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Effective Therapy for Distressed Couples

Emotionally Focused Therapy (EFT) is a short-term (8 – 20 sessions) and structured approach to couples’ therapy developed by Drs. Sue Johnson and Les Greenberg in the 1980’s. It is grounded in research while focusing on negative communication patterns and love as an attachment bond.

Attachment Theory in Couples Therapy

“Attachment” between people typically provides a safe haven: a retreat from the world and a way to obtain comfort, security and a buffer against stress. Attachment also offers a secure base, allowing you to feel safe while you explore the world and learn new information. Its formation begins in childhood with a primary caretaker, such as a parent. Those early, established patterns carry through to adulthood. An “unavailable caretaker” creates distress in a baby akin to an “unavailable partner” creating distress in an adult. Attachment theory provides the emotionally-focused therapist with a “road map” to the drama of distress, emotions and needs between partners.

Grounded in Science in Couples Therapy

According to the website dedicated to EFT, www.ICEEFT.com, a substantial body of research outlining the effectiveness of this treatment exists. It is now considered one of the most (if not the most) empirically validated forms of couples therapy. Research studies have found that 70-75% of couples undergoing EFT successfully move from distress to recovery, and approximately 90% show significant improvements. This recovery is also quite stable and lasting, with little evidence of relapse back into distress.

Couples Therapy Tribeca
New York City Therapist Carolyn Ehrlich focuses on learning how we share space with each other. In therapy, both parties are given the opportunity to speak, guided by a therapist. And most importantly, both will be heard.

EFT is being used with many different kinds of couples in private practice, university training centers, and hospital clinics. It is also quite useful with various cultural groups throughout the world. The distressed couples who may benefit from EFT include those where one or both partners suffer from depression, addiction, post traumatic stress disorders and chronic illness, among other disorders. EFT has proven to be a powerful approach for couples dealing with infidelity or other more traumatic incidents, both current and past.

Effective Therapy for Distressed Couples

Neuroscience also intersects attachment theory and EFT. More recently produced MRI studies demonstrate the significance of secure attachment. Our attachments are potent, and our brains code them as “safety.” According to an article on EFT in Social Work Today, any perceived distance or separation in our close relationships is interpreted as danger. Losing the connection to a loved one threatens our sense of security. “Primal fear” ensues, and sets off an alarm in part of our brain called the , also known as the fear center. Once the amygdala is activated, it triggers our fight-or-flight response. When incoming information is familiar, the amygdala is calm. However, as soon as the amygdala encounters threatening or unfamiliar information, it increases the brain’s anxiety level and focuses the mind’s attention on the immediate situation. People go into a self-preservation mode, often doing what they did to “survive” or cope in childhood. This is the reason we are triggered as adults in our romantic relationships, in the same repeating (and unhealthy) patterns from our formative years. EFT can help to unwind these automatic, counter-productive reactions.

Fostering Healthy Dependency in Couples Therapy

EFT provides a language for healthy dependency between partners and looks at key moves and moments that define an adult love relationship. The primary goal of the model is to expand and re-organize the emotional responses of the couple. New sequences of bonding interactions occur and replace old, negative patterns such as “pursue-withdraw” or “criticize-defend.” These new, positive cycles then become self-reinforcing and create permanent change. The relationship becomes a haven and a healing environment for both partners.

Creating a Secure Bond between Couples

The process reduces couples’ conflict while creating a more secure emotional bond. Couples learn to express deep, underlying emotions from a place of vulnerability and ask for their needs to be met. Partners begin to view undesirable behaviors (i.e., shutting down or angry escalations) as “protests of disconnection.” Couples learn to be emotionally available, empathic and engaged with each other, strengthening the attachment bond and safe haven between them.

EFT has many strengths as a therapeutic model. First, it is supported by extensive research. Second, it is collaborative and respectful of clients. It shifts blame for the couples’ problems to the negative patterns between them, instead of the couples themselves (or the partners). Finally, the change process has been mapped into a clearly defined process consisting of nine steps and three change events that help guide the therapist and track progress. If you are looking for help with a distressed relationship, an EFT trained therapist would be a wise choice.

By Marni Feuerman

Photo: Unsplash

Boca Raton Therapy
Christiane Blanco-Oilar, Ph.D., ABPP is a Board Certified Counseling Psychologist, specializing in Boca Raton Therapy. Dr. Blanco-Oilar has expertise in helping you through life transitions, grief and loss, intimacy issues, relationship difficulties – Couples Therapy Boca Raton – and in supporting your goal to achieve vibrant relationships with yourself and others. Offering therapy in Spanish.

Questioning for Clarity: Online Counseling New Jersey and Nutrition Coach Philadelphia

We have all struggled with uncertainty at one point or another in life, and you may find that the more you search for an answer, the muddier everything becomes. While using our analytical skills is important to help us weigh out the costs and benefits of various options, our analysis only takes us so far. What can you do when you have weighed all the options, and there is still no clear answer?

Manage your mental health symptoms through Online Counseling in New Jersey

Do you want to improve your mental health? Contact me to learn more about working together through online counseling in New Jersey.

Understand Your Motivation

Make a list of your options. Why are you considering these options? What started you on this journey, what led you to this point? Are you making fear-based decisions, or empowered and confident decisions? This process can help us evaluate how we move through our lives in more significant ways, but also in the ways that seem less consequential.

If we are used to moving through our day to day lives motivated by fear rather than feeling empowered, it is likely that this same pattern will be reflected in larger decisions we make. While there is nothing wrong with playing it safe, sometimes playing it safe can mean shrinking. For instance, if you fear judgement from other people, you might choose to keep your thoughts and feelings to yourself to avoid feeling vulnerable. However, there are times when sharing your thoughts and feelings can lead to a greater sense of feeling connected and understood by others. By playing it safe in this way, you avoid discomfort, but you might also be avoiding opportunities for connection.

Decisions on a larger scale are trickier. With any big decision, we often are not lucky enough to have a clear answer presented to us. An example of this might be choosing to move to another city in order to have a more expansive life experience. There are obvious risks in doing this, but also potentially great rewards.

Questions you can ask yourself to explore your motivation include:

  1. What might I be running away from or avoiding if I do make this decision? If I do not?
  2. What feelings do I value in life? Why? (Examples might be feeling adventurous, feeling secure, feeling relaxed, feeling open, feeling engaged)
  3. What feelings come up for me when I consider my options?
  4. What am I afraid will happen if I do make this decision? If I do not?
  5. What am I hopeful will happen if I do make this decision? If I do not?
  6. Why do I want to make this change? Why do I not want to make this change?
  7. Is this the best time for this change? Why or why not?
  8. What will I regret if I do make this change? If I do not?

I am not encouraging anyone to throw caution to the wind and make the more empowered decision if it does not ultimately feel like the right decision. Taking time to reflect on the questions above can help you to sit with and explore your thoughts and feelings in a more intentional way, and hopefully provide you with more insight into what is driving your decision making.

Sarah Tronco, LCSW, provides online counseling in New Jersey and works to develop a strong therapeutic relationship with her clients, which helps to create a secure place where individuals can achieve meaningful change.

I now also offer online counseling in Pennsylvania Nutrition Coach Philadelphia Sarah Tronco, CMHIMP, is a Philadelphia Nutrition Coach specializing in mental nutrition. Sarah offers individualized mental health nutrition coaching that empowers you to make sustainable changes to improve your overall well-being.

Photo by Jac Alexandru on Unsplash

The Guilt of Not Working More, When We’re Done for the Day

At the end of a day of work, there can be a simple practice of wrapping things up and shutting down for the day.

Boca Raton Therapy
Christiane Blanco-Oilar, Ph.D., ABPP is a Board Certified Counseling Psychologist, specializing in Boca Raton Therapy. Dr. Blanco-Oilar has expertise in helping you through life transitions, grief and loss, intimacy issues, relationship difficulties – Couples Therapy Boca Raton – and in supporting your goal to achieve vibrant relationships with yourself and others. Offering therapy in Spanish.

But so many of us feel guilty at simply stopping, and this feeling that we should be doing more … it drives some of us to keep going as long as we can.

This can lead to overwork, burnout, tiredness, and never letting ourselves enjoy a moment of rest.

Do you relate to this guilt of simply stopping and resting?

The thing about this guilt is that it doesn’t have to be rational — it’s simply fear, that we’re not doing enough, that we’re not on top of things, that we’re not going to be OK if we don’t get everything done.

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I know this fear well. I still have it, on a daily basis. It’s not rational, but then fear never is.

This fear will control us if we don’t bring a kind awareness to it, and start to work with us. It will own us, and we’ll always be checking our phones, replying to messages, stuck in perpetual motion. Rest becomes difficult, joy becomes mostly inaccessible.

Here’s how I work with this guilt and fear:

  1. Recognize it when it’s happening. When it’s late in the day, and we could be wrapping things up and closing our work day … notice the urge to do more. Notice the guilt of stopping. Just bring awareness to the fear and guilt, without judging them or needing them to go away.
  2. Breathe, and feel it. Pause, take a few deep breaths, and don’t let yourself buy into the fear. Feel the physical sensation of the fear, but don’t believe it. Give yourself some kindness.
  3. Remind yourself of a bigger truth. The idea that you should be on top of everything and working harder and checking emails and messages … it feels really true in the moment. But it is very rarely true. What’s a bigger truth? That you need rest to be able to serve others. That you are allowed to do other things, to spend time with others, to take care of yourself, to feel joy at spaciousness in your life. And this is a model for how others might live too. Taking rest serves the world. Remind yourself of this truth.
  4. Then take the rest. Feel in your heart how this is worthwhile. And let yourself enjoy the space. You don’t need to fill every moment with more work, more messages, more email.

An anxiety disorder can interfere with your everyday life including work, school, and relationships. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and phobia-related disorders. There are several types of anxiety treatment. To learn more contact WellTalk. Anxiety Disorder Boulder

How To Experience More Wow

Awe might seem an unobtainable luxury to many but, with the right approach, you can enjoy it daily – no mountain required.

On a crisp, clear day in January about four years ago, my children and I joined a few thousand Rhode Islanders in a protest march against a recent change in law that restricted the number of refugees who could enter the United States. As I held the hand of my four-year-old son, I was overcome with emotion. ‘No hate, no fear, refugees are welcome here,’ the crowd chanted as we marched through the streets, my six-year-old daughter joining in stone-faced. With a tightness in my chest and tears in my eyes, I could barely join along without choking up.

At the time, I didn’t have a word to describe exactly what it was that I was feeling, but now I do: awe.

Since the march, I had a spell working as a research and writing fellow at the Greater Good Science Center based at the University of California, Berkeley, which gave me the opportunity and privilege to delve into the burgeoning science of this emotion. The more I learned about it, the more I came to believe that it’s worth recognising awe and trying to cultivate it in our lives.

For centuries, mystics, religious scholars, philosophers and artists have had differing understandings of what the word ‘awe’ means. It originally connoted fear and dread toward divine beings, but now has a more general meaning encompassing a wide variety of experiences. ‘I define it as the feeling of being in the presence of something vast and mysterious that you don’t understand with your current knowledge,’ says Dacher Keltner, the founder and a faculty director of the Greater Good Science Center, and a leading researcher into the psychology of awe.

Couples Therapy Tribeca

New York City Therapist Carolyn Ehrlich focuses on learning how we share space with each other. In therapy, both parties are given the opportunity to speak, guided by a therapist. And most importantly, both will be heard.

A landmark new scientific conceptualisation of awe by Keltner and his fellow psychologist Jonathan Haidt was published in 2003, based on what had been written about it from the fields of religion, philosophy, sociology and psychology. They proposed that, as varied as awe experiences can be, they all share two features: ‘perceived vastness’ and a ‘need for accommodation’.

According to this framework, while the perceived vastness of dramatic vistas such as canyons and mountains can provoke strong feelings of awe, this aspect of the emotion isn’t limited to literal size. Rather, it encompasses ‘anything that is experienced as being much larger than the self, or the self’s ordinary level of experience’, such as I felt on the Rhode Island march, but other related triggers might be extreme ‘social size’ (fame, prestige or authority), conceptual complexity and even outstanding moral goodness.

The other component of awe, ‘need for accommodation’, refers to the way the emotion forces us to change our understanding of the world. Awe can seem mind-bending in part because it is; it forces us to adjust our mental structures to assimilate new information (recent research scanning people’s brains while they experience awe suggests that this effect manifests at a neural level in decreased activity in the left middle temporal gyrus, a brain area that’s known to be involved Couples Therapy Tribeca in adjusting one’s previous schemas and understandings in light of new events and experiences).

Awe isn’t always experienced as a purely positive emotion. In around a quarter of awe experiences, people also report feeling a layer of fear. Imagine the mix of awe and alarm you might feel if you stumbled upon a grizzly bear on a hike, were stuck in a thunderstorm, or contemplated going to Hell. Early evidence suggests that this kind of threat-based awe might be more prominent outside the Western European and North American populations that have been the source of many awe studies. ‘You find more threat-based awe in hierarchical cultures,’ says Keltner. That said, his work has found that, at least in the Western world, most awe experiences are positive and have positive effects. ‘A quarter of the experiences are threat-based but three-quarters are really about exploration and connection, and have a lot of delight in them,’ says Keltner.

There’s a lot we can gain from those more delightful awe experiences. In the past nearly two decades of research on awe, dozens of studies have unearthed benefits associated with the emotion. ‘On all the major checkboxes of what’s good for you, it does a pretty good job,’ says Keltner.

For starters, there appears to be a connection between experiencing awe and better physical health. In a recent study, Jennifer Stellar, a psychologist at the University of Toronto, found that awe was one of the positive emotions most strongly associated with having lower levels of proinflammatory cytokines – protective proteins that are released when you get injured or ill, but which can have negative effects on health when they’re chronically elevated, including raising the risk of cardiovascular disease, diabetes and depression.

In terms of awe’s psychological benefits, there’s even more compelling evidence, with research linking greater experience of the emotion to more life satisfaction, increased humility, better mood, dampened feelings of materialism, and greater scepticism toward weak arguments.

Awe can make us better social beings, too. In multiple studies, participants who have been asked to write about an awe experience or who experienced awe in an experiment displayed more generous and cooperative behaviour than people who were induced to feel other emotions.

Besides boosting life satisfaction and making you a kinder person, awe experiences often just feel good – and important. ‘People report it being a very profound experience to have awe,’ says Stellar. ‘It also makes people see the world in a different way, and I think that’s valuable in its own right.’

Awe might feel profound in part because it encompasses a number of transcendent phenomena. It can change our perception of time, making it seem more plentiful and expansive, allowing us to savour the here and now. During awe, people also report feeling less significant and smaller relative to their environment – a positive effect that researchers term ‘the small self’.

‘When people feel shame, they feel very small, but they also feel very aware of themselves, which is different than awe where they feel small but not so aware of themselves,’ says Stellar. ‘[Awe] seems to be this very interesting situation where you can feel self-diminishment, but it’s a good and exhilarating feeling.’ At a neural level, brain imaging research suggests that this is reflected in reduced activity in the ‘default mode network’, a network of brain regions that are particularly active when our minds are wandering or we’re thinking about ourselves (similar neural effects are observed during meditation, states of flow and psychedelic trips).

While awe makes us less focused on ourselves, evidence suggests it also makes us feel more connected to other people, more a part of a greater whole and something larger than ourselves. In this way, it creates a bridge between what Keltner calls the ‘default self’ – our drive to do well, meet our goals, protect ourselves, rise in status – and our desire, and indeed need, to be part of society and help others. ‘I’ve got to protect myself, but I’ve got to serve the collective – that’s one of the great tensions in identity and in our evolution,’ says Keltner.

While we can imagine how, in the wrong hands, this bridge can be used as a force for manipulation – think of a charismatic cult leader or suicide bomber – the transformative effects of awe can also be powerfully positive. ‘[I]t seems to be this really important emotion for when we’re confronting things that might be scary and bigger than us and hard to understand, but it’s the positive side of that,’ says Stellar. ‘It’s so embedded into humanity’s goal of trying to understand the world better and really taking on that challenge and those scary, unfamiliar parts, rather than shying away from it.’

All that being said, some of us are clearly more awe-prone than others. Modern life can also make awe feel inaccessible. If your life is packed full of work stress, domestic demands and commercialised spaces, you might feel that experiencing awe in your day-to-day existence is a challenge – or even an unobtainable luxury. I know I’ve felt that way, especially in the middle of a global pandemic when I’ve rarely left my suburban home and found myself in a loop of repetitive routines. Fortunately, there’s research suggesting that we don’t need to step out of our everyday lives to experience more awe, and in this Guide I’m going to show you how.

What to do

To foster more awe in your life, Keltner recommends exploring the ‘eight wonders of life’. Before I share these wonders with you, here are a few broad considerations that might make it more likely that you’ll have an awe experience:

*If possible, limit distractions. Complete the task that has been nagging you. Turn off notifications on your phone (or leave it in another room or at home). Ask your partner, roommate and/or children for some space.

*Treat your awe experience like a contemplative exercise. Begin with some deep breathing, and pay attention to the sound and feeling of your breath as you inhale and exhale.

*Turn your attention outward and be open to inspiration. Notice what catches your mind. Do some of your senses seem heightened? Do you feel goosebumps? Do you feel more curious? Delighted?

*Don’t worry if you’re not feeling awe. Awe is different for everyone, and some days you might just not be feeling it.

The nice thing is, once you start thinking about awe, you might begin to notice all the places it shows up in your everyday life. In other words, you might naturally experience awe more often as you start to pay attention to it, similar to how people often feel more gratitude once they begin a gratitude journal. Of course, not all awe experiences will move you to tears or make you feel at one with the Universe. Just as with other emotions, awe comes in a range of intensities – from the gentle awe you might experience on a walk through the woods to the life-changing awe you might experience at the birth of your child.

Some places I believe I’ve experienced awe include concerts, sporting arenas, movie theatres, the Badlands National Park, the Pacific Coast, in my previous life as a neuroscientist, and as a parent. ‘In our studies around the world, people are feeling it two or three times a week,’ says Keltner. ‘I think you can get a little dose every day.’

Now to Keltner’s Eight Wonders of Life – eight ways to seek out more awe:

1. Witness other people’s moral beauty and courage

The first wonder of life, according to Keltner, is other people’s moral beauty and courage. It’s easy to become awestruck by stories of courageous people such as Harriet Tubman, Martin Luther King, Jr or Greta Thunberg. Similarly, Stellar notes that movements for social change, such as Black Lives Matter and March for Our Lives, can be awe-inspiring for people. Generally speaking, Keltner thinks that we tend to discount the extent to which other people are important for awe. ‘We often think of awe as spiritual or natural – and that’s part of it – but the bigger story is it’s about our fellow human beings… We find that 50 to 60 per cent of awe experiences are just like you’re blown away by other people,’ he says. People can also feel awe when observing someone with incredible skill or talent or unique abilities (think Michael Jordan or a contortionist).

2. Move in unison with others

From ceremonial dances to army marches to tapping your toes in rhythm with a friend, humans have a natural proclivity for synchronised movement. Several studies have found that people are more cooperative and generous after moving in unison with others, and that they feel more bonded to their movement partners. Moving together appears to help strengthen social ties and, says Keltner, it can also elicit awe. To test out this wonder, try participating in a form of shared movement such as dance, exercise, playing music, singing in a choir, cheering on a sports team or even walking with a friend.

3. Get out in nature

Importantly, you don’t need to visit the Grand Canyon or the Great Barrier Reef to get a dose of awe from nature. ‘It can just be a walk through a forest that’s near your house,’ says Stellar. To get more awe out of an everyday hike, Keltner recommends taking time to deepen your thinking about the experience. ‘Start to look for patterns in nature, take a moment to think about what’s vast,’ he says. You might consider making a habit of going for ‘awe walks’. In a recent study, Keltner and his colleagues found that older adults assigned to take weekly 15-minute awe walks reported greater increases in positive emotions and decreases in distress in their day-to-day lives than did those assigned to a control walk condition. The Greater Good Science Center offers step-by-step instructions for getting the most out of an awe walk, including how to breathe and shift your awareness to what’s around you.

4. Listen to or create music

Listening to a symphony, singing in a choir, or playing an instrument can produce feelings of awe. If you’ve ever had goosebumps or what people call ‘the chills’ while listening to a particularly moving song, you were likely also experiencing awe. While listening to any form of music has the potential to elicit awe, songs that are exceptionally beautiful or complex are more likely to produce the emotion. Making music with others – be it in a choir, band or orchestra – might also increase the likelihood of awe because those activities have the added benefit of involving synchronised movement.

5. Take in visual art or film

Visits to art galleries and museums (in person or online), public art and sculpture, and movies with stunning visual elements can all provoke awe. Stellar, who lives in Toronto, says she normally seeks out awe in the city by going to museums and galleries. Visuals that might be more likely to evoke awe are those that are very large – such as Michelangelo’s David or the Taj Mahal – or very detailed, intricate or complex, such as a fractal or an exceptionally lifelike painting. Even the most common elements can produce awe when presented in a unique way. In one study, viewers experienced awe when they watched a slow-motion video of drops of coloured water falling into a bowl of milk.

6. Seek out a spiritual or religious experience

For people of faith, religious gatherings, ritual and prayer can be profound sources of awe. Meditation, Stellar notes, can also inspire awe for some. Even recalling a past spiritual or religious experience can evoke feelings of awe. In a 2017 study, participants who wrote about spiritual experiences reported higher levels of awe and a greater sense of ‘a small self’ than did control participants who wrote about humorous experiences. Both religious and non-religious participants experienced these effects despite recalling different types of memories. Religious people recalled more religious events as well as life-and-death events, whereas non-religious people were more likely to recall experiences with nature, science, yoga or meditation. The message here is that the types of experiences that you personally deem spiritually meaningful are the ones most likely to result in awe.

7. Consider a big idea

‘It gets kind of metaphysical,’ says Keltner. ‘Big ideas give people awe – like Marxism, free markets, evolution.’ You might have already had an experience in school or while reading that filled you with awe. The process of wrapping your mind around a new concept is cognitive accommodation, a key competent of awe. So if you take the time to grapple with a new, big idea for you – say quantum physics – that could bring more awe into your life. Similarly, Keltner says poetry that at first glance can seem difficult to comprehend can evoke awe when the reader discovers what the poem is about.

Another related way to add more awe to your life is to deepen your contemplation and curiosity about the world by posing questions or puzzles to yourself – to turn everyday experiences into a way to think about big ideas. For example, Keltner recommends thinking about clouds and how they work – or waves, or rainbows. This is a way to transform simple wonder into awe and discovery. He points out that the obsessions René Descartes and Isaac Newton had with rainbows led them to figure out the physics of light.

I’ve found that parenting can be a fountain of inspiration for this type of awe, both because I experience awe secondhand when my children understand something for the first time, and because human development (such as witnessing children learn to talk, read and do mathematics) is awe-inspiring.

8. Witnessing life and death

For parents, the miracle of pregnancy or birth can create feelings of awe. Contemplating or witnessing death, too, is often tinged with awe, although confronting this aspect of awe can be psychologically difficult. While you might not want to go out of your way to cultivate these experiences in your personal life for the sake of awe, life and death are prominent themes in many memoirs, novels and other forms of art.

Hopefully, one thing that comes across from Keltner’s Eight Wonders of Life is that awe can be found in many corners of our everyday lives. ‘We talk about it as if it’s a once-in-a-lifetime thing, but in fact it’s everywhere,’ says Keltner. That said, research suggests that some people – whether by personality and/or life circumstance – are more naturally prone to experiencing awe. If you’ve tried some of these activities and haven’t experienced awe, don’t despair. Keep seeking out new experiences that interest and excite you. Who knows? You might just discover a ninth wonder.

‘My big advice is that some people aren’t that into music or nature or whatever, but everybody can find something that makes them feel awe,’ says Stellar. ‘Awe is an amazing emotion and there are so many different ways people can experience it. Find that thing that does it for you and keep doing that.’

A note about psychedelics

An elephant in this awe-filled room is psychedelic use. According to Keltner, there is some theorising that the psychedelic experience is essentially the experience of awe. In a 2018 article, Peter Hendricks, a clinical psychologist at the University of Alabama at Birmingham, lays out the case for how ‘mystical experiences elicited by classic psychedelics appear to exemplify awe’.

Indeed, people who use psychedelics report feeling a sense of connectedness with humanity and oneness with the Universe, as well as a changing awareness of the self. In the scientific study of psychedelics, this is known as ‘ego dissolution’, which could be conceptualised as an extreme example of the small-self phenomenon common in awe experiences. Intriguingly, Hendricks also proposes that awe might be the mechanism that underlies the positive effects caused by psychedelic-assisted psychotherapy. While I can’t personally attest to or vouch for or against psychedelic use, this branch of awe research will likely continue to develop as a growing number of municipalities in the US – and the entire state of Oregon – have decriminalised use of the hallucinogen psilocybin. If you’d like to explore further, a previous Psyche Guide covered the basics of how to have a safe psychedelic trip.

Couples Therapy Tribeca Key points

*Awe is a complex emotion that tends to arise when you’re in the presence of something vast that you don’t already understand. It heightens your sense of time, makes everyday concerns fall from view, shifts your perspective, and makes you feel more connected with the world and part of a greater whole.

*Awe is usually, but not always, perceived as positive, and experiencing it more often is associated with a range of physical and psychological benefits including reduced inflammation, greater life satisfaction and humility.

*The vastness that provokes awe doesn’t necessarily have to mean physical size. Any type of stimulus that goes beyond your ordinary experience of the world could qualify, including objects or concepts that are especially complex or people who are exceptionally famous, prestigious or morally good.

*Awe is more common than you might think. People experience awe on average 2.5 times a week. You don’t need to summit a mountain to experience awe. It can be found in your own backyard, in a book or on the internet.

*Adopting the right mindset can increase your chances of experiencing awe, including deepening your breathing and turning your attention outward.

*Look to Keltner’s Eight Wonders of Life for experiences that can make you feel awe: moral beauty and courage, moving with others, nature, music, visual art and film, spiritual and religious experiences, big ideas, life and death.

*Awe experiences are different for everyone. What elicits awe in one person might not have the same effect on you. It’s worth trying a variety of experiences.

Learn more

Our notions about awe – what the emotion is like and what experiences are likely to inspire it – have changed over time. Nowadays, awe has mostly positive connotations, particularly in the Western world, but this wasn’t always the case. Even today, the Merriam-Webster dictionary defines awe as: 1) ‘an emotion variously combining dread, veneration, and wonder that is inspired by authority or by the sacred or sublime’, and 2) ‘[archaic] a: dread, terror; b: the power to inspire dread’.

To chart the meaning of awe over the centuries, Stellar teamed up with a linguist in her university’s computer science department to analyse how the usage of the word ‘awe’ has changed over time in Google’s corpus of texts. ‘There is evidence that it has changed to become more positive,’ says Stellar. ‘It looks like the time period in which it’s changing has to do with transcendentalism and Romanticism as philosophical movements that prioritise beauty in nature and spirituality.’ In other words, rather than being tied to scary gods and fearful experiences, awe began to be tied to beauty in nature, art and music.

This change in the cultural meaning of awe might mirror the changing relationship between people and nature. The American environmental historian William Cronon articulates this change in his essay ‘The Trouble with Wilderness; or, Getting Back to the Wrong Nature’ (1995):

Go back 250 years in American and European history, and you do not find nearly so many people wandering around remote corners of the planet looking for what today we would call ‘the wilderness experience’.

Whereas people today seek solace and awe on mountains and in canyons, this would probably have seemed strange to people in the 18th century or earlier, at which time Cronon says we were much more likely to associate being in wilderness with ‘bewilderment’ or ‘terror’ (and thus closer to the historic darker notions of awe).

One need only look at the Bible, says Cronon, in which the wilderness was a place where people found themselves in ‘moral confusion and despair’ – where Moses wandered for 40 years, and Christ struggled with the Devil, and where Adam and Eve were ousted to from Eden. ‘Wilderness, in short, was a place to which one came only against one’s will, and always in fear and trembling,’ writes Cronon.

This began to change with the spread of Romanticism. The Romantics had the idea that it is in sublime landscapes that people are most likely to experience the sacred and, in Cronon’s words, ‘glimpse the face of God’. Cronon adds: ‘He [God] would most often be found in those vast, powerful landscapes where one could not help feeling insignificant and being reminded of one’s own mortality … God was in the mountaintop, in the chasm, in the waterfall, in the thundercloud, in the rainbow, in the sunset.’

It’s true that early Romantic writers found these kind of nature experiences terrifying. Consider a poem by William Wordsworth about his visit to the Alps where his encounter with the divine evoked a decidedly terror-tinged sense of awe, with ‘Winds thwarting winds bewildered and forlorn’. But a century later, there are signs of this fearful attitude changing. Here’s the Scottish-American naturalist John Muir in 1911 describing Yosemite’s North Dome:

No pain here, no dull empty hours, no fear of the past, no fear of the future. These blessed mountains are so compactly filled with God’s beauty, no petty personal hope or experience has room to be. Drinking this champagne water is pure pleasure, so is breathing the living air, and every movement of limbs is pleasure, while the body seems to feel beauty when exposed to it as it feels the campfire or sunshine, entering not by the eyes alone, but equally through all one’s flesh like radiant heat, making a passionate ecstatic pleasure glow not explainable.

It’s clear that Muir is describing an awe experience here, complete with a changing perspective of time and diminishment of the self, in tune with the contemporary psychological definition of the emotion. This broader cultural shift also meant that by the late 1800s people were beginning to seek out experiences in nature. Natural sites in the US, such as Niagara Falls, the Catskills, Yosemite and Yellowstone, started to become tourist destinations. Wilderness was no longer a place to avoid out of terror or temptation, but rather a place to seek out beauty, the sacred, wonder and awe.

‘The Romantic legacy means that wilderness is more a state of mind than a fact of nature, and the state of mind that today most defines wilderness is wonder,’ writes Cronon in his 1995 essay, although he could just as easily have defined it as awe, wonder’s more magnificent cousin. ‘The striking power of the wild is that wonder in the face of it requires no act of will, but forces itself upon us – as an expression of the nonhuman world experienced through the lens of our cultural history – as proof that ours is not the only presence in the Universe.’

Links & books

My 2018 white paper for the Greater Good Science Center delves into dozens of studies about the science of awe. It includes a discussion about how to define awe, who is most (and least) likely to experience awe, why a feeling such as awe might have evolved, what experiences tend to elicit awe, and what’s known about the physical and psychological effects of awe.

The psychologist and awe researcher Dacher Keltner recommends checking out the Greater Good Science Center’s series of step-by-step awe exercises and this guided awe walk meditation through Muir Woods in California that he did for Mindful.org.

Keltner also recommends Alan Cowen’s Mapping Emotion website. By exploring these maps, you can see what sounds, videos and facial expressions correspond to awe and other emotions. In particular, he recommends the ‘Emotional Experiences Evoked by Video’ map that shows which emotions were most commonly evoked by 2,185 different short video segments. A research study about these findings was published in the Proceedings of the National Academy of Sciences.

The psychologist and awe researcher Jennifer Stellar recommends watching clips from the BBC Earth channel on YouTube, attending virtual or in-person concerts by a symphony orchestra, or visiting a photography exhibit hosted by a museum.

The ultimate awe experience might come from seeing Earth from space. A 2016 paper by the psychologist David Yaden includes several quotes from astronauts discussing this experience, sometimes called the ‘overview effect’. While most of us will never be able to truly experience this first-hand, you can still get a dose of awe from viewing the International Space Station’s live feed of Earth. In a similar vein, I use Chrome’s Earth View from Google Earth browser extension, which displays an image from across the globe each time I open a new tab.

Yaden founded the Varieties Corpus, a website where people can share and learn about self-transcendent and awe-inspiring experiences.

Perhaps surprising to some, Couples Therapy Tribeca social media can be a great place to encounter strange moments of awe. Some recent awe-inspiring posts I’ve seen on Twitter include a giant xylophone in the woods of Japan that plays Bach and a video of the surface of Venus.

Books that touch on personal awe experiences include Mountains of the Mind: Adventures in Reaching the Summit (2004) by Robert Macfarlane, A Private History of Awe (2006) by Scott Russell Sanders, and How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence (2018) by Michael Pollan.

Summer Allenis a freelance science writer and former neuroscientist. She served as a research and writing fellow for the Greater Good Science Center at the University of California, Berkeley. Her work has appeared in The Washington Post, Mindful magazine, and other outlets. She lives in Portland, Oregon.

Photo: Pexels

Active Listening – Online Counseling New Jersey

When communicating in counseling

It can be easy to focus more on what we are saying than how we are listening. If we are not truly hearing what someone is saying to us, then communication is not successful and misunderstandings occur.

While listening may seem straight forward, there are many ways to practice poor listening skills that you may not recognize are barriers to really understanding someone. Some examples of poor listening habits include when you are distracted while someone is speaking, planning your response in your head before someone finishes what they are saying, or responding judgmentally to what someone has shared. Being mindful of the lens you view the world through can increase your awareness of any bias informing how you interpret and respond to information.

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If you have had poor listening habits, no need to worry. Active listening is a skill you can build with practice and commitment. Here are some tips on how to practice active listening2:

  1. Be aware of your nonverbal cues. Even when we aren’t verbally contributing to a conversation, we are contributing through our body language or subtle sounds we might make to indicate our engagement.
  2. As I mentioned above, judgment gets in the way of understanding someone. When you want to make someone feel heard, drop the judgment and know that you do not need to take a stance by agreeing or disagreeing with what’s being said.
  3. Focus on the present moment by devoting your attention to the speaker rather than distractions. It’s easy to get lost in thought if we aren’t making an effort to be present. There is so much information we can absorb when we are really hearing someone, such as changes in their tone of voice or body language.
  4. Reflect back what you are hearing to make sure you are understanding. This shows someone that you are following what they are saying, and if you reflect back inaccurately, it provides an opportunity for clarification.
  5. Dive deeper by asking questions about their experience. This shows that you have not only been following what someone is saying, but that you are interested in learning more about their perspective.

There are many reasons to cultivate active listening skills. It will likely improve your relationships and it will help you understand others. Active listening has been found to be significantly associated with empathy.2

Sarah Tronco, LCSW, provides online counseling in New Jersey and works to develop a strong therapeutic relationship with her clients, which helps to create a secure place where individuals can achieve meaningful change.

Sarah Tronco, LCSW, now also provides online counseling in Pennsylvania, contact her to learn more.

References:

  1. https://positivepsychology.com/active-listening/
  2. https://www.sciencedirect.com/science/article/pii/S2352900816300231
  3. Photo by Bewakoof.com Official on Unsplash

Menstrual Cycle and Mood

The menstrual cycle is composed of four different phases, which vary in duration from woman to woman, and may fluctuate in length. The phases are menstrual, follicular, ovulation, and luteal. While the length of a menstrual cycle varies from woman to woman, many experience a cycle that lasts 28 days. During the fluctuations of a cycle, key hormones – testosterone, progesterone, and estrogen –  increase and decrease in a pattern that influences how we feel.

Nutrition Coach Philadelphia
Sarah Tronco, CMHIMP, is a 
Philadelphia Nutrition Coach specializing in mental nutrition. Sarah offers individualized mental health nutrition coaching that empowers you to make sustainable changes to improve your overall well-being.

Menstrual Phase

The beginning of your menstrual phase happens when your period arrives and, on average, spans five days. The uterus is shedding its lining through the vagina during this time.  This marks the lowest level of estrogen during our cycle. You may be feeling more solitary at the beginning of this phase. As estrogen increases during this week, often we experience increases in energy, improved mood, and more of a desire to be around others.

Follicular Phase (aka the Proliferative Phase)

The follicular phase overlaps with the menstrual phase, since it begins at the start of your period and spans until ovulation. The purpose of this stage is to prepare an egg to be released, which it does by producing follicle stimulating hormone, or FSH. FSH sends a message to the ovaries letting them know to ready an egg to be released from the ovary, known as ovulation. Fluid filled sacs called follicles are contained in the ovaries, and the largest, dominant follicle produces estrogen during growth and is released during ovulation. The average length of the follicular phase is 10-22 days.1 This stage is also known at the proliferative phase because increasing estrogen levels result in the proliferation of the endometrial lining of the uterus.2 Your mood may feel more calm as estrogen has continued to increase during this stage of your cycle.

Ovulation

Beginning around two weeks into your menstrual cycle, luteinizing hormone levels increase due to high levels of estrogen and cause ovulation when the dominant follicle bursts and releases a mature egg into a fallopian tube.3 The phase generally takes place about 14 days before the beginning of the next menstrual phase. Estrogen and testosterone are highest at this point in your cycle, which cause you to feel more aroused as your body tries to get pregnant.

Luteal Phase

The fourth and final stage of your menstrual cycle is the luteal phase, which spans the latter half of your menstrual cycle and lasts approximately 14 days. During this time, the released egg is making its way through the fallopian tubes toward the uterus. You experience a spike in progesterone and estrogen during this phase. Pregnancy will occur if your egg is fertilized by a sperm. However, if this doesn’t happen, then estrogen and progesterone decrease and your body sheds the endometrial lining of your uterus during your next period. During this stage, you may feel increasingly more lethargic or have difficulty focusing. Some women experience negative mood symptoms, such as sadness or irritability. During the luteal phase, you experience a drop in serotonin, which may contribute to feeling of sadness prior to menstruation.4

Nutrition Coach Philadelphia Sarah Tronco, CMHIMP, is a Philadelphia Nutrition Coach specializing in mental nutrition. Sarah offers individualized mental health nutrition coaching that empowers you to make sustainable changes to improve your overall well-being.

 

 

References:

  1. https://helloclue.com/articles/cycle-a-z/the-menstrual-cycle-more-than-just-the-period
  2. https://progyny.com/education/fertility-101/follicular-phase/
  3. https://www.verywellhealth.com/the-menstrual-cycle-3520919
  4. https://www.blackmores.com.au/womens-health/how-your-menstrual-cycle-affects-your-mood
  5. Photo by Andrés Gómez on Unsplash

Cortisol, Stress, and Overall Nutritional Health

Cortisol is our body’s primary stress hormone. Our levels of cortisol fluctuate throughout the day, with morning typically being when we have our highest levels of cortisol with a decrease throughout the rest of the day. The changes in our cortisol levels throughout the day is known as diurnal cortisol slopes.1

What is the function of cortisol in the body?

In the context of mental health, we often associate cortisol with stress, however, it plays a role in many essential bodily processes, such as our immune response, regulating blood sugar, metabolism, and decreasing inflammation. Cortisol belongs to a group of steroid hormones, known as the glucocorticoids, and is produced from the two adrenal glands found on top of each kidney.2 Throughout your body, almost every cell has cortisol receptors, so cortisol’s function varies depending on the type of cell receiving it.3

Nutrition Coach Philadelphia
Sarah Tronco, CMHIMP, is a 
Philadelphia Nutrition Coach specializing in mental nutrition. Sarah offers individualized mental health nutrition coaching that empowers you to make sustainable changes to improve your overall well-being.

When cortisol levels are too high…

When we face a stressful situation, our body experiences a hormonal response, including the release of cortisol in the body. The function of cortisol release is to help the body prepare for fight or flight response (check out my post Soothing the Stressed Amygdala). However, when our lives are full of stressors that don’t necessarily warrant a fight or flight reaction, the frequent release of cortisol can cause issues over time, including gastrointestinal problems, cardiovascular disease, immune system suppression, fertility issues, weight gain and obesity, and blood sugar imbalance and diabetes.2

Managing stress

Certain lifestyle changes, such as incorporating meditation, having a social support network, and exercising, are important for managing stress levels. Being mindful about food choices is another essential tool for caring for yourself, reducing stress, and regulating cortisol. For instance, making sure you are hydrated, choosing black or green tea instead of other caffeinated beverages, incorporating probiotics and prebiotics, dark chocolate, and avoiding excess sugar are all ways to support a healthy stress response.4

Nutrition Coach Philadelphia Sarah Tronco, CMHIMP, is a Philadelphia Nutrition Coach specializing in mental nutrition. Sarah offers individualized mental health nutrition coaching that empowers you to make sustainable changes to improve your overall well-being.

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568897/
  2. https://www.todaysdietitian.com/newarchives/111609p38.shtml
  3. https://www.yourhormones.info/hormones/cortisol/
  4. https://www.healthline.com/nutrition/ways-to-lower-cortisol#TOC_TITLE_HDR_13
  5. Photo by Marcus Dall Col on Unsplash

Staying at the Edge of Uncertainty & Anxiety

When we get into a situation that feels uncertain, most of us will immediately try to get to a place of certainty.

Instead of writing a blog post, I’ll find myself wanting to check emails or my favorite websites.

Instead of having a difficult conversation, we’ll stay in a crappy situation for longer than we need to.

Instead of putting our art out into the world, we’ll hide it in the safety of obscurity.

When things feel chaotic and overwhelming, we look for a system that will feel ordered and simple.

All of us do this in most areas of our lives. Sometimes, we are able to voluntarily stay in uncertainty, but those times are relatively rare, and usually we don’t like it so much.

Here’s the thing: the edge of uncertainty and chaos is where we learn, grow, create, lead, make incredible art and new inventions.

The edge of uncertainty is where we explore, go on adventures, get curious, and reinvent ourselves.

The edge of uncertainty is where we can find unexpected beauty, love, intimacy, vulnerability, meaning.

Everything we truly crave is at the edge of uncertainty, but we run from it.

The trick is to stay in it.

An anxiety disorder can interfere with your everyday life including work, school, and relationships. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and phobia-related disorders. There are several types of anxiety treatment boulder. To learn more contact WellTalk. Anxiety Disorder Boulder.

The Edge of Anxiety, Not Deep in the Pit

I say the “edge of uncertainty” because most of us are unprepared to be fully in uncertainty without some kind of ground under our feet. We need some certainty, some safety. Without it, we feel like we’re spinning out of control.

When our lives become untethered, we need some kind of ground to stand on. When we’re lost in depression or trauma, we need to feel the ground of our basic goodness, of knowing that there are others here with us.

So I don’t recommend letting go of all certainty. Let your life be mostly stable.

But once you have a little stability, let yourself get to the edge of uncertainty.

It’s the place where you’re learning, but not completely lost. Where you are exploring, but not freefalling. Where you’re creating something new, but not without some grasp of what came before you.

Stay at the edge, and then let yourself rest in some kind of comfort. Go to the edge, then come back and take a breather.

How to Train at the Edge

If you’d like to get good at staying in uncertainty, I highly recommend daily training.

And no, it’s not enough to say, “My life is all uncertainty, I’m already doing it!” I mean, that’s probably true, but it’s not deliberate practice. It’s what’s happening to you, but you’re not deliberately training to stay at your edge.

So I recommend daily deliberate practice:

  1. Set aside a time. It’s not usually helpful to say that you’ll do it sometime. You already have enough of those things in your life, adding one more won’t be helpful. So pick a time and set multiple reminders.
  2. Pick something you’re avoiding or feel overwhelmed/afraid of. Writing that book or report, marketing, giving honest feedback, dealing with new technology, making calls, recording videos, etc. It should make you feel somewhere around a 7 out of 10 resistance. Have a good reason to do this task, not just because it’s hard. Are you doing it for something meaningful to you? For someone you care about?
  3. Do it for a short time. Just 10 minutes is fine, or 15. Work up to 30 minutes a day. You just need to stay there a little while, not forever.
  4. Learn to embrace the uncertainty. Notice how you feel like doing something else. Let yourself feel the uncertainty, as a physical sensation in your body. Let yourself stay there, but bring curiosity instead of complaint to the uncertainty. See if there can be any kind of openness, gratitude, even joy in the middle of the uncertainty.
  5. Be kind to yourself. Notice if you’re beating yourself up about not doing more or doing better, and let go of some of that. Be kind. If you’re trying to force yourself to do something you hate, give yourself encouragement. Cultivate a friendly attitude toward yourself in this training.

It also helps to have accountability, or to do it with others (on a video call, for example).

An anxiety disorder can interfere with your everyday life including work, school, and relationships. There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, and phobia-related disorders. There are several types of anxiety treatment boulder. To learn more contact WellTalk. Anxiety Disorder Boulder.

12 Ideas for Establishing a Calming Routine

One of the most rewarding changes in your life can be finding peace with a morning routine.

I’ve made it a habit to wake before most of the world, at about 4:30 a.m., and just enjoy the quiet and solitude.

It has made all the difference in the world.

I sit quietly with a cup of coffee, and enjoy the silence. I go for a morning run, which relieves stress and is perfect for contemplation. I use the quiet time before my family awakes to write something each morning. I read, as a good novel is one of my favorite companions.

Now, not everyone is a morning person, of course. But that doesn’t mean you can’t create your own routine, one that incorporates something that gives you solitude, quiet, or stress release. While morning is an ideal time for such a routine, other ideal times are after work and before bed — and really, any time that works for you is good.

I recommend that if you haven’t yet, you create your own calming routine.

Give it a couple of weeks to become a habit, focusing on doing it every day, and soon, you will not want to miss it.

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Do you feel down? Have you lost interest in things you used to enjoy? Are you critical and judgmental towards yourself? We can help you find the Inner Path that can lead you out of your depression.

Here are just a few ideas to get you started:

  1. Morning coffee. If you’re not a coffee person, tea or cocoa work great as well. Sit and enjoy the silence as you wake up, and even better, watch the sun rise. It’s the perfect way to greet the day.
  2. Exercise. I like to go on an easy run. It relieves stress, and gives me time to myself to think, and enjoy nature. Evening runs are great too, especially as the sun goes down. If you’re not into running, walking, cycling, swimming, or really any exercise works well. Just take it easy in the beginning, and try to do a little every day. Don’t overdo it.
  3. Meditation or yoga. I haven’t been meditating on a regular basis, but when I do, it’s so calming, and so centering. You don’t need to do anything formal — simply focusing on your breathing, as it goes in and out, is a good meditation. While I’ve never been into yoga, I know a lot of people who swear by it, and I would recommend you give it a try if it sounds appealing to you.
  4. Gratitude session. This is one of my favorite rituals: every day, take a couple of minutes to think about everything and everybody you are grateful for in your life. This may sound corny, but it is an amazing ritual. Try it right now — it only takes a minute. Who are you grateful for? What are you grateful for? I’ve found that this little ritual has so much power that it makes me happier and more compassionate. Btw, every time I do it, I thank the people who donated and helped me become a giant step closer to my dream (that’s you guys!).
  5. Goal mantra. This is another one of my absolute favorites. I got the idea from Guy Kawasaki, who tells us that corporate mission statements are basically useless, and recommends you create a corporate mantra instead of three or four words (tops). So instead of creating a corporate mantra, I created a personal mantra to remind myself of why I do everything I’ve been doing this year (with the blog, all my writing, and some new projects that are coming up, including an e-book). Here it is: Liberate Yourself. And I just make sure to repeat this mantra at least once a day (if not several times). It helps me stay focused. I suggest you do the same for your personal mission.
  6. Evening review. I think this would be an especially fruitful routine for anyone. Basically, it’s a routine that Ben Franklin did himself: he would spend some time at the end of each day to review how he did with his goal, and reflect on how his day went. It only needs to take a few minutes, but just go over your day, think about your goal (your mantra), what you did to further that goal, what you did right and what you did wrong today, what you can improve, what you need to do in the future. If you want to journal this, it would be even better!
  7. Bath time. My home doesn’t have a bath tub, but I truly cherish a long hot bath. If you have the time to do this, it can be extremely relaxing.
  8. After work unwinding. Long day at work? Stressed out? Take 30 minutes to unwind. Some great ideas for that: a 20-30 minute nap, snuggling with your kids, deep breathing, stretching, self-massage, or really anything that relaxes you.
  9. Pre-bed ritual. Another ideal time for a calming routine is just before you go to bed. You can do any of the calming things mentioned in the other items, or just develop a routine: get clothes ready, get lunches ready, clean up, brush teeth, decide on your three Most Important Tasks (MITs) for tomorrow, etc.
  10. Journaling or writing. A morning writing ritual is a good thing, but you can do a writing ritual at any time that works for you. Or instead of writing, try journaling. It can be very productive and relaxing.
  11. Conversation. Try this: every night for an hour, just sit and talk to your spouse. Share the highlights and lowlights of your day, talk about your goals, your finances, your relationship, movies, music, books. This can, of course, be adapted for conversation with your children.
  12. Reading time. Ah, one of my favorites. Take time each day to spend with a good book. Or a trashy novel. It doesn’t matter. I actually like to take time in the morning and evening, but whatever time is convenient for you will work.

How to Do the Thing You’re Avoiding

Most of us have something on our task list we’re avoiding or a project we’ve been putting off.

Think for a moment: what’s the task or project you’ve been avoiding lately?

Some possibilities:

  • That report you don’t want to write
  • Your book or blog you’ve been meaning to write
  • The business you’ve been wanting to create for years
  • Your garage you’ve been meaning to declutter
  • That email that’s been sitting in your inbox for a month
  • Going for a run

So what is it you’ve been avoiding? Identify it now before you move on.

In this article, we’ll look at why you’re avoiding it, and how to actually do the thing.

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Do you feel down? Have you lost interest in things you used to enjoy? Are you critical and judgmental towards yourself? We can help you find the Inner Path that can lead you out of your depression.

Why We Avoid the Thing

We often spend our days doing everything but the hard thing we don’t want to do.

We’ll research something to death instead of actually just doing the thing. We’ll talk about it, read about it, buy all the equipment for it, but not actually do the thing. We’ll do our email, messages, small tasks, and check social media or the news — just real quick! — instead of doing the thing.

Why? We’re protecting ourselves from uncertainty. We don’t want to feel like we don’t know what we’re doing. We don’t want to look stupid. We don’t want to feel overwhelmed, we don’t want to feel like we’re not good enough, we don’t want to feel like a failure or disappointment.

We’re protecting ourselves from feeling that. So we do everything else, out of protection.

And of course, it doesn’t work. Avoiding doing the thing actually just makes us feel more overwhelmed, more like a failure or disappointment, more stupid or not good enough.

Avoidance doesn’t actually work.

So how can we stop avoiding, and actually do the thing?

How to Actually Do the Thing

We do the thing by deciding to do the thing. Like, deciding decisively to do it.

We have to pause for a moment and actually consider that we’re avoiding something – which is what I asked you to do at the beginning. Did you do it then? We usually don’t want to face that fact, so it can help to have someone else to talk to about it, to report to, to commit to. Every day, tell someone what hard thing you’re going to do, and by when. Then report to them the next day, right before you tell them what you’re going to do that day.

Decide to do it, and then don’t waver. Don’t let yourself argue about it. When you decide to do it, just commit and do it.

Do it at a certain time: tell your accountability buddy you’re going to do it at 10am, or whatever works best. Set a reminder. Do it when the reminder goes off.

Psyche yourself up, if it helps. Play some pump-up music, get some tea, clear distractions, and then pour yourself into it. Do a countdown: 5-4-3-2-1 and then do it!

Do it with someone else. Meet someone for a focus session on a video call at a certain time, and tell them what you’re going to do for the next hour, while they tell you when they’re going to do. Set a timer, don’t talk, just work. When the timer goes off, report to each other how it went. Repeat daily. Save these focus sessions for the thing you’re avoiding.

Get into the action habit. The habit of recognizing what you’re avoiding, turning towards it (instead of away from it), and then just starting.

Get small victories. Small victories are incredibly powerful. Avoiding doing a big task? Do 5 minutes of it. Do 10 minutes. Eventually, doing an hour of it will be much easier, but do the smallest possible chunk, and get a victory. Celebrate it! Do a dance, acknowledge yourself. Then get another victory.

With practice, the habit of doing the thing you’re avoiding can become so much easier. Use these techniques to get there.

Healing from Narcissistic Abuse

If you’ve decided to read this article, it’s perhaps because you, or someone you know, is trying to heal in the aftermath of a toxic relationship. Or maybe you have been wondering how to leave a toxic relationship and how you will be able to heal.

Whatever drew you to read this article, I want you to know that you are not alone, and that healing from being with someone abusive, is possible.

Let’s start by defining what narcissistic abuse means.

It’s a new term in our colloquial language, and it’s been used more and more to describe people who show a pattern of self-absorption, emotional superficiality, lack of empathy or concern for the needs of others, a high sense of self-Importance, a strong need to be admired and adored, and strong abilities to manipulate others in order to get their needs met. Sound familiar?

Boca Raton Therapy
Christiane Blanco-Oilar, Ph.D., ABPP is a Board Certified Counseling Psychologist, specializing in Boca Raton Therapy. Dr. Blanco-Oilar has expertise in helping you through life transitions, grief and loss, intimacy issues, relationship difficulties and in supporting your goal to achieve vibrant relationships with yourself and others. She also provides therapy in Spanish.

Partners or children of those who fit the narcissistic spectrum often have a chronic feeling of not being good enough, they also suffer from self-doubt and spend large amounts of time and energy trying to device ways to change who they are because they feel if they change for their partner, then they will receive love and respect they yearn for. The thing is, that after years of being with a partner or a parent with narcissistic tendencies, we are starved; starved of the experience of feeling lovable and worthy. Because with a narcissist what we do will never be enough, years of being criticized, undermined, minimized, insulted and rejected will chip away at our self-esteem and sense of worth. The result: we become a shell of who we used to be (in the case of years with a narcissistic partner), or if we grew up with a narcissistic parent we simply never were given a chance to develop a sense of self-worth or self-esteem in the first place.

Victims of narcissistic abuse often come to therapy feeling chronically depressed, unable to leave their partner even though they realize the relationship causes them great pain. Or, they come to therapy deeply depressed and/or anxious, riddled with insecurities and engaging in ample self-sabotaging in their lives, in the case of having been raised by a narcissistic parent. All too often victims will blame themselves, will wonder what they can do to change who they are as they believe what they’ve been told for years: that they’re not good enough.

Healing is a process of shifting our perspective.

When we are raised by a narcissistic parent, or after years of being with a narcissistic partner, our entire focus is on our relationship with the narcissist. We are worried almost exclusively about how to please them, how to make them happy, and how to become good enough based on their definitions of what good enough means (which often changes) imposed on us. As such, in order to heal, we have to shift our focus from the narcissist, to ourselves. We all have a relationship with ourselves, similar to the relationships we have with others. When we are in a narcissistic bond, we abandon ourselves completely. We ignore our needs, we abandon our likes, our desires, our preferences, and absorb the narcissist, as this is the only way that a narcissist will last in a relationship: they have to be the center of that relationship. The healing process, thus, will involve a look at the one and only thing we can change in the situation: ourselves. But this time, the change is not about pleasing the narcissist…the change is an internal change veered towards your own needs, your own goals in life, your own Self. This is the hardest because after years of abandoning yourself, you may not know where to even begin. You may have lost sight of, or never had a chance to even find out, your true Self.

It is time to reflect.

What are your values? What are your likes and dislikes? What makes you feel passionate? What are you interested in? What is unique about you? What are you really good at? What inspires you and makes you motivated in life? In those answers, lie the answers to who you are, that no one can take away from you.

Working with your individual therapist can help you find ways to reconnect with yourself, and ways to empower yourself to make decisions in your life that are in line with your values, your preferences, and your own sense of what makes you happy. Therapy can also help you gain insights as to how it is you found yourself in a toxic relationship so you can have more compassion for yourself, and also a better sense of the red flags to look out for your future relationships. Finally, individual therapy can help you establish a healthy relationship with yourself, which will ensure that in the future you will only accept mutually nurturing and healthy relationships with others.

Trauma Therapy, how does it work?

A therapeutic approach in treatment planning has focused on the initial healing of individuals who have survived Post-Traumatic injury. A consultation, and comprehensive assessment of the client can direct that individual to an improved and motivated quality of life journey.

Though the integration of theory, intervention, insight and to multi-cultural awareness, my goal emphasis has been on clients who are dually diagnosed, complex developmental trauma and psychological effects such as secondary trauma, emotional conflicts, self-medication, substance use to recovery and wanting life back.

Claire Vines, PsyD. is Doctor of Psychology, DAPA practicing in Rancho Mirage, CA in the greater Palm Springs area. She specializes in Couples Therapy Virtual Counseling Counseling Rancho Mirage. Contact her today to schedule an appointment.

I apply strategic attachment trauma, TF-CBT, Psychodynamic, EBP, groups and combination approaches to an emotional directed model towards the discovery. Self validation and externalization through forms of creative expression are also applied.Initial consultations identify the presenting issues. Following sessions focus on the deeper pathway to coping, healing and nurturing the authentic self.

Emotional regulation, balance, self-awareness of internal conflicts between thoughts and feelings, can begin to reduce symptoms of acute distress, uncomplicated post traumatic and other factors surrounding anxiety, panic & depression, developed personality disorders such as Borderline, Depersonalization, mood disorders and dissociation.

While we can’t remove traumatic events, we can work together to better manage the reflections of injurious memories. “When you remember a past event, you’re actually remembering the last time you remembered it, not the event itself”.

Trauma-focused cognitive behavioral therapy (TF-CBT)

TF-CBT is a components-based treatment model that incorporates trauma-sensitive interventions with cognitive behavioral, family, and humanistic principles and techniques. TF-CBT has proven to be effective in addressing Post-traumatic Stress distress, depression, anxiety, panic, startled responses, externalizing behaviors, sexualized behaviors, feelings of shame, rage, fear and mistrust.

Attachment-Trauma Therapy

Attachment-Trauma Therapy, will treat developmental injuries and complex developmental trauma, formed or maintained negative interpersonal relationships, personality disorders such as Borderline personality, moods dysfunctions such as dissociation, self medication and other paths of destruction related to loss, traumatic events or the witnessing of violence. Self-medication and other paths of destructive self-behavior related to loss, traumatic events or the witnessing of violence.

Trauma Therapy

Trauma Therapy is composed of multidimensional interventions, while the focus is on post-traumatic stress, panic, startled responses, depression and manufactured emotions such as, guilt, embarrassment or shame related to abusive emotional associations of reminders to trauma, distortion of events and a negative view of the self, others and the world.

Claire Vines, PsyD. is Doctor of Psychology, DAPA practicing in Rancho Mirage, CA in the greater Palm Springs area. She specializes in Couples Therapy Virtual Counseling Counseling Rancho Mirage. Contact her today to schedule an appointment.

Author: Claire Vines, PsyD. – Doctor of Psychology, DAPA
Photo: Pexels

What is a website builder?

Looking for a therapist website builder?

Website builders are tools that typically allow the construction of websites without manual code editing. They fall into two categories:

  • online proprietary tools provided by web hosting companies. These are typically intended for users to build their private site. Some companies allow the site owner to install alternative tools (commercial or open-source) — the more complex of these may also be described as content management systems.
  • offline software that runs on a computer, creating pages and which can then publish these pages on any host. (These are often considered to be “website design software”, rather than “website builder”.)

Online website builders

typically require customers to sign up with the web hosting company. Some companies provide examples of fully functional websites made with their website builder. The range of services varies anywhere between creating basic personal web pages or social network content to making complete business and e-commerce websites, either template based or, on the more flexible platforms, totally design free.

The main advantage of an online website builder is that it is quick and easy to use, and often does not require prior experience. Often, a website can be built and be up and running live on the Internet quickly. Technical support is usually provided, as are how-to video and help files.

HTML tools are divided into those that allow editing of the source code and those that only have a WYSIWYG mode.

Offline web builders cater to professional web designers who need to create pages for more than one client or web host. Modern offline web builders are usually both WYSIWYG and allow direct editing of source code and cascading style sheets (CSS) styling. They generally require at least a basic understanding of HTML and CSS. Although they are more flexible than online builders, many proprietary offline website builder software can be expensive, however, there are also many open-source website builders.

The first websites were created in the early 1990s. These sites were manually written in HTML.

Over time, software was created to help design web pages: e.g. Microsoft released FrontPage in November 1995.

By 1998, Dreamweaver had been established as the industry leader; however, some have criticized the quality of the code produced by such software as being overblown and reliant on tables. As the industry moved towards W3C standards, Dreamweaver and others were criticized for not being compliant. Compliance has improved over time, but many professionals still prefer to write optimized markup by hand.

Open source tools were typically developed to the standards and made fewer exceptions for the then-dominant Internet Explorer’s deviations from the standards.

The W3C started Amaya in 1996 to showcase Web technologies in a fully featured Web client. This was to provide a framework that integrated many W3C technologies in a single, consistent environment. Amaya started as an HTML and CSS editor and now supports XML, XHTML, MathML, and SVG.

GeoCities was one of the first more modern site builders that didn’t require any technical skills. Five years after its launch in 1994 Yahoo! purchased it for $3.6 billion. After becoming obsolescent, it was shut down in April 2009.

Looking for a complete and fully supported therapist website builder?

Unstuck: Create a New Path for Yourself

Sometimes it can feel like we’re stuck in life, doing the same things we’re unhappy with, over and over again.

Maybe you’ve been procrastinating on your meaningful work, or getting stuck in indecision or perfectionism. Maybe you’ve been putting off exercise or meditation, getting your finances in good shape, or making some other important change in your life.

Depression Treatment Raleigh
Do you feel down? Have you lost interest in things you used to enjoy? Are you critical and judgmental towards yourself? We can help you find the Inner Path that can lead you out of your depression.

We get stuck.

I’ve been stuck many times — and it turns out there’s always a way through the stuckness. It’s not turning away from the stuckness, but turning towards it. Going through it. Embracing the stuckness, and letting it unstick itself.

I’m going to talk about a few principles of getting unstuck, and creating a new path for yourself. And then talk about recommendations for changing your habits this year, or getting good at doing your meaningful work.

Ways to Get Unstuck

There’s no one way to do this, but I’ve found some things are incredibly helpful:

Turn towards the difficulty. If you’ve been avoiding thinking about a difficult project, or your messy finances or messy clutter, or your exercise or diet or other health issues … not much will change until you turn towards it and face it. A willingness to turn towards the difficulty and work with it is one of the most important requirements to change.

Make a decision & set an intention. If we want something different to happen, we have to decide to make a change. It’s as simple as that, and yet what happens is we get stuck in an in-between state, where we want to change but we haven’t made a clear decision to do so. A clear decision means we let go of all of the “should I do this or maybe not?” kind of self-talk, and just commit to the decision fully. And then we set an intention: what would we like to do?

Be compassionate with yourself.

When we keep doing the same things over and over again, we can get really down on ourselves. We get disappointed, discouraged, frustrated, and form a negative self-image. Trust me, I know this well! And yet, none of that helps us get unstuck — it only adds to the stuckness. So what would it be like to be kind to ourselves instead? That doesn’t mean we don’t try to change … it just means we stop adding self-discouragement to our list of challenges. Or at least, if we do, we start adding encouragement and compassion.

Do it with others. Most people try to get unstuck and make a change by themselves. This feels safer. But it means you’re doing something tough on your own — which can work sometimes, but often doesn’t work. I’ve found it incredibly powerful and effective to do it with others. Find a group, do a challenge, get accountability, find a wolf pack to run with. You will find that it helps to not be alone, and to get support when you feel like giving up.

Set a time to practice with it, and keep up the practice. It’s funny how often we say we’re going to do something, but then don’t commit to a time. Make a date with yourself to do it. Or make a date with someone else to do it with them! Keep practicing with it, daily if possible, and you’ll see gradual change.

Small victories, slow change, amazing progress. Focus on small victories at first. I told myself I just had to lace up my shoes and get out the door. I increase very gradually. In a year, I went from not being able to run 10 minutes, to running my first marathon. Gradual change equals huge progress over time.

Progress, not perfection. You’re not trying to be perfect at this. You’re trying to trend in the right direction. Missed 4 days of meditation last week? Focus on the 3 days you did do! Keep making progress, and let go of small misses.

These are some of the most helpful things you can bring to any changes you want to make. Now let’s talk about two ways to change your life I’m offering.

Change Your Habits This Year

I’m committed to helping people get good at changing habits this year. If you get good at the skills of changing habits, you can eventually change your entire life.

We’re spending this year practicing habit skills and changing a range of different habits.

Get Good at Doing Meaningful Work

If you’ve been wanting to get good at doing your meaningful work, but feel stuck … I offer a training in getting unstuck and actually taking action.

The Effect of Oxidative Stress on Mental Health

Understanding oxidative stress is important because we are exposed to many environmental and dietary stressors that can contribute to an imbalance in our body that impacts overall health. Oxidative stress is defined as “a disturbance in the balance between the production of reactive oxygen species (free radicals) and antioxidant defenses.” 1 Oxidative stress occurs when your body has an imbalance of antioxidants and free radicals. Free radicals, or reactive oxygen species (ROS), are molecules that contain oxygen and have an uneven electron number, making them highly reactive with other molecules and able to cause large chain chemical reactions. When these reactions occur, they can be either harmful or beneficial.2

Free radicals are created endogenously during the metabolic process. Exogenous causes of free radicals occur from exposure to toxins such as pollutants in the environment, certain drugs, heavy metals, cigarette smoke, certain styles of cooking, radiation, alcohol, and chemical solvents.3 When ROS are formed excessively, it can cause oxidative stress which leads to cell damage and, eventually, cell death. In response to this, cells have a network of antioxidants that scavenge the excess ROS.4

Nutrition Coach Philadelphia
Sarah Tronco, CMHIMP, is a Philadelphia Nutrition Coach specializing in mental nutrition. Sarah offers individualized mental health nutrition coaching that empowers you to make sustainable changes to improve your overall well-being.

Does Oxidative Stress Affect Mental Health?

The link between oxidative stress and mental health is still being explored, though we know that when the brain has oxidative damage, it causes impairment to the nervous system. Oxidative stress appears to play a role in anxiety disorders, high levels of anxiety, and depression. 5 Animal studies have helped to demonstrate the role of oxidative stress in anxiety-like behaviors. 6 In addition to anxiety and depression, oxidative stress is implicated in mental health issues like schizophrenia and bipolar. 7

Nutrition and Oxidative Stress

Research suggests that diets high in carbohydrates and animal proteins, as well as excessive fat consumption, produces ROS, which subsequently leads to oxidative stress.8 Many healthy foods can help to protect your body from damaging effects of ROS. Incorporating antioxidant rich fruits and vegetables can protect you from cancer as well as reduce mortality, so find ways to incorporate foods rich in vitamin C, beta carotene and vitamin E can help to support your overall health.9

References:
https://pubmed.ncbi.nlm.nih.gov/10693912/
https://www.healthline.com/health/oxidative-stress
hindawi.com/journals/omcl/2017/8416763/
https://www.hindawi.com/journals/omcl/2013/956792/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763246/#:~:text=High%20O2%20consumption%2C%20modest,disorders%20and%20high%20anxiety%20levels
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964745/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964745/
https://www.hindawi.com/journals/omcl/2018/9719584/#conclusions
https://www.news-medical.net/health/Foods-that-Reduce-Oxidative-Stress-and-Prevent-Cancer.aspx
Photo by Yoann Boyer on Unsplash

Anxiety treatment NYC: How To Help A Child Struggling With Anxiety

Childhood anxiety treatment is one of the most important mental health challenges of our time. One in five children will experience some kind of clinical-level anxiety by the time they reach adolescence, according to Danny Pine, a child and adolescent psychiatrist at the National Institute of Mental Health and one of the world’s top anxiety researchers. Pine says that for most kids, these feelings of worry won’t last, but for some, they will — especially if those children don’t get help.

Anxiety Treatment NYC

Carolyn Ehrlich, LCSW specializes in treatment for anxiety. Anxiety is best described as the unhelpful thinking patterns we experience when our mind fixates on threat, uncertainty and negativity. I can provide the tools to help you build resilience during difficult times.

Here are six takeaways that all parents, caregivers and teachers can add to their anxiety toolkits, including information on how anxiety works, how parents can spot it and how to know when it’s time to get professional help.

1. Anxiety is a fear of the future and all its unpredictability.

“The main thing to know about anxiety is that it involves some level of perception about danger,” says Pine, and it thrives on unpredictability. The mind of an anxious child is often on the lookout for some future threat, locked in a state of exhausting vigilance.

We all have some of this hard-wired worry, because we need it. Pine says it’s one of the reasons we humans have managed to survive as long as we have. “Young children are naturally afraid of strangers. That’s an adaptive thing. They’re afraid of separation.”

Full-blown anxiety happens when these common fears get amplified — as if someone turned up the volume — and they last longer than they’re supposed to. Pine says separation anxiety is quite common at age 3, 4 or 5, but it can be a sign of anxiety if it strikes at age 8 or 9. According to research, 11 is the median age for the onset of all anxiety disorders.

A bundle of factors contributes to a child’s likelihood of developing anxiety. Roughly a third to half of the risk is genetic. But environmental factors also play a big part. Exposure to stress, including discord at home, poverty and neighborhood violence, can all lead to anxiety. Research has shown that women are much more likely than men to be diagnosed with an anxiety disorder over their lifetime and that anxiety, as common as it is, appears to be vastly underdiagnosed and undertreated.

That’s why it’s important for parents, caregivers and teachers to spot it early. Be on the lookout for how long anxious feelings last. A few weeks, Pine says, usually isn’t a cause for concern. “It’s really when it goes into the one- to two-month range — that’s where parents should really start … worrying about it.”

Here’s another red flag: “Are there things that the child really wants to do or needs to be doing, and they can’t do those things?” asks Krystal Lewis, a colleague of Pine’s and a clinical researcher at the National Institute of Mental Health who provides therapy to anxious children. “If you feel you’re hitting a wall in terms of trying to get the child to do those things, that might be another indicator that potentially, you know, we should get some help.”

2. Be on the lookout for the physical signs of anxiety.

The worried feelings that come with anxiety can seem hidden to everyone but the child trapped in the turbulence. That’s why it’s especially important for grown-ups to pay close attention to a child’s behavior and to look for the telltale signs of anxiety in children.

Anna, of Brampton, England, remembers when her 7-year-old son started having trouble at school. (We aren’t using parents’ full names to protect their children’s privacy.)

“He was just coming home and saying his stomach hurt. He was very sick,” Anna says. When she followed up with him to try to get to the root of his stomachache, she says, “he did tell me he was worried about school, and he told me specifically it was a teacher that he was worried about.”

A stomachache, headache or vomiting can all signal anxious feelings, especially as a child gets closer to the source of the anxiety.

“You’ll see that they’ll have a rapid heartbeat. They’ll get clammy, you know, because their heart is racing,” says Rosemarie Truglio, the head of curriculum and content at Sesame Workshop. “They’ll become tearful. That’s another sign. … Anxiety is about what’s going to be happening in the future. So there’s a lot of spinning in their head, which they’re not able to articulate.”

It’s near this point of panic that Pine says a child’s anxiety is most visible: “So you can see it in their face. There is a certain way the eyes might look. You can see it in behavior in general. People tend to either freeze, be inhibited not to do things when they’re anxious, or they can get quite upset. They can pace. They might run away.”

Rachel, of Belgrade, Mont., says her 6-year-old son really doesn’t want to swim or go to their local splash park.

“He just says there’s too many kids in there. And he cries, and I’ve tried to go early in the morning when there’s no one there. I mean, I’ve lost count of how many times we’ve driven by just to see if I could get him out of the car and he won’t. And I’m not going to drag him.”

We heard this from so many parents: My child is terrified to do something that I know won’t hurt them, that they might actually enjoy. What do I do?

3. Before you try to reason with a panicked child, help the child relax.

“You’re not going to be able to move forward until you get them to calm down,” says Sesame’s Truglio. “Because if you can’t calm them down, you can’t even reach them. They’re not listening to your words because they can’t. Their body is taking over, so talking and shouting and saying, ‘You’re going to do this!’ is not very helpful.”

How do you break through this kind of panic? We recommend the Swiss Army knife in the mental health toolkit: deep belly breathing.

Now that you’ve managed to calm down your child, it’s time for some anxiety treatment.

4. Validate your child’s anxiety.

We heard from lots of parents who say they really struggle to know how to respond when their kids worry about unlikely things — especially if the fear is getting in the way of a busy daily routine, maybe a fun family outing or sleep.

“She comes down. It’s 2 a.m. And she wakes me up,” says Amber, of Huntsville, Ala., about her 8-year-old daughter. “And she said, ‘I don’t want to go away to college. I want to live at home for college.’ And it’s 2 a.m. … That’s when I really have to filter and not say, ‘That is ridiculous. This is not a big deal!’ ”

Amber’s filtered response was exactly right, says Truglio. Never dismiss a child’s worries, no matter how irrational they may seem. A parent’s priority, she says, should be “validating your child’s feelings and not saying, ‘Oh, you know, buck up. You can do this!’ That’s not helpful.”

Lewis, of the National Institute of Mental Health, has language for parents who in the moment may feel frustrated by a child’s behavior:

” ‘I know that you’re feeling uncomfortable right now. I know these are scary feelings.’ You want to personify the anxiety, and so you can almost say, ‘You know what, we know that this is our worry brain.’ ”

Lewis says it’s crucial that children feel heard and respected. Even if you’re pretty certain aliens aren’t going to take over the planet tomorrow, if your child is worried about it, you need to let your child know that you respect that fear.

5. Help your child face their anxiety.

This is the fine line every parent, caregiver and teacher must walk with a child struggling with anxiety. You must respect the child’s fear, but that does not mean giving in to the fear.

“I think our initial reaction when we see an anxious child is to help them and protect them and not to push them or encourage them to do the things that they’re afraid of,” Pine says. But, he adds, one of the things researchers have learned from years of studying anxiety in children is “how important it is to face your fears.”

This might be hard for some parents to hear, but we heard it from every expert we interviewed. As to why it’s important to face your fears, Lewis says, “the more that you avoid or don’t do certain things, it’s almost implicitly teaching the child that there is a reason to be anxious or afraid if we’re not doing the things that are difficult. It’s sending this message that, ‘Oh well, there is potentially a dangerous component to this.’ ”

So it’s important, Lewis says, “that children understand that things are gonna be difficult in life. Things can be scary. We can do them. … I tell some of my patients, ‘You can feel scared. That’s OK. We’re gonna do it anyway.’ ”

And Truglio agrees. While we do have to validate our kids’ feeling of fearfulness, she says, “we can’t always give in to this feeling. … You need to push them a little bit. And there’s this fine line: You can’t push so far, because that’s going to break them, right? They’re going to fall apart even more.”

How do we grown-ups find that fine line?

6. Build confidence with a baby-step plan.

Helping kids come up with a plan to face their fears is Lewis’ job. It’s called cognitive behavioral therapy, and a big part of that is exposure therapy.

Lewis says she once worked with an 8-year-old who was terrified of vomiting.

“We did a lot of practice, which included buying vomit spray off Amazon and vomit-flavored jelly beans,” she recalls. “We listened to all types of fun vomit sounds using YouTube video. We did a lot of practicing up to the point where we created fake vomit, and we were in the bathroom and just pretending to vomit.”

And Lewis says that baby step after baby step, the girl made important progress.

“One of her peers had vomited in the classroom. And she comes into session, and she was just like, ‘Someone vomited in my class, and I ran to the corner of the classroom’ and was just like, ‘I didn’t leave the classroom!’ … She was very proud of the progress she was making. In the past, she would have run out of the classroom to the counselor’s office and then missed school for, like, the next week.”

Lewis says parents can use rewards to celebrate their kids when they make progress — think small but meaningful rewards like letting your child pick dinner that night or the movie for family movie night.

BY COREY TURNER

IMAGE BY Lindsey Balbierz

A Guide to the Basic Anxiety and Depression of Life

Underlying much of what we do is an uncertainty, an anxiety, a fear, doubts, dissatisfaction, and ultimately depression.

And we react to these anxieties, dissatisfaction and uncertainty in so many unhelpful ways: we seek distraction, we eat unhealthy food, we procrastinate, we get caught in a cycle of anxiety and unhappiness, we lash out at others, we dwell in our loneliness, and then we get in denial about it all and become depressed.

Depression Treatment Raleigh
Do you feel down? Have you lost interest in things you used to enjoy? Are you critical and judgmental towards yourself? We can help you find the Inner Path that can lead you out of your depression.

If we could learn to deal with the basic anxiety of life, we would have much more ease and less struggle.

The Anxiety Underneath Our Problems

On Twitter, I asked people to share a problem they’d like me to write about, the problems were all very difficult, but the basic anxiety of life was the undercurrent to all of them.

Each one has an external problem, with the undercurrent of anxiety, fears or uncertainty underneath the external problem. Let’s take a look at a few:

Feeling of being left out, lack of belonging: We can all relate to this feeling of not belonging. Externally, the problem is not finding people you connect with, not having that connection in your daily life. But on top of that, we add the anxiety/dissatisfaction of feeling like we’re left out and don’t belong. This is normal, but it’s good to notice.

Finding your passion, optimizing potential: The external problem is that you are in a job you’re not passionate about. On top of that is the anxiety/dissatisfaction of not finding that passion, of feeling like we’re not optimizing our potential. We can all relate to this too!

The phase of anxiety before big changes occur: The external issue is that we’re facing a big change, and then because it’s a situation filled with great uncertainty, we feel anxiety about it.

Beginning/purchasing self improvement books/classes/plans and not using them: The external problem is not finding the time or energy to use materials you’ve bought, but we add to that an anxiety about ourselves not living up to our potential, not taking advantage of opportunities, not doing what we hoped we’d do. I think we can all relate to this.

Addiction to social media, videos and cell phone: The external problem is the distractions that keep pulling our attention. But the anxiety is that we feel addicted and feel something is wrong with us for not being less distracted. In addition, the addiction is probably a coping mechanism for dissatisfaction with the moment in front of us, or anxieties in other parts of life.

PTSD — Post Trump Stress Disorder: A lot of people are coping from dissatisfaction with the political scene right now, no matter what your views on the president might be. There’s the external situation of what’s going on, and then we add our dissatisfaction, anxieties about uncertainty, frustration and anger.

Depression – Sometimes feel helpless & empty for a reason I can’t identify. Only time makes that go away but I feel that time was wasted: There’s probably an external situation that’s causing a feeling of uncertainty, anxiety, dissatisfaction and/or helplessness. But the real problem is the feelings about it all, the uncertainty and anxiety about it all, and the anxiety about wasting the time it takes to get over it.

Getting over breakups: The external problem (end of a relationship) is overshadowed by the pain, dissatisfaction, anxiety that follow the breakup. We might have frustration and anxiety about wanting it not to have ended, about not wanting to be alone, about how we feel about ourselves after being dumped, about how the other person acted.
I think we can all relate to these problems, to not only the external situation but the reactions that we have.

There’s a fundamental anxiety and dissatisfaction that runs through the human condition, about whatever we’re experiencing in life, about other people and about ourselves.

So how do we deal with it all?

Where Does Basic Anxiety Come From?
It’s good to start by recognizing why we have this basic anxiety. It’s caused by:

Uncertainty about life, about the current situation, about people
Wanting certainty, stability when life isn’t stable or certain
Dissatisfaction with the above facts — which is also dissatisfaction with our situation, ourselves, and others.

If you sit right now for 5-10 minutes and just pay attention to your breath, you’ll likely notice the fundamental anxiety, it results in wanting to stop paying attention to the breath, wanting the meditation to be over, wanting to get on with the tasks of life, wanting distraction, thinking that the exercise is stupid, wanting to think about problems you have.

But instead of running from this anxiety, instead of getting away from it into thinking about problems or getting out of the meditation, what if we just stayed with it and paid attention to it?

If we can get in touch with this fundamental anxiety that we suffer through in life, we can start to work with it.

Learning to Deal with Basic Anxiety and Depression

Instead of running from the anxiety and depression, instead of trying to cope by using distractions, food, shopping, alcohol, drugs, we’re going to find the courage to face it, with a smile.

Here’s how to work with it:

Face the physical feeling. Drop out of the story that’s spinning around in your head, that’s causing the anxiety. Instead, just be mindful of how your body feels. What does the anxiety feel like, and where in your body is it located?

Stay with it & be curious about it. Don’t run, just stay with the physical feeling. Instead of rejecting it and wanting it to stop, just open up to it and see it with curiosity. What does it feel like? Does it change? What kind of reaction does your mind have to the feeling?

Smile at it. Develop a feeling of friendliness towards the physical sensation of this anxiety. See it as one of the fundamental realities of your existence, and learn to be friends with it. See this as a chance to work with something that will be with you for your entire life, an opportunity to get comfortable with this discomfort. If you can do that, you’ll need your coping mechanisms a lot less.

Open to a bigger space. Our normal way of relating to this feeling is wanting to reject it, because we’re stuck in a small-minded, self-centered way of seeing it (I say this without judgment, it’s just something we do). Instead, we can start to touch the wide-open space of our minds, like a big blue sky, not a small space but expansive. In this open space, we can hold the anxiety like a cloud against the backdrop of the blue sky, but not be lost in the cloud. We can see the anxiety but also see that like a cloud, it’s temporary, it’s not that solid, it’s not all-encompassing, and it’s just floating by. This wide-open space of our mind is always available to us.

It’s that simple, and yet it’s not always easy. Sometimes the anxiety we feel is small, just a bit of tightness in our chest once we investigate it. But sometimes it’s quite big, a looming depression or a manic energy that we just can’t tolerate. So face it in small doses, just for a minute, just for a moment. Then let yourself run. Continue to work with it in small, tolerable doses until you start to trust that you’ll be OK if you face it and smile at it.

Once we start to touch on this anxiety and depression, face it with courage, stay with it like a good friend would, we start to realize it’s not so bad. It’s just something that comes up, like a ripple in a pond, like a breeze in a field, and it will go away. We don’t need to panic, we don’t need to run, we can relax, invite it to tea, and see that nothing else is required. Instead, we stay, we give it love, and see that this place of uncertainty we’re in is absolutely perfect as it is.

Are You Sabotaging Your Relationships?

Warning signs that you might be sabotaging a good thing

You meet someone new and happily date for a little while. The connection is great, there is chemistry, and sex is fun. You start spending more and more time together and begin considering becoming a couple. But then, you stop replying to their texts right away. You cancel dates. You avoid talking about taking things to the next level. Your partner expresses frustration, disappointment, or even anger about your behavior. Not long after, the partner breaks up the relationship.

Does this sound like something that happens to you? If so, you might be self-sabotaging your relationships.

Christiane Blanco-Oilar, Ph.D. offers compassionate psychological services for individuals and Couples Therapy Boca Raton. I enjoy working with individuals and couples going through life transitions, relationship challenges or identity exploration, or those experiencing grief and loss, depression, anxiety, postpartum depression and eating disorders. My goal is to help you recognize, understand and have compassion for how you may have developed less-than-ideal ways of dealing with specific areas of your life.

Why We Self-Sabotage

The specific reasons why someone may self-sabotage relationships are context-specific. Every person has had a different past: parenting, childhood, teenage years and first serious relationships all have an effect on how we act right now.

One of the main reasons why people sabotage their relationships is fear of intimacy. People are afraid of intimacy when they fear emotional or physical closeness with other people.

Everyone wants and needs intimacy, but in people with certain experiences, intimacy may be linked to negative rather than positive experiences, leading to a “push-and-pull”-type behavior that leads to a relationship breakup or avoidance.

Fear of intimacy typically comes from difficult or abusive parental relationships and childhood trauma (physical, sexual, emotional). The deep, embedded belief in people who fear intimacy is: “people who I am close to cannot be trusted”.

Because early trusting relationships with parents or caregivers were broken by abuse, people who fear intimacy believe that people who love them will inevitably hurt them. As children, they could not extricate themselves from these relationships; however, as adults, they have the power to end or leave them, even when they are not inherently abusive.

This fear appears in two types: fear of abandonment and fear of engulfment. In the first, people are worried that those they love will leave them when they are most vulnerable; in the second, people are worried that they will lose their identity or ability to make decisions for themselves. These two fears often exist together, leading to the “push-and-pull” behavior so typical of those with deep fears of intimacy.

Signs Of Self-Sabotage In Relationships

There are many signs that you might have a tendency to self-sabotage even the best of relationships. Here are some of the most common.

You always have an eye on the exit

You avoid anything that leads to bigger commitment: meeting parents, moving in together, etc. You’re always wondering: “if it goes wrong, how can I extricate myself easily from this relationship?” Because commitment reduces your ability to leave a relationship without financial or emotional consequences, you tend to avoid it.

You gaslight your partner

Gaslighting is a form of emotional abuse whose aim is to deny the other person’s reality or experiences. For example, if your partner says: “I’m really upset that you canceled our date”, you respond with something like: “You’re not really upset, it’s your fault I canceled and you’re just trying to blame me for it.” Gaslighting is a sign that you don’t really believe your partners’ feelings are valid or real (even though they are).

You are known as a “serial dater”

Your friends often ask you why you break up with potential partners so often or lament the fact that you never seem to “settle down” with anyone. You break up with partners on the slightest of issues, only to start dating another person right away and repeat the cycle. You don’t want to be seen as a “player” but you can’t seem to find someone who you can commit to.

You are paranoid or extremely jealous

You always worry that your partner might be seeing someone else behind your back. You demand control over every aspect of their life and require constant contact. When they spend time with other people without you, you fret, text constantly, experience jealousy, and ask for proof that they’re being faithful. They break up with you because they find you controlling.

You criticize everything they do

You constantly look for perfection in a partner, even though you know perfection is impossible. You find fault with every little thing they do, from the way they cook to the clothes they wear. You are impossible to please, and your partner eventually gives up trying and breaks up with you.

You avoid facing problems

You spend a lot of time trying to convince yourself that the relationship is perfect, even when it’s not. When your partner wants to address a problem, you avoid the topic or simply say: “I don’t think we’re having an issue; it’s going to go away.” Your partner grows resentful of your inability to face problems together and leaves.

You have sex with other people

While in some cases having sex with other people is okay when both people agree to non-monogamy, in general, going from affair to affair can be a sign of self-sabotage. You’re doing one of the most hurtful things you can do to a romantic partner in the hopes that they’ll find out and leave you.

You always tear yourself down

You always talk about yourself in self-deprecating ways: “I’m not as smart as you”, “I’m just an idiot, why are you with me?”, “You’re just with me because you pity me”, etc. This is a sign of low self-esteem, and most people do not enjoy being told that they love someone who is worthless. When, despite their constant reassurance that you are a good person, you keep tearing yourself down, they give up and break up.

These are just a few examples of how people with a fear of intimacy might sabotage their relationships. Note that many of them are abusive: things like gaslighting, paranoia and control can damage the other person. People with these patterns have childhood trauma and don’t know how else to act.

Ending Self-Sabotage

To end self-sabotage, you first need to take a good, hard look at yourself and your behavior patterns. Unless you are willing to be honest with yourself and face all the ways you may have abused or hurt other people because of your fear of intimacy, you are doomed to repeat it.

Therapy is the first step many take to end their self-sabotaging patterns. A professional can help you identify your behaviors, dig to the root of your issues, and find new, healthier ways to behave.

In general, a few things are important to uncover when ending self-sabotage.

What is your attachment style?

Attachment theory is a framework that explains patterns of behavior with intimate others. The ideal type of attachment is “secure”: this is when people feel like they can trust others and remain a distinct individual, even in close relationships.

However, childhood experiences can lead to anxious, avoidant, or disordered attachment styles: these are the ones that cause issues in adults trying to develop strong relationships and families. The good news: you can work with a therapist on developing a more secure style by facing your fears and removing false beliefs about relationships.

What are your triggers?

Fear of intimacy and self-sabotage can remain dormant until a trigger wakes them up. It might be words, actions or even places. Knowing what triggers your fears will help you either avoid them or work on them so they don’t trigger you anymore.

Do you confuse the past with the present?

One of the main problems of self-sabotaging is that we behave in the present as if the current situation was the same as one in the past. It can be childhood or past adult relationships. Learning to say: “that was then, this is now” can help you make decisions that are based on the present, rather than reacting blindly based on what happened to you in the past.

Can you talk about these issues?

One of the hallmarks of self-sabotage and fear of intimacy is the inability to talk about your feelings and your problems. You avoid talking about these things because talking means feeling, and you want to avoid feeling these things at all costs. Expressing your emotions, your fears and your needs will not only help you identify the problems but will also help others understand you better.

Get The Help You Need

Remember that it’s okay to get help. Seeking therapy, or simply a kind and friendly ear is the first step towards freeing yourself from self-sabotaging behaviors in relationships. Be kind to yourself and accept that everyone needs help once in a while.

By Anabelle Bernard Fournier

Finding Mindfulness in an Age of Depression & Anxiety – Depression Treatment Raleigh

Depression Treatment Raleigh

We live in uncertain times.

Actually, things have always felt uncertain to the people who live in those times, but these days it might feel even more heightened, with the hyperconnectivity of the internet, social media and constant messaging, comparing ourselves to everyone else, and a very tense, divisive political situation (not just in the U.S., but in many countries).

It’s enough to drive anxiety through the roof for many people and depression seems to be a huge problem for many people we work with. Anxiety & depression seem to be on the rise, or at least it can feel that way to many.

So what can we do to deal with this anxiety & depression?

There isn’t one simple solution, but there are some habits we can form to help us cope — even thrive — in the middle of chaos and uncertainty.

Depression Treatment Raleigh
Do you feel down? Have you lost interest in things you used to enjoy? Are you critical and judgmental towards yourself? We can help you find the Inner Path that can lead you out of your depression.

The Causes of Anxiety

In short, our anxiety is caused by uncertainty. It’s a feeling of alarm, of stress, of fear or even slight panic, when things feel unsettled, constantly shifting, out of control.

We feel this kind of “out-of-control”, all the time at some level which can lead to hopelessness and depression. There are times when this feeling is heightened:

  • We lose our job or feel like our job is unstable
  • We get into deep debt or feel like our finances are out of control
  • Someone we love has a crisis (like health crisis)
  • We get sick
  • There’s a death in the family
  • Someone we can’t stand gets elected to the leadership of our country (this has happened in multiple countries, I’m not talking about anyone in particular)
  • You move to a new home in a new city

 

You get the idea — they’re all times of heightened uncertainty, and so the feeling of anxiety starts to increase.

The thing is, if you go through just one of these things, it’ll increase stress and maybe anxiety, but then if things calm down, you have a chance to recover. But if you’re constantly going through these kinds of things, it doesn’t give you a chance to recover. You’re constantly in a fragile state, and everything becomes more stressful.

The key is not to eliminate uncertainty and stress in your life, but instead to increase your resilience by allowing yourself to feel grounded even in the middle of a stressful, uncertain event. Then things become not such a big deal. They might stress you out a bit, but they won’t be the end of the world.

Six Habits that Lead to Mindfulness

The basic habits that lead to this kind of resiliency, and a feeling of groundedness, are things you can practice every single day:

Let ourselves feel it.

When we’re feeling uncertainty, instead of rushing to solve it … or to distracting ourselves or comforting ourselves with food or shopping … we can let ourselves feel the uncertainty. I’m not talking about engaging in a narrative about what the uncertainty is like and why it’s so bad — but instead feeling it physically in your body. Where is the feeling located in your body? Can you give it some attention and curiosity? Can you stay with it for a few moments? This habit of letting ourselves feel the uncertainty and stress is transformative — every bit of anxiety becomes a place to practice, an opportunity to be present with ourselves. It becomes a chance to create a new relationship with our experience.

Learn that it’s OK to feel groundlessness.

You are feeling anxiety & depression because of the uncertainty of your situation. But that’s because uncertainty becomes a reason to freak out. What if, instead, we learned that this groundless, uncertain feeling is actually just fine? It might not be completely pleasant, but it’s nothing to panic about. In fact, it can be an opportunity to find joy and appreciation in the groundlessness — what is there to appreciate in this feeling of complete openness? Start to shift how you see and react to this groundlessness, embracing it rather than panicking about it.

Give ourselves love.

In the middle of stress and uncertainty, instead of engaging in our old habits of shutting down or avoiding, of worrying and fretting, can we try a new habit of giving ourselves love? This is a way of being compassionate and friendly with ourselves, no matter what we’re doing. It’s like giving love to a child who is in pain — the compassion and love pour out of our hearts. Can we practice this for ourselves?

Simplify by being fully present with one thing.

We have so much going on that it can all be overwhelming. Can you simplify by focusing on just one thing right now? Trust that you’ll take care of the other things when it’s needed. Instead, be fully present with this single task. It can be something important, like working on that writing that you’ve been putting off for days. Or it can be something small, like washing this one dish, or drinking this one cup of tea. Be fully with it, and savor the experience fully. This leads to a feeling of groundedness, and helps us to not feel as frazzled.

Find the joy in being fully present and savoring.

The item above, of simplifying by doing one thing, can feel like quite a shift for many of us. It might feel like sacrifice, not constantly switching tasks and being on social media and checking phones. But it can be a way of opening up to the moment, treating yourself with a little focus, joyfully savoring whatever you’ve chosen to do with this moment of your life.

Learn to love being resilient.

Resilience is a matter of saying “No Big Deal” to any kind of uncertainty that arises, of savoring and being present, of giving ourselves love and being present with whatever uncertainty is coming up for us. Resilience is not blowing everything up to End of the World level, just because it’s not under control. Resilience is feeling grounded in the middle of chaos (even if there’s stress present), and finding a joy in being in that uncertainty. Resilience is taking a breath and then savoring that breath. It can be a wonderful thing, if you learn to love it.

For Men Only – Men’s Mental Health

At A New Day Family Counseling, we understand the challenges men face today to improve their mental health.

Men typically engage in fewer health-promoting behaviors, have fewer social supports, possess less effective behavioral responses to stress, and use fewer health care services than women. Men are 4 times more likely than females to die from suicide attempts (Centers for Disease Control and Prevention, 2010). Men with depression are more likely to turn to alcohol and drugs. Men are also more likely to allow anger to be expressed freely without acknowledging other’s feelings and are not likely to ask for help in managing anger. Finally, young men engage in more risky behaviors and are increasingly likely to engage in those behaviors over time (Mahalik et al., 2013).

Untreated mental health problems tend to get worse over time and can lead to serious consequences including addiction, incarceration, destroyed relationships and damage to physical health. Fortunately, with the right treatment most mental health problems are resolved within a relatively short period of time and result in an increased ability to cope with future challenges, improve relationships and improve contentment in life.

Beginning the therapy process is a sign of strength and takes courage.

As E.E. Cummings penned, “It takes courage to grow up and become who you really are.” In recent years, I have had the experience of seeing many more men access mental health services. My heart is touched by these men, who recognize their need for help and allow themselves to take a risk to open up emotionally and be vulnerable in ways that they may never have been before. These men have accessed services for a variety of reasons including divorce or a separation, relationship problems, illness or injury, or for help with addiction, anger, trauma or anxiety and depression. Additionally, fathers have sought help with understanding their children’s needs as they develop or to adapt to the challenging task of parenting. I have also had the experience of seeing young men challenge traditional gender roles and try out new behaviors that would have been shamed or made fun of many years ago. As a result, old gender roles thankfully are changing. The new world demands equality between the sexes in the workplace, in relationships and in child rearing. I believe that these changes are helping men become more satisfied with their relationships and themselves.

A New Day Family Counseling Plainfield, IL  believes in healing not only individuals but attends to the healing of the whole family.  After all, our family relationships are the most important human connection we will have and have the power to hurt or heal us.   We take a collaborative, family-centered approach and use brief, solution-focused and evidence-based treatment methods.  Our therapists listen deeply, empathically and non-judgmentally and seek to understand your feelings and beliefs to help create a new and empowering story about who you are. We will teach you how to identify old, limiting beliefs that interfere with your relationships, your sense of purpose, and inner peace. We will work on healing that unhealthy relationship with yourself so that you may embrace a new one that is whole, genuine, and resilient.  And, we will work on restoring your family relationships with authentic, safe and healing communication, teaching the art of compromise, and restore bonding and attachment that has been challenged by difficult times, loss, trauma, emotional injuries, addiction and mental health issues.

We offer individual counseling for adults, teens and children, family counseling, couple/marital counseling.  We also offer Telehealth services.  We treat anxiety, depression, bi-polar disorder, chronic anger, personality disorders, women’s issues, trauma, grief and loss or coping with stress or inevitable changes in life that challenge us in so many ways. We will assist your family with blending, parenting, step-parenting, and coping with and addressing behavioral and emotional issues and disorders including ADHD, autism, developmental disorders, and mood disorders. We provide help to couples and families suffering from relationship problems, intimacy issues, divorce, physical and mental illness,  loss, or trauma.

We provide counseling services to Plainfield, Romeoville, Shorewood, Joliet, Oswego, Naperville, Yorkville, Bolingbrook, and Aurora and the surrounding areas in Will County, IL. Gwen Ginski, MEd, LCSW

While I have been fortunate to observe these exciting changes in men, it is still true that many men hold on to old, rigid and restrictive stereotypes. These stereotypes have a negative impact on men’s mental and physical health and can be very destructive in family relationships. Men often believe that they must handle problems by themselves and fear that they may seem weak or that others will find out that they are struggling. Boys often socialized from a very early age by their parents, peers, and teachers to “toughen up” and not cry. These norms are further shaped and reinforced by the work force, where emotions are not recognized or denied and men are expected to fulfill a variety of roles that may endanger their emotional well-being.

Some men become so enthralled in the pursuit of a “masculinity ideal” that requires that they have to continuously prove their power, strength and vitality.

These men continually practice norms in the pursuit of wealth, dominance, success, power, status and superiority. On the other end of this spectrum are the men who do not have the access to resources to prove this so-called masculinity and turn to anti-social behaviors in pursuit of this same ideal. This can lead to “Toxic Masculinity” which results in macho behavior, promiscuity, workaholism, authoritarianism and even violence. Toxic Masculinity ultimately results in a loss of internal strength, confidence and stability and leads to interpersonal and emotional problems, and even legal problems.

Men sometimes believe that the best way to handle emotions is to avoid them or bottle them up.

If a man experiences a crisis, which undoubtedly happen in life, whether it be a loss, a divorce, or another difficulty in life, he may not have the ability to process through the intense emotions that go along with these life experiences. As a man, you deserve to be happy and have satisfying healthy relationships. Seeking help for yourself is a sign of great strength. It is much easier to deny and avoid facing problems than it is to take an active step towards improving yourself and your mental health. Reach out and find a therapist that fits your needs and circumstances. Most therapists will provide a free consultation to see if they are a good fit for you. In the meantime, take care of your physical health and don’t compare yourself to others. Remember that everyone copes differently and your coping is not a reflection on your worth as a man. Allow family and friends to support you and ask for that support. Some family members or friends may not be able to be there for you, but some will. Try not to take this personally. Seek out people who can support you! Contact A New Day Family Counseling

Gwen Ginski, MEd, LCSW

Resources for Men

Headsupguys – A self-check to help men determine if they are experiencing symptoms of depression headsupguys.org/mens-depression/self-check/
Alcohol Use Disorders Identification Test (AUDIT) – A self-check tool to screen for unhealthy alcohol use, defined as risky or hazardous consumption or any alcohol use disorder www.audit.org
Anxiety Screening Tool – psychologytoday.tests.psychtests.com/
ManTherapy – A public office campaign that offers information about mental health to reduce the stigma www.mantherapy.org

Understanding Alcoholic Neuropathy – Addiction Counseling Westwood New Jersey

Alcoholic neuropathy is one of the most common and least recognizable consequences of heavy alcohol use. People with a long history of alcohol misuse might experience pain, tingling, weakness, numbness, or loss of balance as a result of alcoholic neuropathy.

Signs and Symptoms of Alcoholic Neuropathy

Signs and symptoms of alcoholic neuropathy can progress gradually, and they are usually subtle at first. Often, a person who drinks heavily might not recognize that the symptoms are related to alcohol or to neuropathy. For addiction counseling Westwood New Jersey. Signs and symptoms include any combination of the following:

*Deceased sensation of the toes, feet, legs, fingers, hands or arms

*Pain, tingling or other unusual feelings in the toes, feet, legs, fingers, hands or arms

*Weakness in the feet or hands

*Lack of coordination of the feet or hands

*Loss of balance/unsteadiness when walking

*Bruises, cuts, sores or skin infections on the toes, feet, or fingers

*Decreased pain from injuries, especially on the feet or hands

*Dizziness, particularly when standing with eyes closed

*Trouble walking a straight line, even without recent alcohol use

*Constipation or diarrhea

*Urinary incontinence

*Sexual dysfunction

Effects of Alcoholic Neuropathy

Alcoholic neuropathy is a nerve disease caused by excessive alcohol consumption over a long period of time. The effects of alcoholic neuropathy are caused by nerve damage and fall into four main categories; decreased sensation, pain/hypersensitivity, muscle weakness, and autonomic.

Decreased Sensation

Alcoholic neuropathy damages sensory nerves, resulting in decreased sensation of the hands and feet. This may not sound like a terrible problem, but diminished sensation actually causes very serious consequences.

Pain and Hypersensitivity

Another prominent effect of alcoholic neuropathy involves painful and uncomfortable sensations. Alcoholic neuropathy can result in hypersensitivity to touch and/or resting pain. Light touch can feel exaggerated and painful, particularly in the fingers and toes.

Constant pain in the hands or feet is one of the most bothersome aspects of alcoholic neuropathy. The pain can feel like burning, throbbing, or sharp pins and needles. As the condition progresses, the pain may vary in intensity, sometimes diminishing for months at a time before worsening again.

Muscle Weakness

For addiction counseling Westwood New Jersey, severe alcoholic neuropathy may cause motor weakness due to nerve damage. Our muscles need to receive a message from nearby nerves in order to function. When this message is interrupted due to damaged nerves, the muscles cannot function as they normally would. This most often manifests with weakness of the hands and feet.

Autonomic Neuropathy

Autonomic nerves control functions of the organs of the body, such as the bladder, stomach, and intestines.2

Alcoholic neuropathy can weaken the autonomic nerves, causing impairment of bowel and bladder function and sexual dysfunction.

Dr. Gerald Opthof has been providing addiction counseling Westwood New Jersey for individuals, couples and families for over 20 years. His practice is built on connection, relating to his clients as whole people and not just the problems they are facing. He offers strategies built on his professional knowledge, experience, and the perspective that he has gained from his own life challenges. Also specializing in Marital counseling Westwood New Jersey.

Causes

In general, it takes years for alcoholic neuropathy to develop, so a long-standing history of heavy alcohol use is typical. Some heavy alcohol users experience a faster onset and progression of alcoholic neuropathy than others. It is not completely clear why some people are more prone to this complication than others.

Alcoholic neuropathy is caused by nutritional deficiency, as well as toxins that build up in the body. Alcohol decreases absorption of nutrients, such as protein and vitamin B12, causing significant deficits that affect many areas of the body, including the nerves. Alcohol also alters the function of the stomach, liver, and kidneys in ways that prevent the body from properly detoxifying waste material, which then builds up and harms many regions of the body, including the nerves.

Nerve damage typically affects the axons, which are the projections that send electrical signals from one nerve to another, as well as the myelin, which is the fatty coating that protects the nerves. Nerves do not have a resilient ability to regenerate if they are severely damaged. The nerve damage of alcoholic neuropathy may be permanent if the damage has been taking place for a long period of time or if it persists.

Diagnosis of Alcoholic Neuropathy

The diagnosis of alcoholic neuropathy involves a combination of medical history, physical examination, and possibly blood tests or nerve tests such as electromyography (EMG) and nerve conduction studies (NCV).

Physical examination: A complete physical and neurological examination tests reflexes, muscle strength, sensation (including light touch, pinprick, vibration and position sense), and coordination. Usually, people with alcoholic neuropathy have diminished reflexes and diminished sensation. In very advanced disease, weakness may be present too.

Electromyography (EMG) and nerve conduction studies (NCV): These tests examine nerve function in detail. Characteristic patterns, such as decreased function in the hands and feet, low amplitude of nerve waves, and slowing of nerve function, are suggestive of alcoholic neuropathy. The nerve tests do not identify the cause of neuropathy, only the extent of nerve damage.

Nerve biopsy: In rare instances, a doctor may suggest a nerve biopsy, which can show a pattern of nerve damage consistent with alcoholic neuropathy.

Other tests: Additional assessments might include blood tests, urine tests, or imaging studies of the brain or spinal cord to rule out other causes of neuropathy symptoms.

Treatment of Alcoholic Neuropathy

There are several medical treatments that can be used to manage the pain of alcoholic neuropathy. These include pain medications and antidepressants. While not specifically approved for the treatment of alcoholic neuropathy, antidepressants are often prescribed to help control the pain. Similarly, anti-seizure medications: As with antidepressants are sometimes prescribed as a way to manage pain.

Since nutritional deficiencies are partly to blame for alcoholic neuropathy, supplementation with vitamin B12, folate, vitamin E, and thiamine may be recommended.

There are no medications that can help improve loss of sensation, strengthen the muscle weakness, or aid the coordination and balance problems caused by alcoholic neuropathy. However, some people notice an improvement in symptoms a few months after discontinuing alcohol intake for addiction counseling Westwood New Jersey

Sometimes alcohol causes such severe damage to the body that a liver transplant may be necessary. In that case, there may be some improvement in the symptoms of alcoholic neuropathy after the liver transplant,4 but often, the neuropathy is so advanced that there may be little, if any, improvement, even after a transplant.

Alcohol use disorder is a challenging condition. The medical community has recognized that addiction is a disease and that some individuals are born with a tendency to become addicted to substances. Thus, it is usually necessary to get medical help to managing alcohol use disorder.

Some of the symptoms of alcoholic neuropathy can be partially reversed, but if the neuropathy becomes advanced, it might not be reversible. Medication can help in reducing some of the symptoms of alcoholic neuropathy. The most important strategy against alcoholic neuropathy lies in preventing the symptoms from getting worse by decreasing alcohol consumption as soon as possible.

By Heidi Moawad, MD, and medically reviewed by Huma Sheikh, MD

Photo: Pexels

What America Can Learn from Couples Therapy

The principles of good communication for Couples Therapy Palo Alto could also apply to divided Americans.

At family gatherings, in bars and restaurants, relatives and friends are shouting at each other instead of engaging in what used to be called political discussions. These high-volume, emotionally charged exchanges are also increasingly the norm in venues ranging from local governments to national ruling bodies across the world.

These shout-fests might remind you of a bad marriage—and we think there is some truth in that. We are clinical psychologists who are couples therapists and researchers who evaluate the benefits of interventions with couples. We do not have answers to urgent questions about how to bridge political and cultural chasms, but we do know a thing or two about how to help two people reduce the conflict in their relationship. What are the principles backed up by both research and clinical experience of working with couples who have unresolved differences? How have they been useful in helping Couples Therapy Palo Alto communicate more effectively about issues on which they disagree? And can these insights be applied to healing political divisions?

We do not assume that Democrats and Republicans—or politicians attempting to negotiate Britain’s exit from the European Union, or Russians debating the power of Vladimir Putin—will suddenly pay attention to these principles. Rather, we offer these ideas with modesty, in hopes that individual readers may find them useful in de-escalating tensions with family and friends with different political and social ideas. While you can’t control what other people believe or how they behave, there are steps you can take to make your conversations more productive.

1. Try to understand their perspective
Before meeting up with someone we expect to disagree with, most of us either think about how to avoid the topic, or we act like lawyers preparing for a trial. We give a great deal of thought to presenting our point of view in a convincing way and to considering the weaknesses and absurdities in the other person’s arguments. While some of this preparation is adaptive, studies suggest that we might find such conversations less troubling and more effective if we took the time to try to understand the perspective of the other person. If the person is someone you know, you can try to reconstruct their side of an argument as best you can. If the person comes from a group with an identifiable point of view, you can examine written material or information from social media that presents the other’s point of view effectively.

Why does all this work? If you can demonstrate that you can understand accurately what the other person is saying, and if you can find some areas of agreement, the other person is more likely to feel heard. And feeling heard tends to reduce the repetition, frustration, and rise in volume that occurs when the other person concludes that you are not listening, you have misunderstood what they have been trying to say, or you are just not very clever!

A more general approach to preparing for a discussion that may get heated is to practice staying in the moment—what is now often called mindfulness. Research suggests that we can reduce the biases that often fuel disagreements by building moment-to-moment awareness of our thoughts, feelings, and surroundings through practices like meditation. Mindfulness can make us more cognizant of the mental shortcuts we take when judging others and help us react less intensely when we feel threatened or upset.

2. Try to confide, not attack or avoid
Dan Wile, a nationally known couples therapist, has pointed out that when we disagree or are upset with each other, there are typically three stances that each person can take: We can avoid, attack, or confide.

Most often when we anticipate a conflict, we tend to engage in avoidance—not raising the issue at all, or stating only a small part of the issue. This may keep the temperature from rising, but it does nothing to resolve disagreements, reduce simmering tension, or formulate actions to solve problems collaboratively.

When one person is on the attack, the most likely response from the other is to fight back or withdraw. This is understandable, but, like avoidance, it does little, if anything, to convince the other to entertain a new idea.

Robert Levenson and John Gottman have been pioneers in studying conflict between opposite-sex and same-sex partners while both are hooked up to equipment that measures their physiological arousal and distress. One of the important findings of this research is that as the disagreement escalates, both partners show sharp increases in physiological arousal, but that for one partner (more often the female), the arousal quickly returns to baseline, while for the other, arousal and distress remain high (more often the male).

This discrepancy tends to result in escalating conflict in which the high-arousal partner attempts to hide the feeling (stonewalling) while the lower-arousal partner is engaged in attempting to solve the problem. When this happens, the problem is that the stonewaller is still upset and their partner is frustrated at the lack of verbal response. Gottman further describes what he considers to be the “four horsemen of the apocalypse.” In addition to stonewalling, he points to criticism, contempt, and defensiveness as emotional nightriders that come along to destroy intimate relationships.

Wile suggests that a more productive strategy is for each person to confide rather than attack or avoid. Confiding involves letting the other person know that you are worried about raising this issue, or that you can see some of the weaknesses in your own arguments or some strengths or at least reasonableness in the other person’s point of view. This confiding style enables people to disagree while maintaining a more collaborative conversation.

For more information about Couples Therapy Palo Alto, please go to my therapist website & contact me.

3. Make it safe for people to confide in you
OK. It’s easy for us to say that a collaborative strategy will be more productive for both people than an avoidant or attacking stance. But how can we achieve this ideal when we feel passionately about our personal or political beliefs?

There are positive communication strategies we can use to encourage disclosure and collaboration and result in both parties feeling they are being heard. Some of the points we list come from the research on the “Speaker Listener Technique” by Scott Stanley, Howard Markman, and Galena Rhoades, who have shown how couples who take turns at being speaker and listener—not interrupting to get a new point across—and who follow some of the suggestions below show improvement in their relationship over time. They coach Couples Therapy Palo Alto to:

Make short statements. Arguments get out of hand when a large number of ideas are presented all at once before allowing a response.

Slow the conversation down. Especially as we get upset, we tend to talk faster and rush past points when we feel that little blip in the gut that signals hurt, anger, or anxiety.

Take time to make sure we understand what the other person is saying. We often assume that we know what the other person means and that what they are saying is either misinformed, wrong, or intentionally hurtful. Instead of walking away or attempting to contradict what sound like errors or even lies, we recommend what may be a counterintuitive step—interviewing the other person carefully to ask more about what they mean.
Use “I” statements that describe what you feel and believe, not “you” statements that characterize the other person’s intentions. (A sentence such as “I feel that you are hostile” is not an “I” statement.)

4. If conversation gets hot, take a break
No matter how well we prepare for an argument or follow good communication guidelines, sometimes our feelings or the other person’s emotions are triggered to the point where one of the four horsemen enters the scene. One or both become critical, defensive, or contemptuous—or go silent while continuing the conversation but not expressing upset. Under these circumstances, it becomes impossible to consider the other’s point of view. We want to underline the seemingly obvious point that people rarely modify their point of view when they are being criticized, shouted at, dismissed, or ignored.

Very often, one of the participants in a heated discussion wants to continue, hoping that in the end the other will see the logic of their point of view. Often the other person tries to get away by leaving the room psychologically or physically. Most couples therapists suggest that their clients agree to a “time out,” which gives both partners a chance to cool off.

But this won’t work unless both people agree on a time to resume the discussion in order to have a “recovery conversation” that is not derailed by feelings of helplessness and anger. That is, a recovery conversation can help to shift from a battle between two warriors, to an exchange between two people working together to address a difference or problem that concerns them both.

5. Don’t slide; decide
Some difficult conversations start because couples need to make an important decision. Stanley, Rhoades, and Markman report that many partners have reservations about what the other proposes, but choose not to express them. Or both partners simply slide into an option rather than struggle together toward a decision, even on important issues like moving in together, or having a baby, or basic values. It seems easier to agree to move in together rather than find two separate places after graduation. One partner may go along with the other’s desire to have a child rather than have a prolonged and difficult fight. Both may choose to keep quiet rather than discuss a serious disagreement about values or politics.

The problem is that down the road, sliders have a much harder time in their relationship than deciders do. Moving in together saves money, but may be premature in terms of the state of the relationship. The reluctant parent, having avoided a pre-baby argument, may now experience heightened levels of individual and relationship stress. Undiscussed value or political issues can lead to increased polarization and emotional distance.

Especially in facing big issues, we recommend that you take advantage of the strategies in steps one to four, rather than skirting around issues in order to avoid a stressful conversation. If you are able to tolerate listening respectfully to each other and slow things down before coming to any final conclusions, you may actually be able to discuss both of your points of view more directly. To lower the tension at the start of a discussion, we often suggest that partners take the tack that “this is a discussion, not a decision.” This often works in Couples Therapy Palo Alto and it might work for you when discussing a political issue on Facebook or at the dinner table. Who knows? Nationally, it might even help politicians and activists on opposite sides have more productive discussions with each other.

Can these steps help America talk again?
Imagine Republicans and Democrats on the floor of the United States House of Representatives or Senate arguing about a proposed new law—but this time our legislators are applying insights about how to resolve conflict between couples. A Republican speaker might address the assembled legislators this way:

I want to express my support for this bill, but I also want to acknowledge that my Democratic colleagues have some concerns about how the new law would operate. My understanding of their chief concern is that it will be difficult to enforce. Have I got it right?

Almost right. What’s missing is a specification of the administrative office that will administer enforcement. I know that my Republican colleagues are leery of creating bigger government, so how can we work together to address the enforcement problem?

And so on, toward compromise and resolution. It’s a nice thought experiment, though this is not how the current United States Congress operates. Getting members of Congress to adopt those guidelines might seem far-fetched—but we believe it is completely possible for ordinary people to follow them. The next time you find yourself disagreeing with an uncle or a neighbor about strongly held ideas and values, try taking some of these steps. You might not win the argument, but you can avoid some antagonism—while keeping your relationships strong.

BY PHIL COWAN, CAROLYN P. COWAN | JANUARY 29, 2020
https://greatergood.berkeley.edu/article/item/what_america_can_learn_from_couples_therapy

Photo: https://www.pexels.com/photo/human-hands-and-us-flag-2240293/

Online Counseling for Work Stress New York City

Online Counseling for Work Stress New York City

What does your reflection reveal?

There are times when we see parts of our character we don’t like. The moments are often fleeting, yet can be haunting.

Did I snap too harshly on the person again?

Was I too passive in the meeting as usual?

Am I too smothering to my child as my parents were to me?

Was it only about me yet again?

We worry, obsess, can’t sleep, or have dreams about this, and can even feel the part of us is right under the surface.

The symptoms are stress, anxiety, work burnout, isolation or depression. We then have to deny, rationalize or escape.

But we can change.

There needs to be a look into character, to study our contradictions, and to minimize balms of the day such as shopping, substances, tv, eating, or social media.

The combination of understanding intellectually and also acting and behaving and experiencing is what makes a person better. You study the self, identify distractions, and challenge the given.

It is a dual process: intellect plus experience.

Without it, we continue to be haunted. With a study of the self, we gain actionable insights, build real changes, and make a more fulfilling life.

When seeing your reflections, what do you do?

Not sure why parts of your character hold you back in your work? For Stress Counseling, Kearns Group helps individuals study the gap between goals and their achievement. Through a contextual counseling we reveal the stress that gets in the way and design strategies to better reach their achievement. Conveniently located in Greenwich Village near Union Square.

Telehealth Stress Counseling: Can it help you too?

Is your stress leading to poor sleep or irritability?

Do you occasionally get down or short tempered?

Realize things about yourself you want to change but find hard to do?

If you don’t get ahead of your mental health care, anxiety can creep up and turn into a bigger deal. It can then easily become a strained life of distraction, hiding, or escaping.

With Telehealth Stress Counseling, there is now a more dynamic and effective approach for change.

As a Mental Health Counselor for working professionals, I am amazed at the accessibility and efficiency of Telehealth Counseling.

People are able to identify work and personal issues more immediately, stay ahead of their stresses more flexibly, and strategically make better choices and build lasting results.

If you are a…

banker who feels even greater pressure to perform

startup employee whose company has pivoted yet again

See unwanted patterns in your relationships again

Or feel more isolated than ever during COVID

it’s time to stop going at it alone.

Get something that sparks you, or someone you care about, in a different way. A mental health approach that is convenient, effective, and helping more and more.

Reach out and connect to Telehealth online Stress Counseling you might like the way you feel.

Can Stress Counseling work for you?

We need to find something that sparks us in a different way to fight our stress. Work on the new recipe, write in the journal, or talk with an old friend.

The spark away from the stress is an assist in helping us get through the rough patch. Finding a new interest away from the anxiety helps us remember we’re going to get through it, even when the skies are grey.

And as you work through the stress, don’t make too big a deal of the situation. If you make it too big of a deal, you don’t go near it. And if you worry all the time, it doesn’t mean you are going to approach it any better. The idea is, how bad can it be? In going through it you usually find out its not the end of the world.

As a mental health professional, Stress Counseling is a big part of my role these days. To help people feel better I emphasize the importance of a spark. I also point out responses to stresses don’t have to be perfect. The idea is to make it good but also recognize you are learning to be better. The process is really about learning to make better choices and learning to work through things.

Put the bat on the ball, return the shot, and treasure the basics. Even spell it out to yourself: is this worth that.

Further, in fighting our stresses, set limits. Limit is all. Somebody pays the piper if you don’t. Have to give attention to your well-being and by setting limits you help yourself.

So find the spark that makes you feel different, try to not make the stress too big, and your response does not have to be perfect but something where we are making better choices.

Online Counseling in Texas

The Pros of Online Therapy

Are you considering Online Counseling in Texas? The internet has opened up new avenues for mental health treatment, but there are some pros and cons you should consider before you decide if e-therapy, also known as teletherapy,1 is right for you. In the face of the social distancing measures required in our COVID-19 crisis, many in-person psychotherapies are becoming online out of necessity.

Pros of Online Therapy
Let’s explore some of the biggest advantages of online therapy.2

Good Option for Remote Areas
Online therapy offers access to mental health information and treatment to people in rural or remote areas. Those who live in such areas simply might not have access to any other form of mental health treatment because there are limited or no mental health practices in their geographic area.

Having to drive long distances and take significant time out of a busy schedule to seek therapy can be a burden on many people in need of help. If you have reliable internet access, online therapy gives you relatively quick and easy access to treatment that might not have been readily available to you otherwise.3

Accessibility for People With Physical Limitations
Online therapy provides accessibility to individuals who are disabled or housebound. Mobility can be a big issue when it comes to accessing mental health care. A therapist practicing out of their own home, for example, may not be set up to accommodate all potential clients.

Individuals who are unable to leave their home for various reasons, such as physical or mental illness, may find online therapy a useful alternative to traditional psychotherapy settings.

Convenience and Affordability of Online Counseling in Texas
Online therapy is usually fairly affordable and convenient. Since you will be attending therapy sessions online in the comfort of your own home, you can often schedule your therapy sessions for times that are the most convenient for you.

Today, many states require insurance providers to cover online therapy just as they would traditional therapy sessions. Contact your insurance company to learn more about how e-therapy treatments will be covered by your policy.

Therapists who only treat patients online likely have fewer overhead costs such as renting office space. Online therapists, therefore, can often offer affordable treatment options for those who are not covered by health insurance.

Dr. Jan Dunn provides Online Counseling in Texas to individuals, couples, and families. Telehealth
Video Therapy Sessions provides the same treatment as in person therapy sessions. Shifting the therapy office to a clients space makes therapy portable, accessible, confidential, and comfortable. In turn, clients often report feeling more at ease, less stressed, and more apt to open up and, in turn, therapy is more effective. The benefits far outweigh any concerns for most clients, as accessibility to care drastically increases and cancellations drastically decrease. Therapy is delivered in the comfort of your home – when and where you need it.

Does Health Insurance Cover Online Counseling in Texas?

Treatment Is More Accessible
The Internet makes mental health treatment more accessible.4 People may feel comfortable talking to friends and family about physical health care issues but may not feel the same discussing mental health concerns that are just as important. Online access makes it easier to overcome the stigma that has historically been attached to mental health issues.

Teletherapy can be an important tool to help people learn more about psychological health. Even if you feel like your mental well-being is strong, online therapy can help you become psychologically stronger.5 You can learn more about health behaviors and coping strategies that will lead to better psychological health.

You don’t need to have a clinically diagnosed condition to benefit from talking to a professional, and online therapy can provide an easy avenue for getting started.

Overlooks Body Language
In many cases, online therapists cannot see facial expressions, vocal signals, or body language. These signals can often be quite telling and give the therapist a clearer picture of your feelings, thoughts, moods, and behaviors.

Some delivery methods such as voice-over-Internet technology and video chats can provide a clearer picture of the situation, but they often lack the intimacy and intricacy that real-world interactions possess.

Some people may feel more comfortable undergoing Online Counseling in Texas in a digital setting, especially younger people who are more intimately familiar with such methods of communication, but others—therapists and patients alike—may get more out of therapy that utilizes more direct human contact.

Ethical and Legal Concerns
Online therapy eliminates geographic restraints, making the enforcement of legal and ethical codes difficult.8 Therapists can treat clients from anywhere in the world, and many states have different licensing requirements and treatment guidelines. It is important to understand your therapist’s qualifications and experience before you begin the treatment process.

Article: https://www.verywellmind.com/advantages-and-disadvantages-of-online-therapy-2795225

Photo: https://www.pexels.com/photo/apartment-architecture-building-contemporary-380330/

Online Counseling in Texas

The Pros of Online Therapy

Are you considering Online Counseling in Texas? The internet has opened up new avenues for mental health treatment, but there are some pros and cons you should consider before you decide if e-therapy, also known as teletherapy,1 is right for you. In the face of the social distancing measures required in our COVID-19 crisis, many in-person psychotherapies are becoming online out of necessity.

Pros of Online Therapy
Let’s explore some of the biggest advantages of online therapy.2

Good Option for Remote Areas
Online therapy offers access to mental health information and treatment to people in rural or remote areas. Those who live in such areas simply might not have access to any other form of mental health treatment because there are limited or no mental health practices in their geographic area.

Having to drive long distances and take significant time out of a busy schedule to seek therapy can be a burden on many people in need of help. If you have reliable internet access, online therapy gives you relatively quick and easy access to treatment that might not have been readily available to you otherwise.3

Accessibility for People With Physical Limitations
Online therapy provides accessibility to individuals who are disabled or housebound. Mobility can be a big issue when it comes to accessing mental health care. A therapist practicing out of their own home, for example, may not be set up to accommodate all potential clients.

Individuals who are unable to leave their home for various reasons, such as physical or mental illness, may find online therapy a useful alternative to traditional psychotherapy settings.

Convenience and Affordability of Online Counseling in Texas
Online therapy is usually fairly affordable and convenient. Since you will be attending therapy sessions online in the comfort of your own home, you can often schedule your therapy sessions for times that are the most convenient for you.

Today, many states require insurance providers to cover online therapy just as they would traditional therapy sessions. Contact your insurance company to learn more about how e-therapy treatments will be covered by your policy.

Therapists who only treat patients online likely have fewer overhead costs such as renting office space. Online therapists, therefore, can often offer affordable treatment options for those who are not covered by health insurance.

Dr. Jan Dunn provides Online Counseling in Texas to individuals, couples, and families. Telehealth
Video Therapy Sessions provides the same treatment as in person therapy sessions. Shifting the therapy office to a clients space makes therapy portable, accessible, confidential, and comfortable. In turn, clients often report feeling more at ease, less stressed, and more apt to open up and, in turn, therapy is more effective. The benefits far outweigh any concerns for most clients, as accessibility to care drastically increases and cancellations drastically decrease. Therapy is delivered in the comfort of your home – when and where you need it.

Does Health Insurance Cover Online Counseling in Texas?

Treatment Is More Accessible
The Internet makes mental health treatment more accessible.4 People may feel comfortable talking to friends and family about physical health care issues but may not feel the same discussing mental health concerns that are just as important. Online access makes it easier to overcome the stigma that has historically been attached to mental health issues.

Teletherapy can be an important tool to help people learn more about psychological health. Even if you feel like your mental well-being is strong, online therapy can help you become psychologically stronger.5 You can learn more about health behaviors and coping strategies that will lead to better psychological health.

You don’t need to have a clinically diagnosed condition to benefit from talking to a professional, and online therapy can provide an easy avenue for getting started.

Overlooks Body Language
In many cases, online therapists cannot see facial expressions, vocal signals, or body language. These signals can often be quite telling and give the therapist a clearer picture of your feelings, thoughts, moods, and behaviors.

Some delivery methods such as voice-over-Internet technology and video chats can provide a clearer picture of the situation, but they often lack the intimacy and intricacy that real-world interactions possess.

Some people may feel more comfortable undergoing Online Counseling in Texas in a digital setting, especially younger people who are more intimately familiar with such methods of communication, but others—therapists and patients alike—may get more out of therapy that utilizes more direct human contact.

Ethical and Legal Concerns
Online therapy eliminates geographic restraints, making the enforcement of legal and ethical codes difficult.8 Therapists can treat clients from anywhere in the world, and many states have different licensing requirements and treatment guidelines. It is important to understand your therapist’s qualifications and experience before you begin the treatment process.

Article: https://www.verywellmind.com/advantages-and-disadvantages-of-online-therapy-2795225

Photo: https://www.pexels.com/photo/apartment-architecture-building-contemporary-380330/

Online therapy in Texas

online therapy Texas

Online counseling is the provision of professional mental health counseling services through the Internet.

Services are typically offered via email, real-time chat, and video conferencing. Some clients use online counseling in conjunction with traditional psychotherapy, or nutritional counseling, and a growing number of clients are using online counseling as a replacement for office visits.

While some form of tele-psychology has been available for over 35 years, the advent of internet video chat systems and the increasing penetration of broadband has resulted in the continuing growth of online therapy. Some clients are using videoconferencing, live chat and email with professional psychologists in place of or in addition to face-to-face meetings. There is also a growing trend with online recovery coaches who can now conduct face-to-face consults with clients online.

History

In 1972, computers from Stanford and UCLA simulated a psychotherapy session that was considered the very beginning of online counseling. At the time the internet went public,[further explanation needed] this launch went hand in hand with the development of the first self-help groups on the internet who were, in that time, very popular.[citation needed] In 1995, Martha Ainsworth began searching for a competent therapist because she had some psychological complaints. Her travel requirements made it difficult for her to consult a face-to-face therapist, and she therefore searched for an effective alternative online, but only found a dozen webpages that offered online treatment for psychological complaints. Afterwards, Martha Ainsworth wanted to reach the general public with her experiences and founded a sort of clearinghouse for mental health websites, named Metanoia. This database seemed to be a very efficient store-room and by the year 2000, this clearinghouse contained over 250 websites of private practices, and more than 700 online clinics where a therapist could be contacted.

According to metanoia.org, the first service to offer online mental healthcare was “Ask Uncle Ezra”, created by staff of Cornell University in 1986 for students. By mid-1995 several fee-based online services offering mental health advice had appeared.

Between 1994 and 2002, a group of trained volunteer crisis counselors called “Samaritans”, began providing suicide prevention services via email.

Accessibility

online therapy Texas is filling the unmet need for clients located in areas traditionally under-served by traditional counselors. Rural residents, people with disabilities and expats, along with under-served minorities often have an easier time finding a suitable therapist online than in their local communities.

Online counseling has been shown to be effective for clients who may have difficulty reaching appointments during normal business hours, while decreasing the number of missed appointments for in-person therapy.

Kathryn McNeer, LPC provides online therapy Texas specializing in couples counseling at the McNeer Group.

Medical uses and effectiveness

Although there is some preliminary support for the possibility that online counseling may help populations that otherwise underutilize traditional in-office counseling, the question of the effectiveness and appropriateness of online therapy Texas has not been resolved.

Mental health

Research from G.S. Stofle suggests that online counseling would benefit people functioning at a moderately high level. J. Suler suggests that people functioning at a particularly high level, and who are well-educated and are artistically inclined, may benefit the most from using text-based online counseling to as a complement to ongoing psychotherapy. Severe situations, such as suicidal ideation or a psychotic episode, might be better served by traditional face-to-face methods, although further research may prove otherwise.

Cohen and Kerr conducted a study on the effectiveness of online therapy for treatment of anxiety disorders in students and found that there was no difference in the level of change for the two modes as measured by the State-Trait Anxiety Inventory.

As the main goal of counseling is to alleviate the distress, anxiety or concerns experienced by a client when he or she enters therapy, online counseling has strong efficacy under that definition. Client satisfaction surveys tend to demonstrate a high level of client satisfaction with online counseling, while the providers sometimes demonstrate lower satisfaction with distance methods.

ref: https://en.wikipedia.org/wiki/Online_counseling
photo: pexels

Online Counseling DC

Welcome back to our Online Counseling DC newsletter series addressing the question we’ve been hearing from our community of clients: Is my response to the abnormality, normal? Last time, we focused on your own thoughts and feelings. In this 3rd installment, we are focusing on what our community is noticing in their relationships with others.

Relating in Isolation

As depicted in the graphic above, our Online Counseling DC community is noticing that we are still very committed to our relationships, but there are shifts in our roles, or we may play multiple roles at once. You may also find yourself having to navigate how to absorb the reactions of others. As isolating as this situation is, our emotions are still occurring in relation to others. This can affect the entire system’s mood and mindset.

Our Personal Reflections

Marjorie

Last week, my 4 year-old son planted “magic beans” to take us to Giant Land, where he was pretty sure “the virus isn’t going around.” He watched the magic beans (we’re not allowed to just call them beans) vigilantly, watered them 27 times a day, packed for himself and his brother, including a pillow, and waited so we could climb the thing and get out of here. When that didn’t work (shocking, I know), this week he decided to build a spaceship with a seat for each of us so we can finally get off of this blasted planet. A life-size space ship. With plywood, screws, and Styrofoam. As a play therapist, I’m seeing a lot of themes in his play, or as he would call it “work.” However, I’m sure I don’t have to explain the meaning of it to you. We all want an escape plan and are fantasizing in one way or another of an alternate life. It’s been a good reminder that kids are dealing with the same stress as adults. Their symptoms are often the same, but the way it plays out (pun intended) is different. It’s been a reminder for me to appreciate his ingenuity and be compassionate about his struggles – and to do the same for myself and others.

Heidi

I’ve noticed the different needs my family members have based on their developmental stages. The toddler seems to be okay with his blissful ignorance to what’s going on. The older kids have been dealing with it based on their developmental abilities, but their personality differences also come through. My kindergartner seems satisfied socially, but needs to be held, physically and emotionally, in her moments of rage that come through. My elementary schooler has engaged in magical thinking. He has this idea about turning the light switch off and COVID turns off too. He imagines everything we will do as soon as it ends, such as vacations and time off of school (because somehow he needs even more time off). I’ve found it’s been helpful to meet them in the moment through – whether it’s imagining or holding space until they can regulate. I’ve noticed the parallel as an adult. We have these same emotions and need space for them as well.

Couples Therapy DC or Relationship Counseling, can help you to connect with one another so that you can bond in a way that may be difficult to do when you are on your own. Relationship counseling support may include couples therapy, pre-marital therapy, separation guidance, or everything in-between, to better understand yourself and your partner. Online Counseling DC is an increasingly popular method for maintaining mental health an it provides the same treatment as in person counseling sessions. Telehealth Video Therapy Sessions are simple, secure, and convenient.

Turning Relationships into Community

The sentiment of being in this together while distancing from each other is strange. But part of what’s helping us all survive right now is how we are consciously engaging with our community. Alicia Bailey, a KCC clinician, recognizes that we are experiencing an “intensified version of the pressure we feel every day as parents, which is forming these human beings, but we have nowhere to outsource.” Not to mention managing their mental health along with our own. And meanwhile, our partnerships might either be falling by the wayside so we can function, or riddled with tension at the moment. However, she notes that this situation is increasing our collective resiliency, because we have to get creative on how to outsource, such as enlisting grandparents or neighbors for childcare.

​It’s amazing for us to see the resourceful ideas that many come up with to connect with others, such as creating “COVID families,” weekly video calls with friends and family, drive-by birthday wishes, sustaining the local economy, and normalizing the struggle so that your loved ones will not feel alone.

We are grateful to continue to be a part of your community. If someone you care about could use some help, please forward this on to them, or pass along our Online Counseling DC information.

Your support around the corner, or wherever there’s WiFi,

Psychologist Chapel Hill N.C. – Telehealth

Recent developments in the COVID-19 pandemic have motivated me to transition to an entirely virtual practice. I believe firmly that social distancing is the safest and most ethical way to ensure the well-being for everyone and protect my clients.

I use a HIPAA-compliant platform that can be accessed by phone, iPad, or computer. No set-up needed; you simply click a link sent to you prior to the session.
While the same rules of confidentiality for in-person sessions apply to virtual or phone sessions, there are some unique aspects to consider:
– Use a private Wi-Fi connection with high speed internet.
– Make sure you are in a private space so that you can ensure your privacy.
– Please be present and ready by your device at the scheduled appointment time.

Research has shown that teletherapy is equivalent in effectiveness to in-person therapy. Thanks to recent technology improvements, the differences between the experience of a video session and a face-to-face session are negligible.

Psychologist Chapel Hill N.C. – Telehealth

If you are committed to improving, you will do well regardless of whether the sessions with your therapist are held in person or remotely.

Most individuals report that they find teletherapy to be as effective as an in-person office visit. Added benefits include that you will not have to spend time commuting to my office and the lack of school and available child-care will not prevent being able to attend regular therapy sessions.

Psychologist Chapel Hill N.C. – Telehealth is an excellent option to ensure you get the help you need even during a pandemic where we need to socially distance to maintain safety. Too often, putting off treatment creates more problems. Fortunately, teletherapy is now widely available.

I am a doctoral-level licensed psychologist in North Carolina; I have expertise in various evidence-based treatments for adults and am committed to providing scientifically validated interventions. I work with a diverse population, including trauma, insomnia, mood disorders, anxiety, and relationship problems. I take my work and clinical specializations seriously and continue to devote a considerable amount of time and effort to advance my training and professional development. For your convenience, my services are provided via telehealth.

Dr. Sara Michelson
Licensed Psychologist Chapel Hill N.C.

I am a psychologist trained in evidence-based treatments.

I have particular expertise in treating psychological trauma and PTSD. I have been certified by the National Center for PTSD as a provider for Prolonged Exposure Therapy (PE) and Cognitive-Processing Therapy (CPT), both evidenced-based treatments to help reduce the symptoms of PTSD.

I also treat insomnia and sleep problems, anxiety disorders, panic attacks, mood disorders, relationship problems, anger, and other stressful life transitions. I have completed specialized training in cognitive behavioral therapy for insomnia (CBT-I), mindfulness, anger therapy, and behavioral activation for depression (BA).

I graduated with a B.A. in psychology and comparative literature from the University of Copenhagen and a Psy.D. in clinical psychology from Roosevelt University in Chicago, IL. I have received training in cognitive behavioral therapies at Northwestern University and the University of Chicago. My doctoral research focused on the effects of childhood trauma on later personality development. I completed my predoctoral internship at the VA Hudson Valley Health Care System and a post-doctoral fellowship at Yale University where I specialized in working with veterans with post-traumatic stress disorder. Since completing my graduate training, I have worked in private practice, VA hospitals, the Center for Deployment Psychology, and with public safety and law enforcement agencies in Illinois and Psychologist Chapel Hill N.C. where I have conducted pre-employment screenings, crisis evaluations, and fitness for duty evaluations.

CBT typically helps individuals address anxiety, depression, relationship problems, etc. by teaching new skills and ways of coping. For example, someone with social anxiety may work to improve the skill of tolerating being in anxiety-inducing social situations. Someone who is prone to extreme worry may work on the skill of talking themselves through their anxiety. Someone with depression may try to improve their ability to engage in behavioral activation. Research has shown that improvements of these skills, can help to alleviate significantly psychological distress.

What are some of the strategies used in CBT?

In CBT, the focus is on thoughts and behavior. Some of the strategies used include:
• Identifying problematic thoughts and thought patterns that are keeping you stuck
• Changing your relationship to the problematic thoughts by accepting their presence and challenging their accuracy
• Developing balanced alternative views to initial interpretations of events
• Learning new problem-solving and emotion regulation skills
• Building motivation and ability to engage in productive and meaningful behavior through exercises

Social Media and Suicide Among Teens

Digital media, including social media, became a centerpiece of day to day life at a seemingly exponential rate. Before I graduated high school in 2006, I remember many evenings spent on ICQ (used to chat with friends), making simple websites with shout outs to my friends which included obnoxious lists of inside jokes, and playing The Sims Online. I whiled away the hours without much consequence – at that time it was  project to upload a picture to the internet (you had to have a digital camera or a scanner), and in order to sign up for Facebook, you needed to have a college email address. These were simpler times.

Fast forward to now, and we are a world of quasi-cyborgs with our phones in our hands and our head in the Cloud. Technology is immensely helpful to us in innumerable ways – it helps us connect with others, provides us with apps that support our well-being, productivity, work, supports us to make healthier lifestyle choices, and so on. However, if this resource is not used intentionally, it may cause irreversible damage. I’m talking about the approximately 60% increase in suicide rates among individuals ages 10-24 between the year 2007 and 2018.1 While we cannot explicitly say that this increase in suicide among young people is mostly due to the growth in use of social media, there seems to be a pretty obvious connection.

Build your self-care skills through Online Counseling in New Jersey

Do you want to improve your self-care skills? Contact me to learn more about working together through online counseling in New Jersey.

I now also offer Online Counseling in Pennsylvania, contact me to learn more.

Take, for instance, the 2017 death of Sadie Riggs from Pennsylvania. Her peers were merciless with their bullying, targeting her in the hallways at school but also through social media, and telling her to kill herself. Her parents, once they discovered what was happening, went to the police and to her school – neither did anything, and they eventually took their daughter’s phone. Unfortunately, it was too late and Sadie completed suicide about a week after her phone was taken.2 Cyberbullying is a type of bullying that extends beyond the boundaries of school; it follows kids home and can infiltrate their life as often as they choose to check their phone, which is at least a couple hours a day for most teens.

What are some of the ways that social media is influencing the increase in suicide among young people? Prosuicidal behavior may be cultivated online in some of the following ways:

  1. Cyberbullying. This refers to when someone is targeted online and repeatedly tormented and harassed. It’s bullying, but online. A study found that victims of cyberbullying were twice as likely to attempt suicide, and the individuals perpetrating the bullying were 1.5 times as likely to have attempted suicide.3
  2. Media Contagion Effect. This refers to the increase in a particular activity that occurs when the media covers it, for instance: mass shootings. One study found that, out of 719 people between the ages of 14-24 years old, almost 60% reported being exposed to suicide related content through internet sources.3; There is also a growing trend of posting suicide notes online, which may influence the decisions of vulnerable individuals.3
  3. Normalizing/disinhibiting suicide or self-harm. Through sharing online, anyone has access to content that may normalize suicide or non-suicidal self harming behavior. Vulnerable individuals who may find extreme chat rooms where others idolize or encourage suicide.3

While there are dangers lurking on the internet, there is also help. If you or someone you know is struggling with suicidal ideation or self harming behaviors, make sure you reach out for help immediately. Here are some resources:

The National Suicide Prevention Lifeline: 800-273-8255

Crisis Text Line: http://www.crisistextline.org/

Society for the Prevention of Teen Suicide: http://www.sptsusa.org/teens/

The Trevor Project, a resource for LGBTQ individuals: http://www.thetrevorproject.org/

Sarah Tronco, LCSW, provides online counseling in New Jersey and works to develop a strong therapeutic relationship with her clients, which helps to create a secure place where individuals can achieve meaningful change.

Sarah Tronco, LCSW, now also provides Online Counseling in Pennsylvania, contact her to learn more.

 

References:

  1. https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-11-508.pdf
  2. https://www.nbcnews.com/news/us-news/social-media-contributing-rising-teen-suicide-rate-n812426
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3477910/

Photo by Danilo Rios on Unsplash

Couples Therapy Palo Alto: Relationships in the Tech World.

Being a Marriage and Family Therapist in the Bay Area specializing in Couples Therapy Palo Alto, means I have the privilege to meet clients from very diverse backgrounds. One of them is the Silicon Valley background which is a culture in and of itself. Clients and couples with this background share some distinct characteristics: high achieving, hard working, intelligent, ambitious, and long working hours. Some people work so hard and long that they don’t even dare to get into any intimate relationship. While a small number of people are content with life without being in a significant relationship, many of us have the innate desire to want to connect with a partner. Because of the demand from work for time, it often creates a lot of challenges for those who work in the Silicon Valley culture to have successful and fulfilling relationships.

Palo Alto, being the heart of Silicon Valley, is one of those cities in which many couples struggle to have a healthy work life balance. Over the years of working with couples from that region, I’ve identified a few helpful ways to create and maintain a fulfilling and loving relationship in the long term.

1: Be Honest and Realistic with Yourself and Your Partner.
More often than not, working in Silicon Valley is a long term and heavy commitment. That’s true for the people working in the industry, as well as for the significant others. So it’s critical that couples be realistic about what they’re committing to professionally and how that will have a direct impact on their personal and relationship life. Otherwise, resentment and bitterness often become the natural by product.

2: Know Your End Game.
I’ve had clients complain about how “cut throat” and brutal the lifestyle working in Silicon Valley is. Working 80 hour weeks often is the norm rather than exception. Naturally it’s not a sustainable lifestyle, especially for those that are more family oriented. So if your goal is to experience that culture and get that on your resume, be concrete about your timeline. On the other hand, if your goal is to take companies public, then you must recognize that you need a partner that believes in your vision as well as is willing to make the necessary sacrifices. In the meantime, you also need to be work extra hard on the relationship to maintain a healthy and happy balance.

For more information about Couples Therapy Palo Alto, please go to my therapist website & contact me.

3: Communication (DUH…)
Literally 100% of the couples that I work with have some level of communication issues. For relationships to thrive in the Silicon Valley culture, having great communication is part of the successful equation. That’s because when time is the scarce commodity, it is crucial that the couple knows how to be effective and efficient in their communication to avoid tension, misunderstanding, and resentment building. One tip that I often give to couples is to over communicate. The reason being that I believe 95% of the time, conflicts arise from misunderstanding. And the best antidote to misunderstanding is over communication.

4: Define a Balanced Relationship with Your Partner.
When you’re unable to fully provide the essential currency in a relationship, TIME, you need to understand how you can still meet your partner’s needs in a straight forward manner. Talk with your partner about how you’d like to define and create a healthy relationship with them despite having less than the ideal amount of time. When there’s a genuine gesture to improve and the desire care for your partner, it tends to create a positive chain reaction in the relationship.

Kin Leung, MFT – Individual and Couples Therapy Palo Alto

Photo: Pexels.com

Family Stress Test

Family Stress Test

Stress is a natural and normal “by-product” of every family’s life. In fact, family stress can bring out the best of us: as we stretch to meet the challenges we face, we become better parents, our children blossom and our families grow. But too much stress can spiral our families in the other direction. Take this Thriving test to see how your family fares.

Set 1

1. There is a lot of bickering in our house. Someone is always angry at someone else.

2. There’s never enough time to sit down together, either to talk or to eat. There’s always too much to do.

3. My spouse and I argue a lot about how to raise the children.

4. It’s like pulling teeth to get the kids to help around the house.

5. Our family has experienced a lot of significant change recently (divorce, death, blending family, job loss, illness, other trauma).

6. Money is very tight. My partner and I have constant conflicts about how to spend it.

7. My child has been having behavioral problems at school.

8. The children get upset when they hear us arguing.

9. I work too much, and it’s really getting to me.

10. We don’t really talk about hard issues; we just try to hold our breath, wait and let them go away.

Counseling Plainfield Illinois, my goal as a therapist offering, is to find solutions that work for you on an individual basis, helping you to discover the true potential of your life, so everyday can be a celebration, and feel like a real ‘breath of fresh air.’ There may be no magic button or quick-fix solution when it comes to changing things from the past that have been difficult, but what we can do is work together to find comfort and resolve in the difficult areas of your life, and the challenges you have to face. Read more about Gwen Ginski, MEd, LCSW.

Set 2

1. We acknowledge feelings, encourage their expression and allow time for dealing with the issues these feelings raise.

2. We plan time for family activities. And we eat together at least once every day.

3. If a blended family, we maintain and nurture original parent-child relationships and let new relationships develop in their own time.

4. I feel confident in my role as parent.

5. Our family easily maintains a sense of humor and playfulness.

6. Family priorities take precedence over work.

7. I know what’s important to my kids.

8. When issues arise that we get stuck on, we ask for help from other family members, support groups, community-based programs, clergy and/or a therapist.

9. We have enough money for the important things.

10. Everyone in the family has responsibilities around the house and does them without being nagged.

If you answered true more often in the first set than in the second set, you may want to seek help lowering the stress level of your family. Families that communicate about problems, who face issues as they arise, who support one another and seek help when it is needed, can build strong bonds among themselves, nurture a healthy and loving family and have a lot more fun doing it!

Author’s content used  under license, © 2008 Claire Communications
Photo: Pexels.com

Disorganized Attachment

Mary Ainsworth’s work on attachment identified three attachment categories (secure, insecure avoidant, and insecure ambivalent/resistant). The development of the disorganized/disoriented classification evolved as a part of Mary Main’s doctoral research in which she noticed that approximately 10% of infants in Ainsworth’s Strange Situation Procedure were difficult to classify.1 Disorganized attachment is an additional attachment category that was identified in 1986 by Mary Main and Judith Solomon at the University of California, Berkeley.

Explore your attachment style through Online Counseling in New Jersey

Are you curious about your attachment style and how it may be impacting the quality of your life and relationships? Contact me to learn more about working together through online counseling in New Jersey.

I now also offer online counseling in Pennsylvaniacontact me to learn more.

The three attachment styles identified by Ainsworth are considered organized because they present behaviors that are consistent.2 In the Strange Situation Procedure, behaviors that were classified as disorganized/disoriented include:

-Obvious displays of fear of the caregiver
-Sequential or simultaneous behaviors or affects that are contradictory
-Movements that are asymmetric, misdirected, stereotypic, or jerky
-Apparent dissociation or freezing 1

These behaviors would typically happen for a moment until an infant’s behaviors returned to those that could more easily be classified into one of Ainsworth’s categories. Disorganized attachment can be seen as coexisting among the other three categories instead of being a replacement category, as disorganized infants were always coded into a second organized category.2

Caregiver Behaviors Associated with Disorganized Attachment

The following parental behaviors have been associated with disorganized/disoriented behavior in infants studied in the Strange Situation Procedure:

-Frightened or frightening parental behavior
-Dissociative, withdrawing, or helpless behavior
-Experiencing a persistent anxiety disorder
-Social and economic disadvantage
-Lack of regulation of the caregiving environment 1

Additional behaviors that can cause disorganized attachment behavior in infants, identified by Main and Hesse, include threatening gestures or expressions from the caregiver toward the infant, submissive behavior of a caregiver, sexual or romantic behavior toward the infant, mocking or teasing the infant, role confusion, and withdrawing (being silent during interaction). 2

The Impact of Disorganized Attachment

Disorganized attachment in infancy can impact the development of the amygdala. Components of maternal and infant disorganized attachment are linked to a larger left amygdala volume in adulthood, which is associated with limbic irritability and dissociation.3 Limbic irritability can result in aggression, violence directed at the self or others, and dysphoria.4 Unresolved trauma contributes to disorganized attachment in adults, with unresolved loss being easier to resolve than abuse that is unresolved.5

Check out my previous post to get a general overview of the different attachment styles.

Sarah Tronco, LCSW, provides online counseling in New Jersey and works to develop a strong therapeutic relationship with her clients, which helps to create a secure place where individuals can achieve meaningful change.

Sarah Tronco, LCSW, now also provides online counseling in Pennsylvaniacontact her to learn more.

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321742/#c36
  2. https://link.springer.com/referenceworkentry/10.1007%2F978-3-319-28099-8_2021
  3. https://www.sciencedirect.com/science/article/pii/S0166432816301905
  4. https://www.dana.org/article/wounds-that-time-wont-heal/
  5. https://www.sciencedirect.com/science/article/pii/S2352250X18301052
  6. Photo by Allef Vinicius on Unsplash

How Well Are You Listening to Your Children and Others?

When our children come to us with a problem, we usually want to help them. So we console, interpret, advise, distract or praise. Other times, we feel we must teach our children, and so we interrogate, lecture, moralize or order. And probably more often than we’d like, we respond angrily—blaming, criticizing, ridiculing, shaming or withdrawing.

However, all of these responses are problematic—whether with our children, or with the important adults in our lives. They often serve to stop the communication of real feelings and the development of individual solutions. Take the quiz below, adapted from the classic Parent Effectiveness Training, by Dr. Thomas Gordon, to assess your listening skills.

1. I let my children feel their difficult feelings, knowing that comments such as “Everyone goes through this” deny the strength of their feelings.

2. I try to listen for the need beneath the words and respond to that.

3. I make it a point to check in to see if I’ve understood something in the way my child intended it. When I do, I try to keep my own feelings, opinions and guidance out of it.

4. When my child tells me something, I try to respond with either noncommittal phrases (such as “I see” or “Is that so”) or with an invitation to say more (such as “Tell me more” or “Go ahead, I’m listening”).

5. I notice that when I listen to my children’s problems, rather than make suggestions or give advice, my children often come up with their own excellent solutions.

Counseling Plainfield Illinois, my goal as a therapist offering, is to find solutions that work for you on an individual basis, helping you to discover the true potential of your life, so everyday can be a celebration, and feel like a real ‘breath of fresh air.’ There may be no magic button or quick-fix solution when it comes to changing things from the past that have been difficult, but what we can do is work together to find comfort and resolve in the difficult areas of your life, and the challenges you have to face. Read more about Gwen Ginski, MEd, LCSW.

6. When I hear my child out fully, my child is often much more willing to listen to my thoughts and ideas.

7. When I let my children express their feelings openly and completely, the feelings often seem to disappear quickly.

8. I really want to hear what my child has to say; if I don’t have the time to listen right at that moment, I say so and make time for it later.

9. I’ve learned to trust that my children can find perfectly good solutions to their problems on their own.

10. I understand that my children are separate, unique individuals, and that their feelings and perceptions are not necessarily the same as mine.

11. When I stay away from moralizing, interpreting, ordering and advising, I find that I learn a lot more about my children. Sometimes, I even learn from my children.

12. I know that just listening doesn’t always bring about immediate change and that it’s sometimes OK to leave things on an inconclusive or incomplete note.

13. I understand that listening to children express their feelings can help them accept a situation they know they cannot change.

Authentic communication with our children (and friends) has rewards more valuable than a pot of gold. Real listening may be the rainbow bridge we need to get there. If you scored fewer “true” answers than false, you could probably benefit from improving your listening skills. Don’t hesitate to call.

Author’s content used under license, © 2008 Claire Communications

Photo Credit: Jason Rosewell, unsplash.com

Couples Therapy DC + Online Counseling DC

Your Reaction to “The New Normal”: Are My Thoughts And Feelings Normal?

How Are You? No, Really, How are you?

The answer to this question is often a resounding, “Eh.” As therapists, we see the silver lining in this: emotional honesty (we can see your eye roll). We have found that because we are in a difficult common experience, we have been able to connect more quickly with one another around difficult emotions. This seems more authentic than the old standard, “I’m fine.”

Am I Normal?

We’ve all been hearing a lot about “the new normal,” but what does that even mean during a time when everything has been upended? It’s our first time going through a global pandemic too, but we know there is comfort in learning that you are not alone in your experience. Here are some common thoughts and feelings from our community (and ourselves) you might relate to:

I kind of like this.

No commute. More quality time with family. Working from home full time. Simple living. It makes sense that you like parts of this change. Soak in any positives you can to help get through this. Engage in self-care so you’re able to be present with your family, or take a moment to be present with little things you used to rush past during your stressful commute.

I feel guilty about liking it.

It also makes sense that you notice your privilege about enjoying aspects of staying home. Others definitely have it worse. You might also feel guilty about the struggles you’re having for the same reason. Something we’ve been pointing out to you, though, is your life is undoubtedly more difficult now than it was before, which is stressful. It’s okay to have complex feelings right now – and any time (but you knew therapists would say that)

I’m super anxious.

Of course you are. About getting sick. About your loved ones. The economy. The news. Food. Keeping the kids busy. And about the many changes you are experiencing. We could go on, and so could you. The DSM-V (Diagnostic & Statistical Manual for Mental Health Diagnoses) requires 6 months of anxiety symptoms, but some of them may sound familiar right now: difficulty controlling worry, feeling on edge, irritability, sleep disturbances. Some of your anxiety might be new, but it might also tie back to older issues as well. Send yourself some compassion, and consider making this a time to do some deeper emotional work.

I’m feeling hopeless about the future.

We don’t know how long this will go on, other than a long time. A symptom of depression is not looking forward to the future. Well, when we all have our picture of the future ripped out from under us, it makes sense that we feel a little depressed. We think that just about everyone might relate to some of the symptoms of depression right now: depressed mood most of the day, loss of interest in activities (especially when you have so few options, right?), significant weight change, loss of energy every day. As The New York Times points out, there is research showing that many aspects of social isolation lead to loneliness and depression. What’s our therapeutic advice about this one? You guessed it: self-care. Starting with therapy, of course :) It’s not just coming from us though – even The Washington Post suggests that therapy could ease your coronavirus stress.

We are finding ourselves doing some very meaningful work with you as these feelings have been coming up. As a result, we have been able to witness some relief and growth.

Couples Therapy DC or Relationship Counseling, can help you to connect with one another so that you can bond in a way that may be difficult to do when you are on your own. Relationship counseling support may include couples therapy, pre-marital therapy, separation guidance, or everything in-between, to better understand yourself and your partner. Online Counseling DC is an increasingly popular method for maintaining mental health an it provides the same treatment as in person counseling sessions. Telehealth Video Therapy Sessions are simple, secure, and convenient.

Your Reaction to “The New Normal”: Connecting Virtually

We are privileged to be trusted with your emotional wellbeing right now, so we want to share what we’ve been learning about the human condition during this time, beginning with the virtual connection.

Most of our human “contact” now happens virtually. By now, you’ve heard our kids and dogs, and we’ve witnessed your family members seeking your attention, including Whiskers stealthily gliding by the camera. We’ve been hearing that people are both surviving on and exhausted by virtual interaction. It seems the key to preventing ‘virtual burnout’ might be similar to your in-person interactions: when you’re able, choose the connections which are fulfilling rather than draining. We’ve also heard that sometimes you just need a break from video calls. You can always empathically shout at your neighbor from 6 feet away instead.

Virtual Therapy

We are honored to find that therapy is one of the fulfilling types of virtual interactions. We’ve been thinking carefully about how to keep it this way for you, such as incorporating mindfulness, being flexible, and taking care of ourselves so we are present for you. Many clients have shared that it is more natural than expected. We are missing being in the room with you, but are so grateful for the ability to virtually connect with you.

​At this point, most of us are searching for humor to get us through this situation (one of our favorite coping mechanisms). Here are Hamilton cast members performing “The Zoom Where It Happened.”

Counseling for women – Infidelity

According to The New York Times, the most consistent data on infidelity comes from the University of Chicago’s General Social Survey (GSS). Interviews with people in non-monogamous relationships since 1972 by the GSS have shown that approximately 12% of men and 7% of women admit to having had an extramarital relationship. Results, however, vary year by year, and also by age-group surveyed. For example, one study conducted by the University of Washington, Seattle found slightly, or significantly higher rates of infidelity for populations under 35, or older than 60. In that study which involved 19,065 people during a 15-year period, rates of infidelity among men were found to have risen from 20 to 28%, and rates for women, 5% to 15%. In more recent nationwide surveys, several researchers found that about twice as many men as women reported having an extramarital affair. A survey conducted in 1990 found 2.2% of married participants reported having more than one partner during the past year. In general, national surveys conducted in the early 1990s reported that between 15–25% of married Americans reported having extramarital affairs. People who had stronger sexual interests, more permissive sexual values, lower subjective satisfaction with their partner, weaker network ties to their partner, and greater sexual opportunities were more likely to be unfaithful. Studies suggest around 30–40% of unmarried relationships and 18–20% of marriages see at least one incident of sexual infidelity.

Rates of infidelity among women are thought to increase with age. In one study, rates were higher in more recent marriages, compared with previous generations; men were found to be only “somewhat” more likely than women to engage in infidelity, with rates for both sexes becoming increasingly similar. Another study found that the likelihood for women to be involved in infidelity reached a peak in the seventh year of their marriage and then declined afterward; whereas for married men, the longer they were in relationships, the less likely they were to engage in infidelity, except for the eighteenth year of marriage, at which point the chance that men will engage in infidelity increases.

One measure of infidelity is covert illegitimacy, a situation that arises when someone who is presumed to be a child’s father (or mother) is in fact not the biological parent. Frequencies as high as 30% are sometimes assumed in the media, but research by sociologist Michael Gilding traced these overestimates back to an informal remark at a 1972 conference. The detection of unsuspected illegitimacy can occur in the context of medical genetic screening, in genetic family name research, and in immigration testing. Such studies show that covert illegitimacy is, in fact, less than 10% among the sampled African populations, less than 5% among the sampled Native American and Polynesian populations, less than 2% of the sampled Middle Eastern population, and generally 1–2% among European samples.


When working with couples in person or online, it is Kathryn’s direct yet non-judgmental approach to any and all issues a couple is facing that provides a safe place for them to do the deep work of counseling and ultimately thrive. She helps couples determine which patterns in their life and relationships are keeping them “stuck” and then helps them establish new, more productive patterns whether in person or online therapy all over Texas. Kathryn works with couples on trust, intimacy, forgiveness, and communication. She has seen it all, and her couples appreciate her no-nonsense approach to helping to sort through the tough stuff. Kathryn provides premarital counseling in addition to couples counseling, marriage counseling, and individual counseling for women & counseling for men.


Counseling for women – Gender

Differences in sexual infidelity as a function of gender have been commonly reported. It is more common for men compared to women to engage in extra-dyadic relationships. The National Health and Social Life Survey found that 4% of married men, 16% of cohabiting men, and 37% of dating men engaged in acts of sexual infidelity in the previous year compared to 1% of married women, 8% of cohabiting women, and 17% of women in dating relationships. These differences have been generally thought due to evolutionary pressures that motivate men towards sexual opportunity and women towards commitment to one partner. In addition, recent research finds that differences in gender may possibly be explained by other mechanisms including power and sensations seeking. For example, one study found that some women in more financially independent and higher positions of power, were also more likely to be more unfaithful to their partners. In another study, when the tendency to sensation seek (i.e., engage in risky behaviors) was controlled for, there were no gender differences in the likelihood to being unfaithful. These findings suggest there may be various factors that might influence the likelihood of some individuals to engage in extra-dyadic relationships, and that such factors may account for observed gender differences beyond actual gender and evolutionary pressures associated with each.

Counseling for women – Emotional

Infidelity causes extreme emotions to occur between males and females alike. Emotions have been proven to change through this process. Below, the three phases of infidelity (beginning, during and after) are explained.

The “Before” Stage:

Infidelity is the biggest fear in most romantic relationships and even friendships. No individual wants to be cheated on and replaced by another, this act usually makes people feel unwanted, jealous, angry and incompetent. The initial stage of the infidelity process is the suspicious beginning; the stage in which it has not been proven, but warning signs are beginning to surface. While suspicion is not hard evidence in infidelity and cannot prove anything, it does affect a person’s affective emotions and cognitive states. Jealousy, the feeling of incompetence, and anger can all be felt in both the affective and cognitive states of emotions; infidelity has a different impact in each of those connected states.

Affective emotions and response are a primary factor in the initial stages of infidelity on both sides. Affective behaviors are how we deal with emotions that we do not anticipate. An affective response immediately indicates to an individual whether something is pleasant or unpleasant and whether they decide to approach or avoid a situation.

To begin, affective emotions and the effect infidelity has on affective jealousy. Both men and women alike feel some kind of jealousy when they suspect their significant other is being unfaithful. If some individual suspects that he or she is being cheated on they begin to question their partner’s actions and may possibly act in more frustrated ways towards them than they normally would. The affective use of jealousy in a seemingly unfaithful relationship is caused by the accusing partner anticipating the infidelity from the other.

Another affective emotion in this beginning stage is incompetence. Feeling incompetent can spring from multiple things in a relationship, but during the initial stages of infidelity, a person can experience this on an increased level. When someone is having incompetent feelings due to someone else’s actions they begin to resent them, creating a build-up and eventually an affective emotion outburst over something small. The faithful partner is not normally aware that their suspicion is the reason they feel incompetent in the relationship and do not expect to be so irritated by the change of simple things; making it an affective response in this stage of infidelity. These unanticipated emotions could lead to more and multiple responses such as this one within the future of the initial stage of infidelity.

An additional affective response or emotion seen in initial infidelity is anger. Anger is an emotion that is felt in all stages of infidelity, but in different ways and at different calibers. In the initial stages of infidelity anger is an underlying emotion that is usually exposed after the buildup of other emotions such as jealousy and Resentment. Anger is noticed to be a key emotion within a situation like infidelity, it takes on many roles and forms throughout the process but in the initial stage of cheating, anger can be an affective emotion because of how unpredictable and rapid it can happen without thinking of one’s actions and feelings before doing so.

Cognitive emotions and states tend to be felt in the initial stages of infidelity whenever the faithful partner is alone or left alone by the suspected unfaithful one. Cognitive emotions and responses are that of those in which an individual anticipates them. Once couples begin to anticipate the actions and emotions of their partners, even if evidence have not been set forth, the emotions of infidelity enter a cognitive state.

To begin with cognitive responses in infidelity, individuals who have been cheated on experience jealousy cognitively for many reasons. They may feel that their partner has lost interest in them and feel that they cannot compare to the persons with whom they are being cheated on with. Therefore, they anticipate the loss of their partner’s emotional interest in them and become jealous for more clear reasons. The anticipation of jealous feelings towards an individual’s significant other causes a cognitive response, even without the burden of proof.

Some more cognitive responses in the young stages of infidelity are incompetence and resentfulness. In the initial stages of infidelity, the feeling of incompetence can lead to cognitive resentment. The partner being cheated on will begin to feel that anything and everything they do is not enough, they may feel incompetent in the ways of love, affection, or sex. Whenever an individual suspects that they are being cheated on they try to change their behavior in hopes of keeping or getting their partner’s attention back onto themselves instead of on the person whom they are having another relationship with. People cheat for many reasons and each of those can cause a faithful person to believe they are not competent enough to be in a romantic relationship. This feeling leads to the resentment of the unfaithful partner’s actions and becomes an ongoing emotion throughout the stages of infidelity instead of simply being a quick and immediate response to a partner’s actions.

Counseling for women – Anger

Anger in infidelity is quite inevitable. In the initial stage of infidelity, anger is not as apparent as it is seen in stage two, because there is not hard facts or evidence supporting one’s suspicions. As previously talked about, the accuser most likely feels jealous and incompetent in the first stage of cheating. These emotions can contract into anger and provide a cognitive state of anger because the accusing person anticipates his or her anger. Unlike jealousy and resentment, it is hard to identify the purpose or cause of the individual’s anger because in reality there is nothing yet to be angry about, there is no proof of their romantic partner’s unfaithfulness. It is hard to pinpoint the anger emotion in the initial stages due to ambiguity; therefore, it begins to take on other emotions turning into a cognitive state of emotional turmoil. The individual knows they are angry and anticipates it, but cannot logically explain it to their partner because of the lack of evidence they have.

Ref Text: https://en.wikipedia.org/wiki/Infidelity
Ref Photo: Pexels.com

What is Anxiety?

(Wikipedia)

Anxiety is an emotion characterized by an unpleasant state of inner turmoil, often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination. It is the subjectively unpleasant feelings of dread over anticipated events.

Anxiety is a feeling of uneasiness and worry, usually generalized and unfocused as an overreaction to a situation that is only subjectively seen as menacing.[3] It is often accompanied by muscular tension,[4] restlessness, fatigue and problems in concentration. Normally considered to be appropriate, when anxiety is experienced regularly the individual may suffer from an anxiety disorder.[4] Anxiety is closely related to fear, which is a response to a real or perceived immediate threat; anxiety involves the expectation of future threat.[4] People facing anxiety may withdraw from situations which have provoked anxiety in the past.[5]

A job applicant with a worried facial expression

Anxiety is distinguished from fear, which is an appropriate cognitive and emotional response to a perceived threat.[6] Anxiety is related to the specific behaviors of fight-or-flight responses, defensive behavior or escape. It occurs in situations only perceived as uncontrollable or unavoidable, but not realistically so.[7] David Barlow defines anxiety as “a future-oriented mood state in which one is not ready or prepared to attempt to cope with upcoming negative events,”[8] and that it is a distinction between future and present dangers which divides anxiety and fear. Another description of anxiety is agony, dread, terror, or even apprehension.[9] In positive psychology, anxiety is described as the mental state that results from a difficult challenge for which the subject has insufficient coping skills.[10]

Fear and anxiety can be differentiated in four domains: (1) duration of emotional experience, (2) temporal focus, (3) specificity of the threat, and (4) motivated direction. Fear is short lived, present focused, geared towards a specific threat, and facilitating escape from threat; anxiety, on the other hand, is long-acting, future focused, broadly focused towards a diffuse threat, and promoting excessive caution while approaching a potential threat and interferes with constructive coping.[11]

Joseph E. LeDoux and Lisa Feldman Barrett have both sought to separate automatic threat responses from additional associated cognitive activity within anxiety.[12][13]

Therapist Anxiety Newport Beach psychologist Dimitra Takos, PsyD a therapist specializing in treating anxiety in young adults in college, adolescent teens in school, and adults in general.

Anxiety Symptoms

Anxiety can be experienced with long, drawn out daily symptoms that reduce quality of life, known as chronic (or generalized) anxiety, or it can be experienced in short spurts with sporadic, stressful panic attacks, known as acute anxiety.[14] Symptoms of anxiety can range in number, intensity, and frequency, depending on the person. While almost everyone has experienced anxiety at some point in their lives, most do not develop long-term problems with anxiety.

Anxiety may cause psychiatric and physiological symptoms.

The risk of anxiety leading to depression could possibly even lead to an individual harming themselves, which is why there are many 24-hour suicide prevention hotlines.[17]

The behavioral effects of anxiety may include withdrawal from situations which have provoked anxiety or negative feelings in the past.[5] Other effects may include changes in sleeping patterns, changes in habits, increase or decrease in food intake, and increased motor tension (such as foot tapping).[5]

The emotional effects of anxiety may include “feelings of apprehension or dread, trouble concentrating, feeling tense or jumpy, anticipating the worst, irritability, restlessness, watching (and waiting) for signs (and occurrences) of danger, and, feeling like your mind’s gone blank”[18] as well as “nightmares/bad dreams, obsessions about sensations, déjà vu, a trapped-in-your-mind feeling, and feeling like everything is scary.”[19]

The cognitive effects of anxiety may include thoughts about suspected dangers, such as fear of dying. “You may … fear that the chest pains are a deadly heart attack or that the shooting pains in your head are the result of a tumor or an aneurysm. You feel an intense fear when you think of dying, or you may think of it more often than normal, or can’t get it out of your mind.”[20]

The physiological symptoms of anxiety may include:

Neurological, as headache, paresthesias, fasciculations, vertigo, or presyncope.
Digestive, as abdominal pain, nausea, diarrhea, indigestion, dry mouth, or bolus.
Respiratory, as shortness of breath or sighing breathing.
Cardiac, as palpitations, tachycardia, or chest pain.
Muscular, as fatigue, tremors, or tetany.
Cutaneous, as perspiration, or itchy skin.
Uro-genital, as frequent urination, urinary urgency, dyspareunia, or impotence, chronic pelvic pain syndrome. Stress hormones released in an anxious state have an impact on bowel function and can manifest physical symptoms that may contribute to or exacerbate IBS.
Types

Painting entitled Anxiety, 1894, by Edvard Munch

There are various types of anxiety. Existential anxiety can occur when a person faces angst, an existential crisis, or nihilistic feelings. People can also face mathematical anxiety, somatic anxiety, stage fright, or test anxiety. Social anxiety and stranger anxiety are caused when people are apprehensive around strangers or other people in general.[citation needed]

Existential

Further information: Angst, Existential crisis, and Nihilism
The philosopher Søren Kierkegaard, in The Concept of Anxiety (1844), described anxiety or dread associated with the “dizziness of freedom” and suggested the possibility for positive resolution of anxiety through the self-conscious exercise of responsibility and choosing. In Art and Artist (1932), the psychologist Otto Rank wrote that the psychological trauma of birth was the pre-eminent human symbol of existential anxiety and encompasses the creative person’s simultaneous fear of – and desire for – separation, individuation, and differentiation.[citation needed]

The theologian Paul Tillich characterized existential anxiety[21] as “the state in which a being is aware of its possible nonbeing” and he listed three categories for the nonbeing and resulting anxiety: ontic (fate and death), moral (guilt and condemnation), and spiritual (emptiness and meaninglessness). According to Tillich, the last of these three types of existential anxiety, i.e. spiritual anxiety, is predominant in modern times while the others were predominant in earlier periods. Tillich argues that this anxiety can be accepted as part of the human condition or it can be resisted but with negative consequences. In its pathological form, spiritual anxiety may tend to “drive the person toward the creation of certitude in systems of meaning which are supported by tradition and authority” even though such “undoubted certitude is not built on the rock of reality”.[21]

According to Viktor Frankl, the author of Man’s Search for Meaning, when a person is faced with extreme mortal dangers, the most basic of all human wishes is to find a meaning of life to combat the “trauma of nonbeing” as death is near.[22]

Depending on the source of the threat, psychoanalytic theory distinguishes the following types of anxiety:

realistic
neurotic
moral[23]

Test and performance

Main articles: Test anxiety, Mathematical anxiety, Stage fright, and Somatic anxiety
According to Yerkes-Dodson law, an optimal level of arousal is necessary to best complete a task such as an exam, performance, or competitive event. However, when the anxiety or level of arousal exceeds that optimum, the result is a decline in performance.[24]

Test anxiety is the uneasiness, apprehension, or nervousness felt by students who have a fear of failing an exam. Students who have test anxiety may experience any of the following: the association of grades with personal worth; fear of embarrassment by a teacher; fear of alienation from parents or friends; time pressures; or feeling a loss of control. Sweating, dizziness, headaches, racing heartbeats, nausea, fidgeting, uncontrollable crying or laughing and drumming on a desk are all common. Because test anxiety hinges on fear of negative evaluation,[25] debate exists as to whether test anxiety is itself a unique anxiety disorder or whether it is a specific type of social phobia.[26] The DSM-IV classifies test anxiety as a type of social phobia.[27]

While the term “test anxiety” refers specifically to students,[28] many workers share the same experience with regard to their career or profession. The fear of failing at a task and being negatively evaluated for failure can have a similarly negative effect on the adult.[29] Management of test anxiety focuses on achieving relaxation and developing mechanisms to manage anxiety.[28]

Stranger, social, and intergroup anxiety

Main articles: Stranger anxiety and Social anxiety
Humans generally require social acceptance and thus sometimes dread the disapproval of others. Apprehension of being judged by others may cause anxiety in social environments.[30]

Anxiety during social interactions, particularly between strangers, is common among young people. It may persist into adulthood and become social anxiety or social phobia. “Stranger anxiety” in small children is not considered a phobia. In adults, an excessive fear of other people is not a developmentally common stage; it is called social anxiety. According to Cutting,[31] social phobics do not fear the crowd but the fact that they may be judged negatively.

Social anxiety varies in degree and severity. For some people, it is characterized by experiencing discomfort or awkwardness during physical social contact (e.g. embracing, shaking hands, etc.), while in other cases it can lead to a fear of interacting with unfamiliar people altogether. Those suffering from this condition may restrict their lifestyles to accommodate the anxiety, minimizing social interaction whenever possible. Social anxiety also forms a core aspect of certain personality disorders, including avoidant personality disorder.[32]

To the extent that a person is fearful of social encounters with unfamiliar others, some people may experience anxiety particularly during interactions with outgroup members, or people who share different group memberships (i.e., by race, ethnicity, class, gender, etc.). Depending on the nature of the antecedent relations, cognitions, and situational factors, intergroup contact may be stressful and lead to feelings of anxiety. This apprehension or fear of contact with outgroup members is often called interracial or intergroup anxiety.[33]

As is the case the more generalized forms of social anxiety, intergroup anxiety has behavioral, cognitive, and affective effects. For instance, increases in schematic processing and simplified information processing can occur when anxiety is high. Indeed, such is consistent with related work on attentional bias in implicit memory.[34][35][36] Additionally recent research has found that implicit racial evaluations (i.e. automatic prejudiced attitudes) can be amplified during intergroup interaction.[37] Negative experiences have been illustrated in producing not only negative expectations, but also avoidant, or antagonistic, behavior such as hostility.[38] Furthermore, when compared to anxiety levels and cognitive effort (e.g., impression management and self-presentation) in intragroup contexts, levels and depletion of resources may be exacerbated in the intergroup situation.

Trait

Anxiety can be either a short-term ‘state’ or a long-term personality “trait”. Trait anxiety reflects a stable tendency across the lifespan of responding with acute, state anxiety in the anticipation of threatening situations (whether they are actually deemed threatening or not).[39] A meta-analysis showed that a high level of neuroticism is a risk factor for development of anxiety symptoms and disorders.[40] Such anxiety may be conscious or unconscious.[41]

Personality can also be a trait leading towards anxiety and depression. Through experience many find it difficult to collect themselves due to their own personal nature.[42]

Choice or decision

Anxiety induced by the need to choose between similar options is increasingly being recognized as a problem for individuals and for organizations.[43] In 2004, Capgemini wrote: “Today we’re all faced with greater choice, more competition and less time to consider our options or seek out the right advice.”[44]

In a decision context, unpredictability or uncertainty may trigger emotional responses in anxious individuals that systematically alter decision-making.[45] There are primarily two forms of this anxiety type. The first form refers to a choice in which there are multiple potential outcomes with known or calculable probabilities. The second form refers to the uncertainty and ambiguity related to a decision context in which there are multiple possible outcomes with unknown probabilities.[45]

Panic Disorder

Panic disorder may share symptoms of stress and anxiety, but it is actually very different. Panic disorder is an anxiety disorder that occurs without any triggers. According to the U.S Department of Health and Human Services, this disorder can be distinguished by unexpected and repeated episodes of intense fear.[46] Someone who suffers from panic disorder will eventually develop constant fear of another attack and as this progresses it will begin to affect daily functioning and an individual’s general quality of life. It is reported by the Cleveland Clinic that panic disorder affects 2 to 3 percent of adult Americans and can begin around the time of the teenage and early adult years. Some symptoms include: difficulty breathing, chest pain, dizziness, trembling or shaking, feeling faint, nausea, fear that you are losing control or are about to die. Even though they suffer from these symptoms during an attack, the main symptom is the persistent fear of having future panic attacks.[47]

Anxiety disorders

Main article: Anxiety disorder
Anxiety disorders are a group of mental disorders characterized by exaggerated feelings of anxiety and fear responses.[48] Anxiety is a worry about future events and fear is a reaction to current events. These feelings may cause physical symptoms, such as a fast heart rate and shakiness. There are a number of anxiety disorders: including generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism. The disorder differs by what results in the symptoms. People often have more than one anxiety disorder.[48]

Anxiety disorders are caused by a complex combination of genetic and environmental factors.[citation needed] To be diagnosed, symptoms typically need to be present for at least six months, be more than would be expected for the situation, and decrease a person’s ability to function in their daily lives.[citation needed] Other problems that may result in similar symptoms include hyperthyroidism, heart disease, caffeine, alcohol, or cannabis use, and withdrawal from certain drugs, among others.[citation needed]

Without treatment, anxiety disorders tend to remain.[48][49] Treatment may include lifestyle changes, counselling, and medications. Counselling is typically with a type of cognitive behavioural therapy.[50] Medications, such as antidepressants or beta blockers, may improve symptoms.[49]

About 12% of people are affected by an anxiety disorder in a given year and between 5–30% are affected at some point in their life.[50][51] They occur about twice as often in women than they do in men, and generally begin before the age of 25.[48][50] The most common are specific phobia which affects nearly 12% and social anxiety disorder which affects 10% at some point in their life. They affect those between the ages of 15 and 35 the most and become less common after the age of 55. Rates appear to be higher in the United States and Europe.[50]

Short- and long-term anxiety

Anxiety can be either a short-term “state” or a long-term “trait”. Whereas trait anxiety represents worrying about future events, anxiety disorders are a group of mental disorders characterized by feelings of anxiety and fear.[48]

Co-morbidity

Anxiety disorders often occur with other mental health disorders, particularly major depressive disorder, bipolar disorder, eating disorders, or certain personality disorders. It also commonly occurs with personality traits such as neuroticism. This observed co-occurrence is partly due to genetic and environmental influences shared between these traits and anxiety.[52][53]

Anxiety is often experienced by those with obsessive–compulsive disorder and is an acute presence in panic disorder.

Risk factors

A marble bust of the Roman Emperor Decius from the Capitoline Museum. This portrait “conveys an impression of anxiety and weariness, as of a man shouldering heavy [state] responsibilities”.[54]
Anxiety disorders are partly genetic, with twin studies suggesting 30-40% genetic influence on individual differences in anxiety.[55] Environmental factors are also important. Twin studies show that individual-specific environments have a large influence on anxiety, whereas shared environmental influences (environments that affect twins in the same way) operate during childhood but decline through adolescence.[56] Specific measured ‘environments’ that have been associated with anxiety include child abuse, family history of mental health disorders, and poverty.[57] Anxiety is also associated with drug use, including alcohol, caffeine, and benzodiazepines (which are often prescribed to treat anxiety).

Neuroanatomy

Neural circuitry involving the amygdala (which regulates emotions like anxiety and fear, stimulating the HPA Axis and sympathetic nervous system) and hippocampus (which is implicated in emotional memory along with the amygdala) is thought to underlie anxiety.[58] People who have anxiety tend to show high activity in response to emotional stimuli in the amygdala.[59] Some writers believe that excessive anxiety can lead to an overpotentiation of the limbic system (which includes the amygdala and nucleus accumbens), giving increased future anxiety, but this does not appear to have been proven.[60][61]

Research upon adolescents who as infants had been highly apprehensive, vigilant, and fearful finds that their nucleus accumbens is more sensitive than that in other people when deciding to make an action that determined whether they received a reward.[62] This suggests a link between circuits responsible for fear and also reward in anxious people. As researchers note, “a sense of ‘responsibility’, or self-agency, in a context of uncertainty (probabilistic outcomes) drives the neural system underlying appetitive motivation (i.e., nucleus accumbens) more strongly in temperamentally inhibited than noninhibited adolescents”.[62]

The gut-brain axis

The microbes of the gut can connect with the brain to affect anxiety. There are various pathways along which this communication can take place. One is through the major neurotransmitters.[63] The gut microbes such as Bifidobacterium and Bacillus produce the neurotransmitters GABA and dopamine, respectively.[64] The neurotransmitters signal to the nervous system of the gastrointestinal tract, and those signals will be carried to the brain through the vagus nerve or the spinal system.[63][64][65] This is demonstrated by the fact that altering the microbiome has shown anxiety- and depression-reducing effects in mice, but not in subjects without vagus nerves.[66]

Another key pathway is the HPA axis, as mentioned above.[65] The microbes can control the levels of cytokines in the body, and altering cytokine levels creates direct effects on areas of the brain such as the hypothalmus, the area that triggers HPA axis activity. The HPA axis regulates production of cortisol, a hormone that takes part in the body’s stress response.[65] When HPA activity spikes, cortisol levels increase, processing and reducing anxiety in stressful situations. These pathways, as well as the specific effects of individual taxa of microbes, are not yet completely clear, but the communication between the gut microbiome and the brain is undeniable, as is the ability of these pathways to alter anxiety levels.

With this communication comes the potential to treat anxiety. Prebiotics and probiotics have been shown to reduced anxiety. For example, experiments in which mice were given fructo- and galacto-oligosaccharide prebiotics[67] and Lactobacillus probiotics[66] have both demonstrated a capability to reduce anxiety. In humans, results are not as concrete, but promising.[68][69]

Genetics

Genetics and family history (e.g. parental anxiety) may put an individual at increased risk of an anxiety disorder, but generally external stimuli will trigger its onset or exacerbation.[57] Estimates of genetic influence on anxiety, based on studies of twins, range from 25–40% depending on the specific type and age-group under study. For example, genetic differences account for about 43% of variance in panic disorder and 28% in generalized anxiety disorder.[citation needed] Longitudinal twin studies have shown the moderate stability of anxiety from childhood through to adulthood is mainly influenced by stability in genetic influence.[70][71] When investigating how anxiety is passed on from parents to children, it is important to account for sharing of genes as well as environments, for example using the intergenerational children-of-twins design.[72]

Many studies in the past used a candidate gene approach to test whether single genes were associated with anxiety. These investigations were based on hypotheses about how certain known genes influence neurotransmitters (such as serotonin and norepinephrine) and hormones (such as cortisol) that are implicated in anxiety. None of these findings are well replicated,[citation needed] with the possible exception of TMEM132D, COMT and MAO-A.[73] The epigenetic signature of BDNF, a gene that codes for a protein called brain derived neurotrophic factor that is found in the brain, has also been associated with anxiety and specific patterns of neural activity.[citation needed] and a receptor gene for BDNF called NTRK2 was associated with anxiety in a large genome-wide investigation.[74] The reason that most candidate gene findings have not replicated is that anxiety is a complex trait that is influenced by many genomic variants, each of which has a small effect on its own. Increasingly, studies of anxiety are using a hypothesis-free approach to look for parts of the genome that are implicated in anxiety using big enough samples to find associations with variants that have small effects. The largest explorations of the common genetic architecture of anxiety have been facilitated by the UK Biobank, the ANGST consortium and the CRC Fear, Anxiety and Anxiety Disorders.[74][75][76]

Medical conditions

Many medical conditions can cause anxiety. This includes conditions that affect the ability to breathe, like COPD and asthma, and the difficulty in breathing that often occurs near death.[77][78][79] Conditions that cause abdominal pain or chest pain can cause anxiety and may in some cases be a somatization of anxiety;[80][81] the same is true for some sexual dysfunctions.[82][83] Conditions that affect the face or the skin can cause social anxiety especially among adolescents,[84] and developmental disabilities often lead to social anxiety for children as well.[85] Life-threatening conditions like cancer also cause anxiety.[86]

Furthermore, certain organic diseases may present with anxiety or symptoms that mimic anxiety.[15][87] These disorders include certain endocrine diseases (hypo- and hyperthyroidism, hyperprolactinemia),[87][88] metabolic disorders (diabetes),[87][89][90] deficiency states (low levels of vitamin D, B2, B12, folic acid),[87] gastrointestinal diseases (celiac disease, non-celiac gluten sensitivity, inflammatory bowel disease),[91][92][93] heart diseases, blood diseases (anemia),[87] cerebral vascular accidents (transient ischemic attack, stroke),[87] and brain degenerative diseases (Parkinson’s disease, dementia, multiple sclerosis, Huntington’s disease), among others.[87][94][95][96]

Substance-induced

Several drugs can cause or worsen anxiety, whether in intoxication, withdrawal or as side effect. These include alcohol, tobacco, cannabis, sedatives (including prescription benzodiazepines), opioids (including prescription pain killers and illicit drugs like heroin), stimulants (such as caffeine, cocaine and amphetamines), hallucinogens, and inhalants.[97] While many often report self-medicating anxiety with these substances, improvements in anxiety from drugs are usually short-lived (with worsening of anxiety in the long term, sometimes with acute anxiety as soon as the drug effects wear off) and tend to be exaggerated. Acute exposure to toxic levels of benzene may cause euphoria, anxiety, and irritability lasting up to 2 weeks after the exposure.[98]

Psychological

Poor coping skills (e.g., rigidity/inflexible problem solving, denial, avoidance, impulsivity, extreme self-expectation, negative thoughts, affective instability, and inability to focus on problems) are associated with anxiety. Anxiety is also linked and perpetuated by the person’s own pessimistic outcome expectancy and how they cope with feedback negativity.[99] Temperament (e.g., neuroticism)[40] and attitudes (e.g. pessimism) have been found to be risk factors for anxiety.[97][100]

Cognitive distortions such as overgeneralizing, catastrophizing, mind reading, emotional reasoning, binocular trick, and mental filter can result in anxiety. For example, an overgeneralized belief that something bad “always” happens may lead someone to have excessive fears of even minimally risky situations and to avoid benign social situations due to anticipatory anxiety of embarrassment. In addition, those who have high anxiety can also create future stressful life events.[101] Together, these findings suggest that anxious thoughts can lead to anticipatory anxiety as well stressful events, which in turn cause more anxiety. Such unhealthy thoughts can be targets for successful treatment with cognitive therapy.

Psychodynamic theory posits that anxiety is often the result of opposing unconscious wishes or fears that manifest via maladaptive defense mechanisms (such as suppression, repression, anticipation, regression, somatization, passive aggression, dissociation) that develop to adapt to problems with early objects (e.g., caregivers) and empathic failures in childhood. For example, persistent parental discouragement of anger may result in repression/suppression of angry feelings which manifests as gastrointestinal distress (somatization) when provoked by another while the anger remains unconscious and outside the individual’s awareness. Such conflicts can be targets for successful treatment with psychodynamic therapy. While psychodynamic therapy tends to explore the underlying roots of anxiety, cognitive behavioral therapy has also been shown to be a successful treatment for anxiety by altering irrational thoughts and unwanted behaviors.

Evolutionary psychology

An evolutionary psychology explanation is that increased anxiety serves the purpose of increased vigilance regarding potential threats in the environment as well as increased tendency to take proactive actions regarding such possible threats. This may cause false positive reactions but an individual suffering from anxiety may also avoid real threats. This may explain why anxious people are less likely to die due to accidents.[102]

When people are confronted with unpleasant and potentially harmful stimuli such as foul odors or tastes, PET-scans show increased blood flow in the amygdala.[103][104] In these studies, the participants also reported moderate anxiety. This might indicate that anxiety is a protective mechanism designed to prevent the organism from engaging in potentially harmful behaviors.

Social

Social risk factors for anxiety include a history of trauma (e.g., physical, sexual or emotional abuse or assault), early life experiences and parenting factors (e.g., rejection, lack of warmth, high hostility, harsh discipline, high parental negative affect, anxious childrearing, modelling of dysfunctional and drug-abusing behaviour, discouragement of emotions, poor socialization, poor attachment, and child abuse and neglect), cultural factors (e.g., stoic families/cultures, persecuted minorities including the disabled), and socioeconomics (e.g., uneducated, unemployed, impoverished although developed countries have higher rates of anxiety disorders than developing countries).[97][105] A 2019 comprehensive systematic review of over 50 studies showed that food insecurity in the United States is strongly associated with depression, anxiety, and sleep disorders.[106] Food-insecure individuals had an almost 3 fold risk increase of testing positive for anxiety when compared to food-secure individuals.

Ref text and photo: Wikipedia & Pexels

Psychology Articles, Therapy News, and Mental Health Topics

A great resource for Psychology Articles, Therapy News, and Mental Health Topics.

The Panelist is valuable place to find articles on health and mental health as well as current events. A recent article that was featured spoke about flouride added to the water, and it’s negative effects. This article also spoke about the possible links of water flouridation to ADD and ADHD, which is such a current topic among therapy professionals.

Grief: Have We Moved Beyond the Five Stages?

At first thought, you may associate grief with death and losing someone close to you. Grief over the loss of a loved one is specifically referred to as bereavement. However, if you’ve experienced any kind of significant loss, such as the loss of a relationship, career, health status, or any other loss that triggered strong emotional distress, then you are no stranger to grief. In this post I am going to explore a popular model for processing grief, and why that may no longer be the best way to approach the experience of loss.

Work through your loss with me through online counseling in New Jersey

I have experience working with individuals dealing with different sources of grief. I’ve spent time as a hospice social worker helping patients and their loved ones process the emotional and practical aspects of death, as well as years in long term care helping people adjust to changes in lifestyle and health status. In my counseling practice, grief shows up in many ways, whether it’s the result of death, divorce, change in health status, career loss, and so on.

In helping you to process your loss, I partner with you to explore and make sense of your unique emotional reactions. Together, we navigate your grief and find ways to process, heal, and move forward in light of the changes that have been created by your loss. Contact me to learn more about working together through online counseling in New Jersey.

The truth about the five stages

You may have heard of the 5 stages of grief as identified by Elizabeth Kübler-Ross, which are denial, anger, bargaining, depression, and acceptance. However, these stages were actually intended to apply to the emotional process that a patient experiences as they adjust to being diagnosed with a terminal illness.1 The grieving processes appeared to be similar for the loved ones experiencing the loss of their loved one, and so Kübler-Ross also applied them to the bereaved as well.

The 5 stages model continues to be widely popular despite major concerns about the theory. An article in OMEGA-Journal of Death and Dying from 2017 by Margaret Stroebe, Henk Schut, and Kathrin Boerner2 identifies issues with the way the stages model represents grief. Here are some of the concerns they identify:

1. Oversimplification – reactions to grief are as diverse and varied as each person who experiences loss. The 5 stages model does not account for this variability.

2. The stages model is passive, meaning that although it describes what a bereaved person experiences, it doesn’t address the struggle of coming to terms with the loss.

3. Stages include concepts that incorporate imprecise and broad terms. Some stages are identified by emotions, while others are cognitive processes.

4. It implies that stages have a smooth progression. This does not accurately represent that we actually know about the experience of grief, like someone may experience only some stages, the stages may be experienced out of order, stages can be re-experienced, and people may have experiences not included in the stage model.

5. Stages are presented in a prescriptive way. For instance, anger is identified as a necessary stage, and although it’s a common symptom, it’s not experienced by everyone.

6. It doesn’t take into account secondary stressors, such as the necessary adaptations that occur following a loss like changes in identity, roles, life changes, etc.

These are some of the concerns noted by Margaret Stroebe, Henk Schut, and Kathrin Boerner2 who feel that the stage theory should be abandoned and that the use of stage theory could potentially be harmful. Here are some examples of how the stage model could be detrimental to a grieving individual:

• If an individual is not experiencing grief in the stages indicated by Kübler-Ross, it could result in someone feeling that they are grieving incorrectly, potentially creating even more emotional distress for an individual.

• Since the stages could be interpreted as prescriptive, someone could end up relying more on the stages than on their own emotional experiences. This could create tension between the way grief is actually presenting vs. the stage of grief someone believes they should be experiencing.

• Mental health practitioners who adhere to the 5 stage model could inadvertently complicate someone’s grieving process by reinforcing the idea that grief must be experienced in these separate stages.

Sarah Tronco, LCSW, provides Online Counseling in New Jersey and works to develop a strong therapeutic relationship with her clients, which helps to create a secure place where individuals can achieve meaningful change.

References:

1. https://www.psychologytoday.com/us/blog/supersurvivors/201707/why-the-five-stages-grief-are-wrong

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5375020/pdf/10.1177_0030222817691870.pdf

3. Photo by Danielle MacInnes on Unsplash

Couples Therapy for Rekindling Romance

Romance fades. However, that doesn’t mean that you’re doomed to a life of the doldrums after the honeymoon phase has worn off. Instead, it means that you need to reinvent your meaning of romance. More importantly, it means getting on the same page as your partner about what romance looks like as your marriage grows. Couples counseling can provide you with a terrific space for figuring that out.

From Romance to Roommates and Back Again

Most relationships follow a common arc in that they start hot and heavy and then fade into something less lusty but steadier. However, if you’re not careful, the romance can slip so far away that it starts to feel like you’re just roommates. When that happens, one or both of you are likely to become dissatisfied.

Unfortunately, you can’t go back to before when you barely knew each other. You can finish each other’s sentences. You know exactly how to push each other’s buttons. And you can’t stop engaging in the mundane details of everyday life. However, you can still get the romance back. It just looks a little different than when you first met. There’s nothing wrong with that. In fact, it gives you the opportunity to get creative, which can be wonderful.

Is There a Problem?

Sometimes romance fades just because of circumstance. You have a few children, you get busy with your careers, you deal with illness … and the romance just kind of slips away. However, sometimes a lack of romance is a sign of an underlying issue in the relationship. Couples counseling can help you come together to communicate about exactly what’s going on. You can figure out if there’s a bigger problem at play, and if so, how you want to address it.

For example, sometimes a lack of romance is due to a series of built-up resentments that you’ve failed to deal with over time. Couples therapy can help you air those resentments, communicate about them in a healthy way, and find methods of moving forward. Once you feel more connected again, the romance issue might resolve itself. If not, couples counseling can help with that too.

Rekindle the Spark in Your Relationship

Couples therapy can also simply serve as a catalyst to rekindle romance. Simply setting aside one hour per week to talk about your relationship is a strong show of commitment. While in therapy, you can communicate about ideas that you might have to rekindle romance. Sometimes you’re shy or afraid about doing that on your own but become empowered to do so in the therapy office.

Your therapist might also offer counseling exercises, therapeutic homework, or simply suggestions for how to find ways to rekindle romance at home. You might learn new techniques for practicing mindfulness in the relationship. You might set goals that help you get romance back on track. Alternatively, you might just find that you’re more committed to date nights and weekend getaways since you feel a bit accountable for reporting back to your therapist.

Rekindling romance can be as simple as adding more handholding and deep kisses to your daily life. Or it can be much more in-depth and creative. The trick is to start somewhere. Couples counseling can help you both start on the same page.

Kathryn McNeer, LPC specializes in Couples Counseling Dallas with her sound, practical and sincere advice. Kathryn’s areas of focus include individual counseling, relationship and couples counseling Dallas. Kathryn has helped countless individuals find their way through life’s inevitable transitions; especially that tricky patch of life known as “the mid life crisis.” Kathryn’s solution-focused, no- nonsense counseling works wonders for men and women in the midst of feeling, “stuck,” or “unhappy.” Kathryn believes her fresh perspective allows her clients find the better days that are ahead. When working with couples, it is Kathryn’s direct yet non-judgmental approach that helps determine which patterns are holding them back and then helps them establish new, more productive patterns. Kathryn draws from Gottman and Cognitive behavioral therapy. When appropriate Kathryn works with couples on trust, intimacy, forgiveness, and communication.

Overcoming Fear of Flying in the Bumpy Skies

Turbulence is a natural occurrence and should be expected — not dreaded. The trick is to learn to go with the flow.

Lately, at airport gates and security lines, I’m increasingly hearing other frequent fliers share stories of spilled coffee and sudden drops on planes. Threaded through nearly every conversation are questions about whether there has been an upswing in air turbulence, and whether climate change is to blame.

Turbulence was never a concern for Ashwin Fernandes, who takes more than 200 flights per year as regional director to the Middle East, North Africa and South Asia for Quacquarelli Symonds (QS) World University Rankings, until a bad flight in 2013 left him spooked.

“We were over the Bay of Bengal during monsoon season and the plane started shaking violently and then dropped suddenly,” he recounts. “I didn’t know what to do, except wonder how much worse it would get and when it would end.”

Since then, Mr. Fernandes has followed a strict set of self-imposed rules, which includes taking daytime flights whenever possible. Red-eye flights, he says, can be more anxiety-provoking because of fatigue. But one question continues to haunt him: Is global warming making the skies less friendly?

Maybe, but only at certain altitudes, said Paul D. Williams, professor of atmospheric science at the University of Reading, who is the co-developer of a turbulence-forecasting algorithm that has helped make flight travel more comfortable by avoiding rough air and greener by reducing carbon dioxide emissions via “low turbulence” routes.

“Climate change is altering temperature patterns and wind speeds in the upper atmosphere,” he says. “The main consequence for aviation is an increase in clear-air turbulence, or in-flight bumpiness at high altitudes in regions devoid of significant cloudiness or nearby thunderstorms, as the jet stream becomes more unstable.”

But severe turbulence, the kind that causes passengers who aren’t wearing their seatbelts to defy gravity and lift up from their seats, remains a very rare occurrence.

“Only around 0.1 percent of the atmosphere at flight cruising levels contains severe turbulence, so even if that figure were to double or treble because of climate change, severe turbulence will still be very rare,” Dr. Williams says, also offering grounds for optimism. “Hopefully, a combination of improved turbulence forecasts and better technology will reduce the number of aircraft encountering turbulence in the future, despite the effects of climate change.”

The takeaway is to remain buckled throughout the flight, as is routinely instructed by the cockpit crew before takeoff. Airlines want passengers to be comfortable throughout the journey, which is the main reason for avoiding turbulence. Cargo planes, filled with packages instead of people, on the other hand, tend to stay the course even when the air is rough.

“No matter how scary it might feel, our pilots are in control and there is no question of structural integrity,” explains Rich Terry, a captain and managing director of fleet support for Delta Air Lines. “Modern aircraft are developed and tested to sustain any level of conceivable turbulence.”

Captain Terry says the easiest way to make sense of turbulence is to think about ocean waves cresting and falling. “That same movement happens in the air, so now picture those same movements throughout the atmosphere. When airplanes intersect those waves, you have turbulence.”

In other words, it’s a natural occurrence and should be expected — not dreaded. Learn to go with the flow.

“Expect, accept, allow” is the self-regulating advice offered by Martin N. Seif, a psychologist with private practices in New York and Connecticut who co-founded the Anxiety and Depression Association of America and is a co-author of “What Every Therapist Needs to Know About Anxiety Disorders” and “Overcoming Unwanted Intrusive Thoughts.”

When experiencing turbulence, Dr. Seif suggests replacing “what if” thoughts with “what is” thoughts. “Stay present,” he advises. “Anxiety is fueled by catastrophic thoughts and is maintained by attempts to avoid it.”

Ashley Nicholls, who frequently flies around the Northeast with her Vermont-based marketing and communications firm, says that when the going gets rough, she distracts herself with math — subtracting from 100 by three’s. “By the time I get to 1, the bumps are done. If they aren’t, I start over.”

What about preparing in advance for turbulence by monitoring weather reports and checking the latest phone apps for flight conditions? Both Mr. Fernandes and Ms. Nicholls believe that this may help to keep the element of surprise at bay, but Dr. Seif disagrees.

“All that stuff reinforces anxiety and puts the focus on the need to avoid turbulence,” he warns. “The best thing you can do is nothing.”

Adam Bluestein, a freelance journalist, grew weary of his worries over weather and decided to rewrite the script in his head. Previously reliant on an array of spiritual talismans — a Ganesh necklace, a tiny Buddha statue, a pouch of crystals, and 36 cents wrapped in a piece of aluminum foil as a Jewish blessing for life — Mr. Bluestein found a better way to check in and zone out.

He embarked on a cognitive behavioral therapy of his own design, which included educating himself in the laws of space and physics, and then flying to Thailand to re-establish his sense of courage. The outcome was a complete reset of his mental state. He no longer obsesses about what’s out of his control. Letting go, he knows, is the biggest obstacle for anxious fliers.

“Now I go up with a calmer state of mind. I observe what’s happening, I don’t react. When I see the wings bend, I know that’s what they are meant to do,” he says, also crediting yoga for helping him “muster of a sense of detachment” even in turbulence.

“Recently, I was on a 747 from Amsterdam, in a middle seat, when out of nowhere, the plane dropped by what seemed like 100 feet and my arms flew up,” he says. “When things like that happen now, it causes me to feel a greater calm because I’ve spent so much time working on it. I like when there’s stuff going on. It’s almost reassuring.

Ultimately, Mr. Bluestein landed on what could be the most grounding response to turbulent skies I’ve encountered: “It’s not about me.”

By Nancy Stearns Bercaw

Kin Leung is a Marriage & Family Therapist, MFT practicing in the San Francisco Bay area. Kin specializes in helping couples overcome struggles related to infidelity, intimacy, miscommunication, mistrust, and parenting. Kin’s kind, thoughtful and compassionate approach to marriage counseling San Francisco helps guide couples to a calmer and safer space to explore issues and move forward in a more productive manner.

In Search of Secure Attachment

Escaping the trap of push-and-pull relationships.

Attachment styles are formed in childhood, when the early relationship between child and parent begins to take shape. Researchers have found that attachment patterns established during childhood tend to manifest themselves again adult relationships.

In short, the attachment pattern you form with your parents is replicated later in your romantic relationships.
Ever heard that we each crave the love that we know?
Attachment styles

About 60% of people have a secure attachment style, meaning their parents represented a safe touch-base from which they set out to explore the world when they were children.

As adults, this lucky bunch is able to form secure relationships, meaning they are attuned to their partner’s needs as well as their own, and are also able to set healthy boundaries inside the relationship. Relationships between people with secure attachment styles will have their ups and downs, but those relationships are usually what we reference as healthy.
The rest of us are divided between anxious and avoidant (about 20% each).

Lisa Firestone Ph.D. explains how anxious and avoidant patterns are formed:

Anxious: “[…]when a parent is available and attuned at times and insensitive or intrusive at others, the child is more likely to experience an anxious ambivalent attachment pattern. An anxiously attached child can feel like they have to cling to their parent to get their needs met.”

In other words, an anxious attachment style is formed whenever a child’s emotional needs is not consistently met. The child is never sure about how her requests for emotional support will be received, since the response from her parents tends to be unreliable.
Avoidant: “This pattern of attachment develops when a child does not consistently feel safe, seen, or soothed by their parent and therefore becomes pseudo-independent.”

When it comes to forming an avoidant attachment pattern, the parents in this scenario are described by Dr. Lisa Firestone as “emotional deserts,” meaning they’re not very responsive. The result is a child who feels she has to either ignore her own emotional needs (since they’re inconvenient to her parents), or take care of them herself (since she can’t count on anyone else to help her with that).

The good news for those of us with a maladaptive attachment patterns (anxious or avoidant) is that it’s possible to work on changing towards secure. Therapy and self-reflection help a lot.

The bad news is that people with maladaptive attachment patterns tend to attract each other, especially when they’re not aware of which attachment pattern they have, or what that means in practical terms.

The match between someone who’s anxious and someone who’s avoidant doesn’t usually form the healthiest relationships.

How the anxious and the avoidant find each other

When they first get together, the anxious and the avoidant feel like the perfect match.

The anxious partner needs frequent validation. She needs to check with her partner constantly that he still loves her, cares for her, and considers her a priority. She sees it as investing in the relationship, as being all-in.

She blows the relationship out of proportion in her head. Love is everything, and doing everything together, texting all the time when you’re apart, and having long conversations about your feelings is what love is.

After they break up, he calls her needy.

The avoidant partner represents the other extreme. He’s too busy, he can’t be bothered. He’ll call later — maybe.

He takes care of his own emotional needs (or so he thinks), after all, so he doesn’t understand how someone could need that much reassurance that often.
After they break up, she tells her friends he was cold, self-centered, and immature.

(I’m using “him” and “her” because it reflects my personal experience, but gender doesn’t actually matter in determining anyone’s attachment pattern.)

I admit, I have first-hand experience on the (im)perfect combination between an anxious attachment style and a dismissive-avoidant attachment style.

When in a relationship, the avoidant partner’s elusiveness confirms the anxious partner’s need to push harder, to insist. The more the anxious partner insists, the more the avoidant partner feels his need for space is justified.

For a while, their characteristic behaviors justify each other, and they’re happy in their little dance — until they’re not.

My mind-blown moment

Identifying my attachment pattern as anxious-preoccupied has opened my eyes to my behavior in relationships. Understanding how someone with an avoidant attachment style can be so attractive to someone like me simply put my past relationships under a completely new light.

I can’t say it explains everything, because people are a bit more complex than their attachment styles, but I feel like it explains a lot.

I would get into relationships with a need to feel emotionally satisfied before I could do anything else — study, pursue a career, and even care for myself.

Feeling secure, to me, meant that I needed constant validation that the relationship mattered as much to my partner as it did to me. In other words, I needed to feel like it mattered more to him than anything else.

That meant that the more I needed my partner, the more he pulled away. The more he pulled away, the more I felt alone, empty, and insecure.

Whenever I fell into a relationship with an avoidant, I ended up subsisting on scraps of emotional attention, while expecting a full meal that would never come.

In the words of Dr. Lisa Firestone, the avoidant partner:

“[…] can appear to be more focused on themselves and to value their priorities above their partner’s. They can seem cool and removed, often showing annoyance or even disdain when their partner is expressing feelings or needs, believing their partner is being “childish” or “dramatic.” These reactions mimic the emotional desert in which they grew up.”

We’re not broken

Having a maladaptive attachment style doesn’t mean anyone’s broken.

It only means that some work is required in order to progress towards a secure attachment style, and to avoid the pain and heartbreak of a mismatch such as the ones I experienced.

Anxious and avoidants don’t always end up together, but knowing they are very likely to attract each other — and make each other very miserable — is reason enough to seek deeper knowledge of your attachment style.

In order to correct a maladaptive attachment style, self-awareness is the first step. By understanding your emotional needs and how you seek to fulfill them, you can make major progress in avoiding a push-and-pull type of relationship in favor of a more secure, well-balanced one.

Seeking the guidance of a qualified therapist is also an important step.

By Rae Gomes

Benu Lahiry is an Associate Marriage and Family Therapist in San Francisco specializing in Couples Counseling Pacific Heights. Her work is especially helpful for people experiencing anxiety, depression, self-doubt, lack of motivation, and for couples with intimacy issues. She is experienced in many evidence-based therapy modalities, including attachment theory, cognitive behavioral therapy, psychodynamic principles, mindfulness practices, and solution-focused therapy. Her therapeutic style is best described as warm, direct, and collaborative.

In Romantic Relationships, People Do Indeed Have a ‘Type’

Researchers show that people do indeed have a ‘type’ when it comes to dating, and that despite best intentions to date outside that type — for example, after a bad relationship — some will gravitate to similar partners.

If you’ve ever come out of a bad relationship and decided you need to date someone different from your usual “type,” you’re not alone.

However, new research by social psychologists at the University of Toronto (U of T) suggests that might be easier said than done. A study published today in Proceedings of the National Academy of Sciences shows people often look for love with the same type of person over and over again.

“It’s common that when a relationship ends, people attribute the breakup to their ex-partner’s personality and decide they need to date a different type of person,” says lead author Yoobin Park, a PhD student in the Department of Psychology in the Faculty of Arts & Science at U of T. “Our research suggests there’s a strong tendency to nevertheless continue to date a similar personality.”

Using data from an ongoing multi-year study on couples and families across several age groups, Park and co-author Geoff MacDonald, a professor in the Department of Psychology at U of T, compared the personalities of current and past partners of 332 people. Their primary finding was the existence of a significant consistency in the personalities of an individual’s romantic partners.

“The effect is more than just a tendency to date someone similar to yourself,” says Park.

Participants in the study along with a sample of current and past partners, assessed their own personality traits related to agreeableness, conscientiousness, extraversion, neuroticism, and openness to experience. They were polled on how much they identified with a series of statements such as, “I am usually modest and reserved,” “I am interested in many different kinds of things” and “I make plans and carry them out.” Respondents were asked to rate their disagreement or agreement with each statement on a five-point scale.

Park and MacDonald’s analysis of the responses showed that overall, the current partners of individuals described themselves in ways that were similar to past partners.

“The degree of consistency from one relationship to the next suggests that people may indeed have a ‘type’,” says MacDonald. “And though our data do not make clear why people’s partners exhibit similar personalities, it is noteworthy that we found partner similarity above and beyond similarity to oneself.”

By examining first-person testimonials of someone’s partners rather than relying on someone’s own description of them, the work accounts for biases found in other studies.

“Our study was particularly rigorous because we didn’t just rely on one person recalling their various partners’ personalities,” said Park. “We had reports from the partners themselves in real time.”

The researchers say the findings offer ways to keep relationships healthy and couples happy.

“In every relationship, people learn strategies for working with their partner’s personality,” says Park. “If your new partner’s personality resembles your ex-partner’s personality, transferring the skills you learned might be an effective way to start a new relationship on a good footing.”

On the other hand, Park says the strategies people learn to manage their partner’s personality can also be negative, and that more research is needed to determine how much meeting someone similar to an ex-partner is a plus, and how much it’s a minus when moving to a new relationship.

“So, if you find you’re having the same issues in relationship after relationship,” says Park, “you may want to think about how gravitating toward the same personality traits in a partner is contributing to the consistency in your problems.”

The data for the research comes from the German Family Panel study launched in 2008, an ongoing longitudinal study on couple and family dynamics with a nationally representative sample of adolescents, young adults, and midlife individuals in Germany.

Story Source:
Materials provided by University of Toronto. Note: Content may be edited for style and length.

Journal Reference:
Yoobin Park, Geoff MacDonald. Consistency between individuals’ past and current romantic partners’ own reports of their personalities. Proceedings of the National Academy of Sciences, June 10, 2019; DOI: 10.1073/pnas.1902937116

Kathryn McNeer, LPC specializes in Couples Counseling Dallas with her sound, practical and sincere advice. Kathryn’s areas of focus include individual counseling, relationship and couples counseling Dallas. Kathryn has helped countless individuals find their way through life’s inevitable transitions; especially that tricky patch of life known as “the mid life crisis.” Kathryn’s solution-focused, no- nonsense counseling works wonders for men and women in the midst of feeling, “stuck,” or “unhappy.” Kathryn believes her fresh perspective allows her clients find the better days that are ahead. When working with couples, it is Kathryn’s direct yet non-judgmental approach that helps determine which patterns are holding them back and then helps them establish new, more productive patterns. Kathryn draws from Gottman and Cognitive behavioral therapy. When appropriate Kathryn works with couples on trust, intimacy, forgiveness, and communication.

Hoarding: Symptoms and Treatment Options

Hoarding is not simply a behavior. It is a mental health condition. In fact, there are different types of hoarding disorders. Oftentimes, hoarding is a subset of OCD, which itself is an anxiety disorder.

What Is Hoarding?

Hoarding is a condition in which a person keeps things that most other people would say are not valuable. Of course, it’s true that “one’s man junk is another man’s treasure.” However, if a person collects items to the point where it interferes with their lives in some significant way, and they are still unable to get rid of those items, then they are hoarding.

Some examples of hoarding negatively impacting someone’s life include:

Their home because difficult to live in due to clutter. They may be unable to cook, shower, sleep in a bed, or move around properly.
They can’t have people in to do normal home repairs because of the “stuff.”
The hoard leads to home damage such as rotting, mold, sagging foundations, etc.
Neighbors and/or city officials complain or take action against the home because of the hoard.
Hoarding limits emergency personnel’s access to the home and its occupants.
The hoard causes physical illness due to contamination, filth, dust, etc.
Animals in the hoard aren’t receiving proper care including medical treatment.
The hoard affects the person’s relationships with loved ones.
Inability to maintain steady employment due to conditions related to the home and/or to shopping to add to the hoard.

People with hoarding disorders often become extremely distressed at the idea of losing their stuff. If someone, such as loved one, comes in and cleans, they get very anxious and angry.

Hoarding and OCD

Compulsive hoarding is a form of obsessive-compulsive disorder (OCD), which is one type of anxiety disorder. Generally speaking, people with hoarding tendencies have high levels of anxiety and the hoarding behaviors helps soothe those anxieties. It’s important to note that although compulsive hoarding is very common among people with OCD, not all hoarding before is OCD-related.

Types of Hoarding

People can truly hoard almost anything. However, there are some common themes that relate to different types of hoarding. They include:

Paper Hoarding

Many hoarders have great anxiety about letting go of any little bit of paper. They worry that they will need the information on that paper and therefore can’t let it go. Their homes get overwhelmed with paper clutter. This can include:

Receipts
Bills
Invoices
Medical forms
Tax forms
Pay stubs
Printed-out copies of online conversations
Report cards
Children’s drawings
Notes, cards, and letters
Mail including coupons and junk mail
Newspapers
Magazines and books

Of course, we all keep some kind of paper clutter in our lives. However, hoarders won’t let go of anything. They often can’t find what they want in the mess. If asked to let go of something such as their child’s third grade report card, they may panic or get angry.

Animal Hoarding

There are laws in most areas limiting the number of pets a person is allowed to have. Those who go above that number may be animal hoarding. However, there’s more to it than this.

Animal hoarding means that, regardless of the law, the person has more animals than they can take care of. They physically, mentally, and financially do not have the means to provide for the animals. Therefore, the animals are undernourished and ill, often dying from unknown causes.

Despite this, the hoarder continues to believe that they love the animals and are even helping them. They don’t want to let any of them animals go to other homes. In fact, they keep acquiring more animals. They may put food out on the porch to encourage strays or even drive to various areas with traps to collect animals. They don’t spay or neuter the animals, so they breed prolifically.

Food Hoarding

Some people have a huge fear of running out of food or running out of the money to buy food. They stockpile. Their cupboards, refrigerator, freezer, pantry, and basement overflow with food and yet they keep buying more. Food hoarders rarely pay attention to expiration dates. They don’t want to throw out any food, even if it’s expired or clearly rotting.

Trash Hoarding AKA Hoarding Everything

There are some people whose hoarding is so generalized that they absolutely don’t want to get rid of anything. They’re sometimes called garbage hoarders because they keep things that other clearly consider to be trash. They don’t ever “take out the garbage.” They may see potential use in everything. Alternatively, throwing something out might just give them too much anxiety. People may keep empty containers and boxes, the plastic wrap off of opened products, or even things like toilet paper and dirty diapers if the hoarding has gotten so extreme.

Dr. Jan Dunn provides Online Counseling in Texas to individuals, couples, and families. Telehealth Video Therapy Sessions provides the same treatment as in person therapy sessions. Shifting the therapy office to a clients space makes therapy portable, accessible, confidential, and comfortable. In turn, clients often report feeling more at ease, less stressed, and more apt to open up and, in turn, therapy is more effective. The benefits far outweigh any concerns for most clients, as accessibility to care drastically increases and cancellations drastically decrease. Therapy is delivered in the comfort of your home – when and where you need it.

Hoarding with Compulsive Shopping

People with compulsive shopping disorders don’t necessarily hoard. However, the two conditions can go hand-in-hand. The person shops impulsively and compulsively, often going into great debt but feeling unable to stop themselves. They never get rid of the items that they purchase; that’s the hoarding part. If they became unable to continue shopping because they lose all access to funds, then they may go “shop” in untraditional places such as dumpsters.

Symptoms of Hoarding

Each form of hoarding is a little bit different from the others. Individuals may experience hoarding to varying degrees. However, here are some common symptoms to look for:

The feeling that you just can’t throw something away
Justifying to others why you can’t get rid of things
High anxiety when asked to try to throw something away
Retrieving items from the trash after throwing them away
Inability to make decisions about what to keep and what to discard
Feeling overwhelmed by “stuff” but unable to do anything to change it
Stress when other people are near your things; worry that people will get rid of your items
Constant fear of not having enough, needing more, or losing something important

Of course, all of the examples described above of how hoarding can negatively impact someone’s life are also warning signs to look out for.

Treatment Options for Hoarding Disorder

Although not all compulsive hoarding is part of an OCD diagnosis, it’s often treated in the same way as OCD. Cognitive Behavioral Treatment and Exposure Response Prevention are two of the most common treatments to help people overcome hoarding. Oftentimes, the therapist will come to the individual’s home to help them work on their thoughts and behaviors in the hoarding environment.

How the Body and Mind Talk To One Another

Have you ever been startled by someone suddenly talking to you when you thought you were alone? Even when they apologise for surprising you, your heart goes on pounding in your chest. You are very aware of this sensation. But what kind of experience is it, and what can it tell us about relations between the heart and the brain?

When considering the senses, we tend to think of sight and sound, taste, touch and smell. However, these are classified as exteroceptive senses, that is, they tell us something about the outside world. In contrast, interoception is a sense that informs us about our internal bodily sensations, such as the pounding of our heart, the flutter of butterflies in our stomach or feelings of hunger.

The brain represents, integrates and prioritises interoceptive information from the internal body. These are communicated through a set of distinct neural and humoural (ie, blood-borne) pathways. This sensing of internal states of the body is part of the interplay between body and brain: it maintains homeostasis, the physiological stability necessary for survival; it provides key motivational drivers such as hunger and thirst; it explicitly represents bodily sensations, such as bladder distension. But that is not all, and herein lies the beauty of interoception, as our feelings, thoughts and perceptions are also influenced by the dynamic interaction between body and brain.

The shaping of emotional experience through the body’s internal physiology has long been recognised. The American philosopher William James argued in 1892 that the mental aspects of emotion, the ‘feeling states’, are a product of physiology. He reversed our intuitive causality, arguing that the physiological changes themselves give rise to the emotional state: our heart does not pound because we are afraid; fear arises from our pounding heart. Contemporary experiments demonstrate the neural and mental representation of internal bodily sensations as integral for the experience of emotions; those individuals with heightened interoception tend to experience emotions with greater intensity. The anterior insula is a key brain area, processing both emotions and internal visceral signals, supporting the idea that this area is key in processing internal bodily sensations as a means to inform emotional experience. Individuals with enhanced interoception also have greater activation of the insula during interoceptive processing and enhanced grey-matter density of this area.

So what is enhanced interoception? Some people are more accurate than others at sensing their own internal bodily sensations. While most of us are perhaps aware of our pounding heart when we are startled or have just run for the bus, not everyone can accurately sense their heartbeats when at rest. Interoceptive accuracy can be tested in the lab; we monitor physiological signals and measure how accurately these can be detected. Historically, research has focused on the heart, as these are discrete signals that can easily be quantified. For example, a typical experiment might involve the presentation of a periodic external stimulus (eg, an auditory tone) that is time-locked to the heartbeat, such that each tone (‘beep’) occurs when the heart is beating, or in between heartbeats. Participants state whether this external stimulus is synchronous or asynchronous with their own heart. An individual’s interoceptive accuracy is an index of how well they are able to do this.

It is also possible to measure subjective indices of how accurate people think they are at detecting internal bodily sensations, ascertained via questionnaires and other self-report measures. My work shows that individuals can be interoceptively accurate (ie, good at these heartbeat-perception tests) without being aware that they are. In this way, interoceptive signals can guide and inform without fully penetrating conscious awareness.

Individual differences in interoception can also be investigated using brain-imaging methods, such as through brain representation of afferent signals (eg, heartbeat-evoked potentials expressed in a neural EEG signal). Functional neuroimaging (fMRI) can also be used to investigate which areas of the brain are more active when focusing on an interoceptive signal (eg, the heart) relative to an exteroceptive signal (eg, an auditory tone).

Our hearts do not beat regularly and, while we can identify that our hearts race with fear or exercise, we might not fully appreciate the complexity of the temporal structure underlying our heartbeats. For example, cardiac signatures are also associated with states such as anticipation. Waiting for something to happen can cause our heartrate to slow down: this will happen at traffic lights, when waiting for them to go green. These effects of anticipation, potentially facilitating the body and mind to adopt an action-ready-state, highlight the meaningful composition of internal bodily signals.

Dr. Jan Dunn provides Online Counseling in Texas to individuals, couples, and families. Telehealth Video Therapy Sessions provides the same treatment as in person therapy sessions. Shifting the therapy office to a clients space makes therapy portable, accessible, confidential, and comfortable. In turn, clients often report feeling more at ease, less stressed, and more apt to open up and, in turn, therapy is more effective. The benefits far outweigh any concerns for most clients, as accessibility to care drastically increases and cancellations drastically decrease. Therapy is delivered in the comfort of your home – when and where you need it.

Internal bodily signals can be deeply informative, which is why sensing them can provide an extra channel of information to influence decision making. Gut instinct or intuition during a card game can also be guided by interoception. Bodily signatures (heart rate, skin-conductance response) can signal which cards are good (ie, more likely to be associated with a positive outcome) even in the absence of conscious knowledge that a card is good. Thus, the heart ‘knows’ what the mind does not yet realise, and access to this bodily signature can guide intuitive decision making to a better outcome. In a real-world extrapolation of this, I visited the London Stock Exchange to work with high-frequency traders. These traders claimed that their decisions were often driven by gut instinct, when faced with fast-coming information that the conscious brain could not yet fully process. My colleagues and I demonstrated that interoceptive accuracy was enhanced in those traders who were most adept at trading, potentially grounding their intuitive instincts in a capacity to sense informative changes in internal bodily signals.

An appreciation that bodily signals can guide emotion and cognition provides potential interoceptive mechanisms through which these processes can be disrupted. Alexithymia, defined as an impaired ability to detect and identify emotions, is associated with reduced interoceptive accuracy. Autistic individuals, who often have difficulty in understanding emotions, have also been shown to have impaired interoceptive accuracy. Neural representation of bodily signatures are altered in borderline personality disorder (also known as emotionally unstable personality disorder), and interventions designed to focus on the body, such as mindfulness, have been shown to reduce anxiety. Insight into the nature of these embodied mechanisms opens up potential avenues for further understanding and targeted intervention.

As well as telling us about our own emotions, our bodies respond to the joy, pain and sadness of others. Our hearts can race as loved ones experience fear, and our pupils can adopt a physiological signature of sadness in response to the sadness of others. If you pay attention to your heart and bodily responses, they can tell you how you are feeling, and allow you to share in the emotions of others. Interoception can enhance the depth of our own emotions, emotionally bind us to those around us, and guide our intuitive instincts. We are now learning just how much the way we think and feel is shaped by this dynamic interaction between body and brain.

Sarah Garfinkel is professor of neuroscience and psychiatry at the University of Sussex. Her work has been published in the Harvard Review of Psychiatry and Brain: A Journal of Neurology, among others. She lives in Brighton.

 

Serving Norwalk – Darien – Westport – New Canaan, Connecticut. Helping balance career demands with emotional needs of our families. As a behavioral therapist with training in DBT and CBT, I focus on cognitive distortions and maladaptive behaviors that damage relationships and sabotage personal and professional goals. Relationship Counseling Norwalk therapist Dennis McAllister LCSW, Employing DBT skills of mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness, I help clients learn new strategies for addressing life’s challenges.

The Intersection of Chronic Illness and Sex

According to the Centers for Disease Control and Prevention, chronic diseases affect 133 million Americans, representing more than 40% of the population of this country. By 2020, that number is projected to be an estimated 157 million, with 81 million having multiple conditions. Chronic illness can have profound negative effects on a relationship and sexual satisfaction. More Americans are living with not just one chronic illness, such as diabetes, heart disease or depression, but with two or more conditions. Almost a third of the population is now living with multiple chronic conditions.

Many chronic diseases can cause problems with sexual function. These conditions can include diabetes, heart and vascular diseases, neurological, and autoimmune diseases. Recent research suggests that sexual dysfunction in couples may be one of the least talked about symptoms of chronic illness.

Experiencing a chronic illness can be earth-shattering. Individuals who are chronically ill often experience emotional distress. This includes the person’s ability to engage in occupational, social, and recreational activities. But what is its impact on sex and the couple? Sex can involve a mix of feelings and emotions when battling a chronic illness. Life becomes uncertain and you both feel at a loss. Your partner feels overwhelmed because you feel shame. You may feel less attractive, less confident, and concerned about how your body works and adapts to an illness. You both become plagued with anxiety due to the worry of sexual activity, and with desire and arousal issues.

When experiencing a chronic illness, some changes may be physical, such as the changes with your body, side effects from medication, sexual dysfunction, fatigue, and pain. You may experience psychological changes such as depression and anxiety. Most of all, there is constant fear around your sexual ability and your sexual performance. We all know that physical intimacy is paramount to the quality of life, and it is still important if you are living with a chronic illness.

Your relationship as a couple can affect the development and management of a chronic illness in a variety of ways. When the both of you are at the optimal balance between intimacy and autonomy, your boundaries touch yet remains distinct. It is critical that both of you are aware of each other’s needs and emotions. Why is this so important? Because this will drive and determine the sexual intimacy in your relationship. It is important to note that your previous success in resolving sexual intimacy concerns will determine how well the both of you will cope with an illness.

Since general coping skills and sexual function are linked in the chronically ill, it is important to identify and foster strengths in your relationship that can mitigate the stress of illness. Even during an illness, relationships should not be neglected. Illness can make each partner vulnerable to fear and loss and to loneliness. Taking time to communicate and to reduce the impact of the illness on intimacy is the key to maintaining happiness despite health problems. One part of that intimacy is sexuality. What people don’t know is that with a life restricted by pain and illness, sex can be a powerful source for comfort, pleasure and intimacy. You and your partner can learn what is possible as opposed to what was once achievable by enhancing their sexual awareness, communication, and sexual styles.

Here are my tips:

Communicate your needs to your partner and have them communicate their needs. Problem-solve together by making it a team approach. State your emotional needs around sexual intimacy and the other factors in your relationship.

Consider couples psychotherapy. I recommend you see a sex therapist. I say this because they will have the knowledge and skill set in helping you and your partner with sexual problems such as the issues related to sexual functioning. They will also provide you with other suggestions to engage in if there is sexual dysfunction (i.e., desire and arousal issues, erectile dysfunction, and sexual pain).

Read up on your condition and share this with your partner. Having knowledge on the illness can bring you closer together. This can build intimacy!
Check in with each other. For the partner who does not have a chronic illness, watch for depression in them and keep an eye on their health as well. The goal here is to be lover not a caregiver, but we find at times, the partner may take on this role. They may want to seek individual counseling. This is healthy!

Acknowledge your loss and build a relationship with the illness. This can help the both of you develop the “new normal” in your relationship. With acceptance, the issue isn’t whether or not you can come to some profound insight about the nature of the illness and your experience with the illness, but rather, it is about how to live your life day to day. The ultimate goal is to accept condition and learn to live well with it. Of course, this is not easy. I watch couples experience this all the time in my practice and when they finally decide to work as a team instead of opponents or avoiders, there is this sense of hope that emerges. This hope promotes what is possible instead of what is achievable. They also report a healthier sex life.

Address stress as much as possible. I would not avoid the stress. Avoidance can make the pain worse or it cause a flare up. I see this all the time with my clients with fibromyalgia. I know this is easier said than done, but try to address the financial issues and the divisions of family responsibilities. Addressing these stressors can help promote the desire in being physically intimate.

Try to be sociable. Socially isolating is common for people with a chronic illness. Try to find a balance where you can be sociable because this can make you feel more positive about life.

Being kind is great. Doing something for your partner can build what is needed for sexual intimacy.

Resources:

Enzlin, P. (2014). Sexuality in the context of chronic illness. In Y. Binik & K. Hall (Eds), Principles and practices of sex therapy (5th ed., pp. 436-456). New York, NY: The Guilford Press.

Schover, L.R., & Jensen, S. B. (1988). Sexuality and chronic illness: A comprehensive approach. New York, NY: The Guilford Press.

By Dr. Lee Phillips

Jennifer Josey LPC LMFT CSAT of Intuitive Pathways Recovery specializes in Sex Addiction Counseling Houston Texas, love addiction, recovery for couples from sex and love addiction, trauma resolution for partners of sex addicts and group therapy. Sexual addiction is a serious problem that affects people of all socioeconomic status, educational status, both males and females and even teenagers and preadolescent children.

Common Relationship Challenges

Like most interpersonal relationships, most romantic couples experience some challenge at some point in their relationship. Some of these common challenges may include infidelity, loss of intimacy, communication difficulties, coping with stress challenges, financial pressures, boundary violations, difficulty balancing individual and couple expectations, divorce, separation and breaking up. Whatever the challenge, it is important to note that all dyadic relationships will experience some kind of distress at some point. We will examine some of the more common romantic relationship challenges below.

Infidelity

Infidelity is increasingly becoming one of the most common relationship challenges in romantic relationships. The acts of infidelity or cheating can have devastating consequences on those involved. Having been cheated on can result in anguish, depression, fury and humiliation (Brand, Markey, Mills & Hodges, 2007). It has been suggested that infidelity is one of the leading causes of divorce and romantic relationship breakdown (Brand, Markey, Mills & Hodges, 2007).

Generally, infidelity is a violation of trust by one or both members of a monogamous romantic relationship that involves a third party individual, with whom one member has an improper relationship. Zola (2007) defines infidelity as an act of emotional and/or physical betrayal characterised by behaviour that is not approved by the other partner and that has contributed to considerable ongoing distress in the non offending partner. Infidelity can be in the form of an emotional affair, a sexual affair or a combination of both. Traditionally, men are considered to be primarily interested in sexual infidelity and women are considered to be primarily interested in emotional infidelity (Zola, 2007).

Zola (2007) suggests that there has always been a greater emotional need or tie when it comes to women and affairs, while men tend to have an affair primarily for sex. One of the reasons given for women’s preference to emotional affairs is to “mate switch”. This refers to the quest of finding a partner without giving up the security derived from the current partner (Brand, Markey, Mills & Hodges, 2007). Infidelity prevalence rates vary according to gender with female incidents reported to be 10% to 15% lower than those of their male counterparts (Zola, 2007).

In resolving this matter, women are found to be more likely to forgive a sexual infidelity where as men find it the most difficult to forgive (Zola, 2007). In support for this argument, Long and Young (2007) suggest that men are more approving of affairs for sexual reasons where as women are more approving of affairs of emotional justification. It is not uncommon that couples who have experienced infidelity in their relationships experience challenges in their attempts to resolve relational problems associated with it. As such, infidelity is considered one of the most challenging issues to treat in couple therapy (Zola, 2007; Brand, Markey, Mills & Hodges, 2007).

Intimacy

The word intimacy has taken on sexual connotations. But it is much more than that. It includes all the different dimensions of our lives. It involves the physical, social, emotional, mental and spiritual aspects as well as sexual components that can enhance the feelings of togetherness between the romantic couple (Larson, Hammond & Harper, 1998). According to Sternberg’s theory of love, intimacy includes emotional bonding and feelings of connectedness. Sternberg suggests that intimacy develops during the course of the relationship and will usually include decisions of loyalty to the relationship (Long & Young, 2007).

Intimacy has also been conceptualised as a sense of self disclosure, sharing of one’s self and feeling closer to one’s partner. Intimacy is maintained by engagement in intimate conversation (Brunell, Pilkington & Webster, 2007; Kirby, Baucom & Peterman, 2005) and is considered a major part of romantic relationships. It is also an important factor for psychological wellbeing and is linked to positive and satisfying relationships (Brunell, Pilkington & Webster, 2007; Long & Young, 2007).

It is fair to assume that the quality of the romantic relationship will often be judged by the frequency of intimate interactions as perceived by each individual. It is these unmet intimacy expectations that can often affect the relationship negatively and pose challenges for the couple (Kirby, Baucom & Peterman, 2005). Therapists dealing with loss of intimacy in romantic relationships should help clients develop trust and communication skills that can help to overcome barriers to intimacy.

Conflict

Conflict is part of any interpersonal relationship and occurs as a result of differences in opinions. People differ in values, dreams, desires and perceptions. Therefore, we are all bound to encounter conflict at some point in our lives (Long & Young, 2007). Conflict can range from less serious mild disagreements to more intensely heated arguments. Previous research has found that marital conflict often stems from unmet needs, wants, and desires. From this perspective, marital conflict is defined as a process of interaction in which one or both partners feel discomfort about some aspect of their relationship and try to resolve it in some manner (Hamamci, 2005).

When one person needs or wants something badly enough, and the other person is unwilling or unable to meet that need, resentment will often grow. Then, if one were to add the power of an unruly tongue, the situation will usually become ripe for very destructive forms of conflict. To look at it pragmatically, romantic relationship conflict will often happen when one member of the couple perceives inequity or experiences an imbalance in rewards or benefits from being in the relationship whereby it is perceived by one member of the couple that the other only cares about his/ her individual needs (Long & Young, 2007).

The negative consequences of conflict are probably familiar to all of us. Conflict can cause psychological pain that manifests in withdrawal and distance, depression, anxiety and/or aggression. Not only between the couple but also with those who are living around them (Choi, 2008). However, there are also constructive outcomes to conflict in romantic relationships. For instance, people who continue to relate to one another despite their conflict may build greater trust and confidence in each another and become more apt in their ability to resolve their problems (Johnson, 2007). However, reoccurring conflict is usually a symptom of a problem in the romantic relationship and therefore should be addressed intentionally by the couple. The role of the counsellor, when dealing with couples who are experiencing conflict, is to help them identify the source of such conflict and its style to assist them in implementing skills to resolve the disagreements (Relationships Australia, 2009).

Communication

A good healthy romantic relationship is often characterised by good communication. Healthy couples speak openly and directly with congruent non verbal cues allowing them to convey the intended message accurately. Communication in romantic relationships connects and reassures partners and allows them to discuss and solve problems and share important information and views (Long & Young, 2007). Challenges occur when the messages we send to the other are misunderstood or misinterpreted.

It is not uncommon when a couple experiences problems in their relationship, communication becomes broken (Long & Young, 2007). Healthy, productive and effective communication is viewed as the binding tool for any romantic relationship. Problems and challenges in intimate relationships are often resolved through developing healthy, productive and effective communication. Therefore, the goal of enhancing communication skills may be a great starting point for the couple therapist.

Sexual Problems

Sexual intimacy is one of the most important factors in romantic relationships. It is one of the factors that differentiate a romantic relationship from any other interpersonal relationship. Sexual problems like all other problems in romantic relationships often develop as a result of an imbalance in the partner’s styles of loving (Long & Young, 2007). In the early stages of the relationship, it is common for couples to experience intense feelings of love, affection and a strong desire for one another. As the relationship grows, external factors such as children and busy schedules can begin to have an impact on the sexual intimacy of the couple, often resulting in frustrations experienced by at least one member of the relationship. As the frustrations develop over time, problems may begin to surface.

Sometimes sexual challenges may occur as a result of sexual dysfunction. Sexual dysfunctions are characterised by psychosocial disturbances in sexual desire resulting in distress and interpersonal difficulty (APA, 2000). According to the DSM- IV-TR, some of the common sexual dysfunction disorders include sexual desire disorder, sexual arousal disorder, and orgasmic disorders. It is crucial for the therapist to differentiate sexual problems from sexual dysfunctions in order to determine the appropriate referral when necessary. If sexual problems are an issue the therapist can help clients explore options for achieving emotional and sexual intimacy in their relationships.

Substance Abuse

While substance abuse, particularly alcohol, has been associated with financial problems and health problems that contribute to relational distress, many people use it as a way of coping with the problems in their relationships. The first issue, of course, is money. Alcohol is expensive. Spending a great deal of money each day on alcoholic beverages is a serious problem that can put a great deal of strain on relationships. Alcohol can cause people to become less sensitive to the feelings of others too. Alcohol can make it difficult for people to distinguish between the other person’s emotions, and thus they may make incorrect judgments that negatively impact their relationship with their partner (Sharf, 2001).

Time is an issue as well. Drinking is not a “one and done” type of activity. It can take hours out of the day, hours that could have been spent as a couple. The imposition on couple time from excessive drinking can cause partners to emotionally drift apart often resulting in problems within the dyadic relationship. Because of these and other factors, alcohol abuse has been singled out as a contributing factor to divorce, physical abuse and lowered marital satisfaction (Long & Young, 2007).

Divorce and Breaking Up

Divorce rates are increasing at an alarming rate. In Australia, 40% of marriages end up in divorce where as in USA, 50% of marriages end up in divorce (www.divorcerates.org). For romantic relationships that continuously experience high distress, low satisfaction and low relationship quality, at some point one partner or both come to a decision to end or terminate the relationship, if such challenges are not resolved. According to ideas derived from social exchange theory, termination of marriages and romantic relationships will often occur as a result of costs exceeding rewards. If the individual perceives that they are not getting more than what they have invested in the relationship, this may lead to dissatisfaction with the relationship (Amato & Hohmann-Marriott, 2007).

Divorce and break up can be a difficult and painful experience for many. The termination of a relationship or divorce can affect an individual financially, socially, emotionally and psychologically (Long & Young, 2007). Feelings of depression, anxiety and other psychiatric disorders are often experienced during this time (Williams & Dunee-Bryant, 2006). The role of the therapist is to assist clients through this life changing transition.

References:

American Psychiatric Association, (2000). Diagnostic and Statistical Manual of Mental Disorders. (4th ed.). Text Revision. Washington, DC: American Psychiatric Association.

Brand, R.J., Markey, C.M., Mills, A., & Hodges, S.D. (2007). Sex differences in self reported infidelity and its collates. Sex Roles , 57, 101-109.

Brunell, A.B., Pilkington, C.J., & Webster, D.G. (2007). Perceptions of risk in intimacy in dating couples: conversation and relationship quality. Journal of Social and Clinical Psychology. 26, 92-119.

Choi, H. (2008). Marital Conflict, depressive symptoms and functional impairment. Journal of Marriage and Family, 70, 377-390

Hamamci, Z. ( 2005). Dysfunctional relationship beliefs in marital conflict. Journal of Relational Emotive and Cognitive Behavioural Therapy, 23, 245-261.

Kirby, J.S., Baucom, D.H., & Peterman, M.A. (2005). An investigation of unmet intimacy needs in marital relationships, Journal of Marital and Family Therapy, 31, 313-325.

Long, L.L., & Young, M.E. (2007). Couselling and Therapy for Couples. (2nd ed.). Belmont, CA: Thompson.

Johnson, S.M. (2007). The emotionally focused couples therapy. Journal of Contemporary Psychotherapy. 37, 47-52.

Zola, M.F. (2007). Beyond infidelity related impasse: an integrated, systematic approach to couples therapy. Journal of Systematic Therapies, 26, 25-41.

Source: mentalhealthacademy.com.au

Christiane Blanco-Oilar, Ph.D. offers compassionate psychological services for individuals and Couples Therapy Boca Raton. I enjoy working with individuals and couples going through life transitions, relationship challenges or identity exploration, or those experiencing grief and loss, depression, anxiety, postpartum depression and eating disorders. My goal is to help you recognize, understand and have compassion for how you may have developed less-than-ideal ways of dealing with specific areas of your life.

Can CBD Oil Help Anxiety?

Cannabidiol is a compound derived from cannabis plants. It may help people with anxiety reduce their symptoms with few or no side effects.

Research on cannabidiol oil (CBD oil) is still in its infancy, but there is mounting evidence to suggest that some people can get relief from anxiety. In this article, we examine what CBD oil is and how it may help reduce anxiety symptoms.

What is CBD oil?

Cannabidiol is extracted from cannabis plants and can be used as an oil. CBD oil is rich in chemicals called cannabinoids that bind to specialized receptors in the brain.

The best-known cannabinoid is tetrahydrocannabinol (THC), which causes the “high” people feel after using marijuana.

THC, however, is just one of many cannabinoids. Cannabidiol also binds to these receptors but does not produce a high. Proponents argue that cannabidiol oil has many health benefits, ranging from slowing the growth of cancer to improved mental health.

CBD oil is edible and can be used as a cooking oil or added to food. People may also take it as a medication by consuming a few drops. CBD oil should not be smoked, and there is no evidence that smoking it offers any benefits.

Does CBD produce a high?
CBD oil derived from hemp will not produce a “high.” Hemp is a type of cannabis plant grown for industrial use, such as making paper and clothing. Unlike other cannabis plants, hemp has not been specially bred to produce high levels of THC.

Cannabidiol may be sold as a type of hemp oil with trace amounts of THC. So, someone using cannabidiol might still test positive for THC on a drug test, even though they will not experience any alterations of mental state after using the oil.

CBD oil and anxiety

Much of the research on cannabis products has looked at the use of marijuana rather than at CBD oil as a standalone product.

Some studies have found that cannabis might help anxiety. Others suggest that having anxiety is a risk factor for recreational marijuana use, or that using marijuana can make a person more vulnerable to anxiety.

People interested in managing their anxiety with CBD oil should look exclusively at research on cannabidiol, not generalized studies of medical marijuana. Although there are fewer studies on cannabidiol specifically, the preliminary research is promising.

A small 2010 study found that cannabidiol could reduce symptoms of social anxiety in people with social anxiety disorder (SAD). Brain scans of participants revealed changes in blood flow to the regions of the brain linked to feelings of anxiety.

In this study, cannabidiol not only made participants feel better but also changed the way their brains responded to anxiety.

A 2011 study also found that cannabidiol could reduce social anxiety. For that study, researchers looked specifically at cannabidiol to treat anxiety associated with public speaking.

Research published in 2014 found that CBD oil had anti-anxiety and antidepressant effects in an animal model.

A 2015 analysis of previous studies concluded that CBD oil is a promising treatment for numerous forms of anxiety, including social anxiety disorder, panic disorder, obsessive-compulsive disorder, generalized anxiety disorder, and post-traumatic stress disorder.

The report cautioned, however, that data on long-term use of CBD oil is limited. While research strongly points to the role of cannabidiol in treating short-term anxiety, little is known about its long-term effects, or how it can be used as a prolonged treatment.

A 2016 case study explored whether cannabidiol could reduce symptoms of post-traumatic stress disorder (PTSD) and anxiety-provoked sleep disorder in a child with a history of trauma. Researchers found that cannabidiol reduced the child’s anxiety and helped her sleep.

Considerations

Research on the use of cannabis suggests that it may have negative health effects, particularly when smoked.

Research specifically on cannabidiol, however, has found few or no negative side effects. This means CBD oil may be a good option for people who do not tolerate the side effects of other medications for anxiety, including addiction.

Not all states in the United States have specifically legalized CBD oil, although some have legalized it for only specific purposes.

A person should educate themselves about the potential risks of purchasing or using it. While CBD oil is not listed on the Controlled Substances Act (CSA), a person should consult their doctor before using it to treat anxiety.

Because CBD oil is not regulated as a medical treatment for anxiety, it is unclear what dosage a person should use, or how frequently they should use it. A person should consult a doctor who has experience with CBD oil to determine the right dosage for their needs.

By Zawn Villines

Dr. Jeffrey Ditzell is a Psychiatrist in New York City and specializes in issues involving anxiety depression and adult ADHD. Medical Marijuana is one of the many treatments Dr. Ditzell offers to treat a variety of mental health issues.

Ketamine Used As An Antidepressant

Long used as an anaesthetic and analgesic, most people familiar with ketamine know of it for this purpose. Others know it as a party drug that can give users an out-of-body experience, leaving them completely disconnected from reality. Less well known is its growing off-label use in the USA for depression, in many cases when other options have been exhausted.

David Feifel, a professor of psychiatry at the University of California, San Diego, was one of the first clinicians to use ketamine off-label to treat depression at UCDS’s Center for Advanced Treatment of Mood and Anxiety Disorders, which he recently founded. “Currently approved medications for depression all have about the same, very limited efficacy. A large percentage of patients with depression do not get an adequate level of relief from these antidepressants even when they have tried several different ones and even when other drugs known to augment their effects are added to them”, Feifel tells The Lancet Psychiatry. “The stagnation in current antidepressant medication on the one hand, and the tremendous number of treatment-resistant patients, has propelled me to explore truly novel treatments like ketamine.”

Compelling published study results and case reports exist of patients’ depression—in some cases deeply entrenched depression that has lasted months or even years—alleviating within hours of use of ketamine. However, critics have warned that the drug has not been studied sufficiently (at least outside clinical trials), and also emphasied the cost. Patients can pay more than $1000 per session for treatment that must usually be repeated several times. That cost is rarely covered by the patient’s medical insurance.

The balance between prescribing ketamine off-label to patients with depression (who have exhausted other options) against making all patients wait until ketamine or a derivative is licensed for depression is the key ethical dilemma, says Dominic Sisti, an assistant professor in the Department of Medical Ethics and Health Policy at the Perelman School of Medicine, University of Pennsylvania, PA, USA. “I don’t think patients who have exhausted all options should have to wait, but I worry that off-label use is not being properly monitored”, says Sisti. “If patients are fully competent and informed, they should have the right to access ketamine—but we have to be sure they understand it is basically an experimental treatment. This is a vulnerable patient population.”

Another criticism is that patients who have exhausted treatment options might be willing to try anything. “This implies that patients with treatment-resistant depression (TRD) may be so desperate for relief that their ability to perform an appropriate calculation of the risks and benefits of trying ketamine is impaired. This insinuation infuriates many TRD patients in my experience”, says Feifel. “The other assumption is an implicit one that somehow using ketamine for depression is highly risky or fraught with many side effects. Both are simply wrong.”

Advocates of ketamine use in depression are excited because it has a different mechanism of action to standard antidepressants, which affect signalling by monoamine neurotransmitters such as serotonin, noradrenaline, or dopamine. Ketamine is thought to act by blocking N-methyl-d-aspartate (NMDA) receptors in the brain, which interact with the aminoacid neurotransmitter glutamate. The resultant chemical changes in the brain caused by ketamine are not yet fully understood, but could involve ketamine-induced gene expression and signalling cascades that act long after the drug has been eliminated from the body. Meanwhile, critics say that the adverse effects of the drug, including the emergence reactions (hallucinations, dreams, and out-of-body experiences) sought after by recreational users, need further study before long-term use of ketamine can be approved for depression. Feifel states that he has patients who have been receiving ketamine treatments every 2–4 weeks for long periods, some for around 3 years, and has not yet seen any safety issues arise.

Pharmaceutical companies are entering this exciting arena by attempting to develop new drugs based on ketamine without similar side-effects. Naurex, situated in Evanston, IL, USA, recently reported results from a phase 2 study of its drug GLYX-13, which reduced depression in around half of the 400 patients in the study without any psychotic side-effects. The drug is given by injection once every 1–2 weeks, and should enter phase 3 trials later in 2015. Other pharmaceutical companies are developing drugs with other modes of administration. Johnson & Johnson (New Brunswick, NJ, USA) are developing a nasal spray containing a ketamine derivative, Crecicor (Baltimore, MD, USA) is developing a once-daily oral pill, and Naurex is also developing an oral version of GLYX-13. However, Feifel dismisses the notion that the dissociative so-called trip induced by ketamine is actually an important negative side-effect. “I have not had a single patient discontinue treatment due to the dissociative psychedelic experience”, he explains. “Although I have had a couple patients have unpleasant ‘trips’, it’s exceedingly rare, usually dose related, and very transitory due to ketamine’s rapid metabolism.” Feifel says that, more often than not, patients find the trip to be positive, or even spiritual, and believe it is an important component of the antidepressant effect they experience afterwards. “There is no doubt the dissociative effect represents a logistical issue, requiring monitoring—and this should be addressed in any approval given for ketamine”, he adds.

In the UK, ketamine has been used in two clinical trials for treating depression. Rupert McShane is the lead consultant for the local electroconvulsive therapy (ECT) service based at Oxford Health NHS Foundation Trust, Oxford, UK. His clinic took part in a UK National Institute for Health Research study (REDKITE) in which ketamine was administered for TRD in a series of 28 cases. These patients were largely referred by secondary care psychiatrists, but some contacted McShane’s team following advertising or after reading about the study on the internet. Some patients had been actively looking for somewhere where they could receive ketamine treatment.

“Our team used one of the beds in the recovery bay of the ECT suite to administer ketamine during sessions where other patients—not those receiving ketamine infusions—were receiving ECT”, explains McShane. “This had the advantage of having a team present which is familiar with treating resistant depression, and also an anaesthetist. Despite evidence of the efficacy of ECT, many patients are unwilling to try it. Thus, ketamine or similar compounds may have a role in those who would otherwise have had ECT.”

McShane adds that his team is “exploring what options there may be for providing a ketamine service for people with treatment resistant depression”. He explains that intravenous infusions seemed to clearly establish whether someone was a responder or not. “Our experience was that a second infusion was necessary in order to be able to decide whether someone was a responder, but if they have not responded by then, then they will not respond to further infusions at the same dose”, explains McShane. “Its effect in those people who respond is dramatic. However, it is hardly surprising that a single dose does not usually have an enduring effect—one would not expect that of a single dose of any antidepressant.” He adds, however, that “a few people seem to have much more prolonged responses—for several months. So far, the only way we know of to create a sustained effect in someone who has a brief response is to give it repeatedly, and also through co-prescription of conventional antidepressants which may also prolong the effect. I cannot see a future in which we will not be harnessing the use of ketamine in some way.”

In terms of the safety profile of ketamine, McShane believes that adverse effects of long-term ketamine use on the bladder, which have been reported in people who misuse it recreationally, are strongly dose and frequency related, and have not occurred in the context of medical use. “The dissociative side-effects are clearly dose related. Some patients will get benefit from ketamine at doses which do not cause them, but there is likely to be a trade-off”, he explains. “Ketamine is safe enough, and there has been so much experience of it, that it is on the WHO essential drugs list. Tolerance may develop, especially if used very frequently, but this would only be problematic if ad libitum use was proposed. Routes such as intranasal, oral, intramuscular, and sublingual all have potential advantages and disadvantages in this regard. Yet whether alternative related compounds will have real safety advantages over ketamine would require formal study: it will be expensive to show that, for a dose of equivalent efficacy, their long-term safety is as good as ketamine.”

Sisti cautions that any clinicians giving ketamine for depression should be fully trained in ketamine administration. “Many are but some may not be”, he says. “Clinics should be outfitted with appropriate emergency equipment, and staff trained on its use. The FDA should set up a voluntary reporting system to track outcomes or adverse events so that some data can be gathered in the field on the safety and efficacy of ketamine for depression.”

Feifel says that it is not for him, but for his patients to decide where the balance of risks and benefits lies in trying ketamine to treat their depression. “I live in a different world from my patients and each one of them in turn lives in a different world from each other”, he explains. “We each place a different value on things, have different priorities, have differing notions of what makes life worthwhile but most importantly, unlike many of the people who come to see me, I am not experiencing the perpetual misery that makes every waking moment a struggle not to end my life. So it is much easier for me to place more weight on the unlikely negative possibilities of a treatment than the more likely potential benefits —this is the trap pundits who decry this off-label use are falling into. One could make a compelling argument that it’s unethical to withhold ketamine treatments from someone who has chronic, severe treatment resistant depression. But I know this from the patients who tell me they would not be in this world right now if it were not for the ketamine.”

Feifel concludes that it is straightforward to talk to TRD patients about ketamine. “I tell them all the relevant information. The efficacy rates, time to onset of benefits, duration limitations, alternatives, lack of insurance coverage, and other information. My job is to make sure they understand the parameters of the treatment, not to decide whether they should do it.”

By Tony Kirby for The Lancet

Dr. Jeffrey Ditzell is a Psychiatrist in New York City and specializes in issues involving anxiety depression and adult ADHD. Ketamine for Depression is one of the many treatments Dr. Ditzell offers to treat a variety of mental health issues.

Communicating & Taking Responsibility

Your significant other is not a mind reader. Well, they’re most likely not a mind reader. Unless your significant other possesses some kind of mythical powers that allow them to tap into your deepest thoughts and feelings, if you don’t say how you feel, they really won’t have any idea. Despite the practice of proper communication being difficult at first, explicitly explaining to your partner how you’re feeling is the cornerstone of a healthy relationship.

Taking responsibility for your feelings is the best way to ensure that your needs are being met and you’re consistently happy in your relationship. Need some tips on how to make that happen? Keep reading to learn how Couples Counseling Costa Mesa can help you learn this valuable skill.

If you and your partner aren’t communicating properly, it can be a difficult, lonely and painful road to be on. By taking responsibility for your relationship and working on your communication skills, you can work towards a strong relationship built on mutual trust and respect.

Communication is a two-way street-If you and your partner are having trouble communicating; it is necessary that you both work towards a resolution. If both people in a relationship aren’t talking and listening effectively, it simply doesn’t work. Communication is also a delicate balance. Both partners need to do equal amounts of listening and speaking. Doing too much of one and too little of the other is almost as dangerous as not communicating at all.

Take responsibility

If you missed an important deadline at work could you tell your boss “I didn’t open my email so I didn’t know I should be working on something”? Probably not. Most likely, you’d never think about being so irresponsible at work, so why should it be allowed in your relationship? If you aren’t being an active participant in your relationship by listening, speaking, and being proactive, don’t be surprised if your significant other is starting to get frustrated.

Be forgiving

Strong communication is hard work, and it takes a while to master. Being (or having) a forgiving partner to encourage you along the way is incredibly important to your overall well being. Being forgiving also breaks down resentment and stops the incessant “blame game” that often occurs when commutation breaks down. Being a forgiving person also helps you forgive yourself, which is a great overall skill to master.

Know that this isn’t easy

Communicating and taking responsibility for yourself and your feelings take some getting used to and at the least, a little bit of work for both you and your partner. If you need some help to start in the right direction, Couples Counseling Costa Mesa can help. Couples Counseling Costa Mesa provides premier couples counseling services that can help your relationship flourish. I have years of experience necessary to help you work on your communication issues both now and in the future. Contact Couples Counseling Costa Mesa today and start working on your happily ever after.

Patrice Hooke, LMFT uses practical honest feedback and focus on the strengths of my clients to help them reach their goals. I believe that with honesty, compassion and understanding, we can all find healing and have a more fulfilling life. She is especially passionate about couples counseling Costa Mesa.

The Cerebral Mystique

Neuroscience gives us invaluable, wondrous knowledge about the brain – including an awareness of its limitations

More than 2,000 years ago, the semi-mythical father of medicine, Hippocrates of Kos, challenged the spiritualists of his time with a bold claim about the nature of the human mind. In response to supernatural explanations of mental phenomena, Hippocrates insisted that ‘from nothing else but the brain come joys, delights, laughter and sports, and sorrows, griefs, despondency, and lamentations’. In the modern age, Hippocrates’ words have been distilled into a Twitter-friendly pop-neuroscience slogan: ‘We are our brains.’ This message resonates with recent trends to blame criminality on the brain, to redefine mental illness as brain disease and, in futuristic-technological circles, to imagine enhancing or preserving our lives by enhancing or preserving our brains. From creativity to drug addiction, there is barely an aspect of human behaviour that has not been attributed to brain function. To many people today, the brain seems like a contemporary surrogate for the soul.

But lost in the public’s romance with the brain is the most fundamental lesson neuroscience has to teach us: that the organ of our minds is a purely physical entity, conceptually and causally embedded in the natural world. Although the brain is required for almost everything we do, it never works alone. Instead, its function is inextricably linked to the body and to the environment around it. The interdependence of these factors is masked however by a cultural phenomenon I call the ‘cerebral mystique’ – a pervasive idealisation of the brain and its singular importance, which protects traditional conceptions about differences between mind and body, the freedom of will and the nature of thought itself.

The mystique is expressed in multiple forms, ranging from ubiquitous depictions of supernatural, ultra-sophisticated brains in science fiction and the popular media to more sober, scientifically supported conceptions of cognitive function that emphasise inorganic qualities or confine mental processes to neural structures. This idealisation is almost reflexively adopted by laypeople and scientists alike (including me!) and it is compatible with both materialist and spiritual world views. The cerebral mystique might help to increase enthusiasm for neuroscience – a valued consequence – but it drastically limits our ability to analyse human behaviour and address important social problems.

The widespread analogy of the brain to a computer contributes powerfully to the cerebral mystique by distancing the brain from the rest of the biology. The contrast between a machine-like brain and the wet, chaotic mess we have throughout the rest of our bodies sets up a brain-body distinction that parallels the historical mind-body distinction drawn by early philosophers such as René Descartes. In keeping with Western religious notions of the soul, Descartes in the 17th century postulated that the mind is an ethereal entity that interacts with the body but does not join with it. With his timeless axiom ‘I think, therefore I am’ Descartes placed the mind in its own universe, autonomous of the material world.

To the extent that the brain resembles a machine, we can more easily imagine removing it from our heads, preserving it for eternity, cloning it or sending it through space. The digital brain thus seems separable from the body in both its substance and causal relations, much like Descartes’s detached spirit. It might be no accident that some of the most influential inorganic analogies to the brain were introduced by physical scientists who in their later years took to the problem of consciousness in the way that elderly people sometimes take to religion. John von Neumann, the computer pioneer, was the best-known of these; he wrote the influential book The Computer and the Brain (1958) shortly before his death in 1957, inaugurating this enduring analogy at the very dawn of the digital age.

Brains are undoubtedly somewhat computer-like – computers, after all, were invented to perform brain-like functions – but brains are also much more than bundles of wiry neurons and the electrical impulses they are famous for propagating. The function of each neuroelectrical signal is to release a little flood of chemicals that helps to stimulate or suppress brain cells, in much the way that chemicals activate or suppress functions such as glucose production by liver cells or immune responses by white blood cells. Even the brain’s electrical signals themselves are the products of chemicals called ions that move in and out of cells, causing tiny ripples that can spread independently of neurons.

Also distinct from neurons are the relatively passive brain cells called glia (Greek for glue) that are roughly equal in number to the neurons but do not conduct electrical signals in the same way. Recent experiments in mice have shown that manipulating these uncharismatic cells can produce dramatic effects on behaviour. In one experiment, a research group in Japan showed that direct stimulation of glia in a brain region called the cerebellum could cause a behavioural response analogous to changes more commonly evoked by stimulation of neurons. Another remarkable study showed that transplantation of human glial cells into mouse brains boosted the animals’ performance in learning tests, again demonstrating the importance of glia in shaping brain function. Chemicals and glue are as integral to brain function as wiring and electricity. With these moist elements factored in, the brain seems much more like an organic part of the body than the idealised prosthetic many people imagine.

Stereotypes about brain complexity also contribute to the mystique of the brain and its distinction from the body. It has become a cliché to refer to the brain as ‘the most complex thing in the known Universe’. This saying is inspired by the finding that human brains contain something on the order of 100,000,000,000 neurons, each of which makes about 10,000 connections (synapses) to other neurons. The daunting nature of such numbers provides cover for people who argue that neuroscience will never decipher consciousness, or that free will lurks somehow among the billions and billions.

But the sheer number of cells in the human brain is unlikely to explain its extraordinary capabilities. Human livers have roughly the same number of cells as brains, but certainly don’t generate the same results. Brains themselves vary in size over a considerable range – by around 50 per cent in mass and likely number of brain cells. Radical removal of half of the brain is sometimes performed as a treatment for epilepsy in children. Commenting on a cohort of more than 50 patients who underwent this procedure, a team at Johns Hopkins in Baltimore wrote that they were ‘awed by the apparent retention of memory after removal of half of the brain, either half, and by the retention of the child’s personality and sense of humour’. Clearly not every brain cell is sacred.

If one looks out into the animal kingdom, vast ranges in brain size fail to correlate with apparent cognitive power at all. Some of the most perspicacious animals are the corvids – crows, ravens, and rooks – which have brains less than 1 per cent the size of a human brain, but still perform feats of cognition comparable to chimpanzees and gorillas. Behavioural studies have shown that these birds can make and use tools, and recognise people on the street, feats that even many primates are not known to achieve. Within individual orders, animals with similar characteristics also display huge differences in brain size. Among rodents, for instance, we can find the 80-gram capybara brain with 1.6 billion neurons and the 0.3-gram pygmy mouse brain with probably fewer than 60 million neurons. Despite a greater than 100-fold difference in brain size, these species live in similar habitats, display similarly social lifestyles, and do not display obvious differences in intelligence. Although neuroscience is only beginning to parse brain function even in small animals, such reference points show that it is mistaken to mystify the brain because of its sheer number of components.

Playing up the machine-like qualities of the brain or its unbelievable complexity distances it from the rest of the biological world in terms of its composition. But a related form of brain-body distinction exaggerates how the brain stands apart in terms of its autonomy from body and environment. This flavour of dualism contributes to the cerebral mystique by enhancing the brain’s reputation as a control centre, receptive to bodily and environmental input but still in charge.

Contrary to this idea, our brains themselves are perpetually influenced by torrents of sensory input. The environment shoots many megabytes of sensory data into the brain every second, enough information to disable many computers. The brain has no firewall against this onslaught. Brain-imaging studies show that even subtle sensory stimuli influence regions of the brain, ranging from low-level sensory regions where input enters the brain to parts of the frontal lobe, the high-level brain area that is expanded in humans compared with many other primates.

Many of these stimuli seem to take direct control of us. For instance, when we view illustrations, visual features often seem to grab our eyes and steer our gaze around in spatial patterns that are largely reproducible from person to person. If we see a face, our focus darts reflexively among eyes, nose and mouth, subconsciously taking in key features. When we walk down the street, our minds are similarly manipulated by stimuli in the surroundings – the honk of a car’s horn, the flashing of a neon light, the smell of pizza – each of which guides our thoughts and actions even if we don’t realise that anything has happened.

Even further below our radar are environmental features that act on a slower timescale to influence our mood and emotions. Seasonal low light levels are famous for their correlation with depression, a phenomenon first described by the South African physician Norman Rosenthal soon after he moved from sunny Johannesburg to the grey northeastern United States in the 1970s. Colours in our surroundings also affect us. Although the idea that colours have psychic power evokes New Age mysticism, careful experiments have repeatedly linked cold colours such as blue and green to positive emotional responses, and hot red hues to negative responses. In one example, researchers showed that participants performed worse on IQ tests labelled with red marks than on tests labelled with green or grey; another study found that subjects performed better on computerised creativity tests delivered on a blue background than on a red background.

Signals from within the body influence behaviour just as powerfully as influences from the environment, again usurping the brain’s command and challenging idealised conceptions of its supremacy. A particularly powerful pathway for reciprocal brain-body interactions is the so-called hypothalamic-pituitary-adrenal (HPA) axis, named for a set of structures both inside and outside the brain that together coordinate the storied fight-or-flight response. Activation of the HPA axis is often triggered by fear-related brain signals that lead to secretion of cortisol and adrenalin from a gland that sits on top of the kidneys. These hormones lead to a range of bodily changes that affect breathing, heartrate, sensory acuity and many other variables, providing feedback to the brain and closing a circuit of mutual brain-body interaction. In some cases, the HPA axis can be engaged from outside the brain, as in pregnancy, when a surge of cortisol originates on its own from the placenta.

The HPA axis provides one of the routes by which our emotional states more generally are coupled to body-wide changes that extend far beyond the brain. Monitoring of externally observable physiological parameters such as skin conductance and respiration has long supported the idea that various emotions produce distinct responses relevant to how emotions are perceived. In a 2014 study, a group of researchers led by Lauri Nummenmaa at Aalto University in Finland asked participants to describe bodily sensations that they associate with 14 distinct emotions. The result was a stunning set of ‘bodily maps’ of the emotions, revealing variegated patterns of increased and decreased sensitivity associated with feelings of anger, fear, happiness, depression, love and so on. The subjects’ ability to report their sensations emphasises that bodily changes are part of how the emotions are experienced, and not just passive, downstream consequences of emotion-related brain activity.

An amazing finding of recent years is the fact that microbes living in the intestines are also part of the physiological network that determines our emotions. Changing the gut microbial population by eating bacteria-rich foods or undergoing an off-putting procedure called a faecal transplant can alter characteristics such as anxiety and aggression. A key experiment was performed in mice, where a two-way exchange of gut microbes between the normally shy BALB/c mouse strain and the more outgoing NIH Swiss strain was enough to flip the two personalities. In human organ-transplant patients, both cognitive and emotional effects are also commonplace. Some of these have to do with correcting the medical condition that required the transplant in the first place. For instance, liver or kidney failure causes a buildup of toxins such as ammonia in the blood; this in turn causes cognitive difficulties that can be corrected by replacing the diseased organ. But even procedures such as stomach stitching, which does not cure a disease, are said to cause personality shifts in about 50 per cent of patients.

Such examples illustrate the extent to which what happens in the brain is interwoven with what goes on in the body and the environment. There is no causal or conceptual boundary between the brain and its surroundings. Aspects of the cerebral mystique – idealised views of the brain as inorganic, hypercomplex, self-contained and autonomous – fail when we look more closely at what the brain is made of and how it operates. The integrated involvement of brain, body and environment is precisely what makes having a biological mind different from having a soul, and the implications of this difference are tremendous.

Most importantly, the cerebral mystique fosters a misleading sense that the brain is the prime mover of our thoughts and actions. As we seek to understand human conduct, the mystique prompts us to think first of brain-related causes, and pay less attention to factors outside the head. This leads us to overemphasise the role of individuals and underemphasise the role of contexts across a range of cultural phenomena.

In the arena of criminal justice, for instance, some writers suggest that the perpetrator’s brain should be blamed for transgressions. This argument often invokes the case of Charles Whitman, who in 1966 committed one of the first mass shootings in the US, at the University of Texas. Whitman had reported psychological disturbances in the months leading up to the crime, and an autopsy later revealed that a large tumour had been growing near a part of his brain called the amygdala, which is involved in stress and emotional regulation. But although advocates of blaming the brain would argue that Whitman’s brain tumour might have caused his crime, the larger reality is that Whitman’s act occurred against a background of many other predisposing factors: growing up with a violent father, the recent divorce of his parents, Whitman’s repeated career rejection and court martial from the army, his substance abuse, great physical stature, and access to high-powered weaponry. Even the high temperature on the day of the crime – 99 degrees Fahrenheit (37 degrees Celsius) – might have contributed to Whitman’s aggressive behaviour on the fateful day.

Blaming the brain for criminal behaviour offers an escape from outmoded principles of morality and retribution, but it still neglects the extended network of influences likely to contribute to any given situation. In the current discussion about the causes of violence in the US, it is more important than ever to maintain a broad view of how multiple factors work together in and around each individual; mental problems, gun access, media influences and social alienation can all play their parts. In other contexts, we miss analogous factors when we attribute drug addiction or adolescent misbehaviour to the brain, or when we credit the brain for creativity and intelligence. In each case, an idealised view that simply locates good and bad personal qualities in the brain is remarkably similar to old-fashioned perspectives that assigned virtue and vice to the metaphysical soul. An updated view should instead accept that any act of brilliance or depravity arises from a combination of brain, body and environment working together.

The cerebral mystique has particular significance for the way that our society grapples with the problem of mental illness. This is because of the widespread drive to redefine mental illnesses as brain disorders. Proponents argue that doing this places psychological problems in the same category as influenza or cancer – sicknesses that don’t evoke the social stigma commonly associated with psychiatric disorders. There is some evidence that using the language of brain disorders in fact lowers the barrier for mental-health patients to seek treatment, an important benefit.

In other respects, however, reclassifying mental illnesses as brain disorders can be highly problematic. For patients, attributing mental problems to intrinsic neurological defects incurs a stigma of its own. Although people with ‘broken brains’ might not be held morally accountable or told to ‘just get over it’, the sense that they are irredeemably flawed can be just as damaging. Biological flaws can be harder to fix than moral lapses, and people with brain dysfunction can be seen as dangerous or even less than fully human. This attitude reached extremes under the Nazis, who murdered thousands of mental-health patients as part of their ‘euthanasia’ programme during the Second World War, but it persists in more subtle forms today. A large analysis of changing attitudes to mental illness in 2012 found that there was no increase in social acceptance of patients with depression or schizophrenia, despite increasing awareness of neurobiological contributions to these conditions.

Regardless of its social implications, blaming the brain for mental illnesses might be scientifically inaccurate in many cases. Although all mental problems involve the brain, the underlying causal factors can be elsewhere. In the 19th century, the sexually transmitted bacterial disease syphilis and the vitamin-B deficiency pellagra were among the greatest contributors to insane-asylum populations in Europe and the US. A more recent study estimated that as many as 20 per cent of psychiatric patients have a bodily disorder that might be producing or worsening their mental condition; the maladies include heart, lung and endocrine problems, all of which have cognitive side effects. Epidemiological surveys have found remarkable correlations between incidence of mental illness and factors such as ethnic minority status, being born in a city, and being born at certain times of year. Although these correlations are not well-explained, they emphasise the likely role of environmental factors well beyond the brain in bringing about psychiatric problems. We must be sensitive to such factors if we want effective treatment and prevention of mental disorders.

At an even deeper level, cultural conventions circumscribe the notion of mental illness in the first place. Just 50 years ago, homosexuality was classified as a pathology in the American Psychiatric Association’s authoritative compendium of mental disorders. In Soviet Russia, political dissidents were sometimes confined on the basis of psychiatric diagnoses that would horrify most observers today. Nevertheless, sexual preference or failure to bow to authority in pursuit of a righteous cause are both psychological traits for which we could imagine finding biological correlates. That does not mean that homosexuality and political dissidence are brain diseases. Society rather than neurobiology ultimately defines the bounds of normality that determine mental-health categories.

The cerebral mystique exaggerates the brain’s contribution to human behaviour, and for some it also prompts remarkable visions of the brain’s role in the future of humanity itself. In technophilic circles, there is increasing talk of ‘hacking the brain’ to improve human cognition. This notion evokes the kind of sophisticated but semi-subversive intervention one might make into a fancy smartphone or a government server, but the reality is usually more like the type of hacking one would perform with a machete. Some of the earliest brain hacks involved the purposeful destruction of parts of the brain, famously as part of the now-extinct psychosurgery procedures that inspired Ken Kesey’s novel One Flew Over the Cuckoo’s Nest (1962). The most advanced of today’s brain hacks involve surgically implanting electrodes for direct stimulation or recording of brain tissue. These interventions can restore basic function to patients with severe movement disorders or paralysis – an incredibly impressive feat, but still a world away from enhancements to normal abilities. This distance has not stopped entrepreneurs such as Elon Musk or the US defence agency DARPA from investing heavily in technology that they hope will one day routinely hardwire healthy human brains to computers.

But this exuberance is largely the product of an artificial distinction between what goes on inside versus outside the brain. The philosopher Nick Bostrom of the Future of Humanity Institute in Oxford points out that ‘most of the benefits you could imagine achieving through [brain implants] you could achieve by having the same device outside of you, and then using your natural interfaces like your eyeballs, which can project 100 million bits per second straight into your brain’. Indeed, most of us are familiar with the kind of cognitive-enhancement aids that live in our desks, pockets and handbags, boosting our memory and communication capabilities without touching a neuron. It is debatable whether connecting smartphone-like devices more directly to brains would add much except annoyance and distraction.

In the medical realm, early efforts to restore vision in blind people using brain implants quickly gave way to much less invasive approaches involving retinal prostheses, which leverage the body’s natural physiology for early processing of visual information. Cochlear implants that restore hearing in deaf patients rely on the similar strategy of interfacing with the auditory nerve in the ear, rather than the brain itself. Except in the most impaired patients, prostheses for restoring or enhancing movement also benefit from interfaces to the body. To give amputees control over mechanised artificial limbs, a technique called ‘targeted muscle reinnervation’ allows physicians to connect loose peripheral nerves from the missing original limb to new muscle groups that in turn communicate with the device. For enhancing motor function in healthy people, powered exoskeletons developed by companies such as Cyberdyne in Japan communicate with the wearer through skin-surface electrodes, also accepting input from the brain through indirect but evolutionarily honed channels. In each of these examples, the brain’s natural interactions with the body help the person use the prosthetic, leveraging rather than denying the continuity between brain and body.

The most extreme direction in futuristic brain technology is the drive to achieve immortality through the postmortem preservation of human brains. Two companies now offer to extract and preserve the brains of dying ‘clients’, who do not wish to go gentle into the good night. The organs will be stored in liquid nitrogen until technology advances to the point (now nowhere in sight) where the brain can be restored to function in some form or analysed in sufficient detail to ‘upload’ the mind into a computer. This venture takes the cerebral mystique to its logical endpoint, fully embracing the fallacy that human life is reducible to brain function and that the brain is just a physical embodiment of the soul.

Although seeking immortality through brain preservation does little harm to anything other than a few people’s bank accounts, this fringe pursuit also epitomises why demystifying the brain is so important. The more we feel that our brains encapsulate our essence as individuals, and the more we believe that our thoughts and actions simply emanate from the bundle of flesh in our heads, the less sensitive we will be to the role of the society and environment around us, and the less we will do to nurture our shared culture and resources – whether in the context of criminal behaviour, creativity, mental illness or any other aspect of human life.

The brain is special because it does not distil us to an essence, it unites us to our surroundings in a way a soul never could. If we value our own experiences, we must protect and strengthen the many factors that enrich our lives from both inside and outside, so that as many people as possible can benefit from them now and in the time to come. We must realise that we are much more than our brains.

Alan Jasanoff is professor of biological engineering, brain and cognitive sciences, and nuclear science and engineering at the Massachusetts Institute of Technology. His latest book is The Biological Mind: How Brain, Body, and Environment Collaborate to Make Us Who We Are (2018).

Besma (Bess) Benali, Clinical Social Work/Therapist, MSW, RSW, Counselling Ottawa Nepean. I am trained in Cognitive Behavioural Therapy (CBT), Brief Psychodynamic Therapy, ACT, and mindfulness. Clients come to me because they are struggling and feel like they are trapped in a darkness that no matter what they have tried (and many have tried therapy before) they can’t pull themselves out. I help my clients understand themselves in ways no one has ever taught them before allowing them to see positive changes.