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

How Do I Know What Kind of Therapist to Choose?

by Annabelle Parr

Choosing a therapist can be overwhelming. If you search Google or Psychology Today, you will likely find a long list of different therapists including licensed marriage and family therapists, licensed professional clinical counselors, licensed clinical social workers, psychologists, and psychiatrists. How do you know what kind of therapist will be the best for you? And what is the difference between all those different licenses?

Licensed Marriage and Family Therapists (LMFT):

An LMFT holds a Master’s degree in counseling, which typically involves between two and three years of school. LMFTs are trained to view individuals from a family systems perspective, meaning that they learn to see individuals in the context of their relationships. Relationships include family, friends, significant others, and even your relationship to yourself. Despite what their license seems to imply, LMFTs also work with individual clients; they do not exclusively offer marriage and family therapy. Their license speaks to the lens through which they view clients and the various presenting problems they may bring into therapy. LMFT’s must complete at least 3,000 hours of supervised experience before becoming licensed, and this experience must include working with children, families, and/or couples.

An Associate Marriage and Family Therapist has completed their Master’s but is still working on their 3,000 hours of supervised experience.

Licensed Professional Clinical Counselors (LPCC):

An LPCC also holds a Master’s degree in counseling. Many Master’s programs qualify students to sit for both the LMFT and LPCC licensing exams. However, LPCCs tend to work more generally, with a focus on mental health issues as opposed to relational issues, and tend to focus on the individual rather than the individual in the context of their relationships. LPCCs also must complete 3,000 hours of supervised experience prior to licensure, and a portion of their experience must be in either a hospital or community based mental health setting.

An Associate Professional Clinical Counselor has completed the Master’s degree requirements but is still working toward the 3,000 hours of supervised experience.

Licensed Clinical Social Workers (LCSW):

An LCSW holds a Master’s degree in social work. Their training teaches them to help connect clients with resources, both externally (like community resources, support groups, etc.) and internally (like coping skills). An LCSW must complete 3,200 hours of supervised experience in order to get licensed, and they must be supervised specifically by another LCSW for a portion of their hours. They may also provide individual, family, or couples therapy, but the lens through which they have been trained focuses on ensuring clients have access to all the resources they need to thrive.

An Associate Clinical Social Worker has completed the Master’s degree requirements but is still working toward the 3,200 hours of supervised experience.

Psychologists:

A licensed psychologist holds a doctorate degree, either a Ph.D. (doctor of philosophy in psychology, focused on both research and clinical work) or a Psy.D. (doctor of psychology, more clinically focused than research focused), which can take between four and seven years to complete. Licensed psychologists also require 3,000 hours of supervised clinical experience for licensure. Psychologists typically have more training in psychometric assessment and test administration than an LMFT, LPCC, or LCSW. A psychologist with a Ph.D. is prepared to practice clinical work, conduct research, and/or teach, whereas a Psy.D. is typically primarily focused on clinical work.

Registered Psychological Assistant or Postdoctoral Fellow: A registered psych assistant is still working toward the doctoral degree and receiving supervised clinical experience. A postdoc has already completed the doctorate, but is completing the supervised clinical experience hours toward licensure.

Psychiatrists:

A psychiatrist holds a medical degree, and has completed a period of residency, and fellowship. Psychiatrists are medical doctors and are able to prescribe medications. A psychologist, LMFT, LPCC, and LCSW are not able to prescribe medication. Psychiatrists are also able to provide psychotherapy services, but their training is more medically focused.

What’s the takeaway?

Ultimately, there can be a lot of overlap in the services provided by the above practitioners. They are all qualified to assess, diagnose, and treat the full range of mental and emotional disorders found in the Diagnostic and Statistical Manual (DSM). The specific license under which a therapist operates speaks to the lens through which they have been educated, and the duration of education.

However, the provider’s area of expertise and scope of practice tends to depend upon the clinical experience that they have gained. So when looking for a therapist, it can help to understand what their license means, but it is perhaps more important to understand the specific supervised and licensed experience that the therapist has. Do they have experience working with anxiety, panic, trauma/PTSD, depression, identity issues, couple’s therapy, child therapy, family therapy? What modalities are they trained in? Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Psychodynamic Therapy, EMDR, Emotion Focused Therapy, Somatic Therapy? Do their areas of expertise and treatment modalities align with your needs and goals?

Research consistently shows that the therapeutic relationship is the most important factor in whether therapy is successful. So it’s key that the therapist you choose feels like the right fit for you personally. But it can be hard to try to figure out who might be a good match based on credentials and website information alone. A good place to start in narrowing your search is looking at the therapist’s areas of expertise and preferred treatment modalities. Once you have found someone whose specialties line up with your goals, you can reach out to the provider and ask any questions that may not have been addressed on the practice website. (If they won’t take the time to respond to your questions, they might not be the best fit!) If you feel comfortable with the therapist during the initial contact, you can schedule your first session. You will want to meet with the therapist 2-3 times to evaluate how safe and comfortable you feel working with this person. Choosing a therapist is a process, and it can feel overwhelming at first. But once you know how to narrow your search and find a provider that feels like a good fit, it can be incredibly rewarding.

Apps for Anxiety

Written by Riley Cropper

Edited by Lauren Helm

Apps for Anxiety

Image source: www.business2community.com

Anxiety, or the anticipation of a future threat, can be an unpleasant and even debilitating aspect of a person’s life. Symptoms of anxiety may include but are not limited to worry, restlessness muscle tension, fatigue, irritability, and difficulty concentrating. Often, those with anxiety symptoms also engage in excessive avoidance of situations that had provoked anxious feelings in the past, thereby reducing an individual’s overall quality of life. According to the National Institute of Mental Health (NIMH), about 40 million American adults are affected by an anxiety disorder in a given year. Fortunately, we live in an age of expanding technology. It is common to search for the answers to our questions on the Internet, or hear from others that “there’s an app for that.”  The Internet and smartphone apps make finding useful tools and information for various types of issues readily accessible and available like never before, so why not use these technological advances to help us to address the unpleasant or stressful feelings we may encounter when we experience anxiety? Many of these apps or online resources are designed to supplement professional psychological care, and should not replace professional treatment; however, they may help you take a mental break in the middle of the day or reduce symptoms during a stressful moment. The best part? All but one app on this list are completely FREE!

Apps for Overall Anxiety Management

• Stop Panic & Anxiety Help for Android (free)
  • Equipped with audio tracks to help you relax in the moment as well as a journal portion that asks you to write what happened and how you overcame it. That way, you can not only look back at all that you have overcome, but how exactly you did in case it ever comes up again! 
• Worry Box Free for Android (free)
  • This app is a journal and self-help guide in one! First, you write down your thoughts or worries, then the app presents you with questions about these stressors and some tips for dealing with them. Additionally, it’s password protected so all of your information will be kept safe
• Self-help for Anxiety Management (SAM) for iPhone and Android (free)
  • Allows the user to rate their level of anxiety or worry, then guides them through one of many relaxation exercises
• Worry Watch for iPhone and iPad ($1.99)
  • User fills out a template that describes a recent worry then eventually makes a note of the outcome and whether this outcome was as bad as their initial worry. Then, the next time you feel worried you can return to the app and view the past entries that show that the outcome is rarely as bad as the original worry. This app is also password protected
• MindShift for iPhone and Android (free)
  • Presents the user with strategies for specific symptoms or scenarios, such as test anxiety, social anxiety, performance anxiety, worry, conflict, panic, and perfectionism. Also allows you to “check yourself” by rating your symptoms. This app is especially helpful as it encourages the user to stop avoiding their worry and shift their fame of mind instead!

Apps for Meditation

• Take a Break! for iPhone and Android (free)
  • A very basic meditation app that presents 2 guided meditations: a 7 minute “work break” or a 13 minute “stress relief” exercise. Also gives you the option to play nature sounds in the background
• Calm for iPhone and Android (free) as well as free online at Calm.com
  • User selects an amount of time to meditate (from 2 to 20 minutes) as well as the theme of the guided meditation such as positivity, self-acceptance, or sleep. User can also select one of the “immersive nature scenes” to display throughout the exercise
• Headspace for iPhone and Android (free)
  • Presents the user with 10 short guided meditations and allows them to track their progress over time and even set reminders for future meditation

Apps for Relaxing Soundtracks

• Relax Melodies Free for iPhone and Android (free)
  • Select from 50 relaxing soundtracks to help put your mind and body at ease! Most useful for helping the user get to sleep as it allows you to set a sleep timer and an alarm for the next morning

Apps for Diaphragmatic Breathing

• Breathe2Relax Free for iPhone and Android (free)
  • Allows user to rate their level of stress then guides them through a diaphragmatic breathing exercise. When phone volume is up the app plays relaxing noises in the background and tells the user when to breathe in and release. Also give the user a visual of the length of their breath and allows you to adjust the length as needed. Keeps track of your stress ratings over time
• BellyBio Interactive Breathing for iPhone (free)
  • This is a biofeedback based app that monitors the user’s breathing while playing a soundtrack of ocean waves in the background

Additional Helpful Apps

• Anti-Stress Quotes for iPhone and Android (free)
  • Presents the user with calming words of wisdom and also gives you the ability to save them for later or share via e-mail, text message, or Facebook
• Positive Activity Jackpot for Android (free)
  • Based on pleasant events scheduling, this app utilizes the phone’s GPS to help users find enjoyable activities near their current location. The user can select the type of activity they’re looking for (e.g., “water activities”) or you can simply “pull the lever” to have the app pick for you! The app also provides you with the exact address of the activity and allows you to save locations for future use
• T2 Mood Tracker for iPhone and Android (free)
  • Allows the user to track symptoms on 6 pre-loaded scales: anxiety, depression, well-being, stress, heady injury, and posttraumatic stress. This allows the user to see their symptoms over time to see what things may be contributing to these symptoms and also to help the user talk to their mental health provider about their progress over time or possible effects of medication changes. 
•  PTSD Coach for iPhone and Android (free)
  • This app screens the user for symptoms of Posttraumatic Stress Disorder and can also track symptoms over time. In addition, it provides tools for dealing with these symptoms, links for additional support, and even a section to help the user teach their friends and family about PTSD
• Previdence for iPhone (free)
  • Allows the user to check symptoms of different disorders such as anxiety and depression, as well as other issues like problematic relationships or drug or alcohol use. App then provides some recommendations based on the reported symptoms
• Operation Reach Out for iPhone and Android (free)
  • This app was developed by the military to help prevent attempts of suicide. If the user is someone that is facing suicidal thoughts, the app allows them to enter the phone numbers of people they can call while in a crisis and also comes pre-loaded with a few suicide prevention hotlines. The app also has videos that encourage the user to reach out for help and provides instruction on how to do so. Other videos in the app give facts about solutions and treatment options, giving the user hope that things can get better. This app can also be helpful for those that are trying to help someone in a crisis, providing suggestions for how to best talk to the friend and get them the help they need. 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders 

(5th ed.). Arlington, VA: American Psychiatric Publishing

Holland, K. (2014, May 27). The 18 best anxiety iPhone & Android apps of 2014. Retrieved

from http://www.healthline.com/health-slideshow/top-anxiety-iphone-android-apps

Kiume, S. (2013). Top 10 Free Mental Health Apps. Psych Central. Retrieved on December 16,

2014, from http://psychcentral.com/blog/archives/2013/09/20/top-10-free-mental-health-apps/

National Institute of Mental Health. (2009). Anxiety disorders. Retrieved from

http://www.nimh.nih.gov/health/publications/anxiety-disorders/nimhanxiety_34436.pdf

Weingus, L. (2014, October 27). 5 apps to help you cope with anxiety. Retrieved from

http://www.huffingtonpost.com/2014/20/27/apps-anxiety_n_6054270.html

Phobias, Fear, & Exposure Therapy

by Lucas Myers

At the Center for Stress and Anxiety Management Halloween has got us thinking about fear. We deal with it all the time, but at CSAM we call fear by another name: Phobia. Classified as a form of anxiety disorder, a phobia is a persistent, irrational, and severe fear of a particular situation, object, or activity. A phobia is much more intense and persistent than ordinary fears. The desire to avoid the source of terror is very powerful. People might avoid certain situations, things, and conditions in an effort to circumvent their fears. Most of those suffering from a phobia recognize that the fear is excessive or unreasonable. More than 12 percent of individuals develop phobias at some point during their lives. In fact, these fears may change over time. For example, fears of crowds, separation, injury, illness, and death are more common among people over 60. Among 20 year olds, common fears included snakes, heights, storms, enclosures, and social situations. 

There may be as many as 700 different phobias. Many of them may only be uncomfortable or embarrassing, but the ones listed below can be so severe that they cause major changes in the way you live your life.

• One of the most well known phobias, arachnophobia is also believed to be one of the most common. If spiders make you feel overwhelmed by extreme anxiety and fear, you have arachnophobia. 

• According to a 1980 study by the Boeing Aircraft Corporation, 25 million Americans suffer from aerophobia. Celebrities Billy Bob Thornton and Cher are two household names that have reported suffering from this powerful aversion to flying in airplanes or hot air balloons.

• Halloween can be tough if you experience necrophobia. Caskets, dead bodies, funeral homes, and funerals or anything that invokes thoughts about death can cause extreme fright. This phobia may develop from attending a loved one's funeral when the painful memory sticks around and develops into a fear of anything related to death.

• You may have Social Phobia if the thought of being watched or scrutinized by other people causes overwhelming panic. Social and performance anxiety can be experienced by anyone but Social Phobia like other extreme fears, can cause nausea, sweating, and a racing heart. Those with Social Phobia may become very reclusive.

• Another common phobia is claustrophobia, an anxiety disorder that sometimes develops in response to an occasion, often in childhood, when a person was trapped in an enclosed space with no way to escape. Claustrophobic individuals may find themselves irrationally fearful of elevators, airplanes, trains, or subways.

• A bout of agoraphobia can really wreck your plans. It can include fear of wide, open spaces, tunnels, bridges, traffic, crowds, airplanes, and public transportation. In it’s most severe form, agorophobia can cause people to refuse to stray far from home. If you have agoraphobia you're in good company. According to many reports, Oscar winning actress Kim Basinger struggled with panic attacks and severe agoraphobia, publicly sharing how difficult it has been for her friends and family to understand.

• Those that suffer from acrophobia are likely to have a convenient excuse when it comes time to visit the Empire State Building with their family, or disappear to the bathroom when everyone gets in line for the Ferris Wheel. That's because acrophobia is the fear of heights. It isn't always seen as very serious, after all, how hard can it be to avoid ladders? For some people though, acrophobia can be a huge problem because it prevents them from crossing bridges. Imagine doubling the length of your commute just to avoid taking the bridge home.

• An irrational fear of germs can be referred to as germophobia, bacterophobia, or mysophobia. Some believe Michael Jackson may have suffered from mysophobia. This is because he was often photographed wearing a surgeon's mask out in public. Others with mysophobia may feel compelled to wash their hands all the time in an attempt to remove germs. Mysophobia is often a form of obsessive compulsive disorder.

If you are suffering from a phobia, there is hope! Specific Phobias can be treated using a powerful intervention called exposure therapy. Exposure therapy involves systematically and gradually exposing individuals to the objects or situations they dread. Exposure therapy works because once individuals have faced the source of their fear, they learn the object or situation is not as dangerous as they previously believed and they learn they can cope with the object, situation and their fear. Ample research has demonstrated the efficacy of Exposure Therapy for phobias and other anxiety disorders as well (e.g., obsessive compulsive disorder, panic disorder, post-traumatic stress disorder).. 

If you would like to talk to one of our expert therapists about a phobia, or any anxiety disorder, contact us at CSAMSanDiego@gmail.com or call us at 858-354-4077.

References:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 24 Octorber 2013]. dsm.psychiatryonline.org doi:10.1176/appi.books.9780890425596.744053

Comber, Ronald J. 2008. Fundamentals of Abnormal Psychology: Fifth edition. New York: Worth.

Smolowe, Jill. “Too Hot to Handle”. People Magazine, Vol. 55, 4. Retrieved on October 24th 2013 from: http://www.people.com/people/archive/article/0,,20133526,00.html

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