The new issue of *Archives of Internal Medicine* (Vol. 170, No. 4,
February 22) includes an article: “The Effect of Exercise Training on
Anxiety Symptoms Among Patients: A Systematic Review.”

The authors are Matthew P. Herring, MS, MEd, Patrick J. O’Connor, PhD, & Rodney K. Dishman, PhD.

Here’s how the article starts:

[begin excerpt]

Anxiety, an unpleasant mood characterized by thoughts of worry, is an
adaptive response to perceived threats that can develop into a
maladaptive anxiety disorder if it becomes severe and chronic.1

Anxiety symptoms and disorders are common among individuals with a
chronic illness,2-8  yet health care providers often fail to recognize
or treat anxiety and may consider it to be an unimportant response to a
chronic illness.9

Anxiety symptoms can have a negative impact on treatment outcomes in
part because anxious patients can be less likely to adhere to prescribed
medical treatments.10-11

Personal costs of anxiety among patients include reduced health-related
quality of life12 and increased disability, role impairment,13 and
health care visits.14

The new issue of *Behaviour Research and Therapy* (vol. 48, #2, pp.
152-157) includes a study: “When self-help is no help: Traditional
cognitive skills training does not prevent depressive symptoms in people
who ruminate.”

The author is Gerald J. Haeffela.

Here’s the abstract:

[begin excerpt]

A randomized trial was conducted to test the efficacy of three self-
directed prevention intervention workbooks for depression.

Cognitively at-risk college freshmen were randomly assigned to one of
three conditions: traditional cognitive, non-traditional cognitive, and
academic skills.

Consistent with hypotheses, participants who were high in rumination and
experienced stress exhibited significantly greater levels of depressive
symptoms after completing the traditional cognitive skills workbook than
after completing the other two workbooks.

This pattern of results held post-intervention and 4 months later.

These findings indicate that rumination may hinder ones ability to
identify and dispute negative thoughts (at least without the help of a
trained professional).

The results underscore the importance of identifying individual
difference variables that moderate intervention efficacy.

They also raise concerns about the potential benefits of self-help
books, an industry that generates billions of dollars each year.

[end abstract]

Here’s the contact info from the author note: Gerald J. Haeffela,
Department of Psychology, University of Notre Dame, Haggar Hall, Notre
Dame, IN 46556, < g h a e f f e l @ n d . e d u >.

Courtesy of Ken Pope

“There is an idea current in the prevailing culture that writing about something that means you heal the pain.  I was not, when I began writing my life story, and I am not now, healed of my mother.  You do gain a small distance from anything by keeping it in suspension in your mind while you work at finding the words to fit it.  The process is so slow and incremental that you do not notice its effect, but the point is that it is a process.  I found out when I was a little girl that if you are crying uncontrollably and want to stop, the thing is to do something useful with your tears — water a plant, say.  They’ll dry up for themselves.  The same happens when you try to make sentences of painful material: the material lightens as it is put to work.”

Nualo O’Faolain in “Almost There”, pg. 36.

Resources on reproductive loss

1) When Part of the Self Is Lost: Helping Clients Heal After Sexual and Reproductive Losses by Constance Hoenk Shapiro was published in 1993 but may be hard to get, its not currently available on Amazon.

2) CBC had a program called “mother of miscarriage” that can be ordered on tape. it is mostly to validate the loss, giving permission to grieve, and reminding the woman she is not alone.

3) Nancy Newman has an excellent website as well:

4) MISS Foundation, online support groups for all family members and resources for caregivers.

5) “Empty Cradle, Broken Heart” by Davis is a written resource.  There is also a website:

Another book is:  An Empty Cradle, a Full Heart: Reflections for Mothers and Fathers After Miscarriage, Stillbirth, or Infant Death
Author: Christine O’Keeffe Lafser.

6) Hope is like the Sun: Finding Hope and Healing after Miscarriage,
stillbirth or Infant death by Lisa Church (Book).

compiled by
Natacha Ferrada, Ph.D
Registered Psychologist,
Vancouver, BC
with input of BC colleagues

“I am Me. In all the world, there is no one else exactly like me. Everything that comes out of me is authentically mine, because I alone chose it — I own everything about me: my body, my feelings, my mouth, my voice, all my actions, whether they be to others or myself. I own my fantasies, my dreams, my hopes, my fears. I own my triumphs and successes, all my failures and mistakes. Because I own all of me, I can become intimately acquainted with me. By so doing, I can love me and be friendly with all my parts. I know there are aspects about myself that puzzle me, and other aspects that I do not know — but as long as I am friendly and loving to myself, I can courageously and hopefully look for solutions to the puzzles and ways to find out more about me. However I look and sound, whatever I say and do, and whatever I think and feel at a given moment in time is authentically me. If later some parts of how I looked, sounded, thought, and felt turn out to be unfitting, I can discard that which is unfitting, keep the rest, and invent something new for that which I discarded. I can see, hear, feel, think, say, and do. I have the tools to survive, to be close to others, to be productive, and to make sense and order out of the world of people and things outside of me. I own me, and therefore, I can engineer me. I am me, and I am Okay.”

– Virginia Satir –


The “Time-Out” is a simple yet effective tool for changing angry violent and abusive behavior. The intention of the time out is not to offer long term solutions to conflict and anger problems. This tool is simply intended to offer a short term alternative to behavior that is no longer desirable.

The “Time-Out” is a technique that requires practice and commitment. Initial obstacles to taking a “Time-Out” may not be foreseen and so it is sometimes recommended that a practice “Time-Out” should take place before a real one is necessary.

There are four steps to the “Time-Out”

l. Identify that you are escalating to the point where you need to get out of the situation. Use the “cues” or red flags to help you get in touch with physical, emotional and situational cues that may help you to know where you are at with your anger.

2. Decide to take the time out before you become intimidating, threatening or physically abusive. Indicate to the other person/s that you are leaving. Do not make any long speeches at this point; simply say that you are taking a “Time-Out”. (Make sure that you have informed others about the “Time-Out” in advance.

3. Leave where you are and go outside. Do not simply go to another room of the house or workplace. It is important that you physically leave the site of the conflict. Don’t get “hooked” into staying in the conflict. Take one hour to calm down before coming back. lf you need longer, let the other person know this. Don’t “stomp out”!

4. Return and decide together whether or not to return to the discussion or issue that took place before you left.

Think of other things Drink/use drugs
Walk, cycle, run, etc. Drive/ talk to unhealthy people
Talk to a positive support Hit or strike anything
Come back in one hour Rehearse the argument
Courtesy of Arla Sinclair Counselling


  • I have a right to be treated with dignity and respect.
  • I have a right to have and express all my feelings.
  • I have a right to take care of myself first if I choose to.
  • I have a right to be listened to and taken seriously.
  • I have a right to make mistakes.
  • I have a right to say NO! I do not need to justify myself or give reasons.
  • I have a right to say NO without feeling guilty.
  • I have a right to say NO to anything I feel I am not ready for.
  • I have a right to say NO to anything that violates my values.
  • I have a right to say NO to anything that I feel is unsafe.
  • I have a right to terminate conversations – because I want to – when I feel humiliated or put down.
  • I have a right to choose who to spend my time with.
  • I have a right to play and have fun.
  • I have a right to set limits for myself
  • I have a right to make my own choices and decisions.
  • I have a right to choose my own spiritual beliefs.
  • I have a right to physical and emotional privacy.
  • I have a right to grieve.
  • I have a right to talk about things that are important to me.
  • I have a right to be angry.
  • I have a right to express my needs.
  • I have a right to make noise, to laugh, and to cry out loud

I don’t agree with every one of these items, but there are some good ideas here if kept in perspective. – BG



l. You act on feelings when you need to.

2. You can say no when you want to without experiencing tidal waves of guilt.

3. You generally do precisely what you want to do rather than depending on the suggestions of others.

4. You no longer blame yourself for everything that goes wrong in a relationship or friendship.

5. You no longer feel responsible for making a relationship work or making another person happy

6. You don’t take things personally. If a friend is inconsiderate or a partner has a wandering eye, you know the behaviour has to do with them and their history and has little or nothing to do with you.

7. You disagree with a friend and yet are able to maintain your friendship.

8. You realize you’re not responsible for the actions of another.

9. You become comfortable in receiving as well as giving.


l. STAY WITH YOUR FEELING – Allow yourself to feel it fully. Remind yourself that it’s none of your business what the other person is feeling.

2. EXPRESS YOUR EMOTIONS – You have a right to express all your emotions. Say how you feel out loud. Share your feelings with others at every opportunity.

3. STATE YOUR PREFERENCES – “I’d rather eat at a different restaurant.” “I would prefer to take my own car.” This helps you to maintain clarity about your own choices and priorities.

4. SET LIMITS – “I can drive you to your class this week, but I can’t drive you every week.” “I love you, but I can’t come over tonight; I have to study.”

  • These limits will help you give to others within healthy boundaries, so that you don’t overextend yourself.
  • Don’t be afraid to disagree with someone. Acknowledge the other person’s opinion and restate your own. Don’t resort to pretending or accommodating in order to keep the peace.
  • Talk about your own experience, such as how you handled such an incident, rather than how the other person ought to do it.

5. HAND THE PROBLEM BACK TO ITS ORIGINATOR: That’s a tough decision, but I’m sure you’ll be able to figure it out.

From the book: Don’t Fall Until You See The Whites of Their Lies by Cheryl Moore Barron

Three strategies for dealing with useless worry
– a cognitive therapy approach.

Some people find the following strategies helpful for reducing pointless and upsetting worry.

1. Thought Stopping

Thought stopping is designed to be used when you find yourself worrying about the same issue again and again. It should only be used if the worry is pointless. If your worrying is actually giving you solutions to the problem, then you might want to keep doing it.  The technique takes a fair bit of practice to learn. Here’s the sequence:

a) Pick a time when you can be undisturbed at home for a couple of hours.

b) Sit down and deliberately start worrying. This may be harder than you think. You should choose an issue that bothers you but not one that will send you into deep depression or make you think about harming yourself.

c) Once you begin to feel worried do three things: stand up, clap your hands once and shout “stop!” you will feel quite silly doing this but do it anyway. You should notice that the worry stops for a bit.

d) The moment you notice yourself worrying again (probably only a few seconds later) stand, clap and shout “stop!” again. Keep repeating this. Eventually you should notice that the worry takes longer and longer to come back. At this point clap and shout without standing.   After a while stop clapping; just shout.

e) Finally stop shouting. Instead picture a large stop sign in your head and imagine yourself shouting “STOP”. Now you can have other people around again. Over the next few weeks make a point of imagining the sign and the shout whenever you catch yourself worrying about the topic. If you like you can wear a rubber band around your wrist and snap it (gently) against the skin at the same time. Then shift your mind onto some other topic. With time you can become very effective at halting periods of pointless worry.

2. Worrying Time

Worrying time is designed to help you stop worrying about problems for most of the day by saving all of your worrying for a particular time. This can be easier than stopping the worrying altogether. As well you may have to think about some of your worries in order to decide what to do about them. Here’s the strategy;

a) Pick a time during the day or week when you will sit down and think about the things that have been worrying you. You probably don’t need to do this every day but more than once a week would be a good idea. Set aside a maximum of 30 minutes when you will not be distracted.

b) Carry a pen and paper (index cards work well) with you at all times. When you catch yourself worrying, make a note of the topic. Assure yourself that you will  think about the issue but not right now. Shift your mind onto something else.

c) When it is time to worry, take out your list of topics and consider each of them in turn. With some topics you may find that you can actually come up with a solution or a decision about how to handle them. Others you may just worry about.  This strategy may sound a bit odd but it is amazingly helpful if you are disciplined about carrying it out.

3 . Worry Inflation

We frequently try to minimize our fears. Worry inflation uses the opposite approach: making the problems as big as possible. Why? Because if you exaggerate many fears they eventually become ridiculous. You find that you can’t really believe that things will get that bad, and the problem shrinks down to realistic proportions. Here’s the strategy:

a) First identify the disturbing thought you want to deal with.

b) Next decide whether inflating the worry will make it seem silly or will only make it seem worse.

c) If it looks like a good topic for worry inflation, exaggerate the disturbing thought out of all proportion. Imagine the most extreme consequences possible. For example: “If I phone my old friend she won’t remember me. She will tell the police she has had a nuisance caller. They will trace the call and arrest me. I’ll spend the rest of my life in jail”. The more extreme the worry gets; the less you may believe in it and the less that thought will be able to bother you in the future.

(Mar 2/09) *New York Times* includes an article: “The Muddled Tracks
of All Those Tears” by Benedict Carey.

Here’s an excerpt:

[begin excerpts]

Now, some researchers say that the common psychological wisdom about
crying — crying as a healthy catharsis — is incomplete and misleading.
Having a “good cry” can and usually does allow people to recover some
mental balance after a loss. But not always and not for everyone,
argues a review article in the current issue of the journal Current
Directions in Psychological Science.

This call for a more nuanced view of crying stems partly from a critique
of previous studies. Over the years, psychologists have confirmed many
common observations about crying. It is infectious. Women break down
more easily and more often than men, for reasons that are very likely
biochemical as well as cultural. And the physical experience mirrors
the psychological one: heart rate and breathing peak during the storm
and taper off as the sky clears.

When asked about tearful episodes, most people, as expected, insist that
the crying allowed them to absorb a blow, to feel better and even to
think more clearly about something or someone they had lost.

At least that’s the way they remember it — and that’s the rub, said
Jonathan Rottenberg, a psychologist at the University of South Florida
and a co-author of the review paper. “A lot of the data supporting the
conventional wisdom is based on people thinking back over time,” he
said, “and it’s contaminated by people’s beliefs about what crying should do.”

Just as researchers have found that people tend, with time, to
selectively remember the best parts of their vacations (the swim-up bars
and dancing) and forget the headaches, so crying may also appear
cathartic in retrospect. Memory tidies up the mixed episodes — the
times when tears brought more shame than relief, more misery than company.

In a study published in the December issue of The Journal of Social and
Clinical Psychology, Dr. Rottenberg, along with Lauren M. Bylsma of the
University of South Florida and Ad Vingerhoets of Tilburg University in
the Netherlands, asked 5,096 people in 35 countries to detail the
circumstances of their most recent crying episode. About 70 percent
said that others’ reactions to their breakdown were positive,
comforting. But about 16 percent cited nasty or angry reactions that,
no surprise, generally made them feel worse.

Given that the most obvious social function of crying is to rally
support and sympathy, the emotional impact of the tears depends partly
on who is around and what they do. The study found crying with just one
other person present was significantly more likely to produce a
cathartic effect than doing so in front of a larger group. “Almost all
emotions are, at some level, directed at others, so their response is
going to be very important,” said James J. Gross, a psychologist at Stanford.

The experience of crying also varies from person to person, and some are
more likely than others to find catharsis. In laboratory studies,
psychologists induce crying by showing participants short clips of very
sad movie scenes, like from “The Champ” or “Steel Magnolias.” Those who
break down — typically about 40 percent of women, very few men — then
report directly on the experience. These kinds of studies, though no
more than a simulation of lived experience, suggest that people with
symptoms of depression and anxiety do not get as worked up, nor recover
as fast, as most people do. In surveys, they are also less likely than
most to report psychological benefits from crying.

People who are confused about the sources of their own emotions — a
condition that in the extreme is called alexithymia — also tend to
report little benefit from a burst of tears, studies have found.

[end excerpt]

The article is online at: