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Coping with Chronic Illness – Skills Roundup (Quick Reference Guide)

Chronic illness and pain can take a toll on emotional and mental wellbeing. I have learned that illness is a journey, often with a long and winding path, and not just a speed bump in the road. When we take this bird’s eye view, and accept the enduring nature some illnesses have (often with no clear end in sight), we take back some power. Even if you cannot immediately defeat symptoms that are wearing you down, you absolutely can, no matter the illness, take steps to fight back against the emotional effects of unpredictable, ongoing pain and discomfort.


For an in-depth look at each of the following topics, please read (or listen to) my 3-Part Series on Chronic Illness and Mental Health. This piece will serve as a quick reference guide. You can think of this as your go-to refresher course to help you remember (and apply) needed strategies.


Here, we will review some of the tactics and practices that will help you deal with chronic illness. Hopefully, these ideas will prompt you to explore more of your own solutions, experiment with what works best for you, and above all, stay mindful of how your physical condition is affecting your mental and emotional health. At the bottom of each skill, you will find a “TAKE HOME MESSAGE” to help guide your practice. The skills are in no particular order of importance, so discover what speaks to you and start there.


Let’s dive right in!


1. Self-Compassion


Lacking self-compassion during a period of illness is like kicking yourself when you are down. Yes, compassion is a need that every human shares, and it is especially heightened when we are going through a rough time.

Not having compassion for yourself is like responding to a loved one in pain by coldly telling them to “buck up!” and “stop being such a baby!” As you can imagine, they may feel worse, cry harder, develop feelings of shame and judgment, and have a more difficult time getting through their distress. The same happens when this harshness is turned inward.


For this reason, developing a sense of compassion for yourself is on the top of this coping list. If you are constantly beating yourself up for not feeling well, even in subtle ways, the vicious cycle will wear down your emotional stability until you feel worse – regardless of your physical symptoms!

Self-criticism is a damaging habit, and when you are not feeling your best, have to cancel plans, move slowly, take more breaks than others around you, it is all too easy to start calling yourself names, label yourself a failure, and so on… Would you ever say these things to someone else?

Would you label a loved one as a loser or call your best friend stupid because their body wasn’t functioning how they wanted? Of course not! Yet, we all too readily use these names in conversations with ourselves.

An antidote to this detrimental self-criticism is two-fold:

  1. Pay close attention to your self talk. (Click here for an exercise in heightening your awareness of the impact this language has on you.).
  2. Start a DAILY self-compassion practice. This means showing up and engaging in the practice, whether or not you feel like it. Here are some resources for practicing:


TAKE HOME MESSAGE Self-compassion is a skill that must be practiced regularly. Use some of the suggestions above or design your own method for practicing and commit. Hint: keep it simple. Sometimes, a nice gentle touch accompanied by three deep breaths is all you need to teach yourself to respond in a sweet, loving way. By keeping your practice brief, you will be more likely to follow through. The key to this practice is consistency (not duration).


2. Clear, Unapologetic Communication


People tend to hide what they perceive as “weakness.” In an effort to appease others, they will often push themselves too hard, make excuses for why they can’t participate in a given activity, or close themselves off from others – instead of communicating clearly about what is actually going on.

All of this secrecy and defensiveness can take a toll on emotional wellbeing, and worse, prevent the people who care about you from being able to help (or even understand what you might be dealing with).

To keep these problems at bay, try practicing open, unapologetic communication, especially with the people closest to you. You can be honest about not feeling well, not having energy, about foods you cannot eat or places you don’t want to go.

If you are transparent and firm about what you need, you will achieve two important objectives.

First, you will let others in, and allow them to have a better understanding of how your illness affects your daily life.

Second, and perhaps more important, you will teach yourself how to ask for what you need and articulate your limits without concession.


If you notice that judgments about yourself or others are getting in the way of communicating clearly:

  1. Review this passage I wrote about Nonjudgment.
  2. Listen to my guided practice in Nonjudgment.


Practicing Nonjudgment can help clear the cobwebs and pave a clear path to knowing – and being able to describe – your experience and needs.


TAKE HOME MESSAGE – Step 1: practice dropping the judgments and describing, in a matter-of-fact way, what is going on with you or what you need. Practice writing this out or saying it to yourself. Step 2: communicate! Extend this clear communication to loved ones. Remember, you are brave! Even if you feel embarrassed or uncomfortable, remind yourself how important this skill of direct, clear, and unapologetic communication is to your health – and go for it. You can do this!


3. Face Your Illness


I CANNOT EMPHASIZE THIS SKILL ENOUGH. A stage most people with a chronic illness pass through is complete and utter denial. This can manifest in forgetting that you have a diagnosis, minimizing the impact your symptoms have on your life (e.g., continue to expect yourself to work just as hard and participate in all of the activities you did pre-illness), and making plans for an arbitrary date when you will feel better (with no evidence that the illness will be cured by this date).


No one wants to be sick, and often, your first instinct is to fight it. This can look like completely refuting the reality of the illness:

  • “I’m not that sick,” I’ve heard someone with Fibromyalgia who was hunched over in pain at work say.
  • “Next year, when I feel so much better, we are planning a trip overseas,” a patient with Multiple Sclerosis and no indication of symptom improvement in the near future stated.
  • “I think I’ll return to work next week,” was matter-of-factly uttered by a migraine sufferer who was unable to keep his eyes open most hours of the day.


While this is a completely normal and understandable reaction to an illness, not facing the full reality of how sick you are (and the impact it has on your life) may cause you to:

  • Push yourself past your limits, causing even more pain and flare-ups
  • Create unrealistic expectations that set you up to feel disappointed when they don’t happen
  • Help you avoid dealing with your new reality and the limits that must be set to support your long-term health and wellbeing


Often times, seeking help in the form of therapy can be a necessary part of coping with chronic illness. If you are having trouble accepting that you are sick, and this lack of acceptance is causing problems, please consider reaching out for professional help. Chronic illness is overwhelming to cope with, and hiring a competent therapist to help support and coach you can be time and money very well spent.


TAKE HOME MESSAGE: You cannot adequately cope with what you do not face. If you are sick, you must accept this reality (and all of its consequences) so that you may effectively plan for your future. If you notice yourself continuing to deny the illness and its effects, reach out for professional help. Ask a friend or family member to help you find a therapist who specializes in treating people with chronic illness.



4. Prioritize Self-Care and Feel All The Feels


Self-care takes center stage when you are coping with an illness. That may mean extra sleep, planned downtime, certain foods… And it may very well mean saying “no” to things you want to do if saying “yes” may produce a pain flare-up or otherwise compromise your overall wellbeing.


Remember, coping is not the same as “powering through.” Denying that you need to take extra care of yourself will likely prolong recovery, make symptoms worse, or take a toll on your emotional wellbeing, leaving you depleted.

The tough part of self-care can be admitting that you need to modify your expectations for yourself and your lifestyle. (See #3: Face Your Illness – for help.) Part of chronic illness involves emotional pain. Facing the truth of your current limitations can feel devastating, so you may want to fight against them and push yourself harder than is helpful. Feeling devastation, despair, grief, and guilt are all part of living with an illness. Read more about grief, illness, and metabolizing your emotions here, and take part in the Welcoming Emotions Practice to help you through.


TAKE HOME MESSAGE: Prioritize your needs, not what you think you “should” need or wish you needed, but your actual needs, given everything as it is right now. If you find yourself resisting, it may be time to “feel all the feels” and process those emotions getting in the way. If you need some encouragement, check out some of my guided practices to help process your emotions, and read my post on the most useful poem on emotions ever written to help change your perspective on those pesky and painful feelings.



5. Validate, Validate, Validate!


Usually, a chronic illness begins with confusion. You and others (doctors, loved ones) try to figure out what is going on, and often, there is a long process before arriving at an accurate diagnosis – let alone treatment.

This road is frequently paved with invalidation. Medical professionals not knowing how to help, family members not understanding what’s wrong, friends and loved ones offering well-meaning, simple solutions to your complicated problems, and even your own uncertainty and sense of betrayal by your body. All this may leave you feeling invalidated, criticized, and misunderstood.


Validation = making sense of.


Validation is a basic human need. Do not underestimate its value!

“Validation” sounds like a simple term, yet we all need to know that at our core, we make sense. There is nothing inherently different and bad about us, there is a cause-and-effect to our experiences, and ultimately, we make sense. For the reasons above, this sense of self-validation can be hard to find amid an illness. This is why deliberately practicing this skill is essential.


Even if you aren’t sure what’s causing your symptoms, or how to describe how you are feeling from moment-to-moment, you still need to be validated. Use this practice to help you master the art of validation. To learn more about validation and chronic illness, read the full articles here.


TAKE HOME MESSAGE: You cannot overestimate the value of validation. Listen to my guided instructions [12] and start validating how emotions make sense. You can practice this on yourself and others. The critical point is that you PRACTICE!


6. Make Meaning


The point of all of these skills is for you to have a life that you know is worth living, even when in the depths of your illness.


I hope that by practicing all of the skills above, you get to a point where you ask yourself, “What now?”


That is, given everything in your life as it is at this moment, what will you make of it? What are your options? How can you, given the cards you have been dealt, design a life that is fulfilling and meaningful, where the world is better off for you having been here, and you feel your worth?


TAKE HOME MESSAGE: After practicing the skills above, including letting yourself feel the depths of despair and anger for the unfairness of your circumstances, you will get to a point where you are ready to ask yourself some questions about the meaning of your life. Get curious, get inquisitive, ask and answer. No matter what is happening, you have a place and a purpose here. What will you do with it?


If you are wondering where to start and what to do now, go back and pick one of the five steps that calls out to you – or feels important to develop. Follow the “Take Home Message” and start gently practicing this skill. For a more in-depth look at chronic illness and mental health, please read my 3-part series here.

My wish for you is that you not only know your worth, you experience it regardless of illness or any other obstacle sent your way. There is only one you on this planet, and you have a unique contribution. Be well in body, mind, and spirit.

Chronic Illness and Mental Health Part 3: Diagnostic Problems/Invalidation



Autoimmune and other disorders that may present with vague or a diffuse cluster of symptoms, or are difficult to diagnose, seem to be at an all-time high. The American Autoimmune Related Diseases Association estimates that approximately 50 million Americans live with an Autoimmune disorder. On the other hand, the National Institutes of Health, also a reliable source of information, claims that only 23.5 million Americans suffer from an autoimmune disorder. The NIH recognizes less than half of what is reported by the AARDA. Why the discrepancy? NIH funded studies include only 24 diseases/disorders, while recent studies by the AARDA now include upwards of 80 to 100 diseases/disorders. Research is ever-evolving and it is hard to keep up!

You can see why chronic illness may be a confusing subject for so many people when two reputable organizations who lead our understanding of what diseases exist, supply different numbers based on what they consider to be different facts. Currently, conventional Western medicine does not seem to know how to detect or diagnose many of these diseases accurately.

You may have personally been to doctor after doctor, hoping to figure out what is wrong and receive a treatment recommendation. When you are not able to be properly diagnosed or treated, it becomes an invalidating experience. You know that your body is physically off, but a doctor looks at your blood tests only to tell you, “Everything looks fine,” or is puzzled by inconclusive or confusing results. Perhaps your health care professional is able to make a diagnosis but then unsure what treatment to provide. Maybe the doctor recommends a medication to hopefully relieve some symptoms, but this often means coping with side-effects, and you both know this is not solving the problem.

When you do not understand why the problem is happening in the first place, the entire process of trying to get back to your normal, healthy functioning is frustrating. People have a range of experiences with attempting to receive a diagnosis, including being told they are exaggerating their symptoms, given a proverbial pat on the head and told to deal with it, being prescribed medications whose side effects make it difficult to impossible to function, or well-meaning doctors shrugging and looking puzzled because they do not know how to help.


Adding this lack of understanding to the stress and exhaustion of having an undiagnosed and/or chronic disease can feel invalidating. This adds additional stress and worry, maybe even worsening how sick you are feeling.

Well-intentioned family and loved ones may also contribute to this feeling of being misunderstood. Have you ever had a cold or flu, or some minor ailment and posted about it on social media? If so, you have probably gotten treatment recommendations from people with whom you didn’t even know you were friends. “Soak your feet in honey,” “Use essential oils – they cure cancer,” “Stop eating red cabbage,” and other off-beat suggestions are almost guaranteed. Often, someone will swear that their best friend’s aunt’s ex-next-door-neighbor, or someone equally as elusive, swears by the cure they are presenting to you.

People typically don’t mean any harm. They want to be helpful and for there to be an easy cure for what ails you. Even so, this can leave you feeling worse than before you reached out for solidarity. What happens is that this advice-giving oversimplifies the chronic problems you are faced with and can make you feel unseen and misunderstood. The suggestions imply that if you just took this one simple action, you would be fine once again.

These feelings of frustration, loneliness, and misunderstanding can also happen in conversations with loved ones. People in your life may not understand your particular limitations or be sensitive to them. Often, when people are in pain, for example, their cognitive abilities and emotional control centers are compromised. Try solving a complicated math problem in the midst of a splitting headache. Even if you can accomplish this task, it is much harder to do than when you feel well and takes putting forth a lot more energy, leaving you feeling depleted afterward.

People in pain or coping with other chronic symptoms may not know or be able to communicate all the ways they are affected. It can take a while to learn that you have brain fog, that your memory is not what it used to be, or that regular physical activities now cause pain and you are unable to finish. Loved ones may be frustrated that you are not trying hard enough when in reality, you can’t think as fast or recall facts you used to be able to, and you also cannot communicate that this problem exists.

If you are struggling with invalidation as the result of the diagnosis or treatment of a chronic illness, or loved ones’ reactions to your experiences, read on for coping strategies.


A first and essential step to coping with the unpredictability, chronicity, and difficulty with diagnosis and treatment, is validation! Everyone needs to be validated on a regular basis. Validation does not mean that you need to be complimented or pacified; rather, validation means feeling like you matter and knowing that you make sense. This is a basic human need.

If you are living with chronic illness, you may feel invalidated by the medical community, family, friends, or even yourself. When doctors throw up their hands and don’t know how to help sufficiently, or friends and family have trouble understanding what you are feeling and need, it is easy to feel demoralized and start questioning yourself: Am I exaggerating this? Is it really that bad? Is there something wrong with me that I can’t cope as well as others?

You may have read in my previous installments, or even personally experienced, how the unpredictability and chronicity of a disease increases the difficulty of being able to cope. When you add chronic invalidation, go through each day feeling misunderstood, and then even perhaps blame yourself, this adds to the stress your body is feeling, making you feel worse, emotionally and physically.


If you see yourself in this description, it may be time to learn and practice the art of self-validation. Self-validation means learning the skill of saying to yourself, “I make sense. What I am experiencing matters, and I make sense.” This can be difficult when you are not sure what you are feeling, what the reason is you’re feeling this way, or know why you are experiencing what you are. Here is a short practice you can use to help yourself learn self-validation:

Notice what you are feeling in this moment and see if you can label it. Describe what you are feeling in words. Are you noticing physical sensations such as pain, temperature (cold or hot), movement, or comfort? Are you noticing any emotional sensations like tightness in your chest, a relaxed belly, or butterflies in your gut? The point is to take a moment to notice what you are feeling in your body in this moment, without judging it as right or wrong, good or bad. Just notice and describe it as best you can to yourself.

Now, whatever you are feeling, say to yourself, “It makes sense that I am feeling _________.” If you know the reason it makes sense (such as it makes sense that you are tired because you didn’t sleep well last night, or maybe have not for many nights), then tell yourself that. If you do not know why you are feeling how you are feeling, you can still say to yourself, “I make sense. Even if I do not understand why I am feeling this way right now, human experiences, emotions, physical sensations, and behaviors all make sense whether I understand them in the moment or not.”

When engaging in this practice, you are grounding yourself in the fact that your experience is real, and it all makes sense whether you know where it comes from or not. See how you feel after practicing this daily for a week. Most people start to notice some relief or burden removed. The illness and symptoms may remain but removing the weight of questioning yourself and your validity leaves you better equipped to cope with your illness. Learning self-validation is one of the most important pieces when it comes to coping with a chronic illness.

Chronic Illness and Mental Health Part 2: Chronicity

Chronic Illness and Mental Health Part 2: Chronicity

Listen to this article on YouTube or Soundcloud. According to the U.S. Department of Health and Human Services, nearly 45% of Americans live with a chronic illness. That means almost half of us are living with daily symptoms and do not experience complete wellness! Given this number, chances are that you or someone you love suffers from the grips of a prolonged illness.

Whether the symptoms are severe or just plain annoying, chronic illness can take a heavy toll on a person’s mental health, be physically draining, and affect day-to-day life. Know this: There is help for those living with chronic illness and improving quality of life is within reach.

In part 1 of my Chronic Illness and Mental Health series, I discussed the Unpredictability (link) of Chronic Illness and ways to cope. In this installment, my focus will be on Chronicity and how to face the truth in the service of self-care.


The chronic nature of certain illnesses makes coping challenging. Everyone has gone through having a cold or flu, and it is miserable! One consoling thought is that you know it will pass, and you will feel better again; you do not always have that comfort with a chronic illness. In addition to the unpredictability of symptoms, you may not know when or if you will fully recover. Days turn into weeks, weeks into months, and sometimes those months can turn into years of feeling ill, and it can take its toll. Sometimes you think you are getting better, only to find yourself struggling with symptoms once again.


Most of us can cope with short-term emotional and physical pain; we have been through break-ups, death and loss, the stress of losing a job or starting a new one, the pain of childbirth or even a stubbed toe. No, I am not comparing childbirth to a stubbed toe! The point is that we have all survived time-limited emotional and physical pain. When pain is short-lived, we are equipped to cope. The same is true for emotional health. If you see a spider and experience fear or feel nervous anxiety anticipating giving a speech at work, you typically feel the emotion flow through you and then feel relief and move on. An anxiety disorder develops when the feelings and behaviors associated with fear (escape, avoidance) are chronic and do not disappear when the stressful event is over.

With chronic illness, such as autoimmune disorders, diabetes, SIBO, painful arthritis, and others, the stressful event does not immediately disappear; your body is under prolonged stress, and your emotions follow. You cannot take a break from illness like taking a vacation from a stressful job. The illness lingers, like a guest overstaying their welcome, until you want to scream at the top of your lungs, “Get out!”


When you are sick and suffer from a disorder everything else you learn about coping depends on your ability to face the fact that you are sick. Often, in my work with others, I hear people report about various long-term symptoms or diagnoses and then sort of brush it off and act like they do not exist. I can certainly understand why. These illnesses are not welcomed. Who wants to be sick? Who wants a diagnosis predicting long-term illness or recovery? Still, I work with my clients to face the fact that their symptoms are a reality because when we can be honest about this, we can then take the steps needed to cope and maybe even heal. 


Prioritizing self-care may seem obvious. Nevertheless, it is often overlooked.

What do you need when you are sick? I need lots of extra sleep, quiet downtime and restful activities, food prepared and ready-to-go, and a clear calendar with as few obligations as possible. Yet, people often try to power through when sick, adhering to the same schedule and ignoring that their needs are now different. When dealing with a chronic illness, coping is not as simple as “powering through” until you feel better. In fact, often, this approach can work to your disadvantage.

As mentioned, if you have a cold or flu, you know it will pass. However, when a chronic illness takes hold, it can be necessary to accept long-term limitations and changes in your functioning. This is why facing the reality of your illness symptoms is such an essential prerequisite for self-care. To prioritize self-care, you must first be honest with yourself about what your new limitations are and what you need. This means putting aside what you think you “should” be capable of, what others seem to be able to do, and how you wish you were or how you used to be. This means standing naked, and full-frontal accepting and addressing what you need given your life at this moment. And then, of course, being brave enough to give that to yourself.

Self-care when chronically ill may not feel like pampering. In fact, it can mean saying “no” to activities you enjoy, asking for help or modifications, or telling others that you do not feel well and cannot participate as you once did. Facing these truths can feel devastating. Feeling despair is often part of this process. Notice the specification that despair is part of this process, not all. When you face the ways that chronic illness has changed your life, you need to grieve what you have lost. Just as with losing someone or something you love, if you can allow yourself to grieve, you will move through it and be able to move forward. If you are in this stage and feeling emotionally overwhelmed, try listening to my Welcome Emotions Practice to help you move through this stage of loss.

Remember that grief is not forever and does not mean that you are accepting your illness, as it stands today, indefinitely. Rather, you are mourning the changes in your body that you do not want so that you can clear your path and move forward in the wisest, most empowering way. Frequently, when we accept our situation and allow ourselves to grieve, this paves the way to change. You may find a helpful treatment provider you hadn’t previously considered, adopt a new perspective you did not realize was available, or other doors may open to you that you had not noticed were there. Through allowing yourself to face the reality and trusting this process, you can find meaning, fulfillment, and joy in your life.


I know facing your illness and prioritizing the reality of self-care needed now can be difficult, so please be gentle with yourself. Chronic illness is a process. For most, it is a long and winding road. Your needs may change periodically, and your symptoms may fluctuate without notice. As a result, how to best care for yourself can take frequent re-evaluation. Practicing gentle, self-compassion may be the kindest thing you can do. Even gently placing a hand on your heart or using soft, gentle tones with yourself can help ease the difficulty. (Listen to the meditation at the end of this article for a quick and simple practice you can use anywhere.) The tasks you are faced with require fierce bravery. Envelop these courageous steps forward in gentle, loving care, and you will see yourself progress faster and with greater ease.


(Adapted from Kristin Neff, Ph.D. and Chris Germer, Ph.D., Mindful Self-Compassion Core Skills Training manual)

Listen to this practice on Youtube or Soundcloud.

An easy way to support ourselves when we are going through a difficult time is to offer self-comforting or a soothing touch.

Start by taking 2-3 nourishing breaths.

Gently place a hand over your heart, simply feeling the gentle pressure and warmth of your hand. If you wish, place both hands over your heart.

Feel the natural rising and falling of your chest as you breathe in and as you breathe out.

Linger with this feeling for as long as you like…

Some people find putting a hand over the heart comforting and this type of touch doesn’t resonate with others. Feel free to explore where on your body a gentle touch is soothing. Let’s try some other possibilities:

Cup you hand over a fist over your heart. Take 2-3 breaths and notice how this feels.

Place one hand over your heart and one on your belly. Again, breath and notice.

Now, place two hands on your belly. With each new position, continuing to breathe and notice how this feels.

Place one hand on your cheek.

Cradle your face in your hands.

Gently stroke your arms.

Cross you arms and give yourself a gentle squeeze.

Gently stroke your chest, back and forth or in small circles. See what feels best.

Allow one hand to tenderly hold the other hand.

Gently cup your hands in your lap.

Take a moment now to notice if there was any one position you liked best, or a gentle touch I didn’t mention that you would like to try. Take the opportunity now to place your hands where they feel most gentle, soothing, and compassionate. Allow your breath to nourish your body as you feel your hands comforting and soothing you.

You can practice this any time you are under stress or use this daily as a reminder to treat yourself with care.

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.


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.




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. Also, listen to my guided meditation on feeling supported and connected at the end of this article.


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!

Dr. Amanda Gale-Bando

Dr. Amanda Gale-Bando