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What You Should Know About the Link Between Anxiety and Self-Harm

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

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Side view of woman standing in field of tall red poppiesWhile many people are much more aware of anxiety now than in the past, some details and symptoms still aren’t as commonly discussed.

One lesser-known symptom of anxiety is the urge to self-harm. Not all or even most people who experience anxiety will have these urges, and there are people who self-harm who do not struggle with anxiety. Yet, when anxiety and self-harm co-occur, it may be crucial to a person’s well-being and safety to identify the issue in order to connect with help.

Can Anxiety Cause Self-Harm?

It’s very possible for anxiety to spark urges to self-harm. Self-harm is frequently associated with a sense of release from overwhelming emotions or situations in those who engage in the behavior. Since anxiety is characterized by a sense of feeling overwhelmed or worried about not being able to handle life situations, self-harm acts can bring relief from anxious feelings. While anxiety does not always lead to self-harm, studies have shown people who engage in self-harm are more likely to experience anxiety and vice-versa.

Types of Anxiety That May Lead to Self-Harm

Certain types of anxiety may be more likely to lead to self-harm than others:

  • Social anxiety: This type of anxiety is characterized by an intense fear or worry of being judged by others. Studies have shown that this type of anxiety has a high likelihood of leading to self-harm behaviors.
  • Generalized anxiety: General anxiety is a constant sense of worry or stress in the long-term that doesn’t seem to have one specific cause. This type of anxiety has also been shown to have a higher chance of leading to self-harm behaviors.

While obsessive-compulsive disorder (OCD) was once listed as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5 lists it as an obsessive-compulsive disorder. Although OCD is now technically in a different category than anxiety, is may frequently co-occur with anxiety and has been known to cause self-harm.

One type of OCD, known as harm OCD, can cause intense fear of hurting oneself or others. While this anxiety about harming oneself may be severe and vivid, those with harm OCD are thought to be no more likely to act on their thoughts of self-harm than someone without harm OCD.

Why Is Anxiety Connected to Self-Harm?

Anxiety is frequently accompanied by overwhelming feelings of worry, racing thoughts, and sometimes panic attacks. This can make people with anxiety feel they’ve completely lost control of their minds and bodies. They may turn to self-harm in order to focus their mind outside of their racing thoughts or worries, or they may use it as a way to regain feeling if they’ve begun to feel numb from long-term anxiety.

Alternatively, self-harm is sometimes used out of anger. People with anxiety may feel frustrated or mad at themselves for not being able to keep their anxious thoughts under control or that they can’t “fix” themselves. In this case, self-harm may not be done for the purpose of relief, but as self-inflicted punishment. Self-harm used in anger can be especially damaging, as it isn’t a coping mechanism, but a sign of deeper emotional struggle.

Self-harming thoughts often lead to self-harming behaviors in an effort to either feel relief, feel pain, or punish oneself.

Angela Avery, MA, LLPC, NCC, a therapist in Clarkston, Michigan, notices that self-harm may tend to occur with social anxiety. She explains,

“In my clinical practice with teenagers, I often see self-harming behaviors co-occur with social anxiety. Those who experience social anxiety are afraid that they will be judged by others and often that belief is validated because they lack social skills and social confidence to create friendships or engage with others.

When you feel like no one is your friend, and you are too afraid to speak to anyone, you tend to feel poorly about yourself. Low self-worth then leads to self-critical, irrational thoughts presuming we are “bad” and “stupid” and “no one likes us.” Self-harming thoughts often lead to self-harming behaviors in an effort to either feel relief, feel pain, or punish oneself.

I tend to view harming behaviors as coping strategies of choice for people who view themselves with a severely critical eye. Add in a sprinkling of social anxiety or limited social skills and we have a combination for continued harm.”

It’s important to note that anxiety can lead to multiple forms of self-harm that aren’t always what people typically think of. The stereotyping around self-harm as a form of “attention seeking” or something people do when they’re into a certain type of music has deeply damaged our society’s ability to recognize self-harming behaviors in some cases.

Anxiety and Personality Disorders As a Cause of Self-Harm

In addition to anxiety, some some studies show that certain personality disorders may have a higher likelihood of leading to self-harm. Some of these disorders are closely linked to anxiety and may co-occur, and some can lead to self-harming behaviors independent of anxious thoughts or feelings.

Some disorders that have been linked to self-harm include:

At the end of the day, regardless of the cause, people who are engage in destructive self-harming behavior should not try to overcome these patterns alone. They’re a maladaptive coping mechanism, and while they can be painful and scary, there is hope. With the help of a licensed mental health professional and plenty of love and encouragement from friends and family, people can learn to manage their anxiety and overcome their self-harm behaviors.

References:

  1. Bhandari, S. (2018, February 21). Mental health and self-injury. Retrieved from https://www.webmd.com/anxiety-panic/guide/self-injuring-hurting#1
  2. Bolton, J., Chartrand, H., Sareen, K., & Toews, M. (2011, September 21). Suicide attempts versus nonsuicidal self‐injury among individuals with anxiety disorders in a nationally representative sample. Depression and Anxiety, 29(3), 172-179. doi: 10.1002/da.20882
  3. Klonsky, E. D., Oltmanns, T., Turkheimer, E. (2003, August 1). Deliberate self-harm in a nonclinical population: Prevalence and psychological correlates. The American Journal of Psychiatry, 160(8), 1501-1508. Retrieved from https://doi.org/10.1176/appi.ajp.160.8.1501
  4. Living with harm OCD: What’s going on? (n.d.). Retrieved from https://www.intrusivethoughts.org/ocd-symptoms/harm-ocd
  5. O’Connor, R., Rasmussen, S., & Hawton, K. (2009). Predicting depression, anxiety and self-harm in adolescents: The role of perfectionism and acute life stress. Behaviour Research and Therapy, 84(1), 52-59. doi: 10.1016/j.brat.2009.09.008
  6. Pierce, L. (2018, April 21). OCD, Self Injury, and Suicidal Thoughts. Retrieved from https://www.verywellmind.com/ocd-self-injury-and-suicidal-thoughts-2510599
  7. Self-harm. (2018, May 25). Retrieved from https://www.nhs.uk/conditions/self-harm

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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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Feeling Completely and Utterly Alone Because You Have a Mental Illness? This Can Help

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

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You have a mental illness, and you feel incredibly alone. Intellectually, you know that you are one of millions of people who also have a mental illness—people who also have depression or an anxiety disorder or bipolar disorder or schizophrenia.

You know that you’re not the only person on this planet to be in pain.

But it doesn’t matter. Because it looks like everyone around you is just fine. You’re the only one who has a hard time getting out of bed, who feels overwhelmed by everything, no matter how small. You’re the only one who feels like an impostor and a fraud. You’re the only one who feels irritable and on edge for no reason. You’re the only one who can’t seem to get through the day. You’re the only one who has strange, sad, uncomfortable and cruel thoughts.

But you’re not. You’re really not.

Sheva Rajaee, MFT, is the founder of the Center for Anxiety and OCD in Irvine, Calif. She’s lost count of the number of times a client has started a session by saying: “I know you hear things every day, but this one is really weird.” When the client shares their “gruesome or socially unacceptable thought,” Rajaee’s face barely registers surprise.

Why?

“…[B]ecause I’ve had the experience of seeing thousands of clients, which means thousands of thoughts. I’ve come to understand that if the brain can think it, the brain can obsess about it, and that everyone experiences dark thoughts and scary feelings,” Rajaee said.

Kevin Chapman, Ph.D, is a clinical psychologist who specializes in treating anxiety disorders in Louisville, Kentucky. His clients regularly tell him that they’re the only ones who feel afraid to go into a carwash, they’re the only ones who freak out at Target, they’re the only ones who feel like they’re dying, and they’re the only ones who are dwelling inside a bubble while everyone else is actually living their lives.

Rosy Saenz-Sierzega, Ph.D, is a counseling psychologist who works with individuals, couples and families in Chandler, Ariz. Her clients have told her: “I know everyone knows what it’s like to be sad, but being depressed is much worse…it’s like the darkest shade of black…it’s like a 100-foot pit that I have fallen into and there is no way out. I’m in there, alone, and I know I can’t get out.” “I can’t even describe what I feel to my friends because they just think I’m exaggerating.” “Being around people is just too difficult, but being alone means it’s only me and my dark thoughts.” “I feel like I have an emptiness I can never fill; I can’t ever deeply connect with anyone because they will never know what it’s like to be me…in my head.”

According to Chris Kingman, LCSW, a therapist who specializes in individual and couples therapy in New York City, “thoughts like ‘I’m the only one….’ or ‘I’m alone in this…’ are cognitive distortions. They are irrational.”

We tend to automatically generate these kinds of thoughts when we’re feeling vulnerable and are in an unsupportive environment,” he said. Sadly, while it’s getting much better, as a whole, our society isn’t very supportive of people with mental illness. That’s “because most people have not had sufficient education about mental health and illness; and [they] feel uncomfortable when faced with others’ mental health struggles.”

Cognitive distortions also are part and parcel of illnesses like depression and anxiety. For instance, Saenz-Sierzega noted that “depression creates a severely negative view of the self, the world and of one’s future—which frequently includes feeling as though no one can possibly understand what you are going through, how you feel, and how to help. [And this makes] it that much harder to seek help.”

While seeking support is certainly challenging, it’s not impossible. And it’s the very thing that will make a huge difference in how you feel and in how you see yourself. So if you’re feeling alone and like a massive outcast, these suggestions can help.

Validate your feelings. Acknowledge, and accept how you’re feeling, without judging yourself. Honor it. “The experience of having a mental health disorder of any kind can be emotionally and physically draining, and even with all the help in the world there will be days when you feel down and alone. This is normal,” Rajaee said.

Revise your self-talk. Kingman stressed the importance of not telling ourselves that we’re alone (or inferior or broken or wrong), because “feelings aren’t facts.” As he said, you might feel alone, and inferior and broken and wrong—and that’s a valid experience, as any emotion is—but these emotions don’t reveal some end-all, be-all truth.

“The issue is that you feel vulnerable and insecure, and you need support but you’re afraid of judgment and rejection.”

Kingman encouraged readers to record your thoughts in a journal. Specifically, observe how you talk to yourself, “catch” yourself when your thoughts are critical or demeaning, and replace these thoughts with constructive, compassionate, supportive self-talk, he said.

Seek therapy. If you’re not seeing a therapist already, it’s vital to find one you trust, Saenz-Sierzega said. A therapist will not only normalize your feelings and help you better understand how your mental illness manifests and functions, but they’ll also help you build a healthier self-image and learn effective coping tools and strategies.

“The gift of mental illness is that if navigated well, you come out a survivor,” Rajaee said. “The same tools and coping strategies you have had to learn through treatment give you a resilience that makes other challenges in life more doable.”

You can start your search for a therapist here.

Reach out. This is a powerful way to “get outside of your own head,” Saenz-Sierzega said. “Surround yourself with person(s) who love you, know your worth, and appreciate you for who you are.” Talk to them about how you’re feeling.

Join an in-person or online support group. For instance, Kingman suggested participating in 12-step recovery groups. They “are free and there are many groups in every city for so many human issues, like alcohol, drugs, gambling, sex, relationships, emotions, over-spending, and more. Lots of acceptance, support and solidarity in these groups for human suffering, diagnoses [and] struggles.”

Also, check out the online depression communities Project Hope & Beyond and Group Beyond Blue.

Rajaee suggested finding online forums with people who’ve been through what you’re experiencing. Psych Central features a variety of forums.

Another option is a therapy group, “where the experience of being human and the struggle of having a mental health disorder is normalized and where you are celebrated for your strength and resilience,” Rajaee said.

Finally, Saenz-Sierzega suggested texting “home” to 741741.

Listen to sound mental health information and relatable stories. “[I]f you’re not ready for [therapy, or want to expand your knowledge], start with a podcast on mental illness to get familiar with how to even talk about it and to learn what helps others,” said Saenz-Sierzega.

She recommended Savvy Psychologist and the Mental Illness Happy Hour. Psych Central also has two excellent podcasts called A Bipolar, a Schizophrenic and a Podcast, and The Psych Central Show.

Read inspiring stories. “To alleviate human suffering, we need solidarity with others who are suffering and working on their own process,” Kingman said. He recommended reading the book Feel the Fear and Do It Anyway by Susan Jeffers. Psychologist David Susman has a blog series called “Stories of Hope,” where individuals share their mental health challenges and the lessons they’ve learned.

Psych Central also features numerous blogs written by individuals who live with mental illness.

Create a list of comforting things. Your list might include activities, movies, songs or photos that make you laugh or spark a fond memory, Saenz-Sierzega said. Turn to something on your list when you’re having a hard time. Let it “remind you of who you are and who you are fighting for.”

Mental illness is common. If you just look at anxiety disorders, the stats are staggering. They affect about 40 million individuals per year, Chapman said. Forty million. Maybe this is reassuring to you. Maybe it’s not. Because your soul feels alone.

This is when reaching out is critical. This is when talking to someone face to face or in an online forum is critical. Because this is when your soul actually hears the truth: You are not alone. You are absolutely not alone.

Feeling Completely and Utterly Alone Because You Have a Mental Illness? This Can Help

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CBD Oil for Depression, Schizophrenia, ADHD, PTSD, Anxiety, Bipolar & More

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

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You can extract over 70 different components from a marijuana plant, technically known as cannabis sativa. Two of the most common constituents are delta-9-tetrahydrocannabinol (known colloquially as THC) and cannabidiol (CBD).

Because CBD is not as regulated as THC (though may be technically illegal under federal laws), nor does it provide any accompanying “high” as THC does, it has become increasingly marketed as a cure-all for virtually any ailment. You can now find CBD oil products online to treat everything from back pain and sleep problems, to anxiety and mental health concerns.

How effective is CBD oil in the treatment of mental disorder symptoms?

Unlike it’s sister THC, CBD doesn’t have any of the associated negative side effects of tolerance or withdrawal (Loflin et al., 2017). CBD is derived from the cannabis plant, and shouldn’t be confused with synthetic cannabinoid receptor agonists like K2 or spice.

Because of its relatively benign nature and more lax legal status, CBD has been more widely studied by researchers in both animals and humans. As researchers Campos et al. (2016) noted, “The investigation of the possible positive impact of CBD in neuropsychiatric disorders began in the 1970s. After a slow progress, this subject has been showing an exponential growth in the last decade.”

Research has shown that CBD oil may be effective as a treatment for a variety of conditions and health concerns. Scientific studies demonstrate effectiveness of CBD to help relieve some of the symptoms associated with: glaucoma, epilepsy, pain, inflammation, multiple sclerosis (MS), Parkinson’s disease, Huntington’s disease, and Alzheimer’s. It appears to help some people with gut diseases, such as gastric ulcers, Crohn’s disease, and irritable bowel syndrome as well (Maurya & Velmurugan, 2018).

You can find low-end and high-end CBD oil products. The most popular CBD oil product on Amazon.com retails for around $25 and contains only 250 mg of CBD extract.

ADHD

In a pilot randomized placebo-controlled study of adults with attention deficit hyperactivity disorder (ADHD), a positive effect was only found on the measurements of hyperactivity and impulsivity, but not on the measurement of attention and cognitive performance (Poleg et al., 2019). The treatment used was a 1:1 ratio of THC:CBD, one of the common CBD treatments being studied along with CBD oil on its own. This finding suggests more research is needed before using CBD oil for help with ADHD symptoms.

Anxiety

There are a number of studies that have found that CBD reduces self-reported anxiety and sympathetic arousal in non-clinical populations (those without a mental disorder). Research also suggests it may reduce anxiety that was artificially induced in an experiment with patients with social phobia, according to Loflin et al. (2017).

Depression

A review of the literature published in 2017 (Loflin et al.) could find no study that examined CBD as a treatment for depression specifically. A mouse study the researchers examined found that mice treated with CBD acted in a way similar to the way they acted after receiving an antidepressant medication. Therefore, there is virtually little to no research support for the use of CBD oil as a treatment for depression.

Sleep

Loflin et al. (2017) only found a single CBD study conducted on sleep quality:

Specifically, 40, 80, and 160 mg CBD capsules were administered to 15 individuals with insomnia. Results suggested that 160 mg CBD was associated with an overall improvement in self-reported sleep quality.

PTSD

There are currently two human trials currently underway that are examining the impact of both THC and CBD on posttraumatic stress disorder (PTSD) symptoms. One is entitled Study of Four Different Potencies of Smoked Marijuana in 76 Veterans With PTSD and the second is entitled Evaluating Safety and Efficacy of Cannabis in Participants With Chronic Posttraumatic Stress Disorder. The first study is expected to be completed this month, while the second should be completed by year’s end. It can take up to a year (or more) after a study has been completed before its results are published in a journal.

Bipolar Disorder & Mania

The depressive episode of bipolar disorder has already been covered in the depression section (above). What about CBD oil’s impact on bipolar disorder’s manic or hypomanic episodes?

Sadly, this has not yet been studied. What has been studies is cannabis use on the effect of bipolar disorder symptoms. More than 70 percent of people with bipolar disorder have reported trying cannabis, and around 30 percent use it regularly. However, such regular use is associated with earlier onset of bipolar disorder, poorer outcomes, and fluctuations in a person’s cycling patterns and severity of manic or hypomanic episodes (Bally et al., 2014).

More research is needed to see whether supplementing CBD oil might help alleviate some of the negative impact of cannabis use. And additional research is needed to examine whether CBD oil on its own might provide some benefits to people with bipolar disorder.

Schizophrenia

Compared to the general population, individuals with schizophrenia are twice as likely to use cannabis. This tends to result in a worsening in psychotic symptoms in most people. It can also increase relapse and result in poorer treatment outcomes (Osborne et al., 2017). CBD has been shown to help alleviate the worse symptoms produced by THC in some research.

In a review of CBD research to date on its impact on schizophrenia, Osborne and associates (2017) found:

In conclusion, the studies presented in the current review demonstrate that CBD has the potential to limit delta-9-THC-induced cognitive impairment and improve cognitive function in various pathological conditions.

Human studies suggest that CBD may have a protective role in delta-9-THC-induced cognitive impairments; however, there is limited human evidence for CBD treatment effects in pathological states (e.g. schizophrenia).

In short, they found that CBD may help alleviate the negative impact of a person with schizophrenia from taking cannabis, both in the psychotic and cognitive symptoms associated with schizophrenia. They did not find, however, any positive use of CBD alone in the treatment of schizophrenia symptoms.

Improved Thinking & Memory

There is little to no scientific evidence that CBD oil has any beneficial impact on cognitive function or memory in healthy people:

“Importantly, studies generally show no impact of CBD on cognitive function in a ‘healthy’ model, that is, outside drug-induced or pathological states (Osborne et al., 2017).”

If you’re taking CBD oil to help you study or for some other cognitive reason, chances are you’re experiencing a placebo effect.

CBD Summary

As you can see, CBD research is still in its early stages for many mental health concerns. There is limited support for the use of CBD oil for some mental disorders. Some disorders, like autism or anorexia, have had little research done to see whether CBD might help with its symptoms.

One of the interesting findings from research to-date is that the dosing found to have some possible beneficial effects in research tends to be much higher than what is found in products typically sold to consumers today. For instance, most over-the-counter CBD oils and supplements are in bottles that contain a total of 250 to 1000 mg.

But the science suggests that an effective daily treatment dose might be anywhere from 30 to 160 mg, depending on the symptoms a person is seeking to alleviate.

This suggests that the way most people are using CBD oil today is not likely to be clinically effective. Instead, at doses of just 2 to 10 mg per day, people are likely mostly benefiting from a placebo effect of these oils and supplements.

Before starting or trying any type of supplement — including CBD oil or other CBD products — please first consult your prescribing physician or psychiatrist. CBD may interact with psychiatric medications in a way that is unintended and could cause negative side effects or health problems.

We also do not really understand the long-term effects and impact of CBD oil use on a daily basis over the course of years, as such longitudinal research simply hasn’t yet been done. There have been some reported negative side effects experienced in the use of cannabis, but it’s hard to generalize such research findings to CBD alone.

In short, CBD shows promise in helping to alleviate some symptoms of some mental disorders. Much of the human-based research is still in its infancy, however, but early signs are promising.

For further information

Reason Magazine: Is CBD a Miracle Cure or a Marketing Scam? (Both.)

Thanks to Elsevier’s ScienceDirect service in providing access to the primary research necessary to write this article.

References

Bally, N., Zullino, D, Aubry, JM. (2014). Cannabis use and first manic episode. Journal of Affective Disorders, 165, 103-108.

Campos, AC., Fogaça, M.V., Sonego, A.B., & Guimarães, F.S. (2016). Cannabidiol, neuroprotection and neuropsychiatric disorders. Pharmacological Research, 112, 119-127.

Loflin, MJE, Babson, K.A., & Bonn-Miller, M.O. (2017). Cannabinoids as therapeutic for PTSD
Current Opinion in Psychology, 14, 78-83.

Maurya, N. & Velmurugan, B.K. (2018). Therapeutic applications of cannabinoids. Chemico-Biological Interactions, 293, 77-88.

Osborne, A.L., Solowij, N., & Weston-Green, K. (2017). A systematic review of the effect of cannabidiol on cognitive function: Relevance to schizophrenia. Neuroscience & Biobehavioral Reviews, 72, 310-324.

Poleg, S., Golubchik, P., Offen, D., & Weizman, A. (2019). Cannabidiol as a suggested candidate for treatment of autism spectrum disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 89, 90-96.

CBD Oil for Depression, Schizophrenia, ADHD, PTSD, Anxiety, Bipolar & More

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Podcast: How to Change Your Psychological Identity

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We all know that addiction, severe depression, and other conditions change our personality. What few know, however, is just how deeply ingrained that change can be, and how difficult (and scary) it can be to try to become “ourselves” again. In this episode, we examine such changes through the experiences of our guest, who overcame depression and addiction, and now helps others do the same.

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About Our Guest

David Essel, MS, OM, is a number one best-selling author (10), counselor, master life coach, international speaker and minister whose mission is to positively affect 2 million people or more every day, in every area of life, regardless of their current circumstances.

His latest #1 best seller, FOCUS! SLAY YOUR GOALS…THE PROVEN GUIDE TO HUGE SUCCESS, A POWERFUL ATTITUDE AND PROFOUND LOVE, was selected by the influential blog “FUPPING” as one of the top 25 books that will make you a better person!

David’s work of 38 years is also highly endorsed by the late Wayne Dyer, “Chicken Soup for the Soul” author Mark Victor Hansen, as well as many other celebrities and radio and television networks from around the world.

He is verified through Psychology Today as one of the top counselors and life coaches in the USA, and is verified through Marriage.com as one of the top relationship counselors and coaches in the world.

David accepts new clients every week into his 1-on-1 programs from around the world at www.davidessel.com

PSYCHOLOGICAL IDENTITY 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 with me as always is Vincent M. Wales. And today Vince and I will be talking with David Essel. David is a number one best selling author, counselor, master life coach, international speaker and minister whose mission it is to positively affect 2 million people or more every day in every area of life, regardless of their current circumstances. David, welcome to the show.

David Essel: Oh gosh, it’s great to be with you, Gabe and Vince. Looking forward to our conversation today.

Gabe Howard: This is wonderful. And just to clarify real quick before we get going… Two million people every day.

David Essel: You know, we don’t believe in tiny goals, do we?

Gabe Howard: No we don’t. Thank you so much for being here.

Vincent M. Wales: That’s a lot of people. So let me ask you… you know there are an awful lot of people out there who do similar things to what you do. And you’ve been helping people for what 30 years? Something like that? That’s that’s a long time. What makes your story about your healing different from the others?

David Essel: The reason in the world of personal growth and mental health addiction recovery and more… the reason why there are 700 million authors, basically, in this industry is the same reason why there’s so many authors in the auto repair industry, and you know personal growth industry in general is massive, but people need to hear different voices and I may be saying the same thing the late Wayne Dyer said and people, X percentage of people would grab Wayne’s words and change their lives and then there’s other people that may not connect and Wayne and I were very good friends when he was alive. And then there are people that may not quite connect with him but they might connect with the way that I talk or the way that I write or the videos we do, so I don’t know if it’s as much “What’s the big difference?” as we need to have different voices out there with different experiences. I know one of the advantages in the world of mental health that I have is that in my background I came from extreme alcoholism and cocaine addiction for years, which was caused or the underlying cause of many addictions is depression and an inability to deal with emotions in life. I went through a severe clinical depression, suicidal, to the point where that I had to get extreme medical care and you know all these things, guys, happened while I’m doing the same work I’m doing today. So not only is my energy different than a lot of other people that do the same work, the words I use might be a little different, but unlike some people that write about these topics that we’re going to talk about that have not experienced extreme mental illness or challenges or anything else, addiction, that I’ve gone through, I think that’s one of the advantages that I bring, too. Because I’ve been on those sides of the fence that are very daunting, extremely scary, and have come back and I think that’s an advantage that our work has that some other people may not be able to go that deep or as deep as we go because they’ve never personally experienced these things,which I don’t wish on anyone, but the end result is is that the empathy and compassion that I can have for people in the world struggling with mental health or addiction is is incredible because I was there. I’m very grateful for the work that I’ve done to remove myself from some of these challenges and also extremely interested in helping as many other people as we can work their way through this stuff.

Vincent M. Wales: Fantastic.

Gabe Howard: When we’re doing research for the show, one of the things that came up a few times that I thought was interesting is that you said it’s scary at first to heal from depression. And I wanted to know what you meant by that. Can you explain that a little more?

David Essel: Well you know when we have some type of a mental health challenge like a depression, we create an identity around it and that that identity is very powerful. We… it’s scary to let go of something you’re comfortable with, even if it isn’t healthy. In other words, let’s say that, during the depression, we create an identity well when we talk to our loved ones or our family, it’s always based on how we’re not feeling that great today, how we don’t have the motivation to go to the gym, how we don’t don’t don’t don’t don’t. When you repeat those phrases either vocally to the outside world or in your head, over the course of months and years we create an identity. The identity says, this is who I am. I’m a depressed person. So to walk away from that identity and then not have people saying to you on a daily basis, Oh my gosh, I’m so sorry, this is such a hard day. Or, come on, we know you can move through this or have you tried this or have you tried that? When we’re doing all these things, thinking we’re helping the depressed person, we’re actually deepening their identity. We are… the compassion and empathy that I think we should all have in the beginning turns into this thing where the depressed person actually looks and will latch on to certain individuals who will also deepen their identity as a depressed person. So when I say it’s scary. it’s like. if we’ve been in a depressed state for a number of years. we don’t know what it’s like to live with a little bit of lightness. a little bit of inner peace. a little bit of joy. and while lightness. inner peace and joy. guys, sounds like three really great things… to the depressed person, it’s like moving to Afghanistan. We don’t know what it’s like. We don’t know the terrain. We don’t know the customs. We don’t know anything other than our identity as a depressed person. So that is frightening. And it’s the same thing with the world of addiction. You know, coming from a serious addiction background, myself, I didn’t know what it was like to go out to dinner without having drinks before I left my house. I didn’t know what it was like to go to sleep at night without multiple drinks to put me to sleep. So it’s scary to walk away from an identity that you’ve held on to for years and to walk into a new life. And that depressed person, of course, at the core wants to be happy and healthy, is so comfortable in their little zone that getting outside of it can seem unbelievably threatening. And we’ve worked with some people that, once they’ve overcome, quote unquote, their depression and started to feel better, missed all of the accolades of people saying, how are you today and we hope you’re getting better and have you tried this. Some people will slip back into the old identity just to get the attention. so it can be scary. Healing on any level can be scary for people that have long term identity based on some condition.

Vincent M. Wales: We get comfortable, even if it’s something that should be uncomfortable. It’s familiar to us. So, you know, you’re right, it is hard to leave it. And that’s that’s pretty sad when you think about it.

Gabe Howard: Well especially if it’s all you’ve ever known.

Vincent M. Wales: Right.

Gabe Howard: As longtime listeners know, I thought about suicide from a very young age. In fact, I don’t remember ever not thinking about suicide and I thought that everybody did. I thought that weighing the pros and cons of life and death was just like a normal thing to do because there’s no mental health education, nobody challenged this belief in me, and then of course that’s not OK. Eventually, I went to a psychiatric hospital, was diagnosed with bipolar disorder and I learned about mental health and mental illness and and that all got fixed. So that was wonderful except, here I am at 26 years old, and for the first time ever, it occurred to me that I could die. And I didn’t want to die. So that was a scary thing. And I just became ultra paranoid about everything. So even though this led to greater potential for my future and you know now I’m 42 and everything is wonderful. You know for a couple of years, it was just really hard. My entire identity was wrapped up in this way of thinking. I knew no other way to think. And it sounds like that’s what you’re describing there.

David Essel: Oh it’s exactly. Gabe. what I’m describing. And you know it doesn’t even have to be from birth. I mean someone could hit a real challenging mental health crisis in their 20s, 30s, 60s, 70s, 80s. It doesn’t take more than about six months of something very extreme of PTSD, high anxiety, bipolar, schizophrenic disorder… It doesn’t take more than six months for the subconscious mind to create an identity that says, this is who I am. To our listeners that maybe have loved ones that struggle with depression, but they haven’t, to hear what we’re talking about, that it’s scary to not be a depressed person, doesn’t make sense. But a lot of conditions in this world – addiction and mental health disorders – don’t make sense. So if you’re listening because you have loved ones that are struggling and we’re talking about people that who are depressed, they create an identity, and they want to stay in their identity, even if it doesn’t sound logical, it’s very true. So understand that when you’re dealing with your loved ones that they may be trying to hold on at some unconscious or subconscious level to their title, to their identity as a depressed person in order just to survive, because they have nothing that they can even compare it to. And let me make this differentiation between the conscious and the subconscious mind. So the conscious mind that the mind says, you know, I’ve been feeling down, I’m always blue, I’ve lost my joy for life, nothing sounds good to eat or to drink and no activities that I used to do sound good anymore. And it’s dragging myself out of bed in the morning and so many of the symptoms of clinical depression that I just mentioned. Wen we have all those things going down and we live with ourselves on a daily basis, that subconscious mind picks up the pattern. We’ll never get out of this. Life is too hard. It’s too challenging. No one understands me. No one could possibly understand me. There is nothing that works. I’ve tried several medications, the side effects are worse than… And it’ll go on and the subconscious will grab that identity that we are a depressed person, and because we’ve rethought it so many times and talked about it so many times and gotten that validation from the outside world – I’m so sorry you’re struggling – that the subconscious then, because it’s so powerful, will hold on and fight like heck for that person to stay in that depressed identity. You know, we work with people that, in the beginning, they were on the correct medication, they were doing the correct coping mechanism skills that we gave them, we have them doing all kinds of exercises on emotion for depression. We believe in our experience in the world of depression that about 90 percent of it is caused by unexplored or submerged emotions like rage and anger, resentments, shame, guilt, like we really believe about 90 percent of depression is caused by emotions that have not been vented, that haven’t had no place to escape. So the subconscious continues to grab onto these thoughts and as that person starts to feel better, they start to see the world open up. There is a percentage that will actually try to retreat back into that depressed identity to get the validation and the feedback from the outside world that they are used to. So again, while it may not make sense to the person that’s never personally struggled with anything we’re discussing tonight, it doesn’t have to make sense to be real and hopefully some of this information that we’re sharing will make it easier for us to understand that person struggling without having to judge them or without having to placate them and keep them in that stuck identity.

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 everyone. We’re here talking with David Essel. You’re not the first that I’ve heard talk about depression being caused by unexpressed emotions, specifically anger is what I’ve heard in the past, so I’ve always found that pretty interesting. I never considered myself an angry person. It takes a lot to get me angry, as Gabe can attest. But when I when I stopped to think about it, I did have a lot of repressed anger, just unexpressed, and that I just would fight down and everything. And it often was that way because there was no target. It was just general, you know, free floating kind of anger with nothing to aim it at. So that was an interesting thing. So you talked a lot about the subconscious versus the conscious mind here, and of course, a lot of us have always heard things like well, you know, subconsciously, yada yada yada. We’re responsible for this and this is what’s causing that. The subconscious, in other words, just sounds like a negative thing but is there a positive aspect to it?

David Essel: Oh gosh, Vince, that’s that’s a great question. And you know, we believe in life that whole concept of yin yang is is absolute perfection. There is an opposite to everything. So if the subconscious that we’re talking about tonight from a negative point of view, keeping us stuck in an identity as a depressed person, then it must also be, there must also be a powerful side of the subconscious. And and there is. Thank God. Because the subconscious works on patterns, whatever you feed it or whatever you’re around listening to or whatever you’re watching or the people you’re hanging out with, they’re all sending messages to the subconscious constantly about someone’s right, someone’s wrong, conspiracy theories, you know, your weight gain is genetics and all this other kind of stuff. When a depressed person can break the chains of an identity based on being depressed and they can start to heal, if they’ll stay with the daily exercises and the possible medication that they may be on that they can stay with the program long enough, they can turn that subconscious mind from battling to hold onto an identity that I am a depressed person or I am a suicidal person. We can actually turn that around, guys, that you can use the subconscious as your greatest ally in the world. Now when I say subconscious, I want to make something else clear, too. We look at subconscious responses and a term that we always use is a subconscious response is a knee jerk reaction. That’s the easiest way to describe it. So someone is talking to you about your mental illness and they say, hey you know I just read the story about this person in some other city that used this new therapy and it was incredible. Now, to most people who are struggling with depression, the immediate response is, well it might work for them, it would never work for me, I’ve tried everything. That happens so fast that it’s not a conscious decision to reply like that to this person. It’s a knee jerk reaction. It’s a defense mechanism, and it happens instantaneously without us even thinking about it. Now the cool thing is, and I’ll sort of jump tracks here over to the world of addiction, for twenty-five plus years, I knew myself as a raging alcoholic, but I was in denial, so I didn’t call myself a raging alcoholic… a cocaine addict, and I was in denial with that, too. For twenty-five plus years, my identity was all about addiction, but I didn’t use the word addiction on myself. I said, this is the way I relax. This is what successful men do. So I created a subconscious identity to protect my addiction so I never had to end it. Now when I ended it, guys, there were three parts of my recovery that were the scariest… It was like living a nightmare. The first was going to a treatment center and knowing that, as of noon when I checked in, I would not have access to any alcohol or drugs. And it scared the hell out of me. The next time I was extremely afraid was the day that I came home, thirty-two days later. And now I was free. I had the freedom. I could go to the store. I could go to my local dealer. I could do whatever I wanted to and that was outrageously scary. And then the third scariest time was basically the next year. When I was changing my identity. I wasn’t drinking. I was doing really heavy duty emotional work with several counselors. But I was still afraid to go to dinners or to go anywhere… I was based in fear. And over time and a lot of work – and that was a number of years ago – the fear totally was gone. The subconscious mind we turned around to be an ally where I am a completely recovered person. We don’t even talk about the word addiction, anymore. I don’t believe that I’m a “recovering” alcoholic. I believe I have fully recovered, which is a pretty strong statement, but we can back it with tons of information, if needed. But the subconscious, now, I go to parties, I go out to dinner, I’ll go to funerals, I’ll go to weddings, I’ll officiate weddings and funerals, and where in the past, it was just really normal for me to look for a glass of wine or someone to offer it right away, now the subconscious has turned around so much, guys, that there’s not even an interest. When the last great depression hit, in 2006, 2007, and I was sober back then, I lost everything. And I over-bet on the real estate industry, I had everything on the real estate industry, and I lost my shirt, as they say. In that time of going through those years, of accumulating all of this wealth and losing it in a matter of a year, completely losing everything… It would have been a great opportunity, if the subconscious hadn’t been so wholly turned around, for me to drink or to do cocaine or do something to get out of the pain. But when you learn the correct coping mechanisms, and the subconscious is turned around, the thought of having a drink never even enters your mind. And that’s the beauty of the subconscious, is that if you’re willing to do the work – which about 90 percent of people in this world (now listen to this) are not willing to do – you can go ahead and take wherever you are with your addictions, with your challenges and with the correct help, and in some cases, as you guys know, the correct medication – which can be really hard to get that correct dosage and the correct medication – but if you’re willing to do the work, we can heal so deeply and turn that subconscious mind that used to have an identity as a depressed person or I can’t do this because I have this other mental health issue or I have an addiction… we can turn that around and find out what freedom truly feels like.

Gabe Howard: I think I understand what you’re saying because, for example, when I work with doctors, social workers, psychologists, people that work with people with, you know, severe and persistent mental illness, you know, bipolar, schizophrenia, major depression… I always ask them what are their goals for their patients. And, oftentimes I get pretty stereotypical answers. They want them to be med compliant, they want them to stop pushing back in therapy, they want them to be on time, they want them to not complain about the wait of the waiting room, they want them to pay the bills on time. You know, a lot of stuff like that, that is all very good things. I mean, I understand why they want them to, you know, take their medicine as prescribed and be on time and not cause a problem in the waiting room, but I pointed out that there’s a disconnect there because their patient’s goal is to go to Hawaii. Their patient’s goal was to get married, is to have a job. They’re not going to see you to be compliant with the treatment that you prescribe. They want the treatment so they can get on with the rest of their life. And it seems like what you’re saying is if the doctors sort of subconsciously believe that the goal is to be compliant, they’re going to subconsciously push that compliance onto their patients. That’s going to make their patients unhappy because they don’t feel that their medical staff understands that their goal isn’t to be compliant. Their goal is to go to Hawaii. And the doctors don’t realize they’re doing this, the medical staff, they don’t realize they’re doing it, they’re not bad people. So yeah, if your knee jerk reaction every time something bad happens is to drink, that is in fact problematic… or however it fits into, you know, anxiety, depression, etc.

David Essel: Yeah. Interesting comment that you just made, too, Gabe, about, you know, do we as professionals, do we understand what someone’s going through? And again I’ll say it’s probably one of the edges that counselors, therapists, psychiatrists who have struggled themselves have. A number of years ago, I started working with a young schizophrenic man, and I still work with them to this day. And when… you know, our traditional sessions for 18 and up is an hour, 17 and lower is a 30 minute session. So, you know, he was they were really struggling with finding the right medication. He would be in the session with me but not there present for about 80 percent of the session. He would be drifting off and, you know, the voices were coming and thoughts were coming and he couldn’t stay… he couldn’t concentrate, just could not concentrate. So I said to his parents one time, I said, hey listen, I love your son, by the way. I’ve worked with him. We do great work together. But I want to make a recommendation, and this is going against all protocol that we’ve been trained with, but I want to do 15 minute sessions. That’s it. I can see that this is a strain on him. I can see that this isn’t what he wants. Now, he walks out of the sessions telling you, mom and dad, that you know he wants to continue to work with David. But I said in the sessions it’s different. So if you’re willing, and thank God they were… guys, we went to 15 minute sessions. This young man blossomed. Right now – and I’m getting shows as I say this – the last time I saw him was three weeks ago because his family went on a vacation. He is now in his… I think he’s 24. He’s in college. He’s going to get an associates degree. Now, it’s going to take him… I think he’s been at it for about three years. I think it’s going to take him another year. Now, he will never live outside of the house, he’ll always live with mom and dad, but for this kid, this young man… and it goes right to what you’re saying, Gabe, it’s like, you know, when we asked him what was his goal, his goal was to finish school. Now according to everyone else that had worked with him, that was an impossibility. He couldn’t go to college, for all the different challenges that he had. And yet, in a year he’s going to graduate. When I saw him just before the Christmas break, the last time I saw him, he was ecstatic. Now he doesn’t show ecstasy like I might or someone else might. But you could see it in his face and his eyes how proud he was that he was able to do this, you know, and able to accomplish something that everyone had told him he couldn’t do. And I think it’s because we modified, extremely modified the program to fit him, not what statistically programs are supposed to be like. Does that make sense?

Vincent M. Wales: Yeah yeah. And that’s that’s a great story. Great story. Thank you. Thank you. Let’s talk about anxiety for a second. What kind of things have you got to say about that?

David Essel: First let’s look at the volume. You know, 40 million people on a daily basis in the U.S. alone struggle with depression and/or anxiety. It’s an interesting topic because we’ve heard over the years that there’s been a continual increase in anxiety in our society and people are blaming social media, and it definitely has a role in it for sure. When we talk about anxiety, and I just had a brand new client this week start, and he came in and he’s filled with anxiety. Now he has a high pressured sales position, so everyone who has always told him, all the counselors he’s worked with,you know, it’s genetically based or it’s something, it’s just you put so much pressure, you’re so competitive, you’re so you’re this, you’re so that… and I just met with him one time, we had our first session, and I asked him – because this is, I think, a missing link with anxiety – I asked him was his grandmother, grandfather, mom, dad, sister, brothers, aunts or uncles… Was there anyone in his life when he grew up that couldn’t relax? That was always on the move. That was always trying to accomplish the next ABCDE. And he looked at me and he started laughing and I said, What’s so funny? He goes, You just called my mother out. I said, Well let me tell you something. In our opinion, and we’re just one opinion of 40 years in the personal growth industry, 30 years in counseling and coaching, he said we see anxiety being created by the core family element between the age of zero and 18 much more so than a genetic link. And what we mean by that is… we’ll go back to the subconscious mind. From zero to 18, we’re in an environment where mom can’t sit down. She’s always up and moving. She can’t relax. She’s always doing that. It might seem productive, you know, that she’s dusting now and she’s sweeping next and she’s picking up this next and she’s got TV’s on one room and and a radio on and another room. That might seem like a productive use of time. Actually it’s an example of a full-blown anxiety episode. So this young man was raised in an environment where it was normal to not relax. It was normal to be hyper-competitive. It was normal that, when friends or relatives were coming over, that that house was freaking spotless. It was normal that all of this anxiety that was produced, not on purpose, but by mom, and she’d probably modeled her mom or dad… he took on because of the environment he was raised in. And right away when I see… when I can when I can pull someone out of, you know, this must be genetic, and everyone wants to use those words, genetic. So with anxiety, a large percentage we see that people – just like almost everything we’re talking about tonight, guys, is that people, when we’re not taught how to deal with emotions, when we’re not asked to go deeper, when we’re not exploring what could be the cause of this depression or anxiety other than the fact that it could be genetically related, that we’re losing out on helping millions of people a day to heal. So anxiety is real. The condition is real. A huge number of people are affected by it. But we have seen in our practice so many people heal from it, get off of their medications, live super productive lives when they learn how to deal with underlying emotions that they didn’t even know were there. Or they can start to see constructively that, oh my god, I’m repeating my dad’s alcoholism or I’m repeating my uncle’s whatever it might be. There are so many conditions that are created in this incubator called zero to 18 and I think that information is crucial to get out because, once again, going back to what I talked about a little while ago, this gentleman that came in the other day, he said, I’ve been diagnosed with full-blown anxiety attacks, panic attacks. I have them once a week. And now we’re going to get to the core and find out what is causing them. And a big part of it could be he’s just repeating the way his mom reacted to life, and if he continues doing that, it’s going to get worse. But we’re gonna help him break through it, for sure.

Gabe Howard: That is wonderful. Thank you so much. We’ve only got a couple of minutes left, is there any final thoughts that you want to leave us with? Where can we find you? Obviously the show notes will have your web page and all of that stuff. But, you know, there’s just so much that we didn’t get a chance to talk about. Can you give us the 30 to 60 second overview of of everything that we can know about you?

David Essel: Absolutely, Gabe. First of all I want to thank you and Vince for having me on, and for our listeners… you know, we offer a lot of free stuff. And that’s – again, how do you reach 2 million people a day, is that you’ve got to be creative, so – if your listeners want to get on our daily video e-mail list – it’s called David Essel’s Daily Video Boost – where we talk about these type of topics, where we talk about what causes depression and what are some of the potential cures and everything else that we’ve discussed today… All they have to do is go to the Web site, which is TalkDavid.com and sign up for the Daily Boost, it’s free. They’ll also find our link for our YouTube videos. Thirteen hundred videos, there’s a lot of videos on depression anxiety et cetera there. So if they just go to TalkDavid.com, they can find out where they can get all the free information, and then if they wanted to do something with the work that we do, they could let us know with an e-mail.

Gabe Howard: That would be wonderful. Thank you so much. And thank you, everybody, for tuning in this week. And remember you can get one week of free, convenient, affordable, private, online counseling anytime, anywhere by visiting betterhelp.com/psychcentral. We will see you all 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: How to Change Your Psychological Identity

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