Young man walkingPeople in their 20s seem to have it all: youth, energy, health, and looks. But they are also still figuring themselves out, and this time of change can bring certain mental health concerns as well. Experts have information on these issues that tend to impact people in their 20s, and provide some solutions for addressing and coping with these problems.

Clinical psychologist Dean Haddock, a marriage, family, and child counselor and the executive director and founder of Community Counseling and Psychological Services, points to a fairly common activity of 20-somethings that can lead to mental health issues if it’s not checked: alcohol and drug use.

“The first problem that leads to many others is alcohol and chemical abuse, which often leads to dependency,” Haddock said in an email. “The mental disorders that follow are often depression, anxiety, and brain injury. Of course, self-esteem and body-image problems often lead to eating disorders.”

Haddock gives three tips to help people in their 20s prevent and get through some common mental health concerns:

  1. Know your genetic history of mental disorders. Knowing is half the battle to avoid those disorders in yourself.
  2. Be choosey about your friends, as they will influence your decisions. Healthy friends lead to healthier decisions.
  3. Self-esteem is often the result of the people who matter to you. If they do not esteem you, then you will not esteem yourself.

Nerina Garcia-Arcement, a clinical psychologist and clinical assistant professor at NYU School of Medicine, suggests that the many life changes people experience in their 20s can cause mental health issues at times.

“Your 20s are filled with life transitions that can be stressful,” Garcia-Arcement said. “This is a time when young adults are solidifying their personalities, developing their independence from family, starting or finishing college, beginning new jobs, developing a career, forming romantic relationships, and learning to manage their existing family relationships and friendships within these context.”

“Individuals in their 20s don’t have a lifetime of experience to draw on when managing multiple life transitions at once,” she added. “When someone experiences these transitions, anxiety and depressive disorders can occur.”

Here are six of Garcia-Arcement’s tips to help people in their 20s cope with mental health issues more common to that age group:

  1. Seek out and form strong support networks.
  2. Seek out others who are going through similar experiences and share your feelings, whether you are feeling worried, nervous, scared, sad, confused, or excited.
  3. Know that you are not alone in your confusion about your career and relationships.
  4. Seek out mentors who have achieved their goals, and ask for advice.
  5. If you are feeling stress, sadness, or anxiety, engage in activities that will help you manage those feelings such as yoga, meditation, exercise, hobbies, social activities, relaxation exercises, and deep breathing.
  6. If you feel you are not getting the necessary support and feel overwhelmed or depressed, seek out mental health professionals who can help you manage the feelings related to your life transitions.

Stephanie Sarkis, a licensed mental health counselor, said in an email that anxiety and depression are some of the main mental health issues 20-somethings face.

“We have seen an increase in these issues due to the lagging economy and difficulties finding employment,” Sarkis said. “Many people in their 20s have moved back in with their parents, which can trigger feelings of failure and frustration.”

Dr. Maiysha Clairborne, a family physician and wellness and stress management coach, added in an email that eating disorders associated with body dysmorphic disorder and body-image issues are also common for people in their 20s. She has three overall tips for people in this age group:

  1. Talk to someone. The worst thing that a person can do when they are feeling depressed, anxious, or alone is to isolate more. Many times when we talk with someone we trust about what’s going on, we come to realize that we are not the only ones experiencing it and then we can get support.
  2. Get active. Staying physically active not only helps to keep the body fit but also helps release endorphins and serotonin in the brain, which help keep the mood elevated. Physical activity is also a good release for stress and anxiety.
  3. Minimize sugar and junk food. Sugar and processed junk foods can worsen the emotions of stress, anxiety, and depression because they cause erratic changes in your body’s blood sugars. This can disrupt the normal release of hormones in the brain that keep your moods stable.

Scott Carroll, a psychiatrist with dual board certifications in adult and child and adolescent psychiatry, said there are many issues specific to people in their 20s, including problems associated with medication use.

“Many people were on stimulants/meds for their ADHD when they were younger, but they thought it was okay to stop their meds when they were done with school,” Carroll said. “Now they are struggling at work and don’t know why. I’ve also seen young adults stop all kinds of meds like their thyroid meds because they didn’t know why they were even on it, and then they have all kinds of problems.”

Bad habits involving drug and alcohol use can start to become a major substance abuse issue when people are in their 20s, and other mental health issues start coming to the forefront at this time in peoples’ lives. Examples include bipolar disorder and schizophrenia. Also, panic attacks can start for people who have a genetic predisposition and who have higher amounts of stress associated with newfound adulthood.

“The 20s are an important time of social/emotional development,” Carroll said. “Unlike previous generations, identity formation often takes the entire 20s due to the complexity of modern society. It could be said that adolescence lasts until the early 30s in today’s society due to [prolonged] periods of education (grad school, law school, med school, etc.), lack of stable job options, and delays in getting married and starting families.”

Carroll, who is also an assistant professor at the University of New Mexico School of Medicine, suggests that when it comes to serious relationships and marriage, people in their 20s should consider how their choices could eventually affect their mental health and how their brain plays a part in their decision.

“Many 20-somethings are tempted to get married, but it is generally a bad idea because the brain in not done developing until about 25 [years old] … which leaves young adults vulnerable to having their rational mind be overwhelmed by their feelings or stress,” Carroll said. “Relationship choices often dramatically change from the early 20s to the late 20s, so many people find that the person that was perfect at 22 is a disaster at 27.  This can be an incredibly hard transition, to have to break up with your former soul mate that you thought you’d love for life because you’ve changed so much over the last several years.”

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Social Anxiety Can Be a Hidden Problem in College
How Schools Could Prevent Depression

Happy young girl with headphonesBinaural beat technology (BBT) was discovered in the early 1800s and first described in the popular literature in the early 1970s. In the last four decades, binaural beat audio programs have been touted as tools for reducing stress, improving sleep, enhancing concentration, and even fostering altered states of consciousness. In the ‘70s and ‘80s, BBT audiotapes were primarily found in more esoteric venues, such as New Age bookstores, health food emporia, and retreat centers dedicated to consciousness exploration. One such center, the Monroe Institute in Virginia, is well known for their use of Hemi-Sync recordings, which feature BBT.

Today, BBT has become more commonplace, as one can download MP3s and smartphone applications in a matter of moments. Although the prevalence and popularity of such products has waxed and waned, several studies examining the potential usefulness off BBT have been conducted with a variety of populations.

What is BBT?
The term “binaural beat” refers to the brain’s tendency to hear the difference between two similar tones that are played in opposite ears as one new tone.  Our ears hear tones in terms of hertz (Hz), or cycles (the number of times a wave repeats itself) per second. Beats played at frequencies that are characteristic of brain wave frequencies are both audible and thought to facilitate alterations in our predominant brain-wave state.

Types of Brain Waves and Their Associated States
At any given time, our predominant brain wave may be in the frequency associated with deep sleep or deep trance (delta; 1-4 Hz), meditation (theta; 4-8 Hz), relaxed awareness or daydreaming, (alpha; 8-12 Hz), a state of relaxed focus (low-beta, or sensorimotor rhythm [SMR]; 12-15 Hz), alert mental activity/concentration (mid-beta; ~15-18 Hz), anxiety (high-beta; >18 Hz), or high-level information processing (gamma; >30 Hz). Gamma brain-wave states appear to be the least well researched. There is no “best” state to be in; however, at different times we will understandably want to be able to shift into one that is appropriate to the task at hand, whether sleeping, working on a project, or relaxing.

What Type of BBT for Which Conditions?
It has been hypothesized that a number of conditions, including chronic stress, chronic and postoperative pain, migraines and other headaches, problems with attention/concentration or learning, and insomnia, to name a few, reflect an imbalance or irregularity in brain-wave states. The deliberate use of BBT to change the predominant brain-wave state is referred to as brain-wave entrainment (BWE). BWE is not limited to BBT, but discussion of other methods is outside the scope of this article. However, a 2008 review of the BWE literature found that delta stimulation was associated with improvement in migraines and other headaches and reduction in short-term stress. A single session of alpha stimulation was associated with stress reduction in some settings, but not for those undergoing root canal. Alpha stimulation was also linked to pain relief. Beta improved attention, reduced short-term stress, alleviated headaches, reduced behavioral problems, and improved performance on measures of overall intelligence. An alpha-beta protocol improved verbal skills performance and attention, and a beta-gamma protocol showed improved arithmetic skills in children who had learning disabilities or attention-deficit hyperactivity. Most of these studies examined photic stimulation (presented via flashing lights) or combined photic and BBT entrainment rather than BBT alone. Thus, it is difficult to draw a definitive conclusion about the specific utility of BBT from this review.

BBT as a Potential Tool for Reducing Anxiety and Pain
The results of a small pilot study published in 2007 found that listening to an hour-long program emphasizing delta BBT for 60 days was associated with a decrease in self-reported trait anxiety and an increase in quality of life among eight healthy adults. The level of dopamine (an excitatory neurotransmitter) was also decreased significantly and may be related to the decrease in trait anxiety scores. Interestingly, the team assessed changes in the level of growth hormone because the BBT’s producer claimed that listening would increase these levels. Growth hormone decreases with age, and thus, an increase would be considered a potentially beneficial outcome; yet, listening to this BBT program was associated with a significant decrease in growth hormone. Both the reasons for this result and it’s implications are unclear.

Perhaps two of the more intriguing studies about BBT were the following trials with patients undergoing surgery. The first is a 2005 double-blind, randomized controlled trial in which 108 patients undergoing general anesthesia for elective surgeries received either a BBT plus music audio, the same music without BBT, or no intervention other than standard care for a 30-minute period prior to their operations. The BBT audio featured a progressively slowing beat that ended with 10 minutes of delta. No adverse events were noted, and although initial state anxiety scores were higher in the BBT group (prior to the intervention), the most significant decrease in anxiety was also in the BBT group—even after adjusting for the fact that participants in this group on average had higher initial anxiety. Listening to music alone was also associated with a significant decrease in anxiety, but this decrease was of a lesser magnitude than that of the BBT group. This study showed that an inexpensive, one-time intervention of short duration was beneficial despite the stress characteristic of undergoing surgery.

The other study was a randomized controlled trial of 60 patients about to have surgery with general anesthesia. Twenty patients were assigned to each of three conditions: a Hemi-Sync BBT program, listening to the music of their choosing, or listening to a blank audiocassette for 30 minutes prior to surgery. None of the participants was offered any sedative premedication. Stereo headsets from all groups of participants were removed before the patients entered the operating room but were replaced and the respective audio programs restarted after the induction of anesthesia. Headsets were discontinued at the conclusion of surgery. The researchers found that using the Hemi-Sync programs resulted in significantly less intraoperative use of fentanyl (a very potent, synthetic opiate pain medication), lower self-reported pain scores several hours after the surgery, and being discharged from the hospital sooner. Unfortunately, the specific frequency of BBT was not described in this article.

Anecdotally, several months ago I went for my first-ever root canal and noticed considerable anxiety at the thought of having a very sensitive tooth drilled (even with anesthetic). On the way to the endodontist’s office, I listened to both a guided imagery program designed specifically for medical procedures in which one must remain awake (available via HealthJourneys.com) and also to a free delta BBT program (Napuru) I’d downloaded for my iPhone. The delta tones were played against a backdrop of ocean waves. My subjective experience was that the BBT and imagery, combined with mindfulness practice before and during the root canal, reduced my anxiety significantly and enabled me to get through what seemed like an eternity of loud drilling. I cannot say what the most “active” ingredient in this integrative approach was; however, the point is that this nondrug, inexpensive, easy-to-use adjunct was effective for me.

BBT has been around for decades and is now readily and inexpensively available. There are some data to suggest that it may be helpful for relieving anxiety in general and in the context of a stressful event. There is also some evidence that BBT or other methods of brainwave entrainment may help with pain, concentration, headaches, and other issues, and serious risks or side effects have not been reported. The current research does not definitively answer the question of whether there would be a dose-response effect or a benefit from listening to BBT more regularly versus listening once; however, this seems plausible. More research needs to be done to better elucidate whether BBT could be used as an independent therapeutic tool, however. Additionally, assuming BBT is effective, one should not drive or perform tasks requiring sharp focus when listening to delta, theta, or alpha tones, as these may induce a very relaxed state.

For More Information:

  1. Dabu-Bondoc, S., Vadivelu, N., Benson, J., Perret, D.,  Kain, Z. N.  (2010). Hemispheric Synchronized sounds and perioperative analgesic requirements. Anethesia & Analgesia, 110(1), 208-210.
  2. Huang, T. L., Charyton, C. (2008). A comprehensive review of the psychological effects of brainwave entrainment. Alternative Therapies in Health and Medicine, 14(5), 38-50.
  3. Padmanabhan, R., Hildreth, A. J., Laws, D. (2005). A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anesthesia for day case surgery. Anesthesia, 60, 874-877.
  4. Wahbeh, H., Calabrese, C., Zwickey, H. (2007). Binaural beat technology in humans: A pilot study to assess psychologic and physiologic effects. The Journal of Alternative and Complementary Medicine, 13(1), 25-32.

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GoodTherapy | Do Men and Women Have Different Sexual Fantasies?

According to a recent article, men spend a bit more time fantasizing about sex than women do. However, contrary to what some people believe, based on the results of a study conducted by Juan Carlos Sierra Freire and Nieves Moyano Munoz, both of the Department of Personality, Psychological Evaluation and Treatment at the University of Granada in Spain, men and women don’t usually fantasize about sexual encounters with strangers, but with their partners. Sources of entertainment that are focused on fulfilling sexual fantasies, like steamy books, racy movies, and even websites, all sensationalize the stranger fantasy. Whether it is with a hot construction worker or a sexy swimsuit model, some of the most sexually stimulating scenarios involve strangers colliding for a thrilling and fulfilling sexual encounter. But this is not what the majority of people actually fantasize about.

For their study, Freire and Munoz surveyed 2,500 men and women ranging in age from 18 to 73. All of the participants questioned had been in some form of heterosexual partnership in the last year. They were asked whether they had ever had a sexual fantasy and if so, to describe the type of fantasy. The researchers assessed whether the fantasies resulted in negative or positive feelings and explored what characters were most prevalent in the fantasies. They found that almost all of the respondents had fantasized about sex at one time or another. Surprisingly, the majority of them, nearly 80%, reported that they had had at least one negative sexual fantasy. For women, negative fantasies involved forced sexual encounters and for men it involved homosexuality.

The team also found that although men did fantasize more often than the women, both men and women usually fantasized about sex with their partners. Other findings revealed that women had more positive sexual fantasies than the men, and men had more experimental sexual fantasies, including fantasies about threesomes and other group sexual encounters. Overall, the researchers believe that having fantasies about sex “favors some aspects as sexual desire and arousal” and is an area of exploration for therapists working with individuals who have sexual concerns.

Source:
University of Granada (2012, July 18). A study shows that men and women have the same sexual fantasies. Retrieved from http://www.alphagalileo.org/ViewItem.aspx?ItemId=122554&CultureCode=en

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Man holding forehead“Why are you out of bed?”
“I’m scared.”
“What are you afraid of?”
“There’s a monster under my bed!”
“There are no monsters. Go back to bed.”
“Nooooooo, I’m scared.”
Sound familiar? Almost every parent has done this. Holding a little hand, down on your hands and knees with a flashlight to prove there is nothing under the bed—unless you count the stray sock, a missing toy, and a few dust bunnies.

Your little one thinks you are a superhero. You faced the monster and saved the day, or in this case, the night. With imagination tamed, feeling safe and secure, your child falls asleep.

Imagination is an amazing thing. Children hone it to a fine art. With a towel on their shoulders and a leap from the couch, they fly!! They feed you imaginary sandwiches and wipe imaginary crumbs from your chin. They introduce you to friends only they can see. They scare themselves at bedtime. Years pass, towels are used for bathing, imaginary sandwiches and friends are forgotten. Monsters no longer hide under the bed. Reality replaces imagination.

Or does it? Many adults continue to exercise their imagination. They don’t have towels on their shoulders or imaginary friends, but they do believe in monsters created entirely with their imagination. Your child, no longer afraid of monsters, is a teenager now. You worry she doesn’t take school seriously, or her current boyfriend is a bad influence, or her college fund isn’t going to be enough. Get the picture?

Adults may not imagine monsters under the bed, but they do imagine a multitude of scenarios that would scare Freddy Krueger, and it’s socially acceptable. A vivid imagination is never questioned if the name is changed from imagination to worry. It is commonly accepted that everyone worries; it’s part of being a responsible adult. How else can you be prepared when the unthinkable happens? If you have played out the worst-case scenarios in your mind, you are ready to deal with them.

Worry is as useful for you as monsters under the bed were for your child. You make things up in your head, believe them, and scare yourself. Who will take you by the hand, shine the flashlight on your imaginary fears, and make them disappear?

Worry is using your thinking to predict the future or to continue to relive the past. Predictions rarely come true, and if they do, worry did not change the outcome. It only made you miserable before the outcome happened. How much have you changed the past by worrying about it? Unless you conquered time travel, it doesn’t work. The past is past. It doesn’t change and it doesn’t cause you pain unless you bring it into your present by thinking about it. So the monsters (worries) of the future and the past are simply you using your imagination to scare yourself. Seems a bit silly, doesn’t it?

Worry (scaring yourself with your imagination) raises your level of tension and lowers your mood. From that low state of mind you expect to find solutions to your problems. It won’t happen. High tension and low mood doesn’t make for good problem solving—ever. Recognizing that you are scaring yourself helps the worries go away. You shine the flashlight on your fears and recognize they are imaginary. From a calmer state of mind, you deal with problems as they occur rather than in the future or the past.

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Empty waiting room The world of psychiatry is full of unusual phobias. There’s symmetrophobia, the fear of symmetry, xerophobia, the fear of dryness, and ideophobia, the fear of ideas. But these phobias are exceedingly rare, and in the psychiatric interest on strange phobias, more mundane—and more dangerous—phobias are easily forgotten. Needle phobia is one such fear. There is significant evidence that fear of needles sparks physical changes in the body that can result in cardiac episodes and other health problems when a patient is exposed to needles. But needles are a part of life and are often necessary for medical treatment. Needle phobia, then, can cause a person to avoid life-saving care and, if a needle is forced upon a phobic patient, the results could be disastrous.

Needle Phobia and Cardiac Episodes
Most people dislike needles, but a true needle phobia feels overwhelming and uncontrollable to patients. People who have needle phobia may experience an extremely elevated heart rate and blood pressure immediately before a needle puncture. When the puncture occurs, the heart rate may drop precipitously. This exposes them to significant danger of heart arrhythmias and other cardiac episodes. Dr. James Hamilton, a pioneer in the treatment and study of needle phobia, reports that at least 23 deaths have been caused by a needle puncture that led to a cardiac episode.

Medical Issues
Doctors, nurses, and other people tasked with administering vaccinations and drawing blood are not typically properly educated about needle phobia. They’re accustomed to patients who dislike needles and may reassure them with promises that the puncture won’t hurt or will only take a minute. But with a true needle phobic, these reassurances don’t work. The person isn’t afraid of pain or injury: he or she is afraid of the needle itself. This poses serious obstacles to medical treatment. As many as 10% of people have some degree of needle phobia, and a significant portion of these individuals report that they would rather die than receive a needle puncture. These people tend to avoid medical care because of their fear, allowing their illnesses much more time to worsen than illnesses of nonphobic people.

Causes
Although traumatic experiences with needles such as painful blood draws or blood transfusions can cause needle phobia, people can’t typically trace the origin of the phobia. Needle phobia seems to run in families, but this does not mean the fear is genetic. Children may learn it from watching their parents show fear of needles. Restraining children during vaccinations and blood draws is strongly correlated with the later development of needle phobia. Consequently, parents should strive to ensure that their children’s early experiences with needles are positive and that children are not restrained unless the needle puncture is needed immediately to save the child’s life.

Treatment
Some people have good luck with hypnotherapy, but the most common treatment for needle phobia is counterconditioning. This process can take several years because the mere sight of a needle is sufficient to send many patients into a full-blown panic attack. Treatment providers typically start by asking the person to envision a needle, progress to showing the person a needle, and ultimately move toward getting the person to accept a needle puncture. For people who require needles for medical treatment, it may be necessary to administer general anesthesia to prevent life-threatening reactions. In less severe cases, anti-anxiety medications can lessen the symptoms of needle phobia.

Sources:

  1. Hamilton, J. G. (n.d.). Needle phobia: A neglected diagnosis. Needle Phobia. Retrieved from http://needlephobia.info/pages/Hamilton-Needlephobia.pdf.
  2. Emanuelson, J. (n.d.). The Needle Phobia Page – fear of needles and needle procedures. The Needle Phobia Page – Fear of Needles and Needle Procedures. Retrieved from http://www.needlephobia.com/
  3. The phobia list. (n.d.). The Phobia List. Retrieved from http://phobialist.com/

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Silhouettes of peopleHow many times have you found yourself in the situation of being worried or anxious about sharing a part of yourself with others? Too often we’re forced to choose one part of ourselves that we want to share over another part that might be equally as important. This can be extreme or subtle.

For example, teenagers who are both gay and Christian might feel like they can’t be both at the same time. These conflicting identities create a bind for them. At church the young person might be given a very direct message that being gay is wrong. For these teens they know that if they want to celebrate their Christianity with their community, they need to pretend to be straight. Gay community can be equally as complicated. After years of oppression from churches many people who are gay, lesbian, bisexual, transgender, or queer have struggled with Christianity. In this situation these teens might not feel able to express their strong religious beliefs within the gay community. For them, there is no place where they feel totally accepted, totally themselves. This example of split identities is very clear; however, sometimes the ways in which we’re forced to hide parts of ourselves is much more subtle.

In my work, I frequently find men who are struggling with a conflict of identity around gender and gender role. What happens when a straight man has interests or beliefs that are labeled as feminine? For example, if he doesn’t want to fight or he prefers conversations with women over watching sports with men. In our culture there is an assumption that men are going to act masculine. Often men are forced to hide parts of their identity that are not seen as masculine enough. This identity bind is much more subtle but still painful.

We face situations like these every day. Our identities have many facets including our ethnicity, race, religion, and sexual orientation as well as other ways we define ourselves, such as pacifist, good listener, or caregiver. Each of us has parts of our identities that we feel comfortable sharing with strangers and other parts that we only want to share with friends. There are things we are proud of and things we are ashamed of. Our identities are multidimensional; they have many layers and many meanings. Sometimes these identities are hierarchical, and one identity may be more important than all of the others. Understanding what our own multidimensional identity looks like can help us in those moments when not sharing our full self makes us feel invisible.

How do you introduce yourself to someone new after you tell them your name? In the United States we often use our professions to describe who we are to other people, “I’m a teacher/lawyer/electrician/therapist/writer.” As a culture we put a lot of value on employment and jobs, so much that sometimes our jobs become our identities. If you could describe yourself to a stranger as something other than your occupation, what would it be? Maybe it would be a description of an important relationship, such as “I’m a dad/mom/sister/uncle/grandma.” These are only two ways in which we might identify ourselves.

Take a moment and list the first five of your identities that you can think of. What made the top five? Are you surprised at any of the ones that are there? Are there any identities missing that you wish were on that top five list? And are there any identities on your list that you have felt you need to hide?

Being proud of ourselves is often much harder than it sounds. We live in a world filled with expectations, some spoken and some unspoken. But just because a part of our identity can’t be seen does not mean that it’s not there. It does mean that you might have to work a little bit harder to give it it’s time in the sun—to find a safe space to share the parts of you that feel invisible. Finding these spaces is an important step towards integrating our identities and feeling whole.

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Woman giving report to classPublic speaking is generally not a favorite activity of most people—in fact many people seem to fear public speaking or at least avoid it when they can. But most people are also not crippled with embarrassment or anxiety when they have to present in front of a class or when they are called on to answer a question. For students with social anxiety, being put into the spotlight occasionally during class presentations or participation is enough to make them avoid those classes altogether.

New research from the University of Plymouth and University of the West of England (UWE) Bristol looked at the impact of social anxiety in higher education, and psychologist Phil Topham estimates that “10% of university students experience significant social anxiety,” according to a news release from UWE Bristol.

Social anxiety disorder or social phobia is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as “a marked and persistent fear of social or performance situations in which embarrassment may occur.” There are several other diagnostic criteria, including that “the social or performance situation is avoided, although it is sometimes endured with dread.” People are diagnosed with the disorder only if their life is significantly negatively impacted.

Out of more than 1,500 students who were surveyed, some students experienced “frequent anxiety in learning situations that involved interacting with students and staff.” To cope with this anxiety, students would not participate in lectures and presentations or would even skip class. Other students wouldn’t take any classes that involved presenting at some point, according to the news release.

The researchers conclude that students who experience social anxiety “could be missing out on learning opportunities and may be distracted from attending to academic information by excessively focusing on their anxieties.”

Although the researchers don’t believe students should be treated as potentially fragile and coddled, there needs to be more support available for students with social anxiety without further stigmatizing these students or making them feel like their “flaws” are exposed. The researchers even give some suggestions for support in the university, including “not singling out students for questioning in lectures or setting assessed presentations in their first term,” and “sensitive appreciation of the shame and conflict caused in students by the desire to succeed and the fear of failure.”

Basically, college professors need to take into consideration the styles of all college students—some love the spotlight, others have social anxiety, so it’s best to ease students into participating and presenting during class.

Mental health experts have some tips on how to succeed in high school and college despite having social anxiety.

Nerina Garcia-Arcement, a clinical assistant professor at NYU School of Medicine and a licensed clinical psychologist, gave one major suggestion in an email to help students who are experiencing social anxiety.

“Do not avoid what you fear,” Garcia-Arcement said. “The more you avoid, you are creating evidence that it is more comfortable to not do something. Instead, if you face what you fear you can slowly prove that your worst fears will not be realized.”

She also suggests that students follow these four steps to take control of their anxiety:

  1. Stop and evaluate what you are feeling (i.e., butterflies in your stomach, sweating, trouble breathing, heart racing).
  2. Stop and evaluate what are you thinking (i.e., “people will laugh at me,” “I will fail,” “I will look ridiculous.”)
  3. Practice activities that will reduce the physical symptoms, such as deep breathing, muscle relaxation exercises and imagining yourself in a safe place.
  4. Challenge your negative thoughts by stopping the critical belief and instead replace it with a positive thought such as “people have never laughed before,” “I can do this,” “looking silly is the point of this activity, and if I do look silly so what.”

There are effective treatment options for students who have access to a mental health professional.

“Talk therapy is extremely effective for social anxiety, especially cognitive behavioral therapy. Medication can be taken in severe cases, Garcia-Arcement said. “Learning to manage the physical anxiety symptoms and stopping and controlling the negative thoughts is essential to controlling social anxiety. Sometimes people can do it on their own, sometimes they need help with monitoring thoughts and feelings and figuring out what gets in the way of using these new skills.”

She has three other tips for students who are trying to decrease their social anxiety:

  1. Practice deep breathing, meditation, yoga, and exercise. These help manage and control anxiety.
  2. Ease into social activities, first with smaller groups and eventually, as you feel comfortable, with larger groups.
  3. Practice what you fear in a controlled environment. First practice the presentation or talking to a stranger in front of a mirror, later practice in front of someone you trust such as a friend or parent, then go into the real situation.

Scott Carroll, a child psychiatrist who works at the University of New Mexico, said that part of the problem can be that some students don’t realize they have an issue that needs to be worked on.

“Many people with social phobia … often just think they are shy and don’t realize they may have a treatable condition,” Carroll said. “Also, if someone has been anxious their whole life, they may not realize they are significantly more anxious than other people.”

Once students do realize they have an issue, they have a variety of treatment options available to them, including individual psychotherapy (such as cognitive behavioral therapy), social skills therapy groups, and multiple types of medications.

Carroll has two other coping methods for college students who have social anxiety: positive self-talk, in which you reassure yourself that it’s OK to talk or say hello, can be helpful with milder forms; and repeated exposure, which leads to decreased anxiety, like joining Toastmasters to get comfortable with public speaking.

Jeffrey Gardere, a contributing psychologist at Healthguru.com, said in an email that it’s beneficial for students with social anxiety to have friends they can rely on to come along with them in situations that could cause more anxiety.  Sometimes self-help books can be useful as well.

“The young person with social anxiety may also want to stay away from stimulants such as energy drinks and caffeine in order to avoid becoming even more nervous,” Gardere said. “And certainly [try] to avoid liquor, marijuana or any other chemical that is a self-medication in order to feel relaxed, simply because they may be more at risk for possible addiction.”

Young woman in white tee shirt leaning against phone booth, holding payphone in left hand. She has her hand on her forehead and looks upset and stressed.What do you do out of guilt?

I recently realized that I was doing a lot of things out of obligation, feelings of guilt, or just a general feeling that if I didn’t do something, I would have bad karma—or worse yet, that people would stop liking me and inviting me to things. I live in Los Angeles, a sunny, warm place with lots of people and a ton of things to do all the time. With the invitations always forthcoming, it is sometimes difficult but necessary to say no. In order to maintain a semblance of sanity and self, one must pick and choose when to say “yes” and when to say “no.” Ideally, when saying “no,” we won’t have to worry about being rejected or left out, missing out, or losing friendships.

This problem also happens in the context of intimate relationships and is very real. Within relationships, there is an intrinsic fear of losing our partner. “If I don’t go along with what my partner wants, they may find someone better.” There is fear of being seen in a bad light, of not compromising, not letting our partner live their life, judgment by our in-laws, and more. And sometimes these fears are so deeply ingrained in our being that it’s hard to even recognize when it’s happening.

The negative side effects of doing something out of guilt, duty, or obligation are the feelings that we are left with: the after-effects that jeopardize our relationship because they build on anger, resentment, and frustration. The things we do out of guilt don’t pay a lot of dividends. Instead, they leave us feeling bereft and unheard and can lead to martyrdom: the “I do so much for you, but what have you done for me lately?” phenomenon—also known as playing the victim. In the recovery world of sobriety and Alcoholics Anonymous, it’s known as enabling or codependence. Doing things that you really don’t want to do because you feel as though you are supposed to is a ticket to disaster.

So how do you break this cycle?

Well, first you have to get to know yourself. Sometimes in the midst of all these desires and fears it is hard to get to the core of who we are, what we need, and what will be best for us right now. I’ve devised a quick list for you to get on your way to knowing yourself, knowing your needs, and then standing up for them—in a nice way that doesn’t offend, hurt, or piss people off.

Repeat the steps above. If you find yourself saying “yes” to things you don’t really want to do, ask yourself what you are getting out of it and why you keep repeating this pattern. Things like fear of losing the relationship or guilt are often ideas we perpetuate for ourselves that don’t have a lot of basis in reality. Knowing yourself and learning to avoid sticky situations that lead to anger, frustration, and resentment are the keys to healthy, happy, and functional relationships.

The ideal standards model (ISM) of interpersonal evaluations suggests that a partner becomes dissatisfied with his or her relationship when the significant other fails to measure up to what he or she expects an ideal mate to be. Likewise, this level of dissatisfaction can occur when one partner perceives that he or she is not living up to his or her partner’s standards. These relationship discrepancies therefore are indirectly caused by each partner, whether that person realizes it or not. Additionally, each type of discrepancy, whether partner generated (PD-Partner) or self-generated (PD-Self) can produce a different behavioral response. Although partner behavior has been studied in the context of ISM, it has not been explored further. Therefore, to address the partner discrepancy origins and effects using the ISM, Sandra D. Lackenbauer of the Department of Psychology at Western University in Ontario, Canada, recently led a series of studies of partners in unmarried and married relationships.

Lackenbauer assessed how PD affected motivation, avoidance, feelings of self-worth and agitation. In the first three studies, Lackenbauer found that those with high levels of PD-partner felt dejected while those with high levels of PD-self had more agitation. This was especially evident on scales that measured trustworthiness and feelings of warmth and caring. In the final two studies, the participants with PD-partner led to promotion-focused emotional responses while the presence of PD-self resulted in more prevention-based strategies.

The findings from these studies extend previous research on ISM and emotional regulation within intimate relationships. Although some existing research suggests that discrepancies are directly related to dissatisfaction within relationships, the results of Lackenbauer’s research suggests otherwise. In fact, the participants who exhibited PD-partner trends engaged in nurturing and promoting behaviors which can be a positive path for increases in satisfaction. The prevention behaviors displayed by those with high levels of PD-self suggest that individuals who perceive themselves as less than ideal take actions that minimize feelings of insecurity and abandonment in their relationships. Additionally, these individuals tend to maximize their assets in an effort to more closely match what they believe their partner’s ideal to be. Lackenbauer added, “Especially for those people involved in generally satisfying and committed relationships, this prevention strategy could be aimed at reducing the partner discrepancy to ultimately maintain the relationship satisfaction.” Regardless, Lackenbauer believes that more research is needed to fully examine how these discrepancies and ensuing behaviors contribute to overall relationship satisfaction.

Recent research continues to support these findings, showing that couples’ emotional regulation strategies and how partners manage discrepancies between expectations and reality remain crucial factors in relationship satisfaction and stability. Studies from 2023 demonstrate that satisfaction with relationship status and the alignment between relationship desires and reality significantly impact mental health outcomes, with higher satisfaction associated with lower depression and romantic loneliness.

Contemporary research emphasizes that difficulties related to partner discrepancies remain among the most common complaints in people seeking relationship therapy, with communication quality playing a key role in how couples manage these discrepancies. Modern studies also highlight how partners’ mutual influences on behavior change intentions and emotional regulation continue to shape relationship dynamics, with individuals experiencing more negative emotions when their partner’s readiness for change differs from their own.

Reference: Lackenbauer, S. D., Campbell, L. (2012). Measuring up: The unique emotional and regulatory outcomes of different perceived partner-ideal discrepancies in romantic relationships. Journal of Personality and Social Psychology. Advance online publication. doi: 10.1037/a0029054

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*The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.*

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References:

  1. Baghaei, N., et al. (2024). The role of interpersonal emotion regulation in couples’ relationships. Iranian Journal of Psychiatry and Behavioral Sciences, 18(1). https://brieflands.com/journals/ijpbs/articles/148166.pdf
  2. Dębek, A., et al. (2023). Relationship (in)congruency may differently impact mental health. Clinical Psychology & Psychotherapy, 30(2), 121-135. https://doi.org/10.1002/cpp.2757
  3. Driebe, J. C., Stern, J., Penke, L., & Gerlach, T. M. (2024). Probing the predictive validity of ideal partner preferences for future partner traits and relationship outcomes across 13 years. Journal of Social and Personal Relationships, 41(4), 832-859. https://doi.org/10.1177/08902070231213797
  4. Galizia, R., Theodorou, A., et al. (2023). Sexual satisfaction mediates the effects of the quality of dyadic sexual communication on the degree of perceived sexual desire discrepancy. Healthcare, 11(5), 648. https://doi.org/10.3390/healthcare11050648
  5. Gouin, J.-P. (2024). Couples-based health behavior change interventions: A relationship science perspective on the unique opportunities and challenges to improve dyadic health. Comprehensive Psychoneuroendocrinology, 19, 100250. https://doi.org/10.1016/j.cpnec.2024.100250
  6. Lackenbauer, S. D., & Campbell, L. (2012). Measuring up: The unique emotional and regulatory outcomes of different perceived partner-ideal discrepancies in romantic relationships. Journal of Personality and Social Psychology, 103(3), 472-488. https://doi.org/10.1037/a0029054
  7. Roth, M., Landolt, S. A., Nussbeck, F. W., Weitkamp, K., & Bodenmann, G. (2024). Positive outcomes of long-term relationship satisfaction trajectories in stable romantic couples: A 10-year longitudinal study. Applied Psychology: Health and Well-Being. https://doi.org/10.1007/s41042-024-00201-1
  8. Wrobel, M., et al. (2023). What matters in a relationship—Age, sexual satisfaction, relationship length, and interpersonal closeness as predictors of relationship satisfaction in young adults. International Journal of Environmental Research and Public Health, 20(5), 4103. https://doi.org/10.3390/ijerph20054103

Bipolar disorder actually refers to a group of mental health conditions that feature alternating and unpredictable mood states. These conditions are sometimes referred to in terms of the “bipolar spectrum.” Mania, an intensely elevated or euphoric mood, and depression are the mental states typically associated with bipolar disorder. Doctors classify the various subtypes of this disease based upon the severity and occurrence pattern of mania and depression. Bipolar II disorder, for example, entails a higher rate of major depressive episodes, with relatively few instances of mania. Appropriate treatment for all forms of bipolar disorder involves regular cognitive therapy sessions and mood stabilization via pharmaceutical interventions. Doctors may prescribe an indefinite course of psychotropic medications to prevent a patient from lapsing into either depression or mania.

The antidepressant medication Prozac (fluoxetine) is part of a typical treatment plan for those suffering from bipolar II disorder. Prozac works by altering the ratio of certain chemicals within the brain. Rigorous testing has confirmed that this medication is both safe and effective, with relatively minor side effects in most patients. The current guidelines for bipolar II treatment recommend discontinuing Prozac within several weeks of depression remission, because clinicians suspect that prolonged antidepressant therapy may trigger a manic state. The mood stabilizer lithium is therefore preferred for long-term maintenance therapy. A team of clinical investigators set out to challenge the notion of Prozac’s danger, testing Prozac against lithium in a double-blind, placebo-controlled study in a group of individuals with bipolar II disorder.

All participants in the study had recently recovered from a depressive episode with the assistance of Prozac. One group was switched to lithium, one to placebo, and one continued on Prozac. Participants were blind to their treatment condition, and the study moved forward for 50 weeks. Psychiatric interviews and patient self-reporting helped pinpoint relapse events and overall mental health status. The results of the study were surprising even to the researchers. Those taking lithium were 2.5 times more likely to relapse than those taking Prozac. Similarly, the time to relapse, when it did occur, was far longer with Prozac than lithium. Most importantly, episodes of mania in the Prozac group were not significantly greater than either the placebo or lithium group.

Conventional wisdom argues against maintenance treatment with antidepressants for bipolar individuals. However, recent study results have challenged that wisdom, at least in the case of bipolar II disorder. For those suffering from this variety of the disease, long-term treatment with Prozac appears to be safe and effective for both preventing relapse and staving off manic episodes.

References

  1. Amsterdam, J.D. & Shults, J. (2010). Efficacy and safety of long-term fluoxetine versus lithium monotherapy of bipolar II disorder: a randomized, double-blind, placebo-substitution study. American Journal of Psychiatry, 167, (7), 792-800.
  2. Fluoxetine – PubMed Health. (n.d.). National Center for Biotechnology Information. Retrieved April 11, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000885/

Horse wearing bridle eating grassAs you may know, eye movement desensitization and reprocessing (EMDR) is a research- and evidence-based therapy created by Francine Shapiro, Ph.D., over 20 years ago. An integrative model, EMDR is comprehensive, including aspects of multiple psychotherapeutic approaches. With this in mind, equine experiential activities, such as those found in equine-assisted psychotherapy (EAP), support and help to facilitate EMDR’s eight-phased model, while also maintaining fidelity to standard protocol.

The EquiLateral™ protocol is brought with a deep respect and understanding of EMDR but also the power of equine-assisted therapy. I am constantly reminded that EMDR and equine-assisted therapy both have the ability to support and often deepen a client’s ability to access where those traumas are stored. In my 10 years of experience as an EMDR therapist, I am still constantly amazed and inspired by the depth of healing that can be reached through EMDR, let alone through horses, who are often our most powerful and forgiving teachers.

Current research emphasizes the importance of maintaining fidelity to EMDR’s eight-phased approach. Nevertheless, in doing so, EMDR “may be implemented in more than one way as long as the broad goals of each phase are achieved” (www.emdria.org).

EquiLateral™ is the first equine-assisted EMDR protocol. We are still doing EMDR but are incorporating equine-assisted experiences within the eight-phased, three-prong, standard EMDR protocol. For more information on this approach to healing trauma, please visit my website: www.dragonflyinternationaltherapy.com

Horses, Comfort, and PTSD
Horses are prey animals. What this means is that they are highly in tune with their environment, readily noticing changes in the world around them and being able to respond to what they notice and actively seek what horseman Buck Brannaman describes as their wanting to return to “peace.” When in this energetic state, their nervous systems are settled and calm. They can readily focus on just being in the world, in the moment, which for them means grazing, moving 20+ miles a day, and relating with herd members. In contrast, when sensing danger, their peace is threatened, and their nervous system becomes activated enabling them to react, primarily through flight, although sometimes through fight or freeze, for self-preservation.

If you are a trauma survivor or know someone who struggles with posttraumatic stress, perhaps you can relate. Our bodies have the capacity to do as horses do, react, respond, then calm down and return to “peace.” But, we humans often learned to “stuff,” “repress,” “deny” what happened when all the body really wants to do is release and move through those feelings and body sensations. Doing so actually helps the trauma memory settle in, to release the “charge” that the body stores about what happened. By nature, horses, like all animals, know how to do this.

But, when trauma is still locked in the body and blocked, our nervous systems don’t return to a baseline of calm and peace. Instead, the fight, flight, or freeze that was experienced at the time of the event continues to remain activated, leading one to feel on alert, hypersensitive, anxious, easily agitated, or constantly “on,” making it challenging and often nearly impossible to relax.

That said, horses know how to relax. But, they also instinctively know to be alert and flee when threatened. They are preyed upon in the wild and are really in tune to danger, of any kind, including that which threatens their physical and even emotional safety, and that sense of comfort and peace that is their baseline state of being. And if you are a trauma survivor, all you want is peace and comfort as well. And this is just the beginning of why the horse and the trauma survivor may just “get” each other.

In light of the powerful connection between horses and trauma survivors, I am consistently shown the power of horses to help heal humans, especially through the integration of EMDR and equine-assisted therapy via this protocol.

Keep an eye out for the Part 2 of this post coming soon!

Related articles:
EMDR: Symptoms and Phases
Common Therapy Approaches to Help You Heal from Trauma
How Trauma Impacts My Sense of “Me-Ness” – Part II

Depression and self-esteem are intertwined and contribute to negative affect. Research has shown how self-esteem influences depression, and some studies have suggested that depression works negatively to decrease self-esteem. Understanding how each of these conditions affects the other is essential in order to effectively treat depression and other conditions that co-occur such as anxiety. In an attempt to determine the nature of the relationship between depressive symptoms and self-esteem, Julia Friederike Sowislo of the Department of Psychology at the University of Basel in Switzerland conducted a review of existing research on these conditions.

Sowislo analyzed 18 studies on anxiety and self-esteem and an additional 77 studies on depression and self-esteem. She looked at the vulnerability factors of each symptom and assessed the impact they had on each other. The data she reviewed were collected from individuals ranging in age from early childhood to late adulthood. The studies Sowislo chose were conducted using a variety of measurements and time periods, allowing for a broad review of data.

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The final analyses revealed a strong relationship between self-esteem and depression but a weak one for depression and self-esteem. Specifically, Sowislo found that decreases in self-esteem were predictive of increases in depression. But she found only minimal evidence for depression decreasing self-esteem. However, when she looked at self-esteem and anxiety, Sowislo found that the relationship was more reciprocal, with both self-esteem and anxiety negatively affecting each other in similar ways. These findings provide additional and clear evidence of the importance of self-esteem in depression. “The robustness of the effect also strengthens the potential importance of self-esteem interventions,” said Sowislo. She believes that treatments aimed at reducing depression by way of improving self-esteem could provide not only short-term gains for clients but also long-term protection from depression for those most at risk. Sowislo added that regardless of age or gender, individuals should be taught how to improve their sense of self-worth in order to effectively manage and overcome their depression.

Reference:
Sowislo, J. F., Orth, U. (2012). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological Bulletin. Advance online publication. doi: 10.1037/a0028931

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