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Depression Tip Sheet – Why You Might Have Trouble Sleeping

An undetected mood or anxiety disorder may be affecting your sleep;
Take a free, anonymous mental health screening on October 5, 2006

Introduction
Tips for Getting a Good Night’s Sleep
Introduction

We all know the old saying, "Early to bed and early to rise, makes a man healthy, wealthy, and wise." But for the nearly 57 million affected by a mental health disorder, getting a good night's rest is no easy task. According to the American Academy of Sleep Medicine, sleep disturbances figure prominently in many psychiatric disorders. In fact, of the estimated 30 million Americans who have chronic insomnia, 40 percent also have a psychiatric disorder, most often depression or anxiety.

If you have been feeling anxious or depressed lately and as a result, have been having difficulty sleeping, you can take a free, anonymous mental health assessment at one of more than 1,500 sites participating in an NDSD Mental Health Screening event on October 5. As part of the program, you will have the opportunity to take a brief, written questionnaire and talk to a health professional about your results. Those who score positive will be referred to local treatment resources.

"Sleep problems are a common symptom of depression, bipolar disorder and anxiety disorders. However, there is also evidence that sleep disorders can be a contributing cause of mood and anxiety disorders. For those who are experiencing issues with sleep, it is important to talk to a health care provider about the possible causes. By taking a screening and talking to a health professional, individuals can take the first step in figuring out whether their issues with sleep stem from something in their daily routine, like coffee or exercise to close to bed time, or an underlying mental health issue," says Douglas G. Jacobs, MD, President and CEO of Screening for Mental Health, the organization that sponsors NDSD.

NDSD Mental Health Screening, now in its sixteenth year, is a program of the nonprofit Screening for Mental Health, Inc. The free program provides a non-threatening way for the public to be screened for depression, bipolar disorder, anxiety, and post-traumatic stress disorder. For more information or to find a screening site near you, visit www.MentalHealthScreening.org.

Tips for Getting a Good Night's Sleep
  • Go to bed and wake up the same time each day. Having a sleep routine can help train your body to know when it is time for sleep. 
  • Don't lie in bed awake for more than 20 minutes. Get up and go read, watch TV or listen to music, until you feel sleepy. The anxiety of being unable to fall asleep can actually contribute to insomnia. 
  • Exercise early in the day. Working out to close to bedtime causes wakefulness. 
  • Avoid caffeine, nicotine and alcohol before bed. Caffeine and nicotine are stimulants and can make falling asleep difficult. Alcohol affects REM and deep sleep. 
  • Create a sleep sanctuary. Your bedroom should be quiet, dark and cool and should not be used for working, eating or watching TV in bed. 
  • Invest in a good bed/mattress. You spend about a third of your life in bed so make sure yours is comfortable. 
  • Try and relax before bed. Take a warm bath or meditate. If you are anxious or worried about something, talk about it with a friend or partner earlier in the day. 
  • If you continue to have trouble sleeping, talk to a health professional to rule out a physical or mental illness.

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Schools and Communities Tip Sheets

Family Safety Tip Sheet – Helping Children Cope With Traumatic Events

Introduction
Helping Your Child

Introduction

By now, many children have witnessed, over and over again on television, acts of horrific violence and destruction. As a consequence, you may notice that your child may begin to act differently. Following are some of the ways children respond and react to violence they've watched on TV.

  • Vivid memories about the events. Your child probably can and will remember detailed scenes of the traumatic incidents he or she has viewed. Children often draw pictures of the disturbing scenes or even act out what they've seen in play. 
  • Questions and concerns. Your child may ask numerous questions about the disturbing images he or she has seen and may be frightened that similar acts of terrorism will occur again. Of course, it is natural for children to be alert and concerned, but excessive worries are a sign that children are having difficulty processing what they've witnessed. 
  • Upset feelings or listlessness. Your child may become more easily upset or angry. Or your child may appear to be just the opposite and seem not to care about anything at all. 
  • A need to talk about it. Children often feel the need to talk about what happened (the traumatic event) again and again. Even a generally quiet child may talk a lot about what he or she saw, felt and did during the time he or she witnessed the troubling event. 
  • Trouble sitting still. Your child may become more active, have problems paying attention, and be more impatient. 
  • Nightmares and trouble sleeping. Your child may be afraid to go to sleep or wake up frightened from bad dreams. 
  • Fears of being alone. Some children are afraid of being left alone. Your child may cling to you and may be frightened of leaving home to go to school. 
  • Physical problems. Your child may suffer from headaches, stomach aches, nausea, and fatigue.
Helping Your Child

You can help your child through this difficult time by: 

  • Letting your child talk about the incidents. It may be painful, but the best thing you can do for children is to listen to their stories, let them draw pictures and/or act out the incidents in their play. Talking, drawing and play-acting are healthy and natural ways for children to work through difficult reactions. 
  • Comforting your child. Make it a point to hold and comfort your child more during this time of adjustment. Your child is reaching out to you for security. Extra love and affection will not spoil him or her and instead will speed emotional healing. 
  • Not being over-protective. This may be the most difficult for you to do, but you must fight the temptation to over-protect your child. It may be very hard even to let him or her out of your sight, but it’s important that your child returns to a regular routine as soon as possible. 
  • Being a good example. Actions speak louder than words, and by your actions, you can set an example for your child of how to handle these reactions in a productive way. Behave in ways that communicate to your child that the world is safe to live in even though very bad and scary things do happen at times. 
  • Encouraging your child to help and reach out to others. If your child is able, you may want to encourage him or her to make a positive difference by, for example, offering a donation to the Red Cross or other volunteer organizations. This is something that you and your child can do together and the act will increase your child's sense of safety with you as well as in the world. 
  • Seeking help if your child is suffering severe and prolonged problems. Your child needs more help if he or she is having extreme reactions, such as repeated nightmares, “flashbacks” of the event, crying spells, behavior problems, and panic reactions. If you feel you've tried to help your child work through his or her reactions to regain a sense of safety, but your child's fears, sadness or anxiety does not seem to be relieved, don't hesitate to seek help from a social worker, pastor, school counselor or other caring individual.

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Related Articles:

Relationship Tip Sheet – Top Ten Tips for Surviving a Divorce

Introduction

Divorce can be a very traumatic situation for families. Social workers can be instrumental in helping families get through divorce by supporting them through the grieving process. These highly trained professionals help to empower their clients by encouraging their resiliency skills as opposed to the all too familiar feelings of victimization one typically feels as a result of a divorce. They encourage their clients to process divorce by becoming involved in proactive activities that will promote a healthy adjustment. Reading, going to therapy, joining support groups and taking part in activities that clients enjoy are all part of making the adjustment of divorce easier. Since it’s easy to be self-absorbed while going through divorce, social workers assist clients in making decisions based on the needs of the family system. 

Here are ten tips to help families survive a divorce: 

  1. How you handle your divorce will impact your life, so it is imperative to maintain integrity as you consider the implications of your decisions surrounding divorce.
  2. It is helpful to balance your emotions with your ability to think through the adjustment of divorce.
  3. Give yourself time to grieve. Grieving is natural. There’s been a death–the death of a relationship. 
  4. Remember that often times you are grieving the death of the “dream of the ideal”. Stay realistic about what you lost. 
  5. Don’t let the lawyers control the divorce process. It’s your divorce and you are in charge. 
  6. Remember, if you have children, you will be in touch with each other for the rest of their lives so when ever possible practice civility. 
  7. Don't rush into dating. When you are vulnerable, your judgment can be impaired. 
  8. When you date, don’t bring the person home to the children right away. Spend some time talking about the person and familiarize your children with your friend. Before exposing your children to an important person in your life, make sure that the person will be an active part of their lives.
  9. Don’t speak negatively about your ex-spouse to the children. 
  10. Listen to the needs of your body and soul. Eat when you’re hungry, drink when you’re thirsty, rest when you’re tired and exercise to blow off steam or to lift your spirits. Taking care of yourself will give you back that all important feeling of control.

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Depression Tip Sheets

Healthy Parenting Tip Sheets

Stress Management Tip Sheet – Dealing With Stress

Introduction
Physical Changes Related to Stress
Examine Your Personal Power to Change the Situation
The Value of Self Talk
Make a List of Things to Do
Bedtime Is for Sleeping
Give Yourself a 15 Minute Time Out
Stress is Short Lived

Introduction

People experiencing stress often come into therapy seeking help for symptoms related to anxiety or depression. A common cause of stress is a lack of insight into problem solving. Another common cause of stress is a feeling of being overwhelmed.

In addition, someone may feel stressed because of his or her inability to control the environment. A person may also feel helpless or frustrated attempting to deal with difficult situations. 

Another potential cause of stress is a person’s inability to envision a positive resolution to a problem. The stress may become even worse if the person is also afraid of disappointing another person, such as a family member or a boss.

Physical Changes Related to Stress

Whatever the reason, stress can become debilitating if the individual cannot find a means of relief or a resolution to a problem. Research has long shown that stress (both good and bad types) is related to changes in bodily functions such as blood pressure, heart rate, sleeping habits and concentration/ emotional expression. Accordingly, it is very important that stress is dealt with effectively as well as consistently.  The more relaxed you are the less stress you may feel.

The following suggestions may be helpful in reducing stress and developing positive habits for relaxation. 

Examine Your Personal Power to Change the Situation

One of the most effective manners for dealing with stress is to first examine your personal power to change the situation. Look at the situation that is causing stress. Next make a decision about your ability to fix the problem. Can you fix it now? If not now, when can you fix it?

Talk to friends or family and brainstorm ways to solve the problem. The most important question to ask yourself is, "Can I solve the problem at all?" If you do not have the power to solve the problem, then feeling stressed about it may be wasted energy.

If you are unable to solve the problem or somehow make it better the next step would involve finding a way to give up the problem.

The Value of Self Talk

Self talk is the manner in which we talk to ourselves on a daily basis. Most of us do not realize that we have an internal conversation going on in our head at all times. Self talk can be positive or negative. Self talk can help your self-confidence by reinforcing positive thoughts about yourself and the world you live in, or it can be negative, when you use thoughts to convince yourself of things in your life which are not necessarily true.

When someone is stressed they cope in various ways. Initially their brain races through past experiences  looking for previous coping methods they have used which worked. If there are no coping methods available, then the person may begin to brainstorm and problem solve. This area is crucial to self talk. If the person is thinking negative thoughts for example, ”Why bother? I am helpless to fix it,” then they may give up trying to solve the problem, and their stress may increase  increase followed by thoughts of failure.

On the other hand if the self talk is more positive, such as ”I have been in bad spots before and I have gotten out of them, I will find a way to make the best of this problem too,” then the person may  become less stressed and deal with the problem effectively.

Even if the problem is not one that is easy to resolve, knowing that you thought it through, tried every avenue of solution and then finally accepted that you did not have the power to change that particular situation, may also work. The reason this type of talk can work is that you can report to yourself all the steps used to solve the problem. Therefore you become more aware of the positive efforts, which makes it easier to move on.

Self talk can be very effective for bringing the reality of the situation to the forefront. Allow yourself to talk the situation through. You can say to yourself, "I have no power to change this problem. I have attempted to manage the situation by (list the ways you have attempted to solve the issue) then say to yourself, "I have no way to fix this, so I am going to…. (List what options you have for letting go of the problem). What if the problem is not something you can let go of—you're single with three children, about to go bankrupt, your son is in the hospital, and your car needs a new transmission.

At first this step will be difficult, especially if you are a person who thinks you have to resolve issues. However as you begin to prioritize your problems and solve the ones you can, table the ones you cannot fix now and work on the long term situations which may take some time (such as saving for a new car). You may find the process effective.

Make a List of Things to Do

Before bed each night you should consider making a list of things you need to do. Many people miss a good night's sleep because they lie in bed and fear they will forget to do something that needs to be done. The list effectively resolves this problem and gives an individual permission to "let it go and go to sleep". Ask yourself: Can I fix this issue tonight? What will change if I go to sleep and deal with it tomorrow? This will help stop you from laying in bed thinking on things and worrying about how you will face things tomorrow.

If you get a good night's rest you may be better able to solve your problems the next day. A good night's sleep will help you see clearly tomorrow as well as give you rest, which usually reduces stress tremendously.

Bedtime Is for Sleeping

If you have problems sleeping, do not watch television in bed or sit in bed to do work. Consider developing a sleep routine that includes a warm bath (or shower) and relaxation before bed. Milk does help. The old wives tell about having warm milk to help sleep is actually related the tryptophan in milk, which is a chemical that may promote sleep in some people (www.shuteye.com). Tryptophan is the same chemical found in turkey which makes many people feel tired after the Thanksgiving dinner.

Tell yourself that when you lie down in bed you are going to bed to sleep. That is what the bed is for and if you condition yourself to believe that the bed is for sleeping, your body will begin to listen and learn to sleep. 

Give Yourself a 15 Minute Time Out

Remember, you are no good to anyone around you if you are tired, grumpy, and hard to deal with. Take a break. Read a book, listen to music, use an electric hand massager on your shoulders or back.
Sit quietly in a chair and do deep breathing exercises to lower your blood pressure and heart rate so you can relax. While you are relaxing, think of a time or place where you felt totally relaxed. Picture the scene in your mind. Relive every moment of that place for those 15 minutes. Take 15 minutes and find something you enjoy doing and do it.

Write in a journal, detailing your feelings, let them go on paper instead of on family. Close your office door, put on the music and dance/de-stress/day dream for 15 minutes. Put your head down on your arms at your desk for your break and rest for 15 minutes. You could get a ticket or get into an accident doing this in your car This is only 15 minutes of your life, but it will feel as if you have given your body an hour of relaxation and rest!

Stress Is Short Lived

Remember: stress is often short lived! Even though it feels as if you are never going to find peace or get away from this moment stress, it is not true. Stress may last for a relatively short time, sometimes  not more than a few weeks, and then you can return to a more normal level. If you use stress techniques and good coping skills, you may come out of a stressful level and function better than before the incident happened, especially if you have developed new coping skills.

Always reinforce to yourself what you did right during the situation. Think of the ways you could have handled a stressful situation better if you could do it over again. That may prepare you for the next stressful event in your life. When the situation is happening, tell yourself "This will only last for a short time; I can do ANYTHING for a short time". Self talk is a positive way to help your body and mind work well together.

Okay… now that you know how to relax and ease stress… get started!!! You owe yourself 15 minutes of relaxation!

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Addiction Tip Sheet – Six Skills for Families and Significant Others Who Are Affected by Someone Who Abuses Substances

Introduction Skill #3: Solidify Your Position
The Effect of Substance Abuse on Families Skill #4: Support Sobriety
Six Skills for Families and Significant Others Skill #5: Simplify Your Approach
Skill #1: Separate Yourself Skill #6: Sustain
Skill #2: Set Limits Conclusion

Introduction

Statistics have shown that the use of alcohol and other drugs is often directly connected to crime, incarcerations, domestic violence, child abuse, and problems related to work. Understandably, the primary focus of treatment and intervention has been on the person who has a problem with substances. However, there are far more people affected than just those persons with alcohol and other drugs problems. Fortunately, more attention is now being given to the serious impact substance misuse has on family members and significant others, who are also greatly impacted by the problem.

The Effect of Substance Use Disorders on Families

Families (including spouses, partners, children, siblings, and others who are connected to someone with a substance use problem) can be affected emotionally, physically, spiritually, and economically. Many family members live in a state of constant fear and uncertainty about what to do. Six skills are summarized below that can be useful to family members and significant others in learning new ways to address substance use problems in the family.

Six Skills for Families and Significant Others

Before reviewing the six skills it is important to note that whether a person with a substance use problem will seek help, stay in recovery, or relapse at some point is impossible to predict, as every individual is unique. Many times when families and significant others seek help first, the person with the substance use problem will follow, although there are no guarantees. Sometimes things can get worse before they get better and it is very important to always address any safety concerns immediately (see Skill #6)

Skill #1: Detach Yourself from the Problem

This can be the most difficult idea to understand at first. Sometimes people understand this to mean that we should walk away from our loved one. Actually, detaching yourself from the problem means  that you should know  that the person who is misusing alcohol or other drugs has the problem, not you.  It is very important to understand this.

Skill #2: Set Limits, Roles and Boundaries

Many family members have done things that seemed as though they could help, but they actually made it easier for the person to continue misusing substances. Calling in sick for them, bailing them out of jail, etc. can actually make things worse by delaying the substance user from having to address their problem. Limits need to be set to stop doing things that make it easier for a person to continue misusing substances.

Skill #3: Solidify Your Position – Know Where You Stand

As the substance abuser begins to see changes in the other family members, he or she may become irritable, angry, or hostile. By deciding on a position and sticking to it, family members will help the addicted person begin to learn that there is a new way that things are going to be handled. This is good for everybody– the person with the problem and the family. Consistency is essential.

Skill #4: Support Sobriety

There are many ways to support sobriety – to clearly let the person know that you are there for them in the recovery process. Compliments about positive change, bringing them to or picking them up from Alcoholics Anonymous, Narcotics Anonymous meetings, etc., and other support groups, participating in family therapy, and asking the person about their progress, are all examples of ways to support sobriety.

Skill # 5: Simplify Your Approach by Setting Small Goals

Those working towards recovery must set small goals like "One Day at a Time." The same is true for families. A good goal is a small goal. Indeed families can become very overwhelmed and it is important to step back and set one small goal just for today.  For example, instead of setting a goal to attend Al-Anon meetings regularly, set a goal to attend one meeting on a specific day this week. Likewise, instead of a goal to take better care of yourself, set aside a specific amount of time today to go to a park and spend some time walking or sitting quietly.

Skill #6: Sustain Your Physical, Mental, and Spiritual Health

A person's physical, mental, and/or spiritual health may all be negatively affected when they misuse substances. The same often happens to those who care about that person. Eating properly, getting exercise, taking breaks, and addressing any spiritual needs are all examples of things that family members should do to take care of themselves.  Taking care of your personal needs is a must, and this also includes any safety concerns such as domestic violence or child abuse. It is critical that if there is an unsafe situation, you may have to leave the situation immediately or contact law enforcement for assistance to help remove others, such as children, from the unsafe situation.

Conclusion

Researchers have found that when family members are involved and supportive of individuals with substance use problems who are seeking treatment, the likelihood of success is improved. Not only can family members work towards making things better for themselves, but they can increase the chances of the person achieving recovery.

Many times we start to see changes in the person with an addiction history when they enter treatment. Their mood, eating patterns, appearance, or friends may change. They may also reduce or stop going to 12-Step meetings or counseling sessions. These can be the initial signs of relapse, which may be seen first in the home. As noted in the first skill, relapse is not a problem for which we are responsible, but we can support a person's sobriety (Skill #4) by providing feedback to them about the changes we see.

Having a loved one who is misusing substances can cause families to feel angry and fearful. The best antidote is to address what is going on. Staying alert and on-track is important.
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To read more articles by Dr. Ligon on this subject, please go to http://chhs.gsu.edu/socialwork/sixstepsligon.asp.

Related Articles:

Stress Management Tip Sheets

Stress Management Tip Sheet: Calling a Crisis Hotline in Times of Disasters or Emergencies

Introduction What to Avoid
Locating a Hotline You Have a Right
Making the Call Follow-Up
What to Expect Summary

Introduction

During these times of national tension over weather emergencies, terrorism, and war, we often see emergency hotlines set up to handle questions and offer support. These hotlines are resources that can prove invaluable both on a personal level and in obtaining access to resources that people may need in these very uncertain times. A hotline can assist with referrals or simply offer much needed emotional support when anxiety, depression, anger, grief, loneliness and fear are at their highest. 

Locating a Hotline

You can often find hotlines or crisis lines listed in the phone book or on the Internet. Many times these numbers are posted on the television or broadcast on the radio. It is important that you call an organization you can trust, and one that best fits your comfort level and particular need. It is helpful to write down your questions or concerns prior to making the call. This will help you organize your thoughts, save time, and avoid the necessity to call back. 

Making the Call

Once you have decided to call, have a paper and pencil handy to write down notes to help you remember needed information or cope better with the event. You can also then create a list of additional phone numbers the hotline worker gives you of other resources to help you deal with the crisis. Be patient and prepared to wait. Many calls may be coming into the center, but it is important that you stay on the line. Have your radio and television turned off or volume down so you will have full concentration. 

What to Expect

Who is on the other end? A reputable hotline will be staffed with trained people. Often they are social workers who are equipped to handle a variety of questions and emergencies. They are a quick and ready resource to help you cut through unnecessary red tape. The person at the other end of the line should be friendly, courteous, and caring. They know that it is a sign of strength to ask for help, not weakness. More importantly, they will listen. A good hotline worker doesn't just talk or give advice. They also know when to be quiet and just listen. They know this is your story and it is sacred as well as confidential. Often, the mere telling of your story is both healing and motivating. 

What to Avoid

You should not be asked personal information such as your name, address, social security number, phone number, etc. Neither should you be asked for money or a contribution. Do not give out credit card information. In certain life and death emergencies you might be asked for your name, address, and phone number, so that emergency response teams may locate you. However, in general this will not be the case. 

You Have a Right

You have a right to this assistance, and to expect a courteous and efficient response. You have a right to ask for the qualifications of the person answering your call. If you are talking to a licensed social worker, you have the right to ask their name and their state license number. If you are not happy with the person you are talking to, don't give up. Ask to be transferred to another person or simply call back. 

Follow-Up

After you hang up, take a moment to organize your thoughts once again. Try to relax, knowing that there are people out there who care and are trying to help you. You are not alone. Call any other numbers provided to you by the hotline staff. Don't quit. Don't give up. If you hit a snag or get disconnected, call the hotline back.

Summary

Your call is important. It is the appropriate action in a time of deep uncertainty. Nothing is trivial or stupid at these times, and will not be treated as such. You do not have to be an adult to make this call. These services are available to everyone regardless of circumstances or age. Most hotlines are a toll free call. There is never a need to go it alone. A helping hand is there – take it.