Chronic Illness and Mental Health Part 1: The Unpredictability of Chronic Illness

Chronic Illness and Mental Health Part 1: The Unpredictability of Chronic Illness

Living with a chronic illness can be overwhelming, both physically and emotionally. You may deal with varying degrees of disability; from brain fog that affects your ability to concentrate and remember, to intense pain that affects your joints and ability to move freely in your body. You may even have “wandering” symptoms, which means that you experience different symptoms from day-to-day or week-to-week, and are never sure what to expect from your body. Sometimes symptoms might even be vague and hard to describe; even though you know something is off in your body, you are not experiencing the vitality you once did.

Listen to the audio version of this article on Soundcloud or YouTube.

When your body is in pain or compromised in some way, it can be physically draining. Your immune system may be working hard to try to keep up, and physical exhaustion, or just plain feeling sluggish, is a common experience. After a while, this tends to take an emotional toll.

I don’t know about you, but after a few days of having a bad cold or the flu, I feel emotionally vulnerable and start to wonder if I’m feeling depressed. This is because when we are sick, our bodies adopt the posture and functioning of someone whose mental health is compromised. You may hunch over, need to rest in bed often, find daily tasks more difficult, or find yourself zoning out and unable to focus. When these types of sickness symptoms happen, our brain, which picks up a lot of information from our body, thinks we are depressed, anxious, or in some way emotionally unhappy. It can become a struggle to maintain a balanced mood when your body is working against it.

If this is you, don’t despair; there is help for those living with chronic illness, and improving your quality of life is within reach. First, we will look at reasons chronic illness is difficult to cope with – the more you understand, the better equipped you are to handle the problem. Then, we will jump into coping strategies to increase your sense of well-being and quality of life.

UNPREDICTABILITY

If you suffer from an illness that causes your symptoms to change and rotate, you are no stranger to unpredictability. There is nothing more frustrating than not knowing how you will physically feel when you wake up in the morning: not knowing how this will affect your ability to engage during the day ahead.

For example, some people experience joint or muscle pain that comes and goes in varying intensities. On some days, they are able to walk and hike, but on others, walking from the parking lot to a restaurant is painful, and this affects their ability to make plans with friends and loved ones. Imagine hearing of a concert you would love to attend, and then not knowing whether you will be able to walk to your seat or stand and enjoy the music.

The unpredictability of symptoms makes it nearly impossible to plan ahead. Your social life may suffer, and relationships can take a toll if you repeatedly cancel plans at the last minute because of unforeseen physical symptoms. Even clothing can be a problem for some. Clothes can fit one week, and then become tight and pinching the next, due to swelling and bloating, or they can become loose and hanging because of unwanted weight loss.

You may have to continually ask yourself questions that healthy people do not give a second thought:

  • Will walking or standing be so painful that you must think ahead to make sure you can park close enough wherever you travel?
  • Are you able to fit into and wear comfortable clothes, or will finding something that fits be an added task and stressor?
  • Will you be able to focus at work and engage in a meeting, or forget what you wanted to contribute and not be able to participate articulately?
  • Are you tired and counting the hours until you can rest again?

Being unable to predict how your body will feel or function from day-to-day adds the unwanted burden of thinking through everything you do. When you feel well, you take for granted all the tasks and situations that are automated. It’s like moving to a strange home and having to learn where everything is. Instead of getting up and starting your day, you must think about where the toothbrush and toothpaste are, where you put your morning coffee mug, where to sit and settle in for breakfast instead of already having a favorite seat, etc. Every decision requires thought, and although each decision is not taxing on its own, when you put them all together, it is exhausting! This is similar to what unpredictability of symptoms from a chronic illness can feel like, day after day.

HOW TO COPE

 

SELF-COMPASSION

When loved ones you care about are in pain, your natural desire is to soften. You talk in soothing tones, try to be helpful, maybe put a gentle hand on their shoulder, or offer a hug. You instinctively understand that being caring is what is needed when someone is struggling. However, most of us often don’t apply this same understanding to ourselves.

When you are having a tough time, do you respond by telling yourself to “buck up” and “push through”, not wanting to ask for help, while berating yourself for having a challenging time in the first place? If so, you are not alone. Self-criticism is rampant in our world, and this is unfortunate because not only does this make pain more difficult to tolerate, it also often slows our progress and prevents clear problem solving.

If you’d like to understand this better, try this little exercise: Take out a pen and paper and write down some of the things that you say to yourself when you are not being kind.

My favorites: “You are so stupid!” “Geez, you can’t do anything. What a failure.” “You are so ugly; you should be ashamed. Just look at you.”

Without censoring, write down those phrases you use to tell yourself you are unworthy and undeserving of love and respect.

Now, close your eyes and imagine a chair in front of you. Imagine someone you love dearly just came and sat down in this chair. Try to picture this person vividly, and feel the sense of love and gratitude you have for this person well up inside of you. Now, tell the person the phrases you use to berate yourself but direct the words toward your loved one. If you tell yourself you are a failure, say to your loved one that he or she is a failure. Use the tone and emphasis you use toward yourself and don’t hold back. Imagine your loved one receiving your words and watch their reaction. What happens? How do they feel? How do you feel?

I tried this exercise in a workshop once, and I couldn’t get past the first few words. In my imagination, my loved one started crying, hunched over and horrified by the hurtful words I hurled toward him. I couldn’t even go on. Now, imagine, this is what you have been doing to yourself.

When illness happens, you are compromised. You cannot function at 100% and perform as you do when you are feeling healthy. When you are in this state, you need compassion more than ever: It does not make sense to kick yourself when you are down. That only puts you in more pain, and you feel greater defeat and inability to cope.

Replacing self-criticism with a compassionate gesture or words can soften the blow, allow you to release the pressure valve, and help you gain the strength and confidence to cope.

Imagine not being able to concentrate or perform as well as you would like and rather than saying the words you identified above, instead, you place a soft hand over your heart, or gently hold your other hand, and say something sweet, such as, “Oh sweetheart, I’m so sorry you’re suffering in this moment.” Sound awkward? That’s a sign you need some practice!

Dr. Kristen Neff developed Mindful Self Compassion, a set of skills to practice changing your harsh self-stance to one of love, gentleness, understanding, and of course, compassion. On her website, she generously provides guided meditations and suggested practices. If you would like to learn more, check out her offerings and start gently practicing. https://self-compassion.org/ Also, listen to my guided meditation on feeling supported and connected at the end of this article.

CLEAR, UNAPOLOGETIC COMMUNICATION

When you are compromised by illness, it is a common experience to feel shame. Embarrassment that you are not functioning as you previously did, or as you or others expect, can get in the way of asking for help or being clear about your abilities and limits.

I have a friend who, unbeknownst to me, was suffering from a severe autoimmune disorder. For a while, I experienced her as rigid, demanding, and defensive, and did not want to spend much time around her as a result. When she finally (and tearfully) told me she was sick and suffering and was acting differently because she was embarrassed and did not want to ask for help, all of my irritation and intolerance melted and I was filled with compassion for her. Instead of wanting to check out of the relationship, her communication made me want to know more, be more understanding, and offer any help I could.

When my friend clearly and directly communicated with me what was going on with her health, how it was affecting her, and what she needed, I was no longer in the dark. I was now provided with context if she canceled plans last minute or needed to rest instead of going on a hike.

Being candid about what you want and need, without apologizing for yourself, and simply stating how things are, can be empowering. If you can put aside the judgments of how you think you “should” feel or what you “should” be doing, and instead respond to the facts of the situation and what you need and want, everybody is happier, including you.

If you are embarrassed or feel shame because you are sick and you respond by hiding (the action urge for shame and embarrassment), you are reinforcing the message that you should be ashamed of yourself. When you are sick, and you feel embarrassed, but then you ask for help anyway, set limits, or let people know what you are struggling with, you give yourself the message that you deserve to be cared for, acknowledged, and that this sickness is not your fault.

When you are coping with chronic illness, communication can prove difficult, especially if symptoms wax and wane in an unpredictable fashion. Because of this, you may not know how to describe how you feel, what to ask for, or what limits to set. In this case, just stating that you are unsure what is going on with you or what to ask for can be clarifying to your loved ones and validating to yourself. The clearer you can be about your current experience, without judgment, the better able you will be to set appropriate limits and gain support, connection, and understanding.

 

Guided Mindfulness Practice for Finding Connection and Support

Listen to the audio version of this practice on Soundcloud or YouTube.

(Modified from DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan.)

An effective way to participate in this meditation is not to get too caught up in thinking about the words. Rather, settle into your breath, your body, and let the words gently float through you, allowing yourself to be just as you are in this moment.

Start by noticing your breath in your body. You do not have to alter or change your breathing. Your breath is perfect as it is. Just notice the feeling of your inhalation and exhalation and how your whole body is involved in this movement of breath.

Focus your attention on your feet touching the ground. Consider the kindness of the ground holding you up, providing a path for you to get to other things, not letting you fall away from everything else.

Focus your attention on your body touching the chair you sit in. Consider how the chair accepts you totally, holds you up, supports your back, and keeps you from falling onto the floor.

Focus your attention on the clothes on your body. Consider the touch of your clothes holding you, surrounding and keeping you warm and comfortable.

If you are indoors, consider the walls in the room. They keep out the wind and the cold and the rain. Think of how the walls are connected to you through the floor and the air in the room. Experience your connection to the walls that provide you with a secure place to do things.

Now, focus your attention on where your body touches an object: floor or ground, air molecules, a chair or armrest, your clothes, you choose. Try to see all the ways you are connected to and accepted by that object. Consider the function of that object in relation to you. That is, consider what the object does for you. Consider its kindness in doing that. Experience the sensation of touching the object, and focus your entire attention on that kindness and notice if you begin to feel a sense of being connected, loved, or cared for arising in your heart.

Continue to notice objects you are connected to and supported by throughout your day. Whenever you are needing a bit more support and comfort, see if you can identify ways that objects around you are kindly providing their support. Breathe this support in and feel connected to the world around you.


5 Signs You Know a Therapist Could Help You with your Relationships

 

Relationships are one of the most delightful and challenging aspects of life. The closer the relationship, the more our emotional buttons get pushed. When we experience intimacy with others, circumstances often challenge us in ways we are never stretched on our own. This is both difficult and a blessing. By giving us the opportunity to grow and change, relationships can also bring the chance to heal and shift into a whole new way of being. Whether this brings to mind a relationship you have with a friend, family member or significant other, opportunities to transform and flourish are abundant.

 

You may know that you need relationship help, but don’t know where to begin. Sometimes therapy focused on your relationship goals may be just what is required to get unstuck. Here are five specific signs that working with a results-oriented therapist could help you improve your relationships:

 

 1- You Have a Tough Time Communicating Effectively

 

Our communication skills affect the quality of our relationships. Maybe you often feel misunderstood by others. You may communicate in ways that make it difficult for others to understand you, such as by expressing too much emotion or sometimes shutting down. Perhaps your communication breaks down even more during times of stress.

 

Working with a therapist can help you develop new skills and strategies that will help you communicate more effectively. A therapist can teach you skills that will help you better describe, express, and assert your thoughts, wants, and needs, while at the same time, reinforcing the other person and ensuring they continue to like you and want to maintain a close relationship. (This is borrowed from the Dialectical Behavior Therapy (DBT) DEAR skill. If you choose a therapist trained in the DBT model, you will have access to learning all the Interpersonal Effectiveness skills relevant to you and your goals.)

 

relationship help, Therapy for your relationship

 2- You Speak or Act Without Thinking and Hurt Those Your Care About

 

We all have times where we say something without thinking or get ourselves into a sticky situation as the result of acting impulsively. You may even intentionally lash out at those you care about without knowing why. If this happens to you often, it can harm the relationships you want to maintain, and working with a therapist can help.

 

A skilled, results-focused therapist can teach you to line up your behaviors and words with your values. Therapy can help you develop the skills to slow down and behave with intention. Becoming more mindful about your actions and words, and then learning new interpersonal skills and language, can help move you towards your relationship goals.

 

 3- You Have Difficulty Balancing Your Needs with The Needs of Others

 

Sometimes in an effort to maintain relationships, we sacrifice our own needs. You may be so focused on getting your needs met that you fail to compromise, and your relationship breaks down. In any situation, there are three things you need to balance. These include objective goals (what you want out of the specific situation), the maintenance of the relationship, and personal needs or self-respect. (See a qualified DBT therapist to learn more about these interpersonal priorities.)

A therapist can help you better discern your goals in different situations so that you can prioritize how you want to balance them. When your goals for your needs, the relationship and your self-respect are in equilibrium, you are more likely to be happy with the outcomes for yourself and your relationship.

 

 4- You and Your Partner Frequently Disagree and Argue

 

No two people can agree on everything. Everyone comes with their own life histories, personal values, opinions, wants, and needs. Each person also comes to the relationship with their own communication style. If you and your partner frequently disagree that can be okay if you are able to talk through those differences without consistently sacrificing your own or the other’s needs.

 

However, if it seems that your disagreements often lead to arguments, then you may consider counseling for help. In a safe environment, a therapist can help you to gain an understanding for balancing your own and your partner’s (or friend’s or family member’s) needs. A therapist can also help you talk through specific issues and diffuse ongoing conflicts.

 5- Something Big Has Happened for You, Your Partner, Or Your Relationship

 

Life brings ups and downs. When one person in a relationship experiences significant life changes, it can be challenging for the other. Sometimes relationships undergo monumental changes such as a transition from being single to marriage, during a loss (such as miscarriage), or if there has been infidelity or breach in a friendship.

 

Meeting with a therapist can help you and your relationship as you navigate through the changes. Therapists can provide an outlet for support, reflection, and accountability. A therapist can also help you learn how to work through problems and changes with your partner, balancing both of your unique needs and the needs of the relationship.

 

Find a therapist who you feel comfortable interacting with, where you feel safe to disclose information and try new strategies. Therapists well-trained in and practicing Dialectical Behavior Therapy (DBT) help their clients learn mindfulness and interpersonal effectiveness skills to optimize handling conflict in relationships and interacting to bring more fulfillment and closeness.

 

To find out if therapy could be the right fit for you, speak with a therapist who specializes in DBT or helping people navigate their relationships and start shifting from surviving to thriving today!

 

 

 

 

 


5 Thoughts to Help Cope with Anxiety in The Moment

Anxiety can feel overwhelming, often involving unpleasant physical sensations accompanied by rumination that just won’t stop. Anxiety can creep up and spoil an otherwise pleasant moment. The very best thing you can do to cope with anxiety when it rises is welcome it in! It’s entirely counter-intuitive to do so, yet it works. In fact, it is the most effective treatment for anxiety.

When you try to avoid feeling anxious, push it away, or try to distract from it, you are feeding the monster and anxiety will continue to grow. If you attempt to escape anxiety, you are learning that anxiety is something dangerous to be feared, which in turn increases your experience of anxiety. When this happens repeatedly, you become more and more anxious. When you not just face anxiety, but welcome the experience in, you will learn that anxiety is not to be feared, you can cope with whatever comes your way, and then, and only then, will anxiety subside and become tolerable.

Use these to encourage yourself to cope with anxiety in-the-moment.

 

 1. “This is a moment of suffering”

Acknowledging that you are in a painful moment is a first step toward tolerating it. Taking a mindful approach by simply labeling that “this is a moment of suffering,” can help you notice and attend to what is happening. When you mindfully label this experience, it can give you some space to decide how to respond. Instead of being caught in the hurricane of anxiety, you can take an internal step back, put words on your experience, and have a moment to get a little perspective to cope with anxiety. Acknowledging when you are in a moment of suffering is also a first step in the practice of mindful self-compassion, a therapy developed to alleviate human suffering.

 2. “I can do it”

Anxiety and fear can make you freeze up, holding you back from some task you need to do or a goal you want to go after. Remind yourself you can do it (after all, you made it this far). Sure, it may not turn out perfect or exactly as you want. However, when you commit to trying, there is hope that it can work out. When you try, you also get a chance to learn. Saying to yourself, “I can do it,” reminds you that even if you are feeling so anxious that you are sweating and shaking, you can still continue to put one foot in front of the other, gently moving toward your goals. Anxiety and fear may come along for the ride, and they don’t have to stop you from getting to where you want to be.

5 Ways to Cope with Anxiety in the Moment

 3. “I can get through this”

Maybe you have tried something new, and it’s not working out. You may feel like your world has crashed down and thoughts like “I can’t cope with this” and “I can’t get through this difficult situation” may cross your mind. Anxiety is a common trigger for the belief that we cannot cope or we can’t make it through. Remind yourself you can get through this. Chances are, you have already faced challenges in your life. Each time, you managed to make it through and learn from the situation – you may have even ended up with a better outcome. Draw upon this inner reflection on strength and resilience to get through this situation too.

 4. “I am here now”

One of the biggest causes of anxiety is the tendency to live in the past and the future, rather than the present. Sometimes, you may dwell on the past with regrets. You may worry about the future and what could be. This adds to anxiety by keeping your mind spinning in many different directions and adding the pain of the past and possible pain of the future to an already difficult moment. Use gentle reminders to pull yourself into the present. You can also support a present-focused mindset with mindfulness techniques, such as slow, deep breathing or noticing and labeling your surroundings, such as describing the shape and color of objects in your environment.

 5. “I am okay”

Fear is a hard-wired response that you have developed through many years of evolution. Fear tells you a threat is near, and you must take action. However, fear does not always fit the facts. Anxiety is fear run amok and the fear of possible threats. When you feel anxiety, check things out. Look at your emotions and the facts of the situation. Evaluate whether that anxiety is well-founded or a false alarm. Sometimes your anxiety is well-founded, and you should react. Most of the time, anxiety is your mind working in overdrive and there is no real life-or-death threat in your path. In those cases, remind yourself that your brain is trying to keep you safe, but you are okay. It helps to notice the fear so you can cope with anxiety and understand that it is the experience of it and, you are okay.

If you struggle with persistent anxiety, you might benefit from the help of a therapist. Mental health providers who use Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT) can help you recognize and challenge your thoughts, tackle anxiety, and provide one-on-one solutions empowering you to manage and cope with anxiety. If needed, contact a qualified therapist to help and start shifting from surviving to thriving today!

 

 


What Happens When You Stop Depressant or Anxiety Medications?

Anti-depressant and anti-anxiety medications work to alter your brain chemistry and support a more balanced mood state. Since psychotropic medication changes your brain chemistry and may also come with side effects, deciding to take medication should not to be made lightly.  It’s helpful to understand how the medication you are prescribed works and what to expect when discontinuing it before deciding to stop. It’s always advised to be under the supervision of a doctor who can ensure your safety and help minimize any side effects before discontinuing psychotropic meds.

(Please skip to the last section of this article if you would like to consider alternatives to psychotropic medication and discuss your options with your prescribing doctor and other healthcare professionals.)

Psychotropic medications, taking medicines, psychotherapist

Why Take Psychotropic Medications?

If you are struggling with depression or anxiety in a way that is significantly affecting your life, your doctor may recommend anti-depressant or anti-anxiety medications. Medications are also sometimes prescribed to alleviate symptoms, making therapy more helpful and useful. When feeling burdened by emotional overwhelm, at times it can be impossible to participate in your therapy in a way that promotes the change you need or motivate yourself to follow up on homework in-between sessions. When this is the case, your doctor may recommend psychotropic medication to help you engage in therapy in the way that you need to give you some relief from the symptoms you are experiencing.

Current-day research supports the use of both psychotropic medication and Cognitive Behavior Therapy (CBT) to treat diagnoses associated with depression. Medication may help you be fully involved and benefit from therapy. CBT will help you make the chemical changes in your brain for the long-term so that if you decide to taper off your medication at some point, you can maintain the brain changes you have worked to achieve in therapy.

In other cases, psychotropic medications may be prescribed to address chronic forms of depression and anxiety. Some people suffer from depression and/or anxiety for years. Despite trying many approaches, they struggle with symptoms on a daily basis. In these cases, medication may be a helpful option. Some people choose to maintain their medication regimen for a lifetime because when the medication is withdrawn, symptoms quickly return. Sometimes, even when engaging in all the behaviors necessary to support your health, the chemical components of the disorder you suffer from are just too strong, and medication is an essential part of your health routine. Each person is unique, as are the type, dosage and length of time prescribed medication works best.

It is very important to note that psychotropic medications may be contraindicated for some anxiety disorders and interfere with treatment and prognosis. Evidence-based treatments for anxiety require that you are able to experience the anxiety to its fullest extent in therapy in order for the treatment to be effective. If you are taking medication to decrease your experience of anxiety, in some case, this may interfere with your therapy. Talk to your treatment provider so that you can collaborate about the most effective treatment for you.

 

How Do Psychotropic Medications Work?

Different anti-depressant and anti-anxiety medication work in distinctive ways. Some medications stimulate the brain to produce more neurotransmitters (chemicals in the brain that regulate mood and other processes). Some help the brain by blocking the effects of neurotransmitters. Others, affect the brain by encouraging it to hold onto extra neurotransmitters. Because it takes some time for these medications to affect and balance the neurotransmitters in the brain, anti-depressant and anti-anxiety medications need to be taken for a minimum period of time before results are noticed. Your prescribing doctor can advise you the time needed to experience the affects from your medication.

 

Why Stop Taking Psychotropic Medications?

People often decide to stop using their medications once they start to feel better. This can be a mistake. It is important to carefully consider this decision and preferably, discuss your desire to discontinue medication with your healthcare professional. Often, it’s wise to wait a while after feeling better before discontinuing your prescription. When people quit taking their medication too soon, symptoms can return and sometimes the medication does not have the same effect or potency on mood symptoms the next time around. It is often preferable to wait until you have made changes in your health behaviors and maintained them for long enough where they have become habits. Once you have made the changes needed to support your sustained mental health, you’ll want to make sure they are engrained and part of your life so that you will continue to be supported in this way after your medication has stopped. Other times, people may find the medication they are taking no longer works and they may need to stop one type of medication to start another. Additionally, people may need to discontinue using their medication due to some other health concern (possible side effects, drug interactions, or in cases of pregnancy).

 

What Happens When You Stop Anti-Depressant or Anti-Anxiety Medications?

If you are taking an anti-depressant medication and suddenly stop, it can cause unpleasant symptoms including nausea, vomiting, headaches, dizziness, nightmares, and paresthesia (unpleasant sensations in the skin). If you are taking an anti-anxiety medication (or anxiolytic) and suddenly stop, symptoms could include nausea, vomiting, seizures, sweating, weight loss, heart palpitations, migraines, muscle pain, insomnia, and even suicidal thoughts. Specific side effects are unique to the medication and the person who is taking it. In either case, you may experience a rebound of psychological symptoms.

Because suddenly stopping anti-depressant or anxiety medication can cause unpleasant side effects, it is very important to consult with a doctor before you stop taking prescribed medications. A doctor can help to assess whether this is the right choice. They will also help you slowly reduce your dosage so that you are weaned off the medication safely, which helps to prevent uncomfortable side effects.

When you start or stop medications, it can be helpful to also seek the services of a qualified therapist who can help you address thoughts, feelings and emotions that may be affecting your mental health. A Dialectical Behavior Therapist (DBT) can provide specific education and skills to help you naturally cope with life’s ups and downs, without medication in some cases. A frequently used DBT slogan is, “Skills over pills.” This means that with learning and practice of DBT skills, often people can reduce or eliminate medication and lean on the DBT strategies they have learned to help them function effectively. The most important thing is to work together with your doctor and therapist to find the healthiest and most effective treatment solution for you.

 

Alternatives to Psychotropic Medications

Taking any type of prescribed medication is a personal choice. While doctors can advise you and make recommendations, ultimately, the decision whether to take psychotropic medication is up to you. Many times, making lifestyle changes can significantly impact your mood and decrease the need for prescription use. However, making these changes can be difficult and requires work. Only you and your wisdom can decide whether you are in a position and have access to the support needed to make these changes, or if now is not the time and medication is a worthwhile option.

If you are interested in making changes to your health behaviors to support a more balanced and stable mood, consider consulting with a Health Psychologist, such as Dr Bando. Health Psychologists are trained to understand all the factors maintaining the ineffective behaviors you are engaging in and help you directly target and change those behaviors to better support you. A good therapist can take out the guesswork and help you move toward your health goals with ease and precision.

Whatever your choice, please consult your wisdom and be gentle with yourself. In a time of difficulty (like experiencing depression or anxiety), increased self-compassion is needed.

Take action today and start shifting from surviving to THRIVING!


Telehealth vs. In Person Therapy: Which is Better?

You may be familiar with the image of counseling taking place in a psychologist’s office, client and therapist sitting opposite each other, or perhaps the client lying down on a couch. While this model is well known, our current-day communication technology makes it possible to access psychological services in the comfort of your own space.

Therapy has changed over the years, as has the consumer. As more information about psychological health has become readily available, those seeking treatment have become savvy customers. You value your time, money and energy and want gold-standard care. In therapy, this translates to more people looking for skills-based treatment delivered efficiently. Replacing the tradition of a therapist asking you to lie on a sofa and talk about your childhood, are therapists who view themselves as expert consultants, able to teach you the techniques and strategies needed to get what you want out of life. Therapy has become solution-focused and results-oriented, making video sessions an ideal platform for counseling.

In today’s busy world, many people find it difficult to schedule an hour plus commute to their therapist’s office on a weekly basis. Others do not want to sit in traffic, add another appointment to their day, or may want to see a specialist who is not located in their neighborhood. Telehealth provides a convenient solution.

Telehealth can provide greater ease and flexibility, and research shows it can be just as effective as traditional therapy. So which option should you choose?

How is Telehealth different from In-Person therapy?

In-person therapy means face-to-face in the same room or office with your therapist. The therapist provides the office space for your therapy session. Telehealth services are provided remotely, meaning that you and your therapist could be miles apart. Your sessions are assisted with HIPAA-secure technology, such as phone, video conferencing, email, online chat platforms, and even texts. In this model, you are responsible for making sure your space is private and confidential, and you feel comfortable enough to speak freely and be able to benefit from the session in the environment you have created.

Telehealth offers the advantage of making therapy services accessible to anyone, anywhere. This makes it easier to access the treatment you need. If the distance to travel to a therapist or the desire to see a specialist who is not in your area has held you back from therapy before, Telehealth might be a viable option to explore. If you want clear, directed, results-oriented therapy this can be easily delivered over Telehealth and help you reach your treatment goals quickly and effectively.

Teletherapy session, Telemedicine therapy, telehealth appointement

Who can benefit from Telehealth?

Anyone who is looking for results-focused treatment, in which the therapist serves as a teacher to help you gain the skills, techniques, and confidence to apply new strategies to your life and see the changes you want, can be a good match for Telehealth. In short, treatments focusing on helping you build skills to effect change are easily delivered via Teletherapy. Treatments such as Cognitive Behavior Therapy (CBT) and Dialectical Behavior Therapy (DBT) can help you with anxiety, depression, emotion dysregulation and interpersonal problems in an online format.

Clients who succeed with Teletherapy have the ability to provide a private, confidential space that allows them the focus needed to gain the benefits from their online sessions. Practical considerations such as having a strong internet connection, making sure your space is soundproofed enough so that you can express yourself freely, and having pen and paper handy, will ensure you get the most from your Telehealth treatment. With an online session, you do not have to lug your notebooks, writing materials, etc., to your therapy appointments. Everything you need is already at your fingertips.

Telehealth also allows you the luxury of sitting in your space, taking notes, and thinking or processing after the session has ended. Many people who have experienced face-to-face counseling know how abrupt it can feel to end a session after exploring vulnerable topics and then head out into the busy world again. With Telehealth, you have the opportunity to slowly absorb what you have learned, perhaps make a plan for optimizing your week ahead, and at your pace, slowly transition back into the outside environment.

Telehealth can also help people utilize counseling when they otherwise could not access services. This is especially true for people that live in rural areas or overseas, where they may not be able to find a therapist in their area with the expertise they need. People who have limited mobility due to health problems, age, or chronic illness can also find Telehealth helpful. Busy professionals and parents who may not have access to childcare can find Teletherapy an ideal choice. The goal is to access help with more convenience.

Does Telehealth really work?

When Telehealth was very new, there was some initial concern that it might not work as well as traditional therapy. However, research has found that remote therapy can be just as helpful as in-person treatment, with equivalent patient satisfaction scores. The benefits of convenience and accessibility make Telehealth the ideal solution in our increasingly busy and technology-driven world.

To find out if Teletherapy could be the right fit for you, speak with a therapist who specializes in Telehealth services and start shifting from surviving to thriving today!


How To Prevent Seasonal Depression This Winter

seasonal depression, seasonal affective disorder, SAD

 

Many people find it hard to get going on a gloomy day. The covers feel extra cozy and that cup of hot coffee or tea, extra warm and inviting. The urge to stay in your pajamas and curl up indoors beckons you.

You may notice the weather can influence your mood. You might feel more tired or even down and blue. It might be hard to motivate yourself to get much done. Feeling subdued is nothing to concern yourself with if it happens for a day or two. Relax and put your feet up (as much as your schedule allows) and give yourself permission to chill out and indulge. The key is to soak up the laziness and enjoy, without shirking your responsibilities or feeling pulled farther and farther into hibernation.

This may be easier said than done. For some, seasonal depression is an experience that lasts all winter long.

What is Seasonal Depression?

Seasonal Depression is sometimes called “the winter blues” and psychologists give it the more formal title of Seasonal Affective Disorder (SAD). It is a set of depressive symptoms that occur with a seasonal pattern, typically emerging in the Fall, when the weather gets colder, and remitting in the Spring, with the more frequent sunshine. Occasionally, people experience the opposite, with symptoms during Spring and Summer.

Typical symptoms include having low energy, feeling tired, sad and sluggish, losing interest in activities, difficulty concentrating, and sleep/appetite changes. Additionally, with seasonal depression, you may experience irritability, agitation, anxiety, hypersensitivity, and conflict in getting along with others. Frequently, symptoms start out mild and can become more severe.

What causes Seasonal Depression?

A major cause of seasonally-based depression is biology. Your biological clock (or circadian rhythm) may be partly to blame.  Changing patterns of sunlight and less daylight affect your biological clock. Reduced sunlight can also cause decreases in serotonin, a neurotransmitter (chemical in the brain) which affects and regulates mood. Finally, the body’s balance of melatonin may be disrupted, which also affects mood and sleep.

Another cause of seasonal depression is vulnerability factors. In Dialectical Behavior Therapy (DBT), vulnerability factors are described as circumstances that make you more vulnerable to experiencing intense, unpleasant emotions. These factors may include environmental stress, a diet that isn’t supporting your needs, sleep irregularities (lack of or too much sleep), lack of exercise (or too much or the wrong kind for you), and physical illness. During Winter, as the weather and winter colds and flu make you feel tired, worn down, and depressed, you may become even more vulnerable, less equipped to handle stressors and feel greater amounts of unpleasant emotions more frequently.  When vulnerability factors are high, intense emotions can follow, making you even more vulnerable.

How to prevent Seasonal Depression?

A gold-standard and evidence-based treatment (research shows it works) for any cause of depression is called Behavioral Activation. In short, this means that as soon as you suspect depression may be on its way (or has arrived), you make a plan to get active. In DBT, this is called Opposite Action.

Specifically, identify all of the depressive behaviors you might want to engage in (e.g., call in sick to work, stay in all weekend without socializing, watch more television). Then, identify their opposites (e.g., show up early to work, make plans ahead of time with friends and keep them, have your shoes and jacket by the door ready to go for a walk after work). Next, get busy doing the opposite behaviors that you feel like doing when you are depressed.

The key is to be clear and specific about what Opposite Action you are going to take (make plans with Joe to see a movie on Sunday afternoon, not vaguely: make plans this weekend), and then throw yourself in all-the-way. Don’t expect it to be easy. Combating depression is exactly that, combat. And, do not be discouraged. It is a battle you can win with persistence and encouragement.

When engaging in Opposite Action, do not suppress how you are feeling or your desire to stay home and put your head under the covers. Instead, allow yourself to feel how you feel AND, at the same time, throw yourself all-the-way into the Opposite Action you have identified and let the skill do the work. (Do not wait until you feel like doing Opposite Action. That day may never come, and it allows Depression to take even more of a hold.) Then, do it again and again until you have gone through your list of Opposite Action tasks and Depression has been sent on his not-so-merry way. If you find it hard to get started, pick one very small step you can take, and take it! Last (and definitely not least), remember to reinforce yourself for taking each step. Reinforcement is a powerful change agent. The more you use it immediately after engaging in desired behaviors, the easier those behaviors will become.

Another way to prevent seasonal depression is by managing your vulnerability factors. Identify what is making you more vulnerable to intense, unpleasant emotions. Although this step may seem obvious, we often do not realize the number of stressors present until we say it out loud to someone else or give it some intentional thought. Once you’ve identified your vulnerability factors (e.g., not sleeping well, feeling under the weather, nutrition has been off the past week), you can brainstorm some ways to attend to them and give yourself really good cold-weather care. For example, if you know that you need extra sleep during the winter and without it, you become quite irritable, see if you can brainstorm some ways to get even just a little bit more sleep each night. Your body and emotions will thank you.

Other treatments for seasonally-based depression address the physical causes. To help combat decreases in natural light, you might use Light Therapy. This works with specially designed light therapy boxes, and research shows it can help. Some people also elect to try vitamins and supplements (in consultation with their health provider) as an alternative to psychotropic medications, such as anti-depressants.

If you have noticed that your mood shifts as the season changes, you may find it helpful to seek out therapeutic support in learning to manage it. Therapists can teach you how to send depression into remission, and then prevent or drastically reduce the likelihood of a relapse. Dialectical Behavior Therapy (DBT) is one helpful approach. DBT offers techniques to help you identify your unique vulnerability factors, engage in self-care to reduce and manage them, and notice earlier when they may be affecting you so that you can take steps to mitigate depression. If you think DBT may help you, contact a qualified therapist and start shifting from surviving to thriving today!

 


Where Does Anxiety Come From?

We’ve all experienced stress, worry, and anxiety from time to time. For some of us, or at certain times in life, it occurs frequently and can feel overwhelming. At its worst, anxiousness can even impair daily functioning. A lot of factors work together to cause the experience that we call anxiety. Let’s take a look at some specific ways that it develops:

From Chronic Stress Conditions 

Most of us equate stress with anxiousness, and oftentimes, these two do go together. However, when we talk about anxiety as opposed to a passing stressor (a stressful life event that comes and goes rather quickly), there is a lot more to it than just feeling stressed. Some people grow up or live in incredibly stressful environments (e.g., low-income households, experiences of neglect and abuse), and these long-term stressful conditions can make people more vulnerable to anxiety, and in some cases, weaken their ability to handle stress. If your system is already taxed by dealing with chronic, daily stress, your ability to manage more stressors thrown your way will very likely be compromised. A buildup of chronic stressful situations that do not go away quickly can lead to an experience of anxiety.

From Reinforcement

Have you ever heard someone say, “You don’t need to worry,” and you want to answer with, “I do need to worry!”? When we are experiencing anxiety, we often believe it’s helpful, because it gets reinforced. When we feel anxious about something and spend time ruminating and worrying, often everything turns out just fine. We can then believe that anxiety helped achieve the desired outcome. There is an old quote by an unknown author that goes, “Worrying works! 90% of the things I worry about never happen.” We continue to feel anxious and sometimes become almost fearful that if we are not anxious, things will not work out. Most of the time, this isn’t even a process we choose. The cycle gets reinforced, and the brain keeps it going without our intent. Reinforcement is brain food; when a behavior is reinforced, it is likely to occur again.

 

Anxiety, anxious, anxiousness, worry

 

From Avoidance

One function of anxiety is that it helps us to avoid other issues. This can be the most puzzling reason for anxiety. Most of us hate the experience of anxiety, and at first glance, it does not make sense that we would use anxiety to avoid anything. Rather, we want to avoid anxiety! Think of it like this: Anxiety gives our mind something to chew on. We may not like it, and it may not feel pleasant, but it occupies us, nonetheless.

Anxiety tells us that something is wrong and we need to fixate on it, wring our hands, figure it out, look up facts, check out others’ opinions, etc., and it keeps us very busy. Sometimes it keeps us so busy that we can’t focus on much else. If we are having an uncomfortable emotional experience or find ourselves in a painful situation that cannot be solved (e.g. a job we cannot quit, the death of a loved one), sometimes we are so overwhelmed that anxiety jumps in to try to give relief. We may prefer (on some level) the experience of spending our time figuring out an unfixable problem than sitting with the feeling of grief or helplessness.

 From Other Emotions

Another function of anxiety is its ability to hide other, more difficult emotions, because it is a secondary emotion. Anxiousness (or any secondary emotion) happens when the primary emotion is not sufficiently experienced and processed. In other words, your anxiety serves as an avoidance (see above for more explanation on this). When we experience it, we don’t feel the underlying emotion. Our way out of anxiety is to feel this primary emotion. When we resolve a primary emotion, the secondary emotion regulates.

 From Itself

One of the most unpleasant aspects of anxiousness is that once we are aware of it, we can start to feel anxious about our anxiousness. The more we work to avoid it, ignore it, fight it, or self-criticize it, the more space it takes up in our mind. We end up feeling anxious about having anxiety and sometimes anxious about the rare times we do not feel anxiety. We may also experience additional concern about others noticing or criticizing our anxiousness.

If you struggle with anxiety, consider seeking therapy. Therapy can help you safely address and resolve unrelenting anxiousness. A therapist who practices Dialectical Behavior Therapy (DBT) is a good choice. DBT can help you build skills to address any vulnerabilities you have, to identify and cope with primary emotions, and to make more effective choices than avoidance. They can also teach the skill of Radical Acceptance, which is learning how to accept things that cannot be changed, rather than adding to your suffering by fighting it or feeling more anxious. If you could benefit from these skills, contact a qualified therapist and start shifting from surviving to thriving today!


How To Get The Most Out Of Your Therapy Session

If you are seeking a therapy session, it is likely because you want something in your life to change and you would like expert support and guidance through the process. You want a skilled professional to help take out the guesswork and help get you to your goals.

In the past, this has meant that on top of the stress or problem(s) for which you are seeking help, you must find the time, during business hours, to leave your home or office and make it to a weekly therapy session. Packed schedules, work requirements, and congested commutes present valid obstacles to taking over an hour out of your day every week to drive to your therapist’s office. Not to mention the trouble if the expert you’d like help from lives far away from you. In today’s busy world, many people are turning to TeleHealth or TeleTherapy sessions. These video therapy sessions use HIPAA-secure formats that function similar to Skype or Facetime to make therapy more accessible.

Whatever format you select for your therapy session, your success depends largely upon the work you put in, not just on the effort of the therapist. When attending therapy, your active participation in the process will help you to get the most out of your therapy appointments and ultimately, achieve the results you want.

Treat Therapy As A Collaborative Process

We often view therapists as the expert in the room. Therapists do bring a great deal of knowledge about psychology and new ideas for how to help you. However, you are also an expert in the room. You know best about your history, what you have tried in the past, and what is happening in your present.

A therapy session will be most successful if you work collaboratively and come prepared with what you want to work on in each session. Then, work with your therapist to set goals, explore information, make discoveries, and learn how to apply new skills to your life. Ultimately, you decide what to take away from the therapy session.

 

Make therapy work for you, Get the most of therapy, California therapist

 

Apply What You Learn Outside Of Session

As you and your therapist work together, you will understand yourself better and identify new, more effective ways of behaving. It is essential to apply these new skills outside of session. Whenever possible, ask for homework and then do it. If it is too challenging (usually this is the case when you find yourself not doing the homework), ask your therapist for help. It is your therapist’s job to help you generalize the skills that you learn in the therapy office to making real-time changes in your life. This means the therapist must use their expertise to assign homework in a way that not only challenges you but also is likely that you will engage with and complete the practice(s) they’ve suggested.

Remember to communicate with your therapist about any barriers you face putting the new skills into action. Trying a new skill once and never again will not help you get to that point of lasting change. Every new skill takes practice to become a new habit, and you are paying with your time and money to get help. Use it to your advantage!

Talk To Your Therapist About Your Therapy

When people go to therapy, it is often because they want to address some concern or problem in their life. You may be focused on discussing that problem and finding solutions, which makes sense. In addition, therapy works best when you also talk to your therapist about your therapy.

This means you can reflect on what is working and share those thoughts with your therapist. If you like a new skill, let your provider know. If you are unhappy about something, talk to your therapist about it and see how the two of you can navigate this situation. Giving your therapist this feedback allows them to respond by adjusting their interventions to be more appealing to you or more relevant to your treatment goals.

Find Therapy That Fits Your Lifestyle

Nowadays, most people don’t want to travel to get to therapy appointments or lie on a couch in the room with a therapist. And you don’t have to do these things to get results. With TeleHealth therapy, you can benefit from the skilled, focused attention of a therapist when and where you need it. Even within the comfort of your home, you can access professional therapy with TeleTherapy services via video calls. Making therapy easier to access means you are more likely to stay engaged and on track with your goals.

Once you have started therapy, use these tips to get the most out of your sessions, get the results you want, and start shifting from surviving to THRIVING.


6 Most Common Questions About Therapy Answered

Going to therapy for the first time can be daunting when you don’t know what to expect. Sometimes, even if you have been to therapy before and have not received the results you wanted, you may have questions about how to return to therapy and achieve a different outcome. The answers to these frequently asked questions can help you wisely invest your time and money in therapy to achieve the success you want.

  1. Why Should I Go To Therapy?

If you’ve never been to therapy before, you might wonder why you should take the step to get treatment. Every therapy experience is different, so defining your personal goals can help to guide both your motivation to go to therapy, as well as your choice of therapy type and therapist. If you wisely choose a change-oriented therapist, treatment can be fruitful as a growth experience or to help you navigate a stressful life situation or relationship. Many people visit a therapist to discuss a specific issue or diagnosis, but you don’t need to have that all figured out before reaching out to a new therapist. Just knowing that you want help is enough. A skilled therapist can help you define your treatment goals and decide what changes you would like to see in your life for therapy to be deemed successful.

What is DBT, Dialectical Behavior Therapy, online therapy service

  1. How Do I Find A Therapist?

Common ways of finding a therapist are through recommendations from family and friends, online directories, your insurance company, online reviews or often, a web search. Searching the web allows you to define exactly what you are looking for, and get to know prospective therapists through their websites, before deciding who to contact. A benefit of our technological age today is that you can choose TeleHealth, or online therapy sessions, for location independent therapy when and where you need it.

  1. How Do I Choose A Therapist?

Choosing the right therapist involves either identifying a problem you want help with or the type of therapy you want and evaluating whether the therapist is the right match for you. Some therapists have individual specialties or areas of interest that may appeal to you, such as Dialectical Behavior Therapy (DBT) or Cognitive Behavior Therapy (CBT). Ask for a phone consultation with your potential therapist to see if this is someone you feel comfortable opening up to and working with.

  1. How Will I Know If A Therapist Is A Good Match?

You want to find out if your therapist’s goals match your goals. Is this clinician results-oriented so you can focus on moving forward (not just talking about moving forward) and from therapy eventually? Can they identify your main problem areas, as well as an action plan to work on them? Can they develop a treatment plan and treatment goals with you, and help you project how long you will need therapy within the first few sessions? Therapy is a collaborative effort, and it is important to ensure your goals and vision match those of your therapist.

  1. How Do I Monitor The Progress of Therapy?

You probably want to heal, grow and progress through therapy, and it is important to know how to measure that. An experienced, results-oriented therapist will understand how to monitor progress according to the goals you set. Progress monitoring is essential because you want to make sure therapy not just helps you feel better, but also helps you get better. Using psychological measures to track your progress can help you and your therapist know whether treatment is working, how fast it is working, and whether the treatment plan needs to be altered to receive better results more quickly.

  1. I’ve Never Been To Therapy Before, What Do I Need To Know?

While it’s natural to feel nervous before your first therapy session, understand that your therapist is a professional who is trained and experienced in helping you face problem areas in your life, and promote growth, healing, and change. If you have put the time and research into choosing the right therapist, you should feel comfortable and at ease in therapy within the first few sessions. Stay open minded, and if you experience that things are not going as planned or the therapist is not meeting your needs as you had hoped, feel free to discuss this with the clinician, or to try a different therapist.

Therapy can promote profound, impactful change to your life. It is important that you are empowered to get the right help for you. Hopefully, the tips in this article will boost your confidence about starting or revisiting therapy with these frequently asked questions answered. Take a step towards the life you want today, and start shifting from surviving to thriving!


What is DBT and How Can It Help Me?

Seeking help and going to therapy can be stressful. Choosing the right approach can ensure you get the care you need to make the changes you want. In this article, I’m going to give you introduction to Dialectical Behavior Therapy (DBT), a treatment that may be helpful if you want more balance in your emotional life. DBT has become a popular technique used to help individuals cope with the stressful challenges life throws their way, and the intense emotions that can follow. The scientific research for this treatment is strong. Individuals often report huge, impactful, positive life change as a result of DBT. DBT focuses on helping people change their reactions and behaviors to create more resilience in life. Understanding what Dialectical Behavior Therapy is and how it works can help you decide if it is the right approach for you.

What Is Dialectical Behavior Therapy?

Dialectical Behavior Therapy is a form of Cognitive Behavioral Therapy (CBT) that was initially developed for people suffering from chronic suicidal thoughts and behaviors, and those diagnosed with Borderline Personality Disorder. However, implementing DBT revealed that it is helpful for people in a range of situations having difficulties managing emotions, and can help to reduce anxiety and improve coping mechanisms under stressful circumstances. DBT teaches you coping techniques and strategies to deal with difficult emotions without being caught up and swept away in them.

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What Does Dialectical Behavior Therapy Involve?

DBT is best administered by an experienced therapist, with a history of training and supervision in DBT by experts in the field. Full program DBT involves weekly individual therapy in addition to attending a weekly DBT Skills Group. Treatment length varies by person and treatment goals.

DBT includes –

  • Collaboration – working with a skilled therapist can help you identify what you want out of life and obstacles getting in your way. Bringing awareness to both your goals and challenges in a specific, systemized way is a key step toward making the changes you want.
  • Learning skills – one of the most important aspects of DBT is learning specific skills to incorporate into your everyday routine for growth, happiness, and fulfillment.
  • Practice – DBT is a behavioral therapy. This means that new behaviors must be practiced for change to occur. Practice, practice, practice, and then some more practice, is a common mantra in DBT.

The Four Modules Of DBT Skills

The four areas of skills learned in DBT are designed to help you better understand your thoughts and feelings, and change your behaviors to better achieve and support the life that you want. These modules include:

  1. Mindfulness
  2. Distress Tolerance
  3. Interpersonal Effectiveness
  4. Emotional Regulation

Who Can Benefit From DBT?

DBT has been shown to be successful in a number of different areas and for those suffering a range of issues including:

  • Relationship problems
  • Low self-esteem or shame
  • Weight management
  • Eating disorders
  • Anxiety
  • Depression
  • Borderline Personality Disorder

DBT can also be used in many other situations, even where a specific diagnosis may not be defined. Under the guidance of an experienced and well-trained DBT therapist, you can learn life-changing skills to make a profound impact on your well-being.

DBT is an inspiring treatment method that can help change your life for the better. Talking with a DBT therapist can help you determine whether DBT is the right therapy approach for you. Contact me today if you may be interested in finding out more about DBT and shifting your life from surviving to thriving!


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Dr. Amanda Gale-Bando

Dr. Amanda Gale-Bando