Facing family celebrations with an empty chair at the table can make unbearable grief so much worse, says Karen Silbert, MD, Associate Professor of Anesthesiology at Cedars-Sinai Medical Center in Los Angeles, who suffered the loss of her five-monthold daughter.

Many people believe that anyone who has experienced great loss should be “over it” in six months or so. If only that were true. Emotions of the bereaved are raw and heal in their own time.

It can be difficult for those who are grieving to cope in social situations during the holidays, when tears would be out of place, Silbert says. At holiday time, many who are dealing with loss are often caught in a dilemma between the need to grieve and the pressure to “get into the spirit” of the season.

But holidays can stimulate memories and a renewed wave of pain, which feels even more pronounced. And it’s not only holidays that may trigger deep feelings of new or renewed grief. Birthdays, anniversaries

and other special occasions present a challenge for many, even after a number of years have passed.

While the experience of grief may ebb and flow, we should not expect it to altogether disappear, say grief counselors and experts. While it’s normal to hurt during the holidays. it’s also possible for the human heart to hope and heal.

Tending Grief

Here are some suggestions from grief expert Dr. Judith Johnson, author, educator, life coach and interfaith minister, to help the bereaved maintain inner balance during the holidays.

1. Reach out. Contact friends, family, support agencies, and anyone who can give you comfort during this difficult time.

2. However, be deeply honest about what you need. Honor what you need to do and not do through the holidays or other significant occasions. Be patient, kind and compassionate with yourself about what is true for you.

3. Allow all your feelings. Grief expresses in many ways. Give yourself permission to feel lethargic, grumpy or out of sorts. Stay focused on what is happening inside you and tend to yourself as you would anyone else you love deeply.

4. Anticipate and plan ahead. “Don’t wait for others to make plans for you that may or may not have anything at all to do with what you really need,” Dr. Johnson said. “Face your truth and communicate what you need.”

5. Make room for your grief or sadness. “Grief is a very private matter and the holidays have a way of magnifying it,” Dr. Johnson counsels. “Welcome your grief. Your sadness and tears are expressions of the healing process.” Be open to your grief and trust that it is healing.

Many people believe that anyone who has experienced great loss should be “over it” in six months or so. If only that were true. Emotions of the bereaved are raw and heal in their own time.

It can be difficult for those who are grieving to cope in social situations during the holidays, when tears would be out of place, Silbert says. At holiday time, many who are dealing with loss are often caught in a dilemma between the need to grieve and the pressure to “get into the spirit” of the season.

But holidays can stimulate memories and a renewed wave of pain, which feels even more pronounced. And it’s not only holidays that may trigger deep feelings of new or renewed grief. Birthdays, anniversaries

and other special occasions present a challenge for many, even after a number of years have passed.

While the experience of grief may ebb and flow, we should not expect it to altogether disappear, say grief counselors and experts. While it’s normal to hurt during the holidays. it’s also possible for the human heart to hope and heal.

Tending Grief

Here are some suggestions from grief expert Dr. Judith Johnson, author, educator, life coach and interfaith minister, to help the bereaved maintain inner balance during the holidays.

1. Reach out. Contact friends, family, support agencies, and anyone who can give you comfort during this difficult time.

2. However, be deeply honest about what you need. Honor what you need to do and not do through the holidays or other significant occasions. Be patient, kind and compassionate with yourself about what is true for you.

3. Allow all your feelings. Grief expresses in many ways. Give yourself permission to feel lethargic, grumpy or out of sorts. Stay focused on what is happening inside you and tend to yourself as you would anyone else you love deeply.

4. Anticipate and plan ahead. “Don’t wait for others to make plans for you that may or may not have anything at all to do with what you really need,” Dr. Johnson said. “Face your truth and communicate what you need.”

5. Make room for your grief or sadness. “Grief is a very private matter and the holidays have a way of magnifying it,” Dr. Johnson counsels. “Welcome your grief. Your sadness and tears are expressions of the healing process.” Be open to your grief and trust that it is healing.

With hectic schedules, busy families, financial pressures and life’s many complications, stress can permeate every aspect of daily living. Whether you’re experiencing more persistent stress or just looking to enjoy the many health benefits of increased relaxation, music can play an important role. It has the power to engage the body, mind and spirit and carry you into a more relaxed state.

The Mind

Listening to music may evoke memories, images or scenes. This is how music soundtracks help “tell” the story of a movie. We can all intentionally create soundtracks for our lives, and music therapist Jennifer Buchanan guides us in doing just that in her book, Tune In: Use Music Intentionally to Curb Stress, Boost Morale and Restore Health. Buchanan says that by choosing to listen to music that you associate with calming memories, images or scenes, you can distract yourself from the negative thoughts that are worrying you. Music can also help engage your creative, problem-solving mind so that you can come up with constructive solutions for the worrisome situation.

The Body

Purposefully chosen music can also evoke the physical sensations of actually being in those relaxing scenarios. Whether you’re lying down and listening to a slow-paced symphony, or letting loose on the dance floor to a loud, thumping beat, music can give you a physical release from stress.

The Spirit

Attending a concert, creating live music with a group of people, or even singing along with the radio can help us to feel connected to a world outside ourselves, and sometimes to a deeper spiritual presence. Indeed, music has a major role in most of the world’s religions. Although the use of music as a healing modality dates back to the writings of Aristotle, music therapy was first identified as a profession following WWI and WWII when it was used with veterans who had a variety of issues, including PTSD (post-traumatic stress disorder). In her book, Jennifer Buchanan shares the story of her first meeting with a music therapy client with PTSD. Before they met, he had closed himself off from the world and spent most of his time in his room. When he first met Jennifer and listened as she sang familiar songs (just one of the many ways that music therapists use music to enhance the health and wellbeing of their clients), the experience brought a spark of life back into his eyes. Soon, he was expressing that aliveness in other ways, by expanding his activities and more closely interacting with the people around him. When it comes to relieving stress, Buchanan says that it’s not the speed of music that is the key—for some people, it is fast music that is relaxing—but finding your own personalized music prescription for stress. She suggests that you first identify which style, speed, instrument or voice seems to soothe you. Choose a piece of music that has those qualities, and then spend 20 minutes immersing yourself in the relaxing power of music with this exercise:

1. Find a comfortable place to sit or lie down near the speakers, or wear a comfortable pair of earphones.
2. Turn on the music, ensuring that the volume is high enough to capture your attention yet low enough to not hurt your eardrums.
3. Take a few minutes to observe your breathing, shifting your mind from the external to the internal.
4. Turn your focus entirely to the music and hold it there. Follow the melody, or pay attention to the pauses in the music. If you find yourself drifting away, gently bring yourself back to the sound.

Repeat often for a long-lasting effect.

Research suggests that your mood will improve and your stress will be greatly reduced by this intentional music listening.

1. Create goals. Get clear on what you really want, write it down and start to take action toward your goals.

1. Commit to your own agenda. As much as possible, before helping others each day, complete the tasks that move you toward your goals.
2. Set boundaries. When you heed your own agenda, you will likely need to set boundaries with the people in your life.
3. Say no when you want to. Respecting your true desires is liberating.
4. Do something you’ve always wanted to do. Fulfilling long-held wishes brings joy and empowerment.
5. Seek balance. Which of these aspects need attention: social/family, spiritual/creative, career or health?
6. Eat well and exercise. Take charge of your energy by treating your body well.
7. Clear clutter. Creating an orderly and beautiful physical environment positively affects our sense of internal order and makes space for the new.
8. Pursue completion. Avoiding unfinished tasks, things that remain unsaid and relationships that need closure, hijacks our thoughts and saps our energy.
9. Get support/find allies. Get help processing uncomfortable feelings and seek friendships with people who appreciate and support your taking charge of your life

Although the lead up to the talk was terrifying—Heather cried in her car on the way to work and nearly turned around—since the meeting, things have been much better at work. The caterer was able to listen to Heather’s statements without attacking her and, on the whole, her work environment has become significantly more pleasant.

Heather’s experience is perfectly normal, especially in regards to the fear she felt before expressing her dissatisfaction. Most people have a difficult time saying what’s true for them when issues come up in family and work life.

They fear the pain of being rejected, writes Mike Robbins in Be Yourself: Everyone Else Is Already Taken, so they alter their words and actions and may even manipulate situations and people to get what they want without having to speak honestly.

However, speaking your truth is not only mentally liberating, it’s beneficial to your physical health. “When we let our true self be seen, when we let our inner pilot light radiate, we heal,” says Rankin, the author of the upcoming book Mind Over Medicine: Scientific Proof You Can Heal Yourself. Holding in emotions and resentments can lead to stress, which can be taxing on the body. Releasing stressful tension is just one of the benefits of speaking truthfully.

But how does one actually do this without alienating others?

1. Aim for being real, not right. Speak from the heart, and focus on expressing your thoughts without attacking the other person.

2. Get to know your own truth through introspective exercises. Think about what you value, what inspires you, what makes you feel grounded, what gives you purpose in life.

3. Practice. Speaking your truth becomes easier with time and repetition. Always pay attention to that inner pilot light. And when something seems off in your outer world, don’t be afraid to let your voice be heard.

As difficult as it may feel to start speaking up, ultimately it’s easier to be truthful than it is to evade the issue. It takes courage to speak up, to risk another’s displeasure, but in the end the physical and mental rewards of doing so are endless.

But when a person experiences extreme emotional highs (mania) followed by extreme lows (depression) and these fluctuations severely and negatively impact how they behave and function in their daily lives, a mood disorder could be the underlying cause. Bipolar disorder (aka manic depression) is an illness that causes severe changes in mood, energy, thinking and behavior. It’s characterized by extreme mood swings, recurring episodes of depression, and one or more episodes of mania. Mania may feel like happiness, but it is not the same thing. Happiness ebbs and flows, while mania is an extreme, prolonged euphoric state that remains high until it crashes. It impairs judgment, negatively interferes with one’s ability to function in daily life and makes one more impulsive and reckless. During a manic episode, people typically experience three or more of the following over the period of a week or more:

• Anger, irritability or aggressiveness
• Feeling unusually optimistic
• Requiring little sleep but feeling extremely energetic
• Increased, loud or rapid talking
• Racing thoughts
• Grandiose belief about one’s ability
• Being much more active than usual
• Extremely distractible (unable to focus)
• Acting on impulse without regard for consequences

Bipolar disorder has no single cause, but both external and psychological factors are believed to affect the disorder and act as “triggers.” The following triggers can initiate episodes and/or exacerbate symptoms:

Stress. Sudden, drastic changes can trigger manic episodes—weddings, getting fired, divorce or moving. Substance Abuse. Drugs like cocaine or ecstasy can trigger mania, while alcohol or tranquilizers can trigger depression.

Medication. Certain cold medications, caffeine, corticosteroids or antidepressant drugs can trigger mania. Seasonal Changes. Episodes of mania and depression typically follow a seasonal pattern. Manic episodes occur more frequently during the summer, while depressive episodes tend to appear during the fall, winter and spring.

Lack of Sleep. Even missing a few hours can bring on an episode of mania. What to Do If You or Someone You Love Has Bipolar Disorder If you recognize the symptoms in yourself or someone you love, don’t wait to get help. Living with Bipolar Disorder affects everything from relationships and employment to physical health. Diagnosing and treating the disease as early as possible can help a person live a more productive, happy life. In addition:

Get educated. Learn all you can about the disorder. Knowing the symptoms and available treatment options can assist in recovery.

Get Treatment. While currently there is no “cure,” the right treatment program, including medication, can help manage symptoms and greatly improve quality of life. Compliance with treatment and medication—even if feeling better—is the key to long-term stability.

Get Therapy. Through therapy you can learn to cope with the disease and change thought patterns.

Lower Stress. Avoid high-stress situations, do something fun, relax, maintain a healthy work-life balance, and incorporate meditation, yoga or deep breathing into your life.

Seek support. Talking to a trusted, supportive person or attending a support group can help you discover coping tips and reminds you that you’re not alone.

Make healthy lifestyle choices. Getting enough sleep, eating a balanced diet, reducing or eliminating caffeine, sugar and alcohol, and exercising regularly helps to stabilize moods.

Monitor your moods. Keeping track of how you’re feeling on a chart or in a journal can help you spot patterns and minimize or even prevent problems before they start.

Structure. Setting regular times for eating, sleeping, exercising, working, socializing and relaxing helps to stabilize mood swings. Although Bipolar Disorder is a chronic mental illness requiring long-term treatment from a doctor and/or therapist, many strategies can be used to help you stay on track. In the throes of a bipolar episode it’s easy to feel as though the illness runs one’s life, but it doesn’t have to. Armed with a solid support system and coping skills, it’s possible to live a full and productive life.

Whether this quote melts your heart at the thought of such commitment or makes you cringe at the idea of a power imbalance, the fact is, we all relate to people in different ways.

Most people would say they want (or have) a balanced relationship with their significant other. But what does a balanced relationship look like and how do you maintain it?

First, people tend to relate to one another in one of three ways: Dependently (or codependently), Independently and Interdependently.

Dependent/codependent: In these relationships one person sets aside his or her personal welfare to maintain the relationship. This dynamic implies that the codependent person in the relationship can’t survive independently of the other person.

Independent: In this configuration, the couple lives mostly separate lives. For example, they have different friends, are rarely together and make decisions autonomously. They may live separately as well and they are fine with that arrangement.

Interdependent: In this type of relationship, two people are intimate with one another but don’t compromise or sacrifice themselves or their values. This dynamic is about collaboration and cooperation. Each person is self-reliant (physically, emotionally, financially, etc.) and, simultaneously, responsible to the other.

While it’s possible to find happiness, at least temporarily, in all three types of relationships, the Interdependent relationship is generally considered the model for a balanced relationship.

What do you do if you don’t consider your relationship to be balanced? Take heart. With a little information and effort it’s possible to attain a balanced relationship. Try starting with this approach:

1. Find Inner Balance by:

• Focusing on what you can control (your thoughts, feelings and actions) not what you can’t (others’ thoughts, feelings and actions).
• Noticing how you feel and, as clearly as you can, communicating those feelings.
• Recognizing and owning your issues, which will help you recognize your partner’s as well. You can be empathic and supportive without having to “fix” everything.

2. Create and Maintain a Balanced Relationship by:

• Staying present and empathic even when your partner is upset.
• Stepping back from conflicts to avoid escalation, assess the problem and make positive changes.
• Reframing the actions/reactions of your partner. For example, seeing a loved one as anxious and fearful, instead of cruel and controlling, paves the way for a more sympathetic, less confrontational approach.
• Being a good listener and focusing on the only person you can change—yourself.

Keep in mind that balance, like a relationship, is dynamic not static. It’s impossible to keep balance 100% of the time in every situation. Even a balanced relationship can, at times, feel like more work than play.

Remember, sometimes the focus will be more on you, other times more on your partner, and still other times when what’s best for “us” needs the focus rather than either individual.

Like a wave, there is an ebb and flow to relationships. But once we are aware of what balanced relationships look like we can better manage that dynamic.

After almost spanking her son when he threw a fit in a grocery store, Joyce realized she needed help.

She reached out to a friend who had dealt with similar challenging behaviors from her own child—yelling, punching and talking back—typical acting-out that didn’t necessarily constitute a psychological disorder.

Joyce’s friend recommended The Difficult Child by Dr. Stanley Turecki.

According to Dr. Turecki, while some children suffer from psychological ailments that respond to medications like Ritalin, too many parents turn to drugs without examining the root causes of their child’s behavior.

Those causes may be as simple as temperament. For instance, Joyce was making Milo play soccer because his brother did. When she asked him what he preferred to do, to her surprise, he said he wanted to visit the library. Once they started going a few days a week, his behavior at school began to improve.

The library seemed to allow Milo the downtime he needed to gather emotional resources.

In addition to allowing your child’s temperament to guide activities, here are some other tips for coping with emotional and behavioral issues in children.

1. Set specific and clear expectations for your child. Parents who are disorganized or without clear boundaries tend to create more of a struggle for themselves.
   Be reliable and loving, while maintaining consistent rules and expectations.
2. Apply the “Positive Parenting” approach. Psychologist Georgia DeGangi, author of Effective Parenting for the Hard-to-Manage Child, recommends that parents “catch” their kids being good, and then reward them through acknowledgement and
   actions. She advises against rewarding bad behavior with attention.
3. Recognize your stress signals and take care of your own wellbeing. Finding appropriate ways to cope with the behaviors of a challenging child is essential. Take time out to relax in healthy ways whenever possible. Be sure to process any feelings
   of guilt before they become toxic. 
4. Seek professional help if needed. Do not be ashamed of reaching out for help if the behaviors continue to seem unmanageable, especially if they are having a negative effect on the family or on your child’s successful development.
   With a few other parenting “tweaks” (and a couple of “Mommy”
   spa afternoons), Joyce began to see a distinct difference in Milo’s
   interactions with the world, and in her own ability to work with his more
   challenging behaviors.

1. Constant worries/dread. You feel anxious nearly all the time, although you may not know why. To help reduce anxiety and stress, aim for 30 minutes of aerobic exercise on most days.
2. Impaired thinking. You have difficulty forming thoughts, concentrating or learning new things.
3. Fatigue. Heightened stress hormones can leave you exhausted. Adequate nutrition, hydration and sleep can boost energy.
4. Irritability/anger. Coping with anxiety can be overwhelming, so you may overreact to situations.
5. Fear/Terror. You may have irrational fears or an impending sense of doom or danger.
6. Panic Attacks. These spikes of terror can feel like a heart attack. A few deep breaths can calm you.
7. Controlling behavior. You try to control situations and people to keep anxiety at bay.
8. Stomach/digestive upsets. These may include nausea, vomiting, constipation, diarrhea, gas and Irritable Bowel Syndrome (IBS).
9. Sleep issues. Insomnia, night–mares and night terrors can occur.
10. Phobia. An exaggerated fear of an object or situation, such as heights, flying or spiders.

If your anxiety interferes with normal life functions, it’s important to seek professional help.

Despite having never left the stove on, Mary was convinced that if she left the house without checking the stove three times, her house would catch fire. If she left the house and forgot to check, or couldn’t remember if she had, she would turn the car around and come back.

One day, Mary had had enough. She just stopped going back, telling herself, “Well, I guess the house is going to burn down then. I’m not turning back.”

At first she was terrified, convinced her house wouldn’t survive, but after a couple of times of confronting her fear, she now feels free of it.

Is Mary quirky or does she have OCD?
Used in everything from creating eccentric TV characters to being the punch line on late
night TV talk shows, Obsessive Compulsive Disorder (OCD) is often oversimplified and misused. But for those who suffer from OCD it’s no joke.

What Is It?
Obsessive Compulsive Disorder (OCD) is an anxiety disorder where people experience obsessions and/or compulsions.

Obsessions are unwanted, persistent thoughts, such as about germs or intruders, or
images of doing—or actual impulses to do—something destructive.

Compulsions are deliberate behaviors (washing, checking, organizing, hoarding) or mental rituals (praying, counting, repetitive statements) typically performed to reduce the anxiety triggered by the obsessions.

For instance, people with an obsessive fear of uncleanliness and infection may wash their hands repeatedly or refuse to shake hands or touch things that they believe are contaminated.”
People who have an obsessive desire for exactness and need everything to be “just so” and “in its place” may be compelled to organize food cans by size and with the labels facing in the same direction.

How Does OCD Impact People’s Lives?
Left unchecked, OCD can rule a person’s life by taking up significant amounts of time and
energy and leaving sufferers feeling anxious and exhausted. This can interfere with one’s ability at work, impeding professional development and advancement. It can also prevent some people from forming intimate relationships.

So how do you know if your quirk rises to the level of OCD?

The Thought/Behavior May Be OCD If It:

• Is constant, recurring and intrusive.
• Interferes with a person’s ability to function in daily life.
• Is out of control.
• Is compulsive or highly ritualistic.
• Causes the person to feel anxious and nervous most of
  the time.

What Can You Do?
If you or someone you know has OCD there are ways to
help.

• Insight. Educating oneself about the symptoms and treatment is a critical first
  step.
• Redirect attention. When obsessive thoughts or compulsive urges surface, try
  diverting your attention to other, healthier thoughts or activities. Do something you
  enjoy, such as walking, listening to music or visiting with a friend.
• Self-care. Eat healthfully, exercise, get enough sleep, and avoid alcohol, caffeine and nicotine. (The latter two are powerful stimulants.)
• Find healthy outlets. Focus your energies on hobbies, exercise and recreational activities. 
• Structure your time. Daily time management helps you stay organized and can help reduce anxiety and stress. 
• Therapy. A therapist can help you learn to respond to (or even curtail) obsessive thoughts without resorting to compulsive behavior.
• Support groups. Interacting with others who can relate can decrease feelings of isolation.
• Medication. This may be warranted for severe symptoms.

It’s not unusual for people to repeat behaviors, such as checking to see if they tuned off the stove or not, or to have thoughts that are upsetting or out of character. It doesn’t mean a person has OCD.

But when these thoughts and behaviors impede daily functioning by becoming frequent, intrusive, time consuming, debilitating and out of control it may be time to consult a doctor or mental health provider.

There is also an increase in  suicides among teenagers to-day and they may not know how to cope with the death of their own peers. They may see suicide as a way to cope with their own problems and They needs someone to model a healthy reaction and to explain that suicide is not a  solution as there is always another way to solve a problem.

They sometimes feel responsible for the death and are likely to express their guilt in intermittent, brief outbursts.

Fear is another symptom and they can often experience anxiety about what will happen or worry about how others will view them.

Grief is a normal reaction to the loss of a loved one. It usually involves shock or numbness. Many people describe it as “like watching themselves going through the motions while experiencing a sense of detachment. There is often denial, anger, depression and an eventual coming to terms with the death and loss. This process can take several months.     

Signs of trouble include; isolation, a general preoccupation with death, unhealthy mechanisms of coping such as use of drugs or alcohol, self-blame etc.

If a teen you know has lost a peer or family member:

• You can be helpful by being patient, caring and available to talk about the death with them. Teens don’t like feeling pressured about how to express their feelings. So, it is important to let them share their feelings in a safe, nonjudgmental setting.
• It is also important to remember that the teen should have opportunities to have normal associations with peers and be involved in school and other activities. They can also benefit from grief support groups for teens from which they can get support from their peers. 
• Adolescents will experience a wider range of emotions and more complex ways of coping. Because of their need for peer acceptance, teens may internalize their pain and suppress their needs and alternate between clinging to and running away from parents. Grief derails this normal process and the death of a family member (especially a parent) may cause them to act out, regress or even become preoccupied with death or experience suicidal thoughts and possibly become clinically depressed during the first year following a death.
• If the relationship with the deceased was conflictual the teen may experience relief mixed with guilt about feeling the relief and may blame themselves for the death.
• They will experience confusion, fear, and concern about what will happen to them and how others (particularly, their peers) will view them.   

Caring for teens

One of the most important sources of help in times of grief is social support. Many teens are reluctant to talk to professionals about their grief and instead turn to siblings, parents, or peers. There is a need to make professional services available to teens in schools and teen organizations. Teen support groups can provide a safe environment for them to express feelings normally associated with adolescence and those related to the death of a loved one.