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

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

Trauma, Panic, and EMDR: Eye Movement Desensitization and Reprocessing

by Annabelle Parr

When you search Google Images for “therapy,” the first thing that comes up is a client laying on a couch talking, while the therapist listens and takes notes. Therapy typically does involve a fair amount of talking and listening, but rarely is it that simple. For example, cognitive behavioral therapy (CBT) is a talk-based form of therapy that involves an active approach where therapist and client work together to change unhelpful thoughts and behaviors that affect the client’s mood.

Though most psychotherapy is talk-based, there are a few exceptions. One form of therapy that is particularly unique and relies on little talking is known as EMDR, or Eye Movement Desensitization and Reprocessing.

What is EMDR?

EMDR is a form of psychotherapy often used to treat trauma, where the therapist asks the client to imagine the distressing event while simultaneously engaging the client in some sort of bilateral stimulation. Typically, this involves therapist directed eye movements from one side to another, but it can also involve taps or tones.

How and why does EMDR work? 

It can be difficult to imagine how therapy might work without relying on much talking. But sometimes we cannot access all of the information that our brain has stored. If we can’t access it, we can’t talk about it. And sometimes, we can rationally understand something, but still feel stuck in painful emotions.

Trauma can be particularly difficult to process because the frontal lobe (the part of the brain involved in higher level processes, like thinking and language) is not always able to fully access the traumatic memory. So we can try to wrestle and reason with it, but find ourselves frustrated by a lack of progress as far as our emotional response goes. EMDR purports to help us approach trauma from a different angle, so that the brain actually reprocesses the way the trauma is stored.

EMDR changes the client’s relationship to the trauma.

Clients tend to find that their thoughts and feelings around the traumatic memory change fairly quickly with EMDR (EMDR Institute, Inc., 2016). There is often a deeper sense of being able to cope with trauma on an emotional level.

EMDR is now offered at CSAM.

CSAM is excited to announce that Dr. Terra Fuhr is now certified in EMDR. Dr. Fuhr explained that she decided to pursue certification because she saw several colleagues find great success using EMDR. Then she began to occasionally refer clients for simultaneous EMDR treatment, and saw firsthand the remarkable healing that it facilitated. She found that EMDR helped clients break through in places where they got stuck using only CBT. This effect was so powerful that she felt inclined to add EMDR to her mental health tool belt as a modality to help her clients, so that now she can offer EMDR in conjunction with CBT and ACT.

What can EMDR be used to treat? 

EMDR was originally used to treat trauma and PTSD, but today is applied to numerous other issues. Dr. Fuhr describes how helpful it can be in treating panic disorder. One reason for this is that clients’ most severe panic attack is stored as a trauma. Using EMDR to heal the trauma of panic can be enormously helpful in helping the client break out of the panic cycle. It can also be applied to “small traumas,” like an embarrassing moment, negative thinking patterns or feelings such as low self-esteem (EMDR Institute, Inc., 2016).

While there is some debate in the scientific community regarding the how and why EMDR helps, studies have offered support for its efficacy, and over the 25 years that it has been in existence, millions of people have been successfully treated using EMDR (EMDR Institute, Inc., 2016). EMDR can be offered on its own, or in conjunction with CBT or ACT. For some clients, it can be a helpful adjunct to their healing process.

CSAM IS HERE TO HELP

If you or someone you love might benefit from eye movement desensitization and reprocessing (EMDR), 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.

For more information about Eye Movement Desensitization and Reprocessing, visit The EMDR Institute.

References:

EMDR Institute, Inc. (2016). What is EMDR? Retrieved from: http://www.emdr.com/what-is-emdr/

Anxiety in the Courtroom

Witness Preparation Services

by Annabelle Parr

Have you ever felt especially nervous before a big presentation? Do you find your heart racing and palms sweating when you have to speak in front of a large group of people? You’re not alone. On average, people rate their fear of public speaking higher than their fear of death. Potentially one of the highest pressure, highest stakes public speaking situations is on the witness stand in a courtroom or during a deposition. Even the most experienced witnesses can feel anxiety, which left unaddressed can hinder their testimony. Anxiety is the number one communication obstacle in legal proceedings (Pitera, 2013).

Source URL: http://www.utahcriminallaw.net/what-happens-if-a-witness-lies-in-court/

Witnesses typically have very specific fears related to testifying. Some common witness fears include, but are not limited to, a fear of letting people down, losing their job, making a mistake, looking incompetent, being embarrassed, judged or blamed, or having to reveal private, personal information. Witnesses also tend to take on more responsibility for the outcome of the case than is necessary or realistic (Pitera, 2013).

Though the source of a witness’s anxiety may be completely unrelated to their credibility or honesty, jurors tend to judge witnesses more on the basis of behavior than testimonial content (Afremow, 2011). Therefore, a testimony could be flawless and completely true, but if it is delivered poorly the concrete verbal content may not matter.

Typical anxious behaviors that jurors tend to interpret as signs of unreliability include non-verbal cues such as poor eye contact, fidgeting, appearing tense, and inconsistency of demeanor or tone (Afremow, 2011). Helping witnesses to become conscious of these subtle reactions as well as the sources of their anxiety before testifying can help them to manage the visible cues thus increasing their perceived credibility.

Meeting with a licensed psychologist who specializes in anxiety management is a great way to help prepare witnesses and allow them to address their anxiety before taking the stand. Using cutting edge, evidence-based, cognitive-behavioral techniques, the therapist can help witnesses modify their anxiety, bringing it into an optimal range for peak performance.

Source URL: http://www.everydayhealth.com/smoking-cessation/living/coping-with-the-urge-behaviorally-and-mentally.aspx

Therapeutic techniques that can help prepare witnesses include:

• cognitive reappraisal, which involves changing catastrophic cognitions that fuel anxiety and lead to poor performance
• grounding, mindfulness, and relaxation
• reduction of safety seeking, avoidance, or anxiety driven behaviors such as lack of eye contact, speaking too softly, fidgeting, talking too much or too little, or looking to the attorney for reassurance
• video-taped feedback, which can help reduce anxiety by showing the witness that they don’t look as anxious as they feel, as well as helping them to notice and address visible safety behaviors

A therapeutic setting offers a safe space to practice testifying and receive non-judgmental, constructive feedback and tools that the witness can apply in court and during depositions. If you or your client are preparing to stand as a witness, know that feeling anxiety is normal, but that it doesn’t have to determine the tone of the testimony.

CSAM IS HERE TO HELP

If you or someone you know might benefit from witness preparation services for anxiety or stress, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Afremow, J. (2011). Witness this: Behavioral science in the courtroom. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/trust-the-talent/201110/witness

Pitera, M. J. (2013). Witness tip: Anxiety is the #1 barrier affecting communication. Litigation Insights. Retrieved from http://www.litigationinsights.com/witness-preparation-2/witness-tip-anxiety-is-the-1-barrier-affecting-communication/

THE POWER OF BREATHING

by Annabelle Parr

Whether or not you struggle with an anxiety disorder, we have all found ourselves overwhelmed by stress or anxiety at some point.  We each have slightly different stressors that trigger our body’s natural stress response, but we all know what the response feels like: sweaty palms, racing heart, tense muscles.  This bodily reaction can feel overwhelming, as if it controls us.  It is easy to feel powerless to our biological response to stress, but we have more control than we think.

THE STRESS RESPONSE

Source URL: http://www.gestaltreality.com/2012/07/11/metabolic-diet-supplements-an-exploration/

Before we deem our biological reaction to stress bad, let’s talk about what happens and what purpose it serves.  When we get stressed out or anxious, our body begins preparing us to face threat.  Stress activates our sympathetic nervous system, triggering the fight-flight-or-freeze response.  This causes the sweaty palms, racing heart, panicky breathing and muscle tension (McGonigal, 2013).  We often look at the stress response as inherently bad, because it is not healthy to be in the fight-flight-or-freeze mode chronically (McGonigal, 2013).  However, it’s important to remember that when your heart starts racing or your palms get sweaty, your body is just trying to help prepare you.  Nevertheless, these sensations can feel overwhelming, and perpetuate our experience of anxiety.  So how can we calm ourselves down once this cycle is in motion?

DEEP BELLY BREATHING

Using our breath, we actually have the power to activate our parasympathetic nervous system.  The parasympathetic nervous system allows our body to “rest and digest” as opposed to the sympathetic nervous system’s fight or flight response (Hunt, 2016).  While “take a deep breath” is common advice, how we actually take that breath is important.  This is how to use the breath to calm down:

Source URL: http://goodrelaxation.com/2015/05/deep-breathing-for-headaches/

1. Find a comfortable, relaxed seated position with your feet planted on the ground; alternatively, you can try breathing laying down.  Now begin to bring your focus to your breath.
2. With each breath, your belly should rise as you inhale and fall as you exhale. 
3. Your shoulders and chest should remain still.  If you notice your shoulders rise, or your chest move, drop the breath down to the belly.  Breathing into your chest is reminiscent of hyperventilating, which will only further activate your sympathetic nervous system (Hunt, 2016).
4. Now focus on breathing into your belly for four counts.  Hold your breath for a second or two.  Now exhale for five counts and relax (Hunt, 2016).  Repeat this process, focusing on your inhalations and exhalations, and making your belly rise and fall.
5. You may notice that your heart rate speeds up at first.  Don’t panic or give up.  Your body is not used to calming itself down, and is simply adjusting.  After a few cycles of inhaling and exhaling, you should notice your heart rate begin to relax. 
6. If you begin to get distracted or thoughts pop into your mind, simply notice they are there and then come back to focus on the breath. 

Source URL: http://goodrelaxation.com/2015/05/deep-breathing-for-headaches/

See if you can practice doing four or five deep belly breaths a day.  Then see if you can work your way up to thirty seconds at a time.  Then maybe a minute.  Eventually, you will be able to sit in this space with your breath for a long period of time.

Being able to tap into your breath to find a calm, centered space, no matter where you are, is an invaluable resource.  This diaphragmatic breathing essentially turns off your sympathetic nervous system and turns on your parasympathetic nervous system (Hunt, 2016). 

This is not to say that you will never feel stressed again, or that you will never experience the fight-flight-or-freeze response.  But using deep belly breathing can help you to calm your body down and lessen the biological reaction to a stressful situation.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), 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.

REFERENCES:

Hunt, M. G. (2016). Reclaim your life from IBS: A scientifically proven plan for relief without restrictive diets. Toronto, ON: Sterling Publishing Co., Inc.

McGonigal, K. (2013, June). Kelly McGonigal: How to make stress your friend [Video File].  Retrieved from: https://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend?language=e

How To Listen When Someone You Love Is Struggling

by Annabelle Parr

Life presents us each with challenges.  While it is often uncomfortable and painful to grapple with adversity, to experience this struggle and to feel pain is to be human.  At some point, we will all find ourselves in this place, as will those we love.  So how can we help each other?  How can we listen when someone we love is struggling, whether it is with a mental health condition or with a painful experience in his/her life?

 LET GO OF THE IMPULSE TO TRY TO FIX

Source URL: https://scott-williams.ca/2013/03/

It is painful to watch someone we care for struggle or hurt.  And it’s natural to want to take away her pain or try to fix the problem at hand.  However, despite our best intentions, trying to “fix” does not actually help.  It tends to make the person struggling feel as though she cannot share her pain, sadness, or anger.  Trying to “fix” sends this message: “I can’t handle seeing you in pain, so I have to make everything better.”  It also implies that it is not okay to feel sad or angry or anxious, and that these feelings should be avoided at all costs.

AVOID ADVICE

Just like our impulse to fix the pain, we also often believe that the best way to help is to offer advice.  But advice is usually not helpful for several reasons.

1. If we offer good advice, our loved one will think that anytime he is struggling, he needs our instruction.

2. If we offer bad advice or our advice doesn’t work as we hoped, our loved one can place the blame on us instead of owning responsibility.

3. Advice takes away the gift of helping our loved one to realize that she knows herself best, and ultimately she is capable of navigating difficult situations herself. (Though, of course, she will always have our love and support).

LIMIT SHARING YOUR OWN SIMILAR EXPERIENCES

Source URL: http://www.lifehack.org/articles/communication/the-biggest-communication-problem-not-listen-understand.html

If you have had a similar experience or believe that you have felt the same way, you can share this with your loved one.  But don’t make it all about you.  Keep your story brief, and make sure the purpose of the story is to let him know that he is not alone.  Also, be sure to include that you understand that your experience, while maybe parallel in some ways, is yours, and you are not claiming to have experienced the exact same situation or feelings.  This allows him to feel comfort in not being alone, but also gives him space to communicate how his experience may be different.

If we shouldn’t try to fix the pain or offer advice, and we should limit how much we share of our own experience, what can we do to help?

REFLECT OR PARAPHRASE BACK TO YOUR LOVED ONE WHAT YOU HEAR HIM/HER EXPRESSING

This shows that we are listening, and gives us the opportunity to clarify that which we don’t understand fully.  While it may sound too simple to just reflect what our loved one is saying, it actually makes the person feel heard and understood.  It also offers her the opportunity to hear what she is expressing, and to clarify how she feels or what she wants.

USE NONVERBAL SIGNALS TO SHOW YOU ARE ENGAGED

Nodding and using eye contact and engaged body language shows that we are interested and open to what our loved one is sharing.  It gives him the space to express himself, and makes him feel heard.

SHOW EMPATHY

Empathy is: “I see that you are struggling and hurting right now, and I am so sorry.  I can’t fix it for you or take it away, but I will sit here with you and listen to your story.  As much as this hurts, it is okay to feel this way.”

Check out Brene Brown’s brilliant short on empathy.

Sometimes, all our loved ones need when they are in pain is to be heard; to be given a space with someone they trust to express how they are feeling.  Sometimes, however, they may need some extra support or professional help.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), 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.

REFERENCES:
Brown, B.  (2013, Dec 10).  Brené Brown on empathy. Retrieved from https://www.youtube.com/watch?v=1Evwgu369Jw