I have found that if i wait until the last step, I tend to eat too fast and the food does not go down very well.  If I eat at the graze stage then I eat too much because I eat small amounts at a time.  The best stage is the middle one when I am starting to go crazy.  I am ready to fix a meal, sit down and slowly enjoy it.

 There are much much more effective ways to give consequences.  I tell parents to find what their children likes most.  Some examples are watching television, playing games on devices, sports, spending time with friends, or playing with a certain toy.  Use that privilege as a consequence and take it away.  Most children respond well to this.  If your child doesn’t then there may be other problems and it would be wise to have your child evaluated.  Contact me if you have questions about your children.  Find me at my website:  www.brighterdays4you.com

Below is a suicide assessment tool that I use and can be used by family members to decide how much of a push is needed to seek treatment.

5 LEVELS OF SUICIDE

LEVEL ONE

This includes thoughts of wanting to die and thoughts of death with no thoughts of suicide.  Just wanting to die of a disease like cancer.  The person may say things like, “I wish I was dead.” when angry or hurt.  Most of us have experienced this at one time or another.

LEVEL TWO

Thoughts of suicide with no plan or intent.  The person may start feeling hopeless or helpless and may voice this.  Things like “‘I just want to kill myself.’ or’ Why don’t I just kill myself.’” might be said when angry or hurt.

LEVEL THREE

Thoughts of suicide with a plan that is not lethal.  Non-lethal plans include plans like taking a bunch of pills or cutting the wrist.  There is no intent to attempt suicide.

LEVEL FOUR

This is where males and females start to diverge.  Women are more likely to develop plans that are non-lethal and are more likely to attempt.  For women look at past suicide attempts because they get more lethal each time.  Men are more likely to develop plans that are lethal but are less likely to attempt so look for a lethal plan with no intent to follow through.  May talk about seeing others as better off with out them but can be talked out of this.

LEVEL FIVE

Thoughts of suicide that are lethal and with intent.  Suicide becomes the only option out of their problems.  See everyone el better off without them and cannot be talked out of this.

Factors

If there is drinking or drug use always raise the person by a level because alcohol and drugs lower inhibitions.  Consider the suicide risk more if the person is single, male, young, or alone. 

Always seek help at all levels because even level one is a symptom of depression and can be treated.  Seek emergency help if at level five.  As the level gets higher the thoughts of suicide increase and become more obsessive. 

A good question to ask is when was the last time the person thought of suicide.  Teenagers are more likely to say that they are not thinking of suicide.  What you will find though is that they are more concrete.  They may be not thinking of suicide in that moment but may have thought of it yesterday and everyday before that.  Ask how frequently were their thoughts such as how many times this month, week or even day.

This week, I want to focus on accountability.  There are many ways to be accountable, being honest with yourself, allowing others to be  honest with you, or changing your behavior to be more accountable to others.  It is this last that I want to talk about.  About a month ago, I went to a terrific workshop offered by Tom Wootton, author of several books including Bipolar Advantage and Depression Advantage.  A technique that he offered on accountability included asking yourself several questions a day.  Questions that led toward a behavioral change.  Since then, I have been asking myself what I can do for my family.  I confess that in the last couple of years, I haven’t done much for them other than cook the occasional meal so I started asking myself what have I done for my family today.  I started with little barely noticeable things like sweeping the floor and then graduated to offering to get things or spontaneously getting things for them.  My reward came last weekend when my daughter wondered why I was being so nice.  I’m not suggesting that everyone do more for their family rather I’m suggesting that we all take a look at our weaknesses and turn them into strengths.  My weakness was laziness.  Tom admitted during his workshop that his was rage.  What is yours and how can you turn this into a strength?  Take a look at different areas of your life such as work, family, lifestyle and spirituality.  What thoughts lead you to behaviors that you are not proud of?  Do you need to change those before you change your behaviors?

For me the rule of thumb is to always rule out biological causes of panic attacks because it is better to be safe than dead before seeing a counselor or obtaining prescriptions for anxiolytics.  This conversation underscores ruling out allergens as well.  The best way to rule out allergens is to keep a food journal and a record of panic attacks.  Be aware of hidden ingredients in foods such as the multiple uses of peanuts and peanut oil.

To do a mantra effectively, get into a relaxed position as you would for a relaxation exercise.  Start with some deep breaths and then repeat a word or a phrase to yourself that has meaning to you.  Some examples are:

• I am loved.
• I am lovable.
• I am at peace.
• I am cared for.
• Love
• Peace
• I am strong.
• I have strength.
• I am full of peace.  (Even if you don’t believe it.)

Use what works for you.  Do this for about 10-15 minutes everyday and you will start to notice a difference in how you feel about yourself and how you react to others.  You will find not only that you feel more peaceful and better about yourself, but also less anxious and less irritable.  If 10 or 16 minutes seem too much for you, try 5 or try it with your eyes open while you are driving or stopped at a stop light.  Try to catch moments through the day when you have a chance to take a deep breath.  Try something like this:  when breathing in, say to yourself, “I breathe in love.” and when breathing out say, “I breathe out peace.”

I have learned a lot with the band already.

• I know what sliming is because I have done it.
• I know what happens when food gets stuck in the band.
• Not to eat french fries.
• Not to eat at all on a day of a fill, but to stick with liquids.
• Breads give me indigestion.
• Gas-x makes a sliming episode worse but water helps.
• Hiccups are a sure sign that I am done eating as is port pain, cramps, and heart burn.
• Stir fries are a great way to get protein in.
• We Americans have an awfully fatty diet.
• Exercise makes the weight melt off faster.
• There are some great support groups out there on the web.
• Liquid protein is great before the band and on fill days but not on other days.
• Not to drink my calories.
• The dietitians who have not lost weight or had weight loss surgery don’t really understand what it is like nor do they necessarily know everything that a bandster goes through.
• Unless a person has been there, no one really understands the looks or the attitudes of others toward overweight people.
• Sometimes emotions can derail weight loss efforts even with the band.

This last one is where I can come in and help you get back on track.  Whether you are thinking of getting weight loss surgery or already have had it, I can help you get past your mental blocks, learn more about yourself and what the band means to you and learn how to stay on track with your weight loss.  Try me and see if I can help you by taking advantage of the free first session.

Physical boundaries are like a bubble around ourselves. There are many types of boundaries.  You can see your own physical boundary by watching what you do when someone gets too close to you. The point at which you backed up or looked down is your physical boundary. Physical boundaries protect us from being physically hurt by another person. Watch what another person does when you move into that person’s space. Did he back up or look down? Was her space bigger or smaller then yours? The space that we give to the opposite sex tends to be wider then to the same sex. The space given for children is smaller and the space given for taller people is bigger.

Emotional boundaries are when someone overly criticizes you, calls you names, puts you down, and does not value you as a person. You do not have to be treated that way. You can set a limit and not allow others to put you down or call you names. Sometimes when we are brought up in households where there is a lot of verbal abuse, our emotional boundaries have been crossed so many times that we set it inappropriately too close and continue to allow others to call us names. This can be unlearned and appropriate boundaries can be taught.

Intellectual boundaries are insidious and difficult to differentiate from emotional boundaries.  Let me start with a story about a family that I saw in counseling. This family had a single mother and 3 daughters. When the mother was confronted on something and started crying, all of her daughters cried. Similarly when one of the daughters started crying everyone in the family cried. The belief in this family was that if one cried then all must cry. That belief is an intellectual boundary. The intellectual boundary of the daughters had been crossed so that they believed what their mother told them about crying. In other words intellectual boundaries get crossed when a certain message or belief is told so many times, it becomes gospel truth in the family. Beliefs cannot be challenged but all family members must be integrated into the family belief system instead. Intellectual boundaries are most commonly violated in families where to believe anything outside of the families beliefs gets met with criticism and ridicule. So for example if the family’s religion is Methodist then anyone stating a Muslim belief would be met with ridicule. Another example is when a family is homophobic and one of the children realizes that he is homosexual. That family member gets met with criticism and hostility.

Spiritual boundaries are when boundaries around spirituality are crossed like when a person mixes spiritual matters and religion with doing something wrong such as physical abuse or sexual abuse.  Doing the right thing as is taught in all religions gets mixed up with doing the wrong thing.  The victim gets confused then about what is right and what is wrong.  Many victims give up spirituality or at the very least religion altogether because God gets blamed.  Examples of this are when ministers sexually abuse children or when parents see themselves as religious yet treat their children with disrespect and abuse.

Sexual boundaries are the boundaries regarding sex and privacy.  These are crossed not only when an adult touches a child in a sexual way but also when crude language is used around children, adult pornography is shown when children are present and physical privacy is disrespected such as when family members are allowed to go into bedrooms and bathrooms unnounced.

MILD

Lack of motivation

Low self esteem

Feeling tired

Isolating self – not seeing friends or family

Sleeping too much

Feeling sad or blue most days

Thoughts of wanting to die from illness

Losing interest in things that used to be enjoyed such as hobbies

MODERATE

Losing sleep

Losing appetite

Losing hope

Thoughts of suicide with no intent to follow through with it

Feeling helpless, trapped

Having problems concentrating and/or making decisions

SEVERE

Feel hopeless and helpless

Thoughts of suicide become obsessive

Can be self destructive or self defeating

Thoughts of suicide with intent

The moderate and severe  categories include all of the symptoms of the ones before it so moderate includes mild and severe includes mild and moderate symptoms.  You may not experience all of the symptoms in the categories below however if you experience two or more in the moderate and one in the severe category then you would fit in those categories.  I have found that it is not enough just to list the symptoms.  You can deny, minimize and find a way to tell yourself  that you are not depressed or only mildly depressed however when you see your symptoms in the moderate or even severe category, it gets harder to deny it. 

The next question is often whether you should take medication for it.  This is the quideline that I use:  There are two criteria that I use to determine whether you should go on medication or whether you can choose for yourself. 

The first is if the thoughts of suicide have become so persistant that they are scaring you, the means for suicide has become lethal, there have been past attempts or alcohol or drugs are involved.  When you are dead, you are dead.  There is no turning back, no changing your mind.  Alcohol and drugs lower inhibitions which means that you are more likely to follow through with killing yourself under the influence. 

 The second is if you having a difficult time functioning at home or at your job.  You have a job to do, you have kids at home, there are people depending on you to maintain order in their lives.  If you have allowed your depression to overtake you then the quickest way to turn this around is with antidepressants.

Antidepressants have a long half life which means basically that you feel the side effects before you feel the good effects. The most common side effects people feel are headaches and stomach aches or nausea. These go away after the first week. If they don’t then talk to your doctor. The good effects are not felt for about 2-4 weeks later depending on the antidepressant prescribed so do not worry if you are not feeling better right away.