GoodTherapy | The Seasons of Trauma: Recognizing When Symptoms Might Flare UpA woman who has experienced a traumatic event seeks counseling when she finds that symptoms related to the trauma affect her ability to enjoy life and function normally. She meets with her therapist once per week for 9 months, and she makes tremendous progress in therapy.

As she works hard and stays committed to the process of resolving her trauma, she feels very proud of herself and receives validating feedback from her therapist, who acknowledges her hard work and progress. She then notices that with the change of seasons, some of the symptoms she tried so hard to minimize or eliminate altogether come creeping back. She notices, as the time of year associated with her trauma approaches, her symptoms worsen still.

She becomes very frustrated. She fears she will experience the same degree of trauma she did immediately after the traumatic event. She wants to just give up. “What’s the point?” she asks herself and her therapist. “I have worked so hard and here I am, going right back to the trauma!”

Why Seasonal Change Can Reawaken Trauma

This case example illustrates a very common occurrence in trauma work. Trauma symptoms may resurface or worsen at certain times of year—it is almost as if the change in seasons is a catalyst that causes a person to feel as though they are regressing. It is easy at these times to dismiss the progress that has been made in therapy and focus, instead, on the reemerging symptoms. Rather than consider this a regression in therapy, I prefer to think of it as an expected occurrence in trauma work that should be normalized and discussed.

Several factors can be at play here. First, as the time of year when the traumatic event occurred comes around again, a very powerful reminder of the trauma often occurs. The brain is triggered and begins remembering. The body also remembers and symptoms reemerge.

Another consideration is that holidays can also trigger trauma memories and symptoms, especially if loss has occurred. The loss of a loved one is one of the most common and difficult traumatic events humans can experience. Even if the loss did not occur around the holidays, holiday times often serve as reminders of loved ones who are deeply missed.

Furthermore, according to the American Psychiatric Association, 80% of people who meet criteria for a diagnosis of posttraumatic stress disorder (PTSD) also meet criteria for other mental health diagnoses. In my experience, one does not have to have an actual diagnosis of PTSD to become more susceptible to other troubling mental health symptoms after a traumatic event. Just experiencing a traumatic event can make someone more likely to experience symptoms related to anxiety, depression, and other challenges.

Certain times of the year can make symptoms worse. For example, with colder weather and less daylight during the winter months, a trauma survivor who also experiences symptoms associated with seasonal affective disorder (SAD) may encounter a worsening of both SAD and trauma symptoms. Similarly, someone prone to anxiety may find symptoms flare up during the holidays, when more cars are out on the road, malls and stores are more crowded, and financial and social pressures are mounting.

Unfortunately, many people are ashamed to talk about reoccurring or worsening symptoms, and this can cause symptoms to escalate even more, impacting well-being and functioning.

Addressing Reoccurring Trauma in Therapy

Unfortunately, many people are ashamed to talk about reoccurring or worsening symptoms, and this can cause symptoms to escalate even more, impacting well-being and functioning. Beliefs may surface that all the time and hard work one has given in moving forward from a traumatic experience has been wasted. Feelings of frustration and an urge to give up on therapy are very common during these times, as illustrated in the case example.

In addition, a fear of disappointing one’s therapist may come up, preventing some people from openly discussing new or reoccurring symptoms. Making progress in therapy is validating and rewarding, as the case example demonstrated. Returning to therapy when symptoms reoccur can bring up feelings of shame or guilt, causing one to feel as though they will somehow disappoint the therapist or that the reoccurring symptoms will suggest to the therapist they are not working hard enough.

Reemerging Trauma as an Opportunity for Healing

I find this point in trauma work is sometimes the most critical, when clients have a wonderful opportunity to make the most progress toward resolving their trauma for good. This is the time to talk to your therapist to let them know exactly what you are experiencing and how it is making you feel. A good trauma therapist will validate and normalize what you are going through and help you to confront the fear of reoccurring symptoms so that when other triggers come up, it is not so daunting to confront them. This is an opportunity to practice skills with your therapist that will reinforce that you are strong and capable of handling whatever may come up.

Going back to our case example: The therapist validated and normalized what the woman was feeling and experiencing. She reassured the woman that what she felt was very common in trauma work and presented it as an opportunity. The woman stuck with therapy, continuing to talk about her urges to give up on therapy and her feelings of disappointment as they came up. She continued working hard and trusting the therapeutic process.

She was able to overcome her reemerging symptoms. The time of year that served as a trigger passed, and she found that when she thought of that time of year rolling around again, she was not as distressed as she expected. She felt better and more confident as she moved forward. Eventually, she did not need to see her therapist anymore, although she always knew she could return if she felt the need. And when the next trigger appeared, she handled it beautifully, which just reinforced her strength and the belief that she could continue to move forward.

Reference:

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

GoodTherapy | Addressing Anxiety and the Negative Feedback LoopDo you often feel anxious or have times of panic? Does your anxiety overwhelm you or interfere with your work, friends, or family? If so, you’re far from alone. According to the National Institute of Mental Health (NIMH), approximately 19 million adults in the United States experience ongoing anxiety. It cuts across all ages, ethnicities, education levels, and socioeconomic levels. Most of us feel it at some point. Anxiety comes in many flavors; it may erupt only in social situations, manifest as an obsession or compulsion, as a specific phobia, or it may be generalized.

Below are signs of two types of anxiety:

  1. Generalized anxiety symptoms: irritability/restlessness/worrying, muscle tension/fatigue, problems concentrating, sleep difficulties.
  2. Panic symptoms: racing heart/trembling, fear of losing control or dying, shortness of breath/chest pains, chills/hot flushes (not due to peri- or menopausal phase), dizziness/light-headedness/nausea, numbness/tingling/sweating.

It’s common to feel embarrassed about your anxiety, to feel alone, and to keep it a secret. It’s scary to think of asking for help. You may have been feeling anxious for long enough that it’s hard to remember a time when you didn’t live with it. Your anxiety may feel like an unpleasant but “normal” part of you. You do not have to live with this ongoing pain: You’ll be reassured to know anxiety can be effectively treated.

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Anxiety is caused by three overlapping events: a trigger or environmental cue (public speaking or party), mental reactivity (a negative thought/self-talk), and physical reactivity (breathing rapidly, clenching fists, etc.). These form a negative feedback loop, where one begets the other. In order to cope with their anxiety, most people avoid the trigger. Though avoidance helps in the immediate moment, it makes anxiety worse in the long term. Why? Two reasons: 1) It reinforces your belief that you’re helpless to deal with it, and 2) you don’t get positive experiences as basis for further success. Below are some basic strategies to help reverse the direction of the feedback loop, turning the dial from negative to positive:

GoodTherapy | Getting Naked: It's Not Just About the SexI’ll never forget the first time my friend took me to Elysian Fields, a “nudist colony” in Topanga Canyon in the Santa Monica Mountains near Los Angeles. I was twenty-something and petrified; I’m not sure why. I guess I was convinced that everyone would be staring at me and evaluating my body. What a surprise to discover that when we’re naked we all look pretty much alike!

When it comes to human intimacy (or lack thereof), there are different types of nakedness. During one-night stands, getting naked means exposing a lot of skin—usually rapidly.

A client once told me that she figured she could strip and shower in the locker room with no problems, so why not strip and hook up with a partner she found attractive? She did this several times until she began to tire of the shallowness and yearn for a partnership with more depth—as she put it, “someone who I can be emotionally naked with.” Years later she found that person, and discovered that true nakedness was both challenging and rewarding.

Often, people assume that their sessions with me are going to be focused on what/when/where with their genitals. They’re often surprised when I suggest we discuss “the importance of getting naked.” A great deal of honesty and trust can be generated when you are nude with one another, something that rarely develops if the sole purpose of getting naked is to have intercourse.

If you and your sweetheart are new together, or trying to resurrect the newness and the thrill of physical intimacy, here are some thoughts and ideas for getting naked together:

Being comfortable in your own skin is an important part of being comfortable and intimate with your partner. If the idea of just being naked together is scary, you may want to consult a therapist. If it’s exciting, go ahead and try it!

GoodTherapy | How Parents Fuel Identity Crises in Their ChildrenIt is not unusual for people to come to therapy with feelings of confusion about what they want, think, and/or feel. I find that many grew up in families in which one or both parents involved themselves in their children’s lives in ways that interfered with the development of separate, individual thoughts and feelings. Most of these parents were well-intentioned. Their intrusion into their child’s life typically came from a need to protect the child from painful feelings or to assure that the child’s behavior and choices were the “right” ones. As a consequence, these children grew up relying on their parents to define not only what they should feel or how they should behave, but ultimately their identity: who they are as individuals. As adults, these children spend a lot of time in their heads worrying about the choices they make, how they are seen in the world, if they upset their parents by having separate ideas, if they did the right thing, etc. They become confused when the thoughts they have about themselves are different from what they know their parents believe. “What is true and real about me?” becomes the question that these patients bring to therapy.

“Sam” came to see me filled with anxiety. He didn’t know if he should continue in a relationship that was becoming serious. “I think I’m in love with Kara,” he said. “We have a really good time together, and she is very good to me. But then I get confused: Do I really want to spend my life with her? My father thinks she isn’t a good match for me. She’s Italian, and I’m German. I never really thought about things like that, but my father thinks that the cultural differences are too much. He also thinks that Kara’s family is very different than ours and that will be a problem when we have a family.” Sam continued to describe his uncertainty about how he felt and what he should do. I asked him if he thought he would be less unclear about Kara if his father approved. It was striking to me that this question seemed to startle Sam. It hadn’t occurred to him that his father’s opinion about what was good for him had such a profound influence.

Sam agreed to begin therapy, and we began to explore how he thought about himself and how he determined what he wanted and needed. It soon became apparent to both of us that Sam’s father had always played a big role in characterizing who Sam was. Sam recalled that he wanted to take guitar lessons when he was about 10. His parents bought him a guitar, and he liked strumming it and learning to play, but he had trouble with dexterity and was not developing into a very good player. After about six months, his father told him, “You’re not very musical. You should find a different hobby. You should try chess; you would be good at that.” Sam recalled: “Even though I enjoyed playing and fooling around on the guitar, I stopped the lessons. My father started to teach me chess. I did get pretty good at it and joined a chess club in middle school. My father always says with great pride how he knew I would love it because I’m such a rational and logical person, that chess is perfect for me.” Sam paused and thought a minute and said, “It’s funny, I never thought about this before. I think of myself as a logical guy, but then I never know what to make of all the feelings that seem to boil up in me. My parents don’t see me as emotional.” Sam paused again, seemed deep in thought, and then sadly said, “Wow, I guess I hide that part of myself from them. They don’t really like emotions.”

As Sam and I continued to talk, he became increasingly upset as he began to discover that much of what he thought about the kind of person he was mirrored his father’s view of him. He also began to realize that there was a judgmental attitude when his father told him what he thought. For example, his father still believed that Kara was not for him. His father had explained, “You’re not someone who can deal with opinionated people. She is too aggressive for you.” Instead of becoming confused and wondering if his father’s idea was true, Sam began to consider his own experience. He was learning to ask himself what was happening in his internal life and to study what went on externally. He thought about Kara and her opinions and realized that many of her ideas were different from those of his parents. But he also saw that she was flexible and, in fact, he often agreed with her. As he was more able to focus on himself and create some space apart from his father’s influence, he could consider how he felt. He didn’t feel conflict with an opinionated Kara. Rather, he was becoming aware that he disagreed with his father. This was not an awareness that he allowed himself to experience very often. It made him anxious, but now he second-guessed his experience less, and he was beginning to make space for his separate feelings and ideas to emerge.

Sam and I still have work to do. He is working on his relationship with Kara. As he develops the ability to know what he wants and feels, he is more able to express himself to Kara and that relationship is getting stronger. Sam continues to work on individuating from his father. After 30 years of relying on him to define and characterize who Sam is, it takes time to develop confidence in his own thoughts and feelings. There is still anxiety for Sam when he asserts his newly found voice with his father. Sam has recognized that his father’s judgmental tone has made it difficult for him to feel that his own perspectives are valid. His memory of his father telling him, “I’m your father and I know what you like and what is best for you” no longer feels just about his father’s love and concern. Sam is beginning to understand that his father is anxious, too, and that it is his anxiety that drives him to try to control Sam and to believe that he knows what’s right. Hopefully, as Sam’s sense of identity becomes more solid, he will be able to negotiate the relationship with his father so there will be room for multiple thoughts, feelings, and perspectives.

Well-intentioned parents who are critical and controlling may promote their child’s reliance on them to determine and define what is good and acceptable about the child. When a loving parent is so certain that he or she knows what is right for the child and does not consider that the child may have valid, different ideas about what he or she wants, needs, and feels, there is no space and no invitation for the child to develop the ability to express his or her own self with separate ideas, feelings, and needs. Over time, as the child grows to adulthood and is exposed to more ways of thinking about things, there is typically a good deal of confusion about identity, thoughts, and feelings. Unless there is an opportunity to develop a separate sense of self, there will likely be a lot of anxious thinking about what is real but little ability to think for oneself in a self-reflective way.

GoodTherapy | Scared to Eat: Conquering Anxiety Around Food AllergiesEating brings pleasure, energy, and well-being to our lives. A disruption of this simple, often mindless, but important activity could lead to stress and anxiety.

People who have food allergies have to be extra careful about what they eat. A simple ingredient such as eggs or nuts could ruin a meal by causing hives or wheezing, and, in extreme cases, cause a reaction so severe that an epinephrine injection is needed to save the person from a life-threatening condition.

Food intolerances, or adverse reactions to specific foods, can also cause harm to a person, but generally lead to minor symptoms such as diarrhea or stomach cramps, according to the National Center for Biotechnology Information website. Celiac disease, for example, is not a food allergy but rather an autoimmune issue. People with celiac disease who eat gluten experience health problems as a result.

Elika Kormeili, a therapist specializing in food-allergy issues and founder of the Center for Healthy and Happy Living, says that she has suffered from food allergies and knows the stress and anxiety they can cause. She says certain social situations that involve food, such as birthday celebrations or work lunches, can be so stressful that people with food allergies might avoid them entirely.

“Sometimes children with severe food allergies (life-threatening) are so scared of being exposed to an allergen that it impacts their ability to participate at school,” Kormeili said. She goes on to say that “Food is a huge part of our socialization and when you are limited in what you can eat, it definitely causes anxiety.”

[fat_widget_left]Food allergies may lead to anxiety, but anxiety may or may not lead to issues with food allergies. Kormeili said stress and anxiety can weaken the immune system to the point of aggravating food allergies. People with food allergies might also experience changes in mood and behavior. Sometimes just getting on a diet to eliminate allergens improves mood, decreases irritability, and allows for better concentration.

She has the following tips for coping with food allergies and the anxiety that sometimes follows:

Stacey Antine, a registered dietician and author of Appetite for Life: The Thumbs-Up, No-Yucks Guide to Getting Your Kid to Be a Great Eater, says that the most important part of alleviating anxiety associated with food allergies is having direct control over the food you’re eating. She encourages growing, harvesting, and cooking your own food. She is the founder of HealthBarn USA, which hosts workshops and other programs on a family farm to help kids and adults understand the importance of natural, healthy food.

She suggests cooking your own food, talking to servers at restaurants to get more information about the preparation and ingredients included in foods, carrying safe snacks to eat just in case, and informing others of your diet restrictions in advance so they can accommodate you. “Cook your own food and rely less on packaged foods. It’s better for your overall health…Also, yoga and at least 20 minutes of meditation daily will help reduce anxiety,” Antine said.

Laurinda Kwan, a naturopathic physician at Arizona Natural Health Care, says that she decided to focus on treating seasonal, environmental, and food allergies because of her own suffering from food allergies and eczema. “If you repeatedly have adverse reactions to your food, just like Pavlov’s dogs, you develop a learned response,” says Kwan. She goes on to say, “We are not born having anxiety to foods. However, over time, if eating food consistently produces unfavorable feedback (e.g., hives, itching, stomach pain), your learned response is going to be that of fear or anxiety to foods.”

She believes that in some cases anxiety itself could create food-intolerance issues. For example, when a person experiences anxiety, sometimes he or she also has gastrointestinal problems such as bloating, abdominal pain, and diarrhea. “If the gastrointestinal tract is compromised, this could lead to intestinal permeability (or ‘leaky gut syndrome’). When the intestinal lining is compromised, substances pass through the lining of the small intestine that normally should not pass into the blood stream, and your body creates an immune response,” Kwan said. She said to keep in mind that there is some debate about leaky gut syndrome, and more information needs to be gathered.

Kwan’s suggestions for alleviating anxiety associated with food allergies include talking to a homeopathic doctor who can treat the whole person, not just immediate physical symptoms. She also said it’s necessary to pay attention to food labels to avoid allergens.

Anxiety is not the only mental health issue associated with food allergies. Kwan said depression could develop as a result of living a restricted lifestyle. Also, because people with food allergies have a tendency to focus on what they do or don’t eat, in some cases eating disorders can develop.

GoodTherapy | Can Social Anxiety Be Caused by a Nutritional Deficiency?If you don’t get the right nutrients, your body won’t function to the best of its ability. Some general health conditions can be linked to nutritional deficiency, but it’s up for debate whether the same applies to specific mental health conditions. Some nutrition experts do claim that unique cases of social anxiety can actually be caused by a nutritional deficiency. In the condition several experts refer to as pyroluria, once the nutritional deficiency is taken care of, the social anxiety is relieved. Other experts are quick to dismiss the validity of this diagnosis.

Trudy Scott, a food-and-mood expert who said in an email that she has suffered from pyroluria, is a certified nutritionist, immediate past president of the National Association of Nutrition Professionals, and author of The Antianxiety Food Solution: How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood and End Cravings.

“The person experiences shyness, inner tension, and social anxiety,” Scott said in regard to symptoms of pyroluria. “Symptoms usually start in childhood and are made worse under stressful situations. The wonderful thing is that the symptoms can be completely alleviated with taking these supplements: zinc, vitamin B6, and evening primrose oil. People typically start to feel less anxious, less shy, and more social within a week. The important thing is that if you do have pyroluria, you do need to take the supplements always.”

Generally only zinc and Vitamin B6 are recommended for pyroluria, but “gamma-linolenic acid (GLA), found in evening primrose oil and borage oil, is also beneficial for those with pyroluria because its levels are often low, and supplementing with GLA improves zinc absorption,” she added. In her book about anxiety, mood, and food, she wrote a whole chapter about pyroluria.

“I am … very passionate about the subject because I have pyroluria myself and used to suffer terribly from social phobia and shyness, anxiety, unexplained fears, waking with a sense of doom and even panic attacks,” Scott said. “I have used the amazing healing powers of foods and nutrients to completely heal. I now help women find natural solutions for anxiety and other mood disorders.”

She has posted a questionnaire on her website for pyroluria. It includes a long list of symptoms, and if 15 or more items are checked on the list, it is likely a person has pyroluria: http://www.everywomanover29.com/blog/pyroluria-questionnaire-from-the-antianxiety-food-solution/

She said that in research studies, pyroluria is also called “the mauve factor.” “Much of what we know about pyroluria is based on the work of Humphrey Osmond, Abram Hoffer, and Carl Pfeiffer,” Scott said. “Much of the original work was done with schizophrenic patients in psychiatric hospital settings. Although pyroluria was first identified in the 1960s, the medical and mental health communities have been slow to recognize it, and many mental health practitioners and physicians remain unfamiliar with this condition.”

She said she learned about the condition mainly from reading the following books:
The Mood Cure by Julia Ross
Depression-Free Naturally by Joan Mathews-Larson
Nutrition and Mental Illness (1988) by Carl Pfeiffer

Her own book goes into the specific details and biological/chemical/genetic aspects of pyroluria. In her book, she cites research prevalence rates from Joan Mathews-Larson, the author of Depression-Free Naturally. Pyroluria is thought to exist in “11 percent of the healthy population” and “40 percent of adults with psychiatric disorders,” according to Scott’s book. For people with alcohol addiction, pyroluria is thought to have a 40% prevalence rate. However, the prevalence rates do depend on the source. In her own experience as a nutritionist, Scott said about 80% of her clients who have moderate to severe anxiety have symptoms associated with pyroluria.

She added that stress can be a major factor for what age pyroluria develops and that it is a genetic condition that seems to affect more women than men. In addition, people who have pyroluria tend to also have gluten sensitivity, especially if they also are dealing with other issues like depression, anxiety, autism, alcoholism, bipolar disorder, and schizophrenia, according to the book. People with pyroluria may also have digestive problems, and they need to make sure to balance out an increased Vitamin B intake with a higher intake of magnesium.

In the book The Mood Cure by Julia Ross, the author includes a discussion of the prevalence, testing, and treatment of pyroluria, as well as a checklist similar to that offered by Trudy Scott. Ross states that the questionnaire was developed by Dr. Carl Pfeiffer, a clinician and researcher. He wrote the book Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry in 1988.

Ross states in her book that pyroluria is fairly uncommon in the general public, but in certain groups of people (like those who have experienced alcohol addiction), it is more common. “I am just getting familiar with this condition, but I can see that it is an important one for certain people, affecting stress levels and mood generally and preventing full response to nutrient therapy until it is addressed,” Ross wrote in her book.

There are a plethora of articles dedicated to nutrition, diet, and mental health in general, as well as multiple research studies suggesting that certain mental health issues can be improved through natural supplements and a healthy overall diet. “Notably, essential vitamins, minerals, and omega-3 fatty acids are often deficient in the general population in America and other developed countries and are exceptionally deficient in patients suffering from mental disorders,” according to an abstract from a research study in Nutrition Journal. “Studies have shown that daily supplements of vital nutrients often effectively reduce patients’ symptoms.”

Another abstract from a research article in the journal Alternative Therapies in Health and Medicine concludes the following: “Many patients will benefit from the use of specific dietary supplements, such as a multivitamin-mineral high in B vitamins and omega-3 fatty acid,” according to the abstract. “And no matter what the underlying cause of the mood disorder, patients should be counseled about the relationship between food and mood, for the evidence now substantiates what laypeople and medical professionals have long known intuitively: the way we eat affects the way we feel.”

The research, authored by Tieraona Low Dog, director of the fellowship at Arizona Center for Integrative Medicine at University of Arizona, added in the research abstract that the healthiest diet for improving mental health is a “low-glycemic, modified Mediterranean diet rich in fruits, vegetables, whole grains, and seafood (if not vegetarian) and low in processed, refined foods.”

Other experts remain unaware of the condition and are skeptical of its legitimacy. Scott Carroll, a psychiatrist with dual board certifications in adult and child and adolescent psychiatry, said in an email that he is not accustomed to pyroluria and had to look it up on Google to find out what it was.

“Once I saw that it is connected to orthomolecular psychiatry, which I have heard of, I knew it was in the pseudoscience realm,” said Carroll, who is also an assistant professor at the University of New Mexico School of Medicine. “Not surprisingly, it claims to be the cause of a number of unrelated psychiatric disorders, which is typical of pseudoscience disorders. Like so many ‘cure-alls,’ it sounds plausible, but there is no scientific basis to it, and it allows dubious practitioners to prey on desperate, suffering people.”

He said there are certain cases where nutrition can play a part in mood and mental disorders. “Inadequate amounts of Omega 3 fatty acids, especially from fish or krill oil, have been shown to affect mood and anxiety in a broad way of which social anxiety can be a part,” Carroll said. “Also, low folate, low Vitamin D, and low B12 have all been associated with negative effects on mood and anxiety.”

“However, in people with low folate, it is more often a case of a genetic inability to transport the folate molecule into the brain rather than a low blood level,” he added. “In those cases, which often present with chronic depression and anxiety that has never responded to antidepressants, there are folate precursors that are more lipophilic and can diffuse into the brain without use of a transport mechanism.”

Nerina Garcia-Arcement, a licensed clinical psychologist and clinical assistant professor at the NYU School of Medicine, said in an email that she didn’t study pyroluria in school and hasn’t read about it in any research studies after graduating from her doctorate program.

“Based on current knowledge it does not appear to be a legitimate health condition,” Garcia-Arcement said. “Further research is required to further explore and understand whether social anxiety or any other mental health condition could be related to improper synthesis in the blood.  Although this theory seems appealing, being able to ‘cure’ a mental disorder with vitamins or supplements … is unlikely.”

“Causes of social anxiety that have been substantiated by research include chemical imbalances in the brain (i.e., serotonin, a neurotransmitter), inherited traits (genetic and through observing anxious family members), negative life events or experiences, and an overactive amygdala (a part of the brain that controls emotions, including fear response),” she added.

She said that good nutrition is important for overall health, but it’s not necessarily linked to mental disorders. “In my experience, the social anxiety could be traced to other causes, not nutritional deficiencies,” Garcia-Arcement said. “Having a healthy and balanced diet is overall beneficial, but it won’t cure social anxiety or a mood disorder. I am more likely to recommend my clients get enough sun exposure to improve their moods (seasonal affective disorder) than recommend diet changes.”

Related articles:
Social Anxiety Can Be a Hidden Problem in College
Breathing Lessons
The Birth of Anxiety

Young person meditating in natureIn counseling, many of the ways to address anger can also be used as tools to address anxiety. Deep breathing is one such tool. Getting that full, deep breath of oxygen will indeed help both our mind and body. Sadly, we may not stop to focus on our breathing or take in enough of that good oxygen. Furthermore, in times of distress, rapid breathing is more likely and will not help the thinking process or our ability to calmly make decisions.

When I sit in session and show clients that taking that breath is a bit more than a second or two process, they seem confused. Yet nearly everyone reports feeling remarkably calmer after trying it. Personally, I like to close my eyes so I am not focused on what is around me. Imagine as you take in that full breath through your nose that you are soaking in positive energy. Hold it a second or two, and then slowly breathe it out through your mouth. This is not a race. In fact, try to expel it slowly. Slowing down your breathing will mean you are slowing down your mind and body.

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Now, in the process of this deep breathing, let’s add some guided imagery. For this, think of a calm place. I would like this to be somewhere you feel relaxed and positive. For me, it is the beach. I want you to see yourself there without having to focus on where else you may need to be or other things you may need to be doing.

Experience as many of the senses as possible. For example, sitting on the sand, I can feel it between my toes. I can feel the warmth of the sun on my arms. I can smell the cool beach air and the scent of suntan lotion, and I can hear the gentle crashing of the waves and even children playing off in the background. I can also see the beauty of the area, as I watch the birds in the distance over the water. The beach is a calming place for me, so as I take in my deep breaths, I imagine soaking in the warmth and wonder of it, even as I am in my car, home, or wherever I am practicing.

The more senses you can envision, the easier it is to remain focused in the moment. Some people choose amusement parks or other loud venues. That’s okay as long you can focus and keep to your steady breathing pattern. The goal here is to consciously and intentionally slow our minds down while adding these positive and relaxing components. When asked if you should practice this when anxiety is creeping up, I say to try and practice these tools at least a few times a day. I don’t want you to have to wait until the anxiety is noticeable. Rather, if we are practicing relaxation, we will not only be in a better position to deal with it in those moments, but hopefully even fend some of it off in the first place via a calmer, more relaxed you.

Your mind is indeed a powerful tool. We hear about sharpening it with memory exercises and such to enhance our cognitive skills, but what about teaching it to relax? We live in a fast-paced society where expectations can be massive and relaxation is not taught in school. Rather, we learn how to be better students and thus more successful human beings. You need to teach your mind and body to calm down and be okay with relaxing once in awhile.

 

GoodTherapy | Breathing Lessons for Coping with Grief

We breathe all the time, right? So, what’s the big deal?

Most of us are not breathing properly throughout our days for optimum health and well-being. Most of us have poor posture, we sit at our desks for long periods of time, slump in our seats, stare at screens, move very little… This is a problem for much of the population.

If grief is added on top of those bad habits, our situation becomes even more difficult. Grieving on its own makes us feel like we want to be slumped down, curled into a ball. It makes us want to protect our hearts. The chaotic yet static state sometimes even stops our breath entirely. If you are grieving, you may notice that your breathing is very shallow, or that you are holding your breath without even realizing it. You may suddenly find yourself gasping for a breath, as if you’ve been under water, reaching for the surface. This is not abnormal in grieving. Grief affects every part of us, including our breathing. Here is your chance to learn to breathe through grief.

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Finding a quiet time at any point in your day to simply breathe can be a wonderfully healing tool. Anytime you notice that you are feeling anxious, particularly tired, or that you are holding your breath, take a moment—right then and there—to breathe.

Stoplights make good cues to practice your breathing as well. In addition to helping you notice your breath and serving as reminders to practice your breathing exercises, breathing at stoplights can help to counteract the stress we experience when we are confronted with the stress of the rest of the world—other drivers, traffic jams, errands that must be run—while we are in the midst of our grief. Inside your car, you can create a space of calm and peace simply with your breath. Practicing your breathing, and any other coping techniques, when you are calm, helps you be able to put them to use when you need them, such in the midst of anxiety or a panic attack (also not uncommon in grief).

Additionally, noticing your breath and increasing your use of breathing practices can also help you to become more mindful of your own thoughts and feelings, giving you a sense of control and stability in an otherwise incredibly chaotic time of life. The more you notice how you feel, what your thought patterns are, how your body is affected by your responses to the world around you, your grief experience, your thoughts and feelings, the less out of control you can begin to feel. A greater sense of calm and control can help you along your healing process.

Many people are told, “Take a deep breath.” But in my practice, I have found that when I ask people to show me how they take a deep breath, they often suck in their stomachs and fill up their chests. This is actually the opposite of deep breathing. Breathing this way restricts our lungs’ ability to take in oxygen and to release carbon dioxide. The result is an excess of CO2 in our bodies. Not inhaling enough oxygen and failing to exhale enough CO2 can create fatigue, mental fog, and decreased tissue function. For a grieving person, this can intensify many of the normal grief reactions that we go through as part of the grief experience. Breathing deeply and fully can be a helpful tool to decrease stress, increase clarity of thought and help to counteract fatigue. Not only that, but chest breathing stimulates our sympathetic nervous system—our fight or flight stress response. Think about it: When we are startled, what do we do? We open our mouths with a sharp intake of a chest breath. This alerts our brains that there is a danger. Breathing into our chests stimulates the very response we are trying to counteract. Learning to take deep belly breaths is essential to decreasing anxiety and getting more oxygen to the brain.

Read on to learn some simple but truly effective breathing exercises to decrease anxiety, clear your mind, and counteract some of the natural symptoms of grief.

Breathing Exercise: Just Breathe

This is an exercise in simply noticing your breath, helping you to become more aware and mindful of your own breath as it moves in and out of your body.

Breathing Exercise: Simple Deep Breathing

For this breathing practice, sit in a comfortable position with your hands relaxed, either in your lap or resting on your thighs or knees. Then begin.

Breathing Exercise: The Three-Part Breath

The three-part breath is a specific breathing technique used in many yoga practices and can be very useful in times of stress or whenever you need to relax. This type of breathing triggers your parasympathetic nervous system or the “relaxation response” (the opposite of the fight/flight stress response) and allows your body and mind to more easily release stress and tension. It is physiologically impossible for your body to be in a stress mode when you practice the deep three-part breath.

Obviously, you can’t breathe this way all the time, but when you do, it can help you think more clearly and decide on another coping skill or something else you can do to move away from the anxiety you may currently be feeling. Or you may decide to use the breath to sit with the pain of grief. This is okay too. Calmness in the midst of pain can help us know that we can survive the next moment, and then the next.

If you feel dizzy or lightheaded while practicing the three-part breath, or any other breathing exercise, stop the practice immediately and allow your breathing to go back to normal. Sometimes if we are not used to a great deal of oxygen, the change can cause lightheadedness or dizziness. Know your own body and be mindful of the changes you notice.

I hope that these breathing lessons may help you through your grief journey and beyond. Just breathe.

AdobeStock 649290748Healthy conflict resolution is essential to maintaining positive and constructive adult relationships. Individuals usually learn how to handle conflict in childhood. Children watch the way adults work through disagreements and model those patterns of behavior as they develop into adults and begin to form relationships with others. The bonds that children have with their caregivers also influence the way in which they address conflicts. People who have secure attachments with their parents and caregivers are often able to work through challenges with other people in respectful, affectionate, and loving ways. They are capable of recognizing when they need to ask for forgiveness and are willing to compromise to achieve a resolution that is mutually satisfying to all involved. Individuals who have insecure attachments, however, are often unable to handle situations as amicably. Insecure attachment can be expressed through avoidant or anxious behaviors. People who are avoidant in nature tend to withdraw and shut down when faced with conflict. Anxious individuals may demand attention, even negative attention, and use aggressive and hostile tactics to engage someone in a conflict dispute.

For children who have grown up witnessing dysfunctional conflict resolution strategies, having a secure attachment with others could help them avoid making the same mistakes of their parents. Rather than continuing the negative behaviors they have seen displayed by their own parents, these secure, self-reliant, and confident people may choose to use healthier mechanisms to maintain harmony in their adult relationships. Joyce A. Baptist of the School of Family Studies and Human Services at Kansas State University wanted to better understand how attachment style affected emotional processing learned in families of origin. She enlisted 203 young adults who had been raised in families with various emotional functioning styles for a study that evaluated how the adult children managed conflict.

Baptist found that the participants who had witnessed extreme disengagement in childhood were more likely to use aggressive and antagonistic disagreement strategies in adulthood. The most anxiously attached individuals in this group were the most apt to engage in hostile behaviors as their anxiety escalated. Those with minimally avoidant styles worked through disagreements in a more civil way. Baptist believes these results suggest that secure attachments can help protect individuals from dysfunctional and destructive conflict resolution patterns. These findings could impact how professionals assist people who have communication and compromise problems in their adult relationships. She added, “Considering the interrelations between emotional processing in families of origin and insecurities in attachment will allow therapists to better identify and treat the root of the destructive conflict behavior.”

Reference:
Baptist, J. A., Thompson, D. E., Norton, A. M., Hardy, N. R., Link, C. D. (2012). The effects of the intergenerational transmission of family emotional processes on conflict styles: The moderating role of attachment. American Journal of Family Therapy 40.1, 56-73.

Vintage photo of young woman relaxing with her dogIf you want to make God laugh, tell him your plans.
-Woody Allen

No matter who you are, things will happen that throw you off-kilter. Life intrudes on inner peace with an uncanny regularity. It may be your boss, spouse or partner, children, house, parents, finances, health, or even a freaky weather event, but life has its own trajectory, and no one can know what new challenge awaits.

Luckily, there are many ways to regain equilibrium. Trial and error, plumbing your depths to see what really works for you, and discerning the differences between various situations that trigger your sympathetic nervous system—your fight or flight reaction—are all very helpful in developing an emotional first aid kit.

When you find you have strayed from your center, allow the imbalance. Just notice what is going on emotionally, physically, and mentally. What are you telling yourself about this experience? Are you ready to regroup, or do you need a bit more time to explore what is happening? Sometimes, the hardest thing is allowing yourself to totter emotionally, to grieve or feel angry, overwhelmed, or exhausted. Whatever is happening, it won’t last.

Ten Tips For Emergency Emotional First Aid

Since it is easy to get thrown off-kilter when you are shocked or surprised by unwelcome news, you may want to try these techniques as first responses:

  1. Take slow, deep breaths, and allow a little extra time to exhale.
  2. Remind yourself that this, too, shall pass.
  3. Allow space for all of your feelings.
  4. Have faith in yourself. The truth is that you can handle more than you might believe at this particular moment. You can use prayer or meditation for added support and to access your belief in a greater power.
  5. Don’t take anything personally.
  6. Try to stick with your routine, even if you are feeling dazed or numb. Having a routine will anchor you.
  7. Eat, sleep, and get some fresh air.
  8. Picture your 6-year-old self, and lovingly embrace that child. Gently reassure the frightened little being inside.
  9. Connect with someone, such as a friend or family member, a therapist or neighbor, even a stranger on a local hot line.
  10. Understand that you are here for everything, good and bad. Visualize yourself as a river of experiences, and let life flow without judgment.

Reading this list takes only a few minutes, but actually working through each item builds resiliency and will help you keep going, one second at a time. Sometimes, just existing during a traumatic experience is the best you can do and remembering that as time passes, your perspective will change. For now, it is best to accept the present, do what you can, and choose to believe everything is happening for your highest good.

If or when you are ready to re-center, reach out to a trusted friend, relative, clergy person, or therapist. Speak honestly and openly. Being heard and understood is one of the most bonding, loving, and freeing experiences you can have, but you have to ask for help. If this has been hard for you in the past, break out of your old rut of being super-independent and pick up the phone. Find a therapist in my area.

If company doesn’t fit the bill, try some solitude. Silence can be soothing and afford you the opportunity to integrate what you have experienced. If that feels overwhelming, try a guided meditation. There are numerous free podcasts on iTunes, like Meditation Oasis, A Quiet Mind, or The Meditation Podcast. If you have the time, try a soothing Yoga Nidra practice—this is a guided practice of yogic sleep, where you are in the liminal space between waking and sleeping, and involves no knowledge of yoga postures. (My favorite is available free from iTunes through Elsie’s Yoga Podcast, episode #62.)

Take a bath with Epsom salts and lavender oil. The magnesium sulfate in the salts will quiet any muscle tension, and the essential oil—about six to eight drops—will calm your mind and act as a pain reliever.

Read something inspirational. Try some poetry, or escape with a novel. Reading is both relaxing and engaging. If audio books work better for you, check some out from the library and download them to your iTunes so you’ll have a ready supply.

Music really can soothe the savage breast, as the playwright William Congreve suggested in the late 17th century. Find something that works for you: it may be hard rock, or hemi-synch. Sanskrit chants can be remarkably helpful, as they bathe you in mantras designed to calm your nervous system. Chanting them yourself will bring even greater benefits, as making the sounds activates different parts of the mouth that correspond to different areas in your brain. The simplest one is om, a sound that is said to embody all sounds.

Moving your body takes the kinks out emotionally, too. Even if the last thing you feel like doing is dancing, yoga, or taking a walk, just do something for five minutes as an experiment. If you feel better, do another five minutes.

Allow nature to work its magic. Dr. Samuel Hahnemann, the father of homeopathic medicine, wrote that eating well, sleeping enough, and getting fresh air are essential to good health, mentally and physically. Don’t underestimate their value.

Rebalance with a favorite ritual, like making yourself a cup of tea and sipping it slowly.

Unhappy man holding faceBad person feelings typically develop early in life. Although it may not be intended, children can get the message that it isn’t simply what they do or think or feel that is bad, but that they themselves are bad.  When these feelings are communicated, verbally or nonverbally, children soon learn to avoid them by working very hard to please and not disappoint parents. They may try so hard to be good (i.e., to be the child the parent expects), that they have little room to develop their own unique selves.

The Experience of “I Am a Bad Person”
When parents yell at their children or verbally or physically abuse them, we can imagine that this might frighten, shame, humiliate, or terrify a child.  But parents can also respond in more subtle ways that can damage a child. When a parent expresses hurt or disappointment by a sigh, a look, crying, head shaking, or leaving the room, the impact can be devastating: “How can I have done this to my parent? I must be a terrible person.” When the parent’s displeasure is expressed as hurt, it is especially difficult for the child to mobilize a strong sense of self and fight back.  The parent’s hurt is evidence that the child is a bad person. It then feels necessary to always please others and behave in ways to avoid the “I am a bad person” feeling.

People Pleasing
In my practice of psychotherapy, I frequently work with patients who have a strong desire to please. They often come to therapy when they find that their anxiety about pleasing others is having a serious impact on their lives.  Worry and rumination about whether or not someone “likes me” characterize most relationships.  Their concern is not only about the feelings of significant others; coworkers and casual acquaintances can create as much worry about being liked as a parent, spouse, or boss.
The focus on pleasing others interferes with developing the ability to consider what would be pleasing to oneself.  Alan came to therapy struggling with what to do with his life. At the age of 29 he wasn’t sure how much he really liked the woman he was dating. He felt he couldn’t trust his feelings. He also had doubts about his job and couldn’t figure out if he was being realistic in what he wanted. He reported that he was tired of trying to keep his girlfriend and his boss happy.  He wasn’t comfortable telling them what wasn’t working for him and he worried that he was too demanding. As is typical with people pleasers, he frequently second guessed himself and questioned what his true feelings were.  Alan spent so much time avoiding displeasing others that he hadn’t developed a sense of who he was, what he wanted, and how to get it.

Disappointment
When struggling with bad person feelings, experiences of disappointing and being a disappointment are prominent. My patient Diane often described how she felt a pit in her stomach or on the verge of tears when she thought she disappointed someone. But what was totally intolerable was when she felt she was a disappointment. She recalled that her mom would look sad and hurt and shake her head when Diane refused to wear what mom had chosen for her. She told me that it wasn’t simply that she felt that her behavior had hurt and disappointed her mother. Tearing up, she said “I felt that I am a disappointment and it felt like that defined my very essence.”
Diane also would become very anxious when she felt that someone disappointed her. She felt she had no right to such feelings and believed she was wrong or exaggerating if she allowed herself to feel that way. She told me “If I let my husband know some of the things that trouble and disappoint me in our relationship, I will hurt his feelings. Then I will feel terrible, that I am a bad person.”  What Diane described is her fear of asserting herself:  someone could get hurt and this will be proof of her badness.

The Tenacity of the Bad Person Feeling
Both Alan and Diane were overly attentive to pleasing others, not disappointing, and protecting themselves from bad person feelings. Both found it difficult and dangerous to please themselves, believing that if they focused on their own needs, they would create hurt and disappointment in others. Both worked to maintain a positive self-image by vigilantly trying to be sure that they never were experienced as having negative impact.
For people who struggle with bad person feelings, the most important goal in relationships is not so much to be related to with positive regard as to avoid negative regard. As a result, whatever positive regard is directed toward people pleasers tends not to be taken seriously.  Alan explained: “I know I bend over backwards to make sure no one is upset or angry or displeased with me. So when people like me, deep down I don’t give it much credence. Sometimes I think I am always acting.”  The point here is that the bad person feelings continue to define the person and are not easily changed by experiences of positive regard from others.

Changing the Bad Person Feeling
The bad person feeling typically digs its claws into the internal life of those who suffer with it.  It feels real, inevitable, and a fundamental part of “who I am.” The feeling defines how one thinks about the self and typically was developed through early relationships with significant others.  As one develops, many relationships mirror the dynamics of the parent-child relationship where the aim is to avoid hurting the other and to not feel like the bad person. Reflecting on these feelings, it is not so easy to consider that a parent, even without intention, was involved in the development of these terrible feelings. If that were to be accepted, it would mean accepting that I am the hurt one. This perspective turns the way the world has been understood upside down. With such a radical shift in thinking needed, how can these feelings be diminished?
You have to be willing to consider alternative ways of thinking about your early experience. Thoughts that once made sense have to be reflected on and reconsidered.  Even if at first, you can’t emotionally accept a new way of thinking, it is important to start by logically considering what you believe about your experiences, perceptions, and feelings. It will be important to become aware of how many of your relationships mirror the anxieties you felt (and feel) with your parents.
Objectively, you may be able to consider that children do no wrong even if a parent feels hurt when they have independent thoughts or don’t do as the parent asks. Can you apply this thought to yourself?  Can you become aware and intellectually accept that as humans in relationships, we all hurt those we love in unintended ways and that this does not make us bad people? Coming up with new ways of thinking about old assumptions is an important beginning in changing bad person feelings. However, it is not enough. To accomplish a change in your definition of self, from the bad person who is a disappointment to a good enough person who doesn’t always please and can disappoint from time to time, requires an emotional shift internally. Therapy is one means of facilitating this shift. Another means is to gradually use your rational thoughts to urge yourself to risk responding honestly.  By this I mean, it becomes necessary to first remind yourself “Yes, I am human and it is okay to express my own unique thoughts even if they are different. I know someone could respond negatively but this doesn’t mean I have done something wrong.”
This takes time. As you repeatedly risk the possibility of making a negative impact by asserting your separate thoughts and feelings, your tolerance for anxiety, risk taking, and bad person feelings will increase. You need to be able to gradually tolerate situations where you do hurt someone. The goal is to increase the experience of being yourself in relationships and learn that typically, you will not hurt the other by being a separate, individuated self. This lesson is crucial.  Most important is the emotional registering of the other person maintaining their acceptance, love, and admiration for you, even when they feel you have hurt, disappointed, or made them angry. This is the emotional experience that will finally lead to change. The end result is that your tolerance for the other’s feelings of anger, hurt, or disappointment are increased and the bad person feelings are diminished.

Related articles:
The Fear of Hurting the Other and the Inhibition of Self
The Price Paid for Being the Perfect Child
Getting to Know (and Esteem) Yourself

A young woman with a sad look on her face talks to her therapist.Psychotherapy is the first form of treatment for depression or anxiety and involves a variety of treatment techniques. During psychotherapy, the person experiencing depression or anxiety speaks with a licensed psychologist or therapist who helps him or her to identify and work on the causative factors. These factors trigger depression or anxiety by working in combination with chemical imbalances in the brain or heredity factors.

Psychotherapy helps people with depression or anxiety in the following ways:

Although psychotherapy can be performed in different ways, such as individual, family, and group therapy, there are also different approaches that psychotherapists can use to provide therapy. After having a brief talk with the client, the therapist will decide on the approach to use based on the underlying factors that contribute to the person’s depression. Many therapists specialize in one or more specific techniques or approaches. These different approaches to psychotherapy include psychodynamic therapy, interpersonal therapy, cognitive behavioral therapy, and solution focused therapy.

Psychodynamic Therapy
This therapy assumes that the person is depressed due to unresolved, unconscious conflicts that often stem from childhood. The goal of this therapy is for the person to understand and cope better with these feelings by talking about such experiences. Psychodynamic therapy usually takes place over several months and can produce excellent results.

Interpersonal Therapy
 Interpersonal therapy mainly focuses on the person’s behaviors and interactions with family and friends. The goal of this therapy is to enhance self-esteem and improve communication skills during a short period of time. This therapy usually lasts for 3 to 4 months and works well for depression caused by social isolation, mourning, major life events, and relationship conflicts.

Psychodynamic therapy and interpersonal therapy help people resolve depression or anxiety caused by loss or grief, role transitions (like becoming a parent or caregiver), and relationship conflicts.

Cognitive Behavioral Therapy
Cognitive behavioral therapy helps people experiencing depression or anxiety to identify and change inaccurate perceptions they have about themselves and the world around them. The psychotherapist helps the client to think differently by directing attention to both the accurate and inaccurate assumptions they have about themselves and others.

This therapy is recommended for the following types of persons:

Solution Focused Therapy
Solution focused therapy is a symptom-specific approach, which means it targets one or two stressors that are causing problems. The result might be helping the person find a better way to handle the boss at work or children at home. A person may simply learn techniques to handle anxiety. One therapist commented that solution focused therapy is like getting new tools in your toolbox to use immediately in your life, therefore helping you feel better quicker.

For an individual living with depression or anxiety, psychotherapy can promote better understanding of the condition and associated symptoms. For a person with depression, being able to talk with a psychologist or therapist who is there to listen, inquire, and help can be comforting as well as rewarding. After just a few sessions of psychotherapy, clients may feel a difference. Research suggests that three to five sessions often cause significant change. Talking through the issues can help identify behaviors and detrimental reactions or circumstances. Coping techniques can also be investigated during therapy sessions, and progress reports can be used to keep track of how these techniques work. For individuals experiencing anxiety or depression, being surrounded by loved ones or being encouraged to attend therapy sessions can provide immense support.

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.

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