Could Schema Therapy Help Treat Narcissistic Personality?

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Narcissistic personality disorder (NPD), or narcissism, as it’s often called, is one of the cluster B personality disorders, or emotional/impulsive personality disorders.

Narcissism is one of the least studied personality disorders. Different subtypes of narcissism present with varying features, making diagnosis challenging. People with narcissism may also see no need for counseling and consider it pointless or beneath them. If they do begin therapy, they may react angrily when faced with challenges, try to manipulate their therapist, or find it hard to consider things from other perspectives. They often leave therapy early, especially if they don’t see any benefit in it.

Recent research aims to identify new therapy approaches that can help people living with personality disorders achieve lasting change. Schema therapy, one such treatment, is considered helpful for people who don’t respond well to other types of therapy. It’s proven effective in treating borderline personality, another condition long considered difficult to treat.

Research looking at schema therapy for narcissism is still in the early stages, but existing clinical data suggests it has promise.

People living with narcissism have a deep need for admiration and recognition and draw self-esteem from the praise and positive regard of others.

The Roots of Narcissism

Personality disorders are characterized by rigid, long-lasting patterns of behavior that affect life and relationships, causing distress and making it difficult to function. People living with personality disorders may not always recognize that some of their behaviors cause problems or affect others negatively.

Like other personality disorders, narcissism is a serious mental health issue. Many consider it more serious and harmful than most other personality disorders, since people with narcissism generally lack empathy and may not care about the effects of their actions.

The causes of narcissism aren’t fully understood. Some potential factors in development may include:

  • Having a parent who is extremely adoring or overly critical, or a parent who switches between these modes
  • Having a parent with narcissism
  • Inheriting certain traits that increase risk for personality disorders
  • Experiencing trauma, abuse, neglect, or indifferent parenting

People living with narcissism have a deep need for admiration and recognition and draw self-esteem from the praise and positive regard of others. Since connecting with people on an intimate level requires a level of vulnerability, people with narcissism may avoid meaningful relationships in order to protect their illusion of grandiosity and keep an unstable self-identity from being revealed.

Researchers have identified four main subtypes of NPD. It’s possible to have features of multiple subtypes or shift between subtypes at different points in life.

  • Overt narcissism most often involves entitled, attention-seeking behavior. A primary feature is an exaggerated sense of self-importance. People with this subtype tend to be charming and arrogant and often exploit others. They may do fairly well in the workplace but struggle to get along with others or do tasks they consider demeaning or otherwise beneath them.
  • Covert narcissism may include anxiety, significant emotional distress, and extreme sensitivity to criticism or perceived insults. This subtype is often characterized by shyness, even social isolation. People with covert narcissism tend to have an internal sense of superiority and fantasize about their talents being recognized while speaking modestly about themselves, even putting themselves down.
  • High-functioning narcissism involves similar traits to overt narcissism, but people with this subtype can generally function well in society and may not appear to have a personality disorder. They are often able to adapt narcissistic traits such as charm and competitiveness in order to achieve success and may have relationships that are shallow but lasting. Criticism, perceived failure, or age-related challenges such as poor health or perceived loss of attractiveness may cause distress or crisis.
  • Malignant narcissism, considered the most severe subtype, involves overt narcissism traits along with traits of antisocial personality and paranoia. People with this subtype may lie and manipulate others easily, behave in aggressive ways, enjoy intimidating others, and avoid any work or task unless it benefits them in some way. They often have no desire to change, so treatment may be very difficult.

Narcissism often involves symptoms that are less known than grandiosity and lack of empathy, including:

Most people with narcissism struggle to maintain employment and personal relationships, changing partners readily when they don’t receive the admiration they need. It’s also common for people to fantasize about being recognized for their superiority and humiliating people who have “wronged” them.

When therapy can help address these concerns, particularly vulnerability and self-esteem, narcissistic behaviors may improve.

Schema Therapy: An Effective Treatment for Narcissistic Personality?

Even when people with narcissism do seek therapy, whether for distress related to narcissism or other mental health symptoms, treatment can be complicated. Believing a therapist has insulted them, failed to recognize their specialness, or isn’t skilled or reputable enough to treat them leads many people with narcissism to quit therapy early in treatment. Research suggests therapy progresses more slowly for people with narcissism, leading to slower improvement of symptoms.

Schema therapy, however, may have increased potential to treat NPD. Schema therapists offer support and validation while helping people work to understand and address the emotional mindsets causing problems in their life. For narcissism, this is often the persistent, private sense of inferiority and fear of failure.

Schema therapy combines elements of cognitive behavioral therapy, emotion-focused therapy, Gestalt therapy, and psychodynamic therapy, among others. The idea behind this approach is that schemas, or patterns of thought and behavior, develop as a result of unmet emotional needs and other early childhood experiences. These schemas are reinforced throughout life by challenges, abuse, trauma, and other negative or harmful experiences. Unless they’re addressed in positive ways, they contribute to the development of harmful or unhealthy methods of coping. These coping styles can affect behavior throughout life, often in ways that cause distress.

Schema therapists offer support and validation while helping people work to understand and address the emotional mindsets causing problems in their life.

The goal of the approach is to help people identify needs that weren’t met in childhood and learn how to get them met in healthy ways that don’t cause harm, either to themselves or to others. To help clients achieve this goal, schema therapists group schemas and coping responses into modes and use a range of strategies to address them, including roleplay, interpersonal techniques, and cognitive behavioral approaches. Therapists may set limits, as a parent would, within the bounds of the therapeutic relationship to help clients confront schemas.

The schema modes commonly associated with narcissism are:

  • Detached Protector/Self-Soother: This avoidant mode involves behaviors that are soothing, stimulating, or distracting—anything that helps turn off emotions. These behaviors might include substance abuse, risky sex, gambling, fantasizing, or overwork. It’s also common to shut out or reject people as well as emotions. Typical function isn’t always affected, but it may seem almost mechanical and lack any personal investment.
  • Self-Aggrandizer: A mode in the overcompensation category, this involves many behaviors typically associated with narcissism—superiority, entitlement, and manipulative tactics. People in this mode tend to show little interest in anyone but themselves, boast of real or inflated achievements, and openly seek admiration to avoid revealing hidden vulnerabilities and insecurities.

By confronting these modes and working through them with the help of the schema therapist, people in therapy can begin to access the Healthy Adult mode, which helps heal the vulnerabilities of early childhood and fosters healthier modes of coping. After reaching this mode, people may be able to begin functioning at a more typical level and be more able to take responsibility for their actions and see how they affect others.

Schema therapy has been successful in the treatment of other personality disorders, including borderline personality. Clinical trials on its use with narcissism are still forthcoming, but research and clinical observations suggest schema therapy could help people with narcissism have more success in treatment.

Why Do Narcissists Seek Therapy?

People living with NPD often believe themselves superior and struggle to consider the feelings and needs of others. This can make their actions particularly hurtful. Narcissism also often involves intentional manipulation or emotional abuse—behaviors that cause significant pain to partners of people with narcissism. In fact, many therapists specialize in helping the partners of people with narcissism heal.

The typical traits linked to narcissism, along with the tendency of many with NPD to see nothing wrong with their behavior, have contributed to the belief that therapy can’t treat narcissism. But therapy can help people with narcissism improve—if they want to change.

Andrea Schneider, LCSW, a therapist in San Dimas, California, explains what might prompt a person with NPD to seek counseling. “Typically,” she says, “Someone … with narcissistic personality may have some flexibility with some behavioral change when they are confronted with significant stressors (like a relationship ending or other crisis).”

People with NPD may not ever seek therapy for symptoms associated with narcissism. Instead, they might decide to get help for other symptoms or issues. These could be co-occurring conditions or long-term mental health effects associated with narcissism. In many cases, it’s these challenges that contribute to the desire for change.

People with narcissism may seek help for:

Narcissistic personality and associated conditions can significantly impact quality of life and emotional well-being. Addiction and stress can cause health concerns, for example, while the inability to sustain a relationship could lead to complete isolation.

To date, few studies have looked at treatment for narcissism because people with NPD don’t seek therapy often. If they do, they may only do so because someone else has urged them into it. Therapy can still have benefit, but the person with narcissism must recognize the problems with their behavior and make efforts toward change.

Finding a Schema Therapist

People who don’t see a need to address their behavior are unlikely to be able to make lasting change. But research on schema therapy suggests the approach could benefit people living with narcissism when other types of therapy don’t help. Experts do agree that narcissism often poses treatment challenges for therapists and can make progress in therapy difficult.

Schema therapy involves validation and empathy for a person’s difficulties and distress. When people with narcissism approach therapy with a willingness to change, or at least to make an effort to address harmful behaviors, the mode work involved in schema therapy may help them learn to confront the vulnerabilities they fear in a healthier way.

It can be difficult to find a schema therapist, especially if you live in a smaller city. But many therapists may be trained to incorporate elements of schema therapy into treatment. If you or a loved one has symptoms of narcissistic personality disorder, consider reaching out to a therapist who offers schema therapy or practices mode work. Don’t be discouraged by the myths about narcissism—change is possible for anyone. Begin your search for a trained, compassionate counselor today.

Author’s Note: If you’re involved in a relationship where there is intimate partner abuse of any kind—physical, emotional, or sexual—relationship therapy is usually not recommended. We encourage you to review our crisis page and reach out for support.

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
  2. Behary, W. T., & Dieckmann, E. (2011, July 20). Schema therapy for narcissism: The art of empathic confrontation, limit-setting, and leverage. In W. K. Campbell and J. D. Miller (Eds.), The handbook of narcissism and narcissistic personality disorder: Theoretical approaches, empirical findings, and treatments. Hoboken, NJ: John Wiley & Sons.
  3. Behary, W. T., & Dieckmann, E. (2013). Schema therapy for pathological narcissism: The art of adaptive reparenting. In J. S. Ogrodniczuk (Ed.), Understanding and treating pathological narcissism (pp. 285-300). Washington, DC, US: American Psychological Association.
  4. Caligor, E., Levy, K. N., & Yeomans, F. E. (2015, April 30). Narcissistic personality disorder: Diagnostic and clinical challenges. American Journal of Psychiatry, 172(5). Retrieved from https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14060723?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
  5. Dieckmann, E., & Behary, W. (2015). Schema therapy: An approach for treating narcissistic personality disorder. Fortschritte der Neurologie-Psychiatrie, 83(8), 463-477. doi: 10.1055/s-0035-1553484
  6. Ekselius, L. (2018). Personality disorder: A disease in disguise. Upsala Journal of Medical Sciences, 123(4), 194-204. doi: 10.1080/03009734.2018.1526235
  7. Mayo Clinic Staff. (2017, November 18). Narcissistic personality disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/narcissistic-personality-disorder/symptoms-causes/syc-20366662
  8. Ritzl, A., Csukly, G., Balázs, K., & Égerházi, A. (2018, September 13). Facial emotion recognition deficits and alexithymia in borderline, narcissistic, and histrionic personality disorders. Psychiatry Research, 270, 154-159. doi: 10.1016/j.psychres.2018.09.017
  9. Young, J., & First, M. (2003). Schema mode listing. Retrieved from http://www.schematherapy.com/id72.htm
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Podcast: There’s More to Trauma than PTSD

This is an interesting article I found on: www.psychcentral.com

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Most of us are familiar with post-traumatic stress disorder. PTSD (deservedly) gets a lot of attention, largely focused on soldiers returning from service. But trauma comes in many forms, and most people have experienced it in one form or another. In this episode, learn about the differences between PTSD and other forms of trauma, how to identify it, and what can be done about it.

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About Our Guest

Robert T. Muller, Ph.D., is the author of the psychotherapy book, “Trauma & the Struggle to Open Up: From Avoidance to Recovery & Growth,” which focuses on healing from trauma.

Dr. Muller trained at Harvard, was on faculty at the University of Massachusetts, and is currently at York University in Toronto. He has over 25 years in the field.

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TRAUMA SHOW TRANSCRIPT

Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Narrator 1: Welcome to the Psych Central show, where each episode presents an in-depth look at issues from the field of psychology and mental health – with host Gabe Howard and co-host Vincent M. Wales.

Gabe Howard: Hello, everyone, and welcome to this week’s episode of the Psych Central Show Podcast. My name is Gabe Howard and I’m here with my fellow host Vincent M. Wales and our guest today is Dr. Robert T. Muller and he is the author of the psychotherapy book Trauma and the Struggle to Open Up: From Avoidance to Recovery and Growth, which focuses on healing from trauma. Robert welcome to the show.

Dr. Robert T. Muller: Very, very glad to be here.

Vincent M. Wales: We are glad to have you. So the word trauma is thrown around a lot these days. What do we really mean by that?

Dr. Robert T. Muller: Well, so there are different kinds of traumatic experiences but they all are based in the fact that something clear has happened to the person in the external world. Something that overwhelms their normal coping abilities and this can be a natural disaster, of course, but it can also be an event that occurs in the home. It could be something like physical or sexual abuse from a caregiver or various kinds of assault. And these are experiences that are overwhelming and most people who go through these overwhelming experiences don’t end up with post-traumatic stress disorder or various kinds of consequences. But a number of them do. and when they do and they’re left with these feelings of great distress and that’s what we refer to as trauma. The feelings that are left in the person that affect them, that affect their choices, that affect their relationships, that affect the way they engage in friendships following an overwhelming experience. And it’s hard, it’s very, very tough for people to deal with.

Gabe Howard: You know, outside of people who work in this field, the only really thing that they understand about trauma is post-traumatic stress disorder. That’s like the closest that the general public gets when you’re talking about trauma. Where does PTSD fit in? Can you kind of help people understand that?

Dr. Robert T. Muller: So the term PTSD we see in the psychiatric literature, and by PTSD we mean that the person has a disorder after a traumatic event post-traumatic stress disorder. So that means that they are continuing to suffer and by disorder we mean that their mental health is suffering and that they’re experiencing symptoms of re-experiencing the event, flashbacks. They may remember and have memory intrusions, memories of the event. And that’s very severe. They also have startle responses where they’re stressed very, very easily and by stress that can be very overwhelming stress. They also have problems with mood because they often feel depressed because of these traumatic experiences. And then finally they try to stay away from the things that remind them about whatever happened. So we see post-traumatic stress disorder in Vietnam vets, Gulf Wars vets, vets who’ve come back from Afghanistan, for sure. So we can also see these symptoms in victims of domestic violence and people who have been to experiences even who haven’t gone to war. So PTSD refers to the psychiatric language that’s used to describe the symptoms that many people have after a traumatic event. So that’s what it’s really meant by PTSD.

Gabe Howard: Thank you so much for that. And just to clarify, you can be traumatized and not develop PTSD. Is that correct?

Well you can be. Yeah. So here we get into a little bit of different words can sometimes mean similar things but when we talk about someone who is traumatized, they have all kinds of symptoms. They may not have exactly that cluster of things that I mentioned that we call PTSD but they’re going to have very similar experiences. There’s something called Complex PTSD and that’s a little bit different. Complex PTSD refers to people very often who have had traumatic events happen in childhood and in relationships. They feel betrayed by people who have who they thought were going to care for them the most. And when people have complex PTSD, very often what they have are huge problems in relationships. So, they’ve been hurt by somebody, they may feel tremendously abandoned by someone who they trusted. And then in life and in relationships, they now struggle to trust and they often really question other people. They question whether they can really trust them and they have a hard time with developing relationships because they feel scared. There are many feelings of fear that come over them. Shame, feelings of shame are common in complex PTSD. So, complex PTSD can take longer to heal than PTSD. If treatment for PTSD tends to be something more like six months to a year, treatment of complex PTSD can be two, three years, maybe even four years something like that. Pretty common. So those are some distinctions.

Vincent M. Wales: Thank you. Gabe and I are both very familiar with abandonment disorder and that sort of thing, attachment disorders. And there seems to be a very clear relation there with complex PTSD?

Dr. Robert T. Muller: For sure there is. There often is that for sure. There are feelings of abandonment very often and people with complex PTSD, and there are attachment problems. So, by attachment, that means that in times of distress they have difficulty turning to others who if you had a secure, what’s called a secure attachment, you might have an easier time turning to the people who feel, you know, should care about you. You know you might do that more easily; you might turn to them and ask for help and feel comfortable with that. But when people have what’s called an insecure attachment, and this is very common in complex PTSD, they have a great deal of difficulty turning to those people, who really you would think that they could turn to, their husbands, wives, their friends. They have a hard time turning to them because they feel very very frightened very often that people are going to just going to let them down. It’s a very very challenging disorder to treat. But it’s important for a therapist who works with people like this be what’s called trauma informed. Where they know about the effects of trauma so they can help people like this manage and find their way through their trauma.

Gabe Howard: Trauma informed care is something again, coming up more and more in mental health circles. Can you explain what trauma informed care means?

Dr. Robert T. Muller: So, there are many conditions that are related to trauma. It’s not just trauma therapists who come across people who have trauma histories. Family doctors very often will come across people who come in complaining of migraines, fibromyalgia, chronic fatigue, irritable bowel syndrome, immune system kind of disorders, stress related disorders. All of those are greatly exacerbated in people who have trauma histories. So it’s very important for family doctors. It’s very important for teachers, actually, to be trauma informed because you may see a kid in your class who appears like they have ADHD. They can’t sit still, they’re irritable, and that may also be a reaction to trauma. And I’m not saying that every person with all these disorders has a trauma history. I’m not saying that. Most of time people have migraines not because of trauma. But, if you do have a trauma history, all of those conditions can be greatly exacerbated. And so it’s very important for professionals who work interpersonally with people, family doctors, chiropractors, dentists, temporomandibular joint dysfunctions can be a symptom of trauma. Teachers, nurses, it’s very important for them to be trauma informed. For them to understand about the different manifestations of trauma. And there are many very often the immune system because of the stress of trauma the immune system has been affected. And that makes you more susceptible to a variety of different disorders. That’s why you need to be trauma informed.

Vincent M. Wales: Now for someone who has a pre-existing mental illness, whether it’s bipolar, or depression, or what have you, how are they affected by trauma? Is it any differently than someone without those issues?

Dr. Robert T. Muller: Yeah. Yeah. So trauma exacerbates other kinds of conditions. People have, let’s say, a family history of depression or family history of bipolar illness and then very traumatic thing happens to them. That can exacerbate other problems that they have. So it’s very difficult to disentangle this symptom is caused by this and this is a symptom caused by that. It’s impossible really to disentangle what’s caused by what. But what you do want to do is you want to work with people if you’re doing therapy with an individual who’s been through this. You want to work with them in a way where if somebody has bipolar illness where you get them seeing a good psychiatrist who can prescribe the right medication. But then if they have a trauma history that doesn’t mean that that’s it. That medication is all of the treatment. No. Somebody has a trauma history, they’ve got to find a way to talk about what’s happened to them. And that’s very difficult when you’ve been through trauma. It’s hard to talk about. And so good trauma informed therapies will work with a person in a measured, paced way to help them slowly feel comfortable. We’re starting to talk about what happened. And that can be very, very challenging.

Gabe Howard: It’s interesting. As someone who lives with bipolar disorder, I know the importance of being able to tell my medical team, whether it’s a psychiatrist, or a social worker, or a psychologist, you know, what’s going on inside my head, what my challenges are, what I need help with. It sounds like you’re saying somebody who just has a trauma background really needs to respond the same way. They have to be able to explain that to their medical team in order to get the right care.

Dr. Robert T. Muller: Well the thing with trauma is that people, a lot of professionals are not trauma informed. And so what ends up happening is that you get people going in for symptoms. So somebody with a trauma history, a typical kind of presentation. I’ll just give a name, Susan. Susan was raped let’s say in university. She experiences all kinds of difficulty in classes. She then goes and sees her doctor, gets put on an antidepressant. Is O K for a year or two on this antidepressant. And then, she starts to date again and then whoa. All these symptoms start to come back. She starts to experience confusion. She experiences other symptoms like headaches. She goes back and gets sent to a specialist. Then she says she has difficulty with her eating. Then the question of what? Does she have an eating disorder? And so what you end up with is this smorgasbord of different professionals. You know, this person specializes in depression, that person specializes in eating disorders, this sort of person specializes in migraines and whatever, trying to treat this person. And you don’t have a coherent treatment plan. And it’s because none of these professionals actually sat down and said, “Tell me a little bit about what happened in your life for the last five years. Walk me through it. What’s happened? Anything important? Tell me about it.” And if you do that with people, you can look for this. Sort of sitting down where you can say OK. Yes. Look at this. This person’s had these depression symptoms and this eating disorder seem to have really gotten a lot worse when dot dot dot. And then you could start to put the pieces of the puzzle together. And so you’re not just treating for this disorder or that disorder or the other disorder, but you develop a coherent plan to help the person find a way to start to deal with the underlying trauma that led to a variety of different responses. So that’s where it’s really important to be trauma informed.

Gabe Howard: We’ll be right back after these words from our sponsor.

Narrator 2: This episode is sponsored by BetterHelp.com, secure, convenient and affordable online counselling. All counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face-to-face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counselling is right for you. BetterHelp.com/PsychCentral.

Vincent M. Wales: Welcome back. We’re here with Dr. Robert T. Muller discussing trauma. There’s a therapy relationship. What’s so important about that?

Dr. Robert T. Muller: Well it’s really, really important, the therapy relationship. And in trauma work, that’s absolutely true. It’s even true in other kinds of psychiatric or psychological problems. Research on outcomes of mental health problems and treatment strategies, what we find is, that regardless of the school of thought that the clinician uses, let’s say people go to see a cognitive behavioral therapist, or the person goes to see a psychoanalyst, or the person goes to see a Gestalt therapist, you name it. Regardless of the school of thought, the one thing that seems to run throughout therapy is the benefits of having a good, strong psychotherapy relationship. And so this means that if you’re a cognitive behavioral therapist, it might be that the person got better in part because you help them look at their underlying thoughts and how their thoughts affect their feelings and how to help them change their behaviors and they’ll improve their feelings. Maybe. Maybe that’s a piece of it. But it also is the case for research what we know is that if you do that in the context where the two of you are really working together and feel like you’re on the same page then therapy will be much more effective. So this is true for all schools of thought of therapy and psychoanalysis and everything else. And so this therapy relationship research shows is really important. So what does that mean? That therapist and client are working together, on the same page working toward similar goals. The same goals really. You have to have similarity of thought around the goals and there’s a sense of warmth. There’s a sense that the client feels that their therapist gives a darn. That they really do actually care. And that the therapist gets it. That the client has to feel that the therapist gets it and is listening and paying attention. These are really important skills. And you know, Carl Rogers in the 1950s really honed in on this. And since then we’ve come up with all kinds of therapies. And I’m not saying these other therapies are not helpful. I’m just saying that going back to basics is really important. That the skills that Rogers taught around empathy turned out to be, in fact research shows, they’re very important. This is really the case with trauma therapy. When you’ve been traumatized and you’ve been traumatized most often when people feel in relationships that they’ve been hurt, then they might work with a therapist and think my therapist doesn’t like me, or my therapist is going to abandon me. My therapist is judging me. And it’s understandable that you’d feel this way as a client. If you’ve been hurt, when your trust has been violated, you’re going to be very cautious for good reason in relationships, and you’re even going to be cautious around your relationship with your therapist. You don’t know whether your therapist is just trying to manipulate you. In all fairness, you don’t know. And so it’s very important for the therapist to be attentive to these kinds of relational issues and trauma. Are my client and I are on the same page? And that sort of thing.

Gabe Howard: Who should go to trauma therapy? I mean who is, I know that the answer might be anybody who is traumatized, but you know more specifically, like who is trauma therapy for exactly?

Dr. Robert T. Muller: So very often if you’re holding something that feels like it’s a huge burden that’s something to notice. So pay attention. Pay attention to this question. Ask yourself, am I carrying around a deep burden from years ago? Am I holding on to a secret? A secret that if other people knew, I would feel judged? I would feel that they would hate me? I would feel ashamed of those sorts of things? Am I being loyal to people who harm me? Those are all questions that you can ask yourself. I talk a little bit about this in Trauma and the Struggle to Open Up, the idea of how people, how many trauma symptoms develop, and these themes are really, really big. The themes of secrecy, feelings of betrayal, themes of loyalty to those who maybe you shouldn’t necessarily be so loyal to. But those are the kinds of questions to ask yourself. That is does the thought or some memory about something, does it make you feel sick? Does it make you feel like this feeling of I’m a bad person? You know, when I think about x y z that happened to me, I feel terrible guilt. How could I? How could I have done that? If you’re asking some questions like why me? Or if you’re asking questions of yourself like why not me? Why did X Y Z happen to my brother and not me? Those sorts of questions are very important questions that can be addressed in trauma therapy. And very often people have those questions in association with symptoms. When you know when you think about x y z that I just mentioned, maybe you feel depressed? Or maybe you feel self-loathing or disappointed in yourself? Why did I do that? Why didn’t I help my sister when such and such? When dad was, I don’t know, especially when Dad was drinking the way he was or mom was? Why didn’t I? So if you ask yourself those kinds of questions and you’re pained by it, that might be a sign that getting help, that talking to a therapist around your history is important. Because you’ve been trying to deal with this on your own for so long, and that can feel very lonely, it can feel very burdensome. And you don’t have to be alone in dealing with these things. That’s where I would think of therapy.

Vincent M. Wales: Right. We also have what we call post-traumatic growth. Is that just a fancy word for recovery or?

Dr. Robert T. Muller: Well no. No, it’s related to recovery. I mean people you hope that through trauma therapy people will get back to the way they were before you know they started really deteriorating. But it doesn’t exactly work that way. Recovery is a bit unpredictable. And what happens is as people start to talk about their problems, and start to talk about their history, they start to deal with things in a way that they never dealt with before. And so they start asking themselves questions like I mentioned. Why me? Why not me? Maybe those kinds of questions. Like what’s my place in the world after what happened to me? I thought my identity would be such and such but now I just don’t know. So when you start addressing questions like that, those kinds of questions lead to a re-evaluation of yourself. And so along with recovery, along with feeling better, along with removing, or removing and recovering from these psychiatric symptoms, that you really want to recover from, along with that comes a new understanding as you start to delve into issues from the past. And so that’s where there’s an opportunity for what’s called post-traumatic growth. That through the process of talking about and questioning and dealing with, there’s a reckoning. And that reckoning can help you grow in ways you may not have imagined. You may realize things about yourself that you hadn’t really thought of before. You know, like you may realize things like previously when I thought about such and such, I just felt guilt about what I did. But now, as I think about it now, actually, I was pretty strong the way I stood up to so and the way I did such and such. And I feel, I actually feel proud of myself for that. That may not sound like a big deal, but it can really feel like a big deal if you’ve felt ashamed of yourself for so long.

Gabe Howard: Do you do you think there’s a lot of people who are suffering from trauma who just don’t realize it? And how do we reach those people? Because you can’t exactly go ask for help if you don’t know that you are in need of help, right?

Dr. Robert T. Muller: Well this is why trauma education is so important. There’s getting to be more and more education about this. I have an online therapy and mental health magazine called The Trauma & Mental Health Report where you know my students and I, we publish articles and they’re very, very straightforward articles written for general consumption. They’re not academic heavy kinds of articles. And we’re trying to teach people about what happens in trauma. We have a lot of stories. You know for example, one of my favorite stories is A Corporal Speaks: 10 Questions for a Soldier Who Served in Afghanistan. And he tells his story. This corporal who came back and happened to be a Canadian, and who served alongside Americans. And many of the stories relate actually to the American soldiers who he served with. And it’s just a really interesting story. And these stories and so we’re trying to teach about how people struggle with these things in a way that the general public can start to learn. Not just people in mental health or whatever academics who know about this stuff, but that people in the general population can start to learn about this. And I think there’s greater interest. There’s more interest lately I’ve noticed in the topic of disassociation, people who have been through trauma, many of them dissociate. So they check out. They sort of go absent at times, you know. Why do they do this? Because sometimes. emotional trauma can be so overwhelming that they lose focus and lose attention to that and start thinking about some totally different things. And that allows them to feel okay. But you know that can be very very challenging when you dissociate a lot in your everyday life. So there’s a little bit more knowledge about that in the general public. I mean I’m noticing increasingly. So I think it’s, I think it’s really about education. And I think what you guys are doing here with this podcast and other people, other mental health podcasts, are becoming much more commonplace and people are asking these questions. There’s more stuff out there. I think that I think is the way to get people to learn about this stuff.

Gabe Howard: We agree with everything you just said except other mental health podcasts. We’re completely unaware of any other podcast other than this one. Don’t search for them. No, just kidding. I just have a couple of more questions because we’re about out of time. But one is please talk about your book for a moment and where folks can find it. I’m assuming you’re going to say Amazon. And what got you interested in researching and writing about trauma in the first place? I imagine they go kind of hand-in-hand.

Dr. Robert T. Muller: Yeah, that’s for sure. So I’ll do the thing about the book. It’s called Trauma and the Struggle to Open Up: From Avoidance to Recovery and Growth. It is available on Amazon and mental health bookstores as well. So there’s a hardcopy and a Kindle as well. So. what got me interested in trauma is not a short answer, but also what originally got me interested is a little bit different than when I realized, you know years later when I worked in the field for a long time. Originally, I just thought it was you know an interesting research topic and my supervisor was interested in it in graduate school. But what I realized in my 40s, was that there was a much deeper unconscious reason, I think, that I really got drawn into it. And I also realized that much more so as I did my own psychotherapy. And that is that my parents were children during the Holocaust. And both of them actually were separated from their families, and I believe to some extent traumatized by the Holocaust to some extent. I would say that their childhoods were shaped in ways that you can never imagine. My father’s father was actually killed. My mother’s parents were not killed they were okay, but they were there. My mom was separated from them. She was only 6 years old. She was separated from her parents for months. And so it was terrifying for a 6-year-old. She had no idea where her parents were and they left her in the care of a non-Jewish woman. Again, this saved my mom’s life, but this was a terrifying experience for her. And so I grew up with stories about the Holocaust and with stories about what it was like to be a child during the Holocaust. What it means to lose your innocence as a child. What it means to lose your childhood as a child. And so those kinds of experiences I think to a very large extent shaped me. I believe that’s ultimately why I went into this. Why I went into this field and why I can connect with trauma survivors I think it’s that experience. That’s a fair answer.

Gabe Howard: Yes. Thank you so much.

Vincent M. Wales: Wow. Well thank you for sharing that story with us.

Dr. Robert T. Muller: No problem.

Vincent M. Wales: That’s really heavy. And thank you so much for being here and for informing us on trauma so that we can recognize it and deal with it when we have it.

Dr. Robert T. Muller: OK. Ok. My pleasure.

Vincent M. Wales: And remember, you can get one week of free, convenient, affordable, private online counseling anytime anywhere by visiting BetterHelp.com/PsychCentral. Thanks. We’ll see you next week.

Narrator 1: Thank you for listening to the Psych Central Show. Please rate, review, and subscribe on iTunes or wherever you found this podcast. We encourage you to share our show on social media and with friends and family. Previous episodes can be found at PsychCentral.com/show. PsychCentral.com is the internet’s oldest and largest independent mental health website. Psych Central is overseen by Dr. John Grohol, a mental health expert and one of the pioneering leaders in online mental health. Our host, Gabe Howard, is an award-winning writer and speaker who travels nationally. You can find more information on Gabe at GabeHoward.com. Our co-host, Vincent M. Wales, is a trained suicide prevention crisis counselor and author of several award-winning speculative fiction novels. You can learn more about Vincent at VincentMWales.com. If you have feedback about the show, please email [email protected].

About The Psych Central Show Podcast Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar and anxiety disorders. He is also one of the co-hosts of the popular show, A Bipolar, a Schizophrenic, and a Podcast. As a speaker, he travels nationally and is available to make your event stand out. To work with Gabe, please visit his website, gabehoward.com.

Vincent M. Wales is a former suicide prevention counselor who lives with persistent depressive disorder. He is also the author of several award-winning novels and creator of the costumed hero, Dynamistress. Visit his websites at www.vincentmwales.com and www.dynamistress.com.

Podcast: There’s More to Trauma than PTSD

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A Couple’s Guide to Coping with Infertility

This is an interesting article I found on: www.goodtherapy.org

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If you and your partner have been trying to get pregnant for a year or longer but haven’t yet conceived, it’s possible you are facing fertility issues. You might already have started talking with your doctor about these challenges and your options for getting pregnant.

Most likely, your doctor is monitoring all aspects of your physical health. But it’s important to take care of your emotional well-being too. People who want to have a child but struggle to get pregnant may face a range of emotions, including anger, frustration, grief, and shame. If these emotions aren’t dealt with productively, they can fester and contribute to pain, resentment, or mental health issues such as depression.

Infertility not only affects you and your partner individually, but also your relationship. Here, we’ll discuss problems you may face as a couple if you’re dealing with infertility and ways you can address them. When difficulties are managed in healthy ways, you’re more likely to grow stronger as partners than grow apart.

Social Stigma Around Infertility

Discovering how common infertility is surprises many people. According to the Centers for Disease Control and Prevention, 12% of American women between the ages of 15 and 44 have trouble getting pregnant or struggle to carry pregnancies to term when they do conceive.

Once a couple marries, it’s often assumed they’ll begin trying to have a child. Certainly, this assumption is flawed in more ways than one, but one main issue is the stigma that often results. Your parents and friends might ask prying questions. Social situations may become uncomfortable if your friends don’t seem to understand what you’re going through. People may avoid inviting you to events like birthday parties or baby showers. Even if they do so out of good intentions, you may still end up feeling excluded.

It’s important to experience your feelings as they come, but it’s also important to avoid blaming yourself or your partner. Blame, self-directed or otherwise, can trap you in a painful cycle that leads to more distress.In the past, women took much of the blame for infertility. While it’s known today that infertility can result from male or female factors, women may still struggle with feelings of failure or shame. Men may deal with similar pain but find it harder to talk about. In society as a whole, there can be a general feeling that couples without children are somehow incomplete, a judgment that can make the distress of infertility even more painful.

In recent years, many celebrity couples have shared their experiences with infertility, including Michelle and Barack Obama. Maybe you’ve talked about your infertility with a loved one and felt empowered and supported by their reaction.

Infertility issues often feel like a private struggle. But reducing the stigma could help more people feel comfortable talking about their own difficulties becoming pregnant. People who don’t feel ready to open up may still draw support from knowing they aren’t alone. No matter which factors contributed to infertility, neither you nor your partner should feel shame.

Avoiding Blame and Shame

Letting yourself experience grief is an important part of coping with infertility. Even if you’re pursuing fertility treatments, facing the reality that becoming pregnant may not be possible can have a heavy emotional impact. Grief and sadness may be your first reaction.

Sometimes the cause of infertility can’t be determined. But finding out infertility issues stem from you can lead to decreased self-esteem, depression, and anxiety. If your partner is the one who is infertile, you may might feel frustrated. You may struggle to keep from blurting out that it’s their fault, not yours.

It’s important to experience your feelings as they come, but it’s also important to avoid blaming yourself or your partner. Blame, self-directed or otherwise, can trap you in a painful cycle that leads to more distress.

Counselors who work with couples dealing with infertility recommend talking to your partner about how you feel, openly and honestly. This might be difficult when you’re angry, but remember: You and your partner are a team, and communication is essential in a good team. Even if you’re angry, hurt, or ashamed, it’s usually better to talk about your emotions calmly, rather than waiting until they burst out during an argument or stressful moment. You may decide not to share your struggles with family and friends, but commit to being honest with each other.

Choosing Other Fertility Options

Assisted Reproductive Technology (ART) helps many couples treat fertility issues. When considering your options, it’s important for you and your partner to agree on how long you’ll pursue treatment, how much money you can spend, and what treatments you’ll try.

Have an honest discussion with your partner about treatments you’re uncomfortable with before planning on any procedures.Your insurance may not cover all (or any) of the cost of fertility treatments. Beginning treatment with a financial limit can help you avoid putting yourself in financial difficulty by continuing indefinitely.

It’s also helpful to decide on a length of time you’ll try treatment for. ART can give you hope, but treatments don’t always work right away. Sometimes they don’t work at all. The uncertainty and stress associated with treatment can have a negative effect on your relationship. Though you may feel renewed grief if you approach the end of the time period and still haven’t conceived, having a limit in place can help relieve some of the uncertainty and emotional distress.

Depending on your specific fertility issue, a range of treatments may be available. Options include medication, in vitro fertilization, and intrauterine (also called artificial) insemination. You might also choose to use donor eggs or sperm or have a surrogate carry a fertilized egg to term.

Some of these options may not work for you due to religious, ethical, or personal beliefs. For example, some people consider freezing embryos to be unethical. Have an honest discussion with your partner about treatments you’re uncomfortable with before planning on any procedures.

Addressing Infertility in Couples Counseling

Though it’s possible to maintain a strong, committed partnership while navigating infertility issues, taking preventative steps can help keep your relationship healthy. Research suggests infertility is a highly stressful and upsetting experience, and any type of stress can affect a relationship negatively. Couples therapists recommend seeking help early on instead of waiting until the crisis you’re facing starts to significantly affect your relationship.

A 2017 study found evidence to suggest couples with compatible coping methods had better communication and were more likely to develop a stronger relationship despite infertility. In other words, it is often better to deal with the issue as a team, even when your instinct may be to deal with your pain alone. Therapy can help you and your partner develop strong coping strategies and quit maladaptive behaviors such as avoidance.

Therapy also provides a safe space for you to talk about your feelings regarding infertility and mental health symptoms you’re experiencing. (Talking about these in individual therapy may also be recommended). Your therapist can support you and your partner through finding helpful ways to cope, relate, and connect during infertility challenges.

If you aren’t already working with a couples therapist, it can help to begin seeing one, even if fertility issues aren’t affecting your relationship at the moment. Some couples therapists may even have specialized training in infertility counseling. You can begin your search for a couples counselor in GoodTherapy’s directory.

References:

  1. Fertility treatments. (n.d.). Planned Parenthood. Retrieved from https://www.plannedparenthood.org/learn/pregnancy/fertility-treatments
  2. Glenn, L. M. (2002). Loss of frozen embryos. AMA Journal of Ethics. Retrieved from https://journalofethics.ama-assn.org/article/loss-frozen-embryos/2002-12
  3. Infertility FAQs. (2019, January 16). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/reproductivehealth/infertility/index.htm
  4. Infertility. (2018, March 8). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/infertility/symptoms-causes/syc-20354317
  5. Itkowitz, C. (2018, November 9). Michelle Obama is one of millions who struggled with infertility. Here’s why her broken silence could matter. Washington Post. Retrieved from https://www.washingtonpost.com/politics/2018/11/09/michelle-obama-is-one-millions-who-silently-struggled-with-infertility-heres-why-her-broken-silence-could-matter/?noredirect=on&utm_term=.8d2645a61c30
  6. Pasch, L. A., & Sullivan, K. T. (2017). Stress and coping in couples facing infertility. Current Opinion in Psychology, 13, 131-135. Retrieved from https://www.sciencedirect.com/science/article/pii/S2352250X16300902
  7. The psychological impact of infertility and its treatment. (2009). Harvard Mental Health Letter. Retrieved from https://www.health.harvard.edu/newsletter_article/The-psychological-impact-of-infertility-and-its-treatment
  8. Volmer, L., Rösner, S., Toth, B., Strowitzki, T., & Wischmann, T. (2017). Infertile partners’ coping strategies are interrelated – implications for targeted psychological counseling. Geburtshilfe Frauenheilkd, 77(1), 52-58. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5283173

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

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Break Free of Your Anxiety and Phobias in 4 Simple Steps

This is an interesting article I found on: www.psychcentral.com

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Anxiety that causes serious discomfort shouldn’t have to go on forever. Yet long-term talk therapy and treatment with medications don’t always free a person who’s suffering. Millions of Americans are dealing with some form of anxiety disorder: according to the Anxiety and Depression Association of America (ADAA), each year, 40 million American adults grapple with an anxiety disorder in some form.

One approach that can help you break free of anxiety and phobias is a simple series of steps. Unlike open-ended talk therapy, it’s not expensive or time-consuming, and unlike pharmacological approaches, it has no side effects.

It’s called LPA — Learning, Philosophizing, and Action.

This direct approach enables you to identify the problem, and think about the problem and its affects on your life, relationships, work, and home. After you learn more about your anxiety or phobia, and consider how it’s limited you, you can start taking clear steps to defuse its power over you.

Once you learn LPA, the only tools you need are a good chair, a pen and a notebook. Try to practice what you’ve learned three or more times a week. It doesn’t have to take long — five minutes is plenty. If you begin to feel uncomfortable, or overwhelmed by fear, stop the exercise, get up, and resolve to try again the next day.

Here’s how each step works:

1. Relax

To follow the LPA steps you need to first quiet the mind. There are many simple and effective relaxation techniques for this.

For instance: Find a quiet spot and a comfortable, supportive chair. Next, take a few easy, deep breaths. Feel yourself begin to float on each breath. When you reach a peaceful state of relaxation, you’re ready to start the next step.

2. Learn

In the learning phase, you focus on the nature and details of the problem by asking yourself questions. Write down all the details of what you remember and realize, including how you feel physically, mentally, and emotionally.

If you’re facing an anxiety, ask yourself:

  • What am I feeling?
  • What is making me anxious?
  • How do I feel when I am anxious — for instance, a stomachache, a headache, sweating?

If you are addressing a phobia, ask yourself:

  • What am I afraid of?
  • What does this fear prevent me from doing — for instance, leaving the house, taking the subway, or driving across a bridge?
  • How do I feel in the grip of this phobia?

Now ask yourself about the first time you began to this way:

  • What is my first memory of feeling this way?
  • What else was going on at the time?
  • What did I learn?

3. Philosophize

Once you have learned about the nature of your anxiety or phobia, you have enough information to look at the bigger picture. During this phase, you step back and challenge the thinking to led to this problem in the first place. Your look for the origins of your anxiety or phobia, and think about how it has affected your life, your relationships, your work and even your financial situation over time.

Ask yourself:

  • Did someone else convince me to feel this way?
  • Is it possible I picked up this anxiety or phobia from a parent?
  • What’s the big picture?
  • How did I take this belief and expand on it myself?

Without meaning to, parents may pass on their anxieties and phobias to their children. But this faulty learning can be fixed. You can use a simple math problem to illustrate: A child walks into kindergarten, having been convinced at home that 2 + 2 = 3. It’s only going to take one quick lesson to show that is wrong. This may be a simplified version, but it shows what happens with learned or even inherited anxieties and phobias. The learning passed on to you was flawed, but you believed it.

Dogs, cars, deep water, dentists — Think about how you picked up on other people’s anxieties. Were you encouraged to feel anxiety or fear in certain situations? You may have grown up thinking that feeling anxious was perfectly normal. But now you can change that thinking. Consider the impact this anxiety or phobia has had on your life. If you could undo its power, wouldn’t you?

4. Act

Taking action means unlearning those behaviors. One effective tool for this step is the Probable or Possible exercise. It helps defuse the power of the anxiety or phobia by looking at whether or not something is likely to actually happen. For instance, if you’re phobic about dogs, you may be afraid of being bitten in circumstances when it would be very hard for that to happen. For example: you are on one side of the street, and a dog and its owner are walking on the other side of the street. Yet you’re afraid the dog will bolt, escape its leash, and come and bite you. That’s often the way fear works: it takes a possibility and intensifies it until it seems like a near-certainty. Irrational or not, you believe it. Asking if it’s possible or problem is a way to take that fear and reduce it down to size.

So ask: It many be possible that the dog runs across the street to bite me. But is it probable?

Think about it: what is the likelihood of that really happening?

Investigate all the factors that would have to be in place for the fear to come true. You could even research the statistics, or learn all about dog behavior. Information is often a missing piece of the anxiety and phobia puzzle.

Once you know the different between the possible risk and the probable risk, remind yourself: This is possible, but it is not really probable. Keep reminding yourself that, and see how you feel the next time you encounter a dog.

The LPA brings new perspectives to old faulty beliefs and problems, helping you see your way out of old patterns. It also works in small steps, each just one part of the process. Do these as much as you want. Remember that you are the one in control. But the more you practice, the more effective it will be. That’s because when you do something successfully a number of times, the success-producing behaviors replace your old thought and behavior patterns with positive, productive ones.

Brick by brick, you can take the actions to face your fears, free yourself from them, change your life. And once you learn LPA and incorporate it into your routine, you can use it to tackle other obstacles. LPA has been proven to be highly effective in dealing with many forms of PTSD and conquering insomnia as well.

Reference:

Anxiety and Depression Association of America: Understand the Facts Depression. Retrieved from https://adaa.org/understanding-anxiety/depression

Break Free of Your Anxiety and Phobias in 4 Simple Steps

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Five Facts About Atypical Depression You Need to Know

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Despite its name, atypical depression is one of the most common types of depression, affecting between 25 to 40 percent of depressed people. Because the symptoms differ from those of typical depression, this subtype of depression is often misdiagnosed.

Atypical depression was named in the 1950s to classify a group of patients who did not respond to electroconvulsive therapy or to the tricyclic antidepressant Tofranil (imipramine). They did, however, respond to monoamine oxidase inhibitor (MAOI) antidepressants.

Some of the same treatments that work for classic depression work for atypical depression, such as selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy; however, full recovery is more achievable when this type of depression is identified and addressed.

Here are a few facts about atypical depression you should know.

Fact One: Atypical Depression Usually Involves Mood Reactivity or Extreme Sensitivity

One of the distinguishing features of atypical depression is “mood reactivity.” A person’s mood lifts in response to actual or potential events. For example, she may be able to enjoy certain activities and is able to be cheered up when something positive happens — like when a friend calls or visits — while a person with classic major depression shows no improvement in mood.

On the flip side, a person with atypical depression also responds to all things negative, especially interpersonal matters, such as being brushed off by a friend or something perceived as a rejection. In fact, a personal rejection or criticism at work could be enough to disable a person with atypical depression. There is a long-standing pattern of rejection sensitivity with this kind of depression that can interfere with work and social functioning.

Fact Two: People with Atypical Depression Tend to Overeat and Oversleep

Instead of experiencing interrupted sleep and loss of appetite as people often do with typical major depressive disorder, people with atypical depression tend to overeat and oversleep, sometimes referred to as reversed vegetative features. It’s not uncommon for someone with atypical depression to gain weight because they can’t stop eating, especially comfort foods, like pizza and pasta. They could sleep all day, unlike the person with typical depression experiencing insomnia.

Oversleeping and overeating are the two most important symptoms for diagnosing atypical depression according to a study published in the Archives of General Psychiatry that compared 304 patients with atypical depression with 836 patients with major depression.

Fact Three: People with Atypical Depression Can Experience Heavy, Leaden Feelings

Fatigue is a symptom of all depression, but persons with atypical depression often experience “leaden paralysis,” a heavy, leaden feeling in the arms or legs.

According to Mark Moran of Psychiatric News, a depressed patient gave a graphic portrayal of his symptoms to researchers at Columbia University College of Physicians and Surgeons 25 years ago: “You know those people who run around the park with lead weights? I feel like that all the time. I feel so heavy and leaden [that] I can’t get out of a chair.” The researchers labeled the symptom “leaden paralysis” and incorporated it into the criteria of diagnosis of atypical depression.

Fact Four: Symptoms Usually Begin at an Earlier Age, Are Chronic, and Affect More Women

Atypical depression tends to begin at an earlier age (younger than age 20), and is chronic in nature. Michael Thase, M.D., Professor of Psychiatry at Perelman School of Medicine at the University of Pennsylvania, discussed atypical depression in a Johns Hopkins Depression & Anxiety Bulletin, where he said, “The younger you are in adult life when you start to have trouble with depression, the more likely you are to have reverse vegetative features. In other words, the likelihood that you’ll overeat and oversleep when depressed is dependent on the age at which you become ill.” This was the subject of a 2000 study published in Journal of Affective Disorders. The illness of the patients with early-onset of atypical depression looked entirely different from those diagnosed with a classic melancholic depression.

Atypical depression also seems to affect more women than men, especially women before menopause. “Ultimately, I see atypical depression as a subtype of depression that reflects the convergence of an early age of onset, female gender, and a chronic but less severe form of major depression throughout pre-menopause,” writes Dr. Thase.

Fact Five: Atypical Depression Often Coincides with Bipolar Disorder and Seasonal-Affective Disorder

Atypical depression is more likely to occur in people with bipolar disorder and seasonal affective disorder. A study published in the European Archives of Psychiatry and Clinical Neuroscience evaluated 140 unipolar and bipolar outpatients who had symptoms of an atypical major depressive episode. The prevalence of bipolar II disorder was 64.2 percent.

In another study published in Comprehensive Psychiatry, 72 percent of 86 major depressive patients with atypical features were found to meet the criteria for bipolar II disorder. There have also been studies reviewing the overlap between atypical depression and seasonal affective disorder, highlighting common biological links underpinning common symptoms.

Five Facts About Atypical Depression You Need to Know

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5 Myths and Facts About Drug Rehab

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Drug abuse is a serious health concern. Overdose-related deaths in the United States have reached epidemic level. In fact, the Centers for Disease Control and Prevention (CDC) estimate an average of 130 people die from opioid overdose each day. This number doesn’t take into account deaths related to other drugs, which may increase this number.

Any drug use can become dangerous. Marijuana, now legal for medicinal and recreational use in many states, may help relieve pain, chemotherapy side effects, and symptoms of mental health concerns such as anxiety and posttraumatic stress. Research has also suggested marijuana may help treat addiction in some people. But despite these potential benefits, it can become addictive and could have health effects such as short-term memory impairment, impaired brain function, and respiratory health issues, among others.

Recreational use of illegal substances, even short-term use, can have serious health effects, including anxiety, paranoia, depression, suicidal thoughts, hallucinations, nausea, increased heart rate and blood pressure, and more. There’s also a risk of death due to overdose or complications. Long-term use of certain drugs could increase risk of violent behavior and may lead to legal trouble. Abusing drugs can also lead to drug dependency, or addiction.

Rehab can help people who’ve reached their absolute low work to overcome addiction, but it can also help people begin to break free of addiction before it significantly impacts their lives.

If you’re experiencing addiction, you’re not alone. According to statistics from the Substance Abuse and Mental Health Services Administration, more than 20 million Americans experienced a substance abuse disorder in 2014. Addiction can be difficult to overcome, no matter how hard a person tries. Professional support, in the form of inpatient or outpatient drug rehab, can benefit many people living with drug addiction.

Myths about drug rehab are plentiful. If you’re considering rehab for yourself or a loved one, making sure you have all the facts will help you make a more informed decision. Here, we present five common myths about drug rehab and the facts to counter them.

Drug Rehab Myths and Facts

Myth: Only wealthy people go to rehab.
Fact: Anyone can go to rehab.

It’s true that drug rehab can become expensive. Some people may not even consider inpatient rehab an option, believing it to be out of their budget. But the cost of drug rehab can depend on a number of factors, and there are rehab options for a range of budgets. See our article here for a more detailed explanation of rehab costs.

Some drug rehab centers offer low-cost or sliding-scale fees, based on your income. According to the 2012 National Survey of Substance Abuse, 62% of rehab facilities charge based on a sliding scale. Facilities may also offer payment programs or other types of financial assistance to people in need. Many drug rehab centers accept insurance, though not all insurance providers cover rehab.

When considering rehab, talk to your insurance provider and the rehab facility you’re interested in to get a better idea of the cost involved. Some centers may be able to work with you or refer you to another quality center that is more affordable. If the cost of inpatient rehab is a barrier, you might also consider outpatient drug rehab programs.

Myth: Rehab is for when you hit “rock bottom.”
Fact: You can begin recovering from addiction at any time.

Many people go to rehab when no other treatment option has worked. Often, they’ve lived with addiction for many years. Rehab can help people who’ve reached their absolute low work to overcome addiction, but it can also help people begin to break free of addiction before it significantly impacts their lives. Research suggests early intervention helps improve treatment outcomes.

Addiction not only contributes to emotional and physical health concerns, it can also lead to homelessness, unemployment, debt, and breakup or divorce. Choosing to enter rehab when you first find yourself becoming dependent on substances can help you begin the recovery process before addiction can have more of an effect on your life.

Myth: Rehab is only for people who can’t quit on their own.
Fact: Anyone experiencing addiction can get help in rehab.

The idea that addiction only happens to weak or flawed people is widespread. It might seem logical: Many people experiment with drugs, but not everyone becomes addicted. But drug abuse alters brain chemistry and affects cognitive function, leading to cravings for the substance and eventually addiction. Certain factors, including genetics, can increase a person’s risk for addiction.

Although a person might choose to try drugs, they don’t choose to become addicted. Once addicted, many people can’t stop using drugs without professional help. Needing rehab isn’t a sign of weakness. Changes in the brain resulting from addiction can make it extremely challenging, if not impossible, to stop using drugs without the support of health care providers trained in addiction support.

Whether you’ve tried to stop using drugs and relapsed or are just beginning to realize you may have a problem with substance abuse, rehab can help you begin recovery.

Myth: Rehab will prevent a person from relapsing.
Fact: Relapse is common, but treatment can help reduce its impact.

Between 40 and 60% of people dealing with addiction will relapse, according to the National Institute on Drug Abuse. While rehab may help reduce your risk of relapse, completing a drug rehab program doesn’t guarantee you’ll never relapse.

But rehab still has benefit. Research shows rehab can help by helping you develop skills to resist cravings, making relapse less likely. If you do relapse, the length of the relapse may be shorter. People who participate in treatment programs such as rehab also tend to relapse fewer times than people who don’t. Rehab can also lead to improvements in your relationships with friends, family, and loved ones. Developing stronger bonds with people you care for can also decrease the likelihood of relapse.

Myth: Rehab doesn’t work if you force someone to go.
Fact: Rehab can work even if you don’t want treatment.

Some people choose to enter rehab on their own, but some people experiencing addiction may not see its effects on their life, or they may not believe they have a problem with substance abuse. They may only decide to enter rehab grudgingly, after a court order or intervention from loved ones.

Being issued an ultimatum or feeling otherwise “forced” into rehab could make some people resistant to treatment, at first. According to the National Institute on Drug Abuse, however, people who feel pressured to overcome addiction in order to maintain an important relationship or avoid criminal charges, for example, often do better in treatment, even though they didn’t choose to enter rehab on their own.

Substance abuse and addiction can have serious, lifelong consequences. But there is help. Drug rehab may seem like an extreme measure, but this is partially due to the many myths surrounding rehab treatment.

Numerous studies support the benefits of rehab for addiction recovery. Inpatient centers provide a safe place to begin the detox and recovery process at any stage of addiction. Some facilities are expensive, but it’s possible to find affordable centers that will work with you to find a treatment program that’s right for your needs and your budget.

Don’t let myths about drug rehab keep you from getting addiction recovery support. Compassionate care is available! Begin your search today at GoodTherapy. Recovery may be a lifelong journey, but you are not alone.

References:

  1. American Addiction Centers. (2019, February 14). How much does rehab cost? Retrieved from https://americanaddictioncenters.org/alcohol-rehab/cost
  2. American Addiction Centers. (2018, October 15). Rehab success rates and statistics. Retrieved from https://americanaddictioncenters.org/rehab-guide/success-rates-and-statistics
  3. Blending perspectives and building common ground. Myths and facts about addiction treatment. (1999, April 1). U.S. Department of Health and Human Services. Retrieved from https://aspe.hhs.gov/report/blending-perspectives-and-building-common-ground/myths-and-facts-about-addiction-and-treatment
  4. Centers for Disease Control and Prevention. (2018, December 19). Understanding the epidemic. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html
  5. Leshner, A. I. (n.d.). Exploring myths about drug abuse. National Institute on Drug Abuse. Retrieved from https://archives.drugabuse.gov/exploring-myths-about-drug-abuse
  6. Mayo Clinic. (2017, July 20). Intervention: Help a loved one overcome addiction. Retrieved from https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/intervention/art-20047451
  7. Mayo Clinic. (2017, October 26). Drug addiction (substance use disorder). Retrieved from https://www.mayoclinic.org/diseases-conditions/drug-addiction/symptoms-causes/syc-20365112
  8. National Academies of Science, Engineering, and Medicine. (2017). The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Retrieved from http://nationalacademies.org/hmd/reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx
  9. National Institute on Drug Abuse. (2018). Drugs, brains, and behavior: The science of addiction. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery
  10. National Institute on Drug Abuse. (2018). Is marijuana addictive? Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/marijuana-addictive
  11. Substance Abuse and Mental Health Services Administration. (2015). Behavioral health trends in the United States: Results from the 2014 national survey on drug use and health. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf
  12. Substance Abuse and Mental Health Services Administration. (2016). Early intervention, treatment, and management of substance use disorders. In Facing addiction in America: The surgeon general’s report on alcohol, drugs, and health [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK424859
  13. Substance Abuse and Mental Health Services Administration. (2019, January 30). Mental health and substance use disorders. Retrieved from https://www.samhsa.gov/find-help/disorders
  14. Walsh, Z., Gonzalez, R., Crosby, K., Thiessena, M. S., Carrolla, C., & Bonn-Miller, M. O. (2017). Medical cannabis and mental health: A guided systematic review. Clinical Psychology Review, 51, 15-29. Retrieved from https://www.sciencedirect.com/science/article/pii/S0272735816300939?via%3Dihub
  15. Weber, L. (2015, July 11). How much does inpatient rehab cost? Retrieved from https://addictionblog.org/rehab/inpatient-rehab/how-much-does-inpatient-rehab-cost

© Copyright 2019 GoodTherapy.org. All rights reserved.

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

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Fight Social Anxiety by Embracing Your Inner Fool

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When I was in seventh grade, my family relocated to the United States after having lived in Europe for several years. Before we moved, my mother took me shopping for new school clothes.

On my first day at that school, I wore a neon green jumpsuit. I loved that jumpsuit. It had shiny silver zippers up the front and on the pockets. It was the coolest thing ever. Except that it wasn’t. Not in 1980s Michigan.

Somehow the latest European trends hadn’t found their way to the Detroit suburbs, where the height of “cool” at the time was Lacoste Alligator shirts and sweaters tied around the neck. Those preppy kids made merciless fun of me and my jumpsuit from Milan.

I begged my mother to take me shopping, but she refused. She told me that I should set trends instead of following them. Sure. Tell that to a seventh grader.

For the rest of that year, I resigned myself to wearing “dorky” clothes. I became obsessed with not drawing further attention to myself in any way that would make me look “uncool.” I elevated being invisible to an art.

Most of us have a similar childhood tale about a time when we felt foolish. We remember how deeply painful that moment felt. That “Inner Kid” takes tyranny over our lives.

As adults, some people go to great lengths to avoid looking foolish in any way. That inner kid is in the driver’s seat of their adult lives. Whenever they think about coming out of their comfort zone, that Inner Kid yells, “Watch out! They may laugh at us or think we’re stupid!”

What has the fear of looking foolish cost you? What were the risks not taken? The words not spoken? The adventures unexperienced?In the extreme form, this fear of negative judgment and the steps taken to avoid it becomes social anxiety. This diagnosis refers to an intense anxiety in situations where one might be negatively evaluated. The fear is typically out of proportion to the situation.

Indeed, as I so often witness in my practice, people find themselves overpreparing for a work meeting to the point of exhaustion. They obsess for weeks about what to wear to a reunion and then, at the last minute, don’t go at all. They turn down a promotion because the new job involves speaking in front of groups. And so, it goes – parties not attended, classes not completed, jobs not applied for, potential partners not met – in short, lives not fully lived.

In the context of discussing success, author Malcolm Gladwell has said, “What I try to do – try to be- is unafraid of making a fool of myself.”

In fact, the empirical research supports just such an approach to vanquishing the inner demons that keep us from stepping forward more confidently in our lives. Numerous meta-studies support the use of exposure therapy, a form of therapy that helps us to confront our fears. One such meta-study analyzed 33 treatment outcome studies conducted between 1977 and 2004. It found exposure-based treatment to be more effective than either no treatment, placebo, or non-exposure-based interventions.

The fear of appearing foolish can crush opportunities for spontaneity, mastery, and joy. What has the fear of looking foolish cost you? What were the risks not taken? The words not spoken? The adventures unexperienced? If more than a few examples come to mind, it may be time to challenge yourself to confront that fear and to learn to embrace “foolishness.”

How, exactly, can we learn to embrace our “Inner Fool?” The answer lies in changing not only how we think about foolishness, but also what we do in response to it.

I tell my clients, “Play it out all the way to the end.” In other words, whatever catastrophic outcome you imagine, play it out to its horrible conclusion (even better, write it out.)

Let’s return to the example of not going to the high school reunion. Maybe, something like this:

“I walk into the room and it turns out that I didn’t get the email that said it was a Beach Party-themed reunion. Everyone is wearing Hawaiian shirts, and I’m way overdressed in a formal wear gown. Everyone has apparently been on Keto for the last 363 days of the year and they all I look amazing. I’ve gained 30 pounds since the last reunion. A few people comment on my weight gain. People are pointing and snickering at me. I go into the bathroom and cry. I sneak out as soon as I get a chance.”

Let’s say that’s the worst that could happen. And now let’s imagine that it does happen. How bad is it?

“Well, pretty bad,” you’d say. And I’d agree. If all of that happened, that would stink. But then the next thing to ask yourself would be, “For how long?”

In other words, would it still matter in a day? Yep. A week? Probably. What about in a month? Less so. What about in a year or five years from now? Probably not. (I am, after all, telling you about my green jumpsuit.)

This is known as perspective-taking. It refers to the ability to look past the immediate feeling of embarrassment and to re-assess it from a perspective further out in time. Perspective-taking helps us take small, positive risks because it helps us to see that even if the worst imaginable thing happens, we will likely still recover and live to tell the tale.

Along with perspective-taking, it helps to do probability testing. In other words, ask, “How likely is it that the worst possible thing that you are imagining will actually happen?”

Odds are, not very likely. The most probable outcome is likely somewhere in between the best-case scenario and the absolute worst-case one. Again, it helps to write these down—the best-case, worst-case, and the most probable outcome.

Anticipatory anxiety is typically far worse than the actual situation.The anxious brain automatically goes to the worst-case scenario, and we often forget to consider the other outcomes as well. Perhaps the reunion goes flawlessly, and you have a fantastic time. Or maybe you feel a little discomfort at first but are later able to relax and even reconnect with a few people.

When we remember to include all the possible outcomes, it helps our brains relax enough to come out of our comfort zones.

Another thing that helps with embracing our Inner Fool is to purposely go out and do something foolish. “Why on Earth would I do that?” you ask.

The research strongly supports leaning into the fear and exposing yourself to the fearful situation rather than avoiding it. Avoidance tends to make the fear stronger because it gives you short-term relief. That short-term relief reinforces the behavior, so you continue to avoid things that make you anxious.

The problem, however, is that the short-term relief creates a long-term sacrifice—a sacrifice of quality of life, a sense of mastery, and increased confidence in the world. Exposing yourself to the feared situation, on the other hand, allows your brain to get the message that it’s not so bad. Anticipatory anxiety is typically far worse than the actual situation.

In my practice, I work with socially anxious clients to come up with experiments that teach them to embrace their Inner Fool. One of my favorites involves going through the drive-through at McDonald’s but ordering as if you were at Taco Bell.

Yes, I know. That sounds horrifically embarrassing, and you can’t even imagine doing such a thing. How did I even come up with such a torture?

Truth is, I didn’t come up with it. I was sitting in the passenger side of my car one afternoon when my jokester husband did exactly this. He has a playful side to his nature and loves to make others laugh. He is, in all ways, a natural jester.

Following his order, there was a long pause. Then a voice responded through the microphone, “Sir, this is McDonald’s, not Taco Bell.” He made some joke at that point and laughed. When we pulled up to the delivery window, the person taking the order was smiling and laughing too.

Natural jesters embrace foolishness and enjoy the spontaneity that comes from those moments. For the rest of us, especially those who may struggle with social anxiety, we must challenge ourselves to discover that most of the fears in our head are unfounded ones. All of my clients who have completed this exercise come back giggling, saying, “I did it! And it was actually kind of fun!”

So, go ahead. Order some fast food at the wrong place. Wear the green jumpsuit. Embrace your Inner Fool.

References:

  1. Abramowitz, J.S., Deacon, B.J., & Whiteside, S.P.H. (2011). Exposure therapy for anxiety: Principles and practice. New York, NY: Guilford Press.
  2. Wolitzky-Taylor, K.B., Horowitz, J.D., Powers, M.B., & Telch, M.J. (2008). Psychological approaches in the treatment of specific phobia: A meta-analysis. Clinical Psychology Review, 28(6), 1021-1037.

© Copyright 2019 GoodTherapy.org. All rights reserved.

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

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How to ease anxiety about travel

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Monday, 15 April 2019

How to ease anxiety about travel

Esther shares her tips for easing worries when travelling abroad.
– Esther
Last summer I embarked on what was the most exciting (and nerve-wracking) adventure of my life thus far – working as a camp counsellor in America. But, not only would this be my first trip to the US, but it would also be the first time I’d be flying solo – quite literally!
I had nightmares about the impending travel; it was all I could think about. For me the worries started weeks before my trip: consumed by thoughts of packing the wrong things, forgetting essential items, my luggage getting lost or somehow ruined. What if airport security interrogated me? What if I didn’t have the correct Visas? Missed my flight? Thoughts like this kept me up at night – working out exactly how many hours before takeoff I should arrive at the airport…
Some may say that my fears were irrational, and okay yes – it was fairly unlikely that I was going to contract Ebola, board the wrong flight (Home Alone 2-eque) and end up in Timbuktu, but my mind was racing, and ultimately, the anxiety I felt about my impending trip was very real.
When it came down to it, whilst I was excited for my new adventure on the surface, my enthusiasm was dampened by fear and worry. Beyond the travel concerns, I was deeply worried about being in a new place, where I didn’t know anyone, without my usual support network. So, how did I combat this? I was fortunate that my cousin had worked at a summer camp the previous year, so I reached out. By expressing my worries and talking through them with someone who had had a similar experience, I was able to calm myself – it was reassuring to know that I was a) not alone, and b) that even though I would be away from home my support network was only a phone call away.
By being brave enough to ask for advice, I was able to implement strategies to manage my mental health condition whilst abroad. I also made sure to get comprehensive travel insurance for my trip, this meant that my pre-existing medical conditions were covered, and helped to put my mind at rest.
Now, the good news is that I thoroughly enjoyed my time in America, so much so that I’m going to be returning this summer! Whilst I am still anxious about travelling, I have been able to prepare myself in order to limit my anxiety. Thankfully my travels went smoothly last year and my preparedness definitely limited any stresses on the day of travel.
So, how did I prepare? Firstly, I made copies of all important documents (such as my passport, itinerary and insurance policy). I shared my itinerary with my family, made sure they knew the time difference and stayed in regular contact with my family and friends back home during my trip. I researched medical professionals in the area where I’d be staying, so should I need support whilst abroad, I knew where to find it. I also made sure that my medications were legal in the States (as rules differ between countries).
I’m proud to say that my mental health did not stop me from travelling and having an amazing summer. Here are my lasting words to help ease those travelling worries:
1. Be prepared – make lists, do your research. It’s obvious but it really helps reduce stress and anxiety.
2. Take a minute for yourself – It’s ok to take your time and gather your thoughts. Have a drink of water. Take a deep breath.
3. Take a little bit of home with you – download your favourite films and music, do those little things that make you feel at ease and are familiar. You might be travelling solo but help (and home) is just a phone call away.
My name is Esther, and I’m a second year history student at King’s College London. My hobbies include fitness and travel, I am also passionate about reducing the stigma surrounding mental health and improving mental health awareness
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6 Mistakes to Avoid in Your Recovery from Depression and Anxiety

This is an interesting article I found on: www.psychcentral.com

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Recovering from depression and anxiety call for the same kind of shrewdness and amount of perspiration as does running a 4,000-person company. I say that having never done the latter. But hear out my logic: great leaders must master impeccable governing skills, develop the discipline of a triathlete, and build enough stamina to manage multiple personalities. And so does anyone wanting to get outside of her head and live a little.

So I think it’s fitting to translate the insight of a book about business success, The Wisdom of Failure: How to Learn the Tough Leadership Lessons Without Paying the Price by Laurence Weinzimmer and Jim McConoughey, to victory over a mood disorder, or even mild but annoying anxiety and depression.

Weinzimmer and McConoughey describe their “taxonomy of leadership mistakes,” or nine common ways an executive falls flat on his face and is made fun of by his peers. The business world is replete with calculated risks. It’s a chess game, and a few too many wrong moves will have you packing up your stuff from the corner office.

As I read through them, I kept thinking about my main job — managing my depression as best I can — and the pitfalls that I so often run into. Many are the same listed in this book. Here are six mistakes business leaders make that are appropriate for our purposes:

Mistake one: Trying to be all things to all people.

The “just say no” problem that I have all the time. If you think of requests from friends, families, bosses, co-workers, and golden retrievers as customers asking you for all kinds of products that you can’t simultaneously produce, then you see the logic in your having to draw the line at some point. You must hang on to your resources to stay well.

Mistake two: Roaming outside the box.

Clarification: thinking outside the box is good. Hanging out there, strolling around in pursuit of some meaning that you keep finding in everything that passes by — that’s dangerous. When it comes to recovery, this is very important to remember. I like to try new things: yoga, new fish oil supplements, a new light lamp, different support groups.

What gets me in trouble is when I start to think that I don’t have bipolar disorder and can go off all meds, healing myself through meditation alone. I tried that once and landed in the hospital twice. Now I double check to make sure the box is still in my peripheral vision.

Mistake three: Efficiencies before effectiveness.

This has to do with seeing the forest behind the trees, and subscribing to a policy of making decisions based on the view of the forest, not the trees that are blocking everything from your sight. The authors cite the example of Circuit City’s CEO who cut 3,400 sales people to decrease costs despite the fact that their research said that customers want knowledgeable sales people to help them make decisions when buying electronics. His approach was efficient, but not all that effective.

When you are desperate to feel better, it’s so easy to reach for the Band-Aid — booze, cigarettes, toxic relationships — that might do an efficient job of killing the pain. Effective in the longterm? Not so much.

Mistake four: Dysfunctional harmony.

Like me! Like me! Please like me! Dysfunctional harmony involves abandoning your needs to please others, which jeopardizes your recovery efforts.

“Being an effective leader [or person in charge of one’s health] means that sometimes you will not make the most popular decisions,” the authors explain. “By doing what is necessary, you will sometimes make some people angry. That’s okay. It’s part of the job. If you are in a leadership role and you try to be liked by everyone all of the time, you will inevitably create drama and undercut your own authority and effectiveness.”

So think of yourself as the CEO of you and start making some authoritative decisions that are in the best interest of You, Inc.

Mistake five: Hoarding

I’m not talking about your sister’s stash of peanuts and Q-Tips. This is about hoarding responsibility. For those of us trying like hell to live a good and happy life, this means giving over the reins now and then to other people, persons, and things that can help us: doctors, husbands, sisters, even pets. It means relying on the people in your life who say they love you and letting them do the small things so that you can try your best to be the best boss of yourself again.

Mistake six: Disengagement

Burnout. It happens in all recovery. I have yet to meet someone who can continue a regiment of daily meditation, boot camp, and spinach and cucumber smoothies for more than three months without calling uncle and reaching for the pepperoni pizza. That’s why it is so critical to pace yourself in your recovery. What’s a realistic number of times to exercise during the week? Are you really going to do that at 4:30 am? Why not allow yourself one day of hotdogs and ice-cream in order to not throw out the whole healthy living initiative at once?

Imagine yourself a great leader of your mind, body, and spirit — managing a staff of personalities inside yourself that need direction. Take it from these two corporate leaders, and don’t make the same mistakes.

6 Mistakes to Avoid in Your Recovery from Depression and Anxiety

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Challenges for Moms Who Have OCD

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I have written before about the challenges children face, and the lessons they can learn, when one of their parents is dealing with obsessive-compulsive disorder. In this post I’d like to focus more on moms who have OCD, and the difficulties they might deal with. I won’t be focusing on postpartum OCD, but rather on moms who have already been diagnosed with the disorder and have been living with it for a while.

Some of the most common types of obsessions in OCD involve various aspects of contamination such as fear of dirt, germs, or illness. The person with OCD might fear the worst for themselves, their loved ones, or even strangers. If you’re a mother (and even if you’re not) you likely know that dirt, germs and illness are an inevitable part of childhood. How can a mom with OCD possibly take her four-year-old child into a public restroom?

Surprisingly, most can and do. Over the years I have connected with moms who have OCD who do what they need to do, despite their fears. By caring for their children, they are actually engaging in the gold-standard psychological treatment for OCD — exposure and response prevention (ERP) therapy.

And because ERP therapy works, these moms find that the more they bring their children into those restrooms, or allow them to play at the playground without trailing behind them with sanitizing wipes, or agree to let them spend time at a friend’s house, the less their OCD rears its ugly head. In short, they habituate, or get used to, being in these situations and accepting the uncertainty of what might happen.

Another comment I hear often from moms with OCD is that because caring for a child (or perhaps multiple children, and even a family pet) is time-consuming and never-ending, they are so busy that they don’t have time to worry about all the things OCD thinks they should worry about. If your baby has a dirty diaper, the dog is barking to go out, your toddler just found the finger paints, and you need to get to the grocery store, you don’t have time to fret over your fear of contamination. You just change the diaper, tend to the dog, quickly wipe your toddler’s hands, and get out the door. OCD might be protesting in the background, but you have no time for its silly demands. Again, great ERP therapy!

Of course, it doesn’t work this way for all moms, and for some OCD is in control. To these moms, I say, first and foremost, please get help from a mental health professional so you can learn to quell your OCD until it is nothing more than background noise as you care for your children. The truth is, if your obsessive-compulsive disorder remains untreated, it will affect your the well-being of your children. Their world will be limited, they will pick up on your anxiety, and they might even mimic your behaviors.

For moms who are struggling with OCD, please resolve to put your children before your OCD. Learn how to spend quality time enjoying them, not ruminating over all the things that might go wrong in a given moment.

The irony is that OCD wants you to believe that giving in to its demands is keeping your children safe, when in reality, your behaviors are likely hurting them. Modeling healthy behavior and how to deal with life’s challenges might be the best gift you ever give your children.

Finally, being a mom with OCD can feel extremely isolating. But you are not alone. Join support groups (online and in-person), talk to an OCD therapist, and accept the love and support of family and friends (but no enabling!). You and your children deserve lives not compromised by OCD.

Challenges for Moms Who Have OCD

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