Lion Breathing: Melt stress and tension from your face

For all the time we spend stretching our body, how often do we pause to stretch our face? With Lion Breathing you can quickly and easily relieve stress and tension by stretching your face.

For all the time we spend stretching our body, how often do we pause to stretch our face? With Lion Breathing you can quickly and easily relieve stress and tension by stretching your face.

This is a wonderful exercise to teach to children (or adults who aren’t too self-conscious to try it). You can think of making this face when ugly thoughts about trauma or stress come up…think about embodying the strength of a lion in the wake of a painful trigger!

Although taking on the full character of a lion is optional with this exercise, allowing yourself to make the face of a lion with this breath exercise can help you with letting go of negative energy.

Jamie Marich, Ph.D., LPCC-S, LICDC-CS, RMT, is the author of EMDR Made Simple: 4 Approaches for Using EMDR with Every Client (2011), Trauma Made Simple (2014) and three other books on trauma recovery. She is the developer of the Dancing Mindfulness practice and a Reiki Master teacher. She also completed the StreetYoga Trauma-Informed Teacher Training Program and she is a Certified Yoga of 12-Step Recovery Facilitator/Space Holder.

Losing a Loved One to Porn (and What You Can Do About It)

It is perhaps unsurprising that the porn-related question we most often hear in our therapy practices relates to the amount of porn people use. Much of the time this question is posed by wives worried about their husband’s online endeavors. In short, these women want to know: How much porn is too much? And when does it cross the line from use to addiction?

It’s no secret that the Internet is bursting at the seams with porn. Sure, we also go online for information, interpersonal communication, dinner reservations, music, shopping, and much more. But porn is without doubt a primary online activity. In fact, search engine data neuroscientists Ogi Ogas and Sai Gaddam analyzed 400 million worldwide searches representing more than two million Internet users and found that 13% of all searches were porn-related. So yes, lots of folks are looking at pornography.

Given the above, it is perhaps unsurprising that the porn-related question we most often hear in our therapy practices relates to the amount of porn people use. Much of the time this question is posed by wives worried about their husband’s online endeavors. In short, these women want to know: How much porn is too much? And when does it cross the line from use to addiction?

This, of course, is a bit like asking how much alcohol makes a person alcoholic—there just isn’t a set answer. In other words, addictions (to both substances and behaviors) are not about the amount of something; rather, they’re about obsession, loss of control, and directly related life problems. People qualify as addicted if:

  • They’re inordinately preoccupied with a potentially addictive substance or behavior (thinking about it, pursuing it, etc.);
  • They’ve lost control over use (using even when they don’t want to, not being able to stop once they’ve started, etc.);
  • Their lives are falling apart as a result (relationship issues, trouble at work, financial problems, legal woes, depression, anxiety, lowered self-esteem, social/emotional isolation, etc.).

Those are the benchmarks therapists use to diagnose porn addiction—and every other kind of addiction. So the amount of porn a person is looking at is not a defining factor. Nonetheless, research does suggest that porn addicts—those individuals who meet the criteria above—typically spend at least 11 hours per week searching for and looking at porn (with or without masturbation). And it’s not uncommon for use to escalate well beyond that level—reaching 20, 30, or more hours per week.

Signs and Symptoms of Porn Addiction

There are numerous other signs and symptoms, beyond the conditions above, that often indicate compulsive porn use:

  • Escalation—increasing amounts of time that a person spends on porn, and/or an increased intensity of the material they view (moving from vanilla porn to hardcore, fetish, or violent porn).
  • Withdrawal—becoming restless, irritable, and discontent when porn is not available.
  • Dishonesty—lying and keeping secrets about porn use (amount of time, content they view, etc.).
  • Disconnection—loss of interest in family, friends, work, and previously enjoyable activities.
  • Sexual Dysfunction—loss of interest in real-world partner sex and/or problems with delayed ejaculation (DE), erectile dysfunction (ED), and/or anorgasmia (inability to reach orgasm).

Over time, many porn addicts will link their porn use to other forms of compulsive sexuality—sexting, webcam masturbation, anonymous and/or casual hookups, serial affairs, prostitution, sex clubs, strip clubs, voyeurism, exhibitionism, online sex games, etc. This is the equivalent of substance abusers escalating in their addiction, ingesting any mind-altering substance they get their hands on. Still, many porn addicts are strictly porn addicts, just as many alcoholics are strictly alcoholics.

Porn-Induced Sexual Dysfunction

As you may have noticed, we list sexual dysfunction as a common sign/symptom of porn addiction—and with good reason. One relatively large-scale survey of sex addicts found that more than a quarter (26.7%) experienced ED, DE, or anorgasmia. Smaller studies suggest that sexual dysfunction is a common sex addiction side effect—17% of sex addicts reported problems in one study, 58% in another.

Unsurprisingly, the primary sexual dysfunction issue is ED—even among younger porn addicts in their teens and twenties. Much of the time these men report that they have no trouble achieving and maintaining an erection when looking at porn, but they struggle with real-world partners. Compulsive porn use seems to create a psychological disconnection that manifests physically in some men as ED. After all, when a guy spends the vast majority of his sexual life engaging with endless amounts of constantly changing, hyper-stimulating online imagery, a single in-the-flesh partner can’t exactly compete—even if the porn addict truly loves that partner.

This, of course, is one of the true paradoxes of sexual addiction: Sex addicts, especially porn addicts, often struggle to perform sexually with their real-life partners. And this is not because they’re not interested in great sex, or they don’t want to be with their partner. It seems that their sexual response has become conditioned to function only in the context of stereotypical porn images. So they struggle to get hard, stay hard, and reach orgasm with actual people. Sometimes they can only manage to perform face-to-face when they replay in their minds the videos and images they’ve seen online. Over time, they often come to desire porn sex more than partner sex.

This becomes a huge issue for the partners of porn addicts. When a man turns to porn and then cannot perform sexually with his partner, this undermines not just his own sexual pleasure but also his partner’s. More important, it undermines the very security of the bond between partners. After all, sex is also a bonding behavior. Worse, partners may take this on themselves, resulting in significant sexual self-image problems.

If you believe you are losing your partner to porn, what can you do about it?

1. Ask your partner if he thinks that the time he spends looking at porn is getting to be a problem or interfering with his ability to really be with you in bed. If you can manage to do this with curiosity and concern, it usually works better than accusing or blaming. It may be that your partner can soothe your fears. For many, occasional porn use does not become in any way addictive, and there may be other things going on, such as unresolved conflicts in your relationship, that reduce a partner’s sex drive or cause him to withdraw physically for a while.

2. Step aside from the shame and fear that arises when you feel less than desired by your loved one. Try to keep in mind that someone can become caught in a less than functional habit for many reasons and in many ways. Gerry helps his wife Anna by telling her, “Look, I started watching porn as an escape from bad feelings way before I met you. It kind of stopped when I met you, but then we were getting into fights and going to porn just made me feel better—less stressed out. This isn’t about you. It’s just the way I learned to cope.”

3. Seek help from a couples therapist who can help you and your partner talk about this calmly and cooperatively. Partners’ perspectives often differ wildly. John says, “You are overreacting. All I am doing is typing and watching people have sex.” Mary counters, “But you don’t have sex with me anymore and your head is full of your onscreen girls. I feel betrayed. It’s like you are having an affair.” The couple’s therapist can help the porn-watching partner decide for himself if his habit is a problem, and also help the anxious partner talk about her fears and her perception of the porn issue. There are also educational resources that can help, such as the video, “Your Brain on Porn,” or the Wendy Maltz book, The Porn Trap. If it seems appropriate, the porn-watching partner can also seek out a sex addiction therapist for an evaluation. They can also join a peer group, such as SA (Sexaholics Anonymous) or SAA (Sex Addicts Anonymous) to get a perspective on how (un)healthy his or her relationship with porn is.

4. The therapist, who hopefully uses an approach outcome studies have shown to indeed help couples, can help improve your communication and emotional connection. The cycle of relationship distress—withdrawal from physical and emotional connection by one partner and anxious complaining and anger by the other—can then become contained. This distress can be either the result of, or the trigger for, a growing addiction to porn. Tim tells Lucy, “After we had the twins, I just felt left out—like I didn’t matter to you. And when I looked at porn, I felt male and strong and calm. I didn’t feel so bad that there was this big space between us.” Lucy responds, “Well, I need you Tim. I want you to come back to me, not go to those girls on the screen. I want you to come to me for comfort and for sex. I never meant to turn away from you.” If you and your partner are really caught in a demon dialogue of criticism/accusation and evasion/withdrawal, then you are both isolated and stressed and really need to change this dance, which simply maintains relationship distress and any porn problem. It is easier for your partner to turn to a screen that is at the command of his fingertips than to deal with you, an enraged partner.

5. You can find a therapist for yourself. Bonding science tells us that feeling shut out and rejected by the person we depend on registers in our brains in much the same way as physical pain. Plus, that rejection is a danger cue that can send us into panic. A therapist can help with such feelings. If finding one is too hard, then finding other ways to de-stress and find comfort are crucial for you.

The best answer to an over-activated relationship with porn is a secure, engaged emotional and sexual relationship with a partner. We are getting better and better at helping people find this. (To read about how the new science of bonding can help, read my book, Hold Me Tight: Seven Conversations for a Lifetime of Love.)

Finally, it is perhaps worth noting that we do not use the word “addiction” in this article to in any way dismiss or judge the many forms of eroticism or the diverse ways that people explore their sexual desires. It is used to refer to a growing pragmatic, clinical reality, and to further the discussion about how to deal with it. For referrals to a certified sex or porn addiction therapist, visit For couples counseling information and referrals, visit

Dr. Stefanie Carnes /

Dr. Sue Johnson /

Susan Johnson, Ed.D., is a best-selling author, clinical psychologist, distinguished research professor, dynamic speaker, and recognized innovator who has changed the field of couples therapy.

She is director of the International Center for Excellence in Emotionally Focused Therapy and distinguished research professor at Alliant University in San Diego, California, as well as professor of clinical psychology at the University of Ottawa, Canada. She trains counselors in EFT worldwide and is recognized as one of the most prominent researchers and presenters in the couples therapy field.



[i] Ogas, O. & Gaddam, S. (2012). A billion wicked thoughts: What the Internet tells us about sexual relationships, p 15. New York, NY: Plume.

[ii] Cooper, A. Putnam D.E., Planchon, A. & Boies, S.C. (1999). Online Sexual Compulsivity: Getting Tangled in the Net. Sexual Addiction and Compulsivity 6(2):79–104.

[iii] Hall, P. (2012). Understanding and treating sex addiction: A comprehensive guide for people who struggle with sex addiction and those who want to help them. Routledge.

[iv] Raymond, N. C., Coleman, E., & Miner, M. H. (2003). Psychiatric comorbidity and compulsive/impulsive traits in compulsive sexual behavior. Comprehensive Psychiatry, 44(5), 370-380.

[v] Voon, V., Mole, T. B., Banca, P., Porter, L., Morris, L., Mitchell, S., … & Irvine, M. (2014). Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PloS one, 9(7), e102419.

[vi] Rosenberg, K. P., Carnes, P., & O’Connor, S. (2014). Evaluation and treatment of sex addiction. Journal of sex & marital therapy, 40(2), 77-91.

7 Spanish Healthcare Phrases You NEED to Know

Did you know that the United States is now the world’s second largest Spanish-speaking country after Mexico, and the US Census Office estimates that the US will have 138 million Spanish speakers by 2050? Learn these 7 must-know phrases for healthcare providers…

Did you know that the United States is now the world’s second largest Spanish-speaking country after Mexico, and the US Census Office estimates that the US will have 138 million Spanish speakers by 2050?

Don’t let a language barrier impact your quality of care! Learn these 7 must-know phrases for healthcare providers from presenter Tracey Long, RN, PhD, MS, CDE, CNE, CHUC, COI, CCRN.

Tracey Long, RN, PhD, MS, CDE, CNE, CHUC, COI, CCRN, has been an RN and Nurse Educator for 28 years, teaching courses in Medical Spanish, Diabetes Education, Cultural Competence, Critical Care, and Global Nursing. She has lived in Spain and served as a health welfare missionary in Colombia, South America for 18 months. She serves as faculty for International Service Learning with nursing students in Belize, Peru, Colombia and Costa Rica providing free medical clinics in underserved areas. With a passion for active learning, and as an international speaker and award winning educator, Tracey helps students not just memorize, but truly learn the content material needed to successfully master skills and learning.

Spanish for Healthcare Providers: A self-paced
online course

Are you ready to learn Spanish in an effective, non-threatening language learning experience, with “real-life” instruction geared for today’s busy professional? Sign up now to get instant access to the Spanish vocabulary medical personnel need to know.


The Opioid Epidemic: What can you do to help your clients?

No longer can we look the other way and assume that these deaths are confined to a certain type, class, race, or gender of person. Fifty-two people die from overdose every single day. This cause of death now outranks motor vehicle accident deaths.

Know what you can do to help your clients…

Every year in May, the U.S. Department of Health and Human Services celebrates National Women’s Health Week. It may seem like a warm and fuzzy time for us to celebrate the great strides we’ve made in protecting women’s health…

But it’s not.

This year’s commemorative week came on the heels of some staggering news about women’s health. For the first time in many years, the Centers for Disease Control and Prevention (CDC) is documenting a drop in life expectancy for white women.

One of the reasons blamed for this is the stark reality of overdose deaths. Many of these deaths are unintentional overdoses of opioids and heroin. The CDC is calling the issue of opioid misuse and death an “epidemic” and is pushing for substantive change. New guidelines for prescribing these medications are being developed. There’s a heightened awareness of the need for behavioral treatment of pain.

No longer can we look the other way and assume that these deaths are confined to a certain type, class, race, or gender of person. This is hitting all types of people, women included.

Fifty-two people die from overdose every single day. This cause of death now outranks motor vehicle accident deaths.

Often the problem starts innocently enough. Maybe a woman has chronic pain, perhaps she has acute pain. Her doctor or dentist prescribes on opioid (Percocet, Oxycontin, hydrocodone, Vicodin, etc.), and within a very short time the problems can begin.

Changes in her brain structure and chemistry are happening, and of course she doesn’t know it. If she has any underlying depression or anxiety, the pills give her an instant boost. If she tries to stop the pills on her own she may feel miserable and desperate.

…And so the problem continues.

We aren’t talking about an addict on the streets with a needle in her arm. We’re talking about your mother, your daughter, your sister, your friend. It’s really up to us to reverse the devastating impact of this problem.

You’ll be hearing a lot more about this in the weeks and months to come. Educate yourself about how you can help. Good resources include the National Safety Council, the CDC, and the Office of National Drug Control Policy. Many communities are taking matters into their own hands and agitating for change.

In honor of the women in our lives, let’s step up and take action to protect those we love from the impact of opioid misuse and overdose.

Before it’s too late.

What can you do to help your clients?

Know the signs of Opioid Use Disorder as defined by the DSM-5®.

Opioid Use Disorder – A Problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period.

1. Opioids are often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.
3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.
4. Craving, or a strong desire or urge to use opioids.
5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.
7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.
8. Recurrent opioid use in situations in which it is physically hazardous.
9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance
11. Withdrawal

Use the one-question screening from the new CDC guidelines on the treatment of chronic pain: “How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?”

The answer of one or more is positive. It is 100% sensitive and 73.5% specific. You won’t miss anyone who has the disorder, but there could be a few false positives where further investigation is needed.

Learn more:

This blog was contributed by PESI speaker Martha Teater, MA, LMFT, LCAS, LPC. Martha trains across the U.S. and internationally on such topics as compassion fatigue, DSM-5, and the treatment of trauma. A prolific writer, she has published over 175 articles in newspapers and magazines, and is the coauthor of Overcoming Compassion Fatigue: A Practical Resilience Workbook.


MBSR-T Interventions: Pleasant Life Moments & Events Calendar

In this video, Gina Biegel, creator of Mindfulness-Based Stress Reduction for Teens (MBSR-T), shares her Pleasant Life Moments and Pleasant Events Calendar interventions. They are powerful teen-focused mindfulness practices that draw awareness to the many positive moments and activities in daily life.

It’s a high-stress life for teens today. The demands of friends and social life, school, work and family can easily become overwhelming for adolescents. But thanks to Jon Kabat-Zinn’s work with MBSR, we know that there are substantial physical and mental health benefits from mindfulness practices.

Gina Biegel, MA, LMFT, has tailored the MBSR program to meet the specific needs of teens. In MBSR-T, she uses language, references and stories that are relevant to today’s adolescents to help them shift their perspective to become more aware of their intentions, attention and attitude.

“It’s important for teens to learn not to categorize their day as all bad or all good, but rather filled with many different moments,” says Biegel. “I find teens need something tangible, a list of things that they engage in that they consider self-care. It gives them a visual of things they can turn to that make them feel good or they enjoy instead of negative coping skills/behavior.”

Watch this short video to learn how Gina Biegel uses Pleasant Life Moments in her work with teens, then download the worksheets below to incorporate the technique into your practice.

Download the worksheets to incorporate into your practice today!

This blog is based on the work of PESI speaker Gina M. Biegel, LMFT. Gina is a San Francisco Bay Area based psychotherapist, researcher and author specializing in bringing mindfulness-based work with adolescents. She is the founder of Stressed Teens, which has offered the MBSR-T to adolescents, families, schools, professionals and the community for over 12 years.

She is the author of the Stress Reduction Workbook for Teens: Mindfulness Skills to Help You Deal with Stress and the Be Mindful Card Deck for Teens.

Before You Scroll, Try This Mindful Social Media Practice

We’re all self-critical—but for teens, self-consciousness is hardwired. Here’s how to become aware of the emotions we’re courting on social media.

How many times a day do you check into your social feeds? How many times do you hit refresh in one visit? Our need to be social can backfire on social media, when we accidentally activate the comparing mind, which is a source of much unhappiness. Of course, this can happen offline, too. But the toll looms larger online, with of all those perfectly curated images of people’s lives inviting us to compare our insides to other people’s projection of their outsides.

For teens and tweens, who are actually hardwired for self-consciousness, the constant comparing and curating, which used to end with the final bell of the school day, when kids could go home and put on their sweatpants, is a twenty-four-hour-a-day job. Socializing and social comparison begins first thing in the morning and ends last thing at night. Predictably, psychology research consistently shows that social media is making kids unhappier and more narcissistic.

The sheer volume and instant nature of digital media means that when we log in, we are drinking from a fire hose of emotional stimulus. We can be anywhere in the world and be met by friends’ posts that trigger joy, resentment, sadness, laughter, grief, jealousy, and more—all within moments. None of us, adults or children, are wired to take in that much emotional content at once without reacting.

Research also reveals that social rewards and punishments feel the same online and off. If someone interacts with us in a positive way online, we get the same neurochemical rewards in our brain as we would in person. When we (or our children) are rejected or ignored online, we get the same feeling of rejection as we would in person. More interestingly, the sense of emotional attack activates the same part of the brain as physical attack does. Emotional pain is just as painful, just as real, as physical pain, whether it comes from the virtual world or not.

None of us, adults or children, are wired to take in that much emotional content at once without reacting.

So, can we teach ourselves, and the young people around us, to approach social media feeds with mindfulness, even occasionally?

Mindful Social Media

Yes, social media is contributing to a new era of adolescent (and adult) social stress, but when we accept that it is here to stay, we can also see it as a new opportunity for connection and mindfulness, if we build it. Mindfulness tells us there is insight to be found in anything when we approach it with mindfulness, and that even includes social media.

Try this social media mindfulness practice to explore what your favorite sites are communicating to your subconscious:

  1. Find a comfortable, alert, and ready posture. Shrug your shoulders, take a few breaths, and bring awareness to your physical and emotional state in this particular moment.
  2. Now open your computer or click on your phone.
  3. Before you open up your favorite social media site, consider your intentions and expectations. As you focus on the icon, notice what experiences you have in your mind and body.
  4. Why are you about to check this site? What are you hoping to see or not see? How are you going to respond to different kinds of updates you encounter? By checking your social media, are you interested in connecting or in disconnecting and distracting?
  5. Close your eyes and focus on your emotional state for three breaths before you begin to engage.
  6. Opening your eyes now, look at the first status update or photo, and then sit back and close your eyes again.
  7. Notice your response—your emotion. Is it excitement? Boredom? Jealousy? Regret? Fear? How do you experience this emotion in the mind and body? What’s the urge—to read on, to click a response, to share yourself, or something else?
  8. Wait a breath or two for the sensations and emotions to fade, or focus on your breath, body, or surrounding sounds.
  9. Try this practice with one social media update, or for three or five minutes, depending on your time and your practice.

Noticing how social media makes you feel can help you discover how to use it more mindfully. As you become more aware of the emotions you’re actually inviting into your day when you visit social media sites, you’ll be able to make better decisions about how often to visit those sites.

And, keep in mind, the science of social media is more complex than we might think. For example, research shows that the more we look at others’ carefully curated social media status, the worse we tend to feel. But, the opposite is also true: if we look back at our own updates, we often see the positive aspects of our life presented and tend to feel better. So consider scrolling through your own updates sometimes, as you look at everyone else’s.

Technology does not define us, despite social media trying to put us into categories and reduce us to a series of likes and interests. Examining and changing our own relationship to technology opens the door for us teach through example and to practice new ways of making technology foster community and wellness.

This article was adapted from Dr. Christopher Willard’s upcoming book Growing Up Mindful, available June 2016. You can pre-order your copy today.

Christopher Willard, PsyD, is a psychologist and educational consultant based in Boston specializing in mindfulness for adolescents and young adults. He has been practicing meditation for over fifteen years. He currently serves on the board of directors at the Institute for Meditation and Psychotherapy and the Mindfulness in Education Network. Dr. Willard has published five books on contemplative practice, including the forthcoming, Growing Up Mindful. He teaches at Harvard Medical School and Lesley University.