Trauma, PTSD, and Evidence Based Treatment

by Annabelle Parr

When someone experiences a life threatening event, the nervous system kicks into gear to help them survive. It automatically initiates a fight, flight, or freeze reaction. Once the event is over, it’s natural to be emotionally, cognitively, and physically distressed by what occurred. However, for some individuals, the brain and the body can get stuck continuing to respond as if the threat is still present. When this occurs for an extended period of time, the person may be experiencing post-traumatic stress disorder (PTSD).

From Victim Blaming to Recognition of Suffering

PTSD is often associated with combat veterans, as the diagnosis was developed in an effort to characterize and explain the cluster of symptoms that some soldiers experienced after returning from combat (Herman, 1997). Prior to the development of an official diagnosis, PTSD in soldiers was known as “shell shock,” and those suffering from shell shock were often blamed, told they were weak, and punished for their symptoms. In the late nineteenth and early to mid twentieth centuries, a significant number of women also exhibited symptoms of PTSD from sexual trauma and domestic violence. However, rather than psychiatric professionals acknowledging or investigating the trauma these women had experienced, they too were blamed for their symptoms, and were diagnosed with “hysteria,” which was explained as a manifestation of inherent female weakness and emotionality. In the 1970s, survivors of both combat and domestic abuse began advocating for themselves. It was not until 1980 that the American Psychological Association finally recognized PTSD as an official diagnosis (Herman, 1997).

What is Trauma?

Trauma can and does include both experiences in combat and sexual abuse, but it is not limited to these events. Trauma is defined by the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-V) as “exposure to actual or threatened death, serious injury, or sexual violence” (American Psychiatric Association, 2013, p. 271). Exposure can include personally experiencing the event, witnessing the event occurring to another, learning that such an event occurred to a loved one, or being exposed to extreme details of a traumatic event (such as a first responder or police officer). While it is common for survivors to compare the intensity of their experience to that of another survivor and to minimize what they have been through, according to Dr. Peter Levine and Maggie Kline (2006) “trauma is defined by its effect on a particular individual’s nervous system, not on the intensity of the circumstance itself” (p. 37). Furthermore, as Dr. Judith Herman (1997) noted, “the severity of traumatic events cannot be measured on any single dimension; simplistic efforts to quantify trauma ultimately lead to meaningless comparisons of horror” (pp. 33-34). Trauma encompasses a wide range of experiences, including but not limited to childhood abuse, sexual assault or rape, emotional abuse, combat, medical procedures, natural disasters, car accidents, and physical assault.

What is PTSD?

PTSD is characterized by intrusion in the form of repetitive and distressing thoughts, memories, or nightmares; avoidance of trauma-related triggers such as people, places, or situations; reactivity in the form of hypervigilance, exagerrated startle, irritability, or similar; and changes in beliefs and mood, such as self blame or detachment (for a more comprehensive list of symptoms, you can refer to the diagnostic criteria in the DSM-V)

While PTSD symptoms often begin soon after experiencing the trauma, they can surface months or even years following the event. It is very common to experience some symptoms of PTSD immediately following a trauma due to the natural reactions of the nervous system when faced with threat. However, for the majority of individuals, recovery tends to occur naturally and the symptoms resolve without treatment. For some, the brain and the body can get stuck, and continue to experience the effects of trauma long after the threat has passed.

Why Does PTSD Occur?

The effects of trauma are incredibly complex, and there is not one clear answer for why PTSD occurs in some but not others. When faced with threat, there are a number of changes that occur in both our brains and our bodies to maximize efficiency and to help us access the resources and responses that allow us the best chance at survival. One factor that seems to distinguish the experiences of those who develop PTSD is “a feeling of ‘intense fear, helplessness, loss of control, and threat of annihilation’….When neither resistance nor escape is possible, the human system of self-defense becomes overwhelmed and disorganized. Each component of the ordinary response to danger, having lost its utility, tends to persist in an altered and exaggerated state long after the actual danger is over” (Herman, 1997, pp. 33-34). Having felt extreme powerlessness at the time of the trauma (and continuing to experience powerlessness after the fact), the individual’s body and brain attempt to reclaim power by continuing to respond to the threat as if it were perpetually present. Feeling and behaving as if the trauma is still occurring in the present rather than lodged safely in the past is a characteristic experience of those with PTSD.

Treatment for PTSD:

PTSD can be incredibly debilitating, tends to place a strain on relationships, and can impair the survivor’s ability to function in other important areas of life, such as work or school. However, the good news is that while we cannot undo the traumatic event, PTSD does not have to be permanent. Evidence based treatments are available to help survivors recover from the aftermath of their trauma.  Evidence based treatments available at CSAM include:

• Prolonged Exposure (PE) involves gradually facing the memories, thoughts, feelings, and situations that the client has been avoiding since the traumatic experience. Avoidance may offer temporary relief, but can severely limit the person’s life and ultimately serves to maintain symptoms of PTSD in the long run.

• Cognitive Processing Therapy (CPT) involves exploring the ways that the trauma has altered the way the client sees him/herself, others, and the world. CPT helps the person to learn new ways to cope with upsetting thoughts, how to challenge unhelpful thoughts, and how to reframe the thoughts in more helpful ways.

• Eye Movement Desensitization Reprocessing (EMDR) involves bringing the traumatic experience to mind while the client moves his/her eyes from side to side or experiences tactile or auditory bilateral stimulation. EMDR can help the client to process the trauma in a new way.

• Acceptance and Commitment Therapy (ACT) focuses on the use of experiential exercises to help foster greater acceptance of emotional experiences, decrease the power of negative thoughts, identify values, and help the client commit to taking action in service of his/her values in order to create a more meaningful and fulfilling life even in the face of pain. ACT also often involves exposure exercises to help decrease avoidance.

Coping with PTSD and deciding to seek treatment takes immense strength and courage. The beautiful thing about treatment for PTSD is that although it is challenging, it gives survivors their power and their voices back. When PTSD limits confidence and life engagement, evidence based therapy conducted in the presence of a warm, supportive, empathic clinician can help restore a sense of safety and willingness to engage in a full and meaningful life.

CSAM’s Lead Trauma Specialist, Dr. Janina Scarlet, is a trauma survivor who is extremely passionate about helping other trauma survivors to cope with and recover from PTSD. Her approach includes finding strength in the trauma survivors. She says, “Every hero has a traumatic origin story. Your trauma does not define you. Your trauma is just the beginning of your quest. The rest is up to you.” She collaboratively works with trauma survivors to turn their pain into a superpower, allowing survivors to move past their pain, and find meaning, hope, and recovery.

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:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. 

Herman, J. (1997). Trauma and recovery: The aftermath of violence – from domestic abuse to political terror. New York, NY: Basic Books.

Levine, P. A., & Kline, M. (2006). Trauma through a child’s eyes: Awakening the ordinary miracle of healing. Berkeley, CA: North Atlantic Books.

My Horcrux Diary

guest blog post by Dr. Nic Hooper

Have you read the quote below by T.E. Lawrence?

"All men dream: but not equally. Those who dream by night in the dusty recesses of their minds wake up in the day to find it was vanity, but the dreamers of the day are dangerous men, for they may act their dreams with open eyes, to make it possible.”  

I’m a dreamer. Always have been. Ever since I could remember, I wanted to do remarkable things that would make the world a better place. Over the years, I’ve had lots of ideas for how to do this but often I would ‘wake up in the day to find it was vanity’. In other words, the ideas remained just that; ideas. On a recent project, I became a ‘dreamer of the day’.

I research an approach to human suffering named Acceptance and Commitment Therapy (ACT). The pitch of ACT goes something like this: if we can be willing to experience all of our thoughts and feelings, both positive and negative, whilst continuing to move in valued directions, then we will do a decent job at this game of life. One night, after delivering an ACT intervention to teachers, I had this thought: “It is really easy to forget our values; I need to create something that will remind people of what is important to them.” In the following weeks I came up with the idea of an annual diary. For the most part, this diary would be like any other diary i.e. it would have days and dates and spaces to record meetings. However, it would also provide an opportunity for the user to record what is important to them at the beginning of each week.

Ok, so there was the idea. Now I had to do something with it. The first step was easy; I loaded Microsoft Word and spent hours and hours and hours (with my co-author Dr. Freddy Jackson Brown) shaping the words and lines that would make up the inside of the diary. The second step was more difficult. I had to figure out how to take that file and turn it into a product. First question: a publisher or a printing house? No publisher was interested so we went with a printing house. Then, more questions. What sort of spine to go for? How thick should the paper be? How many copies should we buy? How should we sell it? What are the best postage and packaging options? How should we advertise it? How should we accept payment for it? How do we pay tax? Who is going to post them? How should we grow the product over time?

During the first and second steps I faced a fair bit of discomfort (i.e. seemingly powerful negative thoughts often crossed my mind: “this is a waste of time”, “nobody will like it” or “you should be spending this time with Max”). However, the third step of making my idea a reality brought the most discomfort: once I had the completed product, I sent it out there into the scary world. And given that success or failure has implications for how I feel about myself, my diary is a bit like a Horcrux in the Harry Potter story. In that story, the bad guy (Voldemort) poured his soul into a number of items and placed them out there in the world. Those items were called ‘Horcruxes’. His thinking was that this strategy would make him more difficult to kill.

Like Voldemort, I poured my soul into this Horcrux. And like Voldemort, any attack on the Horcrux feels like it kills a part of my soul (‘attack’ is an extreme word that is possibly misplaced here. By ‘attack’, what I mean is any evidence I see that the diary is not worthy, whether it be a lack of sales, little interest on social media or negative feedback). My Horcrux diary is now out there in the world fending not just for itself but, in some ways, for me also. A bit of my soul is unprotected; it can be scrutinized, criticized or ignored. It can fail. And if it fails then it will hurt like hell.

The feeling of vulnerability that comes with trying to do something remarkable is tiring, and it often makes me question whether it would have been better to stay a ‘dreamer of the night’. If my Horcrux is inside my mind then nobody can see it; nobody can hurt me. However, every time I think about this I come to the same conclusion. Although being a ‘dreamer of the night’ comes with built-in safety, if I didn’t do something with my dreams then I’d be living a life out of step with my value of making the world a better place, and consequently, I’d feel empty.

Why am I telling you all this? For two reasons. Firstly, I want you to see how ACT is in my blood. Just in this blog you will spot how I used important ACT processes (willingness, defusion, self-as-context, values). Secondly, and more importantly, I want you to see that having ACT in my blood helped me to chase my dreams, and that it can help you to do the same. Chasing dreams will bring vulnerability but if you know what to do with vulnerability then you will be free.

Interested in checking out Dr. Hooper’s Annual Diary for Valued Action? Check it out here.

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, 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

#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

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.

Five Ways Parents Can Help Children with Political Anxiety

Guest Post by Tracy Dunne-Derrell, writer at Teach.com

One hundred years from now, America in 2017 will exist only in history books. Those future writers will have plenty of material to work with: mass shootings, terrorism fears, international turmoil, and “fake news.” But those facts probably won’t capture the anxiety that’s been generated by these events. A poll conducted earlier this year by the American Psychological Association found more than half of American adults cited the current political climate as a source of stress.  

Children are feeling anxious too. A recent UCLA survey found that 51% of teachers reported more anxiety among their students. As a parent, the past year may have presented you with unique challenges as your children grappled with a range of emotions- from general anxiety to personal stress over the impact potential policies could have on them and their friends. You may have a child who’s finding that current events are causing anxiety, and are struggling to figure out how to best provide support.

As an adult, you might be experiencing negative feelings too, but you have the advantage of being able to channel them productively by contacting elected officials and engaging in activism and service. And you’re more likely to have developed meaningful ways to help yourself get through uncertain, difficult times. But your children might not be able to grasp the concepts that are troubling and confusing to them, and they may lack the skills they need to identify and cope with their feelings. Here are some ways to help them.

1. Listen, but accept that you might not always have good answers. 

As a parent, you may be tempted to help by dismissing and downplaying the concerns and worries of your anxious child. But this approach, while well-intentioned, isn’t helpful. Validating kids’ concerns and making sure they understand that it’s ok to feel what they’re feeling is important.  And unfortunately, you can’t magically erase the sources of stress for them. But you can be a sympathetic ear, and make a point to spend a little time each day talking to them about their concerns. Help them develop coping skills, which won’t eliminate the sources of negative feelings, but will help them learn to work through them. The ability to cope with challenging times is a necessary life skill.

2. Help them take action.

With so much beyond their control, your kids may find themselves feeling powerless. They might want to do something to distract them from their fears and help them feel like they’re contributing to the world in a positive way. Some adults are channeling their concerns into helping others, and there are ways children can do the same. Talk with them about some of the needs they observe in your community, and help them think of ways to address them. Young children can choose items from the grocery store to donate to a local food pantry, while older ones can join service-oriented local organizations, or look for a project to support, like a winter coat drive. Even small actions help students feel like they matter, and lead to a life-long involvement with community service.

3. Connect with the school counselor.

Kids spend a substantial amount of time in school, and their counselors are a valuable resource. School counselors are already trained to help students learn to manage a wide range of situations and challenges. And they’ve got ample materials to help them work with students who are living with political anxiety. Last year the American School Counselor Association published a guide for counselors, with suggestions for supporting children experiencing post-election stress. Sitting down with a school counselor could be a great opportunity for your child to share his or her fears with a trained professional. Ask for ideas and strategies to use at home to talk about current events, and the feelings these events generate.

4. Examine the impact of technology.

News and social media might play a role in fostering negative feelings. Escaping bad news used to be as easy as turning off the television and radio. Now, with 24-hour cable channels, mobile apps, and social media, it’s almost impossible to get a break from current events. Consider the role screen time with televisions and gadgets may be playing in your child’s politics-related stress. Evaluate the amount of time your child spends watching and reading news, and discuss alternative activities which may help them manage their stress.

5. Talk about previous times our country experienced turmoil and got through it.

It feels like we’re going through unprecedented uncertainty, but America has faced crisis before, more than once. Our country has survived wars, recessions, and natural disasters. Your children likely have some awareness of challenging times in our history, but events of long ago probably feel abstract to them; they may not be able to connect past and present. Depending on your age, you may have your own personal stories to share which might resonate with your anxious children and help them feel more optimistic. For example, during the 1970s, Watergate dominated the news, and led to concerns about government. In the 1980s, the Cold War between the United States and the former Soviet Union generated fears as both countries and their allies engaged in an arms race, generating legitimate concerns over the possibility of nuclear war. Share your stories and take this opportunity to talk with your kids about America’s resilience.

Providing support for anxious kids is challenging, but it is possible. As a parent, you know your child better than anyone, and are the best person to help them manage stress and anxiety. However, if you need some outside support to help your child, you can check your child’s school for resources, and reach out to outside resources, like local therapists, as well.

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 info@csamsandiego.com