Using Cognitive Behavioral Therapy (CBT) to Manage Holiday Stress

By Kacie Mitterando, LMSW

Holidays are stressful. In fact, in a recent study it was discovered that over a quarter of Americans report “extreme stress” during holiday season and a remarkable 45% would prefer to skill the holidays altogether (1).


Holidays can also be exciting, entertaining and even an opportunity for much needed relaxation with family and friends (especially if they’re some you haven’t seen in a while). However, there’s no denying that the stress can pile up especially if you’re someone who’s already experiencing anxiety.


While the Hallmark Channel and having dinner with loved ones can be fun, the holidays also lead to the feeling of a never-ending to-do list. There’s the responsibility of entertaining guests, cooking, shopping and often times traveling. Additionally, almost all of these occurrences cost money and after a while those little costs here and there may add up to what can feel like a financial burden.


On the other end, often times the holidays can feel extremely lonely. It’s no secret that each family has their own arguments, disagreements and imperfect ways of coping so coming together in forced harmony and peace can easily become not enjoyable.

Below are some tips that might ease a bit of the burden you’re feeling:


If your holiday stress is unpleasant family members:

The holidays are a great place to practice the Cognitive Behavioral Skills you may have learned in therapy. Interacting with family members is a great place to practice reframing.

In a Pyschology Today article by Hal Shorey PhD, shares some top tips for reframing interactions with family members.

  1. Consider lowering your expectations to match the world as it is, instead of your dream of how it should be.

  2. Take responsibility for what you are thinking and what you are saying to yourself in your head. Change the way you think and you will change your emotions and how you behave.

  3. Ask yourself, “what would happen if I let that comment go and don’t respond? Would it really make a difference in the long run?”

Allow each person that is unpleasant or unhealthy for you to be a chance to practice your coping skills and communication. Let’s face it; we’re not going to enjoy everyone we need to be around all the time. Therefore, if we can use the moments where we are in this position to run-through positive techniques, we’ll become more equipped and confident for the next time we’re faced with this dilemma.


If your holiday stress is that you’re feeling lonely:

If you’re away from family that you want to see, open the door for new ways to communicate. Think of possibly Face Timing these family members for dessert or even creating a Facebook Live session where multiple family members can join in. Often, there are other people in our social networks that are away from family as well, such as coworkers. Taking a chance with someone you may not normally spend as much time with could end up being an unexpectedly pleasant experience.


If your holiday stress is that you’re packed with too many responsibilities and commitments:

Stick with your daily routines and ultimately, do less of the “mandatory” holiday obligations. Work with your therapist or talk to someone about better prioritization.

Prioritize what is important to you during the not-holiday season, such as working out or spending your Wednesday nights catching up on your favorite TV shows. Studies show that our brains actually thrive off of habits and routines; therefore, it may help to reduce some stress if you continue to do what feels comfortable. While we often go overboard during the holidays- an abundance of shopping, sending out cards and attending each and every event we get an invite to- pick one responsibility that feels too much and tell yourself “no” this year. Use the time you would have spent on this event/activity to do something for YOU instead.


If your holiday stress is that your anxiety/depression is becoming too much to handle:

First, think of some of the small things you can incorporate into your days to decrease some of the anxiety/depression you may be experiencing- such as going for a run, practicing meditation and getting adequate sleep. However, if your mental health is feeling like “too much” and these coping skills aren’t significantly reducing your worries and concerns, talk to a mental health professional. With New Years coming up, now is the ideal time to make the commit to begin to address your mental health with therapy.

Most importantly don’t be afraid to ask for help.

If you’re traveling and will be away from the area during this holiday season while still seeking support, we currently offer video sessions and will be happy to meet online.

Also, if you are in a crisis and please contact National Suicide Prevention Lifeline

They can help prevent suicide. The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.


1. Holiday Stress | Managing Holiday Stress | Stress During the Holidays. (2018, August 09). Retrieved from

4 Great Therapies for Treating BPD (That Aren't DBT)

Today’s blog is all about finding alternatives to the Dialectical Behavioral Therapy Model (DBT) of treating Borderline Personality Disorder. I decided to focus on this because I have had a lot of calls recently from clients seeking treatment for BPD. Most of these clients have said something like “I’ve done DBT for a long time and I’m not getting the results I want.” Those results often look or feel like deeper connections to the people around them, having more moments of satisfaction in their experiences and being able to trust their decision-making.

DBT is a fantastic treatment modality and has been the gold standard for BPD treatment since it’s development in the 1980s by Marsha Linehan, a psychologist at the University of Washington. Dialectical Behavioral Therapy is traditionally a structured intensive program that addresses issues of safety such as –  mood swings leading to self harm including suicide attempts and harm to others, as well as alcohol & substance abuse. In one study, the use of intensive DBT led to up to 77% of participants no longer meeting the criteria for a DBT diagnosis.  While this is super impressive and many people benefit form DBT, it isn’t for everyone.

So what do you do when you feel DBT isn’t working or isn’t enough?

Consider Treating Trauma

One place where the DBT model falls short is the actual processing a trauma that may be present in those with DBT. If you’ve completed a DBT program and still feel there is work to do, finding a trauma-focused therapist may be a helpful second step. Here are some great types of therapy to address trauma.

1.      Internal Family Systems Therapy  (IFS) – If you are someone that has really learned the skills of DBT and maybe even made great progress but still have trouble trusting others or making decisions, IFS may be a great option. IFS is a type of therapy that is done individually with your clinician (not to be confused with family therapy). IFS is a system of understanding how to work out the many different conflicts we have internally. It is also a great therapy for healing from trauma. Here is a great article by Martha Sweezy from the American Psychological Association on the promising results of Internal Family Systems Therapy on addressing unresolved trauma in people struggling with DBT.  


2.      DBT Informed Hypnotherapy – While hypnotherapy might not be the first thing you think of as an additional treatment for DBT, finding a hypnotherapist who is DBT informed can be extremely powerful.  Hypnotherapy is great for so many things from addictive behaviors to emotional regulation to finding increased satisfaction in our lives. DBT is also great for reducing feelings of panic and overcoming social anxiety. I often recommend this as an addition to DBT (plus its my favorite type of therapy😊


3.      Yoga-Therapy – Another no-brainer combo for DBT in my book is yoga=therapy. Yoga-therapy (not to be confused with a yoga class) is an individualized treatment session that uses body awareness, breathwork, philosophy and compassion-building to deepen a client’s relationship with themselves and the world around them. BPD can be super isolating and painful. Yoga-therapy helps to relieve that.


4.      Art Therapy – Another common experience of someone with BPD is feeling unheard, misunderstood and generally neglected. Art therapy sessions are generally focused around emotional expression and the ability to understand situations in a new way. Art therapy is also a powerful tool to process trauma.


No matter where your next step in your healing journey, its always good to look for practitioners who are familiar with standard practices in treating BPD. That combined with another type of therapeutic framework can be truly transformational.

Need help deciding which type of therapy might be best for you right now?

Let’s hop on a call and chat!

Self-Care For Turbulent Times

By Amanda Polster, LMSW

Social media can be toxic and scary. As much time as we spend on social media, we need an equal (or greater) amount of time mentally recovering from the bombardment of painful images and rhetoric. Today’s blog is all about stressing the importance of being in tune with our energy and checking in with thoughts and feelings that come up during this turbulent political climate.

We can use any activity as self care if we do it mindfully.

Part of implementing self-care is practicing being in harmony with our mind and body. During this blog, practice noticing the emotions and sensations that come up, and acknowledge yourself as courageous for taking this opportunity to learn healthy and sustainable methods of personal growth. At any point during this blog, if you begin to feel uneasy or triggered, recognize that as an opportunity for observation and take the necessary steps for yourself to take a break. Breathe

Breath is the foundational practice of self-care. We can focus on our breath no matter the activity. We can begin to practice it now in this blog.


Mindful Self Care Becomes Even More Important When Tragedy Strikes

This blog hits close to home in the wake of recent national events that have occurred unexpectedly, yet are now occurring ever too frequently. Especially in an era where violence has become more prevalent, it is important to identify ways we can take care of ourselves so to not get consumed by the losses in our community.

The more we practice self-care, the more capable we are at supporting our ourselves, our families and our communities

Below are some tips on how to reframe and implement self-care in our lives.  

1.      Self-Care is Not Selfish – You cannot serve from an empty vessel

You may have heard the saying, “you can’t help others if you are not helping yourself.” Or, as they always say on the airplane before takeoff, “In the event of an emergency, make sure you put your oxygen mask on first before helping the person next to you.” If we do not take care of ourselves, we will not have the capacity to support and serve others. Now, some people are great at helping others as a distraction from dealing with their internal struggles. However, this is not a sustainable practice, and without self-care and proper support, we will eventually reach a breaking point where we feel too overwhelmed and overloaded. In these instances, setting boundaries for ourselves becomes a practice of self-care to identify ways to most appropriately limit the amount we are giving and provide greater opportunity to receive and give back to ourselves. An example of setting boundaries is noticing our triggers and removing ourselves from spaces where we acknowledge triggers may occur. A personal example is recognizing when social media is not serving me and choosing to take a break to limit my access from overwhelming information that comes through my news feed.  

2.      Self-Care is an Opportunity to Grow

Many self-care practices are opportunities to observe and understand our own identities. Self-care practices are things that make us feel happy and provide us with joy and ease. They are activities that give our lives meaning and remind us of the importance of taking care of ourselves, emotionally, physically, and spiritually. These practices help us learn where we feel we are the most supported and areas where we may feel neglected or want additional support. Self-care is also an opportunity to check in our self-talk, and acknowledge the ways we are either affirming and validating our experiences, or judging ourselves for our emotions and behaviors. While we often seek validation and support externally through our support networks, self-care is also an opportunity to learn greater self-compassion and self-gratitude. Mindfulness practices such as loving kindness meditations are a great way of tapping into these self-care practices.

3.      Self-Care is a Priority and Necessity, Not a Luxury

This is my favorite tip, because people often think of self-care as a luxury or privilege. Now, I am not dismissing or denying the fact that not everyone has the same access to a diverse range of self-care practices (i.e. gym memberships, travel opportunities, health care resources). However, many self-care practices can occur internally, such as meditation, self-reflection, self-talk affirmation, that only require conscious awareness. Using our physical bodies as forms of revitalization and energy is often one of the most effective self-care practices. As Tony Robbins states, “emotion is created by motion,” and how we feel is often determined by the physical state our body is in at any given time.

Regardless of if we choose to join a new yoga class, or take a moment to “smell the roses,” self-care requires an investment in taking time for ourselves to remove ourselves from the stressful and often fast-paced environment we live in daily. Taking time for ourselves is not only vital to our mental, physical, emotional, and spiritual capacities, but also supports in our ability to be the best versions of ourselves and aids in our overall quality of life.

If you are in immediate distress please contact the number below:

The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals.


If you would like to make an appointment for ongoing care, schedule a time to speak.

Maintaining Sexual Intimacy In Your Relationship

By Brittany Dursi, LMSW

Ah the “honey moon stage.” The phase of being an untouchable, connected, happy couple. A mix of intense emotions, blended with just enough spice to leave your taste buds begging for more. It is a chapter many hope to experience yet seldom remains central through the relationship.

So, what is it about the “honey moon stage” that fades?  There are endless possibilities, exclusive to each relationship: loss of loved ones, betrayal, money dilemmas, miscommunication, exhaustion etc.  The list is limitless.  When we take one, or multiple obstacles, and allow them to control the relationship it is undeniable romance can lose its spark.  When this happens, every so often it is easier to create distance from our partners instead of working to maintain unity and support.  It is even common to feel like strangers.

Sex can become…well sex.  That is, if it is existent in the relationship.  When our mind is flooded with stressors we can forget how beneficial physical touch and connectedness with our partner is.  We fail to realize being intimate can relieve stress, physical pain, such as headaches and can lead to feelings of security in the relationship.  We may find ourselves rolling over in bed as a result of exhaustion instead of taking a moment to cuddle up to our loved one.  So how can we maintain a consistent, satisfying and exciting sexual relationship with our partner?


Communication is Key


Sustaining a strong sexual relationship first starts with communicating efficiently with our partner.  That means: asking questions and listening. Our partner’s day is just as important as ours.  Ask specific, individualized questions. Listen to understand, not to respond and not to accuse.  Listen to relate, create depth and explore new ways to approach and acknowledge their feelings. Even in times of distress, vocalize your feelings.  You cannot be faulted for expressing how you genuinely feel.  Being transparent and honest with your partner can lead to an increase in trust and ultimately more security within the relationship.


Stay Curious


Remember when you first met your partner?  Everything about them was interesting, the way they walked, the way their hair felt between your fingers, their scent, how they took their coffee, the energy they showed when doing something they loved etc.  We get so used to the distinctive traits that make our partners who they are that sometimes they go unnoticed.  Stay curious. Our partners are ever growing and changing. Take notice.  Find new quirks, interests, things that can create new conversation and build off of it.  We are ever changing, our partner is ever changing, our relationships are ever changing and it is our responsibility to keep up with it.



Explore Together


Mentally, none of us are programmed the same.  We have different interests and fixations that stimulate us, making us all unique.  It is common to feel uncomfortable or unsure about things we may want to explore in the bedroom; and in some cases, results in remaining concealed from our partner.  It is far-reaching to discuss some of these interests with our partner.  It allows our partner to be open with us as well and explore agreed upon options to satisfy the needs of both partners.  When we understand our partner, are open with them, feel understood by them and work together we have a higher chance of both sides feeling satisfied and secure in discovering different layers of the relationship.


Schedule Together Time


We make time for work calls, meetings, bills to paid, errands to be run and other essential daily tasks.  So why not make time to embrace our loved one and give the relationship the nurturing that it deserves.  We lead busy lives, but it is always crucial to take care of ourselves and that means taking care of our relationship.  Why not schedule in a one hour time block to turn off our phones and pay total attention to the one who has our heart?  Even if you live together, or spend hours a day together, is it true quality time? Make the time to embrace one another, talk, laugh and give the attention we all need.  Time together is a human need, schedule it.


Compliment Each Other


When we feel confident and appreciated in our relationship the positive parts of our personalities often will take the forefront.  The same goes for our partner.  If your partner is feeling belittled, betrayed and unworthy the relationship will feed off of that.  Remind your partner of the qualities you like about them.  Have conversations about what you each appreciate, lift each other up and help build confidence.  When each partner feels confident, understood, appreciated and loved the relationship will also be more likely to feed off of that. Never have too much pride to express what you love about your partner.  Never have too much pride to build your relationship.


Need Help Connecting With You Partner?

Contact Us Today To See If Couples Therapy Can Help






Winter Blues? Keep Exercising To Boost Your Mood

By Kacie Mitterando, LMSW

Do you struggle to exercise during the winter? The evidence says it’s super important to keep up your exercise routine throughout the colder months.

Weather and activity level have a synergistic and powerful impact on our mood. In one particular study, Bradley Cardinal (an exercise physiologist at Oregon State), observed a decrease in exercise during the colder months. Cardinal reports believing that this decrease is directly due to the environmental change (1). With depression and anxiety on the rise, it is a crucial time to discuss the impact our physical health has on our emotional and mental health.

While exercise and fitness have great external rewards, such as an increase in physical health and physique, the benefits exercise has outside of physical appearance can be drastically more significant.

Mental Health Benefits of Exercise:


1.      Exercise and depression: In the past few years, research has shown that exercise can help to reduce symptoms of mild and moderate depression in a similar effectiveness as antidepressants. Additionally, the maintenance of an exercise program can even decrease symptoms of depression long-term. Overall, exercise has a positive influence on hormones in the brain. After a period of increased activity the brain releases endorphins, which are a hormone linked to an increase in our overall mood and well-being. Interestingly enough, exercise can actually create new activity patterns inside your brain along with aiding in neural growth.

2.      Exercise and anxiety/stress: Exercise is considered one of the most effective forms of anti-anxiety treatment. By getting up and moving your body for 30 minutes a day, mental energy can increase and tension in the body can decrease. As a result, your body and mind can both feel more relaxed after a workout.

3.      Exercise and trauma: For those who have experienced trauma or even have a PTSD diagnosis, the physical symptoms experienced such as the “freeze” response developed in your nervous system can become debilitating. By paying close attention to the sensations in your body during exercise, such as the way your joints and muscles feel when they move, studies have shown that PTSD symptoms can be reduced (2).


OK, so you’re sold on the exercise piece, but what’s the next step?


1.      Find some form of working out that you love: If running is not an activity that you enjoy, then it is OK to not run. In fact, there are tons of different methods of exercise that can be just as effective. More importantly, the most effective exercise routine is the one that you enjoy. Try a spin, barre, pilates, OrangeTheory or CrossFit class! If these options don’t interest you, a simple internet and Pinterest search can give you some great lifting or at home workout routines.

2.      Start slow: Some of the positive mental health effects of an exercise routine will happen immediately! However, it can take around four weeks to begin to see longer-term changes in the brain. It’s important to not dive head first into working out and push yourself too hard. Start by adding in 1-2 days a week for 30 minutes and slowly add in an extra day with 5 more minutes, as you feel comfortable (3).

3.      Balance: Once you find a workout that you love and feel you’ve set a decent routine in place, the most pivotal piece is to place an importance on a balanced approach to working out. Remind yourself that it is OK to skip a day of exercise for a family event, or a work function. Exercise should only be adding to your life, not taking away. Additionally, practice shifting your thought process to focusing on the internal effects you receive from an exercise routine, such as improved sleep, mood, self-esteem and overall well-being!


1. How to Keep Working Out In The Winter. (n.d.). Retrieved from


2. The Mental Health Benefits of Exercise. (n.d.). Retrieved from


3. Why Exercise Is So Essential for Mental Health. (n.d.). Retrieved from

Rituals & How They Help Us Heal Anxiety

What Are Rituals?

Whether we realize it or not, all of us have rituals. Rituals are the perfect activity to relieve anxiety because they are the patterns that keep us feeling like we have some control over our daily lives. Rituals pre date religion as ways of forming structure around individuals and communities.

An incredible article by Nick Hobson outlining his research around rituals explains that [rituals differ from habits because] rituals are:

i) ceremonious, deeply meaningful acts that are shared between people and embedded in a system of historical/cultural significance, but also

ii) arbitrarily structured, highly repetitive set of action sequences that follow a rigid script.

Hobson’s research suggest that when we add a deep layer of meaning to our daily lives we are provided an extra layer of resilience from negative thinking. One amazing study Hobson references states that we are hardwired to pick up rituals even as infants.

Rituals are one of those mental tools we can use not only heal our lives but to thrive. Everyone from individuals struggling with anxiety to high performing athletes and performers can benefit from the conscious, meaningful attention rituals provide our lives.

“This is what rituals are for. We do spiritual ceremonies as human beings in order to create a safe resting place for our most complicated feelings of joy or trauma, so that we don't have to haul those feelings around with us forever, weighing us down. We all need such places of ritual safekeeping. And I do believe that if your culture or tradition doesn't have the specific ritual you are craving, then you are absolutely permitted to make up a ceremony of your own devising, fixing your own broken-down emotional systems with all the do-it-yourself resourcefulness of a generous plumber/poet.”
― Elizabeth Gilbert, Eat, Pray, Love

How To Develop Rituals in Daily Life -

  1. Focus on the cycles in your life. Everything from our daily calendar to our metabolism runs on a schedule. Most traditional medical systems know this and use it as part of their protocols. For example, according to Ayurvedic philosophy every hour corresponds with a different process taking place in the body. Without getting that specific we can very simply start to add sacredness to the different parts of our day by adding ritual. For example, gentle movement, prayer or meditation upon waking may serve as more therapeutic than immediately browsing your smart phone, Additionally, preparing for bed with breath-work and candles help prepare the body for restful sleep.

  2. Make Returning Home From Work Sacred. Many people come home from work and never get out of “work mode”. Rather than jumping on the phone, television or turning to alcohol, try giving yourself 10 minutes of self care independent of your loved ones. This might involve washing your hands, changing your clothes, deep breathing, sitting quietly or stretching. note The important part is that these things be done in quiet with the intention of leaving your workday behind.

  3. Spend Time In Nature. The research on time spend under trees is pretty significant. Nature provides endless opportunity for ritual. From simply sitting under cherry blossom trees (Japanese tradition called Hanami), to taking photos of nature, try finding your favorite way of honoring the plants that help us sustain life.

  4. Improve Your Relationship With Stuff. Japanese culture also provides lots of inspiration for making our relationship with objects very special. Self help author Louise Hay always reminded her audiences to thank their objects before using them. This simple habit can dramatically transform the way we work, shop, and live with stuff. For example, imagine thanking your credit card for being available with funds every time you used it. How might this change your relationship to shopping?

Want to chat about setting up rituals in your life? Schedule a free 15 minute phone consultation today!