Anxiety Answers

I need help dealing with my anxiety issues.

Hello! Thank you for the question. This is hard for me to answer because I have so many follow up questions! I guess that is the life of a therapist though :)  My first question is are you getting 7-9 hour of sleep per day? With there being this pattern to the anxiety, in that it happens in the evening and is helped by sleeping, I wonder if your body is trying to communicate a need for more rest. Other things to think about to address the biological aspects of anxiety are how much caffeine are you drinking throughout the day, when do you stop having caffeine and other stimulants and what activities do you tend to do in the evening? If you are a student and tend to do school work in the evening, maybe try switching that up and doing it first thing in the morning or in the afternoon. If you are watching exciting shows or playing intense video games, change the times that you do those activities. If there is anything that you do regularly in the evening, try to switch it up to see if that helps. Think about creating an evening routine based solely around calm and relaxation.  The next thing I would encourage you to try to be aware of is your inner dialogue in the evenings. Many times anxiety stems from faulty cognitions (lies) that we have taken to be true. Examples are: I can't handle this, I am dumb, I am wasting my life, I need to do enough to earn love, I am weak, I should be..., I should do.., and there are so many other options. The evenings and nights are when those big fears come up.  So, in summary, here is what I would suggest: 1. Are there lifestyle habits that are contributing to the anxiety? 2. Are there lifestyle changes that can be made to help alleviate the anxiety? This could also include starting a simple calming yoga routine or slow evening walk.  3. Check in with your inner dialogue to see if there are things you are believing that are contributing to the anxiety.  4. For the next week, set a timer for 10 minutes and write without stopping. Start with the topic of your anxiety at night and see where it goes from there. This is not something that should sound good or look good. You don't stop for the 10 minutes, its a free-flow writing exercise to see if you gain any more insight into what is causing your anxiety.  5. If this continues to be problematic, check in with your doctor to see if there is anything physical contributing.  Your BetterHelp Therapist can help you explore your negative thoughts and help you reveal if those are an issue, because it can be tricky to even become aware of the things we are telling ourselves throughout the day! Best of luck! I hope this was helpful. 
(MSW, LISW-S)
Answered on 01/20/2022

What are some ways to make time for work, complete homework on time and handle a household?

Congratulations! You are working very hard to achieve important goals in your life. Prioritize your time!  More importantly, you need to add self- care practices to help you cope with the demands in your life. Even though adding self- care practices might seem counterintuitive to your busy schedule, doing it will help you cope by lessening anxiety, worry and stress. It will improve your quality of sleep, improved self-esteem, and self-acceptance. It also will increase your resilience against uncertainty and other life challenges. I would suggest: Get up a half an hour earlier to do a stretch, meditate and review your today’s to-do list. Visit Better Help's Groupinars on this topic on self-care tips. Here's some other practical suggestions from this website: https://www.wikihow.com/Balance/Homework-and-Chores. They are: 1- Communicate with Your Employer. Be sure to speak with your boss regarding your decision to further your education. He/she will appreciate your honesty, and you’ll likely find you gain support and encouragement for your decision. 2- Take Advantage of Downtime. A day off is like money in the bank. Use holidays wisely. This might not be the time to make time consuming meals or buying presents. Everyone will understand your desire to work on your goals are important and your time is value. 3.  Ask for help- Let others know that you might need their help to do tasks that might not be putting them out of their way and can save you time (e.g., grocery shopping for you). 4. Make a schedule and stick to it. – Have a calendar and fill it with everything you need to do. Use a whiteboard that can be easily erase if some changes occur.  Be sure to color code your various tasks (e.g., Red- for school, Green-paying bills- yellow- appts, etc.) Check out the other suggestions on this website. Remember that your goal is to help you move to further your abilities and increase your earning potential. This effort takes strategic planning and follow-through. If you still feel overwhelmed after trying these suggestions, then reach out to Better Help and a therapist can also provide guidance and support Good Luck!
(LCSW)
Answered on 01/20/2022

How can you stop unwanted thoughts? Sometimes they can be inappropriate or violent or scary?

There are many reasons people have unwanted thoughts and a discussion about your thoughts and personal history is needed to know what the best course of action is to reduce their frequency and impact on you. Some people have intrusive thoughts due to trauma and others have psychological conditions where intrusive thoughts are part of what is going on with them psychologically. Some people have substantial worries that are based on something situational that is out of their control (e.g. a personal medical condition or that of a loved one, or a change in their living situation or employment status). Some questions I might ask would be: What are the thoughts about? When did they start? Have these intrusive thoughts become more intense and frequent (and when)? What is your family history? Personal history? Medical history? Have you acted on these thoughts? What level of anxiety are they causing you? Have you had recent or historical personal trauma?  I would also ask questions about personal circumstances. Unwanted thoughts often reflect very deep emotions that have been unexpressed and may be subconscious. Some people are more biologically prone to having unwanted thoughts. These thoughts can sometimes be scary and anxiety producing because of the intense feelings that accompany them. Talking through your feelings about what is going on in your life with a psychotherapist can be helpful. In between sessions, doing something very ordinary like brushing your teeth or refocusing your attention on something unrelated can sometimes break the cycle of repeated thoughts. Often a fresh air break and a walk or a talk with a friend or a family member about a neutral topic can help to refocus. Anxiety with unwanted thoughts has many origins and talking with a therapist to explore the origin of these thoughts can help. Depending on the person, sometimes medication can help with intrusive thoughts from depression and anxiety. If anxiety about intrusive thoughts  is affecting your activities of daily living to a significant degree, medication might be a recommended course of therapy. A visit with a psychiatrist for an evaluation would determine if this course of action is appropriate. The psychiatrist would prescribe the medication and follow up about how it is working on a regular basis. Medication in combination with psychotherapy has been found to be most effective if medication is needed. 
(LCSW)
Answered on 01/20/2022

How can I turn off all my negative self talk?

D, thank you for your question. I'm really glad you've made it here and that you're considering reconnecting with therapy. I know getting help can be a complicated decision, especially when you've had a less than positive experience in therapy previously which sounds like might have happened here. Therapists do work from different models and in different styles and it's important to find someone you connect and feel comfortable with and who fully understands the complexity of your needs. It takes bravery to make the first step, and it can take even more strength to persist in the face of something not working as you would have wished it to.  Dialectical Behavior Therapy (DBT) is a type of Cognitive Behavioral Therapy (CBT) modified to focus primarily on living in the moment, developing skills for coping with stress,  improving relationships, and regulating your emotions. It was originally developed as a treatment for Borderline Personality Disorder but has been adapted to treat other mental health conditions and post-traumatic stress. The core skills you would learn would be around mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. If that sounds helpful, then DBT might be a really good fit for you.  Our thoughts, feelings, and behavior are closely interconnected and each can influence the other in a myriad of ways. When your thoughts and feelings seem to be in conflict with each other it's important to check in with yourself about where that conflict is coming from. When you are experiencing a clash between your thoughts and emotions, take a moment to embrace how you are feeling. Note any physical sensations that you are experiencing from the emotion, such as shaking or feeling warm. This is the first part of processing your emotions and it is called sensing. Once you've identified the sensations, try to name the emotion and then try to connect the emotion to something that happened either internally or externally. Once you've identified the emotion and potentially a source for it- then you can develop a course of action. Anxiety is the body's response to situations that the brain perceives as threatening (whether they are or not in reality). An important part of managing anxiety is recognizing the signs and symptoms that it's occuring or are on the way. Your body will give you physical signals that something is wrong and this can cause your brain to interpret a given situation as the reason for the reaction- when the reality is very different. Our physical reactions to anxiety are highly individual. Some people experience headaches, stomachaches, or backaches, while for others, breaths become quick and shallow. Beginning to notice what happens in your body and how it feels can give you a powerful way to spot anxiety symptoms. Even if you're not sure what is making you become anxious, taking note of the physical changes helps you to slow down and take deep breaths. Deep breathing is a simple technique that's excellent for managing emotions. Not only is deep breathing effective, it's also discreet and easy to use at any time or place. Anxiety can be magnified by irrational thoughts, or negative self talk as you described. For example, the thoughts that "something bad will happen" or "I will make a mistake" might lack evidence, but still have an impact on how you feel. By examining the evidence and challenging these thoughts, you can reduce anxiety. Ask yourself a series of questions: Is this thought based on facts or feelings? How would my best friend see the situation? How likely is this thing I'm worried about to come true? What is the most likely outcome? Chances are the answers to these questions will help you get back into line with the reality of the situation. One piece of the healing process is taking care of yourself even in the moments where you don't feel like you deserve it. When you make self-care a central part of your life you’ll find that the kindness you show to yourself infuses your life with a general sense of positivity.  Make a daily practice that connects you to your passions, purpose, and gives you a feeling of control or agency in your life. These don't have to be big things but are small reminders that you have power. Treat yourself as valuable, use your time wisely (or watch terrible TV if that’s what you need).  Move your body in a way that makes you feel good, invest in relationships that make you feel good, take care of yourself in relationships that don’t. Follow your dreams, pay your bills, take care of your responsibilities or let go of the responsibilities that you have picked up unnecessarily. Say yes more or say no more, be more present for your loved ones or be more present for yourself. Grieve. Laugh. Take up a hobby, let one drop. Let yourself off the hook, or hold yourself accountable (kindly). You deserve a full life and meaningful relationships. The way you tackle your everyday life and decisions helps define what that looks like. Connecting with a therapist, growing your awareness of your thinking, and engaging in true self-care will all help you move toward those larger goals.
Answered on 01/20/2022

How to overcome social anxiety?

Thank you for asking your question. It can be frustrating and sad when you feel that others are not paying attention to you and your needs, and you feel alone. If you’re having a hard time expressing yourself, it may help to write out your thoughts and feelings. Journaling can be a helpful coping technique to allow you to express yourself. Also, other expressive artistic methods may help, such as drawing, painting, dancing, and writing musical lyrics or poems. Choose a form of expression that fits your style to let out what you’re feeling. Also, it can help to remember your personal strengths. You are a person filled with strengths, as you shared that you are a compassionate person who helps others. You have other strengths, too. By focusing on what you do well and what positive characteristics are part of you, you can use those to overcome or lessen negative or sad thinking by developing plans to use those strengths in new situations. When we think back on a time when we were able to use a certain strength, it helps us see new possibilities and possible outcomes. Perhaps combining the expressional methods above with looking inside yourself at your strengths can help you find a way to use those strengths to ask for what you need. And, reflecting on your personal strengths can help you achieve a more balanced view of yourself. In addition, self-care and coping techniques can be beneficial. Deep breathing, using imagery, journaling (mentioned above), replacing negative thoughts with neutral/positive thoughts (altering your thinking), recognizing triggers and patterns that lead to your anxiety, focusing on what you can control, and caring for yourself (healthy eating, proper sleep, etc) are some ideas to help proactively manage anxiety. Another suggestion is to watch for “never”, “always”, “constantly” – those words are red flags that you are engaging in absolute (or all-or-nothing) thinking, which is a form of a cognitive distortion. It’s rare that statements using those words are true. It’s usually a form of negative thinking. If you find yourself using those words, think of an exception to the statement. For instance, “I never do things right”. Counter that with, “that’s not true – I do ___ well”. Another suggestion are the groupinars at BetterHelp. The Groupinar topics change every so often, so it’s helpful to check back every couple of weeks to see what’s been added. I hope some of those suggestions help and wish you well on your healing journey. Better days are waiting for you! You are not alone – help is within reach at BetterHelp. So, please reach out to your therapist for more help. In wellness – Dr. Sally Gill, LMFT
(PhD, MS, LMFT, C.C.T.S.I.)
Answered on 01/20/2022

How to get through a very hard time with anxiety when the anxious what if thoughts are too much?

Hi there and thank you for your question. Anxiety, put simply, is a pervasive feeling which often ramps up the speed of our thought process to a point where it becomes uncomfortable or unbearable. The thing you are doing in trying to accept the thoughts is very important. That is the best way to move beyond the thought. We used to teach, in psychology, that you had to destroy the thought which was bothering you but we figured out this was not the way to get past these thoughts. In fact, it only made them stronger. The best thing you can do is to accept the thought and see it for what it really is. For much of our thinking in this area we know draw upon what is known as a 'Third-Wave CBT' and also 'mindfulness based CBT'. CBT is Cognitive Behavioral Therapy, which you may have heard of before, and in this formation it exists with a mindfulness component. A format of this which is very popular is known as: Acceptance and Commitment Therapy (ACT). I utilize this model to a great extent and would encourage you to work with a therapist, if you move into doing therapy, who also utilizes this model. One solution this model proposes, among many, to the problem you've described above is to use internal verbal conventions. You can also verbalize these out loud and that may help. You might say, to yourself, something like: "I notice the thought that (fill in the blank and describe the problematic thought to yourself), I accept that the thought is present AND I am choosing to not believe what it is telling me". You would actually verbalize this as you are thinking through it. And as you do this you might have a subsequent thought, which your mind throws at you, that basically communicates you don't believe what you are saying. That is also natural. And the response to that, from what you say out loud, would be: "...and I accept that thought, also". If all of this seems a little odd or abstract you would not the first person to have thought that, however, these techniques work well. You can learn more about these techniques from the well known Australian ACT Psychologist, Russ Harris. He has a book and you can get it on Amazon. It's called: The Happiness Trap. It is a good starting point if you want to learn more about getting through your specific presentation of Anxiety. I think it will help you greatly. Take care and good luck! 
Answered on 01/20/2022

Can I have therapy once every 2 weeks

Dear Ycul,   Thank you for your message and courageously sharing the traumas that you have been through, and what they meant to you and affecting your life at the moment.   This is indeed a painful process that can cause some emotions rising on your end, that is also because for a very long time we have been simply coping with these wounds through our defense mechanisms, rather than actually looking at them and process them.    As you have said, perhaps we have learned to deal and cope with these abuses and traumas by making explanations for them, validating them and even accepting them as a part of our lives. While we have learned to move on without processing these traumas, we could still the effects they bring especially in the form of anxiety and even panic when we are being reminded or triggered by events and people who have inflicted these wounds on us.   To truly move on and not let these traumas affect us, we need to learn to bring closures to these wounds and bind them up. I am glad that you are aware of the need to bring closures, I'll explain more here when it comes to closure.   A lack of closure frequently prevents people from moving forward with their lives and achieving all that they could. It makes it more difficult to reach goals, find self-happiness or make meaningful relationships. For this reason, it is important to find a sense of closure with any situation that you feel is holding you back.   Closure is any interaction, information, or practice that allows a person to feel that a traumatic, upsetting, or confusing life event has been resolved. The term has its origins in Gestalt psychology, but it is more commonly used to refer to the final resolution to a conflict or problem.   Closure means finality; a letting go of what once was. Finding closure implies a complete acceptance of what has happened and an honoring of the transition away from what's finished to something new. In other words, closure describes the ability to go beyond imposed limitations in order to find different possibilities.   People seek answers and explanations: They want to know why. However, finding answers does not necessarily end pain. Sometimes a person who seeks closure finds that an explanation makes no difference, or that it actually worsens their pain. Others find that closure may simply be a starting point for moving past a painful event. Though the trauma is not resolved, the person is better able to work through it. Seeking a definitive way to finalize grief and move on belies the importance of the grieving process. Simply putting an end to one's painful memories may be more harmful than helpful.   In some cases, though, closure is a profoundly transformative experience that does allow the person to move past the traumatic event. For example, a victim of abuse may need to confront the abuser and see them imprisoned before he or she can begin to feel safe again. In acknowledgment of this, the criminal justice system is increasingly recognizing the need for closure by instituting programs allowing victims and their families to meet with offenders in a controlled setting.   Unfortunately, there are times when closure is simply unattainable. This may be true in situations where someone moved locations or passed away before being able to resolve a problem. In some cases, the other involved person is simply unwilling to engage. In times like these, it can be easy to become bogged down by the lack of closure. It can be easy to cover up the underlying problem with meaningless coping mechanisms like substance abuse. With time and effort, there are many ways to move past unattainable closure to live happily once more.   The most important part of moving on from a lack of closure is taking care of yourself, both physically and mentally. This is also why we have began our therapy process with the focus on self-compassion. Self-compassion is the core of why we want to bring closures and bind up these wounds, because they make us feel better and they are the best decisions we can make for ourselves.   When we bring closures to our traumas, we need to keep in mind that we are doing this not because we have to, but we want to. When we practice forgiving those who have wounded us and let them go, we are not agreeing / accepting / acknowledging what they have done and not hold them accountable, we are simply letting go of the bitterness, resentment and hatred that we have hide with us all these years.   As for our physical health, engaging in adequate active exercises could be helpful. Improving your physical health through diet and exercise can help to improve self-esteem and emotional well-being, both of which are essential to moving on from unattainable closure.   Meditation, hobbies and social interaction are all great ways to nurture your mental health and find the inner happiness that makes a lack of closure bearable.   While self-care is essential to moving on from a lack of closure, it is often not enough to resolve the problem altogether. One great exercise to help you move forward is to write a letter to the individual that you have not received closure with. In this letter, you can describe all of your feelings about the situation and how you wish things had ended. Once the letter is complete, you can bury it, burn it, or simply throw it in the trash. Writing an unsent letter can help you get those feelings out that are hiding painfully inside and find a sense of self-resolution.   Forgiveness is another essential component to finding a sense of closure at times that closure cannot otherwise be achieved. Forgiving a person that caused you pain can sometimes seem like an impossible task. However, it is possible with daily efforts. We can go into details later regarding forgiveness, one step at a time.   To move past unattainable closure, you may also need to forgive yourself for anything you feel you did wrong in the situation. If you blame yourself for a broken relationship, death of a love one, or anything else, it will be impossible to move on and find inner happiness.   I'll pause here to learn from your thoughts, looking forward to talking with you more. Jono
(MSW, LICSW, LMHC)
Answered on 01/20/2022

Is there a way to beat this depression ?

Treatment-resistant depression Sometimes depression doesn't get better, even with treatment. Explore what you can do about it. If you've been treated for depression but your symptoms haven't improved, you may have treatment-resistant depression. Taking an antidepressant or going to psychological counseling (psychotherapy) eases depression symptoms for most people. But with treatment-resistant depression, standard treatments aren't enough. They may not help much at all, or your symptoms may improve, only to keep coming back.   If your primary care doctor prescribed antidepressants and your depression symptoms continue despite treatment, ask your doctor if he or she can recommend a health care provider who specializes in diagnosing and treating mental health conditions. The psychiatrist reviews your medical history and may: Ask about life situations that might be contributing to your depression Consider your response to treatment, including medications, psychotherapy or other treatments you've tried Review all of the medications you're taking, including nonprescription drugs and herbal supplements Discuss whether you're taking your medications as prescribed and following other treatment steps Consider physical health conditions that can sometimes cause or worsen depression, such as thyroid disorders, chronic pain or heart problems Consider a diagnosis of another mental health condition, such as bipolar disorder, which can cause or worsen depression and may require different treatment; dysthymia, a mild but long-term (chronic) form of depression; or a personality disorder that contributes to the depression not getting better Treatment-resistant depression symptoms can range from mild to severe and may require trying a number of approaches to identify what helps. Medication strategies   If you've already tried an antidepressant and it didn't work, don't lose hope. You and your physician simply may not have found the right dose, medication or combination of medications that works for you. Here are some medication options that your doctor may discuss with you:   Give your current medications more time. Antidepressants and other medications for depression typically take four to eight weeks to become fully effective and for side effects to ease up. For some people, it takes even longer. Increase your dose, if indicated. Because people respond to medications differently, you may benefit from a higher dose of medication than is usually prescribed. Ask your doctor whether this is an option for you — don't change your dose on your own as several factors are involved in determining the proper dose. Switch antidepressants. For a number of people, the first antidepressant tried isn't effective. You may need to try several before you find one that works for you. Add another type of antidepressant. Your doctor may prescribe two different classes of antidepressants at the same time. That way they'll affect a wider range of brain chemicals linked to mood. These chemicals are neurotransmitters that include dopamine, serotonin and norepinephrine. Add a medication generally used for another condition. Your doctor may prescribe a medication that's generally used for another mental or physical health problem, along with an antidepressant. This approach, known as augmentation, may include antipsychotics, mood stabilizers, anti-anxiety medications, thyroid hormone or other drugs. Consider pharmacogenetic testing. These tests check for specific genes that indicate how well your body can process (metabolize) a medication or how your depression might respond to a particular medication based on additional factors. Currently, pharmacogenetics tests are not a sure way to show if a medication will work for you, but these tests can provide important clues for treatment, particularly in people who have many side effects or have had poor results with certain medications. These tests are not always covered by insurance. Psychological counseling   Psychological counseling (psychotherapy) by a psychiatrist, psychologist or other mental health professional can be very effective. For many people, psychotherapy combined with medication works best. It can help identify underlying concerns that may be adding to your depression. In working with your therapist, you can also learn specific behaviors and strategies to overcome your depression. For example, psychotherapy can help you:   Find better ways to cope with life's challenges Deal with past emotional trauma Manage relationships in a healthier way Learn how to reduce the effects of stress in your life Address substance use issues If counseling doesn't seem helpful, talk to your psychotherapist about trying a different approach. Or consider seeing someone else. As with medications, it may take several tries to find a treatment that works. Psychotherapy for depression may include: Cognitive behavioral therapy. This common type of counseling addresses thoughts, feelings and behaviors that affect your mood. It helps you identify and change distorted or negative thinking patterns and teaches you skills to respond to life's challenges in a positive way. Acceptance and commitment therapy. A form of cognitive behavioral therapy, acceptance and commitment therapy helps you to engage in positive behaviors, even when you have negative thoughts and emotions. It's designed for treatment-resistant conditions. Interpersonal psychotherapy. Interpersonal psychotherapy focuses on resolving relationship issues that may contribute to your depression. Family or marital therapy. This type of therapy involves family members or your spouse or partner in counseling. Working out stress in your relationships can help with depression. Dialectical behavioral therapy. This type of therapy helps you build acceptance strategies and problem-solving skills. This is useful for chronic suicidal thoughts or self-injury behaviors, which sometimes accompany treatment-resistant depression. Group psychotherapy. This type of counseling involves a group of people who struggle with depression working together with a psychotherapist. Mindfulness. Mindfulness involves paying attention and accepting one's thoughts and feelings without judging them as "right" or "wrong" in a given moment. Behavioral activation. This type of treatment works with depressed individuals to gradually decrease their avoidance and isolation and increase their engagement in activities that they once enjoyed or activities that have been shown to improve mood. Procedures to treat depression   If medications and psychotherapy aren't working, you may want to talk to a psychiatrist about additional treatment options: Repetitive transcranial magnetic stimulation (rTMS). This type of treatment uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression. An electromagnetic coil is placed against your scalp near your forehead. The electromagnet used in rTMS creates electric currents that stimulate nerve cells in the region of your brain involved in mood control and depression. Typically, this treatment is delivered over 30-minute sessions in rapid bursts. This treatment can now be delivered over briefer sessions with dosing called intermittent theta burst stimulation. Ketamine is a medication that's delivered through an IV in low doses. It's used for rapid relief of hard-to-treat depressive symptoms and its effects can last from days to weeks. Usually it's given in decreasing frequencies over several weeks. The FDA approved an intranasal form called esketamine that's given in a physician's office or a clinic under the supervision of a health care provider to monitor for possible serious side effects and because of the potential for abuse and misuse. Esketamine is for adults who have tried at least two other antidepressant medications that did not adequately control symptoms. Ketamine and esketamine work in the brain in a different way than standard antidepressants, and each is typically used along with an oral antidepressant. Electroconvulsive therapy (ECT). While you're asleep, a carefully measured dose of electricity is passed through your brain, intentionally triggering a small, brief seizure. ECT seems to cause changes in brain chemistry that can relatively quickly reverse symptoms of major depression. Although there are potential side effects, such as temporary confusion or temporary memory loss, a series of ECT treatments may provide significant relief of severe depression. Vagus nerve stimulation (VNS). Generally, VNS is only tried after other brain stimulation therapies such as ECT and rTMS have not been successful in improving symptoms of depression. VNS stimulates the vagus nerve with electrical impulses. This treatment uses a device implanted in your chest that's connected by a wire to a nerve in your neck (vagus nerve). Electrical signals from the implant travel along the vagus nerve to the mood centers of the brain, which may improve depression symptoms.   Be sure to find out whether your insurance covers any treatment that's recommended. Other steps you can take   To make the most of depression treatment: Stick to your treatment plan. Don't skip therapy sessions or appointments. It'll take time to get better. Even if you feel well, don't skip your medications. If you stop, depression symptoms may come back, and you could experience withdrawal-like symptoms. If side effects or drug costs are a problem, talk with your doctor and pharmacist to discuss options. Stop drinking or using recreational drugs. Many people with depression drink too much alcohol or use recreational drugs or marijuana. In the long run, alcohol and drugs worsen depression and make it harder to treat. If you can't stop drinking alcohol or using drugs on your own, talk to your doctor or mental health professional. Depression treatment may be unsuccessful until you address your substance use. Manage stress. Relationship issues, financial problems, an unhappy work life and many other issues can all contribute to stress, which in turn worsens depression. Try stress-reduction techniques such as yoga, tai chi, meditation, mindfulness, progressive muscle relaxation or writing your thoughts in a journal. Sleep well. Poor sleep may worsen depression. Both the amount of time and how well you sleep can affect your mood, energy level, ability to concentrate and resilience to stress. If you have trouble sleeping, research ways to improve your sleep habits or ask your doctor or mental health professional for advice. Get regular exercise. Exercise has a direct effect on mood. Even physical activity such as gardening or walking can reduce stress, improve sleep and ease depression symptoms.   Don't settle for a treatment that's partially effective at relieving your depression or one that works but causes intolerable side effects. Work with your doctor or other mental health professional to find the best treatment possible, even though it may take time and effort to try new approaches. If you are at risk of harming yourself or someone else, please immediately report to your closest emergency room and/or call the national suicide hotline 800-273-8255
(LPC, NCC, CEDS-S)
Answered on 01/20/2022

How do i stop feeling so anxious, overwhelmed and sad?

Thank you for reaching out, I know it is not easy to ask for help sometimes. The first thing I would do if you want to try and find some mental health services is to see about programs locally that offer therapy for free, or perhaps for a very reduced cost. Some states even have lists of pro bono practitioners that are offering the services you need/want. Websites like this one also provide affordable and accessible mental health services, just ask for promotions or special offers. Now, in the meantime, I am going to help you by giving you tips on how to address some of the issues you just mentioned.  Here are some useful techniques to help you with anxiety, triggers, and even depression:   Physical techniques   These techniques use your five senses or tangible objects — things you can touch — to help you move through distress.   1. Put your hands in water   Focus on the water’s temperature and how it feels on your fingertips, palms, and the backs of your hands. Does it feel the same in each part of your hand?   Use warm water first, then cold. Next, try cold water first, then warm. Does it feel different to switch from cold to warm water versus warm to cold?   2. Pick up or touch items near you   Are the things you touch soft or hard? Heavy or light? Warm or cool? Focus on the texture and color of each item. Challenge yourself to think of specific colors, such as crimson, burgundy, indigo, or turquoise, instead of simply red or blue.   3. Breathe deeply   Slowly inhale, then exhale. If it helps, you can say or think “in” and “out” with each breath. Feel each breath filling your lungs and note how it feels to push it back out.   4. Savor a food or drink   Take small bites or sips of a food or beverage you enjoy, letting yourself fully taste each bite. Think about how it tastes and smells and the flavors that linger on your tongue.   5. Take a short walk   Concentrate on your steps — you can even count them. Notice the rhythm of your footsteps and how it feels to put your foot on the ground and then lift it again.   6. Hold a piece of ice   What does it feel like at first? How long does it take to start melting? How does the sensation change when the ice begins to melt?   7. Savor a scent   Is there a fragrance that appeals to you? This might be a cup of tea, an herb or spice, a favorite soap, or a scented candle. Inhale the fragrance slowly and deeply and try to note its qualities (sweet, spicy, sharp, citrusy, and so on).   8. Move your body   Do a few exercises or stretches. You could try jumping jacks, jumping up and down, jumping rope, jogging in place, or stretching different muscle groups one by one.   Pay attention to how your body feels with each movement and when your hands or feet touch the floor or move through the air. How does the floor feel against your feet and hands? If you jump rope, listen to the sound of the rope in the air and when it hits the ground.   9. Listen to your surroundings   Take a few moments to listen to the noises around you. Do you hear birds? Dogs barking? Machinery or traffic? If you hear people talking, what are they saying? Do you recognize the language? Let the sounds wash over you and remind you where you are.   10. Feel your body   You can do this sitting or standing. Focus on how your body feels from head to toe, noticing each part.   Can you feel your hair on your shoulders or forehead? Glasses on your ears or nose? The weight of your shirt on your shoulders? Do your arms feel loose or stiff at your sides? Can you feel your heartbeat? Is it rapid or steady? Does your stomach feel full, or are you hungry? Are your legs crossed, or are your feet resting on the floor? Is your back straight?   Curl your fingers and wiggle your toes. Are you barefoot or in shoes? How does the floor feel against your feet?   11. Try the 5-4-3-2-1 method   Working backward from 5, use your senses to list things you notice around you. For example, you might start by listing five things you hear, then four things you see, then three things you can touch from where you’re sitting, two things you can smell, and one thing you can taste.   Make an effort to notice the little things you might not always pay attention to, such as the color of the flecks in the carpet or the hum of your computer.     Mental techniques   These grounding exercises use mental distractions to help redirect your thoughts away from distressing feelings and back to the present.   12. Play a memory game   Look at a detailed photograph or picture (like a cityscape or other “busy” scene) for 5 to 10 seconds. Then, turn the photograph face-down and recreate the photograph in your mind, in as much detail as possible. Or, you can mentally list all the things you remember from the picture.   13. Think in categories   Choose one or two broad categories, such as “musical instruments,” “ice cream flavors,” “mammals,” or “baseball teams.” Take a minute or two to mentally list as many things from each category as you can.   14. Use math and numbers   Even if you aren’t a math person, numbers can help center you.   Try:   running through a times table in your head. counting backward from 100 choosing a number and thinking of five ways you could make the number (6 + 11 = 17, 20 – 3 = 17, 8 × 2 + 1 = 17, etc.)   15. Recite something   Think of a poem, song, or book passage you know by heart. Recite it quietly to yourself or in your head. If you say the words aloud, focus on the shape of each word on your lips and in your mouth. If you say the words in your head, visualize each word as you’d see it on a page.   16. Make yourself laugh   Make up a silly joke — the kind you’d find on a candy wrapper or popsicle stick.   You might also make yourself laugh by watching your favorite funny animal video, a clip from a comedian or TV show you enjoy, or anything else you know will make you laugh.   17. Use an anchoring phrase   This might be something like, “I’m Full Name. I’m X years old. I live in City, State. Today is Friday, June 3. It’s 10:04 in the morning. I’m sitting at my desk at work. There’s no one else in the room.”   You can expand on the phrase by adding details until you feel calm, such as, “It’s raining lightly, but I can still see the sun. It’s my break time. I’m thirsty, so I’m going to make a cup of tea.”   18. Visualize a daily task you enjoy or don’t mind doing   If you like doing laundry, for example, think about how you’d put away a finished load.   “The clothes feel warm coming out of the dryer. They’re soft and a little stiff at the same time. They feel light in the basket, even though they spill over the top. I’m spreading them out over the bed so they won’t wrinkle. I’m folding the towels first, shaking them out before folding them into halves, then thirds,” and so on.   19. Describe a common task   Think of an activity you do often or can do very well, such as making coffee, locking up your office, or tuning a guitar. Go through the process step-by-step, as if you’re giving someone else instructions on how to do it.   20. Imagine yourself leaving the painful feelings behind   Picture yourself:   gathering the emotions, balling them up, and putting them into a box walking, swimming, biking, or jogging away from painful feelings Imagine your thoughts as a song or TV show you dislike, changing the channel or turning down the volume — they’re still there, but you don’t have to listen to them.   21. Describe what’s around you   Spend a few minutes taking in your surroundings and noting what you see. Use all five senses to provide as much detail as possible. “This bench is red, but the bench over there is green. It’s warm under my jeans since I’m sitting in the sun. It feels rough, but there aren’t any splinters. The grass is yellow and dry. The air smells like smoke. I hear kids having fun and two dogs barking.”   Soothing techniques   You can use these techniques to comfort yourself in times of emotional distress. These exercises can help promote good feelings that may help the negative feelings fade or seem less overwhelming.   22. Picture the voice or face of someone you love   If you feel upset or distressed, visualize someone positive in your life. Imagine their face or think of what their voice sounds like. Imagine them telling you that the moment is tough, but that you’ll get through it.   23. Practice self-kindness   Repeat kind, compassionate phrases to yourself:   “You’re having a rough time, but you’ll make it through.” “You’re strong, and you can move through this pain.” “You’re trying hard, and you’re doing your best.” Say it, either aloud or in your head, as many times as you need.   24. Sit with your pet   If you’re at home and have a pet, spend a few moments just sitting with them. If they’re of the furry variety, pet them, focusing on how their fur feels. Focus on their markings or unique characteristics. If you have a smaller pet you can hold, concentrate on how they feel in your hand.   Not at home? Think of your favorite things about your pet or how they would comfort you if they were there.   25. List favorites   List three favorite things in several different categories, such as foods, trees, songs, movies, books, places, and so on.   26. Visualize your favorite place   Think of your favorite place, whether it’s the home of a loved one or a foreign country. Use all of your senses to create a mental image. Think of the colors you see, sounds you hear, and sensations you feel on your skin.   Remember the last time you were there. Who were you with, if anyone? What did you do there? How did you feel?   27. Plan an activity   This might be something you do alone or with a friend or loved one. Think of what you’ll do and when. Maybe you’ll go to dinner, take a walk on the beach, see a movie you’ve been looking forward to, or visit a museum.   Focus on the details, such as what you’ll wear, when you’ll go, and how you’ll get there.   28. Touch something comforting   This could be your favorite blanket, a much-loved T-shirt, a smooth stone, a soft carpet, or anything that feels good to touch. Think about how it feels under your fingers or in your hand.   If you have a favorite sweater, scarf, or pair of socks, put them on and spend a moment thinking about the sensation of the fabric on your skin.   29. List positive things   Write or mentally list four or five things in your life that bring you joy, visualizing each of them briefly.   30. Listen to music   Put on your favorite song, but pretend you’re listening to it for the first time. Focus on the melody and lyrics (if there are any). Does the song give you chills or create any other physical sensations? Pay attention to the parts that stand out most to you.   I hope these are helpful, and do not hesitate to ask for more information, have a great day!
(MA, LPC)
Answered on 01/20/2022

Please, how can i overcome anxiety that comes when I am do take up tasks or do a particular work?

Your anxiety is causing you to second guess yourself.  That can be expected when a person goes through a period of mental instability and lose what you are describing as "getting your mojo back."  Developing an understanding of what is triggering your anxiety is the first step and then learning how to implement some coping skills and strategies to rationalize your disordered thoughts will reduce your anxiety because you will have a stronger sense of self-assurance with starting again.  It can be a challenge and it takes work but it is not an impossible feat.  It sounds like you have an acknowledgement of what barriers you are dealing with but may need some guidiance and reassureance to get in the right mindset of reaching your goal to return back to your "normalcy."  I have worked with many patients/clients over the years who have had difficulties with returning to their baseline of functioning in occupational, social, or interpersonal settings.  Obtaining therapeutic tools to overcome such barriers is the key. You may want to consider scheduling with a therapist in order to begin obtaining the coping tools and strategies that will allow you to be more confident and self-assured in working toward getting back to where you desire to be.  You are not alone, anxiety is one of the top disorders that most individuals suffer from and many have the same concerns as you.  When we suffer from a setback in life we develop a tendency to second guess ourselves.  This is a normal response to what we as therapist identify as an "Sentinel Event" in life.  I'd love to explore with you the preceding factors leading to your mental breakdown and the stressor/factors which may have triggered this.  By exploring and discussing your past,  you may gain some insight regarding what "not" to do in the future, which can provide you a valuable learning experience.  Please respond to me if I can be of further assitance.  I am here to help, but if you search the site and find another therapist more suitable to address your needs, please reach out to them directly.  Best regards.  
Answered on 01/20/2022

Is it possible for regular things you do affects a panick attack?

Dear Unique,   Thank you for your message and sharing with me how you've been interacting with yourself, especially on how you've been handling unpleasant feelings and emotions. As you said this has also affected your life significantly. Perhaps by addressing how to handle unpleasant emotions in a healthier manner, we can dive into addressing the issues in your life as well?   Often the experience we've had about anxiety (or any strong emotion such as stress / depression) was so terrible (even physically) that our body sort of become traumatized to it. We naturally become nervous about these unpleasant feelings because we don't like these sensations and experiences. As a result we would do everything we can to avoid / fight these anxious feelings, often using numbing techniques such as using substances or distracting ourselves. Yet only to find that the anxiety gets stronger over time because we have never been able to make peace with it.   Therefore rather than trying to "change" / "fight" / "get rid of" these unpleasant sensations, perhaps the best thing that we can do is to make room for these feelings and even sensations, while staying on track to do what brings us meaning and fulfillment. Floating without judging / blaming ourselves through the anxiety experience, while focusing on making room for anxiety can be helpful.   Here is a short video put up by the author of the book "The Happiness Trap" which does a good job explaining this concept:   Please take some time to watch this and share your thoughts later :) I also highly recommend picking that book as well to supplement this therapy process.   https://www.youtube.com/watch?v=rCp1l16GCXI    We as human beings do not like sufferings, therefore often times we would be doing our best to fight it. However just like the analogy of swimming vs floating that we have talked about before, the more we fight it, the faster we sink. While if we can learn to float with these waves, we will realize that we won't sink.   Radical acceptance / Expansion is about accepting of life on life's terms and not resisting what you cannot or choose not to change. Radical Acceptance is about saying yes to life and all that life brings (including all sorts of emotions such as joy, sadness, peace and pain), just as it is without forcing our ways into our lives.   Why do we want to accept life as it is? Because with anything that we do in life that brings us meaning and fulfillment, it always accompany a wide range of emotions, we can't possibly just choose the ones that we like and fight / avoid those that we don't like. Learning to experience all emotions as they are, is a sign that we are living our lives to the fullest.   To do so we must learn to accept (and make room for) any unpleasant sensations, feelings or thoughts that we experience.   We don't want to fight it because the more we fight, the stronger they will come back.   We don't want to avoid it either because the more we avoid, the more we'll be afraid of it.   So the key here is to make room for these sensations, feelings and thoughts, while continue to do what brings us meaning and fulfillment in life.    Learning to "co-exist" with these feelings will naturally reduce the intensity of them.   Floating, is a form of learning to accept these feelings and make room for it.   Let me give you some practical guidelines on what I mean by accepting these feelings and make room for it.   You can look up "expansion technique" under Acceptance and Commitment Therapy (ACT) for more information as well.   How to accept our emotions (and make room for them):   1. OBSERVE. Bring awareness to the feelings in your body.   2. BREATHE. Take a few deep breaths. Breathe into and around them.   3. EXPAND. Make room for these feelings. Create some space for them.   4. ALLOW. Allow them to be there. Make peace with them   Some people find it helpful to silently say to themselves, 'I don't like this feeling, but I have room for it,' or 'It's unpleasant, but I can accept it.'   • When you're feeling an unpleasant emotion, the first step is to take a few slow, deep breaths, and quickly scan your body from head to toe.   • You will probably notice several uncomfortable sensations. Look for the strongest sensation - the one that bothers you the most. For example, it may be a lump in your throat, or a knot in your stomach, or an ache in your chest.   • Focus your attention on that sensation. Observe it curiously, as if you are a friendly scientist, discovering some interesting new phenomenon.   • Observe the sensation carefully. Notice where it starts and where it ends. Learn as much about it as you can. If you had to draw a line around the sensation, what would the outline look like? Is it on the surface of the body, or inside you, or both? How far inside you does it go? Where is the sensation most intense? Where is it weakest? How is it different in the center than around the edges? Is there any pulsation, or vibration within it? Is it light or heavy? Moving or still? What is its temperature?   • Take a few more deep breaths, and let go of the struggle with that sensation. Breathe into it. Imagine your breath flowing in and around it.   • Make room for it. Loosen up around it. Allow it to be there. You don't have to like it or want it. Simply let it be.   • The idea is to observe the sensation - not to think about it. So when your mind starts commenting on what's happening, just say 'Thanks, mind!' and come back to observing.   • You may find this difficult. You may feel a strong urge to fight with it or push it away. If so, just acknowledge this urge, without giving in to it. (Acknowledging is rather like nodding your head in recognition, as if to say 'There you are. I see you.') Once you've acknowledged that urge, bring your attention back to the sensation itself.   • Don't try to get rid of the sensation or alter it. If it changes by itself, that's okay. If it doesn't change, that's okay too. Changing or getting rid of it is not the goal.   • You may need to focus on this sensation for anything from a few seconds to a few minutes, until you completely give up the struggle with it. Be patient. Take as long as you need. You're learning a valuable skill.   • Once you've done this, scan your body again, and see if there's another strong sensation that's bothering you. If so, repeat the procedure with that one.   • You can do this with as many different sensations as you want to. Keep going until you have a sense of no longer struggling with your feelings.   • As you do this exercise one of two things will happen: either your feelings will change - or they won't. It doesn't matter either way. This exercise is not about changing your feelings. It's about accepting them.   Looking forward to talking with you more, Jono
(MSW, LICSW, LMHC)
Answered on 01/20/2022

1. How I get through with my emotion? 2 And is there any possibility that I have a Anxiety disorder?

1. How I get through with my emotion? 2 And is there any possibility that I have an Anxiety Disorder? I read where you shared that because you easily get the emotions of others specifically an anger emotion and you shared that you cannot control your emotions. You shared that you always get mad easily when others get mad. You also shared that you always think that you are always alone and that no one will be there for you. You also shared that you always feel sad. Based on your questions, I would highly suggest that you try to seek help for your specific mental health needs from a local licensed professional counselor and or a local licensed professional mental health therapist. A licensed professional counselor and or licensed professional mental health therapist can properly assess you for an official diagnosis to see if you actually have Anxiety Disorder. Along with an official diagnosis, a licensed professional counselor and or licensed professional mental health therapist can support you in assessing your specific mental health needs in regards creating a treatment plan specifically for you in regards to you experiencing anger, loneliness, and or sadness. Licensed professional counselors and or licensed professional mental health therapists on the Betterhelp platform are not able to diagnosis you because we cannot see you in person to get a thorough assessment. Therefore, I highly encourage you to continue or to begin to search for a local licensed professional counselor and or licensed professional mental health therapist in your local area who can properly diagnosis you at this time. Once you have been properly assessed and diagnosed by a licensed professional counselor and or licensed professional mental health therapist you can both then discuss and process what your current symptoms of Anxiety Disorder look like at this time. If your symptoms Anxiety Disorder are severe, a licensed professional counselor and or licensed professional mental health therapist can provide you with a referral to a professional psychiatrist and or medical provider for medication after they assess what your specific mental health needs are in regards to your symptoms of Anxiety Disorder. Therapy and medication together can help minimize the severity of your Anxiety Disorder if needed. Individuals who receive therapy and medication often see quicker improvements and overall better outcomes than those who only receive therapy or those individuals who only take medication. Behavior interventions, Psychotherapy, and Cognitive Behavioral Therapy (CBT) have all been beneficial in treating individuals who have struggle with Anxiety Disorder.  A licensed professional counselor and or licensed professional mental health therapist can assist you in learning how to effectively implement coping skills to decease Anxiety Disorder. A licensed professional counselor and or licensed professional mental health therapist can introduce you to deep breathing techniques, calming techniques, grounding techniques, stress management techniques, progressive muscle relaxation, and imagery as a means of decreasing your current symptoms of anger, loneliness and or sadness that you are currently experiencing at this time. In an effort to decrease your current symptoms you can also try to commit to changing the way you think. It will take a lot of practice, dedication and determination to alleviate your symptoms of Anxiety Disorder. However, trying to do this will help you feel better and it can lead to your feeling much better and becoming more productive. You can recognize when it is happening and when you find it happening you can choose to think about something more productive. You can also look for solutions by committing to learning from your mistakes and solving your problems so you can productively move forward, set aside time to think when you notice you are feeling like you want to engaged in emotional distress outside of that scheduled time, remind yourself that you will think about it later, distract yourself with a self care activity and you can practice mindfulness. Mindfulness is the key to living in the "here and now." When you become mindful, you will be completely present in the moment. It can be like a form of meditation that takes a lot of practice, but over time and with consistency, it can be very beneficial in decreasing emotional distress in an effort to help you experience an overall healthier mental well being. Overall, I highly recommend that you seek help from a local licensed professional counselor and or licensed professional mental health therapist and a medical provider if needed to properly assess and diagnose your symptoms of Anxiety Disorder as it can look different for everyone. Please remember that mental health is not a one size fits all, so it is very important to get personalized treatment for your specific and current mental and emotional needs at this time. I highly recommend that you contact the Betterhelp team to discuss what specific payment options and payment plans are available for you to access counseling services at this time. Betterhelp does offer financial aid and various other options for individuals who are seeking counseling for their personal and or emotional well-being through the use of affordable therapy sessions. The Betterhelp Platform is designed to be able to assist you better if you contact them directly. Contacting Betterhelp directly is the best way for them to verify your identity and securely help you with your specific account information and needs. When it comes to questions, issues or concerns in regards to the cost of using the Betterhelp platform please contact the Betterhelp team. You can reach out to the Betterhelp team for issues including but not limited to the following: billing issues, account questions and or concerns, and or subscription questions and or concerns. The Betterhelp members are there to help answer your questions, concerns and or issues, so if you have a question in regards to what the cost would be to begin using the Bettehelp platform you can contact the Beterhelp team members directly to gain accurate information in regards to what payment options are available for you if you decide to join the Betterhelp platform in regards to possibly talking to a licensed professional counselor and or licensed professional mental health therapist. Please feel free to reach out to the Member Success Team directly by emailing contact@betterhelp.com to discuss what payment options are available for you to use the Betterhelp platform for you counseling needs and or therapy needs at this time. Best regards to you!      
(EdS, LPC-S, NCC, BC-TMH)
Answered on 01/20/2022

Does having trichotillomania mean i have OCD?

Hello Shinelesstar,   Thank you for reaching out on The BetterHelp Platform with your question: Does having trichotillomania mean I have OCD? I am glad you reached out for some guidance and support with what you are going through.  The details you share indicate that you might have OCD, checking, tapping ritualistic, and ruminating and catastrophizing.  I will share some information about what maybe going on with you.  I will also share some self-help tools for you to implement.  I encourage you to consider seeking professional mental health counseling support.  A counselor can teach you effective coping strategies to help you manage this situation. What Is Trichotillomania And How Does It Affect You? It sounds like a strange word, and maybe you've even heard it once or twice before, but you may not know what trichotillomania is. In fact, not a lot of people do know what it means. For those who suffer from it, trichotillomania is an extremely serious disorder and one that can be difficult to overcome or even explain to those who don't suffer it. Trichotillomania is considered rare and is classified as an impulse control disorder. It may occur along with other impulse disorders or entirely on its own. Understanding what it is and how it can affect you if you're suffering from it is important. What is Trichotillomania? In simple terms, trichotillomania is hair pulling, but it's a little more complicated than that for those who live with it. You may have a sibling that tugs on your hair as a sign of affection or teasing, or you may be someone who twists their hair when frustrated or nervous. These things are not signs of trichotillomania, at least, not on their own. For those with this disorder, it's an impulse they feel they can't control, and it causes them to pull on their hair to the extent that they pull it out. Though most people think of hair pulling as being related to the hair on the scalp, those with this disorder may pull hair from any part of the body, though it's generally on the scalp, eyelids or eyebrows. With less than 2% of adults or adolescents suffering from the disorder, it's not a common occurrence, which is why many of us have never even heard of it and may not until someone we know (or ourselves) is suffering from it. Symptoms of Trichotillomania So, what should you be on the lookout for? Someone with this disorder will have several different symptoms that you can look for, but keep in mind that this disorder is a very secretive one and most who suffer from it will try to hide their behaviors, including hair loss and any additional behaviors they engage in with the hair that they pull out. The first and most important aspect of this disorder is that the individual is pulling out their hair to the extent that it is causing noticeable hair loss. Of course, they may attempt to cover this hair loss in some different ways. Changing their hairstyle, wearing hats or even using wigs are just some of the way they may try to hide their problem. It may take some time for you to notice that they have hair loss, or you may not realize it at all. That's why it's important to look at some of the other symptoms that go along with the disorder as well. An individual will feel a sense of tension before they engage in hair pulling or if they are attempting to resist pulling their hair. In contrast, they will feel gratification or pleasure when they engage in the activity. For many, they will even try to avoid the behavior, knowing that it is strange or that it's not good for them. They may try to cut down on the number of times that they engage in the activity or attempt to stop it altogether, but hair pulling is an impulse disorder, and it's difficult to take control of the impulse. An individual who engages in this behavior will also likely feel distressed or impaired because of the action. They may feel like they have no control, or they may start to feel shame or embarrassment because of the disorder. This can affect their abilities when it comes to work, school or personal aspects of their life as they try to avoid situations where someone might find out about the disorder. The resulting stress and strain may also cause negative side effects in the way of their personal or professional life as well. Finally, someone with this type of disorder may engage in other behaviors that revolve around the hair. That may mean playing with or examining that hair, chewing or eating it or just about anything else that you might think of in the way of playing with the hair itself. It is important to watch for any of these behaviors and to help the individual who is suffering to seek treatment as quickly as possible to work through it. Though it may not seem like a very serious disorder or problem, it most definitely can be for those who suffer from it, and that's why it's important to help anyone who's fighting this disorder. When Does It Start? For most, trichotillomania tends to appear between the ages of 9 and 13, though it can happen in earlier or younger years. Because of the type of disorder and the fact that it's considered an impulse control disorder, it's common for those who may have difficult emotional states, suffer from boredom or anxiety or even those who have a history of abuse or other trauma in their life or family history. And unfortunately, because of the type of disorder that it is, it can result in even more problems for those who suffer. Someone who suffers from this disorder is likely to feel shame or guilt because of the hair pulling. In situations where entire of patches of hair are pulled out, it can feel especially stressful as it becomes noticeable or may result in shame and teasing. This can result in even more trauma from the disorder and can lead to even more problems in the development of the individual. The younger the individual or, the more sensitive they may be, the more important it is to seek treatment quickly if only for self-esteem reasons. Because of the type of disorder that this is, it's also likely that other obsessive-compulsive symptoms may be present at the same time. Individuals who suffer from this disorder may experience counting, washing, or other impulsive behaviors, which can interfere with regular life as well. On top of that, depression and repetitive behaviors are also common alongside trichotillomania, which can all interfere with professional and personal life and make it even more important to get help with treatment.   Seeking Treatment for Trichotillomania If you have this disorder, seeking treatment right away is best. It may seem like something that you can overcome by yourself, but remember, this is impulse control or obsessive-compulsive type of disorder, and it's a whole lot more difficult to overcome than you might expect it to be. That's why you likely haven't been able to overcome it on your own previously. Behavioral therapy  The benefits of habit reversal training (HRT) in treating trichotillomania works by: ·       Increasing a person’s awareness about trichotillomania symptoms and triggers ·       Replacing the hair pulling behavior with another behavior ·       Finding ways to stay motivated to stop hair pulling behavior ·       Practicing the new learned skills in different situations   Physical Effects ·        Bald spots ·        Patchy hair ·        Inconsistent hair regrowth ·        Sparse or missing eyebrows ·        Uneven hairline ·        Infections ·        Blepharitis   Psychological Effects ·        Shame ·        Embarrassment ·        Feeling like a fraud ·        Self-loathing ·        Feeling alone ·        Feeling crazy ·        Low self-esteem ·        Depression ·        Anxiety ·        Hypersensitive to the reactions of others ·        Hopelessness ·        Fear of judgment Trichotillomania is chronic; however, treatment helps manage the compulsions, impulsivity, and behaviors to help people live free from its powerful grip. Everyone suffering from trichotillomania experiences it differently, therefore, seek treatment from qualified professionals who can help you figure out what will work best for you. People who struggle with trichotillomania have a high risk of developing other mental health disorders.   In some people, anxiety and depression can make trich symptoms worse. Therefore, make sure treatment addresses everything because it is all related. Treatment Categories ·        Medication ·        Cognitive Behavioral Therapy ·        Habit Reversal Training ·        Comprehensive Behavioral Model ·        Acceptance and Commitment Therapy ·        Hypnosis ·        Group Therapy ·        Alternative treatments   Medication First, there is no single medication indicated by the Food and Drug Administration (FDA) for treating trichotillomania. Research suggests some medications can help with impulsivity as well as the depression, anxiety, or stress that often accompanies trichotillomania and makes it worse. Sometimes, reducing the mental and emotional states that trigger pulling behaviors is enough to make a positive difference. However, some of these same medications produce significant side effects that can make pulling behaviors worse. That said, studies indicate the tricyclic antidepressant Anafranil has yielded positive treatment results, while other studies show inconsistent outcomes. Additionally, other medications such as Prozac and other selective serotonin reuptake inhibitors have exhibited some limited aid, but they produce side effects that may be undesirable. Approach the use of medication with caution and under the guidance of a trusted health professional who has experience treating patients with body-focused repetitive behaviors like trichotillomania and co-occurring disorders. Cognitive Behavioral Therapy The best outcomes for trichotillomania treatment result from psychotherapy. The most common method of psychotherapy, CBT (Cognitive Behavioral Therapy) is considered the leading evidence-based practice for treating compulsive hair pulling. There are many subtypes of cognitive behavioral therapies. However, one thing they have in common is the underlying assumption about the interrelatedness between thoughts, feelings, and behaviors. In a simplified example, a person could have a thought about being late for work. That thought may inspire a feeling of fear. The feeling of fear then drives the behavior of speeding on the way to work. The process becomes complicated because behaviors, thoughts, and feelings impact each other which can become a chaotic mess. For example, the behavior of pulling out hair could cause a thought such as, “this is not a good behavior” which creates a feeling of shame, but the feeling of shame creates a negative thought that inspires more pulling. A cognitive behavioral therapist can help you sort out the chaotic mess. Habit Reversal Training (HRT) Habit Reversal Training is a subtype of cognitive behavioral therapy that targets behaviors.   This method of treatment consists of three essential parts: ·        Awareness training helps a person recognize patterns in hair pulling behaviors including where it usually happens, how it happens, and identifying the trigger. This is an observational process with the goal of understanding the ideal scenario for hair pulling to take place which informs the kind of therapeutic techniques that will discourage pulling. ·        Competing response training is a process where you learn to do something that is not compatible with hair-pulling when you feel the urge to pull. For example, when you feel the urge to pull, making fists with your hands and placing your arms in a locked position would make pulling hair impossible. ·        Social Supports involves the introduction of supportive others into the therapy session so that they can participate. Often, they are instrumental in providing positive feedback, recognizing triggers or behavioral patterns, intervening when you need assistance, or reminding you when the you are in a circumstance where the urge to pull hair can happen.   The goal of cognitive behavioral therapy coincides with the other underlying assumption that if a thought, feeling, or behavior changes, it will cause changes in the other areas. In therapy, the process includes breaking down the interconnectedness of the thoughts and feelings that lead to pulling behaviors. Then, making small changes in those areas. A simple example is accepting that trichotillomania is a mental disorder, but it does not define the type of person you are. By removing the judgment associated with the thought of hair pulling, the feeling of shame can be corrected by changing one’s thoughts about the condition. Comprehensive Behavioral Treatment Comprehensive Behavioral Treatment combines all existing cognitive behavioral treatment components and customizing them for an individual’s needs. ·        During assessment and self-monitoring, the therapist and the individual identify problematic thoughts, feelings, and behaviors that occur before, during, and after hair-pulling incidents to learn about the functionality of the person’s trichotillomania. ·        Create sensory substitutes to satiate the urge to pull hair. ·        Alter environments where the hair pulling occurs, so it is less convenient and less comfortable for the person to partake in the unwanted behavior. ·        Identify and process negative feelings, thoughts, and emotions that typically surround the behavior. Acceptance and Commitment Therapy (ACT) Acceptance and Commitment Therapy (ACT) is another form of therapy for trichotillomania treatment. ACT (pronounced ‘act’) is different from CBT because the goal is not to learn how to control thoughts or feelings, but to accept them, especially the unpleasant ones. The therapeutic process includes noticing thoughts, feelings, urges, and unpleasant sensations through observation while learning to experience them and accept them without self-judgment. In therapy, one practices mindfulness to increase awareness and learn to accept the negative feelings they experience. Then, one can choose behaviors that support their values.   For people who pull hair, the goal is to experience the urges associated with pulling, accept the urge, then choose not to act on it. Then, the person can learn that when they experience the negative emotions that surround the act of pulling hair, they can choose not to respond to the urge and not to relieve the negative emotion through pulling. Hypnosis While there is not much research to support it, some people experience therapeutic results with hypnosis. Through this process, the hypnotherapist enters the unconscious mind to draw out ways to help them cope with the urges that come with trichotillomania. This method could be successful in discovering and dealing with traumatic events or incidences of stress that could have initially triggered the beginning of the hair pulling behaviors. Group Therapy For those who want to figure out how to stop hair pulling, yet do not want to go through treatment alone, group therapy is a viable alternative. Group therapy can also supplement individual therapy by providing social support. Group therapy and their less formal counterparts, support groups, offer several benefits: ·        A place to freely be oneself ·        Not feeling alone ·        Increased sense of belonging ·        Decrease shame and embarrassment ·        Learn from the experience of others ·        Help support others by sharing one’s experience Alternative Methods While behavioral therapies are well-documented, evidence-based ways to treat trichotillomania, there are several alternatives or holistic methods that exist as viable options. Use caution with alternative therapies. The research regarding the effectiveness of these therapies is mixed. Consult with your healthcare provider because some herbs, supplements, and treatments can interfere with medication, or can increase the severity of symptoms. Aloe vera ·        Applied topically with gel from a plant or commercially available products. ·        Thought to calm physical sensations on the skin that can trigger hair pulling. Chamomile tea ·        Drinking the tea creates an overall calming effect. ·        Soothing anxiety or stress reduces the urge to pull hair. Kava Kava ·        Supplements or capsules commercially available or chew on the leaves. ·        The plant contains natural calming properties that can reduce the urge to pull hair. Marjoram leaves ·        Chew the leaves. ·        Calms nerves, especially during times of shock or grief. ·        Provides relief to trich sufferers who developed the disorder as a coping mechanism for stress. Aromatherapy ·        Various oils can serve as a therapeutic remedy. ·        People who pull eyebrows or eyelashes should avoid oils because they can be harmful to the eyes. Inositol ·        Dietary supplement considered a B vitamin. ·        Naturally found in cantaloupe, oranges, nuts, beans, high bran content cereal. ·        Helps stabilize mood, reduce stress and anxiety which reduces the urge to pull. N-acetylcysteine (NAC) ·        Natural amino acid (L-cysteine) supplement ·        Moderates over-action in the brain     Coping with Trichotillomania Every person who suffers from trichotillomania experiences it differently, therefore, treatment must be individualized and comprehensive in a way that addresses the physical, psychological, and emotional aspects of the disorder. Regardless of the treatment intervention used, one of the most significant steps of the overall treatment process is learning how to deal with the disorder. There are many ways to cope yet the process contains these aspects: ·        Awareness o   Learn to recognize the behavioral and physical signs that accompany hair pulling. This step is crucial for people who pull their hair without realizing they are doing it. o   There are many ways to increase awareness, and it takes time. Enlist the help of a therapist or a supportive person. o   Increased awareness can help determine if hair pulling relates to another issue such as chronic depression. ·        Acceptance o   Understand that compulsive hair pulling is a problem. It is a mental health disorder. o   Even though the behaviors are a problem, it is not your fault. o   Trich does not define you. ·        Education o   Learn what trichotillomania is and what may be causing it. o   Investigate treatment options. o   Read about or listen to others who manage pulling behaviors. o   Teach others. Many people do not understand trich. By educating others, you not only reduce internal stigma, but you help reduce external stigma which helps you and others. ·        Change your language o   Practice person-first language. Instead of referring to yourself as a “hair puller” consider separating the behavior from your identity by saying “someone who has trich.” o   Person-first language empowers. Instead of the behavior having control over you, research suggests practicing person-first language enables a person to feel more in control of the behaviors. ·        Engage supportive others o   Coping with trich alone tends to make symptoms worse. o   Engage family or close friends for support. o   Enlist the help of your healthcare provider. o   Remain in contact with a qualified therapist. o   Join a support group.     Getting therapy from a mental health professional is a good place to start. BetterHelp is an online option that allows you access to licensed professionals who can provide helpful therapy. With online services, you can attend therapy in the comfort of your own home by video, call, or chat. Your therapist may refer you to speak with your doctor or a psychiatrist about medications that may be helpful with treatment of symptoms. There are multiple options available. Medication combined with therapy in treatment of trichotillomania can be very helpful, but medication isn't necessary for you to begin therapy. No matter what you're going through it's always possible to get the help that you want. It's possible to find someone that can assist you in this process, especially with licensed therapists available online. There is hope, recovery is possible and help is available for you.   I wish you much luck! Best Gaynor 
(MA, LCSW)
Answered on 01/20/2022

How can you diagnose a person who had an OCD?

Hello! I am glad that you reached out. It sounds like you are dealing with many emotions including frustration and anger. You also mentioned that you are having a hard time focusing at times. Since you have several symptoms I recommend that you seek professional support in order to get a thorough assessment. Receiving a through assessment will help with diagnosing the symptoms correctly. It will also help with receiving the right treatment. Therapy can be an effective treatment for a host of mental and emotional problems, including anxiety issues and relationship concerns. Talking about your thoughts and feelings with a supportive person can often make you feel better. It can be very healing, in and of itself, to voice your worries or talk about something that’s weighing on your mind. And it feels good to be listened to—to know that someone else cares about you and wants to help. While it can be very helpful to talk about your problems to close friends and family members, sometimes you need help that the people around you aren’t able to provide. When you need extra support, an outside perspective, or some expert guidance, talking to a therapist or counselor can help. While the support of friends and family is important, therapy is different. Therapists are professionally-trained listeners who can help you get to the root of your problems, overcome emotional challenges, and make positive changes in your life. You don’t have to be diagnosed with a mental health problem to benefit from therapy. Many people in therapy seek help for everyday concerns: relationship problems, job stress, or self-doubt, for example. Others turn to therapy during difficult times, such as a divorce. But in order to reap its benefits, it’s important to choose the right therapist—someone you trust who makes you feel cared for and has the experience to help you make changes for the better in your life. A good therapist helps you become stronger and more self-aware. Finding the right therapist will probably take some time and work, but it’s worth the effort. The connection you have with your therapist is essential. You need someone who you can trust—someone you feel comfortable talking to about difficult subjects and intimate secrets, someone who will be a partner in your recovery. Therapy won’t be effective unless you have this bond, so take some time at the beginning to find the right person. It’s okay to ask questions when interviewing potential therapists. The good thing with Betterhelp is that you have many qualified therapist to choose from. As you start to resolve your past and current issues you are more likely to have control over your thoughts, reduced anxiety and be on a path to a healthier future and in healthier relationships!  I wish you the best moving forward with finding support and the best treatment!
Answered on 01/20/2022

How get my energy and confidence back?

Dear Marty,   Thank you for your message and sharing your thoughts regarding your insecurity. I can hear the pain behind your words of constantly battling these insecurities.   Through your words I think we have built a common understanding that we have this insecurity about ourselves that we are not good enough. We tend to overly-focus on our weakness and mistakes, as a result we feel inferior compare to others and we never give ourselves the validations that we deserve.   Meanwhile it seems that we look for validations through us being needed / wanted by others, does that mean that we don't know our values if we are not getting feedback from others?   Despite being extremely difficult, admitting your weaknesses can pay dividends in the end. Once you admit to your lack of confidence and overcome these insecurities, these aspects of your life will turn from monsters in your closet to facts that you’ve acknowledged and beaten.   Overcoming insecurities is no easy battle, as there are many factors that cause them, and they’re constantly reinforced by daily events. However the more we challenge these core beliefs that we have and the thoughts that generated from it, the more our self-image will change.   Here are some thoughts I have about how to approach insecurity and things that we don't like about ourselves. Please let me know if they make sense to you.    I'll try to be as practical as I can, maybe this approach can help us put something into practice and begin making some changes.   1- Find the root Think about where you are lacking confidence: Do you think you dislike yourself when you look into the mirror? Are you the last to talk to someone because you think you look bad? Do we feel awkward about ourselves because of the response from others after we have said something?   Consider where these thoughts come from. There may have been certain occurrences in your life that made you think less of yourself. Once you’ve found the root of the problem, it’s much easier to get a handle on the insecurity, because it was most likely created by one or two isolated instances that have no real importance on your current life. Recognize where that insecurity started, and it’ll seem more manageable.   2- Invalidate the problem Once you’ve pinpointed the specific incident that created the crater in your self-image, consider why that occurrence doesn’t prove anything about your life as a whole, and think about the times in your life that prove the opposite. We are often too quick to forget the compliments or positive reinforcements that we’ve received from friends or colleagues, dismissing the kind words as pity or politeness.   Don’t focus on your lack of achievement when your cube mate scores a big account at work. Instead, remember when your boss complimented your own work or just how far you’ve come since you were a bottom-feeder at your company. Recognizing your successes will remind you of how great you are and how lucky your company is to have you. This will help you celebrate your coworkers' successes — and remember that it can only be so long before your next big break.   3- Stop comparing yourself to others It’s easy to become insecure when you constantly compare yourself to seemingly strong, flawless people. For example, if you compare yourself to the person who seems to have a grip on socializing with others and appearing confident, you may come out feeling clumsy and awkward in your encounters with others. But, what you’re likely unaware of is that this person has his/her own set of problems that they have to deal with. Maybe they are covering up their fears of being abandoned therefore they need to keep seeking attention? Instead of focusing on how you stack up against them, focus on what you can do and your skills.   If you can’t measure up to your buddy, maybe you should measure up to your own strengths…   It can be equally as treacherous to compare yourself to your friends. For example, when you see your friend — whose downfalls and ineptitude you are familiar with — succeed, you might end up feeling threatened and insecure about your own abilities.    4- Consider your known strengths A lot of your insecurities come from focusing on the things that you have trouble with. The truth is that everybody has strong and weak points, but successful individuals have learned how to play up their good points — a skill that has helped them flourish. Despite your insecurities, you have achieved a certain level of success in your life because you have great qualities. It's your job to pinpoint and foster those qualities and build a successful life.   Take those qualities, learn to focus on them and remember that there are more ways to use your set of skills than you think. Perhaps you’re nervous about giving a presentation to clients because you’re not very good at making anecdotes or using metaphors. What you seem to forget is that you know the project inside and out; focus on that and answer all of your client's questions before they ask them. Remembering what you can do will give you the confidence not to choke under pressure.   5- Put your insecurities behind you Once you’re aware that your strengths and weaknesses will balance out in the end, forget about what you lack and draw on where you rock the competition. If you fumbled today at the office meeting, remind yourself of your performance for the past three months. You can always enhance your weaker points at a later date.   If you find that you’re focusing on your insecurities, think of the faults that other people have and how they’re able to get around them or just remind yourself of all the things that you’ve achieved in life. The more you focus on your strengths, the more they’ll be visible to others. In the end you’ll not only be happier, but you’ll be more successful.   The bottom line for beating your insecurities is this: Everyone has them and the key to success is to identify them, invalidate them and move past them. Focus on your accomplishments and recognize that insecurities are usually irrational fears of inadequacy.   Your faults are no more visible or detrimental to your success than anyone else’s, unless you let them get the better of you. Failure tends to be a self-fulfilling prophecy: If you worry that you will fail, your performance will lack and turn your ruminations into a reality.   Looking forward to talking with you more, Jono  
(MSW, LICSW, LMHC)
Answered on 01/20/2022

Would I benefit from therapy?

Hello SH,   Thank you for reaching out on the BetterHelp Platform with your question: Would I benefit from therapy? I am glad you have reached out for some support and guidance with what you is going on with you at the moment.  I can see that you are struggling with your emotions, and you would perhaps benefit from some support from a professional mental health therapist – someone to listen and help you with some effective coping skills to help with what appears to be feelings of being overwhelmed. In society, there is a lot of talk about therapy. People choose to participate in therapy for diverse reasons and there are many benefits which come along with having therapy. Whether you’re in therapy, out of therapy, or considering it, it can be helpful to learn about treatment options and how they may benefit you.   A Brief Overview Of Therapy Before reviewing the various benefits of therapy, having a general understanding of the practice is a good idea. In a nutshell, therapy is a form of treatment which involves meeting and working with a specialist to solve various issues. The issues in question could involve personal feelings, traumatic events, relationship struggles, the death of a loved one, daily stressors, or something else entirely. Therapy can help with any number of problems or even just navigating life’s ups and downs. When working with a therapist, it’s important to find one that you feel comfortable trusting and confiding in. Your therapist should focus their time and energy on you during sessions, and help you achieve whatever goals and desired outcomes you want to address. The treatment process and improvements which come from therapy can take different amounts of time depending on your situation. The Benefits Of Therapy There are a variety of benefits associated with therapy.  Each one will come in handy at different stages or periods of the process. When it’s all said and done, therapy is about self-betterment and self-improvement. If these are processes which you value, then you will certainly appreciate the following benefits. Healthy Coping Mechanisms Feeling stressed out or overwhelmed is common in today’s world. The ability to cope and deal in a healthy, positive, and constructive manner is often the difference between success and failure in life. A person who is unable to manage themselves when things get tough may have some hard times ahead of them. Attending therapy can change this. By working with a licensed professional who specializes in helping others, you can learn healthy coping mechanisms which allow you to navigate the challenges of life without burning out or falling apart. As human beings, we all face challenges and tough times. Everyone can benefit from learning healthy coping mechanisms. A Sounding Board Loneliness is a problem many people face. Feeling isolated can often contribute to an already overwhelming situation. A strong support system can be helpful in facing the challenges life often presents, and without that system, in place, additional stress may be added to life. This is when having a therapist in your corner can be so beneficial. The job of your therapist is to listen to you, ask appropriate questions, and then work with you to find solutions to the challenges you’re facing. Having someone to talk to, turn to, and confide in can make an amazing difference. Achievement Of Goals Throughout the process of therapy, your therapist is going to work with you and help you set certain goals which will be beneficial to you. Your therapist will also assist you on your journey of reaching and fulfilling these goals. This is a very impactful part of therapy which sets the precedent for what life will be like after your work with your therapist is complete. The ability to set goals and achieve them matters, not just in therapy, but in everyday life as well. You will find that achieving goals will also contribute to your self-esteem. When you set a goal and accomplish it, you’re reinforcing to yourself that you’re capable. This increases confidence and makes you likelier to branch out and challenge yourself more often. This plays a pivotal role in living your best life and making the most of the opportunities which present themselves to you. Overcoming Past Trauma If issues from the past are not dealt with, they can linger, fester, and adversely impact your day-to-day life. Overcoming past trauma is not always easy, but it’s something that you can do when you work with a therapist. Therapists have undergone extensive graduate-level education, training, and supervised work in order to learn and implement science-backed techniques to help you move through things. Working through past trauma is not easy. It’s natural to feel hesitant or uneasy about discussing prior traumas and upsetting events. Certain issues going on in your present life may be the result of prior trauma, and by addressing that root cause, you may be better equipped to move forward. It will take time, but with your dedication and willingness with the help of your therapist, you will overcome. Improved Relationships When going to therapy, the relationships that you have with others are bound to come up. This is a good thing. Relationships share such an intimate tie with our quality of life and who we are as people. The right relationships can make us better people while the wrong relationships can wreak havoc and drag us down. In order to have the best quality of life, we need to enjoy positive, mutually beneficial relationships. The benefits of therapy are not limited to your relationships with others, but also your relationship with yourself. This sets the tone for how you will interact with others. Furthermore, having a great relationship involves treating yourself kindly, taking care of yourself, pushing yourself to achieve your goals, and maintaining high levels of self-esteem. Improving your relationships with others and yourself can take time, but this is an incredible benefit of working with a therapist. Purging Bad Habits When you work with a therapist, you can get rid of self-destructive habits. In many cases, therapy can greatly help you with this by providing various constructive alternatives. Bad habits tend to make adverse situations even worse than they already are. By getting rid of bad habits, you are already on the path to enjoying and experiencing a better quality of life. Therapy Is for Everyone As you go through therapy, you may begin to notice additional benefits which are not on this list. There are some general upsides which virtually everyone experiences, and then there are specific benefits which become apparent after time, and depend on the problems you’re addressing in therapy. There is research that shows therapy to be helpful with specific issues like anxiety, stress, depression, and more. It’s important to note that the therapeutic process is unique for each person. It varies based on the therapist, your preferences and what you’re working on in therapy, and the therapeutic approach that is best suited to your needs. The past stigma associated with therapy is quickly changing. Reaching out for help with navigating life’s challenges is becoming more and more common. The attitude that asking for help, wanting, or needing therapy indicates a personal failure has shifted as more people have come to understand that therapy is beneficial and doesn’t indicate “sickness” or “weakness.” Benefits Of Online Therapy An increasingly large amount of research points to online counseling as an effective form of treatment for those who want help managing the symptoms of an array of mental health concerns. In one broad based study research published in the Database of Abstracts of Reviews of Effects, researchers examined the benefits of online therapy when applied to a range of issues. After aggregating the results of over 90 studies, researchers concluded that online counseling can be a powerful treatment option for everything from panic and anxiety disorders to post-traumatic stress disorder (PTSD) to smoking cessation. They also mention that online therapy was as effective as traditional, in-person therapy. Online therapy is often considered a more accessible form of treatment as it circumvents many common barriers to treatment, including high costs, geographical and time constraints, and perceived stigma. If you’re not comfortable discussing certain issues in person, online therapy through BetterHelp is discreet, allowing you to participate in counseling from the comfort of your home. You can attend sessions via voice call, messaging, videoconferencing, or live chat. A licensed counselor will know how to guide you on the journey to better mental health.  There is hope and there is help available for you. I wish you much luck with your next step to making some healthy changes in your life so you can live a happier and calmer life.   In Kindness, Gaynor 
(MA, LCSW)
Answered on 01/20/2022

How to stop having compulsive thoughts? How to boost self esteem?

Hello, Thank you for reaching out on The BetterHelp Platform with your question: How to stop having compulsive thoughts? How to boost self esteem? I will share some information and tools you can implement yourself.  I would encourage you to reach out for some professional support from a mental health therapist - someone who can teach you effective coping skills to manage the negative thoughts and your compulsion to pull out your hair - a condition known as trichotillomania. What is Trichotillomania? In simple terms, trichotillomania is hair pulling, but it's a little more complicated than that for those who live with it. You may have a sibling that tugs on your hair as a sign of affection or teasing, or you may be someone who twists their hair when frustrated or nervous. These things are not signs of trichotillomania, at least, not on their own. For those with this disorder, it's an impulse they feel they can't control, and it causes them to pull on their hair to the extent that they pull it out. When we think negative thoughts on a regular basis, we are wiring our brain to believe that these negative thoughts are reality. Just like any habit, the more you do it, the more it becomes part of your everyday routine. Repeating negative thoughts over and over in your mind is also referred to as rumination or perseverative thinking. Outcomes of Negative Thinking *Effects on the Brain: Memory is disrupted. The processing of information is slowed. The amygdala, which controls the fight or flight response, becomes unregulated. When a stressful situation occurs, the amygdala cannot differentiate between a life-or-death situation and an annoyance. The outcome is then an overreaction to any stressful situation, whether it is a small annoyance or an actual traumatic occurrence. This could result in a dangerous situation or an inability to deal with any type of stress. *Depression: Depression does not just influence your mind. It can also have damaging physical results like ongoing joint pain, arm/leg pain, and appetite changes. Sleep is often disrupted. Your immune function is decreased. Left untreated, depression can lead to or worsen other mood disorders. *Loneliness: If someone is thought of as a constant negative thinker, they may not have a huge circle of friends. Most people want to steer clear of negativity and find friends who lift them up, not drag them down. This loneliness can also add to feelings of depression. *Job Instability: People who are negative thinkers may not want to try hard at work. They may give up because they think there is no way to solve a problem. Employers want people who are willing to do whatever it takes to get a job done, so a negative mindset will not be a marketable skill. This may show through as early as an interview, and it may be hard for those negative thinkers to get any type of skilled position. *Relationship Issues: Individuals want a life partner who is there for them, who they can talk to, and who they can rely on for feedback. They want someone who is a shoulder to lean on, a cheerleader, and a problem solver. If someone has acquired a negative mindset, it will be hard to endure a long-term relationship because issues are bound to pop up. You need to be able to see someone else’s side or look for productive ways to help the other person resolve their issue. *Bodily Consequences: With negativity comes a decrease in energy. Thinking your appearance is less appealing may affect how you care about yourself, not giving care to physical appearance. A radical negative sensitivity can also lead to an eating disorder in some cases. This isn’t to say that everyone doesn’t have some negative thoughts or feelings throughout their lives. No one goes through life with only positive, happy thoughts. It is when negative thinking is constant, long-term, and repetitive that problems may occur. Reverse It The brain may have been wired to think negative thoughts. That means it can be rewired to think positive thoughts. A habit takes about 21 days to be ingrained, so doing some of the following tasks may have you on your way to positive thinking in three weeks. *Gratitude Journal: Writing 3-5 things you are grateful for every day can give you an enormous positive boost. It doesn’t have to be anything huge or earth-shattering. As a matter of fact, writing about the little things can have a bigger influence on your everyday attitude. It’s those little things that add up to the big things in life. In order to be motivated to do this every day, buy yourself a journal just for this purpose. It can be a notebook, a special journal, or an app on your phone. Just make sure to do it every day to get the best outcome. *Journaling: Writing down your thoughts and feelings can help you to track your thought patterns. It can also open up your mind to why you have the thoughts that you have. Writing and re-reading your thoughts can help you to express yourself and perhaps break your cycle of negative thinking. *Random Acts of Kindness: If you search online, you can find a plethora of kindness type challenges. They usually come in the form of a calendar that lists a random act of kindness that you can do each day. They don’t have to be huge deeds. Like the gratitude journal, the little things can have the biggest impact. These kind acts will return themselves as good karma in your life. *Books to Read: –Self-Talk: How to Train Your Brain to Turn Negative Thinking Into Positive Thinking & Practice Self Love, authored by Aston Sanderson –Beyond Positive Thinking: A No-Nonsense Formula for Getting the Results You Want, authored by Dr. Robert Anthony –Success Through A Positive Mental Attitude, by Napoleon Hill –Everyday Positive Thinking, authored by Louise Hay –The Power of Positive Energy: Powerful Thinking, Powerful Life: 9 Powerful Ways for Self-Improvement, Increasing Self-Esteem & Gaining Positive Energy, Motivation, Forgiveness, Happiness, and Peace of Mind, authored by Andrian Teodoro –The Power of Positive Thinking, authored by Norman Vincent Peale –The Four Agreements: A Practical Guide to Personal Freedom, authored by Don Miguel Ruiz –Positive Thinking: The Most Efficient Guide to Positive Thinking, Overcoming Negativity and Finding Success and Happiness, authored by Jack Morris *Konmari your Friends: If you haven’t heard about the Konmari method, it comes from the book The Life-Changing Magic of Tidying Up by Marie Kondo. Basically, this method has you hold up items that you own and ask yourself, “Does this bring me joy?” If it doesn’t, you get rid of it. As far as your friends go, if they are not bringing you joy, then you may want to break ties with them. You are influenced by those around you, so you want to have positive, uplifting, supportive people in your closest circles. *Meditation: Meditation doesn’t have to be a long process. Even 5 minutes of meditation can be good for your soul and mindset. In meditation, it is not about controlling your thoughts so that you are thinking of nothing. It is about not letting your thoughts control you. There are many podcasts and apps that can help you focus on being present. After you meditate, you will feel lighter and more positive. Start the day with this routine, and you will be able to face anything that comes your way. *Spirituality: Spirituality can come in different forms. Some people may feel a strong pull towards specific organized religion. Others may feel a connection to a higher power that isn’t “God.” None of these alternatives is the right or wrong choice. Having a spiritual custom gives many people a belief in something bigger than themselves that they can rely on and turn to in moments of sadness, hardship, or difficulty. It puts many people in a positive frame of mind where they feel that can deal with any situation that arises. *Breathing Techniques: Breathing exercises can reduce your heart rate, which can make you less anxious and tense. When you reduce anxiety and tension, you have a more positive state of mind. Specific breathing techniques will help you stay in the moment and reduce worry so that you can deal with the current situation. *Yoga: We are put on this earth to be balanced and productive beings. When negative thoughts continuously enter our minds, they make us unbalanced. Our physical bodies can become unbalanced also. When you enter a yoga practice, you are balancing your body and your mind. When you practice yoga, you are encouraged to stay in the present moment, think about why you are there, and consider what you want to get out of that practice at that time. Entering into a yoga routine tends to have a calming, contented effect on all participants. *Replace Negative Thoughts: If you can’t get rid of all negative thoughts, try replacing them with a positive thought. When a negative thought pops up, stop yourself and replace that thought with something positive. For instance, if you have a large job to do, instead of saying, “I’ll never finish this,” say, “I will break this down into smaller pieces and get it done.” For some, patterns of negative thinking create a nuisance in their lives. For others, they lead to serious negative consequences. If you fall in the latter category, you may want to get in touch with an online therapist from BetterHelp. There is a good chance that you will see strong, positive results. Online therapy has been practiced for decades in one form or another. And since its launch, clinical researchers have studied how it works. You might be surprised to know that, today, psychologists believe that online therapy can deliver the same results as most in-person treatments. There’s simply no reason to continue operating under a negative thought cycle. Whenever you make the choice, you can get treatment and advice from licensed mental health practitioners from BetterHelp. The platform allows you a high degree of convenience in gaining treatment. You can get in touch with your counselor via chat, call, or videoconference.    There is hope, recovery is possible and there is help available for you!   I wish you much luck with the next step you take.   In Kindness, Gaynor   
(MA, LCSW)
Answered on 01/20/2022

Moving towards depression

Hello, Thank you for reaching out on The BetterHelp Platform with your query: Moving towards depression. I am glad you reached out with your concerns about your anxiety and how your speech is affected.  I will share some information and tools that may assist you.  I would encourage you to reach out for support from a professional counselor to help you with some effective interventions that can increase your coping skills. There are many types of fears, but there are a few that seem to impact many people. Fear of spiders, fear of snakes, and fear of dying are some of the more common ones. But, another that many people struggle with is fear of public speaking, also known as speech anxiety. It’s actually the most common form of anxiety, with as many as 75% of people identifying as having a fear of public speaking. What Is Speech Anxiety? Speech anxiety, or glossophobia, is simply a fear of public speaking. If you suffer from speech anxiety, you likely experience moderate to severe fear or nervousness when you need to speak in front of others. This could happen whether you are speaking in front of hundreds of people or even very small groups. The symptoms can be physical, verbal, and non-verbal, and may include dry mouth, weak voice, shaking, sweating, blushing, getting hives, and an increased heart rate, to name a few. The website glossphobia.com defines speech anxiety as "intense anxiety before, or simply at the thought of having to verbally communicate with any group, avoidance of events which focus the group's attention on individuals in attendance, physical distress, nausea, or feelings of panic in such circumstances." Determine Why You Struggle with Speech Anxiety There are many different reasons why people struggle with speech anxiety. If you want to learn how to overcome it, then you need to determine where the fear is coming from. Once you identify the reasons for feeling this anxiety, you can start to address those root concerns specifically and help curb or even eliminate the issue. Here are some common reasons people experience speech anxiety: Self-Consciousness Many people who are perfectly fine talking in front of a few people start to panic or feel a sense of uneasiness in larger groups. A larger crowd gives the conversation a more formal feel, as opposed to the casual feel smaller groups provide. More eyes are staring at them. They may start to worry about what the audience is thinking of them and may feel as though they are being judged, becoming more self-conscious of their mannerisms, appearance, and speaking. These things distract them so much that it makes it difficult to focus on what they are supposed to be talking about. Failures From the Past If you have had a bad experience with speaking in front of a group in the past, it can make future encounters with public speaking rather more challenging. You may feel haunted by the events of your past presentation or talk and worry that something could go wrong again. It might cause you to feel anxiety at just the thought of having to do it again. Lack Of Preparation When you are not prepared for the task at hand, it can cause anxiety. If you've waited until the last minute to prepare for the presentation or speech that you have to give, it can trigger speech anxiety as you feel unprepared and ill-equipped. You may feel insecure about the material that you have to present and your ability to properly do so. Lack Of Confidence Another reason that people suffer from speech anxiety is that they have a lack of confidence. If you lack confidence in general and don't believe that you have the skills and abilities needed to perform the task, you may feel anxious. Many people that struggle with this become consumed with fear prior to giving a speech. They worry that they're not good enough, that they don't speak well enough, that they don't know the right way to get the audience engaged, or that they just don't know the material as well as they should. Comparisons Comparing yourself to other people oftentimes complicates matters even more. Many people struggle with speech anxiety because they feel like they don't measure up to others. This could bring about a lack of confidence which can stem from failures in the past. If you are speaking with other presenters, this can be especially hard. You know that the same audience that will be watching you, will be watching the other presenters, and you don't want to perform poorly in comparison to them. How To Overcome Speech Anxiety Once you have identified the underlying cause(s) of your speech anxiety, you can start to address them. Sometimes, getting to the root of the problem can help reveal solutions. In other cases, the solution may not be as obvious or clear. Here are some general tips one can use to alleviate speech anxiety when it strikes. Learn Better Breathing Habits Anxiety is often accompanied by shallow breathing. This often increases the heart rate, which triggers our flight-or-flight response and amps up anxiety even more. If you want to overcome anxiety, it may be helpful to practice deep breathing exercises. Practice breathing in through your nose while making sure that you are expanding your lungs from top to bottom. That means that your diaphragm should move as well while you breathe. Once you have breathed in, hold it in for a few seconds, and then slowly exhale it out through a partially open mouth. Once you have completed your exhale, start again. To help with this, you can practice a method called “box breathing” – breathe in to the count of four, hold for the count of four, breathe out to the count of four, hold at the bottom for the count of four, and repeat as many times as needed. Deep breathing exercises can help calm your nerves and settle your body. Practice Visualization When we experience anxiety about something, we tend to focus on the negatives. We perseverate on it and run all of the negative scenarios in our heads over and over again. You can overcome this by practicing positive visualization. Practice thinking about yourself speaking in front of a group and doing a great job. This can help you build your confidence and feel more comfortable with the task at hand. Join A Group To Practice Your Skills If you are in a position where you are required to speak in front of people on a regular basis, it can help to join a group that helps you practice your skills. These can be local community groups, groups within your university if you’re attending college, social media groups, or online organizations.  Toastmasters International is one such group. You can work on developing your skills with other individuals in similar positions, without having the fear of being judged. Be Prepared There are many ways that you can prepare for a speech or presentation to overcome speech anxiety. Start by making sure that you are familiar with the material you're going to be speaking about. Then, practice it until you feel that you know the material well. Additionally, if possible, make sure that you are familiar with the location you are presenting in and that you know how to get there. Find out where to go once you arrive, and then make sure you're not rushing before you must speak. Practice the deep breathing techniques that we discussed before to help re-center yourself and your thoughts. Practice Self-Care Practicing self-care can go a long way in helping you overcome speech anxiety. Start by exercising on a regular basis, if possible. Exercise helps to cut anxiety and boost your mood and confidence. If you have to give a big presentation or speech, try to make sure that you exercise the morning of, whether it’s a walk, a run, yoga, or weightlifting – whatever works best for you! Make sure that you eat a healthy diet that can help promote a sense of wellbeing and calmness. Avoid having caffeine or sweets the day of your presentation. Avoid soda or the sugary muffin from the coffee shop. Instead, try to eat things like whole grains, fruits, and stay well hydrated. Take care of your personal hygiene and dress per code with comfort. This will help you feel more confident when you get in front of a group. Avoid wearing an outfit that you will need to keep adjusting or feel self-conscious in. Additionally, make sure that you use the restroom before your presentation to minimize the risk of having to go during, or worrying about having to go during. Change Your Focus When we suffer from speech anxiety, we are focused on ourselves. One way to improve this is to change your focus from yourself to your audience. While you are talking, focus on the friendly faces in the crowd. Instead of worrying about how you look, how your voice sounds, or if you're going to get your words right, focus on delivering valuable information to the audience. Think about how the information that you're giving them is going to help them and improve their lives. Keeping the focus on your audience removes your focus from yourself, which can help ease anxiety. Talk To A Counselor If you experience strong anxiety when you need to speak in front of other people, it can help to talk to a licensed therapist. They can work with you to help you get to the root of the problem and properly address it. BetterHelp has professionals that are ready and waiting to help you overcome your speech anxiety. Specifically, a study conducted by the Berkeley University Department of Psychology found that BetterHelp is just as effective as face-to-face therapy, with 94% of users preferring it and 98% of users making significant progress in their mental health journeys. Online therapy is an important bridge to help for people working through speech anxiety, with most users making significant progress.  It's a convenient option for you to use, particularly if you have social anxiety and the idea of going to an office to speak with a therapist in person is a bit intimidating or nerve-wracking for you. Online therapy also tends to be more affordable than traditional in-person therapy.   There is hope, and there is help available for you to manage this situation so you can head off any potential depression state.   I wish you much luck! Kindly Gaynor   
(MA, LCSW)
Answered on 01/20/2022

How can I manage my stress

Stress can be very difficult to manage at times. It is important to incorporate some strategies into your life that will help you combat stress as it creeps in. One strategy that seems very helpful to clients is mindfulness or mediation. The more you practice and incorporate this into your daily living, the more helpful it will be when the stress arises. When you are in a stressful situation, it sounds like it tends to spiral into multiple stressors in your life, which can be totally normal. The key is to really narrow into your thinking. It is good idea to journal and identify what your thinking process looks like. Looking at an event that takes place, what your automatic thought is after the event happens, your feelings regarding to this automatic thought and your behavior following.  Let's say you are stressed about everything going on at work and you are not going to make a deadline. You then get an automatic thought on how terrible you are and you think you may get fired. You then start feeling upset and you get more negative thoughts about yourself.  Here is where you would really try to atune into the negative thinking that creates a negative spiral. This of course can hold you back from getting anything done. If we focus on taking deep breaths and replacing our negative thought processes to positive it will help us get a better outcome when we are dealing with stressful situations. Focusing on what is in your control versus out of your control is also important as well. When a stressor comes into your mind, it would be important to ask yourself if it is something in your control or out and if it is something you should continue to waste energy on or not. This you would do for each stress that comes to mind in the moment.  Incorporating various strategies and techniques to eliminate stress in your life is important such as exercise, getting good sleep, eating healthy, self-care, etc...  This will also help with your thought processes when stress enters your mind. You have strategies to implement to help keep your stress lower that normal. These strategies will help you find less more stressful days than before.   
(Ed.S., LPC)
Answered on 01/20/2022

How can I adjust myself to relieve pressure and what's the better way to deal with Panic Attack?

There are many differnet techniques that you can use for panic attacks, here are some differnt ways to manage panaic attacks: Mental Grounding: Describe your enviornment in detail using all your senses (the walls are blue, there are 2 red chairs, there is a book shelf, there are 5 pictures on the wall, the bed is soft, the window feels cold) Play a categories game (think of types of dogd, types of cars, tv shows, sports) Describe an everday activty in detail (describe all the steps to a meal you cooked, a chore you did) Repeat a favorite saying (such as a prayer, psoitve statement)  Humor (tell yourself a funny story or listen to a persons funny story)  Physical Grounding:  Run cold or hot water over your hands  Holdning and squezzing an ice cube grab tightly to your chair as hard as you can and then relax hands/body Tough various objects around you (a pen, blanket, table) Carry a grounding object in your pocket (clay, rock, ring, piece of cloth) exercise Throw a ball back and forth Coloring Eating (hard candy) eat slowly (after each bite describe in detail what it tasted like Music  Blowing balloons/bubbles  Soothing Grounding: think of favorites (color, food, season, tv show, book) Look at pictures of people you care about Remember the words to a song Saying a coping statemnet over and over (i am ok, i will survive this, I am in control now)  Smelling oils Calling a friend These are many different grounding skills you can utilize, with managing panic attacks finding the proper combination of coping skills will assist you with gainign control over your panic attacks is very important. Consistency is key to mainatin proper mental health. Allow yourself room to grow and make error, we all make mistakes, remember you got this!  5-4-3-2-1 exercise name 5 things you see, 5 things you care hear, 5 things you can feel,   name 4 things you can see, 4 things you can hear, 4 things you can feel  name 3 things you can see, 3 things you can hear, 3 things you can feel name 2 things you can see, 2 things you can hear, 2 things you can feel  name 1 thing you can see, 1 thing you can hear, 1 thing you can feel      
Answered on 01/20/2022