Attitude of Gratitude


Attitude of Gratitude

In my office I have a sign that says “An Attitude of Gratitude, brings blessings.”  In our busy lives it’s easy to get caught up in work, family, social media, and attending events.  All these activities can lead to feeling stressed and overwhelmed.  During the month of November, we celebrate Thanksgiving and gratitude.  I hope each of us can take a step back and focus on the positive, pleasant parts of life.

Several years ago, I had a client who visited her father on Thanksgiving. They had a wonderful day together having a home-cooked meal, sharing stories, and enjoying being together.  That night her father had a heart attack and passed away.  My client had mixed feelings about feelings of gratitude and giving thanks. On the one hand, she and her father had a wonderful day together. On the other hand, she was grief stricken and angry about the loss of her father. The holiday ended up being very bitter-sweet.

Over time, she came to terms with the irony of this event. She worked to “let go” of her anger and accept what happened.  Eventually she was able to focus her attention on feelings of appreciation.  She concluded that bitterness made her grief worse and focusing on positive thoughts and memories made her feel better.

An article titled 14 Health Benefits of Practicing Gratitude According to Science, by Kori Miller, describes many benefits to focusing on gratitude. One of the most important benefits is the release of dopamine in the brain. The dopamine creates a connection between the behavior and feeling good. The more a person focuses on gratitude, the more dopamine is released.

The article provides a list of ways each person can benefit:

Health Benefits

  • Increased happiness and positive mood
  • More life satisfaction
  • Less materialistic
  • Less burnout
  • Improved physical health
  • More energy
  • Lower levels of inflammation
  • More resiliency
  • Encourages the development of positive qualities such as patience, humility, and wisdom

Developing An Attitude Of Gratitude

In the article, Gratitude and Wellbeing; The Benefits of Appreciation, by Sansone & Sansone write about psychological strategies that may enhance feelings of gratitude. They suggest that the following interventions are easy and reasonably effective.

  • Journaling about things for which you are grateful
  • Thinking about someone for whom you are grateful
  • Writing a letter to someone for whom you are grateful
  • Meditating on gratitude
  • Count Your Blessings – at the end of the week, write down three things for which you were grateful
  • Practicing saying “thank you” in a sincere way
  • Writing thank you notes
  • If religious, praying about your gratitude

Most of us have struggles in life; however, we have a choice regarding where to focus our attention.  We can concentrate on positive or negative thoughts and experiences.  There are definite health benefits to focusing on gratitude.  The strategies and skills to develop gratitude are relatively simple and effective.

Wishing you and your family all the best this holiday season,

Steven J. Chen, Ph.D.

Pornography Awareness For Parents


In the last few years, I have seen more and more requests from teens seeking help for problematic pornography use. Here is an example of the type of email I often receive.

One teen wrote,

“I don’t want help… I need help! Porn is a habit I need to break.

Trying to sleep, but can’t? I look at porn! Gotta go to the bathroom?

Great, while I’m sitting, I look at porn. No matter what is happening, I always turn to porn.

I need and want to quit, but don’t know where to start!”


Upon reaching out to this person, I discovered he is a 16-year-old male who has been viewing pornography since age 12. His parents are unaware of his problematic pornography use.

He needs help; however, is very frightened to discuss his pornography problem with his parents.

I hope the following information will raise your awareness about the potential danger pornography use can have on children and adolescents.

As most people know, pornography has become more accessible due to the internet.  The article “20 Mind-Blowing Stats About The Porn Industry And Its Underage Consumers“, indicates that internet pornography is estimated to be a $97 billion international industry (NBC News) and growing daily.

The article “Internet Pornography by The Numbers; A Significant Threat to Society”, discusses how internet pornography use hurts teens. It reports the following effects on teens:

It increases the odds of teenage pregnancy. Adolescents who are frequently exposed to sexual

content have a higher likelihood of teenage pregnancy.

Pornography hinders sexual development. During the adolescent development phase teens are

learning how to handle their sexuality, sexual beliefs and moral values. Teens who are viewing

pornography get a disoriented or distorted view of sexuality.

It raises the risk of depression. The article suggests a significant relationship exists between

teens with frequent pornography use and feelings of loneliness and depression.

Pornography creates distorted expectations which hinder healthy sexual development.

Adolescents who engage in frequent pornography use have lower sexual self-esteem.


Parents need to understand that their children have probably been exposed to pornography on the internet, by society or by acquaintances. The article, “Advice for Parents of Teen Porn Addicts“, indicates that Former Attorney General Jon Ashcroft has estimated that nine in ten teens have been exposed to pornography.

In the article, “For Parents: Your Child Just Told You They Struggle with Porn, Now What”, reports that half of kids are exposed to pornography by accident.  It says parents need to be prepared to discuss pornography in a reasonable manner. Shaming and judging the adolescent is not going to help the situation and will probably close an important line of communication. Children and teens are probably uncomfortable discussing the topics of sex and pornography with their parents. If they already have a problem, they are probably scared to admit it. Parents need to listen and be supportive. Parents need to educate their children about the harmful effects of pornography.

Parents also need to educate their children about sexuality. Some adolescents may start using pornography to become educated about sex, but viewing pornography is not a healthy way to learn about sex.

Parents need to be loving, while at the same time help the child understand the dangers pornography poses. Along with showing support, it is important to act by blocking internet connected devices from accessing pornography whenever possible.

Even though it may be uncomfortable, parents need to get involved. They need to start talking to their kids about sex and dangers of pornography use if they wish to convey healthy values.  Depending upon the severity of the problem, the adolescent might also benefit from therapy.

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Over the years, I have worked with many clients who suffer from anxiety.  Most of us experience anxiety at some point, but the feelings eventually leave.  However, some people have devastating anxiety that does not go away.  For them anxiety can be overwhelming and interfere with functioning.  The American Psychological Association (APA) article Understanding Anxiety Disorders and Effective Treatment discusses the following anxiety disorders.

Generalized Anxiety Disorder (GAD)

According to Anxiety and Depression Association of America (ADAA) approximately 6.8 million people struggle with this disorder.  Women are two times more likely to have this diagnosis.  GAD may be under reported in men.

The APA article says that people with GAD have persistent and excessive fears.  They often think that something bad is going to happen.  Their fears are real and keep them from completing daily tasks.  People with GAD are overly concerned about health, finance, relationship, interpersonal and work problems.  They have physical symptoms of feeling tired, shortness of breath, heart palpitations, dizziness, poor concentration, muscle tension, diarrhea, decreased or increased appetite, irritability, or decreased sex drive.

Panic Disorder

The ADAA indicates that around 6 million people have panic disorder.  Women are twice as likely to have panic disorder.  According to the Diagnostic & Statistical Manual -5 (DSM-5) Panic attacks are characterized by four or more of the following symptoms:

Palpitations, pounding heart, accelerated heart rate, sweating, trembling or shaking, sensations of shortness of breath, a feeling of choking, chest pain or discomfort, nausea, diarrhea, feeling dizzy, feeling of unreality, feeling detached, fear of losing control, fear of dying, numbness or tingling, chills, or hot flushes

The presence of fewer than four of the above symptoms may be considered a limited-symptom panic attack.


ADAA reports that 19 million people have phobias.  Phobias are intense fears. They generally focus on four areas of animals, situations, natural environment, or medical treatment.

Social Anxiety Disorder (SAD)

SAD impacts approximately 15 million people.  SAD has features of anxiety, fear, and avoidance that interfere with daily routines such as work, school or activities.   Symptoms of SAD include fear of being judged, worrying about embarrassing yourself, fear of talking with strangers, physical symptoms of blushing, sweating, trembling, shaky voice, avoiding doing things, avoiding being the center of attention, having intense fear about activities or events, analyzing your performance and identifying flaws after social situations, or expecting the worst consequences or outcomes.

Obsessive-Compulsive Disorder (OCD)

ADAA indicates that about 2.2 million people struggle with OCD.  It is equally common in men and women.  According to the APA article, people with obsessive-compulsive disorder feel the need to check things repeatedly, or they have certain thoughts or perform routines or rituals over and over.  The thoughts and rituals cause distress and get in the way of daily life.

Post Traumatic Stress Disorder (PTSD)

According to ADAA approximately 7.7 million people have PTSD.  Someone who has experienced a severe traumatic event may develop PTSD.  When a person is reminded of a traumatic event, their thoughts, feelings and behavior patterns can be affected.  PTSD symptoms include the following:  shortness of breath, fast heartbeat, trembling, or dizziness.


Many people experience anxiety; however, some people have anxiety that is overwhelming and causes problems with functioning.  Anxiety disorders can be treated successfully.  As a psychologist, I use cognitive therapy techniques to help people develop coping skills to manage their anxiety.


American Psychological Association (APA)  – Understanding Anxiety Disorders and Effective Treatment

Diagnostic And Statistical Manual-5

Anxiety and Depression Association of America (ADAA)

Acronym HALT Teaches Self-Care Skills

Acronym HALT Teaches Self-Care Skills

Several of my clients are currently struggling with self-care issues.  Alcoholics Anonymous and other twelve step groups use the acronym HALT to teach self-care skills.  The definition of “halt” is to bring or come to an abrupt stop.  In recovery, the acronym HALT is used to remind people to slow down and take inventory of their personal status.  They stop or HALT and ask themselves if they are feeling Hungry, Angry, Lonely or Tired. These four emotional states are relevant when a person is emotionally or physically out of balance, because he or she is more likely to engage in unhealthy or counterproductive behaviors.

HALT seems like a simple concept; however, it is often difficult to access our internal states when we are under stress. It takes some thought and time to put this concept into practice.

HUNGRY – represents a physical or emotional state.  I have a client who often goes too long without eating and becomes hypoglycemic.  She gets irritable and loses her temper with others.  As a result, she has negative relationships with family and friends.  A person needs to monitor his or her eating patterns and regularly eat nutritional food.  One also needs to consider “emotional hunger”.  This could include emotional needs like attention, caring, and affection.  Often people with addictive tendencies turn to unhealthy behavior when trying to satisfy unmet needs.  Through the twelve steps, one can identify destructive habits.

ANGRY – is a common emotional state.  The acronym HALT helps one stop and consider where anger is coming from.  Another one of my clients has anger issues.  He finds expressing emotions difficult.  He allows stressors to build up and then becomes aggressive.  When a person develops insight into the source of their anger, they can understand it and eventually decide how to express it appropriately.  A person can learn to express feelings openly by talking to others.  Or a person may need to find other ways to cope with anger like releasing energy through exercise.

LONELY – people can feel lonely when they are by themselves or with others.  Feeling lonely can result from different situations.  I have several clients who are lonely and as a result isolate themselves.  HALT can help a person change their focus on loneliness and encourage him or her to connect with another person.  This concept helps one consider the potential origin of their loneliness.  A person can develop a support system for when he or she feels depressed, anxious or stressed.  One can also benefit from engaging in social activities like meetings, cultural events, or connecting with friends rather than isolating.  The point is to engage with people who can be supportive.

TIRED – being too tired can lead to inaccurate thinking or poor performance.  I have a client who often stays up late and has difficulty getting up for work on time.  When he arrives at work, he struggles to stay awake and complete job tasks.  His job performance is often compromised.  On a physical level, going without sufficient sleep can create an unhealthy state of being.  On an emotional level, one may have difficulty managing one’s feelings.  On an intellectual level, one may struggle to think clearly or solve problems effectively.

The acronym HALT points out that a person needs to engage in self-care every day.  For people in recovery, it is important to pay close attention to one’s overall states of hunger, anger, loneliness or feeling tired in order to help prevent relapse.  Every person can benefit from taking inventory of one’s emotional states in order to cope more effectively with life’s stressors.

Eating Disorders

Eating Disorders

Recently, I had a client who came to see me due to depression and anxiety.  While doing the intake, I realized that this person also had an eating disorder.  Eating disorders often coexist with other mental health issues.  It is important for people to understand that eating disorders need to be taken seriously and can be life threatening.  This client had some of the classic symptoms of anorexia.  She saw herself as very overweight even though in reality she was underweight.  Her self-esteem was very low.  She was abusing laxatives and starving herself.  She also exercised very hard for 2 or 3 hours daily.

Researchers don’t know how many people have eating disorders.  These disorders often occur in teenagers or young adults.  However, children or older adults can also struggle with eating challenges.  Eating disorders affect people from all genders and ethnic backgrounds.  People who struggle with an eating disorder may consume small amounts of food or consume large amounts of food.

There are several types of eating disorders.  The National Institute of Mental Health (NIMH) article on Eating Disorders, describes the following eating disorders:

Anorexia Nervosa

People with anorexia restrict their calorie consumption and diet.  They starve themselves and are often malnourished.  They over exercise and use laxatives.  They have a distorted body image and fear of gaining weight.

NIMH indicates that people with anorexia exhibits the following symptoms:

  • They are extremely thin
  • They want to be thin at all cost
  • They are unwilling to maintain a normal weight
  • They have a distorted body image
  • They have medical issues such as dental decay, dry skin and heart problems
  • Their self-esteem is tied to body weight and shape
  • Women and girls who have this disorder stop menstruating and restrict eating

Bulimia Nervosa

People with bulimia often eat large amounts of food and then purge.  During these episodes, they lack self control and can’t stop eating.  After overeating they vomit, use laxatives, fast and over exercise.  People with bulimia generally maintain a normal weight or are overweight.   People with bulimia fear gaining weight and are unhappy about their body.  They engage in bulimic behaviors secretly because they have feelings of shame around their behavior.  The binge purge cycle ranges from a couple of times a week to several times a day.

NIMH says that people with bulimia may exhibit the following symptoms:

  • Inflamed and sore throat
  • Swollen salivary glands
  • Worn tooth enamel and decaying teeth due to exposure to stomach acid
  • Acid reflux disorder
  • Intestinal distress and irritation from laxative abuse
  • Severe dehydration
  • Electrolyte imbalance which can lead to heart attack

Binge-Eating Disorder

People with binge-eating disorder have loss of control over eating.  They consume large quantities of food.  They don’t purge after eating.  They are generally overweight or obese.  They are at risk for developing health issues such as heart problems or high blood pressure.  They have guilt and shame about their lack of control surrounding eating.

Binge-Eating symptoms:

  • Eating large amounts of food – often very quickly
  • Inability to stop eating
  • Unhappy about their weight


NIMH indicates that clients with eating disorders usually need improved nutrition, appropriate exercise routines, and need to discontinue purging.  Treatment plans generally need to be individually designed.  In chronic cases, medical care, nutritional counseling and hospitalization may be necessary.  In general, clients with eating disorders can benefit from regular talk therapy sessions and possibly medication.

National Institute of Mental Health Pamphlet on Eating Disorder




Today we can communicate with others more easily, but we don’t confide in others.

Communicating, But Not Confiding

Today people can communicate with others much more easily than in the past, but we don’t confide in others. We can call our friends or family day or night throughout most of the world. We can send emails, skype and drop box messages through the internet. We can text on our phones or put posts on various social media outlets. We can also talk face to face to others. Even though we have many ways to communicate and connect with others, sadly many people feel alone.

In a recent article by Allison Sadlier of SWNS, she sites new research conducted by OnePoll on behalf of BetterHelp. The study surveyed 2,000 Americans and found that approximately 1 in 4 Americans think they have no one to confide in. The respondents had various reasons for not confiding in others. Approximately 9 in 10 people admitted to downplaying emotions so they would not worry a loved one. About 7 in 10 were uncomfortable and held back how they really felt from a coworker, friend or partner.

People’s ages made a difference in how they responded to the survey. Young adults ages 18-30 were more withdrawn and uncomfortable discussing money, job stress, parents or friends with a partner. People age 50 and over were more comfortable when discussing these topics.

The people who had difficulty expressing themselves to others had more trouble sleeping, bad focus, short temper and poor eating habits. Around 3 in 10 were more prone to crying spells.

Even though many people believe they have no one to talk to and suffer with stressors, they are hesitant to seek help.

Therapy can be very helpful for anyone who feels disconnected or stressed. Therapy is designed to help people develop better coping skills to deal with challenges.

However, there are many reasons why people don’t seek help. Unfortunately, there is still some stigma surrounding going to therapy. For example, some people are too embarrassed or don’t want others to know what they are dealing with. One in four participants didn’t think their troubles were “serious enough” to warrant talking to someone. Some people are misinformed and think that therapy is only used to work through significant trauma.

What people need to know is that counseling can greatly improve anyone’s mental health. Having someone to talk to who is interested in your welfare can have a positive impact and make life much less stressful.  People truly can benefit from communicating and confiding in others.

1 in 4 Americans feel they have no one to confide in (SWNS Research)

Appreciative – Thank you for the recent training you did regarding sexual addiction.

Dear Dr. Chen,

I would like to take this opportunity to thank you for the recent training you did for UT NASW regarding sexual addiction.  I am very appreciative of your willingness to share knowledge with others.  I believe in the concept of addiction and that people struggle with addictions.  I also acknowledge that some of my clients have challenges with sexual acting out behaviors.  However, I was unsure about whether or not these behaviors fit into the model of addiction.

You generously shared your expertise and experience with us at the seminar.  You were able to clarify issues and answer questions about sexual behavior and possible sexual addiction.  I appreciate you taking the time to identify and explain the 10 criteria for addiction including:  Loss of Control, Compulsive Behavior, Effort to Stop, Significant Amount of Time Lost, Obsessing About the Behavior,  Interference of Obligations, Continuing Despite Negative Consequences, Escalation, Losses, and Withdrawal.  This helped me better understand patterns of behavior, the addiction cycle and how early trauma enables an addiction to develop.  You also provided great insight into sexually compulsive behavior and how it impacts clients.

I believe that because of your willingness to share your expertise, all of us in attendance will be better prepared to recognize possible sexual addiction, assist with these types of issues, and refer the clients for appropriate treatment when necessary.

I truly appreciate the training you provided and time you spent at the event.  Thanks again for your willingness to teach others!

Best Regards,



Sexual Addiction Training-Assessment and Treatment


Sexual Addiction Training – Assessment and Treatment


This sexual addiction training will include assessment and treatment.  It will enable professionals to identify 10 criteria for addiction. They will understand the addiction cycle. They will recognize how early trauma and other components enable an addiction to develop. Providers will be able to identify 10 types of compulsive behavior revealed through research.

Who Should Attend

This training is sponsored by UT NASW.  This is for therapists who work with individuals and couples who are having personal and relationship problems. In some cases, the individual’s and couple’s struggles might be due to underlying sexual addiction issues.

Date: April 12, 2019

Time: 2:00 pm until 4:00 pm

Location: Salt Lake County Youth Services

Salt Lake County Youth Services

177 West Price Avenue (3600 South just west of West Temple)

Salt Lake City, UT

Continuing Education Credit: 2 hours

The following organizations have approved CE credit for this course:

Utah Association of Social Workers

Course Director: Steven J. Chen, Ph.D.

Steven was trained in Clinical Psychology and obtained his Ph.D. in 1992. He has worked at a variety of settings and has more than 25 years’ experience in psychology. Steven has worked with numerous individuals suffering from addiction, including alcohol, sex, and drug dependence. He utilizes a unique intensive outpatient approach, which is highly effective in helping those with addiction as well as spouses and family members. He is a certified sex addiction therapist (CSAT).


More Alcohol Addiction Questions

More Alcohol Addiction Questions

People have numerous questions about alcohol addiction.  In this blog we consider a few more alcohol addiction questions.  The answers presented here are not meant to provide medical advice.  They simply provide information to better understand the health consequences of alcohol abuse and dependence.  Please consult your doctor or other health care provider if you or a family member has an alcohol problem.

Is There A Safe Level Of Drinking?

For most adults, moderate alcohol use- up to two drinks per day for men and one drink per day for women and older people – causes few if any problems.  (One drink equals one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.)

Certain people should not drink at all, however:

  • Women who are pregnant or trying to become pregnant
  • People who plan to drive or engage in other activities that require alertness and skill (such as driving a car)
  • People taking certain over-the-counter or prescription medications
  • People with medical conditions that can be made worse by drinking
  • Recovering alcoholics
  • People younger than age 21.

Does Alcohol Affect Women Differently?

Alcohol does affect women differently than men.  Women become more impaired than men do after drinking the same amount of alcohol, even when differences in body weight are taken into account.  This is because women’s bodies have less water than men’s bodies.

Is It Safe to Drink During Pregnancy?

No, alcohol is not safe to drink during pregnancy.  It can harm the baby if a mother drinks during pregnancy.  The damage caused by prenatal alcohol includes a range of physical, behavioral, and learning problems in babies, the most severe condition is called Fetal Alcohol Syndrome (FAS).

Is Alcohol Good For Your Heart?

Studies have shown that moderate drinkers are less likely to die from one form of heart disease than are people who do not drink any alcohol or who drink more.  If you are a nondrinker; however, you should not start drinking solely to benefit your heart.  You can guard against heart disease by exercising and eating foods that are low in fat.

If you can safely drink alcohol and you choose to drink, do so in moderation.  Heavy drinking can actually increase the risk of heart failure, stroke, and high blood pressure, as well as cause many other medical problems, such as liver cirrhosis.

When Taking Medications, Must You Stop Drinking?

Possibly.  More than 150 medications interact harmfully with alcohol.  These interactions may result in increased risk of illness, injury, and even death.  If you are taking any over-the-counter or prescription medications, ask your doctor or pharmacist if you can safely drink alcohol.

How Can A Person Get Help For An Alcohol Problem?

There are many national and local resources that can help.  The National Drug and Alcohol Treatment Referral Routing Service provides a toll-free telephone number.  1-800-662-HELP (4357), offering various resource information.  Through this service you can speak directly to a representative concerning substance abuse treatment, request printed material on alcohol or other drugs, or obtain local substance abuse treatment referral information in your State.  Many people also find support groups a helpful aid to recovery.  For help with more alcohol addiction questions search these topics:

SAMHSA Substance Abuse and Mental Health Services Administration

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Again, this information is not meant to provide medical advice.  It is presented to simply answer a few more alcohol addiction questions and help people understand the consequences of alcohol abuse and dependence.  Please seek treatment if you are struggling with an alcohol problem.


Struggling Due to Pornography Addiction

Recently, I was working with a couple who were struggling due to the husband’s pornography addiction. The husband talked about no longer finding his wife appealing. The wife was hurt and unhappy about this disclosure, but also quite perplexed because her husband historically found her attractive. Previously, their sexual relationship had been fulfilling. This couple was experiencing one of the unfortunate outcomes from pornography addiction.

In 2013, Dr. Valerie Voon at Cambridge University, conducted a neurological study of men who were reportedly addicted to pornography. The research showed that subjects addicted to pornography and subjects addicted to drugs showed the same changes in the reward center of the brain. Both groups of addicted individuals engaged in addictive behavior due to increased dopamine levels in order to get “high.” In other words, the drug addicts increased substance use to get high and the pornography addict increased pornography consumption to get high. Both groups needed to increase use of their “substance” in order to get “high”. This is due to the dopamine receptor cites being flooded and eventually becoming less sensitive to the dopamine, thus needing more dopamine to achieve the same euphoric effect.

In addition to Dr. Voon’s research, Norman Doidge discussed the research in the article, Brain scans of porn addicts: what’s wrong with this picture. He described a trend that professionals were seeing in the mid-1990’s. A commonly noted scenario was an adult male who is in a happy relationship, gets curious and starts looking at pornography on the internet. This person is initially bored with the sites, then finds sites that fascinate him and eventually starts to crave looking at them.

This pornography scenario illustrates the general addictive cycle.   For the 5% to 7% of the population with a predisposition to addiction, once they start using a substance, they build what is called tolerance which means they need more of their drug of choice to get “high”.

While conducting her research, Dr. Voon noticed some interesting differences with pornography addiction. She reports that while these addicts craved pornography, some didn’t like it. Even though the addict was viewing sexual acts, they were less attracted to their partner. The addict also started to have different sexual desires.

Dr. Voon’s research debunks a common misconception that viewing pornography will somehow increase all couples drive for sexual contact. The research indicates a different finding. The addicted person that views pornography is more likely to become disinterested in their partner. In addition to the decrease in sex drive toward their partner, the addict’s sexual taste can change. The specific change depends upon what they are viewing.

Dr. Voon’s research provides couples who are struggling due to pornography addiction with some clarity and answers regarding changes in taste and interest.

There is hope in these situations. The struggling couple mentioned above was able to heal their relationship. The addict was able to abstain from looking pornography which enabled them to decrease desire to get high and to adjust sexual tastes and desires. The partner was better able to understand the addictive process, make necessary changes and realize that the situation wasn’t about them. If you are struggling with the negative impact of pornography, there is hope for you as well.