This is for family/friends of people who have an addiction.  NOT the person with the addiction.  

Group Lead: Greg Pratt MSW,LISW-S has worked in the Mental Health Field in the Greater Cincinnati area for over eleven years.  He graduated from Thomas More College with a BA in Psychology and from the University of Kentucky with a Master’s Degree in Social Work (MSW). He has worked with individuals and families struggling with a wide range of concerns and specific needs, including individuals with both mental health and substance use struggles.

$25 per group paid upfront at our Anderson Office

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 Until recently, it was thought that sleep deprivation can only be the cause of mental health conditions over time. Recent research now however shows that it can be the other way around, that mental health conditions can actually cause sleep deprivation, where sleep issues are more prevalent with people who already have mental health issues. Research shows that through the practice of mindfulness, sleep quality can be improved for those who experience sleep disturbance due to mental illness like depression, anxiety, ADHD, and bipolar disorder.
 
More and more research is showing how mental health conditions can actually impact sleep. Harvard Medical School says that “chronic sleep problems affect 50% to 80% of patients in a typical psychiatric practice, compared with 10% to 18% of adults in the general U.S. population.”  According to NAMI, sleep problems can be a sign of an impending illness like bipolar disorder, and certain mental health conditions can be worsened by lack of sleep. NAMI says that more than one half of insomnia cases are related to depression, anxiety, or psychological stress. OCD, PTSD, ADHD, Schizophrenia, as well as substance abuse disorders are also each specifically associated with poor sleep. Both Harvard Medical School and NAMI recommend relaxation techniques, including deep breathing, progressive muscle relaxation, and meditation to increase mindfulness. This mindfulness exercises reduce anxiety and help people feel aware and present in their bodies so they can sleep.
 
There are a number of benefits to such relaxation techniques used to achieve mindfulness that aids sleep. Mindfulness and meditation help in three major ways with regard to sleep problems that can be caused by mental illness:

• Mindfulness and meditation combat stress through training your body to elicit the relaxation response. Chronic stress leads to a fight or flight response when you are trying to sleep, where high cortisol levels make it impossible to sleep. Mindfulness and meditation help reduce high cortisol levels so your body is capable of sleeping.
• Mindfulness and meditation strengthen different regions of the brain through having a direct impact on neural structure and functioning, including the part of the brain responsible for REM sleep.
• Mindfulness and meditation increase melatonin levels as well. Research shows a link between meditation before bed and increased amounts of melatonin, the chemical that makes your sleep possible.

 
In combination with the relaxation techniques that NAMI and Harvard Medical School recommends to limit the effects on sleep caused by mental health conditions, consider your overall bedroom environment and how it contributes to mindfulness and serenity. Consider your sleep space as well, where you invest in the right bedding and mattress for you. Once your sleep space and environment are ideal, focus on one or more specific meditation techniques to practice before bed. It may take time for meditation to work, so be patient with yourself and remember that self compassion isn’t selfish!

To learn more about mindfulness and the positive effects it can have on your body, join our Mindfulness Based Stress Reduction Group. The group will meet weekly for 9 weeks and include a time of teaching and a time of practicing techniques. There is daily homework that is essential to getting the most out of the group.

MBSR Group
​Cost: $240 Private Pay
Meets weekly in Fairfield for 9 weeks from 4-6pm
Each group is 2 hours long, There is also an 7 hour session between weeks 5 and 6 for a total of 25 hours
Presenter: Charity Chaney

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​Anxiety comes in many forms, from the general worry that comes from everyday life to the intense fear caused by major psychiatric disorders. As debilitating as anxiety can be to our mental and physical health, it’s also corrosive to our quality of sleep—whether you’re a college student pulling an all-nighter or a veteran jolted awake from a nightmare caused by PTSD. This guide covers how anxiety and sleep are interrelated, change with age, and what you can do to improve both.
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Anxiety and Sleep
Nearly 40 million people in the US experience an anxiety disorder in any given year. More than 40 million Americans also suffer from chronic, long-term sleep disorders. Those numbers aren’t a coincidence. Anxiety and sleep are intimately connected: The less sleep you get, the more anxious you feel. The more anxious you feel, the less sleep you get. It’s a cycle many insomnia and anxiety sufferers find hard to break.

Common anxiety symptoms like restlessness, increased heart rate, rapid breathing, and gastrointestinal (GI) problems make it difficult to fall asleep.
Because insomnia and anxiety are so closely linked, one of the first steps in treatment is to determine which is causing the other — that is, which is the primary cause and which is the secondary symptom. “Sometimes, insomnia is secondary,” says psychotherapist Brooke Sprowl, “in that it is caused by another primary disorder such as depression, anxiety, or a medical condition. In this case, usually treating the primary disorder [improves] the insomnia.”
Whether insomnia is the primary or secondary cause, natural remedies like magnesium glycinate and melatonin have been shown to help with sleep, says Sprowl. Non-medication treatments like cognitive behavior therapy along with good sleep hygiene are also effective at combating insomnia and anxiety.
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Health Risks of Insomnia
Insomnia affects cognitive functions and cripples school and work performance. According to one study, 70% of college students with lower GPAs also had difficulty falling asleep. Insomnia also slows reaction times, raising the risks of driving a car or operating heavy machinery.
Sleep deprivation is also bad for your physical health, increasing your risk for developing high blood pressure and heart disease. And long-term sleep disruptions may even raise the risk of some forms of cancer.

Common Sleep Disorders
There are many forms of sleep disorder besides insomnia. All interrupt sleep, threaten our health, and increase nervousness and stress. Here are a few common ones:
Delayed Sleep Phase SyndromeAnyone who has changed time zones or experienced “jet lag” understands the effects of delayed sleep phase syndrome (DSPS). When your sleep and wake cycles don’t align with the current time zone, you feel groggy when you shouldn’t.
While these symptoms are temporary for most, people with DSPS stay out of sync for long stretches of time, negatively affecting their work and activities. Because people with DSPS are forced to conform to the external clock rather than their internal one, they suffer from lack of sleep and increased anxiety.

Obstructive Sleep Apnea
Obstructive sleep apnea is when a sleeper’s relaxed airways close and obstruct breathing. Interrupted breathing episodes occur numerous times during sleep and are usually accompanied by snoring.

Obstructed airways result in lowered oxygen levels and increased carbon dioxide in the blood. Sufferers are often unaware they have the condition. Sleep apnea increases the risk of heart disease, stroke, diabetes, and cancer. Sleep studies are required to diagnose obstructive sleep apnea.

Forms of Anxiety
How do you know if you have garden-variety nervousness or a more serious anxiety disorder? Usually, the difference is how significantly your anxiety affects your life.
For someone at a party who doesn’t know anyone, a certain level of anxiety is normal. However, if their anxiety is interfering with daily activities (e.g. making friends, school work, job performance), They may have a serious anxiety disorder.Whether social nervousness or a serious phobia, every form of anxiety will affect your quality of sleep if it goes on long enough. Below are descriptions of the five major anxiety disorders. If you think you may have one, consult your physician or therapist about diagnosis and treatment.

​If you’re like many people, you spend a good deal of energy and time beating yourself up! You may frequently engage in an internal monologue about how lame it was for you to have said something or how you’re not successful enough, or not good looking enough. This toxic internal self-speak merely adds to your troubles. Self-compassion, on the other hand, helps us build resilience to difficulties that have the potential to sink us into a state of self-defeat. When we make mistakes or experience a rough day, having self-compassion allows us to get back in the game and try again, rather than being swallowed by a self-centered swamp of self-pity.  
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​What Exactly Is Self-Compassion?
Self-compassion is the antidote to self-deprecation. Sadly, many people put themselves down with self-loathing comments. In the movie Annie Hall, Woody Allen plays a character named Alvy who says, “I would never want to belong to any club that would have someone like me for a member.” Some people think putting themselves down is cool, funny or charming. In Self Compassion: Stop Beating Yourself Up and Leave Insecurity Behind, renowned self-compassion advocate, psychologist, professor and speaker, Kristin Neff, Ph.D., promotes a very different message. Neff explains that self-compassion is a must in today’s day and age. She states that it is very different from selfishness. Neff says self-compassion is comprised of three distinct ingredients: mindfulness, empathy and connection.

Mindfulness
By now, you have likely heard the word Mindfulness a few hundred times. It is quite the buzzword these days! But what exactly does it mean to be mindful and how does mindfulness relate to self-compassion? Mindfulness means being aware of what is. It does not require changing anything. Rather, mindfulness means paying attention to or drawing our awareness to our own thoughts, feelings, reactions, emotions or surroundings, in the moment. Sounds simple, right? Well, not so much because we often go through life reacting without thinking. Have you ever driven to work and then wondered how you got there or not remembered anything about the drive itself? Often, we ruminate about something that occurred in the past or worry about something that could occur in the future, so much that we have little awareness of what is occurring right here and now, in front of us. Mindfulness draws us in to notice and become more aware of what is--a requirement of having self-compassion. You cannot have self-compassion if you are not mindful of what is.  

Empathy
The second ingredient of self-compassion is empathy. When we have self-compassion, we treat ourselves with the same empathy that we would a good friend. Why must we be quick to forgive our friends when they make an honest mistake but we hold ourselves to such high demands that we cannot do the same for ourselves? We are only human, after all. We pride ourselves on being empathetic to others’ needs, treating others with kindness and love, just as we should. Yet, at the same time, when it comes to how we treat ourselves, we are downright relentless. What would happen if we gave ourselves the same sort of empathy that we provide so freely to others? How might that change the way we operate in our daily lives? I believe we would feel calmer, cared for, happier and more peaceful.    

Connection
Neff describes the third and final ingredient of self-compassion as connection or connectedness to others. When we notice our connection with others and appreciate that we’re all human and “we’re all in this together,” it makes facing life’s challenges more tolerable. Conversely, when we believe that we are the only ones in the world with a particular difficulty, we become self-absorbed, we isolate ourselves further, and we pity ourselves. In effect, we become more selfish and self-centered. Whereas, when we feel a connection with those around us, we have confidence that everything will turn out ok—that others face this difficulty too and if we can’t tackle it by ourselves, we know people who have already faced a similar challenge who can help us.

Take Care of Yourself So You Can Take Care of Others
I attended a workshop about a year ago led by Neff who instructed participants to think of the video that airlines show passengers before taking flight on an airplane. The video instructs you to first place an oxygen mask on your own face before helping others with their oxygen masks because if you cannot breathe, you cannot possibly help anyone else. Similarly, when we practice self-compassion, we are better equipped to help those around us. Without adequate self-compassion, we sink into self-absorption, making it more difficult to support others.
This is the distinction between self-compassion and selfishness. It is with mindfulness, empathy toward ourselves, and the recognition that we are all in this thing called life together, that we can practice self-compassion, and more effectively help ourselves and each other. This recipe can be difficult to follow but if you keep at it, the end result can bring you more satisfaction in life.

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REBECCA MORRA, MA, LPC ​

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​So, first things first, why expand “the talk” to your child beyond giving them a book, showing them a video, or describing anatomy without further explanation? As a sex therapist, the majority of my clients come in feeling embarrassed to talk about sex or have a lot of misconceptions about it as adults because no one ever talked to them about it. Many people were raised with the underlying message that sex is awkward, taboo, or shameful to talk about – some were fortunate enough to have parents that were a bit more open to talking about it, but may still have only learned about anatomy, and not much else otherwise.

​By closing off our kids from talking about sex, we’re modeling the notion that there’s something inherently wrong with sex – that it needs to be hidden and can only be discussed with our partner. The problem with this is that as adults, most people have no one to turn to when they’re experiencing sexual difficulties. Forget about talking to a friend, co-worker, spiritual leader, etc. – most people just avoid the topic. And if the doctor doesn’t bring it up (which they probably won’t since they too feel awkward talking about sex), who can one turn to for guidance and advice? Porn? The industry that takes sex and scripts and edits it to look more like a movie than real life? I don’t think so. While porn might teach a technique or two, it doesn’t address issues such as pain, dysfunction, lack of desire, etc. Therefore, by setting a new trend and talking to your child about sex, you’re setting them and society up for better sex education and therefore better sexual health.

            So, when is the best time to start talking to your child about sex? The reality is, as early as possible, so that it never becomes a taboo topic in your home. Teach your child from an early age to label their anatomy properly. Teach girls the difference between vulva and vagina and let boys know about their penis and how sometimes it might grow, and that’s normal! Also, teach your children from an early age about consent. Rather than forcing hugs, kisses, or tickles, ask them if it’s okay to give them a hug, or ask them if they’d like to give Grandma a kiss. Teaching them from an early age that it’s okay to say “no” will help give them a voice early on to advocate for their own rights when it comes to their bodies. This is important not only for lessening any potential shame around sex and our bodies, but it’s also very important in the court of law. There have been cases where a perpetrator did not receive a full conviction because the child didn’t know how to describe the assault that happened to them, since they didn’t know how to properly label their body parts. And while this is an extreme example, it highlights the importance of teaching children proper anatomy and consent.

            As children get older, continue to have the conversation about sex. Answer questions honestly and make yourself available as someone to talk to. If you catch your child self-pleasuring, rather than yelling, smacking hands, shaming, etc., provide a gentle tone and have a discussion with them in private and set the standard that you and your household value. If your values indicate that self-pleasure is not okay, calmly explain to your child why without including shame messages. If your values align more with self-pleasure being acceptable, try explaining to your child that it’s fine for them to do it, but in the privacy of their own room, etc. It’s natural for children to explore their bodies, including their genitals as they age. It’s very likely that at a young age, they will discover masturbation and experiment with it. However, by addressing it in a way that reduces shame through a gentle tone and explanation (rather than just telling them “no” or “don’t do that in public!” ), they are much more likely to be open to coming to you when sexual issues arise. In addition, shame around their body and their natural desires will be much lower.

            Into adolescent and teen years, continue having the conversation. Explain to them about puberty changes so it doesn’t come as a shock when their bodies begin to change. You can give them a “welcome to puberty” package (razor, shaving cream, deodorant, tampons, pads, etc.) and let them know they can come to you with any questions they have about these changes. Make sure you explain to your kids not only the physical repercussions of sex (some potential side effects such as pregnancy, STIs, potential physical enjoyment, etc.) but also the emotional side effects (potential feelings of joy, connectedness, sadness, shame, etc. depending on the outcome of their experience) and again, that they can come to you to process any of these feelings/outcomes. Check and see if your child has a mentor with whom they’re comfortable talking about sex in case they still feel awkward talking about it with you.

            While there is plenty of other information to be considered regarding the sex talk, the biggest highlights are these:

1. Get comfortable with it yourself. If your kids see that you’re feeling shameful/embarrassed about sex, they’re likely going to feel that way too. That might mean that you practice giving “the talk” to yourself first in the mirror, or practice saying the proper anatomical parts out loud by yourself or with your partner.
2. Be open and reduce shame-based messages as much as possible. By showing your kids that sex isn’t something they need to keep hidden and that you’re a safe person to talk to about it, they will hopefully come away with less shame around sex and be more open to discussing any difficulties they’re having in the future.
3. Explain the reasons behind any values that your family has about sex. Kids are less likely to push the boundaries if they understand why they’re in place. If you simply tell them “because I said so,” they’re probably going to try and figure out the why on their own, versus if they had a clear understanding of why something is on- or off-limits.

 
By being open with your kids about sex and their bodies, the hope is that in the future they will experience less shame and be more empowered with making their own decisions regarding their choices. No matter what phase of life they are in right now, it’s never too late to have the talk. You’ve got this!
 

What Is Seasonal Affective Disorder (SAD)?
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SAD or seasonal affective disorder is a depressive disorder that most often occurs in fall and winter. However, It is not to be confused with the common “winter blues” just described. Symptoms of SAD include fatigue (regardless of the amount of sleep one gets) and weight gain associated with overeating, particularly high-carb treats and sweets. It is associated with higher levels of distress and interference with daily functioning than what most experience in the darker, colder months.
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According to the American Psychiatric Association, SAD has been linked to a biochemical imbalance in the brain prompted by shorter daylight hours and less sunlight in winter. With seasonal changes, people’s biological clocks or circadian rhythms can fall out of step with their daily schedules. Symptoms of SAD may require the help of a mental health practitioner. 

Whether SAD or Just Blue, Take Action

You (or anyone) can benefit by being proactive and taking steps now to improve your health and wellness so that you’re better prepared to deal effectively with the challenges of fall and winter. Following are tips to give you a better chance of preventing the winter doldrums:  

1. Give yourself permission to say “no” or turn down invitations for holiday parties that could incite high anxiety. Spending time with family members, friends and neighbors that lead you to excessive levels of anxiety and depression may not be necessary. Choose what you attend wisely.
2. Give yourself permission to not repay every gift given to you (with a gift from you). Tit for tat isn’t necessary and can cause anxiety, especially if you find yourself struggling financially this season. True friends will love you regardless. If you feel it necessary, make them a gift or write them a card. After all, it’s the thought that counts.
3. Spending time with certain family members can agitate us, or increase stress, anger, or sadness. It may make sense to avoid getting together with these family members. Other times, they may be unavoidable in which case, try to be mindful of what you feel and think so that you can increase your chances of responding more thoughtfully, carefully and respectfully.   
4. Schedule regular time with people you love and enjoy spending time with. Quality time with people we love is helpful in times of stress.
5. Do things that bring you joy such as listening to music, baking, being creative, or establishing less stressful, new traditions with friends and family members.
6. Take advantage of the days when the sun is out by exercising outside. Bundle up and take a walk. By absorbing sunlight, you are treating your body to Vitamin D—a vitamin the body can lack in darker months. Vitamin D helps the body use the calcium in your diet.
7. Break from the same old routine. Try something new such as a new food, restaurant, form of exercise, or activity. Doing so can lift your spirits, if only just a bit.
8. Treat yourself. Warm baths, meditation, long walks, movie with a friend, a date night, dinner with a friend, or a massage could be just what you need to improve your mood.
9. Try light therapy. This requires sitting in front of a light therapy box that emits very bright light (and filters out harmful ultraviolet (UV) rays) for about 20 minutes or more a day. Improvements may occur within one or two weeks of treatment. You’ll want treatment to continue through winter so you don’t risk relapsing. Begin light therapy in the early fall to prevent symptoms.
10. Abstain from alcohol and drugs. Alcohol is a depressant. While it is very common for people to drink alcohol at holiday parties and gatherings, it does not need to be. Drugs may be used an escape from the pressures of the holidays and winter months. Both are harmful even in small amounts. You may need professional help to get you through the holidays without partaking in alcohol and drugs, and that is ok.  
11. If you continue to struggle, do not hesitate to call a therapist. Talk therapy with a counselor, social worker or psychologist can help. It is their job to understand you, listen, support you and help you identify and use healthy ways of coping. Compass Point offers Care Connect, a service where clients can be seen by a licensed professional within 48 hours of their call.
12. Medication may also help. Talk to your physician about what you’re experiencing. He or she may prescribe an antidepressant medication in addition to working with a therapist, as the combination of both is often helpful to those experiencing high levels of anxiety and depression.

​If your depression is severe or if you have suicidal thoughts, please consult a doctor immediately, seek help at the closest emergency room or call the National Suicide Prevention Lifeline – 800-273-TALK (8255).

Troubled sleep, insomnia, and oversleeping are classic symptoms of clinical depression. While not all depressed people have sleep disorders, many do. When evaluating patients for depression, doctors typically ask about sleep patterns as part of the diagnosis.
Problematically, sleep problems worsen mood and can cause depression themselves, creating a vicious cycle.
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What is depression?

The CDC estimates that just over 7% of Americans have moderate or severe depression. The severity and symptoms of depression vary, but the most common include:

• Feelings of despair, hopelessness, sadness
• Frequent or occasional thoughts of death or suicide
• Difficulty concentrating
• Lower energy
• Lower libido
• Reduced self-esteem
• Weight gain or loss
• Loss of interest in activities the person formerly enjoyed
• Excessive daytime sleepiness
• Insomnia

As you can see, sleep problems are core symptoms of depression. Both depression and severe sleep problems are major risk factors for suicide and health problems like heart disease, other mental disorders, and smoking. People with depression have trouble being productive in work or school, which can impact their career and social life. The sleep issues are often one of the reasons depressed people seek out professional help.
The symptoms of depression are persistent and pervade all aspects of an individual’s’ life, from work and play to basic needs like eating and sleeping. Within the larger category of depression, there are several different types of depression which come with their own sleep problems:

• Major Depressive Disorder: This is extreme depression where the individual feels sad, hopeless, or suicidal through much of the day, regardless of what they are doing. Feelings of pleasure and happiness are hard to come by. Major depression is associated with insomnia and excessive daytime sleepiness.
• Dysthymia: This is a milder form of major depression, also associated with fragmented sleep and hypersomnia. People with dysthymia experience fewer symptoms from the list above and in a less intense way, but symptoms typically persist for much longer.
• Bipolar Disorder: People with bipolar disorder swing between extreme highs and lows. When they’re high, they’re overly energetic and unable to sleep, even if they’re tired. When they’re low, they oversleep.
• Seasonal Affective Disorder (SAD): SAD is a type of seasonal depression. The vast majority of affected individuals experience it during the winter months, with symptoms like hypersomnia, insomnia, and worsened mood – although about 10% experience it during the summer. SAD is likely brought on by the changing levels of sunlight, which affect the circadian rhythms of affected individuals, messing with their sleep and emotions.

Who’s at risk for depression? Stress, a recent loss or illness diagnosis, and family history are all risk factors for depression.
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Anyone can become depressed, but it affects some people more than others, particularly women and adults in middle age. Coincidentally, these two groups are also more likely to have insomnia. The chart below from the CDC reveals the correlation between age and depression as well as the disproportionate prevalence between the genders:

General diary card instructions:
Each night as you are winding down for the day, take a few moments to reflect on what your daily experiences were. We fill out the diary card left to right, one day at a time.  The first thing you fill out is the day/date! If your session was on a Tuesday and the date was June 3rd, you would write 6/3 in the Tuesday box. Then move across as you would read a book.  There is ample research that shows a strong correlation between tracking and improved outcomes. Whether you want to increase or decrease a behavior, tracking it will help.

The first section asks you to rate your urges for use (drugs/alcohol), self-harm and suicide on an intensity scale from 0-5.  This column does not indicate action, you could have an urge for alcohol at a 5 and not actually drink.  5 is very intense; 0 is non-existent. 

The second section is for emotions.  You are asked to rank the highest intensity of each emotion that day.  5 is very intense; 0 is non-existent. The “P” stands for physical pain (which isn’t an emotion…it just fits there) and the “E” is for emotional pain (which many of my clients like to use as their general stress rating that day.  The goal is NOT all zeros…the goal is not all 3s…the goal is that you are honest. Over time in DBT®, what I tend to see is that a person’s negative emotions will go down first, then their positive emotions will raise up (At about the same time that they start using skills).  Having this sort of proof to look back on can be very helpful when you start to feel jaded or tired from the treatment. I have also found in this section that people tend to block feeling certain emotions; the diary card allows you and your therapist to find this out faster!

The next big section is about drug/alcohol use (including legal prescriptions).  We do need honesty here; your therapist is not going to use this information against you! This section allows us to discover trends much faster. For example, if you have anger outburst every day after a glass of wine…or if you have a depressive slump each time you miss a medication, then we can target that immediately! Some people also find that tracking their medication compliance helps them remember their medications more often.

Next you will find a few blank columns.  This is something for you and your therapist to decide on over time.  Common things to track are: hours slept, bedtime, whether or not you exercised, eating disordered behaviors, etc.

The last section is your actual actions.  This section asks you to indicate (yes or no) whether or not you engaged in self-harm (intentional tissue damage), whether or not you lied (either big lies through the week or lying on the actual diary card) and whether or not you used skills (this is a 0-7 scale indicated on the bottom of the diary card). 

The furthest section to the right and smallest section by far is the reward column. In the column we are asking you to remember that humans rarely learn unless someone rewards a behavioral change; we are asking if you rewarded yourself for a job well done.  This might mean that you had a 5 in anger and you coped well or that you made a choice to go out with friends resulting in a 4 of enjoyment.  A reward could be as simple as positive self-talk/praise or as big as buying yourself a new item (perhaps new workout clothes for going to the gym 3x that week).  A reward doesn’t have to cost anything!

Upon entering session, you are supposed to hand your diary card to your therapist for them to review with you and lay the path for that session. 

The DBT® individual session is structured in the following way:
1. we address any life-threatening behavior (self-harm, suicide attempts)
2. we address any therapy-interfering behavior (not doing diary card, being late to class or session)
3. we address any quality-of-life interfering behavior (substance use, not rewarding self, lying, etc)
 
Other helpful diary card hints:
1. Keep it where you will see it. Inside your planner, the front seat of your car, on your nightstand or where you eat breakfast. We don’t care what condition it’s in when we get it back…just that it’s filled out and that you bring it back!
2. Set a reminder alarm on your phone to complete it
3. Use diary card time as a reminder to do your DBT® homework and/or practice mindfulness
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