumulative effect of stress and are often not related to a trauma.

How do you stop a panic attack in your sleep? Often the panic attack will awaken you and the first thing you need to do is turn on a light because panic attacks at night can be disorienting. You need to then sit up slowly because you may have a rapid heartbeat or a drop in blood pressure all effects of a panic attack. Sit up slowly and literally get your bearings. If you can sit at the side of the bed put your feet on the floor. Having your feet on the floor will help you feel grounded, which will help with the symptoms of the panic attack.

Next, while you are using self-talk to reassure yourself that “you are O.K. and are not having a heart attack”, start breathing through your nose and exhale through your mouth. These don’t need to be deep breaths; just regular breaths, which will help, decrease the feelings of panic. If you have previously had a panic attack, again use self-talk to “tell yourself that you have been through this before and you know that within a few minutes it will be over . . .just breathe!” You are using a Cognitive-Behavioral technique to decrease the effects of a panic attack.

It’s important to just keep breathing and focusing on your breath. If your mind wanders (It will it’s a thinking machine) then just bring your focus back to your breath. As the panic subsides you need to get up and get a drink of water (not a lot) and then tell yourself that you now will go back into a restful state of sleep and deep relaxation.

Go back to bed and focus on your breath and allow yourself to fall into that restful state of sleep and deep relaxation. Deep sleep!

Be Well!
Lawrence J. Schulte, Ph.D. C.Ht.

Ph.D. Clinical Health Psychology (1990-Present)
Registered Hypnotherapist (2016-Present)

What can a clinical psychologist do that a regular person cannot do?

A clinical psychologist has either a Ph.D. in Clinical Psychology or a Psy.D. a Doctor of Psychology degree. The former will write a dissertation based upon original research. The latter will complete a project or more practical research that contributes to the field of psychology. S/he will have completed a pre-doctoral internship and a post-doctoral internship for the required hours to sit for the national EPPP licensing examination.

What can s/he do that a regular person cannot do? A clinical psychologist can see clients/patients for individual, couples, or family therapy. S/he can administer psychological testing for a variety of problems, e.g., learning disorders, psychological disorders, or academic/behavioral problems. Depending upon their training they may work with children providing therapy, they may work in a medical setting or in industrial settings to assess work-related problems. The last area where a psychologist may provide services is in the field of forensic psychology. There are many other areas of specialization where additional training is necessary. Unlike a psychiatrist who has a medical degree and a specialty in psychiatry, psychologists cannot write prescriptions.

Some of the newer areas of training and certification are in Pain Management, the use of Hypnotherapy and Psychology for Addiction & Health Related Problems and the area of Psychoneuroimmunology, the use of the mind/body interaction for the management/treatment of chronic disease processes.

Be Well!
Lawrence J. Schulte, Ph.D. C.Ht.

Ph.D. Clinical Health Psychology (1990-Present)
Registered Hypnotherapist (2016-Present)

First answered in Quora March 25, 2018

How Do I Get Off of My Anxiety Medication Slowly & Safely?

You always need to titrate off of your anxiety pills under the supervision of the psychiatrist who prescribed them to you. If your internist has been giving you anxiety medication you must ask for a referral to a psychiatrist who can assist you with this slow process. Never try this on your own and especially never suddenly stop taking them. Immediate discontinuation of all benzodiazepines increases your risk to a grand-mal seizure even if you have never had a seizure.

The other reason for having your psychiatrist help you off of your medication is to monitor withdrawal symptoms and to know at what rate is realistic for you to come off the medication based on those symptoms. In addition, your psychiatrist should realistically assess the tools that you now have in place to manage your anxiety. If s/he does not know you that well (which s/he should) your psychiatrist should work with your therapist to identify new strategies for you to cope with your anxiety.

You and your psychiatrist should look at triggers to your anxiety including generalized anxiety, but especially if you have a panic disorder. If you have a fear of flying what tools do you now have to get on a flight and not have to take an Ativan? If you have social anxiety what tools do you have to interact with other people and not have a panic attack? Are you taking yoga, have you learned to meditate? What are you going to do if you have a rush of anxiety and you don’t have the medication in your pocket or in your purse? You need to also be very honest with your physician as to why you think you can handle the anxiety on your own. Are you using anything else to self-medicate, e.g., alcohol or cannabis?

I applaud your courage and have had a number of my patients under my treatment with the psychiatrist I work with to come off of anxiety medication. Please be patient with the process and with yourself. Don’t enter a place of shame or increased anxiety if it takes a long time or if there are times in the future where it’s better to take a pill versus white knuckling something for hours on end. I have found that Cognitive-behavioral therapy with relaxation therapy and even hypnotherapy for stress management has been most helpful for my patients. Be Well!

Be Well,
Lawrence J. Schulte, Ph.D. C.Ht.

Ph.D. Clinical Health Psychology (1993-Present)
Registered Hypnotherapist (1996-Present)

Posted on Quora 3/27/18

Why do dying people seem to die when no one is around?

Let me give you some additional background for this answer. My first Practicum (1986- in my Ph.D. program, where you see patients face-to-face) was at Hospice of Pasadena where I saw patients who were on Hospice care secondary to a life-threatening illness. I also saw those who had recently experienced the loss of a loved one who was on Hospice Care.

After my Fellowship at Yale University School of Medicine Department of Psychiatry in Consultation/Liaison Medicine, I returned to Hospice of Pasadena as the Director of Counseling Services from 1992–1998. I had six Practicum Students under my supervision with H. William Worden, Ph.D. International Author & Harvard Researcher on the Tasks of Bereavement and a pioneering study on bereavement and children.

I have led a Parents of Murdered Children’s Support Group from 1995-Present. One of my specialties is Hospice Care and Complicated Bereavement. I have full disclosure to share the following events from my first Hospice patient and her only daughter. Names and circumstances have been altered to fully keep this case confidential.

My first Hospice patient had a progressive liver & colon cancer with metastasis to the spine. When I saw her she was a 69-year-old Caucasian female, oriented to time, place and person. She was on a Morphine drip for pain and had been on Hospice Care for only one month. The Dodger’s were in the play-offs in 1986 my first Practicum Year. I had a Master’s Degree in Clinical Psychology from Xavier University; this was not my first patient contact.

I came into her room and started to ask her some “intake questions” and sat at the edge of her bed. The only chair was filled with IV’s, clothing, magazines, etc., and I didn’t feel that I should move it. She didn’t look at me nor did she answer my initial questions. At the commercial she sternly said: “Why do you G.D. S.O.B. shrinks think you can come in here and sit on my bed and interrupt the play-offs. Who the f__ck do you think you are? Shut up! Game’s back on.”

I moved all of the crap in the chair and sat down and did not say a thing. I believe the Dodger’s lost and I heard another string of expletives! Peggy finally turned to me and said, “So what the hell are you doing here?” I explained my role as a Hospice Intern. She rolled her eyes. “Well I guess you won’t sit on my bed again!” “No Ma'am.” “No Ma’am, listen my name is Peggy and you call me by my first name. Got it?” I almost said: “Yes, Ma’am!”

“Larry?” OMG she was listening enough to get my name! “Can you go to the fridge and get me some sparkling water, the Colon Cancer is a son-of-a gun on my insides?” I brought her a glass of sparkling water and she took the glass in her shaking hand and I realized how weak she was. It was hard for her to hold onto a glass. “I’m sorry I didn’t mean to be such a bitch it’s just I know this will be the last potential World Series for me and my Dodgers. Can we meet at the same time next week?”

“Yes, of course!”

Thus began a short four-month course of my work with Peggy. Cancer in the Colon and the Liver had done its damage to her system. The metastasize to her spine effected her gait, her ability to hold onto objects, and many different neurological sequelae. Each week from 1pm–2pm I would meet with Peggy at her home. Two months into our time together she was once again admitted to the City of Hope. She needed to be stabilized because the Cancer had gone into the portal vein of her liver and she was beginning to have a systemic (total system shut down). I met her daughter (Donna) and husband early on in my work with Peggy. We developed a close relationship because as the Cancer spread, I found myself spending more time with Peggy, her daughter and her son-in-law. During the last month of Peggy’s life I was introduced to her “grandfather.” Peggy’s “grandfather” was an older man (not related) who had pursued Peggy for years. It was only in her latter years of coping with cancer that she allowed herself to spend time with him.

Peggy was transferred to a Hospice bed at the City Of Hope. Donna and I had spent hours at her bedside because the Hospice nurse told us that she could go “at any time.” My role as a Hospice therapist extended to more than one hour per week. With the approval of my supervisor, I knew that Peggy and the family wanted me to be there more frequently. Donna and her husband were exhausted. I told them to go home and get some sleep and I would follow shortly.

They left and I took just a few moments to say “Goodbye for now” to my first hospice patient. Those were my words as her “Grandfather” came into the room. I told him I had not eaten all day and I was going to the coffee shop and get something to eat. I would be back in less than a half of an hour. He nodded and I left.

I came back to Peggy’s room in less than 15 minutes and she had died! I turned to “Grandfather” and I said, “But I was only gone for 15 minutes.” He looked at me and said, “I don’t know, but I know she had a special place in her heart for you! Maybe . . . it was her final gift to you so that you did not have to see her take her final breath. I can assure you my friend, she turned away from me and had a peaceful death.”

Death is a mystery, sometimes people will wait for months for a loved one before they release their spirit, others, like Peggy wait and die in their own time and space, sometimes a final gift to those they love.

“Just one more for the road before I go!”-Peggy

Peace and healing! 

Be Well!
Lawrence J. Schulte, Ph.D. C.Ht.

Ph.D. Clinical Health Psychology (1990-Present)
Registered Hypnotherapist (2016-Present)

How Do I Gain Confidence While Talking?

Find a mirror, pick a subject that is meaningful to you, and start talking to yourself in a mirror. Notice your posture, are you slouching, or standing up straight? Notice your eye contact, do you make eye contact with your image in the mirror or are you looking down or away? Do you smile when you talk? Do you yawn when you are talking? Are you animated?

Find a non-critical friend or sibling. Ask them if they would participate in a behavioral rehearsal and have a casual conversation about your favorite television show, your favorite place to eat, etc.? Sit down so that the two of you are comfortable. You are to initiate the conversation. Pick your favorite place to eat and just talk about why you like it. The content of the conversation is secondary. You want to pay attention to the same things you did in the mirror exercise. Eye contact, relaxed posture, leaning slightly forward to engage the other person, smile, using hand gestures and being animated, all of these are going to make you feel more confident and come across as more confident.

Here are a few other quips for confidence and conversation. Listen to the other person, don’t look away, yawn, or interrupt. Don’t dominate the conversation, often when people are nervous they tend to prattle on and not allow the other person to get in a word, let alone a sentence. At the end of this conversation ask your friend or sibling for objective feedback.

The next step would have you join in a conversation with a group of friends and monitor the same things as outlined in the previous examples. Include a non-judgmental friend in the group conversation and ask him/her for feedback?

Practice makes perfect! 

Be Well!
Lawrence J. Schulte, Ph.D. C.Ht.

Ph.D. Clinical Health Psychology (1990-Present)
Registered Hypnotherapist (2016-Present)

Who has participated in a cognitive-behavior therapy program? Was it helpful with anxiety issues?

I have participated in cognitive-behavioral therapy for anxiety for the treatment of a fear of flying. One of the first techniques that I learned was a simple breath meditation for relaxation. I was taught to breathe through my nose and exhale through my mouth (behavioral) and if my mind wandered to worrying about an upcoming flight (anticipatory anxiety) I would bring my focus back to my breath. This technique was used weeks before the flight.

My therapist focused on my catastrophic thinking (the plane will crash) and helped me challenge these thoughts (cognitive). He also taught me to use self-talk to challenge negative thoughts. “I am actually safer in an airplane than I am while driving my car on an L.A. freeway.” He also taught me to use distraction as a means to relax on longer flights, i.e., books on tape, DVDs, and Ted Talks.

I have used these techniques for other stressful situations, e.g., driving on L.A. freeways. During the course of my training for my Ph.D. in clinical health psychology, I also specialized in cognitive-behavioral therapy and use it every day with my patients with many different presenting problems. I tell them: “if you can change your thoughts, you can change your behavior!”

Be Well!
Lawrence J. Schulte, Ph.D. C.Ht.

Ph.D. Clinical Health Psychology 1990-Present
Registered Hypnotherapist (2016-Present)