Dr. Kathryn Tolle

When faced with a life threatening illness, we are forced to confront the inescapable truth of our own mortality. Facing this sort of challenge is something that most of us fear deeply. I believe that our culture leaves us particularly vulnerable to wanting to deny the process of dying. In order to get through each day it seems preferable to not give much thought to our end of life decisions. However, there comes a time for all of us to face the prospect of our own death. This time of confrontation can come in many forms, perhaps you think about it after a close call, or a death of another family member or friend, or because you are making your will. Whatever the reason, there are moments when we must pause, and take stock of the choices in front of us as well as the choices we are making every day. It can be difficult to think about, but at some point ,we will all run out of treatment options. The way we face what happens next depends on a myriad of factors including our personal and financial resources, family support, religious (or faith) identities, and own views on death and dying.

We learn from each other when it comes to death. Watching the choices others make can help us form our own opinions on how we want it to look for ourselves. What questions might we consider when faced with a set of limited options. I find it endlessly fascinating that the questions we ask about death often convey what is most important to us in our lives. In the end what will be our priority? Where will we find comfort? Thinking about it while still able bodied and a bit removed can help us keep perspective when in the thick of all the medical options. How can we all create a space for acknowledging that death might be the outcome but also continue to be hopeful when there is reason to be hopeful about one treatment or another? Finding that balance between hope for making it past a serious illness and acceptance of death is difficult but absolutely necessary.

When faced with end of life decisions or even serious medical illnesses, too often the questions asked are about how to preserve life at the expense of thinking about what gives our life meaning. Perhaps taking time to consider what brings meaning and vibrancy to life can help guide decision-making in times of strife, but it also might help us live better lives before that time comes. How might your life change if you took time to consider what gives your life meaning? How might you change the way you spend your time? If not much would change, how might your frame of mind change if you took time to consider how fleeting life can be? Can we all take time to appreciate the stage of life we are in and the unique joys and challenges that stage of life brings?
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In therapy, these are the kinds of questions we might ask to hopefully start to make changes that would bring about more meaning and depth to life. This might also be a useful tool as you navigate any major decision. If you find that you need help answering the questions or feel wholly incapable of even facing them (or putting them into action) please consider contacting us. 

By Dr. Chaz Mailey

​Perhaps you are feeling lethargic, discouraged and/or depressed. Possibly you’re feeling anxious or overwhelmed by life and its circumstances. Maybe you feel stuck and tired, and don’t really know what to do next. Stop what you’re doing right now, and go for a brisk walk (well after you’ve read this post of course).
 
Let me begin by stating I won’t be discussing the physical benefits of regular exercise, of which there are many. I also want to clarify that I don’t think exercise is the cure all for psychiatric concerns. A fairly large percentage of the population is aware of both psychological and physiological benefits of exercise, and yet about 25% (some research suggests 35%) of the U.S. population gets little to no physical activity at all or are sedentary. A sedentary lifestyle, in addition to the number of medical problems it can create, can also have deleterious effects on your psychological well-being, including increased depression and anxiety, reduced stress tolerance, and issues with memory. That said, there is an incredible and research-supported connection between your mental health and the amount of physical activity you do or don’t get. Studies consistently demonstrate just how beneficial exercise is to improving and maintaining our emotional health. It enhances mood, improves our ability to deal with stress, aids in sleep, increases energy and can help stave off some of the negative effects of aging on our brain functioning. Additionally, it can enhance self-esteem and self-efficacy, and generally make one feel more confident to deal with life. But I’m probably not telling you much of anything you don’t already know about the benefits of physical activity.
 
Although this discussion won’t be exhaustive, what I hope to do is assist you in finding ways to bring balance to your life and improve your emotional well-being by adding physical activity to your weekly routine. I’m aware that there might be some physical and financial limitations to getting physical activity. Some of these limitations might include, having a disability, living in a place where it is perhaps unsafe to be outside for long periods of time, and/or lack of access or not having the monetary resources to use exercise equipment. There are no easy solutions for all of these issues, but I will try to offer some practical suggestions for strategies you can implement in your own life.
 
I want to recognize that for some the idea of physical activity and exercise seems daunting. A good place to start if this seems to be your struggle, is asking yourself a few questions and then we’ll explore some of the frequent problems associated with the answers to these questions, and some of the strategies for helping to potentially mitigate some of those problems:

1. What is my perception of what it means to exercise and be physically active?
2. What are my goals for being active and what is driving me to be active?
3. What are some of the obstacles I face as a person who wants to be more active?

 
Changing Perceptions of Physical Activity
 
When some answer the first question posed about exercise, one of the images that probably comes to mind is spending hours in a gym, either grunting on a weight machine, running on a treadmill bored out of your mind, or perhaps there is some incredibly fit instructor screaming at you to pedal harder. While those activities are actually pretty good options for exercise, they’re not the only ones and maybe they aren’t all that appealing to some (I don’t really like being yelled at that much). Physical activity can include a range of activities that increase your heart rate and require some sustained effort.
 
If going to the gym is not your thing, look for exercises you can do at home. If you don’t have weights, the human body can provide all the resistance you need. It’s amazing the number of body weight exercises one can find on YouTube or the Internet. If you don’t like to run on a treadmill for an hour at a time or maybe body weight exercises seem too intense, find a friend with whom to play tennis, go for vigorous walks with your pet (I don’t want to assume you have a dog, you might have a tiger or gerbil that does well on a leash), or have a dance party with your roommates. Research consistently shows that we’re more likely to exercise and maintain that exercise if we’re doing something we enjoy. So find your thing (not someone else’s) and you might find you actually look forward to it and WANT to stick with it.
 
A person might also have the perception that unless you’re exercising consistently for half an hour to an hour at a time, it doesn’t “count”. But when it comes to your mental health, this isn’t true. In fact, within the first 5 minutes of engaging in moderate physical activity, one will begin to experience some of the positive psychological benefits, like an improved sense of well-being. So if you do 10 minutes in the morning, 10 more in the afternoon at lunch, and 10 more in the evening before or after dinner, you’ll likely begin to notice a change in your mood. 
 
Goals and Motivation
 
Some of the most common goals for physical activity are that one will lose massive amounts of weight; or, maybe one will be more physically attractive and socially desirable. These are not “bad” or “wrong” goals to have, however, they can and do create unrealistic expectations, and they tend to be extrinsically motivating factors as opposed to intrinsically motivating ones. In brief, extrinsically motivating factors are those factors outside of the self that push one towards certain behaviors (e.g. if you clean your room you’ll earn an allowance), whereas intrinsic motivation refers to an inward drive that leads one to having an increased internal sense of satisfaction (e.g. you clean your room because you feel better after you do some cleaning). Both forms of motivation can move you toward achieving your goals, however, research consistently shows the motivating effect of extrinsic factors can be short-lived and increase feelings of being discouraged when those expectations aren’t met. For example, if the primary expectation is that after exercising for a week, you’re going to lose 15 lbs., and you step on the scale and you’ve lost 3, that’s going to hurt the ego and make it less likely you’ll keep at it. Instead, if the expectation is that you are going to feel better, feel less stressed, and have more energy after being active for 30 minutes, that becomes your motivation. Therefore, if weight loss does occur, it becomes a side effect of doing something you enjoy, rather than the focus of your energy and attention.
 
Something else to consider are the types of goals you might set, and often this can be put into two categories, outcome vs. process goals. Outcome goals tend to be those goals where one is looking at a specific number, like losing 15 lbs. from the example above. Unfortunately for something like weight loss, there could be other factors influencing whether or not weight changes occur, like diet, genetics, or perhaps one is gaining muscle mass. A better way to go is to set process goals. Process goals bring the focus to daily activities that are more within your control. A process-oriented goal might be to get some form of physical activity three times a week. In that way you’re more focused on the doing, rather than what the end result will be.
  
Common Obstacles to Physical Activity and What Can Be Done to Address Them
 
I believe that there certain challenges and obstacles to being physically active and some may be more or less within our control. To overcome some of these barriers, I think it is important to be flexible, creative and committed.
 
Time is often described as a barrier by my clients. People either work many or strange hours, and/or have considerable amounts of homework to do. People might have family or animals for whom they must care, or it would take 20 minutes or more to get to a gym. While time can be a problem, it is not an impossible one to manage. Sometimes it is as simple as taking a look at your day-to-day routine and finding ways of fitting in 10 minutes here and 10 minutes there. Also, be honest with yourself about how you are organizing your day and spending your time. If a person spends 30 minutes a day watching Netflix, make a determination about whether or not this is a necessity, or if you can combine physical activity with watching your show. Maybe you do an in home workout that requires little to no equipment in that 30 minutes you’re watching Parks and Rec.   
 
As stated above, some people may not feel motivated to exercise, because it seems too daunting or overwhelming. One of the pitfalls of starting a physical activity program is attempting to do too much right out of the gate. A person may decide that “today is the day I put on my old basketball shorts and go to open gym for a couple of hours, even though I haven’t played in a few years (who did that… This guy).” The next morning when your entire body dislikes you and wants to spend the next several days sleeping in, this might be discouraging and destroy any motivation you have for trying to remain active. Instead, start small and then build upon the tiny successes you have along the way and focus on one day at a time. If you were able to get out and walk a total of 45 minutes today, great. If not, that’s okay too, because tomorrow is a new day. Also, make it easier on yourself to be motivated with “cues to action.” In simplistic terms, a cue to action is stimulus of some sort that helps increase an overt behavior. For example, this might be sleeping in your gym clothes if you want to exercise in the morning when you wake up, or leaving a pair of comfortable shoes at work so you can take a walk during a break or at lunch. Maybe you send out a group text (if you have this capability) telling people you’ll be at the park later to play some outdoor games.
 
Not having access to resources is another challenge. Not everyone has the finances to join a gym or take fitness classes. Or, maybe because of where you live, a gym is not close by. Again, change your perception of what physical activity is and means to you. If you live in an apartment with multiple stairs, walk the stairs for a while. Do an in-home workout. You can usually find workout programs that require little or no equipment online, and if you don’t have access to the Internet at home, use the Internet at the local library and print something off or write something down.
 
Other obstacles include people having a fear of being judged, or maybe a fear of failure. To help overcome these barriers, focus on you, and you alone. Make increasing or actually getting physical activity about your own psychological well-being and not about numbers or appearance. If you’re anxious about going to the gym or feel discouraged when you see a bunch of seemingly fit people taking photos for the Gram, find a gym where you feel more comfortable or go with a friend. Get people who are important to you involved in your physical activity, so maybe you can turn to them for support when you feel discouraged.
 
As I said before, this is not a be-all-end-all for the psychological benefits of physical activity and how to get yourself moving in a positive direction. There are a number of factors I did not cover, like the ways psychotherapy combined with exercise can have a substantial positive impact on concerns like depression and anxiety, but I would be happy to discuss if you had questions. What I hope you can do is use this post as a springboard to taking a little more control over your mental health and well-being. A therapist can be an incredible resource for initiating this process, because many of us are equipped with the tools to help increase your motivation, and to assist you in making longer-lasting positive changes. 

By Kathryn Tolle

Change is inevitable. Sometimes it can be exciting, other times change can be challenging or even tragic. Even if you are someone who is excited about change and openly embraces it, that does not mean you are immune to the anxiety or uncertainty that can come with change. Though most of us expect to be challenged by change when it is difficult (e.g. losing a job, experiencing a death loss, illness, etc.), it can be surprising and even a bit unsettling when positive change creates anxiety. 

There are many exciting changes over the lifespan that, in theory, should bring a lot of happiness (e.g. graduation, getting married, having children) but that does not mean they are seamless or without their own mourning periods. The complicated feelings such changes may bring about can be unexpected. So many times in life we might think ahead of a particular change to somehow predict how we might feel when change occurs. However, we cannot know how we will react to a new phase of life until we are in that phase of life. It is okay to be uncertain and even scared at times. It is also okay to find transitions easier than you thought. The point is learning to accept whatever reaction comes up for you and do your best to share those important reactions with the people you love. It is an opportunity to both feel supported and potentially open communication to be able to provide support to others. 

When anxiety follows positive change, you might feel reluctant to speak out. Maybe it feels like you "shouldn't" have negative feelings in reaction to some positive change. You should know that all reactions have validity. They may even help inform you about what is missing. For example, if you just had a child and find yourself often frustrated with your partner for seemingly trivial transgressions, perhaps there is a deeper need. Maybe upon reflection you realize that you are not feeling as supported by them as you would like. Having that conversation could allow your partner to more fully support you, for you to feel more connected, and to get a need met. Instead of chastising yourself for having the feelings you have, maybe it is more helpful to more fully understand your emotions and use them as information to help build better relationships. 

I hope you find yourself with many happy changes ahead. I only wanted to remind you of the potential difficulty that comes with any change, even positive change. While most of the time you will likely be able to navigate that change without many bumps and bruises along the way, there may be other times when you need additional support. If you find yourself in this situation, please do not hesitate to reach out to us at 785-537-6051 or email at manhattanmhs@att.net. 

​The future of this country is important to us all, or at least that is the assumption I am bringing into my reaction to the above article. I think there are some terrific pointers in this article, some more realistic than others. In particular the notion of limiting your exposure to the sort of media that showcases the election coverage in a sensational manner. It is important to move past the soundbites and understand the issues being brought up by the candidates in a nuanced way. 

Beyond some of the points brought up in this article, it is my belief that introducing more nuance and attempting to see each issue from a well-rounded place can reap more benefits than taking one extreme stance and pointing to the counter argument as completely wrong or otherwise ill-informed. In other words, moving away from the language of us vs. them and towards the notion of we, what do we need to do to help the current situation? This exercise takes practice and it takes being informed. Doing your best to understand both sides of the argument, even if you feel strongly about one side, can reduce the stress you feel when hearing about these topics because you may come to appreciate some of the ideas on the "other side." I say sometimes because I also want to acknowledge that some individuals in our country may feel more threatened and therefore more anxious due to their race, religion, sexual orientation, or some other factor (e.g. a person who identifies as Muslim being fearful of how one candidate will impact their life due to the potential threat to liberty); which is different than being fearful you will not like some of the policies proposed by a candidate. It is my firm belief that we need a diversity of perspectives in order to make the best choice for our country. 

In addition to attempting to being informed about the issues, I think it is important to be engaged on the local and state levels. While the next president is an imperative position and one in which will make an indelible mark on our country, because of the set up of our country, it is not the only position that matters. We need to become and/or remain engaged in elections for congress, governors, mayors, representatives, etc. If anything, the local governments likely have more impact on our day-to-day lives. Trusting the process can be difficult, but it is the only way a democratic system works.

To sum up, in addition to the pointers from the article above, I would like to encourage you to:
1-Learn as much as you can about all the candidates.
2-Challenge yourself to consider the other side of an argument and to really listen.  
3-Remain engaged in local and state elections. 
4-Trust in the system that has worked up until this point. 
5-Engage in deep breathing exercises and distract yourself with other activities that bring your life joy when you find yourself anxious. 

If you find you are unable to manage your anxiety (this includes anxiety outside the realm of politics) or would like to meet with someone regarding any other problems you are having, consider calling us at 785-537-6051 or filling out the contact form on this website for more information. 

By Dr. Kathryn Tolle
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When I started as a psychologist, I never envisioned how much I would talk about death. It had been and continues to be a topic that creates anxiety for me. I remember the first time I had to talk about it with a client. I remember feeling lost, incompetent, scared. However, over the years, I have had to increase my comfort with talking about it. I have come to realize that our culture, at times, can be insensitive about death and it seems we all avoid thinking about death at one point or another. It can be difficult to know how to comfort others who are experiencing a loss. 

The reality is that death can be brutal. It can be beautiful. It can be all things. Death is the ending to all our lives. Something we will all experience. When someone you know dies, there are a myriad of reactions, all with their own validity. It is important not to judge your own experience or the experience of others. Each journey is unique because each person had a unique relationship with the individual who has died. Sometimes the well-meaning things people say can feel like jabs or superficial cliches in your moment of despair. Sometimes these same sayings can offer comfort. The important thing to remember is that nothing anybody can say or do will change the reality that you are hurting. And that you will hurt. The pain is a normal reaction to something terrible that has happened. Please also remember that some death can be traumatizing (e.g. murder, suicide) and that could involve a different reaction and potentially a longer recovery. Again, completely normal. 

I would love to be able to tie this rather large topic into a nice bow of things to do or say or feel in your times of sorrow, but the truth is, there are no universals. You must find your own ways of coping with the death of someone you know and love. I will say that therapy can offer a place to vent your feelings, be aided in the discovery of the coping you need, and the adjustments that may come to your identity depending on the situation. If you find that you would like to come and talk with someone, please do not hesitate to contact us whenever you need it.

*This blog is in reaction to the article referenced above.

The good news, therapy works, the bad news, fewer people are utilizing this wonderful resource! I believe that there are many different reasons for why people may or may not choose therapy, some of those reasons are quite practical (it takes time and money) and some are based off of misunderstanding what therapy is all about (e.g. some people think therapy is about complaining rather than fixing problems). While medication is certainly a viable treatment option, it is my personal belief that most of the time, it is not the most efficient option. This may sound counter-intuitive. What could be more simple than taking a pill?

One reason I say this is that many psychotropic medications (this means drugs that are designed to treat mental health disorders) often take several weeks to start to take effect. Therapy can have a quicker effect (though not always) with few side effects. Secondly, the proper dosage and actual medication can take time to sort out. It may also be the case that the drug itself is expensive. Not to mention potential side effects that can actually make the situation worse (for example it is documented that some antidepressants may actually contribute to suicidal thoughts).

Therapy is an option that can be quite useful for most people. There is this popular belief out there (and I have heard it many times in my office) that people have depression due to a "chemical imbalance." While this actually might be true, few people realize that behaviors can shape the chemicals that are readily available in your brain. For example, smiling more frequently has been shown to increase serotonin, dopamine, and endorphins (all the chemicals that create positive feelings) (1). This is also likely the reason that exercise is an effective mood lifter. Therapy is so effective because it involves understanding the behavior, thoughts, and feelings that may be contributing to a person's distress. Furthermore, it helps that individual learn alternative coping strategies so that in the future this may help someone manage or even prevent the sorts of feelings that brought them to therapy in the first place. Therapy and medication is much like the old adage, give a person a fish, they eat for a day, teach them to fish and they eat for a lifetime.

I do want to note that medication most definitely has its place and has been shown to be helpful for some. It is just my belief that overall, we may not be considering all treatment options. Please consider talking to your doctor about the possibility of therapy if s/he mentions medication to help treat depression or anxiety. If you need more information about this treatment option, we welcome you to look at our website or contact us directly and we could give you more information. 

1- R.D. (2000). Neural correlates of conscious emotional experience. In R.D. Lane & L. Nadel (Eds.), Cognitive neuroscience of emotion (pp. 345–370). New York: Oxford University Press.

By Dr. Chaz Mailey
As I watched students arriving on campus, I was thrilled to see so many of them with smiles on their faces. Giving strangers high fives and jumping in the air, hands raised, for "freeze frame" shots to show their enthusiasm about being back at school. And then I saw some students who didn't seem to be quite so happy to be on campus. They clutched their backpacks, blood draining from their knuckles and fingers. They chewed on clothes and they were sweating profusely from their palms and their brows (not just from the lovely Kansas heat). Their eyes dart nervously from person-to-person and they sometimes have trouble articulating what it is they might want or need. I'm being somewhat facetious, but it was refreshing to see all of the excitement and joy of a new semester for some of them and I felt a certain sadness for those individuals who seemed so concerned about where they were going or how they might look.

After having some of these individuals enter my office and talk to me about the troubles they were having, much of the pressure they were feeling comes from perfectionist thinking. Perfectionism can be seen as the general idea that anything less than "perfect" is not good enough or it is unacceptable.  Sometimes this way of thinking can have a crippling effect on us or our ability to be productive, creative, and/or our ability to get out and meet new people (this would be a great opportunity to read my colleague's previous and wonderful blog post on "Loneliness").  For example, a person with perfectionist thinking might refuse to go to a party because they just can't seem to get the right color combination for their clothing. Or in the case of some college students who are perfectionists, refusing to hand in assignments because they believe they are "sub par." We can get so engrossed in doing things "exactly right" that we don't allow space for the inevitable, that we'll probably screw up at some point in time. 

This was actually an interesting conversation I had with a co-worker. We discussed that sometimes the thought is that we are not allowed to make mistakes. That somehow doing so is "awful" or the "worst thing that could happen in the world." She said that she often tells her clients that "it's okay to drop the ball." It is okay to be imperfect because none of us are completely without flaws or shortcomings (outside of Beyonce). I think this really simple thought can release us from the significant amount of pressure that we sometimes put on ourselves. It is important that we give ourselves the space to be human.  This can be a major challenge for someone who is a perfectionist, to say to yourself that "it is okay to make a mistake." With perfectionism, I think that the fear is that if we make a mistake it does not just reflect on what we were attempting to do, but on us as an individual. In some ways the incorrect view could be that making a mistake makes one a "less than." That we are not as "good" as others. Or that in order to be worthwhile we must be better than the average person.  Sometimes the first step is seeking out help and admitting that perfectionism is something that you are struggling with, and you really want the opportunity to move past it and learn to accept yourself as you are.


If you think that you struggle with this and it is causing a great deal of tension or displeasure in your life, please contact us here at Manhattan Mental Health Services, LLC. 

By Dr. Kathryn Tolle

I find this video incredibly insightful and clever, but most importantly, true. As he talked about the ways that social media impacts  all of us, I couldn't help but see myself in some of those examples. I admit, sometimes I actually get excited when I have something cool to post on my facebook page like photos from a recent trip. There can be times when I might think of my life as boring because I have nothing to share. But the narrator brings up a good point, have we come to expect more from technology than each other?

I have many people that come to my office expressing a deep fear of being alone. More importantly, their feelings of loneliness may drive them to do all sorts of potentially destructive things like engage in an unhealthy relationship, drink excessive amounts of alcohol, or even consider suicide. As you can see there are pretty dire consequences to feeling lonely. So what are ways that we can all start to form meaningful connections with others rather then engaging in some of the "endless self-promotion" that technology encourages from us?

One important step is to reach out to those that are around you. Confront your fear of rejection by being yourself and seeing what happens. As was mentioned, too often technology allows us to consider exactly what we want to say before we say it (believe me, the irony of this post is not lost on me as I have proofread and rewritten several sentences). You might be surprised by how much people like you when they can tell you are candid and honest. Even if you say the "wrong" thing, it can help you get to know people around you better and give you both the chance to increase feelings of closeness and intimacy.

When you are out with friends, are you looking at your phone, wondering who might be texting, emailing, or calling? What would it be like to leave your phone at home? I wonder how many of us could do that and remain comfortable. There can be anxiety at the thought of losing that technological connection. Psychological studies show that the more one avoids whatever evokes anxiety in them, the more deeply they feel that anxiety.

Finally, I wonder what it might be like to be alone for an extended period of time with few distractions. The simple act of sitting at a table in the park may give you an opportunity to see the world around you and to fully the experience your own inner world. Facing your fear of being alone can be difficult, but it could also be liberating. The fact is we live our whole lives all by ourselves. While others share in the journey, no one else truly knows what it is like to be you and no one else can be there every step of the way.

Here is the challenge to see if you are dependent on technology for connection. First, see what happens when you stop distracting yourself with technology and fully attend to the people around you.  Try leaving the phone at home and going to lunch with a friend. Second, try being alone without distractions and see what comes up for you. Explore whatever thoughts seem to come to you. If you feel you are someone that engages in destructive behaviors to avoid feeling lonely, consider coming to counseling and talking with someone that can help you overcome your fear.