eTalkTherapy

The Benefits of Deep Breathing on Anxiety

by Don Laird and Christina Pettinato

There are many great ways to promote physical and mental health for you and your family during this time of social isolation and distancing. One highly effective technique is quite simple and can be used anytime. Diaphragmatic breathing or deep breathing is intended to help you use the diaphragm (a muscle at the base of the lungs) correctly resulting in less effort and energy to breath. Additionally, it slows your breathing rate and heart rate and decreases oxygen demand, which in turn makes you feel more relaxed and calmer.

There are two ways to perform this exercise. In the video below eTalk Therapist and Mindfulness Expert Christina Pettinato demonstrates the chair method.


You may also perform this technique when lying down.

Lie on your back on a flat surface or in bed. You can use a pillow under your knees to support your legs. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe.

Breathe in slowly, deeply, through your nose so that your stomach moves out against your hand – think of it as a balloon expanding and deflating. The hand on your chest should remain as still as possible. Tighten your stomach muscles as you do this, letting them fall inward as you exhale through your lips.

When you first learn this relaxing breathing technique, it may be easier for you to follow the instructions lying down. As you gain more practice, you can try the diaphragmatic breathing technique while sitting in a chair, as demonstrated above.

You should practice this exercise 5-10 minutes at least two times per day. Most people prefer to do it before bedtime because it can promote a better night’s sleep. Gradually increase the amount of time you spend doing this exercise, use soft music or a guided meditation video or audio to enhance the relaxation experience.

Be safe, be healthy, be well,
Don & Christina

Young sick woman in blanket with thermometer
Don Laird

Anxiety in the Age of COVID19

As human beings, we do not do very well with the unknown. Uncertainty and an undetermined future can create a level of constant worry that is often disproportionate and, at times, unmanageable. Anxiety manifests around that which we cannot control. What compounds this feeling is a sense that what is out of control should not be. When things feel uncertain, we don’t feel safe. However, it is okay to feel stressed or anxious, particularly when there is conflicting information around us.

Currently, most of us are worried about the Coronavirus (COVID-19). We may experience feelings ranging from helplessness to fear about what will happen in the weeks and months ahead. Again, it’s okay to feel this way. It may not feel good, but trying to push it away or act as if it doesn’t exist is the unhealthiest thing you can do.

In short, your mental health will likely suffer over the next several months.  You might feel on edge, nervous, angry, frustrated, helpless or sad. You might want to completely avoid any reminders of what is happening. “Normal” daily activities will alter drastically, and for those who already struggle with depression or anxiety the next few months will be quite challenging.

Remind yourself that you are in control to how you respond to any event (and anxiety thrives when you feel as though you have no choice). Yet, you are stronger than you may believe. Below are three basic things that can help you with your mental hygiene.

  1. You are not alone in this pandemic. Control what you can. Wash your hands. Remind others to do the same. Continue to exercise. Limit your exposure to the news. It’s healthy to update yourself once or twice a day, but over-consumption will have a negative effect. Checking your news feed every few minutes or every hour is not helping you stay informed, but it is helping you develop an unhealthy fixation. Also, limiting screen time is good practice regardless of the reason or situation.
  1. Social distancing does not mean hiding under a rock. Avoid crowds and close contact, but get outside. Exercise helps with both physical and mental health. Being in the sun and fresh air helps restore emotional balance and gives a boost to natural vitamin D levels. Stay grounded by being mindful to the world around you. Do this by noticing what your senses are telling you through sight, sound, taste, and touch. This will help you stay present and avoid projecting into an uncertain future. Remember, choice and change only occurs in the here-and-now.
  1. If you are feeling overwhelmed or need support, please talk to those you trust most. It’s okay to feel afraid or angry – it’s what you do with those feelings that matters. If needed, reach out for extra support or help. You don’t have to be alone, professional help is always available online with a therapist or counselor.

DUE TO THE FINANCIAL IMPACT OF CORONAVIRUS (COVID-19), eTALKTHERAPY IS NOW OFFERING LOWER PER SESSION RATES BASED ON YOUR FINANCIAL NEED.  Contact us today for further pricing details.

Be safe, be healthy, be well,
Don

 

Hand hygiene. Person in the bathroom is cleaning and washing hands with soap
Mandi C. Dalicandro-Turk

Anxiety, Stress, Social Distancing, & Healthy Control

By Mandi C. Dalicandro-Turk MSPC, NCC

Anxiety, frustration, change, and uncertainty are a realistic and at times, a stressful part of life that humans grapple with. Currently, society as a whole is in a pandemic with many feeling highly anxious, fearful, and uncertain of the Coronavirus (COVID-19) and the long-term impact on society, the economy, loved ones, and the outcomes of overall health and wellness. It’s natural to have fear and anxiety of the unknown; to feel your healthy controls are being taxed and possibly becoming depleted.

During this time of uncertainty in the weeks to follow, there are ways to feel reasonably prepared while decreasing stress, anxiety, and worry.

Consider the following:

Grappling with Anxiety & Stress

For those experiencing anxiety, that have anxiety disorders, and/or a predisposition to stress, the fear and worry about the health and wellness of you and your loved ones, the economy, finances, having essential medications and supplies over the next few weeks or longer can feel overwhelming for some. Others are frustrated with feeling society is over preparing. Most are hoping for a level of preparedness and a positive outcome without mass hysteria.

During times of chaos and confusion, many seek out information from the news, social media, and other sources. It’s important to stay informed, it’s also vital to find good information based on statistics, data, and facts. Choosing how much to engage in information and when to disengage (put your phone down) assists with lowering feelings of uncertainty, of being out of control, and catastrophizing what is happening in the world around you. It’s normal to feel a sense of uneasiness, vulnerability, anger, confusion, and cognitive dissonance about the future.

It can be stressful for families and for parents to know how to talk with children about what’s happening. Being open, honest, and factual is important on an age appropriate level.  In addition, it’s important to balance your own fears during conversations and to do your best to monitor your own anxiety, anger, and stress to keep from instilling an unnecessary foundation of anxiety in children to potentially grapple with. It’s an opportunity to open a dialogue for critical thinking about individual feelings, values, the meaning of exploring those feelings moving forward, and how a person can learn and grow from what is happening.

It’s natural to feel the physiological and psychological impact of anxiety, it’s a protective mechanism; the fight or flight response in humans and animals. However, it’s what you do with the anxiety and stress you’re experiencing. Check in with yourself on how intense your feelings are, how long symptoms are lasting, and how your daily life is impacted. Implementing realistic expectations, allowing for flexibility, tapping into positive coping, tolerating frustration, and adapting for what is within your healthy controls day to day can help with lowering symptoms and the long-term impact. It’s beneficial to spend time in the present moments, practice gratitude, and enjoy yourself as much as realistically possible.

Social Distancing

Social distancing puts individuals at risk for social isolation; especially when depression, anxiety, stress, and other mental health issues are present.  It’s important to have awareness of the differences between social distancing and social isolation by checking in with yourself on how you’re feeling day to day. Consider what activities you’re engaging in or not doing at all. This is a good opportunity to carve out time to rebuild a relationship with yourself, reflect on what’s important, watch the sunrise or sunset, and connect with family and friends via phone, social media, or through email. Getting back to basics can feel healing and reaffirming; especially when focusing on significant and already established relationships. Make family time fun by keeping it simple. Hopefully, this is a time for children, adolescents, and adults to take a break from the high stress and pressures of a few daily responsibilities and obligations.

With that being said, if you’re in a stressful situation at home whether it’s due to a strained relationship with your partner or feeling overwhelmed by stress and responsibilities, take time away to rebalance. Consider listening to music, going for a walk or run, spend time with your furry friends, laugh and enjoy yourself, and do your best to focus on who and what you do have in the present moment, which includes your relationship with yourself. Check out online options in your community for working out, yoga, supports, and keeping up with physical and mental health. Focus on your strengths, tap into your supports, and treat yourself with compassion.

Healthy Controls

It’s beneficial to be present and work within what is in your healthy controls. Healthy control is different than attempting to control uncontrollable factors and attempting to control those around you in unhealthy and damaging ways. Healthy control is an internal sense of strength, presence, and balance. It’s trusting yourself and valuing where you are, what you’re feeling, and what is best in moving forward. Therefore, it’s making decisions that work well for you and your loved ones in ethical and healthy manners. Putting life in perspective, having a level of preparedness, and moving forward from there realistically.

Allowing some time to decompress and enjoying time with those in your shared environment as much as possible is within the realm of healthy control.  Check in with yourself and your loved ones; if your mental health or your loved one’s mental health is suffering and/or you or a loved one is struggling, feeling overwhelmed, and need to talk, reach out for support. Therapy where you’re meeting face-to-face online through a HIPAA secure site from the comfort of your own home is a safe, healthy, confidential, and convenient way to work with a therapist and to begin the healing process.

In conclusion, find ways you can feel content, ways you can help yourself feel balanced, and reasonably safe without adding undue stress, anxiety, and social isolation. Do your best to plan in realistic areas and to take one day at a time when planning isn’t possible. Consider where your information is from, look for statistics and data to assist with keeping anxiety and the stress of the unknown as low as possible.  There are many opportunities for self-reflection, growth, connecting with loved ones, and to engage in healthy and beneficial ways. Seek out the support of an online therapist if you’re feeling overwhelmed; even in the midst of a pandemic you can get the help you need. It’s important to treat yourself well, with compassion, and to check in on how you’re feeling.

Keep first responders, medical professionals, and individuals at increased risk for direct exposure in your thoughts, and individuals with higher risk for complications too. It’s important to come together as a community in safe and healthy ways to increase feelings of belonging and to decrease anxiety, stress, fear, and social isolation.

Stay safe, healthy, and well!

Learn, grow, & enjoy,
Mandi

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MandiTurk[1]Mandi Dalicandro-Turk writes about a variety of topics related to mental health, behavioral health, relationships, stress, anxiety, aging, grieving, self-care, therapy, and improving one’s overall quality of life.

Don Laird

You Will Be Visited By Three Spirits

An Existential Yuletide Greeting
by Don Laird, NCC, LPC, DCC

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Illustration by Harry Furniss

“Before I draw nearer to that stone to which you point,” said Scrooge, “answer me one question. Are these the shadows of the things that Will be, or are they the shadows of things that May be, only?”

Scrooge. A word that can immediately conjure images of a bitter and heartless man concerned more with greed than humanity; a cultural archetype of someone wanting nothing further to do with his species and one who has no use for words like “compassion” or “care.” Yet, on closer examination, Scrooge’s story reveals some remarkable insights for our modern times. There are facets to his narrative that are ostensibly universal. Yes, a harsh commentary on the mores of his time, but Scrooge is more relevant today than ever.

On its surface, Dickens’ Victorian yarn can be simply read as “Being a Ghost Story of Christmas.” However, there is much at stake for our cultural and individual well being in this seasonal tale. In fact, I assert to you that Charles Dickens’ seminal 1843 work A Christmas Carol remains one of the finest examples of existential psychotherapy ever written (albeit in fictional form). The tale of Ebeneezer Scrooge opens a time and space for self-reflection for those who want to examine life in a meaningful and in-depth fashion. This is not about instant transformation for the client, positive psychology to sooth the therapist’s fears, or worse, wishful thinking from both parties. It is an existential crisis that is illuminated by one of the key tenets of psychotherapy – fear of death.

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Illustration by Harry Furniss

We all know the story, so it is here that I wish to briefly highlight the other side of Scrooge. No one arrives at a certain point in their development without a back story, and Scrooge’s history is one filled with disappointment and neglect. He is an ignored and isolated child, abandoned even at Christmas by his family and friends. Scrooge knows pain all too well at an early age. The world around him and its inhabitants are not to be trusted. People, above all, should be shunned. They are to be feared as they need and require emotional attachment and engagement. These qualities are easily dismissed by a young man whose growing trust in currency and greed will engulf his life for years.

In the beginning of A Christmas Carol, Scrooge exemplifies one of the central canons of existential depression and anxiety, that one has always been this way, and one always will be. There is a loss of agency and caustic determinism quickly fills in this void. When the Ghost of Christmas Yet to Come points at the tombstone, Scrooge understands for the first time that life can be written differently: what seems to be etched in stone isn’t. The specter’s message is powerful; an opportunity for Scrooge to see what life on earth would be like after his death. Scrooge observes his own forgotten corpse as his peers minimize his demise. He watches in horror as strangers quickly sell his belongings, while mocking his death with no regard or mercy. In death, he can no longer be an agent of change. He is a spectator to a cruel and vicious world he created.  Yet all Three Spirits show him that he was and is agent of change as long as he is alive. It is through an encounter with one’s mortality that a fuller life may occur – to know death is to know life. Scrooge accepts the significance of death, so that he may live his final months and years embraced in the richness of his relationships with others.

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Illustration by Harry Furniss

Death anxiety is real; despite those in modern psychology who often relegate the subject of death to the closet of “let’s not go there unless we have to” (even by some seasoned practitioners who should know better). In short, beware the therapist who professes that the exploration of death anxiety is not particularly helpful in therapy. Yes, therapists can spend far too much time focusing on one area while neglecting another. It happens. Not every therapist is well-rounded enough to create a new therapy for each of her or his clients. However, that shouldn’t allow for a wave of “positivity” to sweep us away from Otto Rank’s maxim, “Some refuse the loan of life to avoid the debt of death.” Exploration of death and dying serves as a profound catalyst toward some remarkable life changes. It is the confluence of both past, present and future; an investigation of life by way of an awareness and acknowledgement of our finite time here on Earth. In this way, we are all a reflection of Dicken’s vision.

Thus, A Christmas Carol calls us to embrace some definitive questions, “How would the world be different if I were to die today?” and “Do I ever have a true sense of how many lives I’ve touched?” Scrooge’s story may, in fact, provide the answers. Our relationships with others are so intrinsic that our absence creates an entirely different existence – a ghostly existential vacuum, if you will.

In the Victorian era, people saw ghosts and had premonitions. It was a system of supernatural beliefs that was not uncommon. Freud came along and said that this was the result of repressed memories. The dead were reduced to misleading or damaged recollections that resulted in certain beliefs and behaviors. Ghosts haunted the mind, not the house. Yet, there is something within Scrooge’s narrative that calls to us, pushes us beyond cause and effect, beyond determinism, and reminds us that we can be responsible and compassionate with our life choices and that no person is indeed an island.

Be well, and remember to keep the spirit of this season in your heart today and throughout the year.

In good health,
Don

Photos courtesy http://www.victorianweb.org/art/illustration/furniss/xmas.html#cc

Feet in Christmas socks near fireplace
Mandi C. Dalicandro-Turk

Navigating the Holidays

by Mandi C. Dalicandro-Turk

During the holiday season, images of a crisp snow covered lane, with the view into the frosted window of a warm and cozy home, the scene of a blazing fire, a long decorative table filled with scrumptious holiday delights, and loved one’s surrounding the table brings feelings of dissonance for many. The holidays absolutely have the potential to bring feelings of intimate experiences filled with belonging, exhilaration, sharing, and gathering with loved ones. For many, however, there are increases in stress, anxiety, depression, feelings of loneliness, difficulties with grieving and loss, conflict, and contemplation.

There is meaning to the ornaments being unboxed, the candles lit, and the years, many times, decades of tradition. There are customs leading up to the season, feelings of anticipation, significance to the day(s) of celebration, and the letdown after everything is put away.

Mental Health Issues Exasperated
During the holidays, mental health, behavioral health, medical issues, and autoimmune issues that individuals grapple with each day have the potential to become exasperated and contribute to increased symptoms, stress, and feelings of exhaustion. For many, it’s extremely difficult to navigate through increases in symptoms and difficulties with coping. Many times, individuals’ cope with negative coping mechanisms (i.e., alcohol, unhealthy eating habits, lowered self-care, and/or misuse of medications).

Consider individuals grappling with Generalized Anxiety Disorder (GAD), “Twelve month prevalence of GAD is .9% among adolescents and 2.9% among adults in the general community of the United States” (American Psychiatric Association, p. 223, 2013). Individuals have the potential to experience symptom increases (i.e., difficulty concentrating, irritability, difficulties controlling worry, levels of fatigue, muscle tension, and issues with sleep), which complicates discomfort and difficulty in managing symptoms (American Psychiatric Association, p. 222, 2013).

Additionally, individuals contending with Social Anxiety Disorder (SAD) grapple with an array of symptoms (i.e., fear of negative evaluation, being humiliated, and/or rejected), many times, avoiding social situations (American Psychiatric Association, p. 202, 2013). During the holidays, it’s difficult to avoid all social situations and associated symptom increases.

Furthermore, consider the significant impact and issues with functioning associated with Major Depressive Disorder (MDD), “Twelve month prevalence of major depressive disorder is approximately 7%, with marked differences by age group” (American Psychiatric Association, p. 165, 2013). Symptom increases (i.e., feelings of sadness, hopelessness, minimal interest and pleasure, fatigue, feelings of worthlessness, diminished concentration, and issues with sleep) complicate already difficult daily functioning and increase the probability of grappling with each facet of holiday obligation and interactions.

Conceptualize the experience of comorbidity of GAD, SAD, and/or MDD with or without substance use (and/or any mental health diagnosis) and its associated symptoms, with the presence of holiday stress, pressures, and the impact physiologically and psychologically. It’s best to seek out therapy prior to the holidays to develop positive coping strategies, realistic expectations, awareness to pressures, work through increases in symptoms, and to decrease the probability of underlying issues being triggered.

Engaging and Balancing Conflict — Differing Views vs. Differing Values
Some families benefit from closeness and healthy working dynamics. However, even when this is present in the environment, there is potential for conflict and tension during high pressure and high stress times; including desirable ones during the holidays.

Inevitably, there will be internal triggers experienced when engaging with others, which has potential to feel agonizing. In this environment, develop awareness to balance what degree of engagement feels healthier. At times, lighter conversations will assist in minimizing triggers. In the event, stress and discomfort become too overwhelming to engage, take a few moments to walk outside for some air. Take a few deep breaths and allow the increases in oxygen to balance parasympathetic response, and increase oxygen to the brain to assist with feelings of relaxation, (Wolford, p. 2, 2015). Furthermore, spend time with younger family members; if this is enjoyable. Children and adolescents have potential to bring a different perspective and magic to the holiday, which increases fun and increases relaxation.

Additionally, avoid family conflict. There are two primary areas of focus. First, refrain from engagement, debate, and argument regarding issues of contention between family members and/or friends in general, and where estrangement is present. At times, there may be pressure to choose sides. There is psychological benefit in refraining from choosing sides, treating each person with respect, and engaging with each person individually, if necessary. Reflect prior to being in the shared environment on personal values and feelings regarding the dynamics surrounding conflict. The cognitive process of reflection has potential to increase levels of confidence to support disengagement in the conflict, while dually engaging with others in regards to the positive aspects of relationships and holiday gatherings. This will lower stress, and minimize increases in mental health symptoms.

Lastly, it’s reasonable to have different views; it’s a driving factor of being human. Many times, human’s enjoy debating these views. There is a level of cognitive stimulation, fun, and strategy involved. With this being said, individuals must consider individual motivations, and how each message is given and received. There are distinct differences in the motivations of debating in positive banter with loved one’s out of pleasure, mutual understanding, and respect, even with the presence of opposing views and/or a heated discussion. Equally, it’s beneficial to refrain from debating in negative, critical manners with a family member and/or friend of differing values where high tensions are present. During holiday gatherings, consider each individual relationship, underlying motivations, and feelings. When tensions are high and values are vastly opposing, different views have opportunity to be debated at another time. In this situation, it’s best to refrain during holiday gatherings. However, in a cohesive and healthy environment, enjoy the banter. Individuals possess varying levels of impulse control. Develop awareness of strengths in impulse control, areas of grappling, and the resulting behaviors of each; then, gauge the best course of action accordingly. In each interaction, engage with respect and graciousness.

Loneliness, Isolation, Grief, and Change
At times, there are shifts in family, friends, supports, and a sense of community. Death, illness, and/or divorce are difficult to navigate through in daily life, and exhausting during the holidays. New traditions that have yet to be created and resistance to shifts in traditions that are no longer possible are common. For divorced partners with children, there are the adjustments for each in regards to splitting time. In the most amicable situations where partners remain respectful and possibly friendly, difficulties, stress, grief, and negative feelings have potential to arise during the holidays. Negotiating for wellness of each individual involved is imperative to maintaining balance and decreasing the probability of future issues.

The loss and associated grieving of a deceased loved one is an excruciating and extensive process. Many times, significant changes to meaningful traditions are a painful reality. Developing awareness that grief will resurface intermittently, many times over, and during meaningful interactions is imperative. Finding ways to honor the deceased loved one will assist with holding on to the meaning of significant traditions, and decrease feelings of isolation and loneliness; including traditions that will inevitably change over time. Grieving is an individual process, the time frame varies from person to person, and is based on the significance of the relationship. It is vital to develop self-compassion and to seek out supports.

Preventative measures
Start with being honest about limits physically, mentally, and emotionally. When there are children in the home, balance spending time with children, and with family and friends. Schedule visits on days close to the holiday celebration instead of over committing in one day. This will increase enjoyment of holiday events and decrease feelings of obligation, and potentially, resentment. Additionally, the gatherings may become a tradition and special day to look forward to for each individual involved.

Reflect honestly
Many times, thoughts, feelings, and ruminations in regards to family dynamics, divorce, death, estranged relationships, and the focus of seemingly endless obligations increase stress, anxiety, and/ or depressive symptoms. It becomes overwhelming for individuals and difficult to balance. Most times, it is beneficial to ask for help, which has the potential to reduce stress and increases the capacities to function well throughout the holidays.

Having awareness that there will be stress assists in setting realistic expectations. Many times, a few simple changes will allow flexibility, while dually honoring traditions (i.e., cooking the meal in advance, offering for each person to choose a dish to bring, setting boundaries to time spent at each gathering, and/or planning finances and budgets a year or more prior). At times, the more an individual attempts to take on without assistance or planning, the more emotional and psychological difficulties are experienced, creating an exasperation of mental health, behavior health, and/or medical issues.

Balancing Obligations and Desirable Engagements
Balance obligations and spending time with loved ones; especially, loved ones with a significant role in life. Plan each day by writing each event, commitment, obligation, and list of items needing completed in a planner. While doing this, implement a block of free time to decompress, and to balance unexpected shifts and obligations along the way. Each will reduce stress and assist in balancing emotions, energy, and mental health. Consider taking vacation and/or personal days if they are available and will not contribute to more stress at another time of the year. Doing so will allow for balancing commitments, downtime, and increase the opportunity to decompress after the holiday.

Continue nutritional habits (refrain from inflammation supporting foods), regular exercise, activities, and incorporating healthy sleep cycles. For long trips, bring snacks and water. In addition, when offered to stay with family and/or friends, consider personal comfort. For example, if one partner feels uncomfortable due to personalities, temperament, family dynamics, and/or if children get tired and need rest, consider staying at a hotel for the night. Make it fun for the family and have awareness of individual feelings, thought processes, and how daily function is potentially impacted. When setting boundaries, be kind, gracious, and genuine. Avoid using children as an excuse – be accountable for individual feelings, emotions, comfort, values, setting boundaries, avoiding “ the shoulds,” and saying no when necessary.

When the Ornaments Are Boxed
After the ornaments are put away, and daily life moves forward, it’s important to consider what to do with unprocessed feelings and emotions, and the grief and loss of the passing season. Begin to navigate the cognitive steps towards healing by seeking out the support of family, friends, community, and a therapeutic relationship. Focusing on gratitude (what is present over what is void), resuming daily activities, and seeking out strong supports assists with this process greatly.

In conclusion, the holidays are layered with complex emotions and meaning; simultaneously filled with the potential to grapple with increased symptoms of mental health and medical issues, stress, loneliness, and the innate desire to connect, share, give, and experience intimate feelings of belonging. Consider the benefits to being mindful that each person’s life experiences, environment, genetic predisposition, personality, temperament, supports, family and friends, and dynamics are different. Ultimately, develop awareness and engage realistically regarding the pleasures and difficulties associated with the holidays – allow for positive interactions to happen organically towards a more genuine and enjoyable experience. 

References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Benson, H. 1979. The Mind/Body Effect. New York: Simon and Schuster.
Benson, H., & Klipper, M. Z. (2000). The Relaxation Response. New York: William Morrow.
Wolford, K. (2015). Relaxation response: Herbert Benson. Salem Press Encyclopedia of Health.

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Mandi is a therapist with over 6 years experience working with adults, couples, older adults, adolescents, and first responders. Mandi works with an array of issues, and is passionate about supporting others. She feels strongly that human-beings benefit from the experiences of learning, growing, and developing throughout each stage of life.