Fostering Resilience during COVID-19 by Connecting with Our Values

By Annabelle Parr

As we enter Mental Health Awareness Month this year, we are collectively experiencing not only a global health crisis, but also a stressor which has potentially significant repercussions for our mental health. At the very least, we are likely to be experiencing a range of painful emotions as a result of this crisis. On any given day, I find myself feeling at least some combination of the following: anxiety, fear, stress, grief, frustration and/or exhaustion. 

As an Acceptance and Commitment Therapy (ACT) therapist, when I am struggling, I ask myself the question: can I be willing to have this pain, and still choose to move in the direction of what matters most to me? The goal of ACT is to help us to live more vital, meaningful lives even as we struggle with the inevitable pain and discomfort inherent in being human. And goodness knows this pandemic has given us all a whopping dose of pain and discomfort.

But what does a meaningful life look like during a global crisis?

Prior to COVID-19, I felt like I had developed a pretty good sense of how to move toward what matters even when I feel anxiety or fear or frustration. But this pandemic has challenged me. At first, I felt overwhelmed as it seemed the world had turned upside down, and I struggled to find ways to live my values when life suddenly felt so restricted by forces beyond my control.

So I began to consider: how can I continue to move toward what matters most to me, even as life has become more restricted by this pandemic?

A few weeks ago, I was scrolling Instagram and came across a post posing the question: “if someone told you that you could save a life, would you?” The post went on to remind us that we are all being given that otherwise very rare opportunity, and that in staying home right now, we are actually saving lives.

https://www.instagram.com/igo_medical/

After reading this Instagram, it clicked for me: I don’t necessarily have to do anything monumental or new or different right now in order to make significant, values based decisions. Instead, I can consider what I am already doing – like staying home except for essential errands, or wearing a mask and maintaining six feet from others when I do need to go out, or calling and connecting with friends and family – and I can connect these actions with my values.

What are values?

Values from an ACT perspective are a collection of verbs, adverbs, and adjectives that describe qualities of being; a.k.a. who and how do I want to be in the world? For me, a few of my values include being compassionate, conscientious, kind, and loving.

Connecting with our values can infuse the choices we are already making with purpose.

When I connect even the simple action of staying home with being compassionate or loving, rather than becoming fused with thoughts about how terrible, frightening, or overwhelming this all is, I can ground myself in a sense of purpose and meaning beyond my discomfort. And I can bring my values to anything I do: when I call family or friends, I can choose to show up lovingly; when I go to the store, I can offer gratitude to the essential workers I interact with; when I watch my favorite TV show, I can connect with my value of being kind and gentle with myself. The key is being intentional about why I do what I do.

You are enough just as you are.

Navigating a pandemic is exhausting; it demands so much of us already, and additional pressure to do more when just getting through the day feels taxing enough can feel less than helpful. Part of the beauty of ACT is that values based actions are not always huge, monumental gestures; in fact, more often, they are the small, intentional choices we make to show up in a particular moment as the type of person that we hope to be in the world. So rather than beating ourselves up for feeling like we are falling short somehow, we might ask ourselves instead, how can I bring the qualities I hope to embody to the actions I am already taking? How can I connect the things I am already doing back with the kind of person that I hope to be? 

“Those who have a why to live can bear almost any how.”

I keep coming back to the wisdom of Viktor Frankl during this time; as a Holocaust survivor and psychiatrist, he is particularly well suited to guide us through crisis. He noted that “those who have a why to live can bear almost any how,” and I might add that those who have a why to act can bear almost any how. The “how’s” of our day-to-day right now pose a whole host of new challenges for us, but when we can connect with a why behind these challenges, we are likely to meet them with much greater resilience.

CSAM IS HERE TO HELP

If you or someone you love needs support and might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, insomnia, or stress related to COVID-19, or if you would like more information about our telehealth services, please contact us at (858) 354-4077 or at info@csamsandiego.com

How Do I Know If I Need Therapy?

By Annabelle Parr

Each May we celebrate Mental Health Awareness Month to draw attention to and reduce stigma around mental health issues. According to the National Alliance on Mental Illness, or NAMI, 1 in 5 people will be affected by mental illness in their lifetime. And as we discussed last May during #CureStigma, “while 1 in 5 Americans are affected by a mental health condition, 5 in 5 Americans know what it is to feel pain. The frequency, intensity, and duration can vary, but pain itself is a function of being human. When culture stigmatizes the 1 in 5 and simultaneously dichotomizes illness and wellness, the resulting message is that it is shameful to struggle and to feel pain. In essence, stigma says that it is shameful to admit our own humanity.”

Do I need therapy?

Given that all of us will at some point encounter painful experiences and emotions, this year we are discussing how to know when it might be helpful to seek therapy. Though it may be clear that those affected by a previously diagnosed mental health condition could benefit from therapy, for those who are either undiagnosed or are struggling with anxiety, stress, grief, sadness, etc. but do not meet diagnostic criteria for a mental health disorder, it may be harder to discern whether therapy is warranted.

How am I functioning in the important areas of my life?

For nearly every condition in the Diagnostic and Statistical Manual (DSM-V; APA, 2013), clinically significant impairment in an important area of functioning is a required criterion to receive a diagnosis. In other words, the presenting symptoms must be making it very difficult to function at work or school, in relationships, or in another important life domain (e.g., a person is feeling so anxious that she is not able to make important presentations at work, or so stressed that he is finding it difficult to connect with his loved ones).  When life has begun to feel unmanageable in some capacity, or if something that was once easy or mildly distressing has become so distressing it feels impossible, it may be worth considering therapy.

Could things be better?

It’s also important to note that you do not have to feel as though things are falling apart before you seek professional counseling. Therapy can be helpful in a wide range of situations. It can help you not only navigate major challenges or emotionally painful periods, but also can enhance your overall wellbeing by helping you to identify your values and lean into them. Maybe things are going fine, but could be better. A therapist can help you identify what could be going better and can help you learn to fine tune the necessary skills.

I want to try therapy, but where do I start?

Whether things feel totally unmanageable or it just feels like they could be better, it’s important to find a therapist with expertise relevant to what you would like assistance with. Working with children requires different expertise to working with adults, just as working with couples and families requires additional expertise to working with individuals. Different conditions also correspond with particular evidence based practices. For stress and anxiety disorders – including social anxiety, generalized anxiety, panic disorder or panic attacks, and phobias – evidence based practices include Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT). The gold standard of treatment for obsessive compulsive disorder (OCD) is Exposure and Response Prevention (ERP), and evidence based treatments for PTSD include Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) (all of these—ERP, PE, and CPT --fall under the CBT umbrella). So no matter what you are seeking treatment for, ensuring that the therapist you choose has expertise that aligns with the types of concerns you are struggling with is critical. For some more tips on finding and choosing a therapist, click here and here. For more information on the different kinds of licenses a therapist may have, click here.  

Though there is no right or wrong answer as to whether or not you need therapy, if you are unable to behave in ways that make life manageable and/or fulfilling because of difficult thoughts or feelings, you may find therapy beneficial.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, or insomnia, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

#CureStigma

by Annabelle Parr

This year for Mental Health Awareness Month, NAMI (National Alliance on Mental Illness) is focusing on curing mental health stigma. The campaign manifesto on the NAMI website reads:

There’s a virus spreading across America. It harms the 1 in 5 Americans affected by mental health conditions. It shames them into silence. It prevents them from seeking help. And in some cases, it takes lives. What virus are we talking about? It’s stigma. Stigma against people with mental health conditions. But there’s good news. Stigma is 100% curable. Compassion, empathy and understanding are the antidote (NAMI, 2018).

Stigma is a nasty virus, but this manifesto fails to capture the fact that stigma doesn’t just hurt the 1 in 5 who are struggling with diagnosable mental health conditions. It hurts every single one of us.

Mental health exists on a continuum. When we create a false dichotomy that suggests that some people are mentally ill while everyone else is healthy and well, we fail to recognize the range of experience that falls somewhere in the middle. And we fail to recognize that where you stand on the continuum can fluctuate and change throughout life.

The continuum enters the realm of DSM diagnosis when a person displays a clinically significant level of functional impairment. In other words, to qualify for a diagnosis, the person must be unable to function in an important area of life as a result of the presenting symptoms. But there are plenty of people who are functioning seemingly well in relationships, work, school, etc., who appear just fine from the outside, yet inside they are hurting and need some help. These folks aren’t feeling “well,” but they don’t necessarily meet the criteria for a mental health diagnosis.

The thing is, while 1 in 5 Americans are affected by a mental health condition, 5 in 5 Americans know what it is to feel pain. The frequency, intensity, and duration can vary, but pain itself is a function of being human. When culture stigmatizes the 1 in 5 and simultaneously dichotomizes illness and wellness, the resulting message is that it is shameful to struggle and to feel pain. In essence, stigma says that it is shameful to admit our own humanity.

With stigma, we all become isolated in our suffering. But with compassion (which means to suffer with), we can find connection in the midst of and even as a result of pain through our experience of common humanity. We all know loss, grief, heartbreak, anger, anxiety, sadness, regret, inadequacy, and disappointment. We all have our own version of the “I’m not good enough” story. What if, instead of burying these feelings deep in our shame vaults, instead we shared them? Stigma wouldn’t be able to survive.

Just because pain is a part of being human, that doesn’t mean a professional can’t help us navigate the more difficult aspects of existence. Despite what stigma says, seeking therapy in the midst of struggle is a sign of strength and wisdom. Therapy can benefit anyone, no matter where the person falls on the continuum of mental health. In fact, even therapists benefit from therapy. A few of the CSAM clinicians decided to share a little bit of their own experiences as clients in therapy.

Dr. Jill Stoddard, CSAM Director, said:

I like to think of my mental health a lot like I think of my physical health--they both need ongoing attention and care to stay at their best.  When I get a small cough or cold, I might just manage it on my own with my neti pot and some Vics Vapo-Rub. But if I have strep throat or a broken bone, I'm going to seek out professional help and continue to follow up with my physician until I'm well.  Even when things are stable and there are no overt signs of trouble, I still see my dentist, optometrist, and dermatologist for regular check-ups.  So goes my mental health.  Life can get really painful.  If I'm dealing with smaller hassles, I might go to yoga or seek support from my friends or family.  But when my mom died, I went to therapy to help process my grief.  When my husband and I were feeling the distance that often comes with raising a young family while also working, we sought out couples’ therapy.  Now, our marriage is stronger than ever, AND we still see our therapist for sporadic "check ups."

Dr. Michelle Lopez, CSAM Assistant Director, wrote:

I think about mental health care as a lot like car care. If my car is having problems, it may need to be in the shop for a while. Other times, it might just need a quick tune up. It might also take me some time to find the right mechanic, and I might have to try a few out before I find the right one. But it’s important to pay attention to signs that the car needs service, because neglecting it is likely to lead to more problems. I’ve participated in therapy at various points in my life, and have sought help to work through life experiences and challenges such as coping with the physical and emotional pain of a physical injury, processing the loss of my dad, living with infertility, and creating a healthy work-life balance. Currently, my car is functioning quite well, but I make sure to take notice when that “check engine” light comes on. 

Dr. Janina Scarlet, CSAM psychologist and founder of Superhero Therapy, shared:

When my dear friend lost her battle with cancer, I was devastated. I couldn't sleep, I couldn't concentrate on my school work, and I found myself too overwhelmed to function. I decided to see a grief counselor. I had never been in counseling before and didn't know what to expect. My therapist was warm, compassionate, and understanding. She helped me process my grief and find meaning in this loss. I am extremely grateful for this experience as it allowed me to find myself again. 

Hopefully, in acknowledging the full range of human experience and removing the false dichotomy that currently separates us into We-Who-Are-Healthy and They-Who-Have-Pathology, we will begin to fill the space that is currently occupied by stigma with acceptance and compassion, both for ourselves and others.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References:

NAMI, 2018. Mental health month. Retrieved from: https://www.nami.org/mentalhealthmonth

Mental Health Awareness Month: Fitness #4Mind4Body

by Annabelle Parr

May is Mental Health Awareness Month. Every year, Mental Health America designates a particular theme for the month to highlight an important aspect of mental health. This year’s theme is Fitness #4Mind4Body, and it focuses on acknowledging the connection between mental and physical wellbeing. #4Mind4Body explores the role of nutrition, exercise, the gut-brain connection, sleep, and stress in our overall wellbeing and examines the ways each of these areas impact our functioning. Below is a summary of the topics covered in the Mental Health Toolkit from Mental Health America.

Diet and Nutrition

Eating a well-balanced, nutritious diet is an integral part of health. Diets high in processed, fried, and sugary foods can increase the risk not only for developing physical health problems like diabetes, heart disease, obesity, and cancer, but are also linked to mental health problems, including increased risk for depression symptoms. A healthy diet consists of a variety of fruits, vegetables, legumes, whole grains, fish, nuts, and olive oil. Maintaining a balanced, nutritious diet is linked with a lower risk for depression and even an improvement in depression symptoms.

Exercise

Regular exercise not only helps control weight, increase strength, and reduce the risk of health problems like high blood pressure, cardiovascular disease, and some cancers, but it also helps boost endorphins and serotonin, among other important proteins and neurotransmitters that impact mental health. Endorphins serve to mitigate pain in the face of stress and increase pleasure in the body. Serotonin affects appetite, sleep, and mood, and is the target of SSRIs, a class of antidepressant commonly used to treat anxiety and depression. Just thirty minutes of exercise per day can help improve mood and mental health.

The Gut-Brain Connection

The gut, also known as the “second brain,” communicates directly with the brain via the vagus nerve and via hormones and neurotransmitters. The communication goes both ways, so anxiety, stress, and depression can impact the gut and result in gastrointestinal symptoms, but changes in the gut microbiome can impact the brain and mood, exacerbating or even resulting in symptoms of anxiety and depression. Eating a nutritious diet that includes prebiotics and probiotics is an important part of maintaining a healthy gut and a healthy mind. 

Sleep

Quality of sleep impacts the immune system, metabolism, appetite, the ability to learn and make new memories, and mood. Good sleep for adults means getting between 7-9 hours of mostly uninterrupted sleep per night. Problems with getting good quality sleep can increase the risk of developing mental health symptoms, and symptoms of anxiety and depression can negatively impact sleep, creating a negative cycle. Cognitive Behavioral Therapy for Insomnia (CBT-I) can help clients reestablish healthy sleep patterns through addressing negative thoughts and worries as well as behavioral patterns that are impacting sleep habits.

Stress

Stress is a normal part of life, and the body is equipped with a fight or flight response designed to help mobilize internal resources to manage stressors. After the stress has passed, the body can return to its regular equilibrium state. However, when stress becomes chronic, it can cause inflammation, impaired immune system functioning, muscle aches, gastrointestinal problems, sexual dysfunction, changes in appetite, and increased risk for heart disease. Too much stress can also impact mental health.

Mental health involves a complex interplay between numerous factors, including but certainly not limited to the areas listed above. Furthermore, though maintaining a healthy diet, regular exercise routine, good sleep habits, and utilizing stress management techniques can help prevent or improve existing mental health symptoms, if you are struggling with mental health issues, it can be difficult to attend to these areas.

If you are struggling with anxiety, stress management, depression, chronic illness, or insomnia, seeking professional assistance can be helpful. Evidence based therapies like Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help to address problematic thoughts and behaviors that are contributing to emotional distress. Therapy offers a warm, supportive, safe environment to explore painful issues. A therapist can also provide support in helping the client to develop good self-care habits, like those mentioned above.

This year’s mental health awareness theme reminds us of the importance of recognizing the multiple avenues through which we can approach mental health, and the variety of tools we have at our disposal to improve overall wellbeing.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, depression, stress, PTSD, insomnia, or chronic illness, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References

Mental Health America. (2018). 2018 Mental Health Month Toolkit. Retrieved from http://www.mentalhealthamerica.net/sites/default/files/Full_2018_MHM_Toolkit_FINAL.pdf

Mental Health Awareness Month

by Annabelle Parr

Since 1949, May has been designated as Mental Health Awareness Month. Given that 20% of U.S. adults will experience a mental health condition in their lifetime, having conversations about mental health and the resources available for those who are struggling is incredibly important.

Risky Business

This year’s mental health theme focuses on “Risky Business.” Mental Health America is working to start a conversation around risky behaviors that may increase the chance of developing mental illness or that may accompany an existing mental health issue. The specific behaviors they are focusing on are: marijuana use, risky sex, prescription drug misuse, internet addiction, compulsive buying, and exercise extremes.

Our State of Mind Impacts Our Emotions and Our Behavior

It’s important to understand that mental illness consists not only of difficult emotions, but also includes behavior changes or an impairment of functioning in day to day life. Such behavior changes can manifest as either avoidance of certain situations and/or engaging in new behaviors to attempt to numb or escape the pain that accompanies the mental health problem. Neither avoidance nor risky/numbing behaviors will resolve the mental health concern; they provide short term relief, but actually serve to maintain and worsen the situation in the long run.

Evidence Based Therapy

If you are concerned that you are struggling with a mental health problem or if you are overwhelmed with feelings of stress, anxiety, or depression and aren’t sure how to cope, seeking professional help can be a good place to start. A therapist can offer support and help you to work through those things that you are struggling with. He or she can also help you address any behaviors that may be impairing your ability to function in life, work, or your relationships.

Evidence based therapies including Cognitive Behavioral Therapy and Acceptance and Commitment Therapy have been scientifically demonstrated to effectively treat anxiety, depression, and many other emotional and physical difficulties.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) involves helping clients learn to identify and modify unhealthy, unhelpful, or inaccurate thoughts and unhealthy or unhelpful behaviors that serve to maintain emotional difficulties. Gradual, repeated exposures to feared situations also help clients learn to face that which they may have avoided previously. CBT challenges clients to face difficulty in the context of a warm, safe, therapeutic environment.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) also involves reducing experiential avoidance behaviors, but differs from CBT in that it focuses on accepting difficult thoughts and feelings in order to live a meaningful, values-based life. ACT challenges clients to embrace difficulty in the context of a warm, safe, therapeutic environment.

The Human Condition

Whether or not you find yourself in the 1 of 5 adults struggling with mental health, all of us will face pain, difficulty, and struggle at some point or another. Asking for help in the midst of struggle is a sign of strength, not weakness. One of the beautiful things about suffering is that it can lead to connection when we let those we trust in on our pain. While it can be tempting to turn to those risky behaviors listed above, we only exacerbate our problems by doing so. In turning to a trusted loved one or a professional, we can begin to find meaning and healing in the midst of pain and suffering.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.