America’s Mental Health Crisis

There are three different crises overlapping the mental health field: the youth mental health crisis as explained by the surgeon general, the crisis surrounding serious mental illnesses that’s contributing to homelessness and incarceration, and the substance use disorder crisis that continues to be fueled by prescription opiates and new, lethal drugs. 90% of Americans believe there is a mental health crisis and much of it is driven by the shortage of mental health care professionals. It is estimated that for every one mental health provider there are 350 individuals needing services. 1 in 3 people live in an area experiencing a shortage of mental health professionals with low-income areas and communities of color being the most impacted. 

Prior to a decade ago, youth have reported the lowest rates of suicide mortality and as of today those between the ages of 10-24 account for 15% of all suicides. This is a 52.2% increase from 2000 and suicide has become the second-leading cause of death for people between the ages of 10-24. Youth who identify as LGBTQ+ are five times more likely to attempt suicide and non-Hispanic American Indian’s or Alaskan Native youth have a suicide rate three times larger than the general population. The serious mental illness (SMI) crisis is due to a crisis of proper care. Less than half of those living with a SMI are receiving care which includes medication, psychological treatments, and rehabilitative care. 

Many people living with a SMI receive treatment in jails or prisons because there is a lack of adequate public hospital beds open for them. Many become homeless with only a few acquiring rehabilitative services. Those living with a SMI have a life expectancy 20-25 years shorter than the general population. Furthermore, 70% reported wanting to work, but less than 20% are employed. Individuals living with a SMI are 10 times more likely to be incarcerated than hospitalized and 16 times more likely to be killed by the police when compared to the general population. 

The substance use disorder crisis in America is not a new problem, rather it has become larger because of its new lethality. The CDC reported 105,452 drug overdose deaths for 2022 alone which is five times greater than 2002 and double the number from 2015. The highest reported death rates are for males between the ages of 35-44. To understand the severity of this, there were about 127,070 deaths from lung and bronchial cancers in 2022 for people 50 or older. The majority of those living with a substance use disorder in the United States are not receiving treatment as evidenced by 15.35% of adults having a substance use disorder in 2023 and 93.5% of them not receiving any treatment. For our youth, 6.34% reported a substance use disorder in 2023 which is around 1.5 million people.

One of the main solutions to the mental health crisis in America is engagement. Currently, there is a lack of capacity for care and utilizing engagement means intervening early, meeting people where they are, and building trust by offering something of value at the first meeting. This is not currently happening because the United States healthcare system is built for payers and providers requiring a diagnosis for reimbursement without prioritizing effective and efficient care. The second solution, quality, is evident. Training providers in skill-based psychotherapy, including primary care physicians prescribing antidepressants and anti-anxiety prescriptions, is vital to improving quality and is proven to benefit population health. Lastly, recovery involves access to medical care and focusing on recovery as opposed to focusing on reducing symptoms. Recovery requires people, place, and purpose where a care system is in place to provide social support, a safe environment, and a reason to recover. 

Source: PEW Trusts, Mental Health America, & Kaiser Permanente

Major Depressive Disorder

Clinical depression, also known as major depressive disorder (MDD), is a mood disorder resulting in persistent feelings of sadness and loss of interest. It impacts how you think, feel, behave and can also cause emotional and physical problems. Those living with MDD might experience difficulties doing day-to-day activities and feel as if life is not worth living. Depression is more than just “feeling blue,” or “down in the dumps,” it is a mental health condition that impacts a person’s overall well-being. 

Depression might occur one time over the course of someone’s entire life and people usually have more than one episode. During depressive episodes, symptoms that may be present most of the day or almost every day include feeling sadness, emptiness or hopelessness, irritability or angry outbursts, loss of interest or pleasure in most or all previously enjoyable activities, and sleep disturbances. Additional symptoms include lack of energy, anxiety, slowed thinking, speaking or body movement, feelings of worthlessness or guilt, self-blame over past events, difficulty concentrating or making decisions, suicidal thoughts, suicide attempts, suicide, and unexplained physical problems. 

Some people living with depression may feel unhappy without a definite reason as to why. Regardless, symptoms can be severe enough that it impacts work, school, social life, and relationships. Depression can present differently in each age group. For younger children, depression often presents as irritability, sadness, clinginess, refusing to go to school, or being underweight. Younger children experiencing depression may also report worrying or aches and pains. In teenagers, depression typically presents as irritability, sadness, negative feelings and worthlessness, anger, poor academic performance or attendance at school, self-harm, using recreational drugs or alcohol, and social isolation. 

For older adults, depression may be less obvious or different because the symptoms for this age group include memory difficulties or personality changes, physical aches or pain, fatigue, loss of appetite, sleep disturbances, loss of interest in sex not caused by a medical condition or medication, a persistent desire to stay home, and suicidal thoughts or feelings. 

If you are experiencing depression and believe you may harm yourself or attempt suicide, it is recommended by Mayo Clinic that you call 911 or contact the Suicide Hotline by calling or texting 988 which is available 24/7. Services provided by the Suicide Hotline, 988, are free and confidential. For U.S. veterans or service members who call 988 there is an option to press “1” for the Veterans Crisis Line. You can also text 838255 instead or chat online. The Suicide and Crisis Lifeline has a Spanish language phone line at 1-888-628-9454. 

There are numerous treatment modalities that aid in the treatment or management of MDD. Medications such as SSRIs, SNRIs, and TCAs may be combined with psychotherapy approaches such as cognitive-behavioral therapy or interpersonal therapy. Behavioral activation works to increase internal motivation in those living with depression while also identifying their depressive cycle and a person’s long-term goals as they relate to personal beliefs and values. Electroconvulsive therapy, or ECT, may be recommended for those experiencing severe psychosis, catatonia, severe depression during pregnancy, acute suicidal thoughts or attempts, or are refusing to eat or drink. Transcranial magnetic stimulation (TMS), is a treatment option for clients who have not reported any benefits of at least one medication trial. Vagus nerve stimulation (VNS) and Esketamine are additional treatment methods that may be recommended if an individual feels that they are not benefiting from medication. 

Source: Mayo Clinic, National Library of Medicine

World Autism Awareness Day

Today, April 2, 2024, is dedicated to promoting the realization of human rights for all and fundamental freedoms for people diagnosed with Autism Spectrum Disorder. Autism Spectrum Disorder, or ASD, is a neurological and developmental disorder that impacts how a person interacts and communicates with others, learns, and behaves. A person can be diagnosed at any age, however symptoms typically appear during the first two years of life. ASD is referred to as a “spectrum” due to a variation of symptoms people may experience. 

ASD is not limited to one gender, race, ethnicity, or socioeconomic status. Treatment and services for ASD aid in improving a person’s symptoms and daily functioning to enhance their overall wellbeing. It is recommended by the American Academy of Pediatrics that all children should be screened for autism. Symptoms of ASD include but are not limited to making little to no eye contact, infrequently sharing interest, emotion, or enjoyment of objects or activities, slow or no response to your name being called, difficulties during conversations, and difficulties seeing from another person’s point of view. Restrictive and repetitive behaviors that are symptoms of autism include echolalia, or repetition of words or phrases, intense interest in specific topics, being upset when slight changes in routine occur, and being more or less sensitive to sensory input.

ASD is a lifelong diagnosis and as mentioned above treatment and services are used to increase a person’s overall well being. Treatment options for ASD include medication to help with irritability, aggression, repetitive behaviors, hyperactivity, attention problems, anxiety, and depression. Additionally, there are behavioral, psychological, educational, and skill-building interventions that are highly structured that may include participation from caregivers, siblings, or other family members. Through these interventions, people with ASD are taught social, communication, and language skills, how to reduce behaviors inhibiting daily functioning, increase strengths, and learn life skills for independent living.

Source: United Nations, National Institute of Mental Health

Polyvagal Therapy

Polyvagal therapy is a form of therapy used to help clients have a deeper understanding and management over their body’s response to stress and trauma. Polyvagal therapy, PVT, has its name due to the focus on our vagus nerve which plays a role in regulating our emotions, behaviors, and stress response. By teaching clients self-regulation techniques and creating new neural pathways, clients develop a sense of safety and resiliency. There is a long list of conditions PVT can help treat with just a few being trauma, PTSD, anxiety, depression, chronic stress, panic disorders, sleep disorders, attention and focus issues, and digestive issues. 

There are three neural pathways that PVT is centered around and they are the ventral vagal complex, sympathetic nervous system, and dorsal vagal complex. The ventral vagal complex is in control when we feel safe and social, feel a sense of calm, and are able to connect with others. PVT’s aim is to increase activation of the ventral vagal complex so client’s can better handle social situations, build relationships, and feel safe. Characteristics associated with the ventral vagal complex include empathy, playfulness, creativity, and improved immune function.

The sympathetic nervous system is what activates the fight or flight response during moments of actual or perceived danger. This nervous system mobilizes the body and through PVT the aim is for this nervous system to become regulated in response to unnecessary activation of fight or flight. The sympathetic nervous system is responsible for hyper-vigilance, increased pulse rate, muscle tension, sweating, slowing digestion, and dilated pupils. The last neural pathway, dorsal vagal complex, is when a person freezes or shuts down because they are overwhelmed by a situation. If someone begins to feel overwhelmed, the dorsal vagal complex triggers a disengagement response. The goal of PVT with the dorsal vagal complex is to help clients have a sense of safety and build resiliency. The dorsal vagal is related to social withdrawal, feeling unable to move, emotional numbness, and decreased pain sensation. 

When doing PVT with a therapist, clients will be taught the PVT ladder, exercises such as mindful awareness, and how to regulate the three neural pathways of the autonomic nervous system that were discussed above. Through this, clients become aware of their bodily sensations and emotional distress so they are able to regulate both during times of stress. 

Source: Choosing Therapy

March: Women’s History Month: Important Women In Mental Health Today

In the United States, March is Women’s History Month and is intended to highlight the contributions women have made throughout American history. This blog will focus on women in the mental health field who have made significant contributions over the past half-century. 

Insoo Kim Berg is a renowned Korean-American author and therapist who co-founded solution-focused brief therapy, or SFBT. Berg began to realize that many times when people are seeking help a lot of their time and energy is spent seeking treatment, meaning clients are still being impacted by their concerns. Through SFBT, a client attends short therapy sessions and the therapist is expected to help the client develop solutions instead of only focusing on their challenges. 

Dr. Marsha Linehan is the developer of dialectical behavior therapy, DBT, which was developed to help those suffering with suicidal behaviors and clients diagnosed with borderline personality disorder. DBT is the only treatment that has been proven to be successful in multiple trials in several different independent research trials. 

Dr. Francine Shapiro is the original developer of EMDR which is short for eye movement desensitization and reprocessing. EMDR is a form of psychotherapy that allows people to heal from distressing symptoms and emotions that are caused by traumatic or upsetting life experiences. 

Dr. Julie Schwartz Gottman is the co-founder and President of The Gottman Institute and is a respected clinical psychologist. Dr. Gottman is an expert advisor on marriage, sexual harassment and assaults, domestic violence, gay and lesbian adoption, same-sex marriage, and parenting issues. 

Dr. Angela Neal-Barnett is an expert in Black mental health with an emphasis on anxiety disorders among Black women. Dr. Neal-Barnett is the founder and director of the Program for research on Anxiety Disorders among African Americans (PRADAA). Additionally, Dr. Neal-Barnett received the 2020 ADAA Jerilyn Ross Clinician Advocate Award. 

Source: RISE Services

Radical Acceptance

Radical acceptance is the ability to accept situations that are not within your control and doing so without judgment to reduce the suffering caused by the situations. This practice believes that suffering doesn’t come directly from pain, but the attachment we experience to the pain. Carl Rogers set forth this practice that has its roots in Buddhism and explains that the first step towards change is acceptance. The key to overcoming suffering in this practice is non-attachment, which does not mean not feeling emotions, but intentionally not letting the pain turn into suffering.

Non-attachment can be achieved by watching your thoughts and feelings to identify when we are making ourselves feel worse than we need to. Not judging the situations does not mean condoning what happened, instead it means accepting reality without getting caught up in an emotional reaction to reality. This practice is not easy by any means because it makes us identify our suffering as a result of the initial pain being prolonged due to an inability to accept. 

A misconception about radical acceptance is that you are supposed to agree with what is happening or what happened to you, and that is incorrect. This practice helps people accept reality because we can cause even more misery for ourselves when we avoid or dwell on things beyond our control. Radical acceptance is not forgiveness because radical acceptance means offering kindness to yourself, not another person. Radical acceptance means acknowledging pain is a part of life while decreasing emotional reactions and feelings of helplessness in order to achieve a sense of calmness and using logical reasoning. Situations cannot always be changed, but you are able to change how you view the situation. 

Radical acceptance is not appropriate to be used in all situations such as being in an abusive relationship, dealing with harassment, being treated poorly, and experiencing burnout. Instances where this practice is appropriate include going through a breakup, the passing of a loved one, and when you’re causing more pain for yourself because of an inability to accept what happened. 

Source: What Is Radical Acceptance by Arlin Cuncic

March 1st: Self-Injury Awareness Day

Self-Injury Awareness Day, or SIAD, is an international day dedicated to raising awareness and educating the general public about self-harming behaviors that are used as an intentional method of self-injury. Self-harm is not typically intended to be lethal, it is an expression for help that can lead to suicidal ideation and behaviors. SIAD aims to call attention to behaviors that tend to go unnoticed while providing resources, assistance, and support to those who need it. Self-injury is an impulsive behavior associated with premeditated thoughts along with negative feelings. When a person tries to refrain from self-injury they usually think about it obsessively, and when they engage in self-harm they expect to feel relief from the negative emotions. After self-injury, a person often feels guilt, shame, and distress leading to a cycle of repetitive self-harm. 

All forms of self-injury should be taken seriously and this prevalent issue should not be overlooked. Research shows that about 5% of adults in the United States have self-harming behaviors, 17% of adolescents report self-injury, and 17-35% of college students also report self-injury. Reasons for self-injury include feeling empty inside, loneliness, not feeling understood, over or under stimulated, an inability to express feelings, and having a fear of intimate relationships and adult responsibilities. Additionally, self-harm can also be about having control over one's body when they have little to no control over different aspects of their lives. It can also be used as a form of punishment when an individual believes they have done something wrong. 

Warning signs a person may be using self-harm behaviors include scars, unexplained frequent injuries, having constant access to sharp objects, low self-esteem, difficulty understanding and working through feelings, feelings of hopelessness and worthlessness, relationship problems, and poor functioning at school or other settings. Treatment options for self-injury include outpatient therapy, partial-inpatient care, inpatient hospitalization, and when behaviors become life-threatening or impact daily living, specialized self-injury hospital programs are recommended. Cognitive behavioral therapy helps clients understand and manage destructive thoughts and behaviors. Interpersonal therapy helps clients gain insight and skills to develop and maintain relationships. Medication can be used when treating depression, anxiety, obsessive-compulsive behaviors, and racing thoughts leading to self-harm. Resources include the Crisis Text Line, S.A.F.E. Alternatives which can be reached at 1-800-366-8288, and if a person is in crisis they can text “MHA” to 741741 or call 1-800-273-8255. 

Source Mental Health America, Diversus Health

Mental Health in Black Communities

Due to barriers surrounding mental health services and care, Black and African Americans report experiencing bias rooted in historical, structural, systemic racism, and discrimination. There are mental health stigmas that obstruct Black and African Americans from seeking help as well as a distrust of the healthcare system. Reasons for this include negative encounters with providers and professionals, a provider shortage due a lack of diverse racial and ethnic backgrounds, and a lack of culturally competent providers that understand cultural, social, and language needs. 

In 2010, 13.4% of the United States population identified as Black or African American and over 16% reported having a mental illness which is more than seven million people. Historically, Black and African Americans have experiences in America that are characterized by trauma and violence more often than White individuals which impacts emotional and mental health of youth and adults. Racism at the structural, institutional, and individual level continues to create disparities in addition to police brutality and political rhetoric that increase the complexity to manage. In 2018, it was reported that more than 1 in 5 Black and African American people lived in poverty and we know that socioeconomic status is linked to mental health. Meaning, people living in poverty, who are homeless, who are incarcerated, or who live with a substance use problem are at a higher risk for mental health problems. 

A major issue in the United States that continues to be ignored is the fact that Black women are three to four times more likely to die from a pregnancy-related death with research indicating that quality healthcare is vital in improving outcomes for racial and ethnic minority women. The rate of deaths, specifically when compared to White women, is not unfamiliar globally due to countries with histories of slavery and forced migration showing disparities in health outcomes centered around social determinants such as race and ethnicity. One study alone found that 60% of hyper-tension related maternal deaths were preventable, however recommended care continues to be ignored. 

To understand the impact of multigenerational oppression, discrimination, and racism forced upon African American communities, it is important to understand Post Traumatic Slave Syndrome, or PTSS. PTSS is a theory developed by Dr.DeGruy based on twelve years of research that explains the etiology of adaptive survival behaviors in African American communities. The syndrome is the result of multigenerational oppression of Africans and their descendants from centuries of slavery. Slavery was then followed by institutionalized racism, resulting in M.A.P: Multigenerational trauma together with continued oppression, Absence of opportunity to heal or access benefits in society leading to, Post Traumatic Slave Syndrome. The three key patterns of PTSS are vacant esteem, marked propensity for anger and violence, and racist socialization/internalized racism. Vacant esteem is characterized by feelings of hopelessness, depression, and a self-destructive outlook. Marked propensity for anger and violence causes extreme feelings of suspicion viewed as negative motivations of others. Racist socialization/internalized racism can be defined as learned helplessness, distorted self-concept, or antipathy for members of one's own cultural or ethnic group, the customs associated with one's heritage, and physical characteristics of one’s own cultural or ethnic group.

Source: Dr. Joy DeGruy, Mental Health America, McLean Hospital, SAMHSA

Panic Disorder

Panic disorder is defined as sudden fear, discomfort, or sense of losing control when there is no clear danger that results in frequent and unexpected panic attacks. The frequent occurrence of panic attacks happen “out of the blue,” whereas anxiety attacks gradually build up in intensity. Having a panic attack does not mean that a person will develop panic disorder, however it is something to be aware of and seek treatment for if panic attacks continue. Panic attacks cause a person to experience an impending sense of doom, a fear of dying, “going crazy,” and again losing control. 

Those living with panic disorder frequently fear having another panic attack and may revolve their life around avoiding one. Physical symptoms of panic attacks include feeling as if you’re having a heart attack, trembling, and rapid heart rate. Panic attacks can range from occurring multiple times a day to a few times a year. Typically, panic disorder starts to develop as a late teenager or early adulthood with women being more likely to develop the disorder. 

Signs and symptoms of panic disorder include being fearful or avoiding places where panic attacks have occurred before, racing heart, chills, sweating, trembling, loss of breath, dizziness, paresthesia or numbness, chest pain, and nausea. Additional symptoms include derealization which is the feeling of unreality, depersonalization which is defined as feeling detached from oneself, and a fear of dying. When a person experiences their first panic attack it is typically due to a distressing or highly stressful event, however most individuals who have at least one panic attack do not develop panic disorder. 

There are two specific theories as to why panic disorder develops with the first one being the Cognitive Theory of Panic. This theory proposes that people living with panic disorder are hypersensitive to their bodily sensations and have a tendency to catastrophize the meaning of sensations. One may think they are having a heart attack because their heart is racing and the automatic thought of “I’m having a heart attack” triggers a panic attack. The second theory, Comprehensive Learning Theory of Panic Disorder, states that panic attacks become associated with initially neutral internal and external cues through a conditioning process. 

Panic disorder is a treatable disorder with cognitive behavioral therapy being recommended as the primary treatment option. This form of psychotherapy helps teach people to identify and change the way they think, feel, and behave prior to or during a panic attack. After learning ways to react differently to physical sensations, panic attacks will start to decrease in frequency. Exposure therapy is a cognitive behavioral therapy method focusing on confronting fears and beliefs that become associated with the disorder to help a person participate in events or activities they tend to avoid. Alongside exposure therapy, learning relaxation exercises is highly recommended. Medication can be used as well to help aid in the treatment of panic disorder. Antidepressants, beta-blockers, and anti-anxiety medications can help reduce the physical symptoms of panic attacks.

Source: National Institute of Mental Health

Substance Use Disorder

Substance use disorder, sometimes referred to as drug addition, is a brain disease that results from a genetic predisposition and unresolved trauma. Because this disorder is a disease, the myth that addiction is a choice and a person can stop at any time is not factual. Substance use disorder has a negative impact on a person’s brain and behaviors resulting in an inability to control the use of legal or illegal substances. The dysregulated nervous system is seeking a way to regulate itself, and when a substance causes an individual’s nervous system to feel regulated that feeling is further craved. 

Substance use disorder is considered a family disease for three specific reasons. The first being that the disease requires a genetic predisposition which is why we see families with generational reports of substance use disorders. Second, family dynamics play a massive role in the development and perpetuation of substance use. Lastly, addiction has a massive impact on both the individual living with the substance use disorder and those within the family. Education during family therapy should highlight how the family members enable and contribute to the person diagnosed with a substance use disorder while becoming educated on the disorder as a whole. 

Symptoms of substance use disorder include feeling like you require the substance daily, intense urges that block out other thoughts, gradually requiring more of the substance to experience the same effects, withdrawal symptoms, continued substance use despite harm it may be causing, and risky behaviors such as stealing or driving under the influence. Adolescent substance use disorder may look like problems at school or work, physical health issues, decrease in hygiene, changes in behavior, and financial issues. Signs and symptoms of drug use or intoxication can vary depending on the substance being used. For example, a person under the influence of benzodiazepines may have slurred speech, a lack of inhibition, and a lack of coordination. However, someone under the influence of cocaine may have increased alertness, rapid or rambling speech, and insomnia. 

When receiving treatment for a substance use disorder, there are a plethora of options that can help. The three types of rehab treatment include detoxification centers, inpatient/residential rehab, and outpatient rehab. Individual, group and family therapy are highly suggested and the format should be based on what an individual believes will work best for them. Cognitive Behavioral Therapy, Contingency Management, Dialectical Behavioral Therapy, EMDR, Rational Emotive Behavior Therapy, and 12-Step Facilitation are evidence-based treatments that are proven to help aid in the treatment of a substance use disorder.

Source: American Addiction Centers, Mayo Clinic

Black History Month: African American Psychologists

During the month of February, the United States of America celebrates Black History Month. This month of celebration was established to appreciate and acknowledge “the countless Black men and women who contributed to the advancement of human civilization,” as explained by the Association for the study of African American Life and History. The purpose of this blog is to be aware of and celebrate African American Psychologists who have contributed to improving the mental health field. 

Dr. Herman George Canady was a social psychologist born in 1901 who lived until 1970. Dr. Canady wrote the famous article “The Effect of ‘Rapport’ on the I.Q.: A New Approach to the Problem of Racial Psychology,” and was the first psychologist to research how race impacts examiner bias factors in IQ testing. Dr. Ruth Winifred Howard Beckham is nicknamed “the feminist psychologist,” and was one of the first African American women to obtain a PhD in Psychology. Dr. Beckham was an active member of the American Psychological Association, the International Council of Women Psychologists, the American Association of University Women, and much more. She lived between the years 1900-1997 and is still remembered today for her advancements in the mental health field. 

Dr. Mamie Phipps Clark became the first Black woman to receive a PhD from Columbia University in 1943. Dr. Clark’s thesis is considered historic and was used to make racial segregation unconstitutional in American public schools. Following her thesis, Dr. Clark opened The Northside Center for Child Development in Harlem, NY in 1946. Dr. Joseph L. White is considered the “Father of Black Psychology,” due to him exposing implicit whiteness in the field of psychology. With this knowledge, Dr. White published the article “Toward a Black Psychology,” here he confronted the APA on its history of defining the Black community as “ignorant, deviant, and lacking in intelligence.” In 1968, Dr. White helped establish the Association of Black Psychologists as well as the first Black Studies program during the strike at San Francisco State University. 

Dr. Joy DeGruy is the author of Post Traumatic Slave Syndrome: America’s Legacy of Enduring Injury and Healing and is the President and Chief Executive Officer of her own publication company. Dr. DeGruy’s work focuses on the intersection between American chattel slavery, violence, racism, and trauma. Dr. Kenneth Clark, husband to Dr. Mamie Phipps Clark, was the first African American man to obtain a doctoral degree from Columbia University. Additionally, Dr. Clark was the first African-American President of the APA and the first African American assigned to the New York State Board of Regents. 

Source: California Institute of Integral Studies

Social Anxiety Disorder

Social anxiety disorder (SAD) is defined as an intense and constant fear of being watched and judged by other people. This anxiety is constant during work, school, and other activities such as grocery shopping. People living with SAD fear situations where they may be subjected to scrutiny and judgment, this can range from anxiety about meeting new people to eating in front of others. The deep rooted anxiety is linked to the fear of humiliation and rejection. With this disorder, anxiety feels beyond the control of the person living with it, some individuals living with this disorder are able to complete tasks that are required of them but feel an immense amount of anxiety while doing so. 

Avoidance tendencies usually occur when dealing with anxiety or an anxiety disorder causing people to miss events due to high levels of distress. Anxiety can occur weeks before an event due to thinking about having an obligation to attend and results in a massive amount of stress. It is important to note that some people with SAD do not experience anxiety during social interactions but experience it when they have to perform. This can be seen during a sports game, presenting a project at school or work, or being a member of a school play. During childhood, SAD can present are shyness or avoidance and occurs more frequently in females than males. 

Signs and symptoms of SAD are usually experienced when performing in front of others. These signs and symptoms include sweating or trembling, increased heart rate, feeling as if your mind has gone blank, feeling sick to your stomach, and rigid body posture. Additionally, a person may experience speaking with a very soft voice, difficulty making or maintaining eye contact even if they want to maintain it, feeling self-conscious at the thought of being judged, and avoiding places where groups of people tend to be. 

SAD is a common disorder that can be treated with cognitive behavioral therapy, or CBT, and teaches a client new ways of thinking, behaving, and feeling during situations that cause anxiety. Exposure therapy focuses on consistently confronting the underlying fears of a person's anxiety disorder to help the client engage in activities they have been avoiding. Typically, exposure therapy will also include relaxation techniques to help the client self-soothe and reduce physical symptoms of anxiety. Acceptance and commitment therapy (ACT), uses mindfulness and goal setting to reduce feelings of anxiety and discomfort. Medications such as benzodiazepines, beta-blockers, and antidepressants can be prescribed to a client living with SAD. Support groups can also be beneficial to those living with anxiety because they will receive unbiased feedback from other people within the group. Additionally, support groups allow others to learn how other people living with SAD have overcome their own fears and what has worked best for them. 

Source: NIH

Burnout

Burnout is caused by prolonged stress that results in emotional, physical, and mental exhaustion. When the stress does not decline we become overwhelmed, emotionally drained, and have difficulties meeting our needs. Many people experiencing burnout start to lose interest and motivation, in return the lack of productivity decreases our energy. Because of this, feelings of helplessness and hopelessness, as well becoming cynical and resentful may occur. Home life, work, and social life can all be impacted by burnout in addition to becoming more vulnerable to illnesses. 

The beginning of burnout may manifest as feeling like every day is a bad day, constant exhaustion, feeling as if nothing you do is appreciated, most of your day is spent on tasks you feel are pointless or overwhelming, and that caring about your work or home life is a waste of time. It is important to note that burnout is gradual, it does not happen overnight. Being aware of signs and symptoms can help prevent a major breakdown if we intentionally work to reduce our stress level. Physical symptoms include daily fatigue, higher susceptibility to illnesses, headaches or muscle pain, and changes to appetite or sleeping habits. Emotional signs include a sense of failure, feeling defeated, detachment, loss of motivation, and decreased satisfaction. Behavioral symptoms look like withdrawing and isolation, procrastinating, using substances to cope, emotional outbursts, and skipping work. 

Identifying burnout can be difficult because it can be confused for stress, however there is a difference. Stress results from over-engagement, our emotions become over reactive, there is a loss of energy, it can cause hyperactivity, most damage is physical which can result in premature death, and cause one to develop an anxiety disorder. Burnout, however, is characterized by disengagement, emotions are blunt, feelings of hopelessness occur, there is a loss of motivation as well as hope, most damage is emotional making life seem like it’s not worth living, and people become detached or depressed. 

You may be asking yourself, what are the causes of burnout? Work-related causes include feeling a lack of control over work, lack of recognition at your job, and working in a high-pressure work environment. Lifestyle habits that have been linked to burnout are working too much without socializing or relaxing, a lack of supportive relationships, not getting the proper amount of sleep, and helping others too much without help being reciprocated. Personality traits such as perfectionism, pessimism, a constant need for control, and Type A personalities have been linked to experiencing burnout. 

Once you have realized the “red flags of burnout,” it’s time to overcome it in order to become healthier and happier. Treating burnout requires the “Three R” approach which is recognize, reverse, and resilience. Recognize the warning signs of burnout, reverse the damage by managing stress and seeking support, and build resilience to stress by taking care of your overall health. Reaching out to those we have a close relationship with, being sociable with coworkers, limiting contact with people who have a negative impact on us, and connecting with your local community can help reduce burnout. 

Source: HelpGuide.org

Transgender Awareness Week

During the week of November 13-19 we celebrate Transgender Awareness Week to honor transgender people whose lives have been lost as a result of anti-transgender violence. This week is for transgender people and allies to take action in order to bring awareness to the trans community through education, sharing stories, and advocating issues of prejudice, discrimination, and violence impacting the community. Transgender is an umbrella term for people whose gender identity or expression differs from societal expectations of their sex assigned at birth. Additionally, nonbinary is defined as people who do not describe their gender identity exclusively as male or female. 

Historically, the LGBTQ+ community has been subjected to discrimination and oppression because of politics, religion, and societal standards based on sex assigned at birth. An argument used against the LGBTQ+ community by Catholicism and Christianity is that God views homosexuality as a sin so therefore it is wrong. However, the Old Testament’s original German translation had the word ‘knabenschander’ meaning boy molester. Leviticus 18-22 was originally written as: Man shall not lie with young boys as he does with a woman, for it is an abomination. Furthermore, 1 Corinthians originally said: Boy molesters will not inherit the kingdom of God. In 1892, Germans created the term “homosexual” & an American company, Biblica, paid for an updated German bible using the word ‘homosexual’ instead of ‘boy molesters’. The English translation is now “Man shall not lie with man, for it is an abomination.” 

In Florida alone, we have seen an attack on the trans community being used for political gain, transgender teachers are no longer able to use their preferred pronouns or titles, such as Mr. or Mrs., in class. Politicians such as Ron DeSantis have introduced bills such as the “Don’t Say Gay'' law and banning books that disproportionately target LGBTQ+ literature in public schools. H.B. 1521 makes it illegal for trangender teachers, staff, and students to use the bathroom that best fits their gender identity. Because of this, teachers and staff face professional discipline while students face a “penalty” and a “disciplinary referral.” With all of that being said, it should not come as a shock that transgender people face higher levels of depression, anxiety, and thoughts of suicide when compared to the general population. Specifically, transgender people have the highest rates of mental health challenges among the LGBTQ+ community because of the extreme political focus to condemn them and a lack of support. 

Factors influencing mental health challenges among the trans community include discrimination, transphobia, financial instability, and health challenges. One study examining reasons for suicidal thoughts in transgender youth reported “school belonging, emotional neglect by family, and internalized self-stigma created a statistically significant contribution to past 6-month suicidality.”  More than 1 in 5 transgender youth reported being threatened with or forced into conversion therapy to “cure” their gender identity. The APA, American Psychiatric Association, explains that “conversion therapy is based on the prior assumption that diverse sexual orientations and gender identities are mentally ill and should change.” We now know that there are no proven benefits of conversion therapy, in fact it causes significant mental health problems, and diverse gender identities and sexual orientations are not any form of a mental illness and do not need to be changed. 

Source: GLAAD, HealthPartners, APA

The Anger Iceberg

Dr. Daniel Goleman explained that “emotions are, in essence, impulses to act, the instant plans for handling life that evolution has instilled in us.” Anger causes our blood to flow to our hands which makes it easier for us to fight, additionally our heart begins to race causing a surge of adrenaline strong enough to take “vigorous action.” The purpose of anger is to protect us, however anger should be thought of as an iceberg with what’s causing the anger to be below the surface of the water. This means that when we are angry there are emotions hidden underneath the surface, which are our underlying feelings driving the anger. Anger is one of the six “basic emotions” alongside disgust, fear, happiness, sadness, and surprise. Because of this, anger can be used to protect the feelings lying beneath it because those emotions are driving the anger. 

Feelings that may be at the bottom of the anger iceberg include embarrassment, loneliness, depression, fear, or a combination of multiple feelings. Understanding this can help families and couples understand each other better and have healthier conversations. When someone, especially a loved one, is directing anger towards us we tend to become defensive because it brings our anger to the surface. This can then result in heated arguments causing everyone involved to feel misunderstood and hurt. The three tips for listening to anger include: not taking it personally, not telling your partner to “calm down,” and identify the obstacles. 

Not taking anger personally is important because typically the anger being directed at us by another person has nothing to do with us, but their own feelings. Becoming curious about why someone is angry can help address the underlying emotions driving that anger and opens an opportunity for genuine conversation instead of both people acting defensively. You want to avoid telling your partner who is angry to “calm down” because it comes across as not caring about how they feel or that how they feel is unacceptable. We do not want to change or fix someone’s emotions, that is not our job it is theirs, but rather express an understanding about how they feel. This results in your partner being heard which causes higher levels of trust between partners. Lastly, identifying the obstacle is important because anger is an obstacle blocking a goal. By identifying what is driving someone's anger they can provide insight into why they are feeling angry and work to resolve it. 

Source: The Gottman Institute

Gender Dysphoria

Gender dysphoria is defined as the feeling of discomfort or distress that occurs in people whose gender identity differs from their sex assigned at birth and/or their sex-related physical characteristics. Those living with gender dysphoria tend to feel uncomfortable in their own body and may want to change how they express their gender. Expressing gender can look like what an individual wears, transitioning socially such as what pronouns they use, transitioning medically or surgically, or a combination of these. It is important to note that some transgender and gender-diverse people feel comfortable within their body with or without medical intervention. The DSM-5 has a gender dysphoria diagnosis that can help people receive health care and effective treatment that focuses on the discomfort as the problem as opposed to their identity. 

Symptoms of gender dysphoria include distress, anxiety, depression, negative self-image, a strong dislike of one's sexual anatomy, and a strong preference for toys and activities associated with other genders can be seen in children. Additional symptoms include a strong belief of having the typical feelings and reactions of another gender, a desire to have the genitals and secondary sex characteristics of another gender, a desire to be or be treated as another gender, and a desire to prevent the development of secondary sex characteristics. Gender dysphoria may start in childhood and continue into adolescence and adulthood, however individuals can have periods of time where they do not experience the dysphoria. There is not a set time frame where gender dysphoria occurs because it can begin before or during puberty as well as in adulthood. 

Source: Mayo Clinic, Boston Children’s Hospital

The Cycle of Anxiety

Anxiety causes us to worry about an event we believe might potentially happen while trying to find ways to cope with the negatives that could follow it. This is done by paying extra attention to possible signs of a potential threat, looking internally to see if you can cope with the threat which results in noticing your anxiety symptoms, believing you cannot handle the situation, and becoming more anxious. The cycle of anxiety starts with anxiety, moves to increased scanning for danger with physical symptoms increasing, seeking a way to escape or avoid the situation, short term relief following avoidance, and a long term increase in physical anxiety symptoms, more worry, less confidence, and an increase in safety behaviors. 

One of the main ways people try to reduce symptoms of anxiety and worry is by avoiding the situation all together, however this only creates more anxiety in the long run. Avoidance causes one to believe that their emotion is dangerous and should be avoided by all means necessary. By acting on these avoidance behaviors, you continue to scan the environment for signals of danger and safety which can result in an increase in anxiety and generalize to other situations. “Safety behaviors” are things such as always having an exit plan for anxiety inducing situations, relying on the security of your phone, or only doing things when people you are close to are involved. Creating and using these safety behaviors causes a dependence on them without learning that our emotions do not equal actual danger. By suppressing the emotion we are actually heightening the emotion and increasing future distress. 

Reversing the cycle of anxiety looks like confronting the feared situations without utilizing safety behaviors, short term slight increase in anxiety with a decrease in physical symptoms and attention scanning, use of coping skills causing anxiety to reduce to a manageable level, and greater belief in one's ability to control their own responses. It’s important to note that fears should be gradually confronted because it will improve confidence with less feelings of being overwhelmed or unsafe. “Graded exposure,” or taking the feared situation step-by-step as opposed to fully head on is recommended. Starting with situations that feel easier to handle and then working your way up to tasks that seem more challenging show better outcomes.

Source: CCI Health

Parenting Styles

There are four different types of parenting styles and each style acts as a guide for a child’s morals, principles, and conduct. Typically, most parents can be categorized into one type of parenting style, however it is possible to have some characteristics from another category. 

The first style, authoritarian parenting, is seen when a parent uses strict rules that are not explained and the child is expected to obey them with no room for negotiations or errors. There tends to be little warmth or positive involvement stemming from the parent to their child in addition to not considering the child’s desires or opinions. Here, there is a lot of anger and displeasure directed towards the child and when the child behaves poorly or does something inadequately harsh punishment is used. Children raised in this parenting style typically are the most well-behaved due to consequences of misbehaving, however they have higher levels of aggression which they have difficulty managing since they were never properly guided. Additionally, children raised in this category usually have poorer self-esteem, rebel against authority figures as they get older, are shy, and have difficulty making decisions. 

The second style, authoritative parenting, revolves around the parent and child having a nurturing, warm, involved and responsive relationship. The parent has guidelines they expect their child to follow and explain why they are being disciplined as a way to support the child instead of punishing them. Parents practicing this style consider a child’s desires, opinions and ideas because they value their input. There is an appropriate level of communication between parent and child with the parent not yielding to child coercion. Parents expect mature, independent, and age-appropriate behaviors due to the standards, communication and enforcements they have set. Generally, this style leads to the healthiest outcomes and children tend to become confident, responsible, and have the ability to self-regulate. Children raised in this style have a better ability to handle negative emotions leading to better social outcomes and emotional health. Children learn they are able to meet their goals independently, have higher self-esteem, and have higher levels of academic achievement.

Permissive parenting is seen when the parent is warm and nurturing, but there are little to no expectations for the child. Here, a parent acts more like a friend as opposed to a parent figure. Parents glorify free expression of impulses and desires while not communicating or enforcing rules. Poor behavior is typically ignored or accepted and in result the parent doesn’t expect maturity. Limited rules can result in unhealthy eating habits, impulsivity, demanding behaviors, selfishness, and a lack of self-regulation. 

The last parenting style, uninvolved parenting, is seen when a child is given absolute freedom because the parent is not involved with the child. A parent will try to avoid their child and/or fail to monitor activities their child is engaging in. Parents here tend to be neglectful and unresponsive while pursuing self-gratification at the expense of their child’s welfare. Although basic needs such as food, water and clothing are usually met, parents remain detached from anything else going on in their child’s life. Discipline is not utilized, there is limited communication, and there are no expectations for the child to meet. Children raised in this parenting style are usually resilient and self-sufficient because they were forced to develop these skills out of necessity. Additionally, children can have difficulties managing their emotions, have less effective coping skills, greater academic challenges, and difficulty maintaining social relationships. 

Source: National Library of Medicine

Phobias

Phobias can be defined as an overwhelming and exhausting fear of an object, place, situation, feeling or animal. Phobias develop when an individual has an unrealistic sensation of danger and can become so severe that the person organizes their life around being able to avoid the root of their anxiety. In America alone there are about 19 million people that have one or more phobias that vary in severity. Typically, phobias are first seen between the ages of 15 and 20, however they can develop in early childhood. Men and women are affected equally, but men tend to seek treatment for their phobias more when compared to women. 

Genetic and environmental factors impact the manifestation of a phobia and certain phobias can be linked to a negative first encounter with the feared object, situation, place, feeling or animal. Phobias are a type of anxiety disorder and symptoms include dizziness, nausea, sweating, heart palpitations, shortness of breath, trembling, and stomach issues. There are a variety of things someone can develop a phobia about, but there are two main categories: specific/simple phobias and complex phobias. Specific or simple phobias are centered around a certain object, animal, situation or activity that often develops during childhood or adolescence and tends to become less severe in adulthood. Examples of specific phobias include animal phobias, environmental phobias, situational phobias such as flying, bodily phobias such as vomit, or sexual phobias such as contracting an STI. 

Complex phobias are typically more debilitating when compared to specific phobias and usually develop during adulthood. These phobias tend to be associated with a deep-rooted fear or anxiety about a situation or circumstance. The two most known complex phobias are agoraphobia and social phobia, or social anxiety disorder. People living with a phobia are usually aware of the problem and may choose to live with it, however there are treatment options available. Simple phobias can be treated by a clinician through self-exposure therapy where the client is gradually exposed to what is causing them fear and anxiety. Treatment for complex phobias include psychotherapy and cognitive behavioral therapy, additionally medications such as antidepressants or beta blockers can help with anxiety.

Source: John Hopkins Medicine, National Health Service

October: National Domestic Violence Awareness Month

October has been assigned National Domestic Violence Awareness Month for the past 34 years and is used as a time to acknowledge survivors and be a voice for victims. Domestic violence is seen in every community regardless of age, socio-economic status, sexual orientation, gender, race, religion, or nationality. This form of abuse has systematic patterns of dominance and control, additionally abusers often use emotional abuse to gain even more control over their victim(s). Progress has been made in reducing reported cases of domestic violence, however there are still more than 10 million abuse victims annually in America alone. 1 in 3 women and 1 in 4 men have experienced physical abuse from an intimate partner resulting in millions living in fear within their own homes. Furthermore, children who are exposed to this violence have a long-lasting negative effect on their well-being, social and academic functioning. 

Domestic violence is an interrelated pattern using a range of abusive behaviors that increase in frequency and intensity over time. The cycle of violence has three phases with phase one beginning with the abuser picking fights, acting possessive, being critical, and drinking or using drugs. During phase one, survivors may begin to feel like they are walking on eggshells, need to appease or calm the abuse, keep children quiet, and feel afraid and anxious. In phase two, abusers begin to restrain their partner, commit verbal, sexual, emotional, and physical abuse, destroy property, and increase control over their victims finances. During this phase, survivors begin to experience fear and shock, try to flee, protect themselves and their children, and call for help. Phase three is seen when abusers ask for forgiveness, promise to change, stop using substances, seek counseling, act affectionate and intimate, and deny abuse. Survivors during phase three may blame themselves, minimize or deny abuse, forgive, feel manipulated, or feel hopeful. This cycle of phases can happen multiple times within an abusive relationship and can take anywhere from hours or years to complete. 

Safety plans are a personalized plan to improve safety while experiencing abuse, preparing to leave an abusive partner, or after leaving an abusive partner. Leaving an abusive relationship is when the survivor is most at risk, so having a safety plan in place can help protect yourself and others in stressful situations. To see examples of safety plans for during an incident, preparing to leave, obtaining a restraining order, being home or outside your home after a separation, and emotional health please visit: https://www.courts.oregon.gov/programs/family/domestic-violence/Documents/DVSafetyPlan.pdf 

National Domestic Violence Hotline: (800) 799-7233

Sources: NCTSN, Doorways VA, National Domestic Violence Hotline