Ask a therapist

How do I heal my fear of attachment and abandonment?

A way of starting the path to healing is to honor the spectum of emotions (comfortable and uncomfrotable).  When we experience traumas and in this case learning that a parental figure would no longer be in the same home on the day-to-day basis is rightfully so- a difficult event for a child to process. The emotions that have resulted from this experience and the residual effects (that show up in your present day life) are all trailheads of information to further explore.  What did you need back then that you can give to yourself in the present? (verbally, symbolically, creatively etc).  As you strengthen your muscle of vulnerability you can start with establishing what safety looks/feels like for you in proximity to other people. Trust is something that takes time to establish and being mindful of your needs and ability to communicate them to those you share space with is a starting point.  As you are mindful of your current attachment style, give yourself grace along the way as you unlearn patterns that are no longer working for the way you want to show up in relationships moving forward.  I'm curious, what you mean by "safely grow"? To be vulnerable is to risk, there is the possibility that things will not turn out how we want them and even in that there is still an opportunity to be present with ourselves and how we respond to the situation. When things work in our favor (comfortable emotions), things to consider include but are not limited to:  1. Did I honor my own boundaries? 2. Do I feel safe to share what I actually felt without holding back? 3. Is this relationship recriprocal? When uncomfortable emotions come to visit, curioisty around the emotions that still sting are trailheads of areas in your life that need further attention.  In the opportunities available to further explore and get to know yourself intimately, you can build on the information that you gradually uncover and move from a place of authencitity at the pace that works for you in the place you are currently in.  Addressing abandonment wounds take time, be gentle with yourself as you gradually address something that has been challenging. 
Answered on 11/28/2021

How to overcome anxiety

Hello! First I would like to thank you for having the courage to reach out with your question. It is not always easy to ask for help with the things which we are having intimate struggles. It takes courage and self-awareness to identify that there is something that needs to be addressed and then to take the steps necessary to get that help. You have already taken that first step!Anxiety is a many layered thing and there are so many different types that play off of one another and give fuel to other areas of concern. Social anxiety, and the inability to engage in a functional way can lead to problems in academics, career and interpersonal relationships. Often, when I approach anxiety with the members that I work with, I first try to take a look at what exactly triggers the anxiety. Is there a catalyst? Is it predictable? Is there no obvious trigger and is the anxiety more of a constant? Then, we work on how the anxiety actually manifests. You mentioned in your question that you create distance when the anxiety comes on and you are struggling in general with the ability to stay consistent in a job position. Your anxiety may then manifest in avoidance, isolation and withdrawing from work or other areas of life that cause you stress. It can take time to really tease out these first few steps and process what the cause and effect of the anxiety is. But once we are able to truly understand it, we can begin to work toward coping with it and managing the symptoms so they do not disrupt our day to day.Coping with anxiety looks different for everyone and you may find that works well for 99% of the population seems to do nothing for you. But that’s okay! There are a number of ways to address anxiety and work toward a more functional life. We will discuss various ways of coping, self-care and other protective strategies. There may be need for healthy boundary setting or scheduled time for mindfulness and meditation. By making efforts in these areas and setting small, attainable goals, it is possible to develop a routine that helps you to, over time, overcome the anxiety you are struggling with.
Answered on 11/10/2021

How do I stop feeling so depressed and low all the time?

Hello there, I want to send over some information on depression and anxiety. If you believe any of these things apply to you, I highly encourage you to seek out support from a therapist. You can do that through an app like BetterHelp, call your insurance company and see who is in network, or search for therapists in your area and see if they offer reasonable rates or a sliding scale fee. What is Depression? Depression, otherwise known as major depressive disorder or clinical depression, is a common and serious mood disorder. Those who suffer from depression experience persistent feelings of sadness and hopelessness and lose interest in activities they once enjoyed. Aside from the emotional problems caused by depression, individuals can also present with a physical symptom such as chronic pain or digestive issues. To be diagnosed with depression, symptoms must be present for at least two weeks.   Depression DSM-5 Diagnostic Criteria The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure. Depressed mood most of the day, nearly every day. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down). Fatigue or loss of energy nearly every day. Feelings of worthlessness or excessive or inappropriate guilt nearly every day. Diminished ability to think or concentrate, or indecisiveness, nearly every day. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition. Associated Features Major depressive disorder is associated with high mortality, much of which is accounted for by suicide. As a result, if you think someone you care about may be suffering from depression it is important to know the warning signs of suicide and to take suicidal statements extremely seriously. An active statement by someone with suicidal ideation might be something like, “I’m going to kill myself,” but other passive statements such as, “I wish I could just go to sleep and never wake up,” are equally worrying. If someone with depression exhibits these verbal markers, encourage them to consult a mental health professional immediately. Depressed individuals also present with irritability, brooding, and obsessive rumination, and report anxiety, phobias, excessive worry over physical health, and complain of pain.   New Specifiers for Depression in DSM-5 The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5, added two specifiers to further classify diagnoses: With Mixed Features – This specifier allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the full criteria for a manic episode. With Anxious Distress – The presence of anxiety in patients may affect prognosis, treatment options, and the patient’s response to them. Clinicians will need to assess whether or not the individual experiencing depression also presents with anxious distress.   How is Depression Different from Sadness? What is the difference between depression and sadness? Given that the primary symptom associated with depression is sadness it can be hard to know how to make a distinction between the two psychological states. But depression is more than just sadness, and not simply by a measure of degree. The difference doesn’t lie in the extent to which a person feels down, but rather in a combination of factors relating to the duration of these negative feelings, other symptoms, bodily impact, and the effect upon the individual’s ability to function in daily life. Sadness is a normal emotion that everyone will experience at some point in his or her life. Be it the loss of a job, the end of a relationship, or the death of a loved one, sadness is usually caused by a specific situation, person, or event. When it comes to depression, however, no such trigger is needed. A person suffering from depression feels sad or hopeless about everything. This person may have every reason in the world to be happy and yet they lose the ability to experience joy or pleasure. With sadness, you might feel down in the dumps for a day or two, but you’re still able to enjoy simple things like your favorite TV show, food, or spending time with friends. This isn’t the case when someone is dealing with depression. Even activities that they once enjoyed are no longer interesting or pleasurable. What’s more, when you experience sadness triggered by a certain something you’re still able to sleep as you usually would, remain motivated to do things, and maintain your desire to eat. Depression, on the other hand, is associated with serious disruption of normal eating and sleeping patterns, as well as not wanting to get out of bed all day. In sadness, you might feel regret or remorse for something you said or did, but you won’t experience any permanent sense of worthlessness or guilt as you might with depression. One of the diagnostic features of depression is this kind of self-diminishing, negative thought patterns. Finally, self-harm and suicidal inclinations don’t arise from non-depressive sadness. Those struggling with severe depression may have thoughts of self-harm, death, or suicide, or have a suicide plan. If you’re feeling suicidal or just need to talk, call the National Suicide Prevention Lifeline for free at 1-800-273-8255.   Depression and Loss Although there is a clear distinction to be made between depression and sadness, it is possible for major depressive disorder to occur in addition to sadness resulting from a significant loss, such as bereavement, financial ruin, or a serious medical illness. The decision as to whether a diagnosis of depression should be made will depend on the judgment of the clinician treating the individual.   How To Get Help If you think you or someone you care about may be suffering from depression, we encourage you to seek help from a mental health professional. The following online directories can be consulted to find a therapist in your area: • PsychCentral: https://psychcentral.com/find-help/• Psychology Today: https://therapists.psychologytoday.com/rms• GoodTherapy.org: http://www.goodtherapy.org/find-therapist.html If you’re thinking about suicide, are worried about someone else, or just need emotional support, the emergency Lifeline network is available 24/7. You can call 1-800-273-8255 or go to their website for a live chat. Generalized anxiety disorder (GAD) can be a challenge to diagnose. People consider panic attacks a hallmark of all anxiety disorders, but GAD is different in that there are generally no panic attacks associated with the condition.1         As a result of this misconception, without the experience of panic attacks, a person may think they are "just worrying too much." Their struggles with constant worry may be minimized or dismissed and, in turn, not properly diagnosed or treated.1    Most of us experience worry and situations that can cause us to feel anxious, so what are professionals looking for to help determine if someone's worry and anxiety are related to GAD?   An evaluation of symptom criteria, as outlined in "The Diagnostic and Statistical Manual of Mental Disorders," 5th Edition (also known as the DSM-5), is the first step. Mental health professionals look for factors like excessive, hindering worry paired with a variety of physical symptoms,2 then use proven diagnostic assessments to make a diagnosis and rule out other possibilities.   Verywell / Cindy Chung   Symptoms The DSM-5 outlines specific criteria to help professionals diagnose generalized anxiety disorder. Having a standard set of symptoms to reference when assessing clients helps them to more accurately diagnose mental health concerns and, in turn, create a more effective plan of care.   Criteria for Diagnosing GAD When assessing for GAD, clinical professionals are looking for the following: The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least six months and is clearly excessive. The worry is experienced as very challenging to control. The worry in both adults and children may easily shift from one topic to another. The anxiety and worry are accompanied by at least three of the following physical or cognitive symptoms (In children, only one of these symptoms is necessary for a diagnosis of GAD): Edginess or restlessness Tiring easily; more fatigued than usual Impaired concentration or feeling as though the mind goes blank Irritability (which may or may not be observable to others) Increased muscle aches or soreness Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep) Excessive worry means worrying even when there is no specific threat present or in a manner that is disproportionate to the actual risk.3 Someone struggling with GAD experiences a high percentage of their waking hours worrying about something. The worry may be accompanied by reassurance-seeking from others.4   In adults, the worry can be about job responsibilities or performance, one’s own health or the health of family members, financial matters, and other everyday, typical life circumstances. In children, the worry is more likely to be about their abilities or the quality of their performance (for example, in school).5 Many people with GAD also experience symptoms such as sweating, nausea, or diarrhea.6   The anxiety, worry, and other associated symptoms make it hard to carry out day-to-day activities and responsibilities. They may cause problems in relationships, at work, or in other important areas of life.7   In order to give a diagnosis of GAD, these symptoms also must be unrelated to any other medical conditions and cannot be explained by a different mental disorder or by the effect of substance use, including prescription medication, alcohol, or recreational drugs.8     Assessment During an assessment, your clinician will use the diagnostic criteria, standardized assessments, and their clinical judgment to make a diagnosis.   Generally, they will ask about your symptoms in an open-ended way, but you may also be asked to complete self-report questionnaires. These typically brief measures can help determine the diagnosis (as the Generalized Anxiety Disorder Scale-7 does) or severity of symptoms.9   In specialized care settings, like an anxiety disorders clinic, standardized assessment tools are sometimes used to evaluate symptoms. In this case, your clinician conducts a semi-structured interview. The interview is likely to include a standardized set of questions, and your answers will help your clinician to make an accurate diagnosis.   Commonly used and well-validated diagnostic interviews for adults include the Structured Clinical Interview for DSM Disorders (SCID) and the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5). There is a child version of the ADIS, in which both the parent and the child are asked about the child’s symptoms. These interviews also evaluate the presence of other associated conditions such as depression.   Your Visit Remember to be honest with your provider at the first visit—both when filling out forms and discussing your symptoms face-to-face. Being upfront and honest can help determine what is happening and put together a plan of care specifically tailored to your needs.   Self-Assessment If you are wondering whether you or your child might have GAD, you can consider completing a brief online self-screening tool for adults or for children provided by the Anxiety and Depression Association of America (ADAA).10 If you do this, you should still speak with a mental health professional or your physician for a proper diagnosis and treatment.   When to Seek Help  Many people who struggle with GAD experience symptoms for a long time before seeking help. Reaching out for a diagnosis can feel challenging, especially when anxiety feels so constant and widespread.     Only around 20% of people who have symptoms of anxiety seek treatment. In 2020, a national coalition of women's health professionals recommended that all women aged 13 and older should be screened for anxiety.11 The lifetime prevalence of anxiety disorders is approximately two times higher in women than in men, so preventative screenings may be helpful in ensuring that women and girls receive appropriate interventions to improve health and well-being. Contacting a mental health or other clinical provider is a courageous step that can help clarify what is happening and, in turn, lead to creating a plan of care that can help you find relief and regain a sense of well-being.   When deciding to seek help, something to consider is how difficult it is to feel any sense of calm, comfort, and reassurance around your worry.   If you find yourself constantly seeking reassurance from others, or repeatedly trying different methods of stress management and relaxation to no avail, it may be worth contacting a professional. Also, know that not experiencing panic attacks is another primary reason people don't seek help for their anxiety. Their worry may be chronic and concerning but, because there are no periods of acute panic attacks, they simply chalk the challenges up to being a "worrywart."   They may even be told this by others when seeking reassurance or trying to find comfort. Remember, however, that GAD is different in that panic attacks aren't typically present, so don't let this factor stop you from seeking help.   Additionally, take note of the physical symptoms that are accompanying your worry. As the anxiety continues, you may find more and more challenges with things like headaches, digestion, restlessness, and fatigue.1 Should you find that your worry feels excessive and begins leading to other physical symptoms, you may benefit from talking with a mental health or other care providers.   Finding a Clinician Take time to research and seek out providers who specialize in the treatment of anxiety. Because anxiety is present in so many mental health conditions, you will want to talk with someone who understands the specific criteria required so you can be accurately diagnosed and treated.   Primary care physicians can often provide referrals to trusted and specialized mental health providers. Otherwise, to find a psychotherapist in your area, consult referral resources such as:   Anxiety and Depression Association of America Association for Behavioral and Cognitive Therapies Association for Contextual Behavioral Science   The American Psychiatric Association (APA) is a national organization of psychiatrists that can also provide recommendations for local providers who are able to provide psychiatric evaluation and prescribe medications.   Another option is to try an online therapy program.    The Best Online Anxiety Support Groups   Differential Diagnosis Anxiety symptoms can be found in many categories of mental health conditions listed in the DSM-5, such as within mood disorders, eating disorders, and cognitive disorders. Within the category of anxiety disorders, there are many symptoms that will overlap and anxiety conditions can sometimes be confused with one another.   While sitting with a mental health provider, they will be seeking information that will help them to best diagnose your condition. To give a differential diagnosis means to distinguish one condition from another when there are symptoms that overlap.   Some conditions that may need to be ruled out include:1   Obsessive-compulsive disorder (OCD) Panic disorder Social anxiety disorder   Although some of these conditions are discussed more casually by the general public, there are specific criteria that would need to be met in order for one of these (or other conditions) to be properly diagnosed.   There can be other behaviors and symptoms that can be present with anxiety. For example, when someone engages in self-sabotaging behavior, such as procrastination, they can be perceived as struggling with self-regulation and behavioral conditions. Overlooking elements of anxiety related to this behavior can end up creating an obstacle for someone to receive effective treatment.     Sitting with a qualified professional to determine an accurate diagnosis is key. Having the willingness to reach out for help, being honest with your provider, and participating actively in treatment can help you regain a sense of well-being.  
(LPC, NCC, CEDS-S)
Answered on 11/02/2021

Do you speak Spanish.

Thank you for your question. I am bilingual/bicultural and have spoken Spanish for most of my life. I have also worked with many Spanish speaking only clients and we've been able to develop a good therapeutic relationship to help them address their concerns in a culturally sensitive way. In my experience I've learned that individuals who experience any kind of significant stressors or trauma, they usually do this in their native language. When someone's native language is not English, it can be difficult to express those experiences in English when they were experienced in another language. Being able to express stressors or past trauma that occurred in someone's native language, really should be verbalized in that language, when at all possible, to help the individual express themselves more appropriately and accurately.  Trauma research suggests that traumatic memories, for example, may be encoded differently from other memories like a particular birthday party or visiting relatives during the holidays. If one can use the same language at the time of the experience to the language when it is being retrieved during a therapy session, this can help promote the path to healing by allowing access to the memories through their native language. Some individuals will try and express themselves in English if their clinician is not bilingual. They may feel shame or embarrassment at not being able to effectively respond to questions in English regarding a past trauma as they are learning to be bilingual themselves. But they usually struggle with effective communication as their experiences were in their native language and some significant details or emotions will be left out if they solely try to respond in English. It's also important for individuals, whose native language is not English, to feel confident about stating their preference for a clinician who is fluent in their native language. This will encourage more fluid narratives from the individuals. The goal is to help them process their trauma or stressors in the most effective way possible that will lead to healing from that specific trauma or stressor. I would be very happy to learn more about you and work with you to help you address any concerns/issues you are experiencing at this time.   Thank you. Adlin de Cardi, MA LMFT  
(MA, LMFT)
Answered on 10/17/2021

My girlfriend has dealt with anxiety and an eating disorder

Dear User 12,   You are doing the right thing in reaching out for help. When someone you love is dealing with mental health issues, it presents a challenge to both of you, and to your relationship. It can be taxing on your own coping skills to be the primary support person for someone who is struggling and vulnerable. You have likely taken on the role of being “the strong one” as your girlfriend has gone through the recovery process. Having someone like that to depend on often makes a huge difference in a person’s recovery. But you are human too, and cannot always be strong. Your relationship needs to have room for you to have your own ups and downs. The metaphor of "putting on your own oxygen mask first" is very applicable here, because depleting your own resources to meet someone else’s needs is not sustainable and does not serve either of you or help her recovery.   When you say that you are the only person who knows, I wonder if you mean you’re the only one in her personal circle of friends, family, etc. I would hope that she is receiving therapy to assist in her ongoing recovery. This is essential, or at least highly recommended, to help a person manage stress and minimize the risk of relapse. People with eating disorders can also benefit from opportunities to connect with others who are also recovering. Sharing mutual support in groups, online chat rooms, or through a “buddy system” with an accountability partner can be a key component of recovery. The value of this kind of peer support can apply to anxiety as well.   I’m glad to see that you have identified your own need to have someone to talk to. Pursuing individual therapy for yourself is an important proactive step for safeguarding your own mental health and resilience. It can also help you to build stronger communication skills. These can benefit you in every area of your life, of course, and can be a huge advantage for anyone who is a key support person in someone else’s recovery. The need to have periodic honest but difficult conversations will present over time, and the better equipped you are to listen deeply, and find the right words to express your concerns the better it will be for both you and your girlfriend.   Having a lasting relationship with someone who has mental health challenges means going through a lot of ups and downs together. Of course there will be good times, and hopefully they will be increasing as your girlfriend gets stronger in her recovery. But there will also be low points. And you will feel the pain with her because of how much you care. This is natural; of course her happiness is important to you. However, as much as compassion is important, it will also be best for both of you if you can maintain enough emotional distance or autonomy that you can find your own happiness alongside your empathy for her. I find this to be a key component to being a successful long-term partner to someone who has depression, anxiety, or any other mental or physical illness. It might sound selfish to say that you should be happy in spite of her pain, but in reality, becoming anxious or depressed yourself benefits no one and ultimately harms your relationship.   If there is any way to expand your girlfriend’s circle of support, I would strongly encourage her to do that. If she would be willing to share her struggles with additional friends or family members, even one or two, there could be benefits all around. She would have someone besides you to turn to, allowing you bear a smaller portion of the load during difficult times, and others might provide a helpful perspective and appreciate the chance to offer their support.   Now that we have addressed your own self-care, here are some resources to help you be the best support person you can be for your girlfriend.    https://centerfordiscovery.com/blog/eight-ways-help-friend-eating-disorder-recovery/   https://themeadowglade.com/support-someone-recovering-from-eating-disorder/   https://www.verywellmind.com/how-to-help-someone-with-anxiety-5089005   Here is a brief summary of some of the tips in the articles:   Make an effort to talk to her about other things and have normal, everyday conversations even during difficult times. If you are preoccupied with concern about her eating disorder or a possible relapse, be sure to not over-question. Save serious discussions for serious times, and limit the duration of these talks.   Don’t discuss weight, dieting, or label either foods or body size as good or bad as if they were moral issues. If at all possible, redirect the conversation when others get onto these topics around your girlfriend.   Do not police your girlfriend’s food choices, but refrain from participating in behaviors that encourage disordered eating such as late night bingeing and excessive exercising. If you witness her engaging in unhealthy behaviors, avoid blame and instead use “I statements” to express your concerns, such as, “I sense that you’ve been more preoccupied with calorie-counting lately. Do you think that’s something to be concerned about?”   In regard to supporting her efforts to overcome anxiety, learn to recognize the first signs that she is worrying more than usual. Give her gentle, positive messages reminding her that she has handled difficult things in the past and that you are confident that she is also equal to future challenges. If you find her getting caught up in “what-ifs,” such as asking some form of “What if something terrible happens?” and then looking to you for reassurance, offer that reassurance briefly, but refrain from providing it constantly. Instead, remind her that she has the tools to bring herself back to a safe place emotionally, and encourage her to practice these skills.   Thank you for reaching out and I hope my answer has provided some guidance about how to establish and maintain a healthy emotional environment for yourself and be a positive influence on your girlfriend’s recovery.   Best wishes to both of you.   Julie            
(LCSW)
Answered on 10/15/2021

How do I cope with loneliness?

It seems as though something deeper is brewing beneath the surface that might be causing the feeling of loneliness. As I read this question, my thoughts are what is the duration and frequency of the feeling you are experiencing? Moreover, I feel that this should be explored more with a therapist in a clinical session. A therapist can assist you with  how to express your emotions in a healthy way and show you ways to practice sitting with your emotions to be present with your emotions. You can can also learn to reflect and accept your emotions. Have you done journaling or doodling as a way to express yourself? You can also let your family know you're struggling with loneliness. Perhaps, this will allow them to identify how they might be able to help you feel less lonely. I also recommend joining a group, specifically meetup groups. These types of groups are online platforms that provides access to various types of groups and club activities often founded on common interests and hobbies-depending on your residing Meetup groups can give you things to do when you feel lonely as well and, it's a great way to make friends. Keep in mind, building quality relationships should be a priority over the quantity of relationships because building genuine bonds with people can help to combat loneliness. If you already have good relationships; work on strengthening those relationships. You can also consider volunteering if you are able to in your area. Volunteering is a good way to meet people and help with feelings of loneliness. Research shows that helping others can really help improve mental health and well-being. Check your local organizations for volunteering opportunities.  Remember that loneliness is a part of being human. You are allowed to open up about how you feel and it by no means a weakness, it is taking the act of courage to express how you feel to help create connection with someone you trust. You are in control: you can use the power within yourself to make positive change this feeling of loneliness. Again, I encourage you to speak with a therapist.
Answered on 10/14/2021

Am I showing signs of Borderline personality disorder?

Hello, So of course I wouldn't be able to give you a diagnosis based on the information you provided or without meeting with you in person, but I'll give you some of my thoughts. There are a number of features often seen in Borderline Personality Disorder, and "explosive" moments can be one, as well as rapid mood shifts. However, there are several other mental health disorders that also would fit with these as well.  If I were to assess you for a mental health disorder, I would want to take a look at your life history first of all. The most common "ruleout" I would make before looking at a Borderline diagnosis is Posttraumatic Stress Disorder. It is very common for those who present with "explosive" behaviors to have a history of trauma. When this trauma has not been addressed in therapy, there can be a wide range of unhealthy behaviors that result. In fact, the majority of the clients that I meet with who have previously been diagnosed with Borderline Personality Disorder I end up giving a diagnosis to of Posttraumatic Stress Disorder. There are also mood disorder, such as Bipolar Disorder, that could apply, although I find that this is often also overdiagnosed. There is also Intermittent Explosive Disorder which involves, as the name implies, occassional violent, aggressive behaviors. I woudl also want to look at any substance use history (even if it is not occurring presently).  Above all else, I'd want to look at what your life looks like in general. For example, if you are dealing with a lot of stress and a lack of self-care, that could certainly explain those feelings of detachment and some explosive episodes. If you're feeling trapped, dealing with a lot of guilt, having difficulty coping with grief, etc., these are all potential explanations for what is occurring. There can even be medical factors that could be playing a role, such as some vitamin deficiencies. Borderline Personality Disorder tends to be fairly inflexible. You can work on the symptoms, and it is possible for them to go away, but as a personality disorder it tends to be more inflexible than some other mental health disorders. From personal experience I've seen many clients who are convinced they have Borderline Personality Disorder or another personality disorder work on issues that are resulting in their maladaptive behaviors and by doing so no cope much more effectively. In other words, they probably never had Borderline Personality Disorder in the first place. So, here are the two most important points I want to make: One is that the diagnosis really doesn't matter. Even if you did receive the Borderline Personality Diagnosis (which I would perhaps ignore unless it was done very carefully and by collecting a considerable amount of information, as it is often misdiagnosed), the problem isn't the diganosis--the concern is your well-being and your behaviors. Getting a diagnosis really doesn't fix anything, and if it's an incorrect diagnosis, it can definitely do more harm than good. I secondly want to strongly encourage you to give mental health treatment a try, whether you choose to participate in therapy on this platform or reach out for help elsewhere. The symptoms you're experiencing can be addressed, but we would want to dig deeper into what is causing them. If you would like to participate in therapy, or even if you just have further questions for me, please don't hestitate to ask. No matter what the diagnosis is, it's very likely that with some help your mental health can improve. Take care. Nick 
(MRC, LPCC-S, LICDC)
Answered on 10/12/2021

Just wondering what type of mental illness I have

Dear Molly,  Thanks for reaching our with this question. I think it takes strength and courage to take this first step and reach out with a question. It sounds like you likely are dealing with symptoms of challenges in your functioning or life that leaving you wondering whether or not mental illness might explain some of these experiences. I would say, if you are questioning the impact or are experiencing symptoms, it is a good idea to reach out for more formalized support.  As a starting place, there are several mental health screeners that are available at many mental health organizations as well as mental health agencies. Screeners are NOT intended for diagnosis, but are a way to provide a quick snap shot of your mental health. A screener may indicate that you have symptoms of a mental health illness, but a full assessment is required to better understand what this means and to seek treatment for each individual person. These tools or screeners are designed to provide information, resources, and tools to help you understand your health. Basic screeners are available for things like depression, anxiety, addiction, and a few other general mental health concerns.  I would use these screeners as designed and seek more a formalized assessment by a licensed provider if you are seeking diagnosis and treatment. Attempted to engage in a process called self-diagnosis, can be damaging to your mental health. This process typically involves a wrong self diagnosis, followed by incorrect treatment. Similar to how you most likely would not self-diagnosis a medical concern and self treat, you should exercise the same caution with mental health. Seeking out a professional assessment and accurate diagnosis is one of the most important aspects of a recovery plan. This can lead to gaining a better understanding of your diagnosis and seeking out a treatment plan that is individualized.  I understand that this process can sometimes bring on strong emotions as you seek understanding and clarity into your distress. As you consider what options are best for you, I want to remind you of a few options that might be helpful. First, betterhelp does not provide diagnostic clarification, but can provide treatment. If you are seeking assistance with this first step, you can discuss with your primary care provider or seek out a mental health clinic in your community as a starting place.  As you continue this journey, I wish you the best of luck.  Best,  Kelsey Place, MSW, LICSW
(MSW, LICSW)
Answered on 10/11/2021

Who can I ask for help when I feel like I have borderline personality disorder?

Thank you so much for your question. Coping with Borderline Personality Disorder (BPD) can be very challenging. BPD is characterized by the difficulty in being able to regulate one's emotions. Emotions can be felt more intensely for extended periods of time for people who are diagnosed with this condition. These challenges in healthy mood regulation can lead to impulsivity, poor self-image, conflict in interpersonal relationships, and intense emotional responses to stressors.  I am going to answer this question from two main perspectives of (1) a person with a confirmed diagnosis from licensed mental health professions and (2) a person without a confirmed diagnosis. I would also encourage you to contact your benefits provider to find out what kind of behavioral health care coverage you have because oftentimes if you have assistance for medical coverage, the benefits plan will account for mental health as well.  (1) If you have already received a diagnosis of Borderline Personality Disorder (BPD) from a licensed professional, the next step would be to try to get engaged with treatment services. Psychotherapy has been proven to be very effective in the treatment of BPD as it addresses the emotional dysregulation associated with the disorder. You can check to see if there are any providers that your insurance may cover that offer Dialectical Behavioral Therapy (DBT) and/or Cognitive Behavioral Therapy (CBT). -DBT focuses on teaching coping skills to help fight destructive urges, regulate emotions, improve relationships, and practicing mindfulness. -CBT focuses on helping to reduce negative thinking and the behaviors associated with BPD by learning effective coping strategies. Sometimes medication-assisted treatment can be effective with the combination of psychotherapy which usually requires a prescriber. Some things you can do on your own include: -Connecting with others through support groups (in-person or online) -Taking care of your physical health (eating balanced meals, getting adequate rest, stress-relieving activities like meditation or yoga) -Avoid the use of mood-altering substances like alcohol and drugs as it can exacerbate symptoms of BPD   (2) The first thing a person would benefit from doing if they suspect they have BPD is to get assessed by a licensed mental health professional, preferably one who specializes in personality disorders. It is important to not self-diagnose because these professionals are trained to look for symptomatology and potential causes of these conditions. A licensed professional with be able to help a person navigate the mouse appropriate level of care.   For more free resources please check out these sites below: https://www.nhs.uk/mental-health/conditions/borderline-personality-disorder/treatment/ https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Borderline-Personality-Disorder/Overview https://www.borderlinepersonalitydisorder.org/consumer-recovery-resources/
(MA, NCC, LPC)
Answered on 10/09/2021

Are your Anger Management class court approved? I'm under court orders for Anger Management class.

This is a great question, thank you for asking.  In my experience of 7 years of providing anger management classes for the courts, they prefer that those classes take place in brick and mortar locations, typically in group settings. They do accept virtual groups.  They expect their providers to work either under their own license or under the license of the agency that they are working for and be trained specifically in anger management. It is also expected that the client seeking treatment go through an initial assessment that takes anywhere between 60-120 minutes that covers pretty much all areas of life.  Sessions are usually conducted from a state-approved curriculum. Once you complete the curriculum successfully, you are considered successfully completed and a letter is sent to your referral agent (court, probation officer, etc) and you are done.  Unfortunately, though I have the credentials to do so, I am not state-approved as a Better Help provider to provide state court-ordered treatment anymore.  Your best options to find anger management courses accepted by the courts are your local community mental health center (Summitstone Health Services, Centennial Mental Health, Jefferson Mental Health, Denver Mental Health, Aurora Mental Health, Adams Mental Health, etc)  If you happen to be in Southern or Western Colorado where I am not as familiar, just Google your location and regional mental health center and you'll find the closest mental health center.  Those will likely be the cheapest and will work on a sliding scale.  Because of what they do, they are also guaranteed to be state/court-approved.   Another option is to check around your local community to see if any of your local agencies that provide outpatient drug and alcohol treatment provide court-approved anger management classes.  Anger management classes are often provided by those agencies and they are often court-approved.  You can ask when you make contact with them if they are court-approved.  Many of them also offer sliding fee scales based on income and the classes are also offered in group settings which save you some money vs. individual sessions. Like with the mental health centers, you will be asked to complete an intake prior to your first group where they will ask you questions about different areas of your life and how you ended up in anger management classes.  You will be expected to complete their curriculum and once you have successfully done so, a letter of successful completion will be sent and you will have been considered to have completed the required treatment.  I hope that this all answers your question.  I wish that I could help more.  If you have any additional questions, please let me know.  
(LCSW, LAC, EMDR, Trained)
Answered on 10/04/2021

How can I do away with my anger bitterness insecurities and how can I forgive myself and my past.

Anger is said to be a secondary emotion,  it is the halfway point, so we need to keep going pass it and further down into our emotions.   It often ends up to be hurt, disappointment due to some unmet need.  Often what gets in the way of focusing on emotions is that fight, flight or freeze programming.  The adrenaline and cortisol rush in saying attack or run.  It is not mindful it is more like a bad habit because it is a habit that we have gone to as a way to cope--maladaptively cope for many years--so it is just like it is second nature to us.  We think it is a way to protect ourselves--cope.  Yet, when we have calmed down and can think more straight then we often if capable of being honest with ourselves see our errors and have some regrets or justify our behavior by pointing at something external.  We point at something outside of ourselves to justify our actions.  He/she was late,  he/she talked rude to me,  he/she is calling me a liar or attacking my personhood in some way.    Instructions on how to manage anger:  first--one must pay attention by noticing themselves becoming disturbed.  Notice how you are experiencing your disturbance--once you notice that you are getting upset whether you notice your strong negative thoughts, strong feelings,  bodily sensations one or all that is when one must immediately start to practice diaphragmatic breathing.  There are a million youtube videos on how to do this.  Once you start breathing it is physiologically impossible for the heart rate to not slow and the negative harmful chemical--adrenaline to slow.  Now when you are breathing there is a count going on such as breathe in counting to two and breather out counting to four.  two in and four out so that means that two in will have to be big and deep because you are counting four out. this counting distracts you from your negative thoughts and makes you focus on your counting and breathing--so it like taking a time out--  pausing.    It is at this point you ask yourself are my old behaviors and thoughts effective------the honest answer is, no.  And you know it because for years they have not served you well.  You ask yourself,  what would be the effective way of dealing with this situation?  It might be say nothing.  It might be take a walk.  it might be to laugh at how silly this is. Or it might be to realize that it is not the "me show" meaning that what others do is about them not you--it has nothing to do with you, it is bout them and them only.   It is their behavior, their attitude, or emotional state not yours.    Now as far as the bitterness, there is also a process to go through there also--it is a self-inventory of resentments and to see how hanging on to these resentments is like drinking poison and hoping it will kill the person you are bitter at.   It is a fact-finding proposition of looking at how your bitterness only hurts you and no matter who has hurt you or wronged you they are not going to fix it for you so your left to take responsibility for that if you want more happiness.  If nothing changes nothing changes, right.
Answered on 10/04/2021

Why do I feel so lonely? Is it something I can prevent or do I need extra help?

Aly, Thank you for your question. I am glad you are here.    First of all, the loneliness you are feeling after a move is completely normal. Moving and adjusting to a different space is stressful for everyone. Three months is not that long of a time to have adjusted to the new place. However, you should start to adjust as time goes on. For the feelings of being down at night, I will list a coping skill that you can use as you battle those feelings:   Peace Begins With Me There is a quick practice that is involved with Kundalini yoga, which involves a breathing exercise that can be done quietly and anywhere that you are. This technique can help you stay centered when you’re feeling overwhelmed or out of control. Press your thumb into your index finger, then your middle finger, followed by the ring finger, and lastly the pinkie finger. Practice this a few times. Go slowly. After you get the hang of this, practice saying these words as you touch thumb to index finger- “Peace,” thumb to middle finger, “Begins,” thumb to ring finger, “With,” thumb to pinkie finger, “Me.” Breathe deeply and fully as you practice this technique.   Another coping skill that you can use when dealing with feelings of loneliness and depression is cognitive restructuring.    Cognitive Restructuring Cognitive Restructuring is a process of identifying your negative and irrational thoughts. A negative or an irrational thought is called a cognitive distortion. EVERYONE has cognitive distortions; however, if you are a person who has a lot of cognitive distortions, it can contribute to developing a mental disorder such as depression or anxiety.   How can you identify and challenge these cognitive distortions?   Step 1: Understand how powerful cognitive distortions are in influencing your mood. For example, it's your birthday. Your friend does not call to wish you a happy birthday. Your thought is, "My friend doesn't care about me the way that I care about them; I called them on their birthday." Your thought makes you FEEL hurt. Your feeling of hurt turns into the behavior of avoiding your friend for the next month. The cognitive distortion of "My friend doesn't care about me the way that I care about them" yielded the chain of events that led you to feel hurt and to behave by avoiding your friend.  Thoughts are POWERFUL; they start the chain of events to everything.    Step 2: Increase your awareness of your thoughts.  Learn to identify your cognitive distortions. Look for negative emotions and try to pinpoint what thoughts started those feelings.    Step 3: Keep a Thought Record/Thought Log. Break down your experience into a record. For example: The situation was ______________, My thoughts were ________________, My emotions were ________________, My behaviors were ___________________. An alternate thought could've been __________________________.   I hope the above tips help.   The second thing I wanted to address was the sexual trauma that you have endured throughout your life. It would be beneficial for you to work with a trauma-informed therapist to address these incidences that you describe. I am sorry that this happened to you. Trauma can mimic symptoms of anxiety and depression, among others. Trauma can also restructure the brain and the body essentially keeps score of the trauma. I encourage you to do some research on your own about the effects of trauma on mental health and on physical health. I'd like to discuss this with you further, if you are interested.    I wish you well and trust you will have a wonderful week ahead.   Sara Lacaria, LPCBetter Help Therapist
(LPC)
Answered on 10/03/2021

What help should a person with skin picking disorder get?

Hello there,I would, of course, require more information before being able to render a diagnosis however, you are talking about symptoms that sound very similar to OCD - Obsessive Compulsive Disorder.  Generally speaking, when it comes to anxiety, you do NOT want to avoid the things that make you anxious. All this does is strengthen the anxiety. What is most helpful with anxiety management is facing the anxiety head-on, doing the things that make you uncomfortable. Safety is a big priority though, so please do not forget that.    OCD can show up in the form of skin picking, hair pulling, etc. Do you know what your triggers are to picking your skin, what makes you want to do it or what triggers you to engage in that behavior?    Do you think it would be beneficial for you to seek out the support of a therapist to help you? It is hard to provide a clear and direct answer within this forum since I cannot ask you questions and get more information.   Below is the DSM 5 definition of OCD from BeyondOCD.org; Clinical Definition of OCDThe DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) provides clinicians with official definitions of and criteria for diagnosing mental disorders and dysfunctions.  Although not all experts agree on the definitions and criteria outlined in the DSM-5, it is considered the “gold standard” by most mental health professionals in the United States.DSM-5 Diagnostic Criteria for Obsessive-Compulsive Disorder (300.3)A.    Presence of obsessions, compulsions, or both:Obsessions are defined by (1) and (2):1. Recurrent and persistent thoughts, urges, or impulses that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.2. The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize them with some other thought or action (i.e., by performing a compulsion).Compulsions are defined by (1) and (2):1. Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.2. The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are excessive.Note: Young children may not be able to articulate the aims of these behaviors or mental acts.B. The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.C. The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.D. The disturbance is not better explained by the symptoms of another mental disorder (e.g., excessive worries, as in generalized anxiety disorder; preoccupation with appearance, as in body dysmorphic disorder; difficulty discarding or parting with possessions, as in hoarding disorder; hair pulling, as in trichotillomania [hair-pulling disorder]; skin picking, as in excoriation [skin-picking] disorder; stereotypies, as in stereotypic movement disorder; ritualized eating behavior, as in eating disorders; preoccupation with substances or gambling, as in substance-related and addictive disorders; preoccupation with having an illness, as in illness anxiety disorder; sexual urges or fantasies, as in paraphilic disorders; impulses, as in disruptive, impulse-control, and conduct disorders; guilty ruminations, as in major depressive disorder; thought insertion or delusional preoccupations, as in schizophrenia spectrum and other psychotic disorders; or repetitive patterns of behavior, as in autism spectrum disorder).Specify if:With good or fair insight: The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true or that they may or may not be true.With poor insight:  The individual thinks obsessive-compulsive disorder beliefs are probably true.With absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.Specify if:Tic-related: The individual has a current or past history of a tic disorder.Reprint permission pending from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (Copyright 2013). American Psychiatric Association.I am going to define Exposure Response Prevention therapy below. This definition is taken from IOCDF.org. This is the gold standard treatment and care for anxiety disorders. You can also go to this website to see if any therapists near you specialize in OCD.What is Exposure and Response Prevention?You may have heard of Cognitive Behavior Therapy (CBT) before. CBT refers to a group of similar types of therapies used by mental health therapists for treating psychological disorders, with the most important type of CBT for OCD being Exposure and Response Prevention (ERP).Exposure in ERP refers to exposing yourself to the thoughts, images, objects, and situations that make you anxious and/or start your obsessions. While the Response Prevention part of ERP refers to making a choice not to do a compulsive behavior once the anxiety or obsessions have been “triggered.” All of this is done under the guidance of a therapist at the beginning — though you will eventually learn to do your ERP exercises to help manage your symptoms.That said, this strategy of purposefully exposing yourself to things that make you anxious may not sound quite right to you. If you have OCD, you have probably tried to confront your obsessions and anxiety many times only to see your anxiety skyrocket. With ERP, the difference is that when you choose to confront your anxiety and obsessions you must also commit to not give in and engage in the compulsive behavior. When you don’t do the compulsive behaviors, over time you will feel a drop in your anxiety level. This natural drop in anxiety that happens when you stay “exposed” and “prevent” the compulsive “response” is called habituation.Another Way to Think About ERP:Think of your anxiety as an alarm system. If an alarm goes off, what does it mean? The alarm is there to get your attention. If an intruder is trying to break into your house, the alarm goes off, wakes you up, gets you to act. To do something. To protect yourself and your family. But, what if the alarm system went off when a bird landed on the roof instead? Your body would respond to that alarm the same way it would if there were an actual threat such as an intruder.OCD takes over your body’s alarm system, a system that should be there to protect you. But instead of only warning you of real danger, that alarm system begins to respond to any trigger (no matter how small) as an absolute, terrifying, catastrophic threat.When your anxiety “goes off” like an alarm system, it communicates information that you are in danger, rather than “pay attention, you might be in danger.”Unfortunately, with OCD, your brain tells you that you are in danger a lot, even in situations where you “know” that there is a very small likelihood that something bad might happen. This is one of the cruelest parts of this disorder.Now consider that your compulsive behaviors are your attempts to keep yourself safe when that alarm goes off. But, what does that mean you are telling your brain when you engage in these behaviors? You are reinforcing the brain’s idea that you must be in danger. A bird on the roof is the same as a real intruder breaking into your home.In other words, your compulsive behavior fuels that part of your brain that gives out these many unwarranted alarm signals. The bottom line is that to reduce your anxiety and your obsessions, you have to decide to stop the compulsive behaviors.However, starting Exposure and Response Prevention therapy can be a difficult decision to make. It may feel like you are choosing to put yourself in danger. It is important to know that Exposure and Response Prevention changes your OCD and changes your brain. You begin to challenge and bring your alarm system (your anxiety) more in line with what is happening to you.How is ERP different from traditional talk therapy (psychotherapy)?Traditional talk therapy (or psychotherapy) tries to improve a psychological condition by helping the patient gain “insight” into their problems. Talk therapy can be a very valuable treatment for some disorders, but it is not effective at treating the active symptoms of OCD.While talk therapy may be of benefit at some point in an OCD patient’s recovery, it is important to try ERP or medication first, as these are the types of treatment that have been shown through extensive research to be the most effective for treating OCD.
(LPC, NCC, CEDS-S)
Answered on 09/30/2021

what do I do when I feel tired of my life?

6 Tips to Help You Regain Your Zest for Life 1. Picture Your Ideal Life You’re tired of the life that you’re living now. But if you think about it, is there a life that you imagine that you would absolutely love? This won’t be a picture you can imagine instantly. Give yourself time to figure out the aspects of life that come to your mind when you think about the ‘ideal’ lifestyle. Is it a life in the same place but with a different mental state? Or do you picture a completely different physical environment? What kind of people surround you? Whatever you idealize, note it down. 2. Look Back on the Life That You Enjoyed the Most Nobody gets tired of life as soon as they are born. They live a good life before they get to a point of exhaustion .Look back. Think of the times when you lived your life to the fullest. It could’ve been your time at school or when you had different relationships or you lived in a different city. Also, think about the hobbies and activities you had at this time. You may have had a different passion back then. List down the factors that you think made your life worthwhile back then. 3. What’s Missing From Your Life Right Now? Now, you’ve got a list of things that either made your life amazing in the past or you think will improve your life. It’s time to point out exactly what’s missing. Since you’re tired of life, you probably don’t have anything from the list in your life. However, look closer. Maybe you’re the one who has pushed those factors away. Whatever the case is, pinpoint what you feel like is missing from your life. Once again, list them down so that you have written proof of how your mind perceives all this information. This isn’t a list that you should or have to make within a day. Give it some time. Refine your list so that it has the things that you really think will make your life better. Add to it, remove from it, and once you think everything on the list is exactly what you need, it’s time to move to the next tip. 4. Highlight the Things That Are in Your Control By this point, you know what you want in life, what you’ve already got, and what’s missing. So, naturally, the next step to fix your life is to add the things that are missing. Usually, when we’re trying to improve our lives, what we tend to do it focus on the negative. So instead of finding out what would make us feel better, we point out the negatives and try to eradicate them. But if you’re tired of life, you’re probably going to perceive in your current life as bad. Therefore, instead of suggesting you get rid of the negatives, you should first add some positives. From the list you made in the previous tip, highlight the things that you think are in your control. For example, you can change relationships, work towards a different career, shift homes, etc. If you think it’s in your control, get on with it. Devise an extensive plan on how you can achieve it. Work every day on your plan to achieve one thing at a time. With your mind on the road to what you think will be a better life, it’ll be way easier for you to regain your enthusiasm. 5. Make an Effort in Areas That Seem to Be Out of Your Hands  The difficult part of the list is where you think you’re not in control. You may not have the money to shift to the city that you want to. You may have lost a loved one that you can’t bring back. Whatever the case is, remember that there’s always a second option. You can always find a second-best alternative that is quite possibly in your hands too. This is a time-consuming step. You’ll have to convince yourself, get content with the idea, and then work to achieve it. 6. Set Goals Remember how not having anything to look forward to was a sign of your exhaustion from life? Well, guess who’s got the control to fix it? Yes, it’s you. Really think about it. What are your goals? Why are you even living? What’s the point of your existence? If you haven’t got anything that you’re constantly trying to achieve, you’re basically living a purposeless life. This is one huge factor that makes you want to give up on life. So it’s only right if you set some goals for yourself. These goals can be a way to achieve the life that you idealize, work on your health, strive for a better lifestyle, and anything else that you think is worth fighting for. What you set as a goal isn’t important. But how you define that goal impacts your progress. You might have heard of SMART goals. That’s what you’ve got to keep in mind so that you can actually work on them without losing more motivation.   How to Regain Motivation A major contributing factor to your will to live is your motivation level. Once you start wanting to do little things in life, you’ll start enjoying life in general, too. It’s something that you have to try and test yourself to figure out what works best for you. Start by assigning one day of the week solely for yourself. This day, do anything that you have the slightest will to do – paint, dance, meet someone, or just sleep all day long. For the other 6 days, continue your normal regime but add in some motivational stepping stones here and there. Wear your favorite perfume, dress comfortably, exercise, stay hydrated, eat well, and stay away from things that drain you mentally or physically.    Bottom Line  Being tired of life isn’t a feeling you should ignore. Try out these tips to feel better and don’t shy away from seeking professional help. Pay attention to your mental health, work hard for your happiness, and stay enthusiastic about the life that you’ve been gifted!
(LPC, LAC, NCC)
Answered on 09/29/2021

How do I stop overthinking?

Dear NG,   Thank you for your message and sharing.   I understand how difficult it is to try stopping your thoughts. I could imagine how hard you have been trying and how frustrating to feel that nothing is working.    We can't stop our thoughts, but the more we practice being mindful of the present, the better we can catch ourselves with our thoughts and develop an alternative response to them, and learn to let go.   During moments like this I remind myself the teachings regarding worries, it is consisted with a 2 part questions:   1. Is this problem within my control? If so, then this problem will be solved given time and the right intervention. 2. Would worrying about it make any difference? If not, then is it worth it to sacrifice our time and mental health worrying over something that (1. can't be solved anyway / 2. will be solved anyway)?   This is definitely easier said than done, therefore as a fellow human being, I am working with you to pay attention to what is good, what is kind rather than our worries.   Obsessive or consuming thoughts can make living miserable when you are plagued by them, but this very situation can become the invitation to transcend mind and be free of suffering forever.   Can you stop obsessive thoughts? - If you could, it would be great, but the truth is that it's slightly more complicated than just suppressing your thoughts which at-most you can do for a few seconds. Plus suppressing thoughts is even worse than enduring thoughts. It builds up a lot of negative energy inside.   So how to stop these stops thoughts? The secret to stopping these thoughts is to detach from the mind because You cannot fight mind with the mind. Let's look at this in more detail.   What Causes Obsessive Thoughts?   If you generated the thoughts, you could've controlled them too.   The truth is that you don't generate thoughts, the mind does. And the mind is on auto-mode most of the time.   You can see this for yourself; can you predict what you will think 30 seconds from now? If you can't how can you assume that you are generating the thoughts?   If you believe that you are your mind, that's a false notion again.   If you are your mind then how can you observe the thoughts? So you must be separate from the mind to see what the mind is doing.   The mind generates thoughts, which are mostly just energy forms. These thoughts pass through like clouds. We identify with some of these thoughts and obsess over them.   So in truth, all thoughts are just neutral energy forms; it's your interest or association with the thoughts that makes them obsessive. If you can understand this truth, you have taken the first step towards getting rid of obsessive thoughts.   How to Stop Obsessive Negative Thoughts?   If you are asking this question, ask yourself another question - "is this question not another thought? It's a thought about killing thoughts".   All your attempts at suppressing and stopping thoughts fail because you are using the mind to stop the mind. The police man and thief are both the mind; so how can the police man catch the thief?   So you cannot kill the mind by force. The mind dies its own death by the poison of disassociation.   What gives power to a thought? - Your interest. If you have no interest in a particular thought then it loses its hold over you.   You can try this out now. Let the thoughts flow through your mind but don't take interest in them. Just stay as a bystander or a watcher and let the thoughts float.   Initially you might have a hard time watching thoughts because of your inherent habit of associating with each thought that arises.   It helps to know that you are not your thoughts, that thoughts are just energy forms created in the mind. Why does the mind create thoughts? No one knows - it's just something it does, why bother. Do you ever ask why does the heart beat?   With a little practice you will get really good at watching thoughts and not involving yourself with them.   You will stop giving power to thoughts by not giving them your interest. Thoughts die immediately when they are deprived of this fuel of interest. If you don't associate with the thought or give power to the thought, it will wither away quickly.   What Are Thoughts?   Past events get stored as memories. Your mind conditioning and beliefs are also stored as memories. All this is unconscious storage; the mind does all this in auto mode.   Perceptions and interpretations are created in the mind based on its past "external" conditioning and also its natural conditioning (genetics). These interpretations, perceptions and judgments come up as thoughts in the mind, and they can be positive or negative depending on the mind's conditioning.   Thoughts are generated based on the past incidents/memories, future projections and interpretations on the present life situation. It's like a computer trying to predict or conjure up projection based on the data it has collected so far.   When thoughts are negative in nature (thoughts of worry, anxiety, stress, lack, resentment, guilt etc.) they produce resistance to the movement of your life, and this resistance is felt as suffering. Negative thoughts will always stand in resistance to the movement of your life, like blocks of stone in the midst of a swift current of water.   Life is a stream of pure positive energy and hence any negative thought will stand in opposition to it, causing friction which is felt as suffering in the body.   The thoughts in your mind gain power from your attention and interest. Your attention is the fuel for your mind. So when you give attention to consuming thoughts in the mind, you are unconsciously fueling it and thus attracting more momentum for these negative thoughts.   The momentum of negative thoughts in your mind will slow down, and ebb away, automatically when you stop feeding your attention to it. Stay as an open space of awareness without focusing your attention on the negative thoughts of the mind, and soon they will lose their momentum.   You can focus on the positive thoughts generated in the mind, and thus develop a positive momentum in your mind. Every time your mind produces some positive thoughts, e.g thoughts of love, joy, excitement, abundance, beauty, appreciation, passion, peace etc, focus on it, milk it, and give attention to it.   This will cause your mind to attract more positive thoughts and thus build a positive momentum.   Whenever the mind thinks negatively, don't give it attention or interest, this will cause the ebbing away of the momentum of negative thinking. It's really that simple. Once you understand the mechanics of how thoughts gain momentum in the mind, you will be in total control of your state of being.   The Practice of Watching the Mind   All you need to do to get rid of obsessive thoughts is to watch the mind without getting involved.   You will get really good at this with just a little practice. This practice, or "sadhana" as called in Hindu scriptures, is the root of awakening from the illusion of mind.   Without trying to understand this practice just implement it. The more you try to understand the more mind gets involved. Just watch the mind and you will soon see that you are not the mind at all.   That the mind is like a machine in your head that generates thoughts based on your attention/interest. Be free of your mind by depriving it of your interest. This is the only direct path of becoming free of the mind.   Please let me know if this is helpful, looking forward to talking with you more :) Jono
(MSW, LICSW, LMHC)
Answered on 09/29/2021

How do I get better at managing guilt and shame?

  Yes, triggering thoughts and feeling emotional can feel very vulnerable! Breathe through it. You are not your emotion, it can be important to observe our emotions and acknowledge they exists. Try to experience your emotions like wave, coming and going. Notice how the water is calm, you begin to see the wave building (that is the emotion/feeling). What happens after the wave passes? (Water is still and calm). Recognize that the emotion will pass, it won’t last forever. You may find it helpful to concentrate on some part of the emotion, like how your body is feeling, or what the emotion looks like. Don't try to push the emotion away - This makes the emotion stronger, and increases our suffering.   Emotions are neither “good or bad”; it’s just there. Remember, we label our experiences as ‘good’ or ‘bad’. Anger, fear, sadness are all painful emotions, but they are not bad.  We all experience these feelings.   Here is a strategy that can help us create distance between our thoughts/feelings and our personalities. Remember - You are not your feeling. Your emotion is part of you, and it does not define you Practice creating distance by saying “I am having the Feeling _____” or “I am having the thought____” versus “I am angry” “I will fail”.               It can be helpful to first learn about what worry/anxiety is, when it comes up, and to be more aware of the 'worry process'.  These thoughts can get in the way of what we want, and can impact our confidence, self-esteem, and overall well-being. Worry is like a rocking chair - it gives us something to do, but does not get us anywhere (fun, but also realistic quote!). Our thoughts, feelings, and behaviors are SO connected. When we experience a particular thought, it can trigger a feeling and lead to a behavior.For example: thought (I can't do this/I'm not good enough) leads to feeling (anxious, sad, depressed) which leads to behavior (isolate, withdraw). The reason I share this, is because when we shift the way we think, it will shift the way we feel and behave. Which gives us more control of our emotions.For example: thought (it is going to be okay) leads to feeling (calm, relaxed) leads to behavior (engaged, motivated).It is important to stay grounded in our thought patterns. Often times, "worry" is about the past or the future, and with that - we completely miss the present moment. And this impacts our emotional control!   - it may be helpful to reflect on what exactly feels triggering in those moments. Is it the core beliefs of 'not being good enough' or irrational thoughts of 'what could happen' (things that actually have not happened, worst case scenario) Some thoughts like predicting or assuming what is going to happen - these are known as 'fortune telling' basically assuming the outcome of the future…without evidence, this is actually not happened AND it takes you away from enjoying the present moment. I'll share some more worksheets on these particular thought patterns (core beliefs and cognitive distortions) which will help you gain more awareness into what is triggering some of the feelings you experience.   Even this thought of "not good enough" is another judgment or opinion we might have of ourselves which adds to feeling upset, bothered, or insecure. We can challenge this thought by reflecting on 'what is good enough'. Make expectations of yourself more realistic, you are Human, you are allowed to make mistakes and there is no such thing as perfect.           Cognitive distortions are irrational thoughts that we can get stuck in. They are common, yet unhelpful    Cognitive distortions are simply ways that our mind convinces us of something that isn’t really true. These inaccurate thoughts are usually used to reinforce negative thinking or emotions — telling ourselves things that sound rational and accurate, but really only serve to keep us feeling bad about ourselves        ALL-OR-NOTHING THINKING ·       You see things in black and white categories. If your performance falls short of perfect, you see yourself as a total failure.   OVERGENERALIZATION ·       You see a single negative event as a never-ending pattern of defeat.   MENTAL FILTER ·       You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.   DISQUALIFYING THE POSITIVE ·       You reject positive experiences by insisting they "don't count" for some reason or other. In this way you can maintain a negative belief that is contradicted by your everyday experiences.   JUMPING TO CONCLUSIONS ·       You make a negative interpretation even though there are no definite facts that convincingly support your conclusions.   Mind Reading. You arbitrarily conclude that someone is reacting negatively to you, and you don't bother to check this out.   The Fortune Teller Error. You anticipate that things will turn out badly, and you feel convinced that your prediction is an already established fact.   MAGNIFICATION OR MINIMIZATION ·       You exaggerate the importance of things (such as your goof-up or someone else's achievement). Or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other fellow's imperfections). ·       This is also called the "binocular trick."   EMOTIONAL REASONING ·       You assume that your negative emotions necessarily reflect the way things really are: "I feel it, therefore it must be true."   SHOULD STATEMENTS ·       You try to motivate yourself with shoulds and shouldn'ts, as if you had to be whipped and punished before you could be expected to do anything. "Musts" and "oughts" are also offenders. ·       The emotional consequence is guilt. When you direct should statements toward others, you feel anger, frustration, and resentment.   LABELING AND MISLABELING ·       This is an extreme form of over-generalization. Instead of describing your error, you attach a negative label to yourself: "I'm a loser." When someone else's behavior rubs you the wrong way, you attach a negative label to them: "they are annoying." ·       Mislabeling involves describing an event with language that is highly colored and emotionally loaded.   PERSONALIZATION ·       You see yourself as the cause of some negative event which in fact you were not primarily responsible for.                                          Core beliefs are the very essence of how we see ourselves, other people, the world, and the future. Sometimes, these core beliefs become 'activated' in certain situations. This is where the automatic thoughts/cognitive distortions can stem from         Just because we have thoughts does not mean they are 100% true. We can work towards challenging the self-talk into something more healthier and rational. We can challenge the thoughts by asking ourselves questions…   Some examples: ·       What negative thought about a situation/incident/experience am I having? ·       How is having this thought helping me? ·       How is having this thought hurting me? ·       What evidence/facts support my thought? Is there evidence contrary to or against my thought? ·       Am I interpreting/judging/labeling the situation or experience without examining all of the evidence? ·       How would a friend think about this situation? What would a friend say? ·       How can I think about the situation/incident in a positive way? ·       What else can I tell myself in this moment? ·       Will this situation or experience matter six months from now? How about one year from now? Five years?       Cognitive Therapy Techniques/Skills to Change Your Thoughts Identify Distortions in automatic thoughts. Examine the Evidence - Instead of assuming that your negative thought is true, examine the actual evidence for it.  For example, is it true that I never do anything right? What are some things I do well? What are the things I'm not so good at? The Double-Standard Method - Ask yourself, "Would I say this to a close friend who was very much like me and had a similar problem?" "What would I say to a friend?" Practice saying that to yourself. The Experimental Technique - When you have a negative thought, ask yourself if there is a way you could test it to find out if it is really true. Thinking in Shades of Gray - (useful for all-or-nothing thinking) Remind yourself that things are usually somewhere between 0 and 100 percent.  Instead of insisting "I am perfect and never make a mistake" or "I am a horrible person, I messed up/I'm giving up…."  acknowledge a mistake, forgive yourself, and move forward with your life The Survey Method - Ask yourself "Would other people agree that the thought is valid?"  Or ask people in your life you trust questions to find out if your thoughts and attitudes are realistic. Define terms - (useful if you are labeling yourself). Instead of putting yourself down as "a failure" or "a loser" or "a fool." Ask yourself:  What does failure mean? What is a loser? What is a fool? The Semantic Method - (useful for "should statements"). Substitute a phrase like "it would be nice" or "it would be preferable" in place of "I should."  This may help you look at the thoughts without having expectations, and decrease times of being too self-critical. Re-attribution - (useful for personalization). Ask yourself what other factors may have contributed to this problem.  Focus on solving the problem one step at a time, instead of using up energy towards feeling guilty or blaming yourself. Cost-Benefit analysis. Ask yourself, "How will having this thought/belief help me, and how will it hurt me?"  You can also use this question on negative behavior patterns (i.e. lying in bed, spending too much time on social media) or self-defeating beliefs like "I must always try to be perfect."       Each of us has a set of messages that play over and over in our minds.  This internal dialogue, or personal commentary, frames our reactions to life and its circumstances.  One of the ways to recognize, promote, and sustain optimism, hope, and joy is to intentionally fill our thoughts with positive self-talk.  Too often, the pattern of self-talk we’ve developed is negative.  We remember the negative things we were told as children by our parents, siblings, or teachers.  We remember the negative reactions from other children that diminished how we felt about ourselves.  Throughout the years, these messages have played over and over in our minds, fueling our feelings of anger, fear, guilt, and hopelessness.  That voice inside your head has a huge impact on who you are and how you live your life. You may not think so, but with practice you can change your self-talk. Why wouldn’t anyone want to develop a habit of positive self-talk? It uplifts you; it helps increase your confidence, it enables you to attract what your heart desires, it allows you to adopt a healthier lifestyle and it helps reduce stress. Try the following exercise.  Write down some of the negative messages inside your mind that undermine your ability to be the best version of yourself.  Be specific, whenever possible, and include anyone you remember who contributed to that message.  Now, take a moment to intentionally counteract those negative messages with positive truths in your life.  Don’t give up if you don’t find them quickly.  For every negative message there is a positive truth that will override the weight of despair.  These truths always exist; keep looking until you find them.  You may have a negative message that replays in your head every time you make a mistake.  As a child you have been told, “You’ll never amount to anything” or “You can’t do anything right.”  When you make a mistake—and you will because we all do, and we are allowed to make mistakes, we are Human—you can choose to overwrite that message with a positive one, such as “I choose to accept and grow from my mistake” or “As I learn from my mistakes, I am becoming a better person.”  During this exercise, mistakes become opportunities to replace negative views of who you are with positive options for personal enhancement.  Positive self-talk is not self-deception.  It is not mentally looking at circumstances with eyes that see only what you want to see.  Rather, positive self-talk is about recognizing the truth, in situations and in yourself.  One of the fundamental truths is that you will make mistakes.  To expect perfection in yourself or anyone else is unrealistic.  To expect no difficulties in life, whether through your own actions or sheer circumstances, is also unrealistic.  However, it can easily slip your mind to regularly practice positive self-talk if you don’t make it a habit. And yes, it might sound and feel ridiculous at first, but if you keep going with your positive self-talk it will become natural to you. To help you stay on track, you may like to put some post-it notes wherever you'll see them: on the bathroom mirror, on your computer screen, inside of your wallet, in your car — wherever works for you. It’s important to constantly remind yourself to speak kindly to yourself until it becomes a habit.   Bring your awareness to your self-talk when you wake up, when you’re driving to work, waiting to be served at a restaurant, exercising, or lying down; use it every day, in all situations. When negative events or mistakes happen, positive self-talk seeks to bring the positive out of the negative to help you do better, go further, or just keep moving forward.  The practice of positive self-talk is often the process that allows you to discover the obscured optimism, hope, and joy in any given situation. Your self-talk creates your reality. Some examples of messages you can remind yourself of: ·       I am capable. ·       I know who I am and I am enough. ·       I choose to be present in all that I do. ·       I choose to think thoughts that serve me well. ·       I choose to reach for a better feeling. ·       I share my happiness with those around me. ·       My body is my vehicle in life; I choose to fill it with goodness. ·       I feel energetic and alive. ·       My life is unfolding beautifully. ·       I am confident. ·       I always observe before reacting. ·       I know with time and effort I can achieve. ·       I love challenges and what I learn from overcoming them. ·       Each step is taking me to where I want to be. Notice Your Patterns The first step toward change is to become more aware of the problem. You probably don’t realize how often you say negative things in your head, or how much it affects your experience. The following strategies can help you become more conscious of your internal dialogue and its content. ·       Journal Writing: Whether you carry a journal around with you and jot down negative comments when you think them, write a general summary of your thoughts at the end of the day, or just start writing about your feelings on a certain topic and later go back to analyze it for content, journaling can be an effective tool for examining your inner process. ·       Thought-Stopping: As you notice yourself saying something negative in your mind, you can stop your thought mid-stream my saying to yourself “Stop”. Saying this aloud will be more powerful, and having to say it aloud will make you more aware of how many times you are stopping negative thoughts, and where. ·       Rubber-Band Snap:  Another therapeutic trick is to walk around with a rubber band around your wrist; as you notice negative self-talk, pull the band away from your skin and let it snap back. It’ll hurt a little, and serve as a slightly negative consequence that will both make you more aware of your thoughts and help to stop them! (Or, if you don’t want to subject yourself to walking around with a rubber band on your wrist, you’ll be even more careful to limit the negative thoughts!)     Replace Negative Statements  A good way to stop a bad habit is to replace it with something better. Once you’re aware of your internal dialogue, here are some ways to change it: ·       Milder Wording:  Have you ever been to a hospital and noticed how the nurses talk about ‘discomfort’ instead of ‘pain’? This is generally done because ‘pain’ is a much more powerful word, and discussing your ‘pain’ level can actually make your experience of it more intense than if you’re discussing your ‘discomfort’ level. You can try this strategy in your daily life. In your self-talk, turning more powerful negative words to more neutral ones can actually help neutralize your experience. Instead of using words like ‘hate’ and ‘angry’ (as in, “I hate traffic! It makes me so angry!”), you can use words like ‘don’t like’ and ‘annoyed’ (“I don’t like traffic; it makes me annoyed,” sounds much milder, doesn’t it?) ·       Change Negative to Neutral or Positive:  As you find yourself mentally complaining about something, rethink your assumptions. Are you assuming something is a negative event when it isn’t, necessarily? (For example, having your plans canceled at the last minute can be seen as a negative, but what you do with your newly-freed schedule can be what you make of it.) The next time you find yourself stressing about something or deciding you’re not up to a challenge, stop and rethink, and see if you can come up with a neutral or positive replacement. ·       Change Self-Limiting Statements to Questions:  Self-limiting statements like “I can’t handle this!” or “This is impossible!” are particularly damaging because they increase your stress in a given situation and they stop you from searching for solutions. The next time you find yourself thinking something that limits the possibilities of a given situation, turn it into a question. Doesn’t “How can I handle this?” or “How is this possible?” sound more hopeful and open up your imagination to new possibilities?    
Answered on 09/25/2021

How to manage anxiety?

Hello Fox,   Thank you for sharing some of your story about the anxiety you are currently dealing with in your life on The Betterhelp Platform.  I can see that you might be feeling overwhelmed with your life and your current love situation.    I will answer your question: How to manage anxiety?   I will share some information explaining what anxiety disorders are, the symptoms, possible causes and treatmetns and then offers some tips on how you might manage your symptoms. If you are feeling overwhelmed and unable to cope I would encourage you to reach out to your medical provider or to a professional mental heath therapist for some support.  If you were unable to share all your details on here perhaps you might want to talk your details through with an impartial listener.   What Are Anxiety Disorders?   Anxiety is a normal emotion. It’s your brain’s way of reacting to stress and alerting you of potential danger ahead.    Everyone feels anxious now and then. For example, you may worry when faced with a problem at work, before taking a test, or before making an important decision.   Occasional anxiety is OK. But anxiety disorders are different. They’re a group of mental illnesses that cause constant and overwhelming anxiety and fear.  The excessive anxiety can make you avoid work, school, family get-togethers, and other social situations that might trigger or worsen your symptoms.      With treatment, many people with anxiety disorders can manage their feelings   Types of Anxiety Disorders   There are several types of anxiety disorders:   Generalized anxiety disorder. You feel excessive, unrealistic worry and tension with little or no reason. Panic Disorder. You feel sudden, intense fear that brings on a panic disorder. During a panic attack you may break out in a sweat, have chest pain, and have a pounding heartbeat palpitations. Sometimes you may feel like you’re choking or having a heart attack. Social Anxiety disorder. Also called social phobia, this is when you feel overwhelming worry and self-consciousness about everyday social situations. You obsessively worry about others judging you or being embarrassed or ridiculed. Specific phobias. You feel intense fear of a specific object or situation, such as heights or flying. The fear goes beyond what’s appropriate and may cause you to avoid ordinary situations. Agoraphobia.You have an intense fear of being in a place where it seems hard to escape or get help if an emergency occurs. For example, you may panic or feel anxious when on an airplane, public transportation, or standing in line with a crowd.   Separation anxiety. Little kids aren’t the only ones who feel scared or anxious when a loved one leaves. Anyone can get separation anxiety disorder. If you do, you’ll feel very anxious or fearful when a person you’re close with leaves your sight. You’ll always worry that something bad may happen to your loved one.  Selective mutism. This is a type of social anxiety in which young kids who talk normally with their family don’t speak in public, like at school. Medication-induced anxiety disorder. Use of certain medications or illegal drugs, or withdrawal from certain drugs, can trigger some symptoms of anxiety disorder.     Anxiety Disorder Symptoms The main symptom of anxiety disorders is excessive fear or worry. Anxiety disorders can also make it hard to breathe, sleep, stay still, and concentrate.  Your specific symptoms depend on the type of anxiety disorder you have.    Common symptoms are:  Panic, fear, and uneasiness Feelings of panic, doom, or danger Sleep problems Not being able to stay calm and still Cold, sweaty, numb, or tingling hands or feet Shortness of breath Breathing faster and more quickly than normal (hyperventilation) Heart palpitations Dry Mouth Nausea Tense muscles Dizziness Thinking about a problem over and over again and unable to stop (rumination) Inability to concentrate Intensely or obsessively avoiding feared objects or places   Anxiety Disorder Causes and Risk Factors   Researchers don’t know exactly what brings on anxiety disorders. A complex mix of things play a role in who does and doesn’t get one.    Causes of Anxiety Disorder   Some causes of anxiety disorders are:  Genetics. Anxiety disorders can run in families.  Brain chemistry. Some research suggests anxiety disorders may be linked to faulty circuits in the brain that control fear and emotions.  Environmental stress. This refers to stressful events you have seen or lived through. Life events often linked to anxiety disorders include childhood abuse and neglect, a death of a loved one, or being attacked or seeing violence.   Drug withdrawal or misuse. Certain drugs may be used to hide or decrease certain anxiety symptoms. Anxiety disorder often goes hand in hand with alcohol and substance use. Medical conditions. Some heart, lung, and thyroid conditions can cause symptoms similar to anxiety disorders or make anxiety symptoms worse. It’s important to get a full physical exam to rule out other medical conditions when talking to your doctor about anxiety.    Risk Factors for Anxiety Disorder   Some things also make you more likely to develop an anxiety disorder. These are called risk factors. Some risk factors you can’t change, but others you can.    Risk factors for anxiety disorders include:    History of mental health disorder. Having another mental health disorder, like depression, raises your risk for anxiety disorder.  Childhood sexual abuse. Emotional, physical, and sexual abuse or neglect during childhood is linked to anxiety disorders later in life.  Trauma. Living through a traumatic event increases the risk of post traumatic stress disorder (PTSD), which can cause panic attacks. Negative life events. Stressful or negative life events, like losing a parent in early childhood, increase your risk for anxiety disorder.   Severe illness or chronic health condition. Constant worry about your health or the health of a loved one, or caring for someone who is sick, can cause you to feel overwhelmed and anxious.  Substance abuse. The use of alcohol and illegal drugs makes you more likely to get an anxiety disorder. Some people also use these substances to hide or ease anxiety symptoms. Being shy as a child. Shyness and withdrawal from unfamiliar people and places during childhood is linked to social anxiety in teens and adults.  Low self-esteem. Negative perceptions about yourself may lead to social anxiety disorder.   Anxiety Disorder Diagnosis   If you have symptoms, your doctor will examine you and ask questions about your medical history. They may run tests to rule out other health conditions that might be causing your symptoms. No lab tests can specifically diagnose anxiety disorders.   If your doctor doesn’t find any physical reason for how you’re feeling, they may send you to a psychiatrist, psychologist, or another mental health specialist. Those doctors will ask you questions and use tools and testing to find out if you may have an anxiety disorder.   Your doctors will consider how long you’ve had symptoms and how intense they are  when diagnosing you. It’s important to let your doctors or counselors know if your anxiety makes it hard to enjoy or complete everyday tasks at home, work, or school.    Anxiety Disorder Treatments   There are many treatments to reduce and manage symptoms of anxiety disorder. Usually, people with anxiety disorder take medicine and go to counseling.  Treatments for anxiety disorder include:    Medications Several types of drugs are used to treat anxiety disorders. Talk to your doctor or psychiatrist about the pros and cons of each medicine to decide which one is best for you.    Antidepressants. Modern antidepressants (SSRIs and SNRIs) are typically the first drugs prescribed to someone with an anxiety disorder.  Examples of SSRIs are lexapro and Prozac.   SNRIs include duloxetine Effexor. Bupropion. This is another type of antidepressant commonly used to treat chronic anxiety. It works differently than SSRIs and SNRIs. Other antidepressants. These include tricyclics and monoamine oxidase inhibitors (MAOIs). They are less commonly used because side effects, like drops in blood pressure, dry mouth, blurry vision, and urinary retention, can be unpleasant or unsafe for some people.   Benzodiazepines. Your doctor may prescribe one of these drugs if you’re having persistent panicky feelings or anxiety. They help lower anxiety. Examples are Xanax and Klonopin. They work quickly, but you can become dependent on them. Usually, they’re meant to be an add-on to your anxiety disorder treatment and you shouldn’t take them for a long time.  Beta-blockers. This type of high blood pressure drug can help you feel better if you’re having physical symptoms of anxiety, such as a racing heart, trembling, or shaking.  A beta-blocker may help you relax during an acute anxiety attack. Anticonvulsants. Used to prevent seizures in people with epilepsy, these drugs also can relieve certain anxiety disorder symptoms.  Antipsychotics. Low doses of these drugs can be added to help make other treatments work better.  Buspirone (BuSpar). This anti-anxiety drug is sometimes used to treat chronic anxiety. You’ll need to take it for a few weeks before seeing full symptom relief.    Psychotherapy: This is a type of counseling that helps you learn how your emotions affect your behaviors. It’s sometimes called talk therapy. A trained mental health specialist listens and talks to you about your thoughts and feelings and suggests ways to understand and manage them and your anxiety disorder.   Cognitive behavioral therapy  (CBT): This common type of psychotherapy teaches you how to turn negative, or panic-causing, thoughts and behaviors into positive ones. You’ll learn ways to carefully approach and manage fearful or worrisome situations without anxiety. Some places offer family CBT sessions.   Managing Anxiety Disorder Symptoms   These tips may help you control or lessen your symptoms:   Learn about your disorder. The more you know, the better prepared you will be to manage symptoms and roadblocks along the way. Don’t be afraid to ask your doctor any questions you might have. Remember, you are a key part of your health care team.  Stick to your treatment plan. Suddenly stopping your meds can cause unpleasant side effects and can even trigger anxiety symptoms.  Cut down on foods and drinks that have caffeine such as coffee, tea, cola, energy drinks, and chocolate. Caffeine is a mood-altering drug, and it may make symptoms of anxiety disorders worse. Don’t use alcohol and recreational street drugs. Substance abuse increases your risk of anxiety disorders. Eat right and exercise. Brisk aerobic exercises like jogging and biking help release brain chemicals that cut stress and improve your mood. Get better sleep. Sleep problems and anxiety disorder often go hand in hand. Make getting good rest a priority. Follow a relaxing bedtime routine. Talk to your doctor if you still have trouble sleeping. Learn to relax. Stress management is an important part of your anxiety disorder treatment plan. Things like meditation, or mindfulness, can help you unwind after a stressful day and may make your treatment work better. Keep a journal. Writing down your thoughts before the day is down may help you relax so you’re not tossing and turning with anxious thoughts all night.  Manage your negative thoughts. Thinking positive thoughts instead of worrisome ones can help reduce anxiety. This can be challenging if you have certain types of anxiety, however. Cognitive behavioral therapy can teach you how to redirect your thoughts.  Get together with friends. Whether it’s in person, on the phone, or the computer, social connections help people thrive and stay healthy. People who have a close group of friends that support and chat with them have lower levels of social anxiety.  Seek support. Some people find it helpful and uplifting to talk to others who are experiencing the same symptoms and emotions. Self-help or support groups let you share your concerns and achievements with others who are or who have been there.  Ask your doctor or pharmacist before taking any over-the-counter meds or herbal remedies. Many have chemicals that can make anxiety symptoms worse.   Anxiety Disorder Outlook It can be challenging and frustrating to live with an anxiety disorder. The constant worry and fear can make you feel tired and scared. If you’ve talked to a doctor about your symptoms, then you’ve taken the first step toward letting go of the worry.    It can take some time to find the right treatment that works for you. If you have more than one anxiety disorder, you may need several kinds of treatment. For most people with anxiety disorders, a combination of medicine and counseling is best. With proper care and treatment, you can learn how to manage your symptoms and thrive.     There is hope!   I wish you the best of luck with getting your life back on track.   Kind Regards,   Gaynor           
(MA, LCSW)
Answered on 09/24/2021

How do I deal with relationship anxiety ?

I'm sorry that this has happened to you. Being blindsided by someone that you love and that has expressed love for you can be an emotionally draining event to go through. In your question, I wasn't sure if I was reading it correctly, but the way I read it was that something had happened with a prior relationship and now this situation is another situation that has happened.  If you were to look back over the course of the relationship, were there any "red flags" that stood out to you as being odd or just not seeming to be right? When it comes to relationships, we learn by those relationships that we grow up with. Look at how your parents relationship was or if you had any close family friends or other family members and think about what their relationships were like.  Something to think about as you move forward into any other relationship is to define what it actually is that you want out of a relationship. Define the terms that you want your partner to have and seek someone out with those characteristics. As you are leaving this relationship, think back over what parts of it you enjoyed and how you would  like to have those parts in the next relationship. As you think of what you want in a relationship, consider why you want to be in a relationship to begin with. Many people get into relationships, just because they don't want to be alone. Use this time for you and to reconnect with who you are as a person and think about what you have to offer to a relationship and a partner. Lastly, you also have to allow yourself to heal from all of your relationships that you have had. If you do not allow yourself to take some time and get to know yourself again, then you could be setting yourself up for failure again by getting into a relationship too soon. When you are ready to begin seeking out a new relationship, make sure to take your time to get to know others and take the relationship at a slower pace. Don't be afraid to ask questions. Think of dating as an interview for a life partner. 
(MS, LPC)
Answered on 09/23/2021

How do I cope with feelings of loneliness and hopelessness?

Loneliness and hopelessness are two pretty strong emotions that are often associated with depression.  Depression can be a short term thing that is triggered by an event (such as loss of a loved one or a break up as in your case), or depression can be a longer-term chronic condition that lasts because of an initial triggering event but then difficulty coping or a series of events that maintain the depression.  Loneliness is not related to the number of people that we know or are surrounded by but is more related to the people (or lack of people) that we connect with and relate to.  Hopelessness is a feeling of intensity that tells us that we don't see an end in sight or feel like things will ever change.  The key to hopelessness is remembering that when we are in a situation or it is recent, we become so focused on being in the situation that we can't see any way out or anything else as possible.  Imagine if we were in a dark room, we probably wouldn't see anything else except the dark. Even when we don't see light at this moment, we need to be able to believe that there is a door or window somewhere that leads to an outside world that has light. A few keys to remember about your situation here is that just as you pointed out; 1) you recently started grad school which represents a lot of adjustments to possibly a new location, new people, and new routines such as classes; 2) you are probably missing the support of family and friends that aren't as readily accessible, and familiar places that you are comfortable being in 3)  you just had a breakup from someone that you were very connected to, and the most common reaction to that is to feel rejected and question ourselves and our abilities. The key to overcoming loneliness and hopelessness in your case is multi-layered.  Step 1 is integrating old routines with new ones by looking at what routines and self-care you can maintain despite being in your new environment; this is often basic self care such as eating the same, keeping the same exercise routines, and engaging in the same hobbies or activities such as playing music or sports.  Step 2 is integrating opportunities for new connections while creating opportunities to maintain old connections.  In addition to meeting new people, getting a routine for talking or visiting regularly with old friends and family can be important for support as well as connectedness as it may take time to develop new relationships and build trust.  Lastly, step 3 involves being kind, realistic, and patient with yourself by realizing that you are currently going through a lot of changes and the things you are feeling are normal emotions that demand attention.  All emotions, even negative feelings of loneliness and hopelessness are actually very helpful as they are merely messages that tell us that we need to change something (so we need to pay attention to them and not ignore them and hope they go away).    Like many things, grad school can be both exciting and scary at the same time because of the many changes, but paying attention to our feelings (just as you are) helps us to adapt to any situation to get the most out of it and hopefully even truly enjoy it.  Good luck with your studies!
(M.Ed, LMFT)
Answered on 09/23/2021

How to deal with the feeling of emptiness?

How to deal with the feeling of emptiness? You shared what should you do when you wake up on a random day and feel that gnawing empty feeling and nothing feels pleasurable and life does not feel worth living? You also questioned how can you avoid feeling that way in the first place, when there are no obvious triggers for why it happens? You questioned how to deal with the feeling of emptiness at this time. Based on your statement, “What should I do when I wake up on a random day and feel that gnawing empty feeling and nothing feels pleasurable and life doesn't feel worth living?” I am very concerned with you sharing that you have suicidal thoughts. I do want to share with you that being suicidal is considered a medical emergency. When you share that you have thoughts of suicide, I recommend that you get an assessment from a licensed professional counselor and or licensed mental health professional therapist immediately. If you are not sure who you can go to, you can go to your local emergency room or call 911.Please understand that the services provided through BetterHelp are not intended for crisis situations such as individuals who are having currently thoughts of suicide and or urgent needs. In a crisis situation, please call 911 or your local emergency services or you can also visit the nearest emergency room. Once you have sought the proper mental health treatment to discuss and process your suicidal thoughts. Then, I would highly recommend that you start seeking mental health therapy with a licensed professional counselor and or licensed mental health professional therapist or that you continue seeking treatment from a licensed professional counselor and or licensed mental health professional therapist if you are seeing someone at this time. Based on your question, I would highly recommend that you seek help from a licensed professional counselor and or licensed mental health professional therapist to discuss your thoughts and feelings regarding what you should do when you wake up on a random day and you feel that gnawing empty feeling and nothing feels pleasurable and life does not feel worth living. A licensed professional counselor and or licensed mental health professional therapist can help you discuss and process what triggers you to experience a gnawing empty feeling where nothing feels pleasurable and life does not feel worth living. A gnawing empty feeling and nothing feels pleasurable and life does not feel worth living can help you learn to implement effective coping skills to reduce your feelings of emptiness in regards once you seek proper help for your suicidal ideations. Emotional distress is a huge factor in possibly adding to some of your current feelings of emptiness and loss of pleasure that can easily manifest into depression. It is quite beneficial to have a licensed professional counselor and or licensed mental health therapist to discuss your specific thoughts and feelings in a safe and conducive environment of your choice. Taking the time to find the proper licensed professional counselor and or licensed mental health therapist is very important, so you can feel comfortable in working to making the necessary changes to improve your mental well being as a means of decreasing your emotional distress at this time that may have manifested into depression. Depression can be treated with the use medication and therapy combined.  Behavior interventions, Psychotherapy, and Cognitive Behavioral Therapy (CBT) have all been beneficial in treating individuals who have struggled with feelings of emptiness. A gnawing empty feeling and nothing feels pleasurable and life does not feel worth living can assist you in learning how to effectively implement coping skills to decease your feelings of emptiness. A licensed professional counselor and or a licensed mental health therapist can provide you counseling in a safe and confidential setting without feeling judged or ridiculed. A licensed professional counselor and or a licensed mental health therapist can also introduce you to deep breathing techniques, stress relaxation techniques, calming techniques, progressive muscle relaxation, grounding techniques positive interpersonal social skills and imagery as a means of decreasing your feelings of emptiness at this time. In an effort to decrease your feelings of emptiness, you can also try to commit to changing the way you think. It will take a lot of practice, dedication and determination to alleviate increased feelings of emptiness. 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 not feeling productive 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 thoughts of not being productive in an effort to help you experience an overall healthier mental well-being at this time. Overall, I highly recommend that you seek help from a licensed professional counselor and or a licensed mental health therapist to properly assess your thoughts of feelings of emptiness in regards to your current emotional distress at this time. Emotional and mental distress can look different for everyone because mental health is not a one size fits all. Therefore, it is very important to get personalized treatment for your specific and current mental and emotional needs in regards to decreasing your feelings of emptiness in that is currently causing you emotional distress at this time. Best regards to you!
(EdS, LPC-S, NCC, BC-TMH)
Answered on 09/23/2021