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

America's Suicide Problem Pt. 2: Getting Help

by Lucas Myers

In our last blog, we discussed what suicide is and the high rates of suicide impacting many of us nationwide. Now it is time to talk about solutions. If you or someone you care about is thinking about suicide, stop and think for a moment about who you could go to for help. Regardless of your age, think about who the trusted adults and friends are in your life. It isn't an easy conversation to have, so if you or someone you know is struggling, it can be really helpful to have a caring person in your corner. If a person is in need, she may be working hard to hide how she feels, but hoping desperately that someone notices how much she is hurting. If you need someone to talk to and you don't have the words to ask, start with “I need help”.

If someone comes to you for help, the first thing you should do is stay with the person in need. Don’t leave her alone. Unless there is a threat of harm to you, stay with her even if it’s just on the phone. Even if you’re going to be late for work, or school, or dinner at Mom's, stay with her, others will understand.. 

Next, listen; really listen. There is an old saying that we were given 2 ears and 1 mouth so we could listen twice as much as we speak. This is too important to make a joke or dismiss the person’s concerns. Be supportive. There are some tough questions you can ask that will show you care. “Are you ok? Are you thinking of hurting yourself? Will you go with me to get help? Who would you like to talk to?” These questions are about getting the help needed to survive this crisis. 

The most important thing you can do is to get help. Chances are, you aren’t a trained counselor. Getting help is essential because this isn’t a simple situation you can handle on your own. Even though I’ve received training in crisis counseling and suicide assessment, the first thing I do with a person in crisis is to notify my supervisor for backup. It’s always OK to ask for help. It is ALWAYS OK to ask for help. This problem is bigger than one person, so ask “Are you getting help? Can I help you get help?” There are two numbers that you can use to get help. 1-888-724-7240 is a local San Diego crisis line available 24-7. The other number is a national number you can use if the crisis is out of the area and that is 1-800-273-TALK. These numbers are both nation-wide and toll free 24-7. You can call and speak to a professional for immediate help. Also, don’t be afraid to call 911. This is an emergency. 

Your friend may ask you to keep what he’s told you a secret. Don’t do it. This is too important. You are not a friend if you’re letting the person you care about keep all that pain to himself instead of getting help. This secret is not worth dying for.

How do we know if someone needs help? The major warning signs are actually pretty obvious. If you hear someone is threatening to kill himself, looking for ways to kill himself, or talking or writing about suicide or death you need to find help immediately. We can’t afford to ignore statements like “I wish I was dead. I never should have been born. You would be better off without me.” These are cries for help. A person who is contemplating suicide may feel hopeless, angry, or vengeful, and act recklessly without thinking. If something seems wrong and you are worried, get help immediately. For someone in a suicidal crisis, help can’t wait. What happens if your friend was just being dramatic and you called 911? He might be pretty embarrassed, he might have some explaining to do. What if he wasn’t being dramatic? Boom. Embarrassment just became the best-case scenario. Better to lose a friendship than to lose a friend.

Pay attention if your friend suddenly starts using more drugs and alcohol. 50% of those that attempt suicide are under the influence, most frequently alcohol. People who feel suicidal might seem moody, anxious, agitated or sleep all the time or not at all. Often, suicidal people give away their favorite things to their favorite people, or stop participating in their favorite sports and activities. Adults may pay off all the bills or update their will. If a teen quits the team or tries to give away her iPod, surfboard, Xbox, or favorite boots to her best friends, she might be saying goodbye. This is a big one because the adults in a teen's life probably won’t know about it if friends don’t speak up. If someone suddenly doesn’t want to hang out with her friends or avoids talking to her family, she may be withdrawing in preparation for life to end. This is when your friend needs you the most. Take her out to do something she might enjoy, or if she won’t go out, then go to her. Don’t put it off. Spending time with someone who cares is especially important because people who are depressed or suicidal often feel an intense sense of loneliness and worthlessness. 

In addition to warning signs, we can also look at risk factors. Breakups, divorces, major life transitions like changing schools, jobs, or moving away from friends, trauma or loss such as death of loved ones, abuse, or bullying are all potential risk factors for depression or suicide. If you or someone you know is being abused, tell a trusted friend or adult. Nobody should have to put up with physical, sexual, or emotional abuse. These days bullies are on Facebook, in school hallways, at work, and even texting on your cellphone, and it's hard to get away. Many adults and teens don't know that lesbian, gay, bi-sexual, transgender and questioning youth are 4x more likely to attempt suicide than their heterosexual peers because of the way they are treated in their homes, schools, communities, and religious institutions. If you see someone who can’t stand up for himself then stand up for him. We don’t have to tolerate hate. No one should suffer alone.

We’ve got to take care of ourselves too. Everyone feels overwhelmed sometimes, but there are some really simple things we can do to cope. Two of the best things we can do are exercise and eat healthfully. In fact, since the early 1980's, research has shown that regular exercise may be as effective as antidepressant medication for combating depression. Also I highly recommend dark chocolate. Very helpful tool, boosts serotonin, a happy chemical in your brain. Add it to the grocery list. Laughter and keeping your sense of humor is another way to cope. Keeping busy with activities or working with others as a volunteer to make a difference in your community is a great way to feel good about your life. These are good supplements to professional treatment and are good coping strategies even for people who aren’t feeling depressed to decrease overall stress. 

If you would like to speak with a professional at The Center for Stress and Anxiety Management, you may contact us at 858-354-4077 or csamsandiego@gmail.com. To see a list of other mental health conditions that we specialize in, click here.

References: 

American Association of Suicidology from: 

http://www.suicidology.org/stats-and-tools/suicide-fact-sheets

San Diego Unified School District Youth Risk Behavior Survey from: 

http://www.cdc.gov/healthyyouth/states/locals/ca-sandiego.htm

American Foundation for Suicide Prevention from: 

http://www.afsp.org/understanding-suicide/facts-and-figures

Walcutt, D. (2009). Chocolate and Mood Disorders. Psych Central. Retrieved on September 14, 2013, from http://psychcentral.com/blog/archives/2009/04/27/chocolate-and-mood- disorders/

Pedersen, T. (2013). New Guidelines for Using Exercise as an Antidepressant. Psych Central. 

Retrieved on September 14, 2013 from: http://psychcentral.com/news/2013/05/11/new-guidelines-for-using- exercise-as-an-antidepressant/54728.html

Tags: anxiety, therapy, mental health treatment, San Diego, support, depression, suicide, stigma

America's Suicide Problem, Pt. 1: It's Serious

by Lucas Myers

The week starting September 8th is National Suicide Prevention Week. Did you know we are losing 34,000 Americans every year to suicide? 5,000 of these are teenagers. For every one completed suicide there are 100-200 attempts. If you do the math, that’s 5000 x 100 or 200 = between 500,000 and a million suicide attempts every year by people between 14 and 24 years of age. That’s a big, big, deal especially because we have learned that if someone has attempted suicide once, they are at a much higher risk to attempt it again.

Did you know that suicide is rising faster in youth between 10 and 14 than in any other age group? What grade are you in when you’re 10 years old? 5th right? Some of us probably have family, friends, or neighbors that age. Did you know that suicide is the #2 cause of death for college aged Americans? Right here in San Diego, on average, we lose one teen between 15 and 19 years old to suicide every month. We’re losing children, friends, nieces, nephews, cousins, brothers and sisters to suicide every day, and sometime in your life suicide may affect you or someone you know.

There is a myth about suicide that if you talk about it someone will attempt it. Does that make sense to you?

Of course not.

People that attempt suicide are in pain. They feel alone and they feel that they have no other way out. They need to talk! Some people think that when someone decides to attempt suicide there is nothing you can do to stop them. Well everyone has good days and bad days right? Suicidal feelings are usually temporary, but suicide is permanent. These people have usually had a lot of bad days in a row, and that is called depression, and they need help. As much as 90% of suicides are the result of an undiagnosed mental illness, mostly depression. That is awesome news, because although we can’t see depression, , we can treat it. Suicide can be prevented. Depression treatment has a very high success rate. Medication can be helpful and therapy can teach those suffering from depression methods for getting healthy and feeling good. I’ll tell you more about that later. For now, I want you to remember that you may not be able to help getting depressed, but you can help yourself get help.

If you are concerned that you or someone you know might be thinking about suicide get help! In an emergency, call 911. For information and support there are two numbers that you can use to get help. These numbers are both nation-wide and toll free 24-7. 1-888-724-7240 is a local San Diego crisis line. The other number is a national number you can use if the crisis is out of the area, that is 1-800-273-TALK. 

Over the next few weeks, this blog will be sharing a story about the author's personal encounter with suicide and sharing tips for how to recognize and prevent suicidal behavior. The first step toward preventing suicide is to start conversations and take away the stigma that isolates people with suicidal thoughts. Please check back to learn more and share these blogs with the people you care about.

If you are suffering from anxiety or depression, don't wait until it becomes a crisis. 

If you would like to speak with a professional at The Center for Stress and Anxiety Management, you may contact us at 858-354-4077 or csamsandiego@gmail.com. To see a list of other mental health conditions that we specialize in, click here.

If you are interested in spreading awareness on how to prevent suicide in San Diego you can learn more from Yellow Ribbon of San Diego.

References: 

American Association of Suicidology from: 

http://www.suicidology.org/stats-and-tools/suicide-fact-sheets

San Diego Unified School District Youth Risk Behavior Survey from: 

http://www.cdc.gov/healthyyouth/states/locals/ca-sandiego.htm

American Foundation for Suicide Prevention from: 

http://www.afsp.org/understanding-suicide/facts-and-figures

County of San Diego Health and Human Services Agency, Emergency Medical Services, Medical Examiner database, 2001-2010.

San Diego Community Health Statistics Suicide Report 2011

Tags: anxiety, therapy, mental health treatment, San Diego, support, depression, suicide, stigma