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This Is What Dissociation Feels Like - Psych Central 25 Apr 2022

From daydreaming to altering personalities, dissociation can look different for everyone.

Though a somewhat vague term, disassociation involves cognitive disconnections between your thoughts, memories, and actions.

Disassociation can also affect your sense of identity and alter your perception of the world around you. It’s the hallmark symptom of dissociative disorders, including dissociative identity disorder (DID), previously known as multiple personality disorder.

But people with various mental and physical conditions can experience dissociative events, in addition to other symptoms.

If left untreated, dissociation can lead to significant problems in daily functioning and worsening mental health. But learning coping strategies can help you manage these potentially distressing events.

What is dissociation? According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), dissociation is generally defined as a disruption or discontinuity in:

  • consciousness
  • identity
  • memory
  • perception
  • emotion
  • motor control
  • behavior These components of your cognition may not come together as they should during dissociative events, which could last for just a few minutes or years, in extreme cases.

Awareness of yourself and what’s going on around you can be compromised during dissociation, which might feel like an unwelcome and frightening intrusion into your mind.

On a psychological level, dissociating can be an involuntary means of coping with acute stress, such as physical abuse. Disassociation can act as an emergency escape route, preventing your mind from focusing on an overwhelming or traumatizing stimulus.

Approximately 73% of people who endure a traumatic incident experience dissociation during and directly following the event.

But in protecting you from trauma in the short term, dissociation creates negative consequences in the long term, like:

  • personality altering
  • memory loss
  • emotional disfunction

How the experience of dissociation feels Dissociation looks and feels different for each person who experiences it. But what’s typically consistent in most cases is a sense of departing from reality.

A participant in a 2021 study explained their fragile relationship with reality, saying, “It’s kind of like walking on thin ice, it can break at any moment.”

You may suddenly lose your sense of identity or recognition of your surroundings. You could feel as though you’re observing yourself from the outside in — or what some describe as an “out-of-body experience.” Your thoughts and perceptions might be foggy, and you could be confused by what’s going on around you.

In some cases, dissociation can be marked by an altering of your:

  • personality
  • identity
  • behavior You might feel as though you’ve become a different person altogether with different attributes and thoughts.

Dissociation can take place during a traumatic or stressful event and can sometimes continue in the days or weeks after, such that your memories and events recounted to you might not line up.

One first-hand account describes a woman who reported being told that she had said and done things that she had absolutely no memory of. While some people have no recollection of their dissociations, others can remember when it occurred and what it felt like.

Symptoms Symptoms of dissociation are wide-ranging in their type and severity and can be both physical and psychological.

Some of the most common mental signs and symptoms of dissociation include:

  • fogginess and confusion
  • detachment
  • memory loss
  • difficulty accessing or retrieving information
  • alexithymia (difficulty recognizing or describing your emotions)
  • sudden behavioral changes
  • significant shifts in mood Some people experience physical symptoms as well, such as:

  • dulled senses, including pain

  • sense of weightlessness or emptiness

  • pounding heart

  • lightheadedness or dizziness

Types of dissociation There’s generally a broad spectrum in the severity of dissociation. Most people have experienced dissociation at some point in their lives.

Situations that can be considered dissociative include:

  • a wandering mind during class
  • closing track of the road as you’re driving
  • certain meditative states But the more severe types of dissociation — those typically associated with mental disorders — take many forms, including:

  • Dissociative amnesia. The central symptom is loss of memory — forgetting entirely or misremembering details about specific events, periods of time, or your own life history.

  • Dissociative fugue. This is a form of amnesia involving physical movement, in which you travel from one place to another with no memory of how you arrived there. Sense of identity is often lost.

  • Depersonalization. This is a detachment from your thoughts, emotions, body, or life altogether. It may feel like you’re watching yourself from an outside perspective.

  • Derealization. The world around you seems unreal, including other people. This is despite a maintained logical awareness that your surroundings are, in fact, real.

  • Identity alteration or confusion. You may adopt a different personality, voice, behavior, and sense of self. In milder forms, this could be a sense that you are or have acted in a way that doesn’t align with your true identity.

Causes and triggers Unlike many other mental health events, genetics likely play little to no role in a person’s tendency to disassociate.

The overwhelming consensus among researchers and mental health experts is that traumatic events — particularly in youth — may be the most common underlying cause of dissociation and many related disorders.

Childhood trauma leading to dissociation could include:

  • sexual abuse
  • physical abuse
  • neglect
  • exposure to war or violence
  • car accidents
  • natural disasters

There are some potential physical causes of dissociation as well, like:

  • epilepsy
  • head trauma
  • brain tumors For those who begin to dissociate once they’ve already reached adulthood, physical conditions are more likely to be responsible, including:

  • combat

  • torture

  • repeated abuse Dissociating might be considered a form of protection in these traumatizing situations, shielding you from unbearable or overwhelming experiences.

But in some cases, dissociation can become your go-to defense mechanism. Possible triggers of dissociation can include:

  • alcohol
  • substances like phencyclidine (PCP) and ketamine
  • depressive episodes
  • acute stress or anxiety A 2018 case studyTrusted Source focusing on one 55-year-old woman identified that her dissociative events — in her case, alternating personalities — were triggered by stress and substance use.

Sleep might also play an important role in the frequency of dissociative events, with poorer quality sleep potentially making dissociation more likely.

Related mental health conditions Some 2017 research tells us that dissociation can be a symptom of many mental health conditions.

Of course, dissociative events are most commonly associated with dissociative disorders.

Data suggests that about 7% of the population has met the criteria for a dissociative disorder at some point in their lives. Still, difficulty identifying these conditions could mean this estimate isn’t entirely accurate.

The DSM-5 defines five dissociative disorders:

  • dissociative identity disorder (DID)
  • dissociative amnesia, including fugue
  • depersonalization or derealization disorder
  • other specified dissociative disorder
  • unspecified dissociative disorder

But dissociation isn’t found only in dissociative disorders — it can also be a symptom of other mental conditions, such as: - post-traumatic stress disorder (PTSD) - substance use disorder - schizophrenia - borderline personality disorder (BPD) - obsessive-compulsive disorder (OCD) It’s also common for people who experience dissociation to have depression or an anxiety disorder, largely due to the psychological stress dissociation can create.

Managing dissociation Even though dissociation can be frustrating and intrusive, there are techniques and strategies to help you manage your symptoms and regain control of your life.

What works for one person may not work for another. You may have to try multiple strategies before discovering the tools that are most beneficial to you.

Therapy Professional guidance with a therapist, such as cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT), may be the best option for meaningful, long-term improvements in managing disassociation.

Record your reality Referring back to something you created could help jog your memory and reduce the frustration of forgetfulness associated with disassociation.

If you have difficulties with memory loss and disassociation, try keeping a daily diary or taking pictures to help you record:

  • events
  • thoughts
  • emotions
  • Mindfulness Dedication to mindfulness can work wonders for several mental health conditions and symptoms. To mitigate dissociative events, 2022 research suggests that practicing mindfulness and reassuring yourself that you’re safe in the present moment might be helpful.

Grounding techniques Grounding techniques can also firmly connect you back to reality in times of disassociation. This could include exercising all your senses, like:

  • smelling essential oils
  • reading a poem aloud
  • petting your dog
  • Lifestyle changes

Lifestyle changes are accessible at home and can make a big impact on mental health. Simple self-care measures for managing disassociation might include:

  • keeping a consistent sleep schedule
  • exercising regularly
  • eating nutritious food
  • spending time outdoors

Next steps Those who experience dissociation may face stigma or skepticism from friends, family, and even some doctors who still have misconceptions about this condition.

But as scientific knowledge and exploration grow, so does the understanding of this complicated phenomenon.

If you’re experiencing dissociative events or related symptoms, you’re not alone. Reaching out to your doctor or therapist can be an important first step.

If you’re ready to get help but don’t know where to begin, you can visit Psych Central’s guide to finding mental health care.

Management and even resolution of dissociation are possible with the right strategies and guidance.

For more information about dissociation, you can check out the International Society for the Study of Trauma and Dissociation (ISSTD) “Dissociation FAQs” page.


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Anxiety Can Lead to Irrational Fears: Here Are 5 Ways to Cope - Psych Central 20 Mar 2022

Irrational fears can feed underlying anxiety. Keeping them in check may involve retraining your brain’s response to fear.

Fear is not only natural — it’s important. Fear tells you when you’re in danger physically or emotionally. The brain doesn’t distinguish between real or imagined danger.

Faced with fear, your body jumps into action with a flight, fight, or freeze response that allows you to protect yourself from harm.

In our modern lives, where the threat of saying something embarrassing in a meeting is more prevalent than being eaten by a tiger, our systems can go into overdrive trying to fend off potential, future danger.

Some people might find themselves worrying about speaking in public and get sweaty palms before a presentation but present anyway. For others, intense fear may lead them to avoid meetings or speaking in groups at all.

If you experience an exaggerated response to an irrational fear, like public speaking, it’s possible to calm your nervous system when it warns you of a nonexistent danger.

What makes a fear ”irrational”? Fear is a typical human response to danger. But when your fears are out of proportion to the situation, they are considered irrational.

For example, a rational fear might show up as anxiety on a flight during turbulence. Irrational fear is being terrified of flying or the possibility of a plane crash to the point that you don’t take vacations anywhere that requires a flight.

Irrational fears pop up when no actual threat exists. They can also be fears of fictional future situations. These imagined fears come with intense, frightening thoughts and an outsized reaction, like going out of the way to avoid the possibility of the scenario ever occurring.

For example, dating can make all of us nervous and can be awkward. But there’s no real danger in going out on a date and socializing.

Someone with an irrational fear might worry intensely about a fictional extreme situation, like their date humiliating them. That fear might drive them to avoid dating entirely.

What is the link between anxiety and irrational fears? Irrational fears play a central role in anxiety disorders. Anxiety disorders are characterized by strong feelings of fear or worry. Intense feelings of fear can feel uncontrollable and spark avoidance tactics in people with anxiety.

Many of the fears that are underlying in anxiety conditions are about situations that pose little or no real danger, making them irrational fears. Many people living with anxiety know their fears are irrational, but certain thoughts and situations still set off a flight, fight, or freeze response.

Here are some of the anxiety disorders that involve irrational fears:

Generalized anxiety disorder (GAD) involves irrational fear that isn’t related to anything specific. Social anxiety disorder is tied to an irrational fear of embarrassing yourself publicly and limits you at school, work, social circles. Specific phobias are centered around an intense irrational fear of a specific object or situation, like airplanes, spiders, and public speaking. Panic disorder occurs when intense and possibly irrational fears bring on a panic attack. You may develop an irrational fear of panic attacks themselves. One studyTrusted Source shows a link between specific phobias and the part of the brain where fear is conditioned.

More than 31%Trusted Source of adults will experience anxiety in their lives. Symptoms of anxiety may include:

feeling tense or edgy, both mentally and physically fatigue irritability inability to concentrate or focus difficulty sleeping This anxiety quiz may help you assess whether you have anxiety, and in what form. It should not replace seeing a medical professional.

Here are some tips for managing and treating irrational fears:

  • Practice mindfulness Mindfulness practices may help you learn to evaluate when your fears go from rational to irrational, and can help you manage your reactions to them.
  • Learning to be patient with yourself and accepting your irrational fears for what they are, including the limits they place on your life, can help you begin to retrain yourself to react differently to them.2. Learn to control what you can How can you best feel in control of your life? Anxiety is rooted in irrational fears of what might happen. In other words, a sense of a lack of control.

    Add in activities that help you regain a sense of control, like volunteering for an organization you care about or joining a sports league. Exerting this sense of agency over your life can help you overcome a tendency to stew on unknown outcomes.

  • Check out cognitive behavioral therapy Cognitive behavioral therapy (CBT) can teach you new ways to engage with and react to your irrational fears, thus helping soothe your anxiety about them.
  • You may learn new social skillsTrusted Source and techniques that can help you cope in a situation that normally causes fear.

  • Try exposure therapy A component of CBT, exposure therapy means that you will expose yourself to your fear as a way to lessen its impact on you over time. Research shows that 80% to 90%Trusted Source of people with specific phobias benefit from exposure therapy.
  • If you fear going to the doctor, you might start by looking at a photo of a doctor’s office. In the next exposure session, you might call and talk to your doctor’s receptionist. You’d continue increasing the significance of the exposure until eventually, you’d work your way up to going to the doctor.

  • Develop go-to relaxation techniques When you feel your body responding to irrational fear, pause to calm your nervous system down. Close your eyes and try a deep breathing technique or go for a walk outside. Experiment with calming activities you love, like sipping your favorite tea, coloring, or using an anxiety relief product.
  • Next steps When you know your fears are irrational, but you cannot see a way to escape the cycle of anxiety, know that help is available. Anxiety disorders are treatable.

    You can learn — whether through mindfulness, through therapy or support groups, or with the help of medication as well — to break the cycle of irrational fear.

    Consider connecting with people who’ve had similar experiences in anxiety online support groups.

    Talk with your doctor about your symptoms and if anti-anxiety medication might help your anxiety disorder. Treatment for specific phobias typically focuses on therapy. But as you’re working on your fears, antidepressants, benzodiazepines, and beta-blockers might reduce anxiety symptoms that get in the way of your everyday life.


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    8 Foods to Boost Serotonin and Improve * YOUR* Mental Health - By Psych Central 18 Feb 2022

    Low serotonin can impact your well-being. Learn how you can boost your serotonin levels with food and what to add to your diet.

    Serotonin is a chemical messenger that your digestive tract and central nervous system produce. This “happy hormone” can directly impact your mood and mental health.

    “Neurotransmitters carry out important signaling between the cells of the brain (called neurons) that govern essential brain functions like mood, cognition, focus, and rest,” says Uma Naidoo, MD, a nutritional psychiatrist, professional chef, and author of “This Is Your Brain on Food.”

    According to Naidoo, low serotonin levels are typically associated with mental health conditions such as:

    • mood disorders (like depression)
    • anxiety
    • insomnia
    • obsessive-compulsive disorder
    • post-traumatic stress disorder If you’re low on serotonin, eating certain foods can increase your serotonin production.

    You may even get a boost in your mood as a bonus.

    How food may boost your mood “While we generally can’t get serotonin directly from whole-food sources (with a few exceptions), there are a variety of nutrients and plant compounds that can promote our body’s ability to produce serotonin and other mood-boosting neurotransmitters in the brain,” Naidoo says.

    Foods that may increase serotonin Here are eight types of food that may produce serotonin and could help improve your mental health:

    • eggs
    • dairy
    • tofu
    • nuts and seeds
    • fermented foods
    • spinach
    • fruits and vegetables
    • turkey

    A research review from 2016 mentions that serotonin is synthesized from the amino acid tryptophan. Therefore, eating tryptophan-rich foods may be key to improving your mood and feeling better.

    “Aside from boosting serotonin, however, incorporating certain groups of foods into a healthy, balanced diet can drastically improve your mental health,” Naidoo says.

    Eggs “Research [from 2015] found that even small amounts of tryptophan-rich egg protein influenced serotonin levels and significantly improved the moods of female participants aged 45 to 65,” Naidoo says.

    For the best nutrient sourcing, Naidoo recommends pastured eggs from cage-free chickens. Consider starting your day with:

    scrambled eggs an omelet a baked frittata

    Dairy “Foods like cow’s milk, cheeses, or plain yogurt are noted to be naturally rich in the protein alpha-lactalbumin, which was shown in [2005] researchTrusted Source to increase blood tryptophan levels and improve sleep quality and mood,” Naidoo says.

    Consider trying whole unsweetened Greek yogurt with live cultures to help improve both your gut and mental health. Naidoo suggests adding a handful of wild blueberries for natural sweetness, gut-loving fiber, and mood-boosting antioxidants.

    Tofu If you’re vegetarian or vegan or otherwise don’t eat eggs or dairy, soy products such as tofu are a great protein option.

    “Organic non-GMO-sourced tofu is an excellent, versatile protein that’s rich in tryptophan [and] soy isoflavones, which have a demonstrated association with [fewer] symptoms of depression,” Naidoo says.

    You might try tryptophan-packed tofu as a substitute for meat-based proteins.

    Nuts and seeds Certain nuts and seeds may help you produce more serotonin.

    Naidoo says that eating a handful of walnuts each day has been associated with a reduced risk of depressive symptoms, according to a 2019 study.

    You might consider eating a handful of nuts and seeds as a snack on their own or sprinkling them into a salad or cup of yogurt.

    Fermented foods Fermented foods are rich in important bacteria that nourish your natural gut microbiome and may improve your mental health.

    You could try adding any of these fermented foods to your diet:

    • kimchi
    • miso
    • sauerkraut
    • unsweetened coconut milk
    • cashew milk yogurt
    • Other prebiotic foods, such as garlic, leeks, and onions, may help too.

    Spinach “Rich in iron and folate, spinach packs a powerful dose of key vitamins and minerals that are absolutely necessary for the production of serotonin in the brain,” Naidoo says.

    “In fact, folate deficiency shares a significant association with symptoms of depression, and therapy with folic acid has shown to improve these symptoms.”

    Consider tossing spinach into:

    an omelet a smoothie a salad

    Fruits and vegetables Many fruits and vegetables may help increase serotonin. Some tryptophan-rich fruits and veggies you may want to try are:

    pineapple bananas kiwis plums beans “For an extra veggie punch, pair spinach with sweet potatoes and cherry tomatoes — shown to be among the richest sources of plant serotonin — for a delicious, mood-boosting breakfast hash,” says Naidoo.

    Turkey If you celebrate Thanksgiving, then you may have heard that turkey is high in tryptophan.

    Consider sliced turkey on whole-grain bread for an easy sandwich or turkey meatballs instead of beef.

    “[Nutritional psychiatry] brings back to the individual the notion that the power to care for your own mental health rests, in large part, in your hands,” says Naidoo. “It’s what’s on your plate and at the tip of your fork.“

    The bottom line is that eating nutritious foods may have a positive impact on your mental health — and research can back that up. For instance, research shows that a well-balanced Mediterranean diet may benefit mental well-being.

    Changing your diet can feel hard, but healthier eating is possible — even when you’re on a budget

    Remember that frozen and canned foods, such as frozen fruits and veggies or canned fish, can be healthy options too.

    It’s also important to keep in mind that dietary changes are not the only self-care strategy you can try to boost your serotonin levels. If you want to learn about other things you can do, consider reading this article. https://psychcentral.com/depression/self-help-for-depression


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    8 Mental Health Trends to Watch in 2022 - by Psych Central 25 Jan 2022

    Keep an eye out for these emerging trends and exciting new research developments in mental health in the new year.

    Mental health became an important part of the public conversation in 2021, as Olympic athletes, celebrities, and other public figures came forward about their well-being and helped reduce the stigma.

    As we enter the third year of the pandemic, we can expect mental health to continue to be a top priority in 2022.

    In fact, a recent poll by the American Psychiatric Association showed that one-quarter of Americans made a new year’s resolution to improve their mental health in 2022.

    Although 2021 wasn’t without its challenges, the past year brought growth, understanding, and hopefully, renewed optimism.

    New developments in science, such as the COVID-19 vaccines, are a testament to humanity’s commitment to healing.

    Other exciting research studies have shown us how we can improve mental health services, address racial and socioeconomic disparities, and ultimately, enhance our overall well-being from the inside out.

    Suffice it to say, there’s a lot happening in the mental health space — too much for one article alone. To determine our top mental health trends of 2022, we consulted experts in the field and Psych Central’s Medical Affairs Team.

    Note that some of these trends aren’t yet available, but we expect a continued increase in research and accessibility in the months to come.

    1. Trauma-informed care Nearly 61% of adults have experienced at least one traumatic event in their lifetimes, according to the Adverse Childhood Experiences (ACES) studyTrusted Source.

    Around 1 in 6 adults endure four or more traumatic events during childhood, with women and people from minoritized communities facing a greater risk.

    Clinicians, health care practitioners, educators, and mental health professionals are widely embracing a trauma-informed approach to careTrusted Source to address trauma among the broader population.

    Trauma-informed care will only continue to be emphasized in 2022, according to Nathaniel Ivers, PhD, department chair and associate professor at Wake Forest University in Winston-Salem, North Carolina.

    For trauma-informed care to be effective, Ivers emphasizes the need for a holistic approach that includes treatments and strategies that play to an individual’s strengths versus their weaknesses. In some cases, trauma-informed care could run the risk of hyper-focusing on an individual’s trauma exclusively, rather than homing in on an individual’s strengths to effectively understand and treat them.

    2. Blood tests for mental illness Soon, you could have the option to take a blood test to easily detect a mental health condition like depression.

    In April 2021Trusted Source, researchers at the Indiana University School of Medicine developed a novel blood test for mental illness, suggesting that biological markers for mood disorders can be found within RNA biomarkers.

    The breakthrough study indicated that a blood test can determine the severity of depression and the risk for developing severe depression and bipolar disorder in the future. The blood test may also help tailor an individual’s medication choices.

    “This is an exciting prospect for identifying biological markers of depression among researchers, but very preliminary in its understanding and potential for use,” says Matthew Boland, PhD, a clinical psychologist in Reno, Nevada, and a member of Psych Central’s Medical Affairs Team.

    Although blood tests for mental illnesses are still in their early development stages, this scientific advancement could change, even improve, how mental health conditions are diagnosed, which is often by trial and error.

    “This method will remain an adjunctive to traditional diagnostic tools, as mental illnesses are complex and have biological, psychological, and sociocultural etiologies,” Ivers adds.

    3. Advancements in psychedelic research Psychedelics have been used for religious, medical, and ceremonial purposes around the world for centuries, predominantly among Indigenous cultures.

    And recent research suggests that psychoactive substances like psilocybin, MDMA, LSD, and ketamine can help treat mental health conditions like depression, anxiety, and more.

    Although psychedelics are still classified as controlled substances and illegal in many countries, including the United States, laws, policies, and stigma are starting to ease up.

    For instance, the Drug Enforcement Administration (DEA) recently authorized an increase in the production of psychedelics to meet growing research demands.

    From Yale to Johns Hopkins to New York University, to the newly minted Center for Psychedelic Research and Therapy at the University of Texas, research scientists are becoming increasingly interested in the therapeutic value of psychedelics and other psychoactive substances.

    In addition, emerging research shows the potential mental health benefits of psychedelic-assisted psychotherapy (PAP), a form of therapy combined with ingesting a psychoactive substance.

    “Adjunctive therapy is needed to keep old habits [from] solidifying following dosing,” Boland says. “More established methods will be slower to adopt, partially due to legality and awaiting increased research findings for efficacy for many specific conditions.”

    While psychedelic therapy is still at least a few years away from being offered at your therapist’s office, we’ll likely continue to see more scientific discoveries on the possible benefits.

    4. Setting healthy boundaries with social media If you have a smartphone, you’re probably well aware that limiting your screen time can be a challenge. Not to mention, spending too much time online can negatively affect your well-being.

    And if you’ve watched Netflix’s “The Social Dilemma,” you’re familiar that Facebook, Instagram, and Pinterest specifically designed these apps to hold your attention for as long as possible.

    You might also recall when a former Facebook employee testified before Congress in October 2021 on the negative effects of Instagram on teens’ mental health, which was dovetailed by a global Facebook outage.

    The events sparked an overdue dialogue about the potentially harmful effects of social media platforms and the need for taking an occasional break.

    We can expect to hear more conversations about “digital wellness” and establishing healthy boundaries with social media, particularly as research continues to shed light on the negative effects on adolescents and adults alike.

    “Larger overall scrutiny of the effects of social media on mental health will likely continue and increase,” Boland says. “Whether or not that translates to definitive action by lawmakers may be a different story.”

    What “social media boundaries” might look like will vary based on the individual, and whether they’re effective is still up for debate. While more research is needed, Boland suggests that setting the following boundaries can be helpful:

    • Limit screen time.
    • Unfollow people.
    • Don’t read comments. According to Ivers, the mental health effects of “doom scrolling” and virtual privacy could see more traction in 2022 as well.

    “I also believe there will be an increase in discussions about the disproportionate influence of social media on people’s ideas, attitudes, and behaviors, particularly for impressionable youth,” Ivers says.

    5. Artificial intelligence in clinical settings Advancements in artificial intelligence (AI) technologies could improve the future of therapy sessions and mental health diagnoses. According to research published in December 2021, AI motion sensors can be used to detect symptoms of anxiety such as:

    • nail biting
    • knuckle cracking
    • hand tapping

    Additionally, research from October 2021Trusted Source suggests that AI can help train therapists by evaluating their skills, including whether or not they’re creating an optimal environment for their clients.

    Although the use of AI in mental health training and treatment could increase in the new year and beyond, experts say the technology is unlikely to replace traditional mental health services with human beings.

    6. Continued expansion in telehealth services Therapy administered via telemental health picked up steam in 2020, sustained in 2021, and is here to stay, according to experts.

    “Because of the COVID-19 pandemic, many mental health professionals now have the training, experience, confidence, and technology to conduct telemental health services effectively and ethically,” Ivers says. “It also has the potential to increase mental health treatment access to rural and older adult communities.”

    According to Boland, around 60% of mental health practitioners currently have full caseloads solely on telehealth.

    “Clients largely appear to enjoy the convenience — only a few clients have requested in-person,” Boland says. “Some mental health and business analysts project that telemental health could expand even more.”

    Virtual mental health services can be especially helpful for those who:

    • are immunocompromised
    • have transportation challenges
    • have physical disabilities

    7. Increase in transcranial magnetic stimulation Transcranial magnetic stimulation (TMS), a non-invasive method of brain stimulation, has been studied extensively in recent years and is being increasingly used to treat certain mental health conditions.

    The safety and efficacy have been so promising that the Food and Drug Administration (FDA)Trusted Source continues to approve innovative TMS technologies like NeuroStar and BrainsWay. TMS stimulates areas of the brain that are known to be underactive in individuals with mental health conditions such as:

    mood disorders (i.e., depression and bipolar disorder) attention deficit hyperactivity disorder (ADHD) obsessive-compulsive disorder (OCD) “If depression levels continue to increase, I suspect that TMS will be utilized more frequently in 2022, especially for individuals whose depression is not improving with traditional methods,” Ivers says.

    8. Virtual reality for chronic pain and care The FDA recently authorizedTrusted Source marketing for a virtual reality (VR) program for chronic pain reduction as an alternative to opioid prescriptions.

    VR treatments could be revolutionary, offering a different type of therapy for folks who wish to avoid pain medication to relieve their symptoms.

    “People are put into a virtual world where they conduct movements, learn about the nature of pain sensations in their body, and learn a number of behavioral and cognitive skills on how to effectively respond to pain and cope with the stress associated with it,” Boland says.

    “[VR] is meant to work along with medication, physical treatments, and behavioral clinician work,” he adds.

    As VR technology becomes more accessible, experts say we’ll see a continued expansion for treatments for different mental health and medical conditions.

    “As virtual worlds become more prevalent and useful and as the metaverse evolves, I believe that medical and mental health professionals will find ways to help clients through these technologies,” Ivers says.

    Looking ahead 2021 was an innovative year for scientific research in the mental health space — and we’re excited to see what 2022 has in store.

    From trauma-informed care to psychedelic research to artificial intelligence and virtual reality, there are many exciting developments to be on the lookout for, especially as we all become a little more comfortable talking about our mental health.



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    Crossroads Recovery Centre is group of private alcohol and drug rehab centres located in Gauteng in South Africa. Our 12 Step treatment facilities based in Pretoria and Johannesburg offer personalized recovery solutions for individuals suffering under the tremendous weight of their addictions. We offer expert, professional addiction treatment for substance abuse and physical addictions to food, sex and gambling.

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    Crossroads Recovery Centre is situated in the green belt of Boskruin in the north of Johannesburg, near to the beautiful Boschkop Nature Reserve. Offering a tranquil and picturesque environment, it is ideal for those in need of a safe space in which to heal, grow and recover. The residence is nestled peacefully in a lush, leafy garden setting that makes it easy to feel far from the hustle, bustle and worries of Joburg. This exclusion from the triggers and pressures of everyday life provides patients the ideal respite needed to begin their road to recovery. The privacy of the home ensures discretion and a restorative, secluded environment that is so crucial to the rehabilitation process. The double story villa can accommodate 19 patients in comfort with access to lovely recreational spaces and ample counselling and group areas to ensure all therapeutic activities are carried out in bright and functional quarters conducive to the recovery process.

    Accommodation includes 7 standard and 5 en-suite bedrooms. Recreational zones allow patients to enjoy their downtime on the patio, in the garden or outside gym area and of course the spacious dining room doubles up as a recreation space in which to unwind. Our staff is on call with facilities that include a nurse’s office and 2 counselling rooms.

    Security is important to us and the facility is surrounded by an electric fence linked to armed response, complete with an alarm system and panic buttons. It is also patrolled at night by a security guard with paramedic training.

    Find yourself. Find your way. Find us at 71 C.R. Swart Drive Boskruin.

    Call for free assessment: 0748951043


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    In Case of Anxiety: Male Anxiety - an opinion piece by Jon Patrick Hatcher 11 Oct 2021

    I’m not a “man’s man”: I don’t look or sound tough. My only gun is for caulking my shower. Plus I have anxiety, hereto named “manxiety.”

    My life is a dichotomy in that I’ve spent years in taekwondo, love football and rodeos, but have an affinity for frozen yogurt, and watching Netflix with merlot and soy vanilla candles next to my cats, Thelma and Louise.

    I attribute my temperament to genes and California hippie tap water.

    The origins of personal traits, including anxiety, can be genetic, environmental, or inadvertently “seed-planted” by parenting. Male anxiety, or manxiety, can be contagious if you’re around it long enough. I should know.

    My dad, a virile victim of indecisiveness, often had me second-guessing my own life choices, or not making one at all. To this day, I’m often paralyzed by an Applebee’s lunch menu or yellow traffic light.

    Men are stalwarts of resolve… until we’re not We recognize that our cars and lawnmowers need tune-ups and diagnostic tests, but we rarely wash our feet in the shower, let alone visit a physician for our own checkups — especially for anything regarding the brain.

    If you’re a man with anxiety, however, the norms become skewed and irrational.

    I grew up a hypochondriac. I visited the hospital countless times per year while my parents spent innumerable sums on deductibles and copays.

    What I thought was testicular cancer was an inguinal hernia from doing deadlifts. What I was certain was genital herpes was ingrown hair. What I feared was Lyme disease was an allergic reaction to grass. And what I accepted as a heart attack turned out to be… anxiety.

    Only twice did I not go to a hospital when I should have.

    The first was at 18 while having intense chest pains and labored breathing because I had unknowingly collapsed a lung. In my defense, I thought it was heartburn.

    The second was when I intermittently peed blood over a 10-month stint.

    The only thing worse than my fear of potential hospice was the anxiety of a pending appointment to put a camera up my urethra.

    Consequently, I settled on platinum-level denial until I landed in surgery and chemo. Ignorance is a prickly muse. With chronic male anxiety, it’s torturous to determine what warrants an ER visit versus antacids.

    And when it came to my mental health, I handled it like most men: denial, distraction, and drugs. In that order.

    Most men with anxiety don’t accept it as the reason for their angst Denial and distraction might be why so many men walk around with addiction. In the absence of knowing any healthier coping mechanisms to life’s stressors, or a willingness to seek help regarding anxiety, we plug the holes however we can.

    But if you treated any other disorder by ignoring or avoiding it, the outcome would be similarly grim. You can ignore asthma and diabetes for a while too. But every disorder has its dues.

    My first coping tactic for anxiety was denial, lest I appear weak and vulnerable among my peers.

    “While some may consider this a stereotype — that men do not seek help for mental health issues — it is statistically correct… men are much more stigmatized by any admission of a psychiatric illness and are much less likely to seek treatment,” says Dr. Sammie LaMont Moss, a psychiatrist with Kaiser Permanente in Denver, Colorado.

    This is particularly troublesome as depression and anxiety in men are more likelyTrusted Source to manifest in substance misuse and suicidal behavior.

    “We often see in the clinical setting that an attempt to address anxiety can manifest in different ways. For example, men will turn to substances like alcohol or cannabis for some immediate relief, which can cause long-term, harmful effects,” explains Moss.

    How anxiety presents in men

    I’m an exceptionally kind and empathetic guy, but anxiety makes me irritable and angry. If I’m forced to socially interact or deal with a rude stranger, I become a chupacabra with a flashpoint of Aqua Net. I try to determine when I’m feeling anxious before it defaults to a villainous persona.

    But distinguishing between anxiety and moodiness can be difficult.

    “Due to the social pressure that men experience based on the unwritten rule that men are to be strong and in control at all times, anxiety is not easily identifiable in men, even if that man’s anxiety has reached overwhelming levels” says San Diego psychologist and singer-songwriter Dr. Bruce Thiessen.

    “Many of the symptoms may express [physically] in the form of medical problems or conditions, such as ulcers, back pain, hypertension, and the like,” Thiessen says.

    Chicago-based clinical psychologist and founder of the LEAP Center for Anxiety, Dr. Dustin Siegel, agrees.

    “A lot of men have been told their whole lives to ‘man up’ or ‘be tough.’ It’s hard for many men to talk to someone else about their vulnerabilities, and one of the paradoxical truths about mental health is that the more a person — male or female — tries to bottle up their feelings, the more likely they are to develop a problem,” Siegel says.

    If I simply ignored my feelings of angst, I could pretend anxiety didn’t exist for me. And when denying anxiety exacerbated problems, I turned to distraction, which also avoids addressing the core issue.

    *How does chronic anxiety differ in men? *

    “The most obvious signs of male anxiety are the physical ones,” says Dr. Lindsay Israel, psychiatrist and chief medical officer at Success TMS.

    “Men might find themselves going to the emergency room or their primary care [doctor] with complaints of chest pain, fearful they’re having a heart attack,” she says.

    Israel goes on to say, “Men are more likely to develop severe symptoms of anxiety and possibly develop an additional depressive disorder due to the lack of treatment intervention.”

    Thiessen confirms this assertion.

    “Men are also more likely to become aggressive and to develop problems in their relationships due to dysfunctional ways of expressing their anxiety,” he adds. “Many men turn to drugs, alcohol, gambling, and personally destructive sexual addictions to relieve chronic stress through escape.”

    In my case, I wielded distraction-like artillery over my physical well-being. I overtrained in the gym, overran the trails, and overswam in the lap pool. But I also overimbibed alcohol.

    I would later harm-reduce to cannabis edibles, tinctures, and vapes. And on a few occasions, I casually overdid those too.

    So, what to do with all this ‘manxiety’? Men are historically hailed as fixers. It’s important to note that the acute stress that prompts us to do our taxes or flee a K-pop mob is healthy. Once anxiety becomes long-term or chronic, however, it can be detrimental to one’s physical and mental health.

    “One of the best ways for men to become comfortable with accepting that he has a mental health issue is to speak to other people,” Moss says.

    “Quite often a man will be surprised to learn how many other people are [being challenged by] similar difficulties. Finding out that you’re not alone can go a long way to help normalize what you’re experiencing,” Moss adds.

    Anxiety doesn’t always love company, but it needs perspective.

    Thiessen upholds this tenant.

    “Men need to feel accepted, and not judged, for showing both strength and [vulnerability]. Society might judge them, mental health [professionals] will not,” he says.

    In almost every instance when I’ve revealed my anxiety challenges to another man, he’s replied in commiseration with his own. It’s indicative of the ratio and cross-section of some men who silently endure anxiety.

    You don’t need a panic room; you need a panic plan

    There are simple and clinically effective things men can do to lower their anxiety:

    • Talk with your primary care physician Your doc could potentially prescribe medication or refer you to other specialists who can help.

    “This is also an area where group therapy, segregated by gender, may help — particularly for men who are stigmatized and think they’re being seen as weak or as a victim. Learning what other men experience can help break that stigma,” Moss says.

    • Download (and use) mental health apps Apps at the comfort of your palm are helpful for anything from interpreting your cat’s meows and fermenting mead in your man-shed to treating your anxiety while preserving your privacy.

    Moss encourages his patients to leverage smartphone apps like Calm, Headspace, and myStrength.

    • Therapeutic strategies Noninvasive approaches such as biofeedback and transcranial magnetic stimulation (TMS) are some effective anxiety treatment options.

    So are medications typically prescribed for anxiety.

    Many people leverage a combination of meds and clinical therapy.

    “Typically, it’s not any one modality that targets these symptoms for a person, it’s more often a combination of various modalities that gives the most optimal results,” Israel says.

    • Exercise “Exercise prevents an excessive buildup of (the hormone) cortisol in the body, while increasing levels of (chemical brain messengers) epinephrine and norepinephrine, neurotransmitters that modulate anxiety, and regulate mood and emotion, yielding a sense of peace of mind,” Thiessen explains.

    Moss suggests also integrating healthy lifestyle choices, nutritious eating, and limiting substances like alcohol and cannabis.

    More than just the “greatest hits” to contest manxiety, this is my own triage to maintaining a career, relationships, and a life largely unfettered by the cerebral minesweeper of anxiety.

    Because there’s no place like “om.”


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    How Social Media, Drugs, and the Changing Landscape of Sexuality Are Challenging Younger Generations’ Mental Health 17 Sep 2021

    In an era of expanding sexual norms, legalization of marijuana, and lives lived online, today’s teens and young adults are facing a new set of life questions and stressors compared to previous generations — all amidst a global pandemic. This is how they're dealing.

    When Simone Biles withdrew from the Tokyo Olympics gymnastics team finals in July, she catapulted a conversation into the mainstream that had been gaining steam like her run-ups to the vault: Even the most accomplished among us sometimes have to take a step back to take care of our mental health. And for people in the 24-year-old gold medalist’s age group who are living under pressures like no generation before, recognizing when you’re not okay and in need of support and self-care is more important than ever.

    “Today’s adolescents and young adults are growing up in an age of anxiety,” says Patrice Harris, MD, a psychiatrist and Everyday Health's medical editor in chief at large. "They're living in an age of active shooter drills at school, bullying, ‘fear of missing out,’ and success measured by the number of likes — along with pressure, often from peers — that comes with social media use. And when your peers are not just your classmates, but millions of people, as with Olympians, there's even greater pressure."

    Today’s adolescents and young adults are growing up in an age of anxiety. — Patrice Harris, MD

    Indeed while the pressures of being the gymnastics GOAT are largely in a category of their own (Biles told Hota Kotb on Today that the sexual abuse she and hundreds of others suffered under former USA Gymnastics team doctor Larry Nassar may have been a trigger during the Games), today’s teens and young adults ages 16 to 26 don’t have to be in the international spotlight to experience a new set of stressors beyond previous generations’ traditional expectations to succeed in sports, academics, performing arts, and careers.

    This group, ranging from the youngest millennials (starting at age 24) to Generation Z (up to age 24), is coming of age in an era of tumultuous sociopolitical issues — including constant pandemic uncertainty, gun violence, climate change, rapidly shifting social norms, and a reckoning with systemic racism and sexual assault — that are proven to take a toll on mental health, according to the American Psychological Association’s (APA) “Stress in America: Generation Z” report. As a result, symptoms of anxiety and depression in this generation are on the rise and have been reported by more than half of 18- to 29-year-olds, as reported in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report in April 2021.

    Particularly with the surge of symptoms in this demographic, it’s important that they get support as soon as they start to struggle. And with Biles and fellow superstar athletes like Naomi Osaka and Michael Phelps sharing their stories on the world stage, understanding of the issues grows. “It is important that we raise the level of awareness around mental health and increase our advocacy for equitable, accessible, available treatment opportunities,” Dr. Harris says. “I am hopeful that the awareness raised by Simone Biles, Naomi Osaka, and others will encourage people to seek help when they need it.”

    One of the biggest differences between this and past generations is the ubiquitousness of social media in our lives. While today’s social media culture can provide a source of connection, it can also magnify everyday pressures for young adults.

    “Youth are growing up under a microscope in a way that’s never happened before,” says Anne Marie Albano, PhD, a clinical psychologist and director of the Columbia University Clinic for Anxiety and Related Disorders in New York City who specializes in anxiety and mood disorders in children, adolescents, and young adults. “From birth, parents are sharing pictures and videos of their kids on Instagram, YouTube, you name it. Kids’ lives are now public.”

    The Pew Research Center reports that 48 percent of young adults ages 18 to 29 are online almost constantly, and a study published in Creative Education in July 2021 showed that gadget addiction among Gen Z can be a contributor to mental health issues. In addition, those who use social media often are more likely to be involved in cyber-bullying, which is linked to depression, self-harm, and suicidal thoughts, according to research published in 2019 by the APA in the Journal of Abnormal Psychology.

    RELATED: Could You Be Addicted to the Internet? https://www.everydayhealth.com/internet-addiction/guide/

    “There’s tremendous pressure on how kids appear to others on social media,” says Dr. Albano. “On one hand, they’ve got to be the coolest and get the most likes from their friends. At the same time, they have to balance not crossing a line for parents and other adults who are saying, ‘Colleges and future employers will see what you post on TikTok.’” This all adds up to a stressful and confusing picture to navigate for an age group that’s already grappling with other pressures such as exploring their identities.

    RELATED: 5 Tips for Kick-Starting a ‘Mindful Tech’ Self-Care Habit https://www.everydayhealth.com/wellness/5-tips-for-kick-starting-a-mindful-tech-self-care-habit/


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    Talking to children about their mental health - By SingleCare Team - Medically reviewed by Gerardo Sison, Pharm.D. 02 Jun 2021

    As a parent, there are many things you need to help your kids with—and helping children learn to talk about their feelings and emotions is one of them.

    Why is my child’s mental health important? Your child’s mental health is important because good mental health will help your child perform better in school, develop strong relationships, and grow into high-functioning adults. The skills children learn to manage their feelings as kids and teenagers will carry with them through their entire life.

    What are some examples of mental illness in children? Examples of mental illness in children include anxiety, depression, oppositional defiant disorder (ODD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD).

    It can be helpful to think of mental disorders in two categories: internalizing disorders and externalizing disorders.

    Internalizing disorders primarily concern thoughts and feelings. Children experiencing internalizing disorders, like anxiety or depression, do not always show obvious symptoms that they are in trouble.

    Externalizing disorders express themselves in specific behaviors. For example, children diagnosed with oppositional defiant disorder will become angry, refuse to listen to adult instructions, or act out toward others more often than other children their age. ADHD is another example of a disorder with clear, externalized symptoms.

    talking to children about their mental health

    What causes mental health issues in children? Among children ages 6 to 17, approximately 1 in 6 will experience at least one mental health disorder. There is no way to predict whether a child will experience mental illness, and no magic formula for preventing it. But experts agree that children who experience certain situations or events are more likely to develop mental problems. These situations or events are called risk factors.

    Individual risk factors These risk factors are normal parts of adolescence but when combined with additional risk factors (or when extreme) may lead to mental disorders.

    Examples of individual risk factors include:

    • Low self-esteem
    • Anxiety
    • Poor concentration
    • Poor social skills
    • Insecure attachment
    • Early puberty
    • Family risk factors
    • Family risk factors generally relate to the mental and emotional health of a child’s parents.

    Examples of family risk factors include:

    • Parental depression
    • Parent-child conflict
    • Poor parenting
    • Negative family environment (may include substance abuse in parents)
    • Child abuse/maltreatment

    If any of these risk factors apply to you or your caregiving partner, help is available.

    School, neighborhood, and community risk factors Events and situations outside of the home can trigger mental illness. Again, these factors aren’t uncommon and can be simply a part of growing up, but in some children, they are among the causes of mental health challenges.

    Examples of social, neighborhood, and community risk factors include:

    • Peer rejection
    • Poor academic achievement
    • Poverty
    • Violence or stressful events in the community
    • Violence or stressful events at school

    If you are concerned about your child’s learning environment, speak to their teacher, counselor, or a school administrator.

    When should I worry about my child’s mental health? Children’s mental health is as important as their physical health. Stay vigilant about both.

    If your children are having mood swings, or changes in behavior that last more than a few weeks and that affect their ability to function, talk to your children’s healthcare provider.

    How do I know if my child has mental health issues?

    Common warning signs of mental health issues in children include:

    • Changes in school performance
    • Excessive worry or anxiety, for instance fighting to avoid bed or school
    • Hyperactive behavior
    • Frequent nightmares
    • Frequent disobedience or aggression
    • Frequent temper tantrums
    • Self-harm
    • Outbursts or extreme irritability
    • Weight loss or gain
    • Frequent stomach aches or headaches None of these issues are necessarily related to mental illness, so before you jump to any conclusion, have your child see a health professional.

    How can I improve my child’s mental health? Experts say that an important element of positive mental health is a healthy lifestyle. That includes:

    • Eating healthy, including plenty of fruits, vegetables, and lean proteins
    • Getting exercise—at least 60 minutes a day
    • Getting enough sleep—at least nine hours for kids 6 to 12, and at least eight hours for kids 13 and older
    • Practicing meditation, mindfulness, or relaxation techniques
    • Talking to your children about their mental health is important, too.

    How should I talk to my child about their mental health? Like anything you do in life, talking about your feelings and emotions gets easier with practice. Don’t think of “talking about mental health” as an emergency measure. Make it part of your daily routine.

    This effort starts with you. Be open about your own feelings with your children. If you are feeling sad or angry, explain to your child what’s making you feel the way you do. This way, children see that it’s okay to share negative emotions. If you hold all your feelings inside, your child will do the same. That’s not healthy for either of you.

    Every day, ask at least one question about your children’s feelings, emotions, relationships, and other factors that play a role in their mental health. Don’t force them to tell you, just give them the chance to share. And pay attention to sudden changes in what they say, or how much they say. Drastic changes could be a warning sign that something is wrong.

    Talking points for mental health issues Ask direct questions that invite your child to provide answers.

    • Concern: Depression, frequent crying, seeming unusually down
    • Question: “Have you been feeling sad lately?”

    • Concern: Bullying, irritability, lack of friends

    • Question: “Is anyone at school mean to you?”

    • Concern: Anxiety, violence at school or in the community

    • Question: “Do you ever feel afraid?”

    • Concern: School performance

    • Question: “What are your favourite classes? Are there any you don’t like?”

    • Concern: Frequent nightmares

    • Question: “Do you notice familiar places or people in your scary dreams?”

    • Concern: Frequent temper tantrums

    • Question: “Do you know why [EVENT] made you so angry?”

    Here are some additional tips for talking to your children about mental health, especially if you have specific concerns.

    Be age appropriate You can help children open up about their emotions by explaining and giving them communication tools that are right for them.

    Preschool children are more likely to focus on what they can see. If they see you or a stranger getting angry, they’ll notice and may want to understand why. Similarly, showing an emoji or drawing may give them a way to share with you how they are feeling—rather than making them try to think up the correct word.

    School-age children are trying to understand the world around them, and they ask a lot of questions. It is also common for school-age children to have fears about the safety of family and friends. Don’t dismiss their questions or concerns. Treat them seriously.

    Teenagers are independent, and are more likely to seek out information on the Internet or from conversation with their friends, than to ask their parents. This is natural, but with something as important as mental health, there’s danger if they get the wrong information. It’s critical that you keep tabs on their feelings and emotions, so you can get them the right information at the right time.

    Be honest about your own mental health Whether or not you have a diagnosed mental illness, everyone deals with feelings of anxiety, sadness, and confusion.

    What you do to combat those feelings—whether it’s taking prescribed medication, jogging every morning, or doing 15 minutes meditation at bedtime—are actions your child surely knows about. Share the importance of maintaining mental health with your children, the same way you share the importance of brushing their teeth every day.

    Make sure your child feels safe and comfortable If you are sensing warning signs from your children, or feel that you need to have a deeper conversation, make sure you have them at ease. Don’t surprise them or spring the conversation on them at an unexpected time (which will be easier if you have made a point to talk about mental health every day, not only when problems arise).

    If your children react badly to what you have to say, then it’s time to back up the conversation rather than pushing them and making them feel uncomfortable. Explain why you are asking these questions, and why it’s important to talk.

    Listen; don’t diagnose or treat At first, listen. Avoid the urge to label what your children are feeling, or to advance an opinion about what they should do. This could make them less likely to share in the future. And try not to react too strongly to what they say.

    The most important thing you can do is get a full understanding of how your child is feeling. Then determine what the best next steps are, perhaps in consultation with your child’s healthcare provider.

    If you feel your child needs to talk to a professional right away, or may need to in the future, give them information about the suicide/mental health Lifeline.

    Creating a circle of mental health Given that suicide is the second-leading cause of death for children, adolescents, and young adults, it’s normal for a parent to worry about their child’s mental health. In fact, anxiety about your child’s mental health could end up affecting your mental health. Opening up with your child, and giving them a space to share their feelings every day, will ultimately be good for both of you. And it doesn’t have to stop when they turn 18; you can help support each other for the rest of your lives.


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    Teenage Depression Facts: All You Need to Know - Psych Central 27 May 2021

    Your teen years are full of significant changes. Physically, mentally, and socially — your brain, body, and environment are going through a major evolution.

    You might feel bogged down from the demands of high school and college assignments piling up. Or you may feel sadness about transitioning to a more independent and unfamiliar life. Throw in a worldwide pandemic, and it’s no surprise that uneasy feelings are on the rise, as shown by recent teen depression statistics and research.

    These changes can easily become overwhelming. Understandably, you might shut down, become irritable, or lose interest in the activities that previously made you light up.

    While these responses are valid and usual, depression is a condition that’s much more serious than fleeting teen moodiness.

    If negative emotions are keeping keep you from functioning like you usually do, or you’ve experienced a sense of hopelessness for more than 2 weeks, you might want to consider treatment for depression.

    8 facts about teen depression

    1. It’s more common than you might think Everyone goes through a rough patch or feels listless on occasion. But major depression is a leading cause of disability in the United States, and teens are becoming the most likely group to screen for symptoms of this mental health condition.

    Data shows that depression affects high numbers of young people:

    Data from the 2016 National Survey of Children’s Health showed that 3.2% of children ages 3 to 17 had a depression diagnosis. The frequency of depression diagnosis tends to increase as children enter their teen years. Around 3.2 million teens ages 12 to 17 had one major depressive episode in 2017. According to a 2021 Mental Health America (MHA) report, severe major depression has increased in youth to 9.7%. This is an increase from 9.2% in 2020. The 2021 MHA report also states that youth ages 11 to 17 were the most likely age group to score in the moderate-to-severe depression categories when screened for mental health conditions.

    The symptoms of depression might be a bit different in teens and adults. You can read about the symptoms of depression in teens here.

    2. Depression rates are higher in females and gender minority teens While depression can affect teens of any sex and gender identity, a study published by the JAMA NetworkTrusted Source found that by 15 years old, females were twice as likely to have experienced episodic depression than males.

    When comparing male and female depression rates, depression continues to present at a higher rate in females than males from the teen years into adulthood.

    Also, according to the National Institute of Mental Health, risk factors leading to depression are highest among adolescents and young adults who identify with a gender minority, such as transgender, genderqueer, and nonbinary.

    3. Teens with two or more racial or ethnic identities report the highest rates of depression Your teen years are often called the “coming-of-age” era for a reason. You’re discovering, questioning, and deciding many aspects of your identity, including what your cultural, racial, and ethnic identity means in your life.

    This, coupled with societal pressures and prejudices, can reasonably leave you feeling stressed and emotionally shaken up.

    Teens ages 12 to 17 years old with more than one racial identity are the most at-risk racial or ethnic group to report a major depressive episode, according to data published by Substance Abuse and Mental Health Services in 2017.

    4. LGBTQ+ teens are at greater risk for depression Recent research shows that sexual identity can impact rates of depression among teens. The Centers for Disease Control and Prevention (CDC)Trusted Source reports that lesbian, gay, and bisexual youth are at a higher risk for depression, suicide, and substance use.

    But factors like supportive parents and an accepting atmosphere at school can also decrease the risk of depression in LGBTQ+ adolescents.

    5. Most teens with depression are not receiving treatment Depression is not a weakness, and you should never feel ashamed of a depression diagnosis. While major depression is a widespread mental health condition, it still requires attention and professional treatment.

    You may be tempted to ignore your negative feelings and symptoms associated with depression, but a consistent treatment plan is vital for depression management.

    Left untreated, depression has a higher chance of recurring throughout your lifetime.

    According to the MHA, the majority of adolescents with depression — 60% — did not receive treatment for their major depression from 2017 to 2018. Further, more than two-thirds of adolescents diagnosed with depression did not continue with consistent treatment.

    6. COVID has increased depression and uncertainty in teens As if the normal stressors and changes happening during your teen years weren’t enough, for many, the pandemic has upended any remaining sense of normalcy and routine as well.

    Quarantine, loss of social interactions, illness, fear of illness, the loss of loved ones, and financial distress are only some of the compounding and life-altering stressors that teens have faced since March 2020.

    These changes have had a lasting physical and psychological impact on U.S. society. According to teen depression statistics in the Stress in America 2020 survey, Generation Z teens and young adults ages 13 to 23 years old have reported increased uncertainty and depression symptoms.

    For all ages, loneliness and isolation trended as the top reason for uncertainty and mental health conditions during the pandemic.

    7. There’s no single cause of depression Depression often brings deeply negative or apathetic feelings, but it’s important to remember that these emotions do not reflect any character flaws.

    In fact, depression often stems from events outside of your control, such as:

    • early childhood trauma
    • genetics
    • a major life crisis
    • Depression can also accompany or become exacerbated by existing medical conditions.

    These include:

    • poor sleep
    • chronic pain
    • anxiety
    • attention deficit hyperactivity disorder
    • substance use disorder Of course, depression can also develop without a specific triggering event or preexisting condition, just as it can result from numerous sources. Exploring the causes of your depression with a professional can help you determine the most effective treatment plan.

    8. There are many types of depression If you feel depressed, it does not automatically mean you have a depressive disorder. Depression may be a symptom of another physical or psychological medical condition.

    Depression could also be a natural response to a major stressor and does not indicate that you’ll need to prepare to live with recurring depression.

    Some types of depression include:

    • major depressive disorder (MDD)
    • seasonal depression
    • peripartum depression
    • postpartum depression
    • persistent depressive disorder
    • premenstrual dysphoric disorder No matter what form your depression takes, it’s important to work with a medical professional to identify the type of depression you are experiencing and, ultimately, develop a treatment plan tailored to your needs.

    Treatment for depression When you’re already managing the challenging emotions associated with depression, acknowledging the condition and opening up to someone can feel difficult. But overcoming this hurdle is the first task to getting proper treatment.

    Let a parent or guardian know about the depression symptoms you’ve been experiencing so you can ultimately get an appointment with a medical professional.

    A doctor can talk with you about medical conditions that mimic depressive symptoms or refer you to a psychologist, psychiatrist, counselor, or therapist to help with a depressive disorder.

    Treatment for depression might include psychotherapy, medications, or a combination of the two, depending on what works best for you.

    Want to know more? You can read all about treatments for depression here.

    Next steps If you’re having trouble finding the right words to communicate your symptoms, try taking a screening tool, such as this one on the Mental Health America website, or contact SADAG.

    A screening tool will help you personally evaluate the severity of your symptoms and provide the terminology to describe your symptoms to a parent or medical professional.

    Remember, depression is extremely common and becoming more widespread as the pandemic shakes up our society’s usual structure. But you don’t have to live with depression symptoms without support. Reaching out to an adult for assistance with depression during your teen years can reap a lifetime of benefit.

    Medically reviewed by Nicole Washington, DO, MPH — Written by Madelyn Brown on May 9, 2021


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    What Are the Signs and Symptoms of Substance Use Disorder? 15 Apr 2021

    Symptoms of substance use disorder vary widely from person to person and may include physical, psychological, or behavioral signs.

    _ If you feel as if you or someone close is frequently using a substance like alcohol, tobacco, or opioids in a way that affects you or others negatively, you may be worried that you (or they) have developed a substance use disorder (SUD). _

    SUD is a complex and challenging condition that affects nearly 21 million people in the United States. That’s more than the number of people with any cancer combined.

    While misconceptions surrounding substance use may lead you to believe that the condition is caused by a person’s behavior or lack of willpower, it’s important to keep in mind that that’s untrue. Biological factors beyond a person’s control play a major role.

    Activation of the brain’s reward center is the primary reason for most addictions. Whether the SUD is due to alcohol, stimulants, or opioids, the rewarding feeling gained from use — involving an abnormally high dopamine release — is often overpowering.

    Continued use of the substance may lead to changes in the brain’s structure and function. This can result in intense cravings, withdrawal symptoms, learning and memory problems, and personality changes.

    Learning to recognize the signs and symptoms of substance use disorder can be the first step toward seeking help and receiving treatment.

    Types of substance use disorder Substances for which an individual can form a substance use disorder include:

    • alcohol
    • cannabis
    • hallucinogens, including LSD and phencyclidine
    • inhalants
    • opioids, such as heroin or prescription medications
    • sedatives, hypnotics (sleep-inducing medications), or anxiolytics (anti-anxiety medications)
    • stimulants like amphetamines or cocaine
    • tobacco

    Dependence on two or more substances is common. For example, evidence suggests that among people with heroin use disorder: over 66% are also dependent on nicotine nearly 25% have alcohol use disorder over 20% have cocaine use disorder

    Similarly, among those with cocaine use disorder: nearly 60% have alcohol use disorder about 48% are dependent on nicotine over 21% have cannabis use disorder

    Signs and symptoms of substance use disorder Signs and symptoms of substance use vary widely from person to person and depend on the substance, length and severity of use, and an individual’s personality. Below are some of the general symptoms of substance use.

    Physical signs of substance use disorder - sudden weight loss or gain - pupils that are smaller or larger than usual - bloodshot eyes - changes in appetite and sleeping patterns - slurred speech - impaired coordination or tremors - deterioration of physical appearance or changes in grooming practices - runny nose - unusual odors on breath, body, or clothes

    Psychological signs of substance use disorder - feeling paranoid, anxious, or fearful - unexplained change in personality - feeling “spaced out” - lack of motivation - feeling excessively tired - periods of excessive energy, mental instability, or restlessness - sudden changes in mood - increased agitation or anger - Behavioral signs of substance use disorder - beginning to act in a secretive or suspicious way - experiencing problems in relationships due to the condition - using more than originally intended (being unable to control the substance use) - neglecting family and friendships, as well as duties at home, school, or work - getting into legal trouble, including driving under the influence, fights, or accidents - suddenly changing hobbies, friends, or activities - using the substance under conditions that may not be safe, such as sex without a condom or other barrier method, driving under the influence, or using syringes that are not sterile - experiencing sudden unexplained financial problems, which may include frequently asking for money or stealing - frequently trying to avoid or relieve withdrawal symptoms - experiencing increased tolerance for the substance, which may cause the person to use more and more of it noticing that life revolves around substance use and recovering from use, e.g., always thinking about using or consumed with how to get more - no longer engaging in previously enjoyed activities due to substance use - continuing to use despite negative health consequences

    How is substance use disorder diagnosed? To assess a person’s risk for SUD, a healthcare professional may begin with a short screening. This may then be followed by a comprehensive evaluation and a referral to a licensed alcohol and drug counselor, psychologist, or psychiatrist.

    One commonly used short screening for substance use is the UNCOPE questionnaire.

    Although it was originally developed based on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-4), research shows that it may also help identify SUD based on the fifth edition (DSM-5).

    The UNCOPE screening asks the following questions:

    • Have you continued to use alcohol or drugs longer than you originally planned?
    • Have you ever neglected some of your usual responsibilities because of your substance use?
    • Have you ever wanted to cut back or quit using the substance but could not?
    • Has a loved one or anyone else ever told you they objected to your alcohol or drug use?
    • Have you ever found yourself preoccupied with the thought of using alcohol or drugs?
    • Have you ever used alcohol or drugs to soothe emotional pain, such as sadness, anger, or boredom?

    For a more comprehensive evaluation and to diagnose substance use disorder, most clinicians rely on the following 11 criteria published in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

    • feeling as if you have to consume the substance regularly (daily or several times a day) and more than originally planned
    • spending a large portion of your time finding, using, and/or recovering from the substance
    • craving the substance
    • needing more of the substance to get the same effect
    • experiencing withdrawal when you stop taking the substance
    • being unable to meet obligations at home, work, or school because of using the substance
    • recurring thoughts of quitting but not managing to quit successfully
    • continuing to use despite the problems it causes in relationships
    • continuing to use despite mental or physical health problems caused or worsened by it
    • giving up or cutting back on social or recreational activities due to the substance use
    • using the substance under situations that may be unsafe, such as driving under the influence or using syringes that are not sterile
    • A substance use disorder can be considered mild, moderate, or severe based on the number of symptoms a person exhibits within a 12-month period.

    According to the DSM-5, a person must have the following number of symptoms outlined above to be diagnosed with mild, moderate, or severe SUD:

    • Mild: 2–3 symptoms
    • Moderate: 4–5 symptoms
    • Severe: 6 or more symptoms

    Dual diagnosis Diagnosis is also more complex for people with both a substance use disorder and a mental health condition — known as a dual diagnosis. That’s because it’s often difficult to disentangle overlapping symptoms, such as withdrawal and mental illness symptoms.

    In 2019, 9.5 million adults in the United States lived with both mental illness and a substance use disorder, according to the National Survey on Drug Use and Health.

    People with a dual diagnosis often have symptoms that are more severe, persistent, and resistant to treatment than those with an SUD alone.

    Next steps Signs and symptoms of substance use disorder vary from person to person. The most noticeable signs include:

    • disinterest in school, work, or other activities
    • physical health issues like bloodshot eyes, lack of energy, or weight loss or gain
    • lack of interest in grooming or keeping clean
    • behavioral changes like acting in a secretive manner, increased irritability or changes in mood, or being fearful or - - paranoid
    • financial problems Recognizing these signs and symptoms may be the first step toward recovery.

    _ If you suspect that you or someone you love has a substance use disorder, consider reaching out to a trusted healthcare professional for an evaluation. Together, you can develop the right treatment plan for you._

    If you’re not quite ready to see a healthcare professional yet or you’re looking for more information, maybe check out the organizations below, which offer additional resources and support groups:

    SADAG - https://www.sadag.org www.findHelp.co.za The Substance Abuse and Mental Health Services and Administration’s (SAMHSA) national helpline is a free and confidential 24-hour referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders. Alcoholics Anonymous and Narcotics Anonymous are well-known 12-step groups for individuals recovering from alcohol or drug addiction.


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    Brave conversations need to happen — but we need to think bigger if we want to end stigma for good.

    I remember the first time I expressed a desire to go to therapy. I was 17 years old, unknowingly struggling with obsessive-compulsive disorder (OCD).

    The anxiety I was living with tormented me, but I was still terrified to ask for help.

    When I finally found the courage to tell my parents I needed support, their response was less than stellar. “That’s family business,” they said, aghast.

    The shame was written all over their faces. They rejected the idea that their son might need professional help — and I quickly internalized that shame, too.

    It would take another year, tormented by my condition, before I would finally get the help I so badly needed.

    Why are mental health issues so stigmatized? Stories like mine are far from unique.

    More than half of Americans with a mental health condition still remain untreated, impacted by a deep societal stigma that leaves us reluctant to reach out.

    The impact on those already struggling is undeniable.

    According to the American Psychiatric Association (APA), stigma results in reduced hope, lower self-esteem, increased symptoms, difficulties at work, and a lower likelihood of maintaining your treatment plan.

    So where does this stigma come from? Attitudes around mental illness are still reinforced in our culture and media.

    People with mental illnesses — especially those with less understood conditions, like bipolar disorder and schizophrenia — are still widely believed to be dangerous, untrustworthy, and incompetent, despite experience and evidence showing this is rarely the case.

    In fact, people with schizophrenia are more likely to be the victim of violence, rather than the perpetrator.

    Still, being labeled “crazy” by what feels like much of society can feel like a shameful burden that few are willing to take on.

    Even the jokes we make — like calling ourselves “so OCD” when we wash our hands or “bipolar” when our moods shift — lead to others taking these disorders less seriously.

    This stigma is intensified further for historically marginalized groups — like people of color, women, and LGBTQIA+ people — who have traditionally been depicted as “crazy” or “unstable” due to prejudice, increasing their mistrust of the mental health system.

    This is a system that frequently misdiagnoses vulnerable communities because of these same prejudices.

    The consequences of stigma are far-reaching, too. Research has shownTrusted Source that discrimination in the workplace, housing, healthcare, and more can be connected to mental health stigma.

    How do we reduce stigma? There’s a far-reaching assumption that simply talking about mental health is enough to reduce stigma. However, recent researchTrusted Source suggests that the effectiveness of these campaigns is actually very limited — more must be done.

    To truly break down stigma, it has to be addressed at multiple levels:

    Systemic change. Discrimination is still an everyday reality for those with disabilities, including psychiatric disabilities. There’s a high correlation between stigma and structural inequality. To truly address stigma, the rights and dignity of people with disabilities have to be meaningfully addressed in education, housing, the workplace, and healthcare, including increased access to treatment. Research and funding. To better understand mental health and illness, more research is needed to increase our knowledge about these conditions and to improve the effectiveness of our interventions, as well as funding to make treatment more accessible.

    Media interventions. Media, including television and film, can be a huge accelerant of stigma. Media must be challenged to handle topics of mental health and illness more responsibly to reduce stigma. Mental health literacy. Simply being “aware” of mental health isn’t enough to address stigma. People must be empowered to take command over their own mental health, like knowing where to access help and how to advocate for themselves.

    Increased awareness. For many people, there’s still mystery about what mental healthcare really is or looks like. By becoming more active and visible in their communities, healthcare practitioners can reduce a possible fear of the unknown. For communities with a history of mistrust in the healthcare system, seeing a healthcare professional who looks like them and is from the same community can be beneficial. While talking about mental health is a great starting place, more will be needed to truly better the lives of those with mental health conditions.

    Common myths about mental health conditions While stigma won’t change overnight, it’s still true that change begins with us. This starts by addressing our own attitudes about mental health.

    Below are some common myths that still exist today:

    Mental illness is just an excuse for poor behavior Mental illnesses aren’t chosen — and they certainly aren’t an excuse for someone’s behavior.

    They’re complex conditions that result from biological, genetic, and environmental factors.

    Only a certain kind of person ends up with a mental illness Mental health conditions touch every single community.

    Chances are, you already know someone who lives with a mental health condition. Mental illness doesn’t affect a certain kind of person — it can affect anyone.

    You could snap out of it if you tried hard enough If we could snap out of it, most of us would, gladly. These conditions are much more complicated than that, though.

    Most people with a mental health condition will benefit immensely from some combination of therapy, medication, and community support. This is why it’s crucial that we support people seeking the help they need.

    Mental illness is a private issue that shouldn’t be talked about Everyone will have a different relationship to their health journey. Some will choose to keep their mental health issues private; others will find it empowering to share their story.

    There’s no right or wrong way to talk about your mental health.

    Mental illness can be completely cured While many people will see improvements in their mental health, and some may make a full recovery, most mental health conditions can’t actually be cured. They’re chronic conditions to be managed with the right support.

    What’s next? Since my teen years, I’ve had the privilege of accessing therapy and medication for my OCD. It’s made an enormous difference — as it has for many people living with mental health conditions.

    While stigma won’t change overnight, that change begins with brave conversations.

    More than just talking about mental health, we need to examine what changes have to happen to make mental health accessible to all.

    As I approach my 30th birthday, I’m immensely grateful that so many people are opening their hearts and minds to these conversations.

    Far from being “family business” or a personal issue, mental health is our collective business and responsibility. Each and every person deserves mental health. And we deserve to live in a world where people with mental health conditions feel safe, supported, and affirmed.


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    What Is a Personality Disorder? - Psych Central 10 Mar 2021

    You are unique. And this, no doubt, is mostly to your merit — but it’s also a result of where you’ve been, what you’ve experienced, and who you’ve experienced it with.

    This unique character — which comes from a combination of external factors, behaviors, thoughts, and emotions — makes up your personality. It embraces how you, as an individual, see and relate to yourself and others.

    Sometimes, some of these behaviors, thoughts, and emotions can cause you a great deal of distress that negatively impacts the way you function in the world. When this happens for a long time — and repeatedly — mental health professionals call it a personality disorder.

    What are personality disorders? Your personality helps you function in life, with all the challenges that might usually come up. This means that even if you go through painful or stressful situations, you’ll have a strong chance to overcome them and move on.

    How you cope with hardship may be different from how somebody else does. We all have our own ways of getting through, and that depends greatly on our dominant personality traits.

    For example, you may be, among other things, patient, resilient, and persistent. These personality traits may help you overcome losing a job and become motivated to find a new and better one.

    They’ll help you bounce back from your initial feelings of disappointment and devote time to finding another position. Even if you know it might not happen overnight, you stay motivated.

    You may also reflect on the circumstances that led you here, assume responsibility (if any), and take note of the lessons learned.

    If you have a personality disorder, though, this isn’t the case.

    With a personality disorder, you typically experience emotions and thoughts that diminish your ability to:

    -face and adapt to stress

    -connect and bond with other people

    -effectively solve problems

    For example, if you have a personality disorder, your reaction to losing a job might be blaming your co-workers for the dismissal and getting into a fight with your boss. You might not realize how some of your behaviors might have led you to face these difficulties.

    Now, it’s true that people who aren’t living with a personality disorder could have this same reaction. We all may feel angry, emotional, and paranoid at times.

    But if you cope with stress in a similar way every time, and these traits are causing ongoing problems in your life, a mental health professional may reach the diagnosis of a personality disorder.

    In other words, most people might recognize in themselves a few traits from a personality disorder.

    But to actually receive the diagnosis, you would have to show all or almost all of the traits that characterize that disorder. Also, these traits would cause you a great deal of distress and problems in your life.

    Not all personality disorders have the same symptoms and dominant traits. Something they all have in common, though, is that people with the disorder experience difficulties responding to the demands of life.

    These difficulties affect:


    -work performance

    -views of the world

    -inner experiences

    This isn’t a personal choice. Personality disorders are the result of many factors that have influenced your life, including:

    -genetic inheritance

    -biological processes

    -learning development

    -cultural experiences

    -traumatic situations

    -childhood relationships

    There’s no one cause for personality disorders. And it’s not clear why not everyone reacts the same way to the same external and internal factors.

    This is why experts believe the cause might be a specific combination of all of the above.

    How are personality disorders diagnosed? Personality disorders are mental health conditions. That means only a trained mental health professional can make a proper diagnosis.

    To do this, they’ll follow established guidelines for mental health.

    The guidelines to diagnose a personality disorder typically come from the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. This handbook contains definitions, symptoms, and diagnostic criteria for most mental health conditions.

    To make a diagnosis, a mental health professional will want to learn about your personal and medical history and assess your thoughts, emotions, and behaviors. Then, they will compare these observations to the criteria established by the latest edition of the DSM — currently the fifth edition (DSM-5).

    Specifically, the five criteria that must be met to make a personality disorder diagnosis are:

    1. Impairments These are difficulties you experience in how you see and relate to yourself (identity and self-esteem) and how you connect to other people (intimacy).

    In other words, this refers to recurrent thoughts, emotions, and behaviors that might be hurtful to yourself and others.

    2. Pathological personality traits To make a diagnosis, a mental health professional will look for a long-standing pattern of pathological traits.

    These are traits that once and again make it difficult for you to interact with others or adapt to change. Or they may be traits that are not expected or accepted in your culture.

    3. Duration and flexibility To be considered a personality disorder, these impairments and pathological personality traits must be stable, inflexible, and consistent throughout your life.

    In other words, you’ve experienced these difficulties and responses for a long time and repeatedly across different situations.

    4. Independent of culture or developmental stage This means that the specific behaviors and thoughts your therapist is looking at can’t be explained by your cultural customs or by the capabilities and needs of your age.

    For example, an impulsivity trait in an adolescent is almost expected in some circumstances. But if you’re in your 40s, this same impulsivity might be assessed differently.

    5. Not related to external factors A mental health professional will want to make sure that these behaviors, emotions, and thoughts aren’t a result of a substance you may be taking or a general medical condition or injury you’ve sustained.

    In sum, if these five requirements are met, a mental health professional will move to diagnose you with a personality disorder.

    Since there are 10 of them, that diagnosis will not be the same for everyone. It’ll depend on the specific impairments and personality traits that may be impacting your life the most.

    Types of personality disorders The 10 personality disorders are classified into three groups, or clusters. These are based on the most representative emotional responses and behaviors:

    -Cluster A: odd and eccentric

    -Cluster B: dramatic, emotional, and erratic

    -Cluster C: fearful and anxious

    This is just an overview of all the types of personality disorders. Much more that goes into making a diagnosis than just observing a few behaviors.

    Cluster A personality disorders Those with cluster A personality disorders have difficulty relating to other people and often behave in a way that others might consider odd or eccentric.

    Paranoid personality disorder People diagnosed with paranoid personality disorder usually interpret other people’s behaviors as menacing or judgmental, even when this is not the case.

    If you have this personality disorder, you’ll tend to perceive others around you as being deceitful, patronizing, or mean toward you. This might make you feel untrusting and angry all the time, leading you to have destructive outbursts and avoid developing close relationships.

    Others may also perceive you as emotionally detached.

    Schizotypal personality disorder A schizotypal personality disorder may lead you to feel very anxious in social situations and uncomfortable and awkward in close relationships. It may also be that you have an eccentric way of dressing and speaking, and others find you very peculiar.

    People with this personality disorder may also have:

    -paranoid ideas

    -odd beliefs

    -distorted thinking

    For example, you may feel you can read other people’s minds, see into the future, or have close relationships with beings from another planet.

    You may also dislike talking with other people and often talk to yourself.

    Schizoid personality disorder Those diagnosed with schizoid personality disorder are usually shy, withdrawn, distant, and not socially responsive. They’re also usually very disinterested in others.

    If you’ve been diagnosed with this personality disorder, you may find yourself absorbed in daydreaming and fantasizing a lot. These fantasies might be more interesting to you than what’s actually happening around you.

    You may also actively withdraw from and lack interest in intimacy with other people, including close relatives. This might lead others to describe you as cold and detached.

    Cluster B personality disorders Cluster B personality disorders usually evidence difficulty in controlling your own emotions and a tendency to act unpredictably.

    Narcissistic personality disorder The most typical symptoms of narcissistic personality disorder (NPD) are:

    -an inflated sense of self-importance

    -a constant need for attention and praise

    -a lack of empathy toward others

    With NPD, you may feel superior to everyone else and often fantasize about unlimited beauty, power, money, and success. To earn these, you may feel it’s necessary to get other people out of the way by any means, without acknowledging their needs or feelings.

    You might also be extremely sensitive to criticism and failure and experience intense variations in your mood.

    Antisocial personality disorder Mental health professionals diagnose someone with antisocial personality disorder when there’s a persistent display of impulsive, reckless, and aggressive behaviors and no remorse about them.

    These recurrent actions might come from:

    -not realizing how your actions affect other people

    -blaming others for what happens in your life

    -constantly feeling overwhelmed and frustrated

    -You may have a history of violent relationships, legal challenges, and even substance abuse if you have this personality disorder.

    Borderline personality disorder You may experience constant and intense fluctuations in your mood if you have a borderline personality disorder (BPD). These changes in how you feel may also impact the way you think and feel about yourself.

    You may also tend to think of others in black-and-white terms. You might think someone is perfect today, then not want to associate with them at all tomorrow.

    This tendency to constantly feel disappointed in people might also lead you to experience feelings of emptiness and despair.

    If you’ve developed BPD, you may also hate being alone and fear abandonment — which could lead you to use manipulation tactics such as self-mutilation, silent treatment, or suicidal warnings.

    The term “borderline” is considered controversial because it has been misused to judge or discriminate against groups of people. We refer to this term here as a clinical diagnosis established by the DSM-5 and not as a judgment.

    Histrionic personality disorder Someone with histrionic personality disorder (HPD) feels they need to be the center of attention in all situations. This may lead to overdramatic behaviors that others might perceive as odd and inappropriate.

    If you live with HPD, you may feel anxious and frustrated if others ignore you or give more attention to someone else over you. You may also place a lot of importance on your physical appearance and modify it in a way that you feel will call more attention to you.

    Cluster C personality disorders People with cluster C personality disorders usually live with strong feelings of anxiety, doubt, and fear.

    Obsessive-compulsive personality disorder Obsessive-compulsive personality disorder is not the same as pbsessive-compulsive disorder (OCD). Someone with the personality disorder is likely not aware of their behavior, while someone with OCD realizes their obsessions and compulsions aren’t rational.

    If you live with an obsessive-compulsive personality disorder, you may strive for perfection in all aspects of your life. To accomplish that, you might find yourself taking on way more than you can deal with, and you might feel no achievement is ever enough.

    Other people might regard you as very reliable, tidy, and dependable, but also inflexible, stubborn, and strict. This may be because you usually have a hard time adapting to change or changing opinions.

    You may also take a long time making any decision and completing tasks daily because you want everything to be perfect. When you can’t control the situation or things change around you, you might feel extremely anxious and vulnerable.

    Dependent personality disorder Someone with a dependent personality disorder is usually submissive, letting other people assume control over their lives and decisions. There might also be a strong need for others to take care of you.

    If you live with this personality disorder, you might have a hard time making decisions on your own. You’d rather ask for other people’s opinions or go with what they decide in every situation.

    You may also find yourself extremely hurt if someone criticizes or rejects you.

    You may be perceived as a “people pleaser” and could feel very anxious when you’re alone. You might not feel comfortable doing anything on your own.

    You may also rely on your relationships and become depressed if one of them ends.

    Avoidant personality disorder A diagnosis of avoidant personality disorder may mean you’re extremely fearful of rejection and abandonment. This could lead you to avoid almost all social activities and events, even when internally you wish you’d go.

    With this personality disorder, you may also feel insecure around other people, worrying that you may say something silly or inappropriate. Sometimes, if placed in a situation where you have to interact with others, you may end up blushing, crying, and trembling.

    People with this personality disorder feel the need to connect to others and establish close relationships, but they don’t because of their insecurities. This, in turn, makes them very upset.

    TREATMENT FOR PERSONALITY DISORDERS Research shows that long-term psychotherapy is the most effective treatment for personality disorders. It may help you explore your thoughts and emotions and how these affect you and other people.

    Therapy can also help you manage some of your symptoms so that you can cope with some situations more effectively.

    In some instances, some symptoms might be treated with medications such as antidepressants. But this isn’t true for every personality disorder or every individual case.

    Sometimes, your doctor might recommend including other health professionals in your treatment. They may also suggest your close relatives join you in a few therapy sessions, if you approve.

    Because personality disorders all have different symptoms and triggers, they’re not all treated in the same way. The type of approach your doctor chooses will depend on your symptoms, their intensity, and your personal and medical history.

    In general, psychotherapy for personality disorders will aim to:

    -increase your ability to adapt to stress

    -decrease or manage behaviors that might be causing you problems at work or in your relationships

    -increase your ability to manage your moods

    -reduce your distress

    -help you understand your responsibility in stressful situations

    These are just general objectives. When talking with your therapist, you’ll have the opportunity to participate in your treatment and set your own goals.

    These are some of the most commonly used types of psychotherapy for personality disorders:

    -cognitive behavioral therapy

    -psychoanalytic therapy

    -dialectical behavioral therapy

    -schema therapy

    Treatment for personality disorders is typically long term. It requires a strong commitment and persistence on your part. But you may experience relief and learn how to manage some emotions if you continue your treatment.

    NEXT STEPS Even though there are five universal criteria to diagnose personality disorders, not all of them have the same symptoms.

    More importantly, personality disorders are complex mental health conditions beyond a given set of behaviors and emotions. This is why only a trained professional is equipped to make a proper diagnosis.


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    A Story of trying to feel.. your feelings - Margarita Tartakovsky, MS 19 Nov 2020

    After my dad’s passing in August of ’09, I’d say that for the most part, I’m OK.

    I go about my day just fine. Create a to-do list. Happily check items off. Take breaks. Go work out. Run errands. Hang with loved ones. And live life.

    But sometimes the grief breaks through.

    And I have to tell myself to save it because I can’t fall apart right now. I have things to do.

    We’ve talked before on Weightless about the importance of feeling our feelings. That we emerge liberated, relieved and unstuck. Unburdened. The overwhelming release from your brain and body.

    Because gripping on to those feelings can lead to unhealthy consequences, such as emotional eating or even a negative body image. We focus so much on shooing away our feelings that they arise in other ways. Maybe we nitpick at our bodies. Or we feel bloated, gross or unloveable.

    But it’s really the tension of the bottled-up feelings, the unexpressed emotions. The body bashing and eating just facades.

    We think that not feeling our feelings keeps us unscathed. It keeps the “ugliness” from coming up and doing further damage.

    I can’t worry about my dad’s death because I have things to do, I say to myself. I have to interview experts, I have to write up articles, I have to get inspired, I have to catch up on email.

    I’m sorry, papa, but I can’t think about your loss right now.

    I have things to do. And I can’t fall apart right now. Not even a glimmer, not even a chard of glass can fall from my fortress. Because, then, well, then, the whole thing I’ve built up so diligently, so perfectly, will shatter.

    Maya Stein, whose poems I absolutely love, recently wrote about the beauty of grief. To say that her poem is powerful is an understatement. (All her pieces are breathtaking.)

    I wanted to share it with you because it illuminates the importance of feeling our feelings. It shows us that we can still be strong when releasing the pain. We can find strength in something so vulnerable.

    Sure, this might be something we know. At least, intellectually.

    But I know that I, at least, need the reminder from time to time.

    (Please check out the entire poem here; I’ve left out a chunk of the first section.)

    No one knows she cried her eyes out three days ago, sat in her desk chair and wept, unable to see the screen. No one knows how harshly she spoke to herself, flagellated her already fragile spirit, lay on her bed with her forearms pinching her eyelids flat, and made mad proclamations against her weak, fractured heart. No one knows the hours she’s devoted to circling her sadness like a vulture, the mileage she’s worn into her soles, walking the hills of her city in a series of unsuccessful attempts at forgetting.

    She had convinced herself of her own ruin, a fault line splitting her body in two. Her lungs felt as thin as moth wings, and she was certain her bones had been worn brittle, stilts of a house helpless against a hurricane.

    But this is the beauty of grief.

    What she saw in the mirror was not the deep ravine left by loss, The war she was waging had not hollowed her cheeks or made an anarchy of her skin. Her lips had not unpinked from slaughter.

    Instead, a pliancy and sheen had birthed from the rubble. The eyes looking back at her were bright as promises and it wasn’t the overhead light or the sudden April sun. Grief had lifted the rawness out of her, clutched at the throat of her darkness and pulled until it lay silent and sleeping at her feet, a feral dog fed and full, and what was left was neither muscle nor wound but horizon line, a ripe nothingness some fresh story beginning, etching her face clean.

    I’m not sure I’ll ever come to terms with my dad’s passing. (Do people ever come to terms?)

    The grief comes and goes.

    Sometimes, it’s raw, just like it happened yesterday.

    Sometimes, in the middle of doing something, I realize to my horror that my dad is gone.

    Sometimes, I realize the horror of how accustomed to life I’ve gotten without my dad. That he could just be plucked from this earth, and I’ve managed to pick up the pieces.

    How scary is that?

    That someone so pivotal in my life, such a shining light, is gone, has dimmed – and I haven’t suffered a nervous breakdown. I haven’t fallen to the floor and stayed there, crying for days.

    Part of it is my personality. I’ve always been introverted with my feelings. Kept quiet whether I was angry, frustrated, depressed or distraught.

    Part of it is worry about the aftermath. I assume that this grief, this heavy, heavy grief, will ruin me. Lungs like moth wings, bones so brittle and a shaky foundation, bending to the weakest of winds.

    Because let’s be honest, feeling your feelings is hard work. It’s hard to dig through the rubble, forest, flood and fire of feelings.

    But it’s OK if it takes time. It’s OK if you’re not ready.

    What I pay attention to are my thoughts and behaviors. Am I letting these feelings spark unhealthy behaviors? Am I eating to soothe my pain? Am I beating myself up as a result of bottling up these feelings? Am I doing something that doesn’t honor me? I ask myself these questions. And the answer has been no.

    And for now, I’m OK with stopping there.

    For now, that’s good enough.

    For now, this is my fresh beginning and my cleansed face.

    What helps you process your feelings? Do you think bottled up feelings can lead to unhealthy behaviors?


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    Coping when your Child is diagnosed with a Mental Illness. 29 Jul 2020

    As someone who has supported children who have mental illnesses, I have always been an advocate for their health and safety. Recently, through speaking with families, I found that many describe the experience of having a child with a mental health diagnosis as complicated and turbulent. Parenting a child with a mental illness can be an experience filled with helplessness, and often leads parents to question if what they are doing is right for their child.

    The National Mental Health Association identifies that one in every five young people experiences difficulty with their mental health. And, a study of posts on internet forums found that a child’s mental illness impacts the entire family, with parents often struggling to cope. The most common concerns included feelings of hopelessness, seeking advice on how to cope and questions about their child’s diagnosis and medication.

    Sara (name changed for anonymity), a mother adapting to supporting her daughter with generalized anxiety disorder (GAD), depression, and anorexia nervosa, shared her struggles with the Trauma and Mental Health Report (TMHR):

    “My daughter was hospitalized for about a week because she couldn’t handle the stress of school, work, losing her boyfriend & her weight. She also had expressed thoughts about committing suicide. I unfortunately, didn’t know there was a problem until she admitted herself into the hospital for stress; she was hysterical and couldn’t stop crying and had trouble speaking. I did notice her being unhappy for weeks before but thought she was just being a normal teenager and was just moody. I thought she just didn’t want to speak with her “mommy”. She also was concerned with her weight and was dieting to lose a lot; I did take her to the doctor, but the doctor thought she was dieting responsibly and also she was eating all the food I was making. However, in hindsight, I didn’t realize she was vomiting afterwards.”

    Adjusting to a child’s diagnosis can be difficult for parents as they are challenged with supporting their child through their struggles, while also managing their own mental health. Sara identified the entire process as full of personal confusion, helplessness, and self-doubt:

    “I was devastated and confused when I found out. I didn’t understand how much my daughter needed the help, and I was very upset with myself that I didn’t notice sooner. I didn’t understand what was going on and was extremely worried that my daughter would have to be medicated and/or hospitalized in order for her to cope with her issues. I also did blame myself for not seeing the “signs” and thought as her mother I should have noticed there was a problem and should’ve acted earlier on her behalf.”

    In an interview with the TMHR, Elizabeth Mazur, a researcher at Pennsylvania State University who studies family stress and coping as it relates to disability, mental health and parenting, described the impact of receiving a diagnosis:

    “Parents have to adjust to the child having “good days” and “bad days,” and maybe mostly bad days. However, a diagnosis can also be a relief in that parents have an answer to what might have seemed as intractable problems of a child’s temperament. Also, with a diagnosis one can better seek treatment although the roadmap is not always as clear as parents (and professionals) might like.”

    Several factors effect a person’s ability to cope. Counselling, stability, social support, adaptability, individual temperament, knowledge, and positive attachment can all help an individual cope with a stressful or overwhelming situation. Confiding in close others and increasing open communication with your family are also important. Sara stressed the importance of having access to therapy:

    “I wanted to be strong for my daughter but felt I wasn’t a good mother and needed a lot of help and counselling too…I couldn’t have helped my daughter if I didn’t understand what was going on with my own mental health. Counselling would have helped us all. The whole family was in need of it and while we did receive some group counselling but afterwards it was just my daughter and myself attending the weekly sessions. I think it helped but I also believe that more should have been done by the doctors to help our family cope.”

    Above all, Sara advises parents to reach out for help if needed:

    “There are a lot of resources made available to parents and families; do not be afraid to advocate for yourself because your mental health is just as important, even if sometimes as a parent it doesn’t feel that way to you.”

    -Jessica Ferrier, Contributing Writer


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    The Surprising Intimacy of Therapy Phone Sessions - Daniela Gitlin 30 Jun 2020

    I’ve been working remotely since the middle of March. While most of us seem to be using video chat programs such as Zoom, Facetime, or doxy.me, I find video so inferior to phone contact, I’m not using it at all in my practice. Surprisingly, all my clients have refused the video option too. Why?

    Obvious reasons include not having access to the internet (common in our rural community); not owning a computer, tablet or smart phone (also common); not having the skills (the elderly, the tech challenged), or simply being too ill to manage being online.

    A less obvious reason, but possibly more compelling, could be this. Clients make themselves vulnerable enough when they shower and dress to come in to see me in the neutral space of my office.

    Video chat takes away that safe neutrality by visually letting me into their homes, which violates their privacy and arouses a variety of trust-undermining feelings, such as of shame, anxiety, and humiliation.

    “It’s a mess! I don’t want you to see it,” one client admitted. Meanwhile, I’m able to work from my office (I’m the only one there), which means my personal privacy is protected while theirs isn’t. Seeing me in my personal space wouldn’t level the emotional playing field, though. It would only be another distraction, yet another challenge to keeping the focus of treatment on them.

    Many of my clients don’t have access to a delegated private space in their homes. “I can’t even hide out in the bathroom, we only have the one, and someone will need it once I’m in there,” another said. Clients can’t do their work in session unless they’re assured it’s confidential, without risk of interruption, eavesdroppers, or intruders. I believe the camera asks too much of clients.

    From my side, video-chat technology destroys the intimacy required to do our sensitive work. The position of the computer, tablet, or phone camera rarely allows for reliable eye contact, which makes us both feel unsettled and uneasy. The image of myself in the upper corner is distracting: every movement draws my eyes and attention away from the client. The same has to be true for them.

    The countless distortions that are a function of the way video images are digitally encoded, decoded, and adjusted cause the image to freeze, blur, and drop, and worst of all, to be out of synch with the audio. These glitches and delays scramble subtle social cues and interfere with perceptual processing. We unceasingly, out of consciousness, strain to fill in the gaps. A full workday of that leaves me exhausted, anxious, and dissatisfied. Rather than feeling connected, I often feel the opposite: isolated and disconnected.

    If we must have technology in session with us, the phone approximates live contact better. The rate of speech transmission is closer to live conversation and the fidelity of sound far higher, especially from a landline, which is what I use when calling clients. Because I’m deprived of visual cues, my hearing sharpens and my sensitivity increases to subtle nuances of speech rate, rhythm and tone; pauses; and—this is really helpful—the client’s breathing. There are many more moments during the session where all my available senses are fully engaged, and it’s the same for the client.

    It’s true my mind wanders more but I use the usual self-management techniques to rein it back. That said, here’s a silver lining to phone work. Thinking requires looking in. In a live session, when a client is speaking and looking at me, I maintain eye contact unless they break it. If they do, that releases me to gaze inside to think. But I still have to keep my eyes on them so as not to miss their return. Phone work frees my eyes to do what they want (they tend to wander vaguely around the room), which lets me think while continuing to actively listen and engage with the client.

    Here’s an example. Betsy, 65, works as the head of social work at a local nursing home. She’s been in treatment with me for over 25 years, initially to recover from her abusive marriage. As the years passed and layers peeled away, it became clear that the source of all her symptoms and interpersonal problems was childhood trauma. Four years ago, she had a disastrous affair with a man from work.

    Breaking from him took two years and the struggle ripped away her usual defenses, allowing for new insights. Enter the pandemic and remote phone work.

    It took a few sessions for the two of us to establish a working rhythm. In a way, it was like being with a new client. Much more frequently than I would in an in-person session, I mirrored, reviewed, and asked for confirmation that I understood what she was telling me. Then we had a real-time a-ha moment.

    “So, wait,” I said into the phone, pausing to think as I glanced around the room without seeing it, “are you saying….” I leaned forward in my chair, my attention closely tuned to her breathing,“… that this boyfriend, and the one before, and your ex-husband, are all the same kind of man?”

    “Yes!” she said. A long silence ensued. I waited, listening intently to her deep, regular, slow breaths. Then, a little huff, a pause, and— “Oh my god.” Her silence was so active, it was like hearing her think. “Could it be…?” she whispered.

    “…they’re all variations of your father?” I said, feeling the risk run through my body even as I let the words go.

    It’s not like we hadn’t discussed this insight before. We had, many times. But there was something going on here that was new, and it was important to not miss the opportunity. How would she react? I couldn’t see her. I couldn’t scan her face or her body language. All I had was the surf-like regularity of her breath in my ear. Then, a creak, and a rustling of cloth against cloth. She started chuckling, at first low and soft at the back of her throat, then building to a full out laugh. I sagged back in my chair with a combination of relief, amazement, and fatigue.

    So you see, despite the limitations, it’s possible to do transformative work by phone. I don’t find that to be true for video. Still, it goes without saying (I’ll say it anyway) contact in any form is better than none. No matter how you “see” your clients these days, do it. They need us more than ever.

    Daniela Gitlin, MD, is a psychiatrist in private practice for more than 25 years in rural upstate New York. Practice, Practice, Practice: This Psychiatrist’s Life is her first book. Contact: danielagitlin.com.


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    Your child’s mental health - 12 Feb 2020

    Mental health affects the way people think, feel and act. Taking care of our mental health is just as important as having a healthy body. As a parent, you play an important role in your child's mental health:

    You can promote good mental health by the things you say and do, and through the environment you create at home. You can also learn about the early signs of mental health problems and know where to go for help.


    Help children build strong, caring relationships:

    It’s important for children and youth to have strong relationships with family and friends. Spend some time together each night around the dinner table. A significant person who is consistently present in a child’s life plays a crucial role in helping them develop resilience. This person—often a parent or other family member—is someone your child spends a lot of time with and knows they can turn to when they need help. Show your children how to solve problems. Help children and youth develop self-esteem, so that they feel good about themselves:

    Show lots of love and acceptance. Praise them when they do well. Recognize their efforts as well as what they achieve. Ask questions about their activities and interests. Help them set realistic goals. Listen, and respect their feelings:

    It’s OK for children and youth to feel sad or angry. Encourage them to talk about how they feel. Keep communication and conversation flowing by asking questions and listening to your child. Mealtime can be a good time for talking. Help your child find someone to talk to if they don’t feel comfortable talking to you.

    Create a safe, positive home environment:

    Be aware of your child’s media use, both the content and the amount of time spent on screens. This includes TV, movies, Internet, and gaming devices. Be aware of who they might be interacting with on social media and online games. Be careful about discussing serious family issues—such as finances, marital problems, or illness—around your children. Children can worry about these things. Provide time for physical activity, play, and family activities. Be a role model by taking care of your own mental health: Talk about your feelings. Make time for things you enjoy.

    In difficult situations, help children and youth solve problems:

    Teach your child how to relax when they feel upset. This could be deep breathing, doing something calming (such as a quiet activity they enjoy), taking some time alone, or going for a walk. Talk about possible solutions or ideas to improve a situation and how to make it happen. Try not to take over. How common are mental health problems among children and youth? One out of every 5 children and youth in Canada (20%) has a diagnosable mental health condition. Examples include attention deficit hyperactivity disorder (ADHD), anxiety, depression, substance abuse, eating disorders and learning disabilities. Many more children have milder but significant emotional and behavioural problems.

    Mental health issues can affect youth at any age. But certain situations can place some young people at a higher risk, including:

    A family history of mental illness. New immigrants and refugees who experience difficult economic circumstances. Indigenous children and youth who have poorer overall health, live in isolated communities and have scarce educational and work-related opportunities. LGBTQ children and youth who experience bullying and/or rejection from their families. Big life changes such as moving to a new city or new school, caregiver separation or divorce, serious illness or death in a close relative or friend. Facing or witnessing trauma, including abuse. Substance use. Unfortunately, too many children and youth don’t get help soon enough. Mental health disorders can prevent children and youth from succeeding in school, from making friends, or becoming independent from their parents. Children and youth with mental health disorders may have trouble reaching their developmental milestones.

    The good news is that mental health disorders are treatable. There are many different approaches to helping children and youth struggling with emotional or mental health problems. Getting help early is important. It can prevent problems from becoming more serious, and can lessen the effect they have on your child’s development.

    How do I know if my child or youth has a mental health problem? All children and youth are different. If you’re concerned your child may have a problem, look at whether there are changes in the way they think, feel or act. Mental health problems can also lead to physical changes. Ask yourself how your child is doing at home, at school and with friends.

    Changes in thinking Saying negative things about themselves or blaming themselves for things beyond their control. Trouble concentrating. Frequent negative thoughts. Changes in school performance. Changes in feelings Reactions or feelings that seem bigger than the situation. Seeming very unhappy, worried, guilty, fearful, irritable, sad, or angry. Feeling helpless, hopeless, lonely or rejected. Changes in behaviour Wanting to be alone often. Crying easily. Showing less interest in or withdrawing from sports, games or other activities that they normally enjoy. Over-reacting, or sudden outbursts of anger or tears over small incidents. Seeming quieter than usual, less energetic. Trouble relaxing or sleeping. Spending a lot of time daydreaming. Falling back to less mature behaviours. Trouble getting along with friends. Physical changes Headaches, tummy aches, neck pain, or general aches and pains. Lack of energy, or feeling tired all the time. Sleeping or eating problems. Too much energy or nervous habits such as nail biting, hair twisting or thumb sucking. Remember: Just because you notice one or more of these changes does not mean your child or youth has a mental health problem.

    Where do I go for help? There are many ways to help your child achieve good mental health. Sharing your concerns with the doctor is one of them. Talk to your child’s doctor:

    if the behaviours described above last for a while, or if they interfere with your child’s ability to function; if you have concerns about your child’s emotional and mental health; about your child’s behavioural development and emotional health at each well-child visit. If your child or teen talks about suicide or harming themselves, call your doctor or local mental health crisis line right away.


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    Understanding psychotherapy and how it works - American Psychological Association 25 Nov 2019

    Do you ever feel too overwhelmed to deal with your problems? If so, you're not alone.

    According to the National Institute of Mental Health, more than a quarter of American adults experience depression, anxiety or another mental disorder in any given year. Others need help coping with a serious illness, losing weight or stopping smoking. Still others struggle to cope with relationship troubles, job loss, the death of a loved one, stress, substance abuse or other issues. And these problems can often become debilitating.

    What is psychotherapy? A psychologist can help you work through such problems. Through psychotherapy, psychologists help people of all ages live happier, healthier and more productive lives.

    In psychotherapy, psychologists apply scientifically validated procedures to help people develop healthier, more effective habits. There are several approaches to psychotherapy — including cognitive-behavioral, interpersonal and other kinds of talk therapy — that help individuals work through their problems.

    Psychotherapy is a collaborative treatment based on the relationship between an individual and a psychologist. Grounded in dialogue, it provides a supportive environment that allows you to talk openly with someone who’s objective, neutral and nonjudgmental. You and your psychologist will work together to identify and change the thought and behavior patterns that are keeping you from feeling your best.

    By the time you’re done, you will not only have solved the problem that brought you in, but you will have learned new skills so you can better cope with whatever challenges arise in the future.

    When should you consider psychotherapy? Because of the many misconceptions about psychotherapy, you may be reluctant to try it out. Even if you know the realities instead of the myths, you may feel nervous about trying it yourself.

    Feeling depressed, anxious or angry Overcoming that nervousness is worth it. That’s because any time your quality of life isn’t what you want it to be, psychotherapy can help.

    Some people seek psychotherapy because they have felt depressed, anxious or angry for a long time. Others may want help for a chronic illness that is interfering with their emotional or physical well-being. Still others may have short-term problems they need help navigating. They may be going through a divorce, facing an empty nest, feeling overwhelmed by a new job or grieving a family member's death, for example.

    Signs that you could benefit from therapy include:

    You feel an overwhelming, prolonged sense of helplessness and sadness. Your problems don't seem to get better despite your efforts and help from family and friends. You find it difficult to concentrate on work assignments or to carry out other everyday activities. You worry excessively, expect the worst or are constantly on edge. Your actions, such as drinking too much alcohol, using drugs or being aggressive, are harming you or others. What are the different kinds of psychotherapy? There are many different approaches to psychotherapy. Psychologists generally draw on one or more of these. Each theoretical perspective acts as a roadmap to help the psychologist understand their clients and their problems and develop solutions.

    The kind of treatment you receive will depend on a variety of factors: current psychological research, your psychologist's theoretical orientation and what works best for your situation.

    Your psychologist’s theoretical perspective will affect what goes on in his or her office. Psychologists who use cognitive-behavioral therapy, for example, have a practical approach to treatment. Your psychologist might ask you to tackle certain tasks designed to help you develop more effective coping skills. This approach often involves homework assignments. Your psychologist might ask you to gather more information, such as logging your reactions to a particular situation as they occur. Or your psychologist might want you to practice new skills between sessions, such as asking someone with an elevator phobia to practice pushing elevator buttons. You might also have reading assignments so you can learn more about a particular topic.

    In contrast, psychoanalytic and humanistic approaches typically focus more on talking than doing. You might spend your sessions discussing your early experiences to help you and your psychologist better understand the root causes of your current problems.

    Your psychologist may combine elements from several styles of psychotherapy. In fact, most therapists don’t tie themselves to any one approach. Instead, they blend elements from different approaches and tailor their treatment according to each client’s needs.

    The main thing to know is whether your psychologist has expertise in the area you need help with and whether your psychologist feels he or she can help you.


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    Depression at Work: 4 Tips to get You back on Track By Amy Pierce Romine 15 Nov 2019

    I believe depression at work is one of the hardest mental illness symptoms to manage. It kills productivity to the point that it becomes too costly to ignore. It is estimated that each year employers lose about $44 billion due to the ramifications of depression on the job site.

    It’s no wonder there are stigmas towards mental health. Employers do not want to hire personnel whose illness causes problems to the point of missing work – for many days each calendar year. And if employers had a choice between someone else on the possible employee interview list, the hiring manager will not choose the person with a mental illness.

    Individuals with depression at their profession, can have huge declines in their work performance. A person can develop one of two different attendance patterns: presenteeism and absenteeism. The former means you are “present” at work, but can “barely function”. Absenteeism is where the employee misses multiple days of work because of the depression.

    When the depression at work sets in, it is a good idea to be prepared to combat some of the indicators such as fatigue, deep sadness, or lack of motivation. Below are four tips used to overcome depression at your occupation while getting things accomplished.

    4 Tips to Defeat Depression at Work

    Choose tasks that are easy and quick to finish. Clean out your email Inbox, send emails, do an office supply check for your work space, work on a PowerPoint presentation, or draft simple correspondence. These tasks may ease pressure from professional stress. These tasks take little to no effort so you can use this time to breathe.

    Keep your mind active. When I lose my motivation to do anything, my thoughts turn negative. Often I will say to myself, “You are a failure at your job.” Or “Nobody likes you.” I need to shut these negative thoughts down and fast before it worsens! Examples: self-hypnosis, practice deep breathing, do some filing, or catch up with another colleague.

    Get moving. This tip is my favorite one out of the four. When I feel the depression rolling in like a summer thunderstorm, I knew I needed to get up and move. I would push myself away from the desk and get moving…anywhere. To keep the fatigue from the depression from winning, I would take short walks that had a purpose. For instance: I went to the kitchen and filled up my water bottle, emptied my shred box, filing, or took the mail to the mail room.

    Talk to your mental health providers. If you try these tips as well as others to assist with your depression during the work day, and they do not help, you need some bigger reinforcements. Your psychiatrist is a great place to start. He/she might need to adjust your medicine. Or you might need to make an emergency appointment with your therapist. During that session, the therapist could give you more ideas to lift the depression fog at work.

    Remember, your treatment does not happen in a vacuum. The increased dose or newly added prescription might take a few weeks to really work. Be patient. Also, the new depression destroyer technique could take a little getting used to.

    Conclusion If properly treated, depression at work can be managed. Instead of burning up sick time or personal time off, you can try these tips to support you in working with your depression on the job.


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    Mental Wellness the most overlooked aspect of health - By Dr. Helena Lass 21 May 2019

    Our society and nature of the work we do has forever changed. Most of today’s office work is not in the slightest bit physical; about 90% of the time we use our heads as our main ‘work asset’. Although we rely predominantly on our inner mental functions to get our work done, the current workplace approach to mental health has been mostly a reactive based approach, only becoming highlighted when serious problems emerge.

    What we need instead is similar to financial education – how to be successful and avoid problems in the first place as the importance of personal, social and work related strategies for mental wellness have been massively overlooked for years.

    Nature of the problem at workplaces

    Employees often look to employers to present a mental health solution, but it is often the case that companies are themselves ill equipped to provide one. The Global Wellness Institute 2016, ‘The Future of Wellness at Work’ report stated that when people are unwell at work, they report a decreased ability to get their tasks done (62 percent), are not engaged (63 percent) and are unmotivated (62 percent).

    According to a 2017 Gallup report ‘State of the Global Workplace’, 67 percent of employees are not engaged and 18 percent are actively disengaged at work. Doing some simple maths illustrates the potential difference in revenue – what would happen to a business’s performance if even 50 percent of employees were actively engaged and motivated as opposed to current global average of 15 percent?

    Both these statistics clearly illustrate that problems actually originate elsewhere. For example, most burnout originates from positive stress, not from negative stress. When things are tough, nervousness may lead to anxiety and untreated stress can cause burnout that can lead to depression. I.S. Schonfeld and R. Bianchi in their scientific paper ‘Burnout and Depression: two entities or one?,’ published by the Journal of Clinical Psychology in 2016, found that there is 86 percent overlap between burnout and depression.

    Therefore it is a mistake to assume that what employees need is more motivation training or positivity. People are already overwhelmed with stress and struggle in handling their inner mental reactions. Boredom and indifference are not physical issues, and can cause organizations and economies huge financial loss.

    Evans-Lacko, S. & Knapp, M.’s scientific paper from 2016 entitled, ‘Global patterns of workplace productivity for people with depression: absenteeism and presenteeism costs across eight diverse countries’, saw data collected from almost 8,000 employees spanning eight countries. The results of the survey revealed that worldwide workplace depression collectively costs almost US$250 billion.

    For the U.S. this translates to US$84.7 billion (or 0.5% of U.S. GDP) in losses due to non-existent productivity when at work (presenteeism) and US$6 billion lost through people not showing to work (absenteeism) because of illness. The study also saw 3.7 percent of the collective American workforce have more than 21 consecutive days off from work because of depression.

    Making the distinction between mental wellness and mental illness

    Too often the words ‘mental health’ are confused with ‘mental illness’, however the two couldn’t be further from each other. Mental health is something that every person has when his or her inner functions operate in their most optimal manner and is a level of psychological well-being. Good mental health is mental wellness.

    Mental illness on the other hand, is a lack of health and a result of not dealing with problematic ways of internal functioning when problems first emerge. By letting problems escalate until they become chronic is due to a lack of specific education in intrapersonal skills (‘intra’ meaning inside). Illness is a direct result of neglecting the need for proactive education, instead favoring a bias towards prioritizing fire-fighting the consequences.

    Need for new proactive approach to mental health

    As there is no single gene known to cause psychiatric illnesses there are no simple medical solutions. The majority of methods in psychology have been developed as forms of intervention for a therapy setting and not as a proactive education. That needs to change if we want to turn the tide and secure that people who are already well also stay well. Staying well does not just happen, it demands access to practical intrapersonal education.

    Routledge recently published my scientific paper “Developing Intra-Personal Skills as a Proactive Way to Personal Sustainability – The Preventative Side of the Mental Health Equation”. In it I bring forward a new proactive approach to mental health as something that everyone should actively strive towards. It is one of the first scientific papers to summarize the whole mental wellness topic and opens up a new pathway that is wellness orientated and suitable for all. However, the path towards changing the paradigm is a hard one. People would rather continue to talk about illnesses, than focus on a preventative and proactive solution. That is why I see that workplaces need to lead the way; employers have a lot to gain from improved productivity that always comes along with excellent mental wellness.

    What is mental wellness?

    Mental wellness is the discipline that helps to keep our inner mental capabilities in good shape. When people are equipped with effective methods to handle every-day challenges, pressures will not escalate stress and then from there to seeds of illness. Mental wellness enables us to effectively nip the problem in the bud.

    Good mental health equals wellness, optimum inner functioning and effective use of our innate potentials: purposeful attention, embracing change and unknown, initiative, creativity, inner motivation, having insights, awareness of emotions, good time-management and more. These are all specific inner capabilities that can be developed into useful practical intrapersonal skills that people can use in their daily lives and in their work.

    Both businesses and employees would greatly benefit from learning intrapersonal skills that enable them to sustain performance at the highest level. Mental wellness and intrapersonal education are therefore enablers in reducing health related costs and should be seen as a crucial investment for all companies wanting to stay competitive.


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    Parenting in a Digital Age: What Experts Are Saying - Diana Graber M.A. 10 Apr 2019

    Parenting is tough, the pay is horrible, and you basically get one shot at doing it right. And that was before some genius invented the smartphone. That little go-everywhere, always-connected device makes raising kids even more challenging.

    While parenting is not for sissies, consider what it must be like to be a teen today. Your young brain is all wired and ready to test boundaries, connect with peers, and make poor decisions without a care for long-term consequences—and you’ve got that very same smartphone in your possession. It almost seems unfair. Any kid who can survive modern adolescence without suffering a digital mishap should win an Olympic medal.

    Is The Massive Pressure of Constant Connectivity Getting To Our Kids?

    A new study in the Journal of Abnormal Psychology asserts that teen depression increased more than 60% between 2009 and 2017. For children ages 12 to 13, depression rates increased by 47%. Researchers noted the same upward trend in suicides, attempted suicides, and serious psychological distress amongst youth too. While unable to clearly pinpoint the cause of this adolescent distress, in their summary the study’s authors call for “more research to understand the role of factors such as technology and digital media use.”

    It’s easy to blame adolescent angst on technology. After all, the suddenness of technology's sheer ubiquity makes it the obvious culprit. But isn't it also possible that technology just amplifies all of the world’s other problems—like climate change, gun violence, the difficulty of getting into college, and more? Plus, technology provides youth a place to escape from these problems and to commiserate with peers. It’s complex and there’s still a lot we don’t know.

    What Experts Say

    While writing a book about digital parenting, I turned to over 30 experts to get their advice on everything from screen time and sexting to cyberbullying and digital reputation management. While their responses were wide-ranging, experts did converge on three broad topics of concern.

    1. Empathy Needed.

    Nearly every expert told me if they could grant kids just one digital superpower it would be empathy. Empathy is the ability to put oneself in another’s shoes. It encompasses perspective taking, and it allows one to feel what another is feeling. Educational psychologist Michele Borba, author of UnSelfie: Why Empathetic Kids Succeed in Our All-About-Me World, says empathy is “the cornerstone for becoming a happy, well-adjusted, successful adult. It makes our children more likable, more employable, more resilient, better leaders, more conscience-driven, and increases their lifespans.”

    Unfortunately, between 1979 and 2009, American college students’ scores on two measures of empathy plummeted a whopping 40%, with the steepest decline occurring from 2000 onward.

    This “empathy dip” is particularly concerning when it comes to connected kids because, as Internet safety expert Richard Guerry explains, "they should be able to let loose and be human and not have to worry about someone else taking a picture or filming them and then posting that somewhere.”

    Guerry, who is the founder of the Institute for Responsible Online and Cellphone Communication (IROC2), says kids need empathy for one another when they use technology because they hold power over their own reputations as well as the reputations of their friends—and the long-term consequences of a poor online reputation can be devasting.

    Empathy is also the antidote to cyberbullying because it can curb it before it starts. Shelley Kelley, Educational Director at Journey School in Aliso Viejo, CA, told me their cyberbullying prevention strategy basically centers around rich stories that employ empathy as a theme. These include tales about heroes, honorable people, role models, and other real-life upstanders. Sameer Hinduja and Justin Patchin, directors of the Cyberbullying Research Center, are fans of stories, too. As Hinduja explains, stories “cultivate empathy among youth to make sure they can emotionally understand the harm they can inflict with some of their actions online.” Empathy-building books they recommend include: El Deafo, Wonder, Same Sun Here, Inside Out and Back Again, Night (by Elie Wiesel), Where the Red Fern Grows, and Out of My Mind.

    Sue Scheff, author of Shame Nation: Choosing Kindness and Compassion in an Age of Cruelty and Trolling, suggests that “the moment children open a first social media account they should be told to be “thoughtful, kind, and caring… and to remember to post with empathy for others.”

    2. The Fastest Growing Concern? Sexting.

    “Sexting,” sending and/or receiving sexually-explicit or sexually-suggestive messages online, came up again and again as one of the most concerning—and fastest growing—technological problems of today’s youth. In early 2018, a comprehensive study on teen sexting published in the Journal of the American Medical Association (JAMA) revealed that roughly 15% of kids between 11 and 17 years of age send sexts and 28% receive them.

    “What you have here is a perfect storm of budding sexuality combined with a child’s first freedom on their own technological device,” says Dr. Michele Drouin, an expert on technology and relationships. “On top of all that, this budding sexuality happens well before the prefrontal cortex—the part of the brain responsible for impulse control—is fully developed.”

    What concerns the experts I spoke with, including Drouin, was how very few kids (and adults, for that matter) understand, or even know about, the severe consequences of getting caught exchanging such messages. The sending or receiving of “sexts” between people under the age of 18, even between two teenagers in a relationship, is illegal in most states. In California, for example, “individuals who distribute, possess, or produce a sexually explicit image of a minor could be charged under the State’s child pornography statutes. If the individual is tried as an adult and is convicted, they could receive up to six years in jail and will generally be required to register as a sex offender.”

    According to Drouin, “sexting is a part of the normative teenage, early adulthood experience now. So it is very, very common to send some type of sexually explicit message. More than half of my young adult students have sent this type of message. And by the time they hit young adulthood, more than half have sent sexually explicit pictures.”

    This, according to experts, is where the problem lies. Schools and parents are failing to educate youth on what could happen if they, or a friend, get caught sexting. Schools are largely unaware of how to handle a sexting incident. And many parents don’t know that, in many states, the possession of sexually explicit material portraying minors falls under existing child pornography laws.

    3. What Today’s Digital Kids Need Most: Help.

    Experts were united on this one. Kids need help. “What really gets me is how deeply kids are craving help, and knowledge, and direction when it comes to all this stuff,” says Liz Repking, founder of Cybersafety Consulting. “They are craving it so, so deeply. We have to give these kids the help they need.”

    Parents, of course, are in the best position to provide help. “But here’s the problem,” says Michele Ciulla Lipkin, Executive Director of the National Association for Media Literacy Education (NAMLE), “parents are really worried and overwhelmed themselves.”

    “I’ve had parents moved to tears because all they do is fight with their kids about media. Then when I talk to the kids, I can’t believe how nervous they are about digital life, all because their parents are petrified. It really doesn’t have to be this hard,” says Ciulla Lipkin.

    “Parents have to open up a dialogue about these issues in their communities and find support. Parents and schools have to work together, because we no longer live in a world where we can separate home and school. Administrators must support teachers getting professional development, because teachers have to understand these issues, too. We all have to ask if we are having these conversations in our communities.”

    The Bottom Line?

    If kids don’t get the help they need, from their parents and their schools, then those rising depression rates may be our fault. Not technology's.


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    Is Your Childhood Blueprint Holding You Back? - By Drew Coster 26 Feb 2019

    Do you find you don’t deal with situations or relationships as successfully as you’d like? Do you feel depressed, anxious, or think negative things about yourself, others or the world? If so, it could be that your blueprint is holding you back.

    You can think of your blueprint as everything you felt, saw, thought, touch, tasted, laughed or cried at. Millions of experiential data points creating your unique map of how the world works. But a map created before you are cognitively mature enough to understand or handle difficult situations.

    Because this blueprint comes from the cause and effect on a child mind there can be limitations on how we now see the world. If we had good mentoring, a stable view of ourselves, and satisfying relationships, then it’s likely we’ll have a healthy blueprint. However, if we experienced poor mentoring, a negative view of ourselves, with less than stable relationships, then our blueprint could be more dysfunctional. Leading us to see the world as unpredictable, uncaring and even traumatic.

    These are simplistic extremes for sure, and most people’s lives are far less black and white. However, the point is the same: no matter how the creation of our blueprint happened, it will influence our adult decision-making for the rest of our lives. If this blueprint is mostly dysfunctional, it can leave us vulnerable to mental health issues unless we take steps to change our reoccurring unhealthy responses.1

    Our blueprint is important because it plays an integral part in everything we do. Without being aware of it, every day your brain is constantly using your blueprint to predict your environment by following pre-programmed, default responses for familiar tasks2 : how you cook dinner, how you eat, drive, order your coffee, etc. It doesn’t matter the situation, you’ll have a response ready: In this situation you will = think this, feel this, and act like this. And most of the time this is okay. But what happens when we come across a situation that our younger self couldn’t deal with in a healthy way?

    Let’s say you had difficulties feeling worthy and appreciated as a child and one day at work your boss shouts at you in front of your colleagues? How do you respond? Well, that’s up to your old blueprint. In less than a second your brain is accessing how you managed similar situations in the past. Maybe it accesses the time you were 12 and a teacher shouted at you in front of the class. You cried and the shame you felt was painful. So, now in front of your boss, your blueprint tells you to “stay quiet and shut down your feelings.” So, that is exactly what you do. Your old responses leaving you helpless in the face of an aggressive other.

    If you think you don’t manage certain situations or people well, it might be time edit your old blueprint. To do this, I encourage you to reflect on any given situation you struggle with. Once you have a situation, park any preconceived notion you have about yourself. It doesn’t matter if the situations were wrong, or unfair, the goal is to examine your thinking, feeling, and behaviors analytically. You want to discover whether your blueprint helps or hurts you. What responses you want to keep and which to replace.

    Here are six questions to get started.

    Is this my typical response in this situation? Have I reacted this way before (i.e. is this habitual responding)? What event from my past does this situation/person remind me of? Does my current reaction help me or hurt me? How would I prefer to respond/react to this challenging situation? What do I tell myself that stops me from responding in this healthier way? Now you have this new information, you can get to work on practicing your new responses. With time, effort, and practice, these new habitual responses will happen naturally. But be aware, you might have another hidden habitual response that stops you from making these changes “just in case” things get worse. And it’s this cycle of wanting to change but fearing change that keeps many people stuck in the same blueprint.

    It is worth acknowledging a lot of our old blueprint emerged as self-protection. Created during a time when being turned down by someone you had a crush on hurt to the core. Or when kids laughing at you felt like the most shameful experience you could ever imagine. As children a lot of things seemed like the end of the world, but as adults they’re not even close. If a person you like turns you down, that’s okay. If other people laugh at you for making a mistake, you’ll survive just fine. You really don’t have to follow the same program over and over, you can change it.

    Breaking old habits is hard, but creating a new adult blueprint will help make you more confident and robust in the face of all life’s challenges.


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    Should you get Therapy or a Life Coach -By Marcia Naomi Berger 31 Jan 2019

    Life coaching is viewed by some as an alternative to therapy. Actually, coaching was one of many cognitive behavior therapy methods I learned to practice in graduate school. Thirty years into my career as a psychotherapist, I coach clients toward achieving their goals when they’re likely to benefit from this approach.

    Certainly, neither coaching as a separate practice nor psychotherapy has a monopoly on traits such as wisdom, intuition, kindness, or empathy. Practitioners in both disciplines may be good listeners, supportive, and encourage clients to set goals. So how do you decide whom to trust for help with relationships, addictions, work situations, parenting concerns, anxiety, depression, or other personal challenges?

    Former life coach client Jesse Harless, who is now a life coach himself, describes his experience receiving coaching: “I felt like I had some control over my life for the first time. What I realized in working with a life coach over the past few years, is that we have a tremendous amount of untapped potential. It’s just waiting to be brought out of us.

    He cites these benefits of life coaching:

    You get to choose what to work on. You gain “immediate” clarity on your actions and goals. You connect with someone who cares about your well-being, hopes, and dreams to whom you’re accountable about what matters most. You gain greater self-awareness. I would have missed the opportunity to overcome one of my biggest fears and live out my life’s purpose had I not worked with a life coach. “One of my favorite reasons for working with a life coach is I have someone cheering for me. I think we all need someone in our corner who will help us celebrate our small victories.” People benefit similarly from good therapy. So what’s the difference between a coach and a therapist if both approaches help people in these ways? A key difference is that standards for practicing differ widely, as shown here:

    Standards for Coaches and Therapists Requirements Coach
    Formal Education No formal education or training is required, Anyone can call themselves a coach, life coach, or personal coach. Quick basic training can last a few hours. A certificate can be earned in a couple of days. Additional training can last at least six months. No coaching program requires years of masters or doctorate degree level training.

    **Psychotherapist** At least six years of formal education is required: a four-year college degree and at least two years of graduate school. Graduate school typically includes at least two years or more of internship placements to gain supervised practical experience.

    License needed? Coach
    No. No coaching program requires years of masters or doctorate degree level training.

    **Psychotherapist** Yes. After earning a masters or doctorate degree, at least two years of supervised clinical work establishes eligibility to take the licensing exam which consists of intensive tests.

    Code of Ethics Coach
    No code of ethics exists for all coaches. However, coaches who join the International Coach Federation (ICF) are expected to adhere to its code of ethics.

    **Psychotherapist** Yes. Licensed clinical social workers, psychologists, marriage and family therapists, and professional counselors must adhere to their profession’s code of ethics.

    Regulation Coach No regulation exists for coaches to assure that ethical and legal responsibilities are upheld.

    **Psychotherapist** Regulation exists for psychotherapists or any other Mental Health Practioner. They need to be certified by the HPCSA in South Africa.

    Many people can benefit from coaching, depending upon the kind of challenge they face and upon the sensitivity, education, training, and experience of the practitioner. Although coaches are not subject to the strict standards, legal licensing requirements, and high education and training requirements of psychotherapists, this is not necessarily a reason to rule out seeing a coach who is a good fit for you and your situation.

    Clinical social workers, psychologists, marriage and family therapists, and other professionals must adhere to strict standards. Yet a license to practice psychotherapy does not automatically mean that its possessor will be more helpful than a coach for someone’s particular situation.

    Coaching used to be associated with training for athletes and team sports. Coaches for baseball, basketball, football, and so on, are typically people who earlier excelled in that sport. Similarly, executive coaches are usually qualified as mentors because of their real life achievements.

    Therapists and coaches often specialize in helping people deal with issues similar to those that they’ve dealt with successfully themselves, e.g., weight loss, relationships, addictions, depression. Therapists who specialize in treating people with depression or anxiety may well also have become experts in these areas after having succeeded in dealing with related challenges in their own lives.

    As a therapist, I can’t help but be biased toward my profession when it comes to aiding people with a wide range of personal or emotionally laden issues. As my colleague, Patricia Ravitz, MFT, puts it, “Once you complete all the education and training involved to be a therapist, you become a different person. You’re transformed.” Consequently, a good therapist is likely to be well equipped to help people grow and succeed in areas that reflect the fullness and complexities of life.

    Author and former accountant Francine Falk-Allen, says she has had excellent experiences with both a psychotherapist and a coach. Yet not always. She says, “I’ve also experienced coaches who treated everyone the same way without regard to individual differences and needs, and I’ve seen a therapist who didn’t understand my issues.” Her advice to someone looking for a coach: “Get recommendations from people who’ve found coaching helpful and ask the coach about his or her education, training, and experience in coaching people with issues similar to yours.” It’s probably a plus if the coach is a member of a respected organization that fosters high standards for coaches.

    Debunking Misconceptions about Therapy

    Although everyone has issues that they can benefit from exploring and working toward resolving, too many troubled people think, “I don’t need therapy; I’m not crazy.” They may have issues that call for a sensitive, well-trained therapist, but not get the help they need because they view receiving therapy for emotional support as a stigma.

    Another false belief about therapy is that it focuses on the past instead of helping people move forward in their lives.

    Good Therapy Fosters Personal Growth and Solutions

    The truth is that good therapy includes goal setting, clarity, personal growth and solutions.

    Therapists typically ask clients what they hope to gain from therapy, i.e., their goal.

    Reaching one’s goal can include some looking back to earlier influences. This kind of reflection is useful when something from the past causes us to behave in ways that block us from achieving what we want. We may need to find out what’s holding us back before we can move forward. This is how we can get “unstuck” from an old, unproductive behavior or thought pattern. As another person who’s benefited from both therapy and coaching puts it, “Therapists go deeper.”

    The trusting relationship that typically develops over time between the therapist and client can be enormously helpful for repairing trust that was broken in a person’s past.

    Example: How Knowledge of the Past is Helpful

    Someone might want to be more assertive and gain self-esteem, but something’s getting in his way. Perhaps as a child he was criticized by his parents for expressing feelings or needs that they were uncomfortable hearing. They told him he was bad, selfish, inconsiderate, or wrong and maybe they punished him. Suppose a therapist encourages him to express himself constructively, but he’s still hearing old, competing messages in his head telling him not “burden” others with his thoughts, feelings, wants, and needs.

    By recognizing what’s getting in their way of changing, many people move from prohibitions to permission to change. Some coaches may be able to help clients identify and move past what’s blocking them. Good coaches know when to refer a client to therapy rather than practice beyond their knowledge or skill level.

    Whether you choose to receive coaching or therapy, it’s important to find someone who’s a good fit for you. You want to work with someone with who you’ll be comfortable opening yourself up about what you’re struggling with and what you want to accomplish. That’s the first step toward gaining confidence and a more meaningful life.


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    Addicted ..... to Sugar ? - by Alicia King 09 Jan 2019

    In that first meeting I went to for my sugar addiction, I heard others admit to doing the same things I did. Sneaking. Lying. Throwing food in the bin to halt a binge only to come back later and fish it out to eat.

    It was right in front of my face, but I couldn’t see it for what it was for years. Addiction is a wayward beast. God knows you can’t see much when you’re laid flat on your back, pinned down by invisible yet ferocious forces.

    The narrative was just so unfamiliar that I doubted it was real. Where were the used syringes, grubby spoons, and Ewan McGregor swimming in a lav to Brian Eno music? Where were the gin and tequila bottles strewn next to stained ashtrays?

    A glance into my dependence only revealed brightly coloured plastic wrappers and packaging, crumbs strewn on the car floor, stomach pains, abominable flatulence, and soft velvety chocolate stains on the couch and seat of my pants. Far from Trainspotting or Leaving Las Vegas, this was more like Leaving Seven Eleven.

    It was almost laughable, only it wasn’t, it was excruciating. I ate the way an alcoholic drinks and an addict uses. The notion that food could derail a person the way hard drugs or booze can sounds extreme. And whilst the destruction is not as ostensibly violent and as speedily lethal, my spirit was decaying.

    When you’re enslaved by compulsion and obsession, no matter what the substance or behavior — you suffer. Your inner freedom withers away and you are caught in a most painful cycle.

    I could not stop binge eating. And for some reason I never equated my lawless benders on sweet things as a bona fide addiction. Denial is blinding but it wasn’t only mine. I was seeking the help of health professionals — psychologists and health counsellors — who were also missing the reality of the problem. They would say “But it’s not that bad, right?” and minimize my behaviour in an attempt to make me feel better. But it was that bad, and their diminishing comments made me feel worse.

    They were kind and well intentioned and approached the issue by trying to help me find moderation in my relationship with food, namely sugar: my white powdery blow. I’d find that balance for periods — sometimes days, weeks or even months — but I’d inevitably topple into blowout. And I’m not talking a couple of pieces of cake or a tub of ice cream.

    There is a cultural denial around the legitimacy of sugar and food addiction and treatment for disordered eating is usually centered around balance. And that is the ideal solution. But what if that doesn’t work? What if the notion of moderation is the very thing that keeps some of us monumentally stuck?

    My continual failure to eat “normally” left me bereft and berating myself for my inability to halt this self-abuse. I couldn’t implement what I was being advised to do. What in hell was wrong with me? I’ve never had a DUI for drunk driving, but I have shamefully dinged my car (and others) more than once as I scoffed food blindly from the passenger seat.

    I’d swear off bingeing; writing and typing up resolutions only to rip them up or delete them when I’d inevitably slide into another spree.

    Then one day the penny dropped when a health counsellor I’d been working with for four years said, “I’ve got it…You’re addicted to sugar!” Well yeah…anyone could see that, but what was her point?

    She told me I needed to treat it like a legitimate addiction, find a support group, and face the fact I couldn’t eat processed sugar in moderation, which meant not eating it. At all.

    At all…

    Was Alicia able to refrain completely and beat her sugar addiction? Find out in the original article The Other White Powder: My Addiction to Sugar at The Fix.



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    Depression in Teens and Children - By Kalman Heller, PhD 18 Oct 2018

    Depression is one of the most prevalent mental health disorders in the country and it is on the rise as one of the most serious health concerns facing us. The irony is that it is also one of the most treatable disorders, through psychotherapy and/or medication. Yet barely a third of the people with depression seek help or are properly diagnosed.

    It is estimated that about 10 to 15 percent of children and teens are depressed at any given time. Research indicates that one of every four adolescents will have an episode of major depression during high school with the average age of onset being 14 years!

    These episodes typically last several months when untreated. While this indicates the main problem is likely to abate without treatment, these teens are at much higher risk for suicide which is a leading cause of death during adolescence. In addition, during an untreated episode of major depression, teens are more likely to get into serious substance abuse addictions or suffer significant rates of dropping out of their typical activities and social groups. Thus, even if the depressive episode wanes, significant problems may continue on.

    The milder form of depression, called dysthymia, is more difficult to diagnose, especially in primary school children. Yet this form of depression actually lasts much longer. Typical episodes last seven years and often longer. Many depressed adults can trace their sad, discouraged, or self-dislike feelings back to childhood or adolescence.

    With children, although typical adult features may be present, they are more likely to show symptoms of somatic complaints, withdrawal, antisocial behaviour, clinging behaviours, nightmares, and boredom. Yes, many of these are common for non-depressed children. But usually they are transient, lasting about four to six weeks. You should become concerned when the symptoms last for at least two months, don’t respond to reasonable parental interventions, and seem to pervade the child’s life rather than be confined to just one aspect.

    I have referred to major depression and dysthymia as two primary forms of depression. Very briefly, there are a number of symptoms common to both but with a greater severity in the former. In adults, depressed mood, loss of interest or pleasure in activities, loss of appetite or overeating, sleeping a lot or not being able to sleep, loss of energy, loss of self-esteem, indecisiveness, hopelessness, problems with concentration, and suicidal thoughts or attempts are the signs of depression. People rarely have all of them.

    We usually look for at least four or more and, again, severity and longevity are important determinants when making a diagnosis. Teens will exhibit more adult-like symptoms but severe withdrawal is especially significant.

    In childhood, boys actually may have a higher rate of depression than girls but it is often missed because many of the depressed boys act out and the underlying depression is missed. In adolescence, girls begin the same predominance as women, about two to three times the rate of males. Contrary to popular belief, research rejects the notion that it is related to hormonal changes associated with adolescence. Instead, just as with adult women, sexual harassment and experiences of discrimination appear to be more significant causes.

    Primary causes of depression in children are parental conflict (with or without divorce), maternal depression (mothers interact much more with their children), poor social skills, and pessimistic attitudes. Divorced parents who are still fighting have the highest rate of depressed children (about 18 percent).

    Regarding depression in mothers, it is the symptoms of irritability, criticism, and expressed pessimism that are especially significant. Also, the environmental factors contributing to the mother’s depression (marital or financial problems) also may impact directly on the children. Depressed children are more likely to have poor social skills, fewer friends, and give up easily (which also contributes to poor school performance and lack of success in activities). You must differentiate, however, from the shy, loner child who is actually content to spend more time alone.

    What to do? When concerned, talk with teachers and pediatricians. (However, both of these front-line professional groups need more training in diagnosing depression.) If there seems to be a valid concern, then seek help from mental health professionals who specialise in working with children. (Parents: above all, follow your instincts because there is a tendency to under diagnose problems in younger children.)

    If marital conflict is present, then seek couples therapy (if divorced, seek help for cooperative parenting). If one or both parents are depressed, then individual therapy may be needed for each. Children’s therapy groups are particularly effective for those with social skills deficits. Family therapy is also very effective, particularly with older children or teens.

    Depression does run in families and may have a biological basis. Antidepressants are especially important in these cases and may also be important even if the causes are primarily psychological because they help the child (or adult) attain the level of functioning needed to benefit from other interventions. Since children and teens are less certain to respond positively to medications for depression than adults, it is especially important to use child psychiatrists who specialise in psychopharmacology.


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    Diet and Depression.... by Monique Tello, MD, MPH 03 Sep 2018

    Just this week, I have seen three patients with depression requiring treatment. Treatment options include medications, therapy, and self-care. Self-care includes things like sleep, physical activity, and diet, and is just as important as meds and therapy — sometimes more so.

    In counseling my patients about self-care, I always feel like we don’t have enough time to get into diet. I am passionate about diet and lifestyle measures for good health, because there is overwhelming evidence supporting the benefits of a healthy diet and lifestyle for, oh, just about everything: preventing cardiovascular disease, cancer, dementia, and mental health disorders, including depression.

    Diet and emotional well-being Diet is such an important component of mental health that it has inspired an entire field of medicine called nutritional psychiatry. Mind-body medicine specialist Eva Selhub, MD has written a superb summary of what nutritional psychiatry is and what it means for you right here on this blog, and it’s worth reading.

    What it boils down to is that what we eat matters for every aspect of our health, but especially our mental health. Several recent research analyses looking at multiple studies support that there is a link between what one eats and our risk of depression, specifically. One analysis concluded:

    “A dietary pattern characterized by a high intake of fruit, vegetables, whole grain, fish, olive oil, low-fat dairy and antioxidants and low intakes of animal foods was apparently associated with a decreased risk of depression. A dietary pattern characterized by a high consumption of red and/or processed meat, refined grains, sweets, high-fat dairy products, butter, potatoes and high-fat gravy, and low intakes of fruits and vegetables is associated with an increased risk of depression.”

    Which comes first? Poor diet or depression? One could argue that, well, being depressed makes us more likely to eat unhealthy foods. This is true, so we should ask what came first, the diet or the depression? Researchers have addressed this question, thankfully. Another large analysis looked only at prospective studies, meaning, they looked at baseline diet and then calculated the risk of study volunteers going on to develop depression. Researchers found that a healthy diet (the Mediterranean diet as an example) was associated with a significantly lower risk of developing depressive symptoms.

    So, how should I counsel my patients on diet? There are several healthy options that can be used as a guide. One that comes up again and again is the Mediterranean diet. Another wonderful resource for folks is the Harvard T.H. Chan School of Public Health website with an introductory guide to healthy diet.

    The bottom line The gist of it is, eat plants, and lots of them, including fruits and veggies, whole grains (in unprocessed form, ideally), seeds and nuts, with some lean proteins like fish and yogurt. Avoid things made with added sugars or flours (like breads, baked goods, cereals, and pastas), and minimize animal fats, processed meats (sorry, bacon), and butter. Occasional intake of these “bad” foods is probably fine; remember, everything in moderation. And, for those who are trying to lose weight, you can’t go wrong with colorful fruits and veggies. No one got fat eating berries or broccoli. Quality matters over quantity. And when it comes to what we eat, quality really, really matters.

    Resources Dietary patterns and depression risk: A meta-analysis. Psychiatry Research, July 2017.

    Diet quality and depression risk: A systematic review and dose-response meta-analysis of prospective studies. Journal of Affective Disorders, January 15, 2018.


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    Teens Who Self-Harm By Marie Hartwell-Walker, Ed.D. 21 Jun 2018

    Sandy’s mother, Lily, is beside herself. “I didn’t notice anything was wrong all winter,” she said. “Oh, she was quieter than usual and her grades weren’t the best. But we moved last fall and I figured she was just adjusting. Last week, though, spring really came on with 80-degree days and she insisted on wearing a wool sweater to school. Sandy got furious when I told her to go change. I’ve never seen her that upset! Three days of long sleeved shirts and I finally caught on. I’d heard about this, of course. But I never thought my daughter would be doing it. There are scars all up and down her arms!” Lily was doing her best to hold back tears. “Sandy wouldn’t come here with me. She won’t talk to me. What can I do?”

    Lily is upset and bewildered. She can’t understand why her beautiful, accomplished 14-year-old would do something so self-destructive and painful. She feels terrible that her daughter is hurting herself. She feels terribly guilty that she didn’t notice something that has apparently been going on for months.

    Sadly, Lily’s daughter is not alone. Self-harm has become far more common than most parents suspect. Some studies show that 2 to 3 million Americans engage in some form of self-injury (cutting, burning, or striking themselves to the point of soft tissue damage) each year. There are people who self-harm at every age, socio-economic, and ethnic group.

    Why do kids do it? Often they learn from peers that it can be a way to actually feel better. They may then read about it on the Internet. Sometimes it starts as an experiment; sometimes as as a response to a dare. Sometimes a group of kids try it out as a way to be cool. Sometimes it really does begin with an accidental injury. And, rarely, it’s the result of a failed suicide attempt.

    That last possibility especially terrifies parents. But kids who self-harm generally are not looking for a way to end life. They are actually looking for a way to end emotional pain, Some have found that hurting themselves brings their anxiety and stress down to a manageable level. Others, who have learned to dissociate (distance themselves from their bodies and minds) when under stress, find that the pain of inflicting injury brings them back in touch with themselves. Self-injury for these kids is a way to stay alive.

    Contrary to what some adults believe, self-harming is rarely a bid for attention. Most of these kids are ashamed of what they do and do their best to hide it. Ironically, the energy needed to keep it a secret only adds another stress. Some are mentally ill and although some may suffer from depression, most do not. The most common mental health diagnosis for a teen who self-injures is borderline personality disorder. For kids who self-injure, hurting themselves has become a primary coping skill in the face of challenging feelings or situations. Often these kids have also learned that their feelings are wrong or bad. Often they never developed less drastic ways to deal with stress.

    Self-harmers need to be understood, not scolded. They need to unlearn the idea that their feelings are “wrong” and learn that it’s okay to feel them. Most important, they need to learn new ways to manage stress and emotions that they find overwhelming.

    When asked a few questions about Sandy’s history, Lily revealed that she left her husband last summer after years of verbal abuse. “From the time Sandy was little, he’d yell at her that she was too sensitive whenever she cried. He would threaten that he’d give her something to cry about if she didn’t stop. He never actually hit her but I never knew if maybe this time he would. It was hard enough for me to put up with his rages but after a while, I couldn’t stand watching what he was doing to our daughter. When a possibility for a transfer with a raise came about, I just packed us both up and left. Funny thing is, she misses her dad.”

    Since Sandy won’t hear of coming to therapy, my job is to coach her mother. Lily needs to know that we can work as a team and that I don’t see her as a neglectful mom. Sandy has put a good face on the move and has even expressed how relieved she is to be out of all the family fighting. Meanwhile, Lily has been caught up with learning a new job and doing the thousand things that go with settling into a new town – from learning where to shop to finding a new doctor and dentist for them both. It’s no wonder to me that discovering that her daughter is cutting is a surprise and a shock. It often is.

    Lily’s first step is simply to validate Sandy’s feelings. It’s a reasonable guess that she both misses her dad and is angry with him; that she is glad her mother got her out of the situation, but feels guilty that she is glad. She both loves her mother and is angry with her for not only taking her away from her father but for taking her away from her home, her school, and her friends. It probably makes no sense to her that she is feeling all those feelings at once. Complicating things further is that she was raised by her dad to think that her sensitivities are somehow wrong.

    Lily needs to let her daughter know that she understands how overwhelming and confusing the move has probably been for her and that there are ways to handle her feelings that don’t put her at risk of giving herself a serious wound or leave her with permanent scars. Yes, Lily needs to be the mom. But she can also let Sandy know that the reason she can be understanding is that sometimes she also feels mad and glad and sad about the move and wishes there had been another way to make things better.

    Once Sandy feels supported and heard by her mom, I’m hopeful that she will come to the next appointment. If not, Lily can still be coached to help her daughter learn new ways to discharge the emotional buildup that happens when she keeps suppressing her feelings. We can teach her that physical exercise (dancing, running, going to the gym) can release the same relieving endorphins into her system that cutting does. We can teach her other ways to relax like taking a warm bath, listening to music or making art. And we can give her some coping skills. Deep breathing or washing her hands or or getting a cold drink of water can calm her while she works to get the urge to hurt herself under control. Most important, we can help her learn to value her feelings by keeping a journal and talking to her mom or a friend or even to me.

    While all this is going on, Sandy also may need a little help fitting in with her new school and making friends. Lily had lost sight of how hard it is for a kid to move in the eighth grade. She agreed that she could be more encouraging about having other kids hang out at her place and be a little less focused on grades for now.

    I’m certain that before we’re finished, we’ll also need to at least attempt to involve Sandy’s dad. She doesn’t miss his rages but there is more to him than a walking ball of anger. There were good times too. She loves the dad who shot hoops with her in the backyard and who joked around with her when he was feeling good. My guess is that he’s a guy who can’t tolerate his own feelings and who hated feeling out of control when his daughter cried. Perhaps if he feels understood, he’ll be open to working on himself and his relationship with his daughter. Lily is okay with the idea as long as she has assurance that we’ll prepare Sandy to deal with disappointment if her dad doesn’t respond.

    Coaching Sandy’s mom like this may work. Not all “therapy” happens in an office. A loving mother who can listen, stay calm, and offer some practical advice can also give a young person exactly what she needs. Learning some concrete ways to be helpful and having some support gives Lily hope and focus. She’s highly motivated to do the best she can for her daughter.

    If this method doesn’t work – or doesn’t work enough – my hope is that Lily’s efforts will help Sandy eventually feel okay about getting some additional support. She might come to see me, alone or with her mom, or she might be more comfortable joining a support group with other teens who are struggling to learn how to manage strong and sometimes contradictory feelings. Whatever path therapy takes, she’ll know her mom is there to help.


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    Child Protection Week South Africa 2018: What you need to know - 29 May 2018

    Child Protection week runs from 27 May to 3 June under the theme: “Let us protect all children to move South Africa forward.”

    Social Development Minister Susan Shabangu kicked off Child Protection Week by putting the spotlight on issues facing young South Africans under the age of 18. She spoke of the effects of social media on children and combating sexual abuse.

    National Child Protection Week is marked annually to raise awareness for the rights of children. It aims to mobilise all sectors of society to care for and protect children.

    Children’s Rights and the Constitution The Bill of Rights in the Constitution specifically states that every child has the right to be protected from maltreatment, neglect, abuse or degradation. South Africa has also drafted legislation to protect children based on the United Nations Convention of the Rights of the Child, and the African Charter on the Rights and Welfare of the Child.

    Protections are further reinforced through the Children’s Act, which emphasises the State’s role in the provision of social services to strengthen the capacity of families and communities to care for and protect children.

    The Child Justice Act (Act No. 75 of 2008) establishes a separate criminal justice system for children who have come in conflict with the law. The Sexual Offences and Related Matters Amendment Act (Act No. 32 of 2007) includes a wide range of crimes that commonly occur against children. The Prevention and Combating of Trafficking in Persons Act (Act 7 of 2013), deals with the global phenomena of child trafficking.

    However, despite these and other protections, many children still remain vulnerable to abuse, neglect and exploitation. In a statement, the government called on all South Africans to protect children:

    “As a society we have a duty to do more to ensure that the most vulnerable in our society do not suffer abuse. It is in our hands to stop the cycle of neglect, abuse, violence and exploitation of children. By working together we can create safer and healthier communities so that our children can thrive. Government calls on all South Africans to support Child Protection Week by wearing a green ribbon.”

    What is abuse? Abuse constitutes any behaviour that causes fear, bodily harm and forces a person to do things against their will. Forms of abuse include child abuse, rape, emotional abuse, physical abuse, sexual harassment and financial abuse.


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    Eating Disorders - By John M. Grohol, Psy.D. 14 Mar 2018

    Eating disorders are one of the unspoken secrets that affect many families. Millions of Americans are afflicted with this disorder every year, and most of them — up to 90 percent — are adolescent and young women. Rarely talked about, an eating disorder can affect up to 5 percent of the population of teenage girls.

    Why are teenage and young adult women so susceptible to getting an eating disorder? According to the National Institute of Mental Health, it is because during this period of time, women are more likely to diet — or try extreme dieting — to try to stay thin. Certain sports (such as gymnastics) and careers (such as modeling) are especially prone to reinforcing the need to keep a fit figure, even if it means purging food or not eating at all.

    There are three main types of eating disorders:

    Anorexia Nervosa

    Bulimia Nervosa

    Binge Eating Disorder

    Anorexia (also known as anorexia nervosa) is the name for simply starving yourself because you are convinced you are overweight. If you are at least 15 percent under your normal body weight and you are losing weight through not eating, you may be suffering from this disorder.

    Bulimia (also known as bulimia nervosa) is characterized by excessive eating, and then ridding yourself of the food by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. This behavior of ridding yourself of the calories from consumed food is often called “purging.”

    A person who suffers from this disorder can have it go undetected for years, because the person’s body weight will often remain normal. “Binging” and “purging” behavior is often done in secret and with a great deal of shame attached to the behavior. It is also the more common eating disorder.

    Eating disorders are serious problems and need to be diagnosed and treated like any medical disease. If they continue to go untreated, these behaviors can result in future severe medical complications that can be life-threatening.

    Treatment of eating disorders nearly always includes cognitive-behavioral or group psychotherapy. Medications may also be appropriate and have been found to be effective in the treatment of these disorders, when combined with psychotherapy.

    If you believe you may be suffering from an eating disorder or know someone who is, please get help. Once properly diagnosed by a mental health professional, such disorders are readily treatable and often cured within a few months’ time.

    A person with an eating disorder should not be blamed for having it! The disorders are caused by a complex interaction of social, biological, and psychological factors which bring about the harmful behaviors.

    The important thing is to stop as soon as you recognize these behaviors in yourself, or to get help to begin the road to recovery.


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    What does Depression feel like - By Gabe Howard 12 Mar 2018

    What Does Depression Feel Like? By Gabe Howard

    Feeling Depression I’ve lived with depression my entire life. As far back as I can remember, I thought about suicide every day. On good days, I decided that I wouldn’t commit suicide and on bad days, I would think about how I would do it.

    When I was younger, I didn’t realize this was abnormal. I assumed everyone thought about suicide daily. I just thought it was part of the human experience to weigh the pros and cons of living on an ongoing basis. I did recognize that I was sad — mostly because I recognized that others were happy.

    I didn’t know I was depressed, however. I just thought I was bad at life. I believed that I just hadn’t found what I needed to be happy. I spent the first 25 years of my life feeling as if I was always one step away from happiness.

    All of the accomplishments that I thought would make me happy didn’t. They would provide temporary happiness, of course, but a couple weeks of feeling like I was on top of the world would quickly decline into depression. When that would happen, I’d just choose a new something I needed in order to be happy.

    Depression Is Like You’re Running on a Treadmill

    In many ways, depression is like running on a treadmill. It takes a great deal of effort — along with a physical and mental toll — but you don’t get anywhere. But, unlike when on a treadmill, you don’t have any positive outcomes. No calories burned or smaller waistline. Just frustration.

    It’s difficult to explain depression to someone because it feels like emptiness. Depression is best described as feeling completely numb, rather than feeling badly. And for people with chronic depression, it feels normal, because chronic depression has a way of wrapping itself around a person and taking control of all emotions.

    It feels like swimming with someone who is trying to pull you under and not being sure you care whether they are successful. At first, you try to swim away, but after a while, you become comforted by the fact they are there.

    You start to relate to the person trying to drown you and wonder if they are right to pull you under. Subconsciously, you start swimming in areas where it’s easier for them to grab your ankle. The fact that they are trying to harm you becomes irrelevant, because you’re so used to that feeling that you can’t function without it.

    I don’t know that depression can every truly be understood by someone who hasn’t experienced it first-hand. When I’m depressed, I see no way forward. It’s an all-encompassing killer of emotions.

    Depression is not darkness without hope for light. Depression is being pulled into darkness and forgetting that light ever existed.