The ABCs of behaviour

Aay, bee, cee, dee, eee, eff... sorry, got a little off track there. Lots of ABCs going on both at home and at HMC Launceston these days. Which brings me to todays blog topic: What are the ABCs of behaviour. 

A is for Antecedents

Or Anticipating a behaviour, depending on who you talk to. For both options, it means what is happening immediately before a behaviour occurs. It can be something happening in the individual's environment, or it can be an internal event such as an individual's thought or feeling. 

B is for behaviour

This one is pretty obvious; it's the actual behaviour that occurs. Remember, behaviours can also be what we want to see occurring, not just a "problem behaviour" that we want to reduce in frequency (how often it happens), intensity (how big/strong it gets), or duration (how long the behaviour goes for).

C is for consequences

Understanding the consequences of a behaviour, or what happens immediately after a behaviour occurs, is almost as important as understanding the behaviour itself. This is because consequences are VERY important in determining whether a behaviour is more or less likely to occur again the next time the individual is in a similar situation. 

Why do we care about understanding behaviour?

Our actions can have significant implications for our social, emotional, and educational/occupational functioning. Being able to understand why a particular behaviour is occurring what what can be done to increase or decrease the likelihood of that behaviour occurring can make our lives, and the lives of those around us far more pleasant, happy, and less stressful. 

Putting it all together

Think about the following example: Jimmy, aged 4 and his Mum are at the supermarket. Jimmy doesn't want to stay next to the shopping trolley (even for some Coles Mini's at the end) and runs off to the other end of the supermarket isle (the Behaviour). What happened immediately before (Jimmy seeing a big long expanse of space to run in) and immediately after (Jimmy's Mum running after him yelling for him to come back, which is quite exciting for Jimmy whilst she chases him around the supermarket) can make Jimmy more likely to do the same thing next time him and his mum go shopping. By changing the antecedents (for example, Jimmy's mum clearly establishing rules, what will happen if he breaks the rules, and giving him his own shopping list to follow) and the consequences (for example, Jimmy's Mum requiring him to hold her hand throughout the rest of the shopping trip), we can expect that Jimmy's behaviour to be closer to what his mum would like, next time. 

One final point...

When we are attempting to shape/change another person's behaviour, it is important to remember that reducing a problem behaviour is not enough. We also need to reinforce the desired behaviour (what we want to see the individual doing next time), so the individual has something to replace their old behaviour with. 

If you need some help with behaviour (yours or someone else's), have a chat to one of our clinicians who can help you work it all out. 

Olivia Boer is a Clinical Psychologist and Director of Healthy Mind Centre Launceston, a private allied health practice in Launceston, Tasmania. 

What causes children's misbehaviour?

It's really easy to blame someone when kids are being naughty, oppositional, or defiant. "They are just so difficult...", "She is doing this for attention!", or "He is just like his father!" are common ideas that come to mind. Especially when your child just won't cooperate, listen, or do what they are asked. 

Often, though, we might not understand the child's behaviour enough to accurately pinpoint what causes the behaviour, and why it keeps happening.

As parents, we try the strategies we have been told, the things we saw our friend do, or what our own parents did with us. And yet, the oppositionality continues. We read a parenting website, Google "What do I do when my kid won't behave?", and find ourselves getting frustrated and yelling more than we would like. Then they talk back to us and run off. 

There are a few key steps to understanding children's behaviour that we will be looking at over the coming weeks. The first is an idea discussed by Dr Russell Barkley, one of the pioneers in ADHD and Oppositional Defiant Disorder research, in his behavioural parent training work. Dr Barkley notes there are four main causes of, or contributors to children's misbehaviour. 

1. Child Factors

These include a wide range of child-specific problems including temperament (including inherited predispositions toward irritability, low frustration tolerance, and anger), impulsivity, attentional problems, learning problems, intellectual and developmental difficulties, sensory sensitivities, activity levels, emotional regulation ability, physical characteristics (including motor coordination, stamina, and appearance), etc. It is not difficult to see how these child-specific elements can lead to conflict with parents or caregivers. It is also easy to see how child misbehaviour can be solely attributed to these characteristics. However, according to Dr Barkley, another key element that contributes to child misbehaviour is parent factors. 

2. Parent Factors

Parent factors are not that different to child factors, but they definitely impact how parents interact with their children and manage their kids' behaviour problems. Parent factors can include things like (you guessed it!): temperament, impulsivity, learning and intellectual difficulties, emotional regulation ability, physical characteristics, etc, etc. Pretty much all the same things that kids bring to the equation. Because (and it's really important to remember this), parent-child interactions are bi-directional. They go two ways; parent to child, and child to parent. Unless one of you is a robot of course, and in that case, you are reading the wrong blog. 

3. Family Stress Events

There are a wide range of stressful events or situations that families can experience, that can also contribute to children's misbehaviour. These can include significant or catostrophic events like the death of a family member, exposure to family violence, family separation or restructuring, loss of stable housing, or loss of financial security. Less severe events also are worth a mention here, including financial strain, marital discord, tense relationships with relatives, etc. 

Now, at this point a lot of families tell me they can't do anything about these factors. And they are largely right. We are stuck with genetic predispositions, can't do a lot about our in-laws, and that physical characteristic is largely permanent. There may be some things you can do to modify some of these factors though. And, if you can, the time is now. Go and seek some financial counselling, set some limits with your extended family members, and get a health check-up with your GP. 

This brings me to the final factor, the one you really CAN do something about. 

4. Situational Consequences. 

Now, I'm not going to go into detail here as this area definitely deserves it's own post. But for now, be assured that understanding how that happens around the same time as the child's behaviour can a) help you to better understand why the problem behaviour keeps happening, and b) help you to understand what needs to happen to change it. 

Keep a lookout for our next post to learn more, and leave a comment if there are any topics you would like us to explain further. 

Olivia Boer is a Clinical Psychologist and Director of Healthy Mind Centre Launceston, a private allied health practice in Launceston, Tasmania. 

Help! My child won't do what they are asked and my home is becoming a miserable place.

To follow on from our series on stress, I thought I might shift into another problem we commonly see at HMC Launceston: unhappy homes and negative relationships between parents and their kids or teens. To the point where you love each other of course, but you really don't like each other sometimes. Obviously, this is a huge source of stress for all involved. And sometimes things get to the point when you need a bit of help. An outside perspective with some ideas about why all those things you are trying (time out, reward charts, negotiating like a rational person) aren't working. 

The thing is, kids and teens often aren't logical and rational. 

Especially when big feelings are involved. Add in some big feelings from parents, who may be struggling with their own emotions, thoughts, behaviours, and life-stressors, and it's no wonder things start going downhill. 

The thing is, most humans benefit from more structure. Most kids definitely benefit from clear behavioural expectations and routines, and parents certainly benefit from being proactive rather than reactive, and being confident in their parenting plan. This is where something called "Behavioural Parent Training" comes in. 

Behavioural parent training doesn't mean you need to be trained on how to parent. 

As parents, we are typically the ones who know our children the best of anyone. Especially in the younger years. And you definitely know your family. But parents typically don't have a background in a behavioural science, such as psychology, and this is where a health professional might come in. We walk the path together and combine our respective expertise; your expertise on your family and your child, and our expertise on the application of behaviour change theory.

Our next blog series will be all about the important things to know when things aren't going so well at home. We will be investigating some the works of a pioneer in this area, Dr Russell Barkley, a clinical psychologist in the US and international expert on ADHD, as well as a couple of other key researchers in the field. Follow our blog series through facebook (@hmclaunceston) or the HMC Launceston website for more tips and to find out more!

Olivia Boer is a Clinical Psychologist and Director of Healthy Mind Centre Launceston, a private allied health practice in Launceston, Tasmania. 

So, you think you can breathe?

Most people could benefit from slowing down and relaxing a bit more. We get caught up in our busy lives, rushing around, and all of a sudden it's the end of the day. Then it's the end of the week. And before we know it, another year has passed. 

How many times over the past year did you purposely slow down and relax?

Really slow down, I mean. Stop, breathe, connect with the moment. Focus on calming down any physiological stress or tension in your body. Maybe you had a massage a few months ago, and there WAS that week off over Christmas. But, actually, that week was mostly spent running back and forth between various relatives and trying to manage overtired and overstimulated children. And while you were having that massage you were actually planning your partner's birthday present for next week and what you had to get done at work that afternoon. Hmmm. 

The problem is often our attitude. I'm not saying we don't believe relaxing is important. But... how often do you prioritise rushing over relaxing? Our attitude and judgements make this really hard. We often don't truly believe that it needs to come first, or that other things or other people can generally wait. Instead, we rush all day and then at the end of the day we flop on the couch and scroll through facebook for the rest of the evening. Yes, when sitting down are bodies are slowing down. Technically. But this doesn't really give our minds an opportunity to slow down too. 

This is where breathing comes in. 

By purposefully and intentionally stopping to prioritise relaxation (such as breathing practice), we are changing our behaviours. Changing our behaviours can help us to develop new habits, spend more time doing what is meaningful and brings vitality to our lives, and help us to challenge some of those unhelpful attitudes and judgements. Breathing helps us focus, and calms down our physiological stress response. 

But I've been breathing my whole life, I hear you say. 

Well, of course. But automatic, everyday breathing isn't the same as intentional, focused breathing. What's worse is when our everyday breathing becomes stressed, shallow, and a little too fast. Diaphragmatic (or slow, deep, "belly") breathing can help us undo this, by using our lungs to their full potential. See, when we are stressed we can hyperventilate, or "over-breathe". This results in an imbalance between our oxygen and carbon dioxide levels in our body. By breathing too quickly, we get a sharp drop in our carbon dioxide levels. This causes our blood vessels to constrict, chest pain or heart palpitations, dizziness, and a sensation of not getting enough air (amongst other things). Although this isn't dangerous, it is uncomfortable and if you are prone to anxiety, can lead you to misinterpret what is happening in your body as something really bad, leading to higher stress and over-breathing even more! Hello, panic attack! Slowing down your breaths, and using your full lungs to breathe deeply assists us to re-balance our carbon dioxide and oxygen levels. Doing this intentionally, with an attitude that relaxation is essential and is worth prioritising over other less-essential parts of our lives, can help us start to slow down and relax. 

How do we breathe this way, then?

First, find a quiet place where you are unlikely to be interrupted for 10 minutes. A comfy place such as your bed or favourite chair works well. If all else fails, head to the toilet if that's the only place you won't be bothered. If you have young children, pick your time when someone else is around to help out, or when they are taking a nap. Or when Paw Patrol is on. Whatever works. Put on some slow, relaxing music or nature sounds. 

Start by breathing normally, about 3 seconds in - brief pause - 3 seconds out - brief pause. Gradually extend this to a four second cycle, and keep extending as far as it feels comfortable. Let your belly relax and extend. This is not the time for sucking your tummy in. Let your shoulders hang. Expel all the air from your lungs and allow them to refill. As you breathe in, imagine you are taking a huge whiff of something delicious. Freshly baked chocolate-chip cookies or the like. Breathe in a big lungful and allow your belly to expand. Pause, and breathe out like you are blowing on a spoonful of piping hot chicken soup. Enough to cool it, but not enough to splatter it everywhere. Chocolate-chip cookies - pause - chicken soup - pause. Chocolate-chip cookies - pause - chicken soup - pause. Focus your mind on the sensation and experience of breathing, and when you choose to finish, reflect on what it feels like in your body and what it was like to purposefully stop and prioritise your mental well-being. 

Try it. I'd love to hear how you go. 

Olivia Boer is a Clinical Psychologist and Director of Healthy Mind Centre Launceston, a private allied health practice in Launceston, Tasmania. 

The importance of being "present"

We often fail to recognise the impact our thoughts have on our emotional well-being. It's pretty easy to recognise when you are feeling a negative emotion, after all, it feels bad. We feel tense, irritable, stressed-out. Sometimes, we recognise our behaviours that are associated with these feelings. We withdraw, stomp around, or pace the hallways. But what about our thoughts?

Actually, it all starts with our thoughts...

Wait, what? Our thoughts come first? Well, yes, according to CBT, or Cognitive Behaviour Therapy theory. This idea suggests that it's our interpretations of situations that lead to a particular feeling and set of actions. Helpful, realistic, coping-oriented thoughts or interpretations lead to helpful, realistic, coping-oriented feelings and behaviours. And vice versa. Extreme, unhelpful thoughts, that overestimate how bad something is or how likely it is the bad thing is going to happen (or overestimate how bad something was that actually happened), lead to extreme feelings, and extreme behaviours. But what does this have to do with being present?

Being "present" means being in the here and now.

Having our attention focused on our experience right in this moment. Connecting with what is actually happening right here, right now. It's a concept called "Mindfulness", and it's making it's way into many therapy rooms across the globe. But why is is helpful to be mindful? Well, think about when we are having those stressed thoughts. The ones about last week, or yesterday, or this afternoon, or next year. When we spend time up in our heads, time-travelling with our thoughts, it takes us away from what is right in front of us. The important things. The things that bring meaning, richness, and connection to our lives. Our children. Our gardens. What is on our dinner plate. Well, these things bring richness to my life. Whatever brings richness to your lives is what you might want to spend some more time engaging with. 

So, how does one be present?

Well, there are lots of ways actually. But a good place to start is to think about your five senses. Sight, hearing, touch, taste and smell. Your senses tell you about this exact moment. What you hear is occurring right now. Not yesterday. Not tomorrow. This very moment. Same for the other senses. I like to show my clients an activity called the 5,4,3,2,1 game, to help them start to connect with their present experience (and disconnect from their time-travelling stressed thoughts). It involves noticing 5 things you can see, 4 things you can hear, 3 things you can touch, 2 things you can smell, and 1 thing you can taste. You CAN mix up the order, but I find this version works well.

Try it now. And next time you are eating dinner, or in the shower, or going for a walk. And notice whether that experience added richness and meaning to your life. Then recognise that now, you have the ability to be present and connected with the here and now. There are heaps of other ways to add richness and meaning to your life. Reach out to your therapist to find out more. 

Olivia Boer is a Clinical Psychologist and Director of Healthy Mind Centre Launceston, a private psychology practice in Launceston, Tasmania. 

Your bucket is overflowing...

So, you have worked out you are stressed, tried some basic strategies, and are now keeping track of your stress levels (if you haven't done this, go back and have a look at our last two blog posts here). But how do you put it all together?

One nice, neat analogy is the stress bucket. Essentially, most people have a bit of stress (or SUDS of 3/10). This can be thought of as a bucket 3/10th full. When your bucket is just under a third full, then you have just over two thirds left of capacity before your emotional bucket overflows. Now, not everyone starts at the same place. People who have very little stress, or great resilience, start off with a little less. People who have a lot going on, or lots of things topping up their bucket, start off with a bit more. Or a lot more.

If you are starting out with a bucket half-full (wow, that sounds optimistic hey!) or two thirds full of stress, then you have less coping capacity to deal with stressful things that happen. If you have a large amount of stressful things happening, and your resilience is low, you might find yourself sitting at 95%. Then, all it takes is one more (sometimes small) thing and whoosh, your bucket overflows. 

Now for some people an overflowing bucket looks like bursting into tears, or yelling at your children, or saying out loud that statement you have fantasised screaming at your boss. Or maybe it's getting into bed, turning over to face the wall and pulling the covers up. And for those who are struggling the most, thinking that there is no way out and our bucket will be like this forever. Or that the bucket can't be emptied. 

You CAN get your bucket levels down. Sometimes it's by reducing the amount of stress coming into your bucket (life), sometimes it's getting more effective at letting it out. Mostly it's a combination of both. But often we aren't sure how to do this on our own, and that's where someone like a psychologist, counsellor, or your GP can help you move into a less-stressed and healthier head space. 

Olivia Boer is a Clinical Psychologist and Director of Healthy Mind Centre Launceston, a private psychology practice in Launceston, Tasmania. 

How much stress do you have in your life?

Stress can impact most, if not all areas of our lives. Every day. In fact, even things that we typically see as good, such as a new relationship or doing something exciting, add stress to our lives. 

No one has no stress (unless we are unconscious, and even then our brains and bodies can experience stress - nightmares, anyone?). Additionally, stress is a very individual and often internal experience. Other people might not know how stressed we are just by looking at us.

One helpful way to measure how stressed you are is using a Subjective Units of Distress Scale (SUDS). Using SUDS allows us to compare our stress levels across events, and at different times of the day. It's a technique psychologists and other counsellors often use, so we can accurately understand someone's internal experience. A SUDS scale can be 0-100 or 0-10. I prefer 0-10 for simplicity (and because I work with a lot of children, not all who can easily count to 100!). Generally, 0 = no distress (comatose) and 10 = extreme distress.

So, back to no one has no stress. Average, everyday stress levels for the average, everyday person could be about 3/10. Enough so they look before they cross the road and make a bit of an effort in life. Netflix and Chill is around 2/10. At about 5/10, you are noticing signs of stress in your emotions and body, but you can still do the things you need to do. At around 7/10, your level of functioning begins to become impaired - you can no longer concentrate as well as you would like to, and it's getting tricky not to high-tail it out of there or scream at someone. By 9/10, you are on the verge of losing control. And 10/10, well, you've lost it. 

Try getting into the habit of checking in with yourself regularly (or your partner or children) at different times and working out what your number is at any given time. It's a very useful strategy as it can guide what you do next, as well as help predict the times you are likely to be more vulnerable in the future. Keeping note in a diary or on your phone is a great idea too. Have a chat to your psychologist for more guidance - we can help you work out what next. 

5 signs you might be too stressed, and what you can do about it

Stress is something that affects us all, at least some of the time. It begins when we are infants and continues throughout life. In fact, our brains and bodies are designed to experience stress. However, this very clever adaptive function (which we will explore more in a subsequent post) can sometimes become a little too sensitive... and that can be a problem. Here are five signs you might be stressed, and some helpful tips to feel better. 

1. You are having trouble sleeping. This fact is commonly known, and many (?most) people will have had a sleepless night at some stage. But why does this occur? One key reason is due to the release of the stress hormone, Cortisol. Cortisol helps your body to be alert for threats - not what you want when you are chasing zzz's. To reduce stress before bed, try having a warm bath or shower, practising some mindful deep breathing, and dimming the lights. Having a regular wind-down routine and staying away from screens can help too. 

2. You are more irritable than you would like. Face it, we all get cranky sometimes. And that's OK, irritability is a normal and valid human emotion after all. However, when we are stressed we can find ourselves being a little too cranky, and feeling guilty afterwards. Some time-out can be helpful here. Notice the ideas running through your mind and try and change them into something a little more helpful or balanced. Adding "My thought is" to the start of an irritable idea (e.g. "My thought is he just wants to annoy me") can give you a bit of emotional distance and new perspective. If you can't take a break, take some deep breaths and where possible recruit some supports to help you schedule a break soon. 

3. You lose your appetite... or you just can't eat enough. Appetite changes are another common effect of too much stress. Make sure you are hydrated - we often don't drink enough water anyway and when you are stressed, fluid intake is the last thing on your mind. And remember, treats are generally fine in moderation. Try filling up on healthier food first; it'll do wonders for your energy levels. Speaking of which...

4. Your energy levels drop. After an initial stressed "buzz" (thanks, Cortisol), our energy levels can drop. Cue sluggishness, low motivation, and not getting off the couch. Energy levels are a funny thing - often the more we do, the better our energy is. The steam train can be hard to get going, but even taking a gentle walk and practising mindfulness (being present in the here and now) can do wonders for how much spark we have. The trick here is keeping it regular and pushing yourself to do things, even when you don't really feel like it. 

5. Concentration becomes an issue. Stress has a huge impact on our ability to stay focused and on task, and we can find ourselves not achieving anything (which can be an additional source of stress in itself!). It's important to be kind to yourself, and be realistic with what you can expect from your poor old frontal lobes. If you can't take a break right now (hello, exams) then try and break down tasks into more achievable chunks and make sure you vigorously cross them off your to-do list, congratulating yourself as you go. 

Remember, if you are feeling too overwhelmed, have a chat to your GP or psychologist for further strategies that can help. 

Welcome to Healthy Minds: A blog about all things psychology, mental health, and living a better life.

It's 2018, and we are mixing it up a bit this year. At HMC we strive to be bright, innovative, and creative... and we like technology. Therefore, this year, we are jumping on the bandwagon and starting a blog. 

You can expect a range of different content, from musings to step-by-step guides (and the occasional guest collaboration!). BUT, blog writing is a new thing for me. I figured I would start with some content that we see a lot of at HMC: the struggles that come along with stress and anxiety. Keep a look out for our posts, and feel free to share anything you find helpful or relevant.