A Sense of Accomplishment – Brandon Vazirian, MS, LMFT

In my experience over the years I have seen 1000’s of people come and go through various partial programs I have worked for, and one common thing they say is “when is this going to go away”: (meaning depression, anxiety, or overwhelming panic or fear). My usual response is that unfortunately depression/anxiety does not go away right away. It is process that takes time and the person who has the most control over how long this lasts is you. Most people will look for the “one” intervention that will cure all, or will finally get them through, but really what is most affective is taking an approach of changing a lot of the small things in a person’s life. One small example of this is something as simple as making the bed in the morning. This simple activity signifies that sleep is done, sometimes prevents the person from getting back in, and it also gives the person a sense of accomplishment after they have done it.  Another small example of something small is going for a mindful walk. Depression and Anxiety are often things that are internal, so it is important to focus on the beauty of a 3 dimensional external world.  These and many interventions are what we teach to our patients here at choices in the many educational groups we provide. It is our goal not only give individuals a safe place to deal with their problems, but also the tools they need to live life to the best of their ability. Thank you for reading! 

- Brandon Vazirian, MS, MFT

Deep Breathing – Anne Lee, MS, RDN, LMFT

One of the best and basic tools that we teach at Choices is Deep Breathing. When you are stressed or anxious you may find that you have poor breathing habits. Poor breathing habits include:

● Shallow breathing - breathing in too quickly

● Monitored breathing - over thinking your breathing

● Over-breathing - breathing in more air because you think you're not getting enough in

These poor breathing techniques can lead to hyperventilating.  

Learning to have healthy breathing habits can help calm your mind and body especially when you're stressed or anxious. Practice deep or diaphragmatic breathing when you are in a safe and relaxed environment.  Practice at least once a day and be patient as you give yourself time for this to become an effective tool for relaxation. Also, if you have a medical condition, always check with your doctor before you start any relaxation training or exercise program

How to practice diaphragmatic or deep breathing

Find a quiet place free of distractions. Lie on the floor or recline in a chair, loosen any tight clothing and remove glasses or contacts. Rest your hands in your lap or on the arms of the chair.
Place one hand on your upper chest and the other hand on your stomach. Inhale, taking a deep breath from your abdomen as you count to three. As you inhale you should feel your stomach rise up. The hand on your chest should not move.
After a short pause, slowly exhale while counting to three. Your stomach should fall back down as you exhale.

Continue this pattern of rhythmic breathing for five to ten minutes

- Anne Lee, MS, RDN, LMFT

Healthy Relationships - Lynn Oravetz, MA, MSW.

By virtue of the fact that we are social beings, we humans are all about relationships. This is one of the great joys of life. Wonderful as many relationships may be, they can also be a source of much conflict if they are not healthy. In fact, an unhealthy relationship can be a contributing factor to the difficulties associated with many psychological disorders. A relationship that is healthy is characterized by individuals coming together out of choice, not need. When two independent individuals come together, they make a strong couple. When two dependent individuals come together, they make a weak couple. In other words, it is just as important to be the best partner as it is it is to find the best partner. At CHOICES we focus on the development of the self in order to foster healthier relationships. We invite you to learn more about our program and obtain the skills necessary to maximize your relationship potential.

Lynn Oravetz, MA, MSW.


Life Challenges

In his classic book, The Road Less Traveled, M. Scott Peck tells us that, "Life is difficult.” Yes, life can be challenging! Whether we are faced with health, job, relationship, money, legal or emotional problems, they can take a toll on our well-being. Unfortunately, none of us escapes life's challenges. Keep in mind, however, that we are not defined by our difficulties, but rather by our responses to them.  We do have a choice. Are we resilient, adaptable, resourceful, and comfortable in our own skin? There are certain behaviors that set us up to be successful despite our challenges. Making our mental health a priority is one of those behaviors. Do we practice good self-care? At CHOICES we encourage the acquisition and maintenance of self-care, through education, meditation, and stress management, just to name a few. Stay connected to our blog to learn more about how to be the best "you" you can be, regardless to the current challenges you face in your life today.



Ways To Challenge your Thoughts (part 2) by Rich Wayne, LMFT

You don’t need to challenge all your thoughts, just the ones that cause you to feel bad. If a thought helps you feel good, keep it. When I’m speaking of thoughts, I also mean beliefs, stories, labels, experiences, predictions, self-doubts, worries and suspicions about others and the world. All of these are meanings that your subconscious mind reacts to as truths, and they’re not.

So how do we challenge them? In my last blog post I gave you a short form approach based on The Work by Byron Katie. If you want more of that in depth, check it out at www.thework.com. There are a wealth of free resources on that site that are designed to turn you into a lover of reality.

There are lots of ways to challenge your thoughts. Christine Padesky and Dennis Greenberger identify a number of them in their book Mind Over Mood, which is one of the best places to start if the Cognitive Therapy approach is intriguing to you. Cognitive therapy assumes that as we think, so we feel. So if you change your thoughts, you’ll change your feelings. It is considered one of the most effective and fast forms of therapy.

They ask the questions: “What was going through my mind right before I started to feel this way. What does this say about me? What does it mean about me, my life, my future?” Then write down your answers, your thoughts. Writing down your thoughts, exposing them to the light of day, sometimes reveals the falsehoods in them. If they just stay in our head, they tend to ring true. 

Greenberger and Pedesky then have us identify the “Hot Thought” that’s responsible for the majority of our negative emotions, and run it through a series of questions designed to give us a reality check on the thought and create a more balanced view of our situation in our mind. Some of the questions are: “What is the evidence for and against the hot thought? Have I had any experiences that show that this thought is not completely true all the time? If my best friend had this thought, what would I tell them? If my best friend knew I was thinking this thought, what would they say to me? What evidence would they point out that might dispute this thought? How have I handled similar situations in the past? Is there anything I learned that might help me now. Am I jumping to unwarranted conclusions? Am I ignoring strengths or positives? 

Finally, Pedesky and Greenberger suggest we create a more balanced alternative thought comprised of the evidence for and against our hot thought. My favorite suggestion of theirs is to write one long sentence that incorporates all of the evidence for and against our hot thought. That is really balanced thinking. If you determine that your thought is true, what’s the worst outcome, best outcome, likely outcome? I’ve found the outcome tends to be toward the good side to the right of center most of the time, but rarely the best or worst case.  

If this approach is intriguing to you pick up their book or Feeling Good by David Burns, MD. Burn’s book has been shown to be effective in alleviating depression in 72-73% of the cases in clinical trials, every time it’s tested. That’s better than any single medication.

Ways to Challenge Your Thoughts (blog 1) by Rich Wayne, LMFT

How we feel is a function of many things but there are certain paths that effect how we feel in a dramatic way. These are things we choose, sometimes consciously, but mostly subconsciously (beneath our conscious awareness) Because we do have a degree of choice about them, we can choose differently to begin to feel and get better fast. We’re going to address 3 key areas that can dramatically effect how we feel:

Focus – Where you put your attention.
Meaning – The stories you tell yourself.
Physiology – How your mind/body is affected by the focus and meaning.


When you focus on what you don’t want to happen or didn’t want to happen, you will start to feel bad, not just some of the time, but 100% of the time. The more you don’t want what you’re focusing on, the worse you’ll feel. 

Worriers are good examples of this phenomenon. People who tend to worry, tend to use their amazing imagination to visualize the worst case scenario. When they do this, the primitive part of their mind (which doesn’t know its not happening yet , and may never happen) sends them emotions that reflect the situation 

and might help them deal with or act on the horrible catastrophe that has occurred.

Remember Venn diagrams from High School? Worry is the intersection, the overlap, the common point between depression and anxiety. When you start to eliminate worry, you start to eliminate depression and anxiety. They can’t exist without the prediction of and focus on a negative future (Which, by the way is often highly unlikely to happen).

How do you solve the Focus problem? Become aware of how you’re using your imagination, stop it, focus on something else, like what you want to have happen, really visualize that, then see how you feel.


Meaning is what you tell yourself about an event, person or situation. It’s a story you’ve created even though it seems like the gospel truth. It often includes what others think about you and what that’ll mean to your life. Many times that includes a prediction about a negative future. Subconscious mind reacts to the meaning as though it is true and current. It creates emotions that compel you to take action to deal with the dreaded outcome.

Much of cognitive therapy is focused on challenging the meaning of our thoughts. Cognitive therapists believe that as we think, so we feel. So if you can challenge or change the thoughts, you can change the feelings. Change the feelings and you change the behavior. The fastest and most powerful way to change meanings is to recognize that: 


Meaning is in the mind of the perceiver and perception is reality, until you decide it’s not. Meaning is not inherent in the situation. We make and add the meaning, often automatically, based on our view of the world or the situation.

Ask yourself: “What story am I telling myself that is making me feel so bad? Is it true? Can I absolutely, positively know it’s true? True or false, how do I feel when I believe this story? Is there another way to look at it that would change how I feel? If so, look at it that way. In my next blog post I’ll give you some other tried and true ways to challenge your beliefs, the meaning mind is attaching.


This is a tough one. It is a nearly 100% unconscious reaction of your mind and body to your focus and the meaning you’ve made of it. It is instantaneous and hard to shift, especially when it’s got a head of steam going. People who suffer from anxiety, agoraphobia and panic disorders know this first hand. People who procrastinate, or have been depressed, know the effect your physiology can have on your ability to get moving.

Surprisingly, you can get control over your physiology if you’re willing to work at it. If you’re not living in Iraq or some other really dangerous place as you read this, you need to learn to relax and take time out to do it, everyday, many times a day. If you do live in a dangerous place, move if you can. Then relax. If you can’t escape the danger completely, get to a relatively safe place, then relax. 

So how do you manage your physiology when you’re freaked out most of the time? You have to train your mind/body to do what you want it to do. As it turns out, it’s pretty simple and it’s just like physical exercise, the more you do it with purpose and guidance, the better you get at it. A great place to start is learning how to manage your arousal level. Learning how to calm your self. Success in this comes from practicing the proper method. Over time your mind/body comes to understand your intention when you start your relaxation ritual and it starts to do the relaxing for you. 

Technique for calming yourself: Imagine you are in a safe place, a place where you're very relaxed. a place where you're extraordinarily calm. It can be a real place you've experienced or it can be a place that would calm you down. It’s totally safe here. Make it real by seeing what you would see there (in your mind’s eye), hearing what you would hear there, feeling what you would feel there. If you want to make it even stronger you could smell what you’d smell and taste what you would taste in a calming, safe environment. Speak affirmatively to yourself: “Be calm, relax, everything is going to be alright. You feel peace coming over you.” Words to that effect. As it turns out, the subconscious part of our minds doesn’t understand negation. So when someone says to themselves “Don’t worry, don’t panic, don’t be afraid.” Subconscious hears “Worry, panic, be afraid” and it does so. When speaking to yourself, speak only what you want to happen, not what you don’t want to happen. See yourself in that safe place then imagine you’re there.

Next you have to lower your arousal level. The best way to do this is through slow, deep, diaphragmatic breathing. When starting this breathing technique I recommend the 4-7-8 method advocated by Dr. Andrew Weil, the famous wellness expert. 

Breathe in for the count of 4
Hold the breath for the count of 7
Breathe out over an 8 count

This technique slows the breathing and ensures a longer out-breath than in-breath, which lowers the heart rate and arousal level. 

Breathing for 4 minutes in this different way with relaxed imagery will activate the parasympathetic nervous system, calming a fear/anxiety response and causing a state of relaxation to take place. This is miraculous in and of itself, but it isn’t the big miracle. 

The big miracle happens when you practice this technique. Practice 10 times a day for a minute or two: consistent relaxed imagery, affirmative self-talk, slow deep diaphragmatic breathing with a longer out breath. In 2-3 weeks you shorten up the time it takes to activate your parasympathetic nervous system (PNS) from 4 minutes to 3 to 2 to 1 to 0 minutes. After that, PNS activates when you start the ritual. 

Every time you practice, you’re taking a break from your day and lowering your stress level. Every time you practice you're telling your mind and body that you want to relax right now. Every time you practice you break the old pattern of relentless climbing anxiety, and the fear that engenders.

This practice can change your life for the good, forever.

Beyond The Couch - Brandon Vazirian, MS, MFT

This blog is being started by the therapists at Choices for the purpose of connecting with the community. It is our mission and passion to help others through education, support, and offering specific tools to assist people as they go through difficult times in their life. Here you will find various educational insights into various mental health disorders or responses to what is currently taking place in the mental health community. At times, we will offer coping tools for depression, anxiety, Bipolar D/O etc. as we focus on what research based interventions we have seen to be the most affective.  We will also review various mental health disorders educating you what Specific symptoms go along with each, as well as their onset and Etiology. We hope that these writings assist you or your family members in any trials or struggles you may be going through. We want to thank you for taking the time to read our entries and if we can serve you in any way please feel free to contact our offices.

Battling Depression and Anxiety - Anne Lee

Brandon is so right about the importance of taking notice of our surroundings. Most  of my patients are so depressed or filled with anxiety that they can't seem to focus on anything else. One of the tools we teach is Mindfulness. Mindfulness is doing one thing at a time (no multitasking!) in the present moment with your full attention...and with acceptance. Not trying to change the moment or judging it. Just accepting it. This may seem to be a simple concept but it can be a challenge to do. Start with something simple like taking a walk. As you walk take in your surroundings with all 5 senses.   As you practice Mindfulness you'll find that it can help to improve your physical and mental well being. Some things to try:

Basic mindfulness meditation – Sit quietly and focus on your natural breathing or on a word or “mantra” that you repeat silently. Allow thoughts to come and go without judgment and gently return your focus back to your breath or mantra.

Body sensations – Notice subtle body sensations such as an itch or tingling or your heart beating in your chest...without judgment and let them pass. Notice each part of your body in succession from head to toe.

Sensory – Notice sights, sounds, smells, tastes, and touches. Name them “sight,” “sound,” “smell,” “taste,” or “touch”...Observe them without judgment and let them go.

Emotions – Allow emotions to be present without judgment. Practice a steady and relaxed naming of emotions: “joy,” “anger,” “frustration.” Accept the presence of the emotions without judgment and let them go. If you notice a judgment acknowledge it and let it go.

Urge surfing – Cope with cravings (for addictive substances or behaviors) and allow them to pass. Notice how your body feels as the craving enters. Replace the wish for the craving to go away with the certain knowledge that it will subside.

- Anne Lee

The Art Of Self Care - Tonja Gaudette, MSW

Welcome to the Choices webpage. In working on emotional recovery, there are two words that are really important to remember, “self care.” That is, loving ourselves through the act of nurturing our mind, body, and soul. Examples of self care include going for a walk, taking a bath, meditation, going to the beach, or getting a massage. Often times during emotional recovery individuals do not participate in self care due to: they don't feel they deserve it, they spend all of their extra time fulfilling others needs, or they minimize the importance of these activities. One way to overcome these feelings is to say to yourself, in order to have the emotional and physical energy to complete my daily tasks i.e. going to working, caring for a child or loved one, taking care of the house, etc. I need to participate in self care. Think of it as filling your gas tank. You must fill up and replenish your gas used up from stressors and activities from the day before by allowing yourself the opportunity to participate in self care. During early emotional recovery, you may wish to schedule in your self care just as you would schedule in a work meeting or a doctors appointment. As you go about your week, think or journal about what activities or environments from the past or present bring me joy or relaxation and how can I incorporate them into my weekly schedule. 

Thanks for visiting our site!

-Tonja Gaudette, MSW