Common Signs of Someone Who May Be Suicidal

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About 70 percent of people who commit suicide give some sort of verbal or nonverbal clue about their intention to end their life. That means you could be in a position to guide someone to get help before they commit the one action that can never be taken back.

While 30,000 Americans die each year due to suicide, more than 800,000 Americans attempt suicide. Although women attempt suicide three times as often as men, men are four times more likely to be successful in their attempt.

Warning signs of suicide are not difficult to spot, but professionals differentiate between someone who simply has a passing thought of suicide or ending his or her own life, and someone who has persistent thoughts and has a definite plan. However you don’t have to know how serious a person is in order to help them.

Possible Suicide Warning Signs

Have you ever heard someone say two or more of the following?

  • Life isn’t worth living.
  • My family (or friends or girlfriend/boyfriend) would be better off without me.
  • Next time I’ll take enough pills to do the job right.
  • Take my prized collection or valuables — I don’t need this stuff anymore.
  • Don’t worry, I won’t be around to deal with that.
  • You’ll be sorry when I’m gone.
  • I won’t be in your way much longer.
  • I just can’t deal with everything — life’s too hard.
  • Soon I won’t be a burden anymore.
  • Nobody understands me — nobody feels the way I do.
  • There’s nothing I can do to make it better.
  • I’d be better off dead.
  • I feel like there is no way out.
  • You’d be better off without me.

Have you noticed them doing one or more of the following activities?

  • Getting their affairs in order (paying off debts, changing a will)
  • Giving away their personal possessions
  • Signs of planning a suicide, such as obtaining a weapon or writing a suicide note

Friends and family who are close to an individual are in the best position to spot warning signs. Often times people feel helpless in dealing with someone who is depressed or suicidal. Usually it is helpful to encourage the person to seek professional help from a therapist, psychiatrist, school counselor, or even telling their family doctor about their feelings. The National Suicide Prevention Lifeline (1-800-273-8255) offers free and confidential support for people in distress as well as prevention and crisis resources for you and your loved ones.

Remember, depression is a treatable mental disorder, it’s not something you can “catch” or a sign of personal weakness. Your friend or loved one needs to know you’re there for them, that you care and you will support them no matter what.

Suicide is one of the most serious symptoms of someone who is suffering from severe depression. Common signs of depression include:

  • Depressed or sad mood (e.g., feeling “blue” or “down in the dumps”)
  • A change in the person’s sleeping patterns (e.g., sleeping too much or too little, or having difficulty sleeping the night through)
  • A significant change in the person’s weight or appetite
  • Speaking and/or moving with unusual speed or slowness
  • Loss of interest or pleasure in usual activities (e.g., hobbies, outdoor activities, hanging around with friends)
  • Withdrawal from family and friends
  • Fatigue or loss of energy
  • Diminished ability to think or concentrate, slowed thinking or indecisiveness
  • Feelings of worthlessness, self-reproach, or guilt
  • Thoughts of death, suicide, or wishes to be dead

Sometimes someone who is trying to cope with depression on their own might turn to substances like alcohol or drugs to help ward away the depressive feelings. Others might eat more, watch television for hours on end, and not want to leave their home or even their bed. Sometimes a person who is depressed may stop caring about their physical appearance on a regular basis, or whether they shower or brush their teeth.

It’s important to realize that people who suffer from serious, clinical depression feel depressed for weeks or months on end. Someone who’s just having a particularly rough or stressful week (because of school or work demands, relationship problems, money issues, etc.) may not be suffering from clinical depression.

Common Signs of Someone Who May Be Suicidal

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Dying for the Ultimate Selfie: We’re Really Bad at Accurately Assessing Risk

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

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Selfies are the journaling of our time. We take them everywhere we go, not only to remind our future selves of things we’ve done, but to also broadcast to the world what a fun, exciting, and carefully-curated life we lead.

But in a story that’s becoming as commonplace as school shootings in America, more and more people are either dying or putting themselves in extreme physical danger to take the ultimate selfie. And for what? Fame in the form of more likes and followers on social media.

Why are we so bad at rationally assessing risk in situations such as this?

It’s hard to believe we’ve come to a point in humanity where a simple act of photography could be life-threatening. But combine narcissism, the desire for popularity that extends beyond high school, and the human psychology of risk assessment, and you get a dangerous combination.

Reasons People Put Their Life at Risk for a Selfie

Humans fundamentally underestimate risk. Our minds have developed evolutionary shortcuts in order to make decisions more quickly — especially decisions about risk. This quick shortcut reaction in our brains evolved because it provided us an advantage in our fight-or-flight response, allowing us to decide whether we needed to get away from a potential predator or fight it. It served humanity well for thousands of years.

But over time, the risks changed from natural predators and dangers in the wild to less obvious risks in a mechanical and technologically-driven world. Our brains aren’t naturally wired to take into account these new man-made risks, and so the brain engages in a faulty and biased risk assessment.

Rewards can obscure the risk. When a person becomes so focused on the reward of attaining a goal they’ve worked hard to get — such as taking that ultimate selfie — their brains put aside risk or downplay it in such a way as to make the risk seem significantly less than it actually is. The amount of new follows and likes a person believes they are likely to receive from an amazing selfie simply outweigh their own personal safety.

Sunk costs may come into play as well. If a person has spent the past two hours trying to get to a specific remote rock outcropping to take the ultimate selfie, most people can’t imagine spending all that time and effort — and then not take the selfie. At that point, the person already has so much sunk cost — a cost that has already been expended in time, money, and effort that cannot be recovered. Turning back doesn’t seem like a reasonable option to most people’s brains. The supposed benefits gained from the once-in-a-lifetime selfie simply outweigh the risk.

Risks that we have control over — such as standing on a dangerous ledge — are perceived as lesser and more acceptable than risks we don’t have control over. This is why flying in an airplane is so scary to some — they aren’t the ones driving it; they have no control over the minimal risk they’re taking. This is also why nobody thinks about injury or death when getting into their car. Even though the statistical chances are infinitely higher in getting into an automobile accident rather than an airplane accident, we have control over the car we drive. In our brain, such control provides more acceptable risk — even when the data show that our brain is biased and wrong.

Memory also gets us into trouble when it comes to accurate risk assessment. If we’ve taken dozens of selfies in potentially-dangerous situations in the past without issue, our mind remembers and emphasizes that datapoint. So if 100 percent of the previous times we’ve taken a risky selfie, we’ve had no problem, our brain says, “Why would this time be any different?”

Humans regularly overestimate the odds of unlikely or rare events occurring, while simultaneously underestimating how dangerous or risky commonplace events can be. For instance, we believe that catastrophes, like a school shooting, happen far more frequently than they do. Some people even have a fear of going to school because of them. It’s splashed all over the news when it happens. Statistically, however, school shootings are still relatively rare events.

Everyday risks, on the other hand, we take for granted. They never get any news coverage. Auto accidents, for instance, occur far more frequently and are just as traumatizing to those involved. But you rarely see one in the news, or hear about it from friends — unless it affects someone you personally know.

That’s why people driving an automobile feel safer and believe they’ll never get into an accident — that sort of thing happens to other people. This false belief completely obscures the truth — that most people will be involved in an auto accident in their lifetime. And some people will even lose their lives from one.

Add all these reasons up, and you have a perfect equation for why people take extreme risks to take a selfie. Their brains have miscalculated the risks involved and decided that the rewards, sunk costs, and sense of control outweigh any possible downside.

Sadly, some people are paying for it with their lives. No selfie is worth a person’s life. But saying that won’t magically make a person reassess their selfie choices, because fame and popularity are the virtual drug of choice these days. Sometimes common sense just won’t win out until the fad has faded.

Dying for the Ultimate Selfie: We’re Really Bad at Accurately Assessing Risk

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When Your Anxiety Doesn’t Have a Trigger

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It’s very common for Kristin Bianchi’s clients to tell her that they’re feeling anxious, but they’re not sure why. They say they recently haven’t experienced anything particularly stressful or anxiety provoking, so it doesn’t make much sense.

Consequently, “they frequently become worried about the meaning behind these seemingly random feelings of anxiety,” said Bianchi, a licensed clinical psychologist who specializes in treating OCD, anxiety disorders, PTSD, and depression at the Center for Anxiety & Behavioral Change in Rockville, M.d.

In other words, she noted, “they become worried about worrying, or frightened of fear.”

When many of Regine Galanti’s clients initially start working with her, they, too, describe their anxiety as just happening. Galanti is a licensed psychologist and director of Long Island Behavioral Psychology, where she specializes in using evidence-based treatments for anxiety and related disorders in children, teens, and adults.

Many of us believe our anxiety comes out of the blue. It just feels so random and sudden—startling us like the siren of a smoke alarm, or a squirrel jumping out of the bushes.

But this is rarely the case. Rather, we simply don’t notice our triggers. What we do notice is our anxiety, because it tends to be blaringly, glaringly loud. “When we feel something strongly, we often zero in on it and discount all the information leading up to and surrounding it,” Galanti said.

And the information that leads up to your blaringly, glaringly loud anxiety might be a thought, feeling, or behavior. Galanti noted that anxiety, and really all emotions, consist of those three parts. For instance, you might feel horribly anxious the morning after going to sleep past midnight, she said. You might become anxious as you notice your heart beating faster, she said.

Bianchi noted that it’s very common not to recognize that our thoughts are a significant trigger. “Thinking happens so quickly and automatically that we often don’t realize that we’re having stressful dialogues or creating catastrophic narratives in our own heads.”

For instance, she said, you might not even realize that you’re revisiting a recent conversation that caused you some stress. Maybe you’re replaying how your coworker was gossiping about your boss, which made you very uncomfortable. Maybe earlier this morning you and your spouse fought over your monthly budget (or lack thereof). Maybe your mind drifted to the sarcastic remarks your date was making (and how annoying they were).

The catastrophic narratives your head is spinning might include: “wondering whether or not you turned off certain household appliances, then imagining your house burning down if you forgot to do so; worrying that something bad will happen to a loved one, then imagining your reaction if that type of personal tragedy were to occur; creating ‘worst-case scenarios’ involving academic, career, or financial ruin when thinking about a recent disappointment or setback in any of those domains,” according to Bianchi.

Panic attacks also are a prime example. They seem sudden, but there are usually specific triggers, Galanti said. It might be a thought, “I can’t easily escape this situation,” or a physical sensation, such as your heart rate speeding up, she said.

And then there’s our digital culture. “We reflexively hop from tab to tab, app to app, and website to website, generally giving very little thought to the process,” Bianchi said. But while we might not notice that we’re doing all this hopping and scrolling, we’re still responding emotionally to what we’re consuming, she said.

That means that we are responding emotionally to sensationalist news headlines, flawless Instagram images, and emails from colleagues and clients, all of which can trigger anxiety. However, we’re too hyper-focused on these stimuli to notice what’s brewing inside our bodies.

“Even low-level anxiety reflects that we’re experiencing a fight-or-fight response,” Bianchi said. “When we finally notice it, it can come as a surprise to us, as we hadn’t been paying attention to it up until that point.”

So what can you do? What are your options when your anxiety seems to arise out of the blue?

Below, you’ll find a few tips on identifying your triggers—even the subtle ones—and reducing anxiety when it starts. It’s especially helpful to practice the relaxation strategies when you’re not anxious. This way you’re familiar with them, and maybe even created a habit.

  • Act like a scientist. Galanti tells clients that the goal is to help them treat their anxiety like a scientist: to “take an outsider perspective on their insides.” To do this, she suggested readers use a journal or the notes section on your phone to record your anxiety. That is, whenever you feel anxiety coming on, she said, ask yourself, “What just happened?” “literally, what happened immediately before and then try and pinpoint [your] thoughts, physical feelings, and what [you] do.” Maybe you downed a huge cup of coffee. Maybe you thought about your to-do list. Maybe your thoughts shifted to your child’s first big presentation. Maybe you read an email from your boss. Maybe you said yes to an invitation (that you really, really didn’t want to accept). Maybe you started sweating because it’s so hot. Tracking what triggers your anxiety helps you to spot patterns, and “those patterns can help people come up with solutions,” Galanti added.
  • Slow down your breathing. Bianchi suggested “breathing in slowly through your nose to a count of 4 to 6 seconds, holding your in-breath for 1 to 2 seconds, then slowly breathing out through your mouth to a count of 4 to 6 seconds.” When you’re breathing out, it helps to “imagine that you’re blowing fuzz off a dandelion or blowing a stream of bubbles,” she said.
  • Practice this grounding technique. According to Bianchi, find five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. “This shifts our focus away from the anxiety and helps us to reconnect to the present moment using our five senses.”
  • Practice progressive muscle relaxation. This involves scanning your body for muscle tension, and then “unclenching” tight muscles to release that tension, Bianchi said. “When doing this, it’s important to remember to relax your jaw, open your mouth slightly, and make sure that your tongue is positioned at the bottom of your mouth (versus flexed against the roof of your mouth).” You also can use an app that offers a guided practice, such as Headspace; Stop, Breathe, and Think; and Pacifica, Bianchi said.
  • Face your fears. Avoidance only amplifies and strengthens our anxiety. Facing your fears, a skill known as “exposure” in cognitive behavioral therapy (CBT), is incredibly effective in reducing anxiety. Galanti suggested devising a list of small steps to help you face your triggers. For instance, she said, if caffeine triggers your anxiety, you might “start drinking a little bit of coffee a day, and see what happens. Even if you do feel anxious, maybe you can handle it better than you think you can.” Another option is to work with a therapist who specializes in treating anxiety with CBT or other successful treatments. Bianchi suggested starting your search at a professional organization, such as https://adaa.org, and http://www.abct.org.

Anxiety can sometimes feel like it has zero rhyme or reason, which can be exceptionally frustrating. It can feel like you’re going about your business, and BAM! an object falls from the sky and smacks you on your head.

But when you delve deeper, you realize that there’s a thought, feeling, or behavior that sparked that bam! And that’s valuable information. Because now you can focus on the root of the issue and try to resolve it, whether that’s a conflict with a loved one, difficulty saying no, the fear of fear, not enough sleep, or something else altogether.

When Your Anxiety Doesn’t Have a Trigger

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Small Things I Do Every Day to Manage My Depression

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Some days you feel well, and other days, darkness envelopes you. You feel achingly sad, or you feel absolutely nothing. You’re exhausted, and every task feels too big to start. You feel weighed down, as though there are sandbags attached to your shoulders.

Managing the symptoms of depression can be hard. But even the smallest steps taken every day (or on most days) can make a significant difference.

Below, you’ll learn how five different women live with depression on a daily basis, and the small, yet pivotal actions they take.

Having a daily routine. “Having a daily routine helps me push through the days when I’m not feeling my best,” said Denita Stevens, a writer and author of the recently released poetry collection Invisible Veils, which delves into her experiences with depression, anxiety, and post-traumatic stress disorder (PTSD).

Stevens’s routine starts at night with two morning alarms: one alarm is optional, the second one, which rings around 7 a.m., is not. “I take a moment to gauge how I’m feeling before deciding which one I wake up to.  Sometimes I don’t always have a good night’s sleep and an extra hour of rest helps.”

When she’s up, she drinks coffee and reads. Then she focuses on work. The evenings are dedicated to personal time. This “gives me motivation to accomplish what I need to do during the workday in a timely manner and allows me to end the day investing my time in myself,” Stevens said. This me-time might mean socializing, exercising, relaxing, or working on a writing project—right now she’s working on a memoir about what it was like to live with undiagnosed PTSD and how she recovered.

On weekends, Stevens doesn’t have a schedule. “A balance between scheduled and unscheduled time every week seems to work best for me,” she said.

Setting boundaries. “Setting boundaries is extremely important to my mental and emotional well-being,” said T-Kea Blackman, a mental health advocate who hosts a weekly podcast called Fireflies Unite With Kea.

For instance, Blackman has set her phone to go into “Do Not Disturb” mode every night at 9 p.m., because she wakes up at 4:45 a.m. to exercise. “Working out has been beneficial as it helps to improve my mood and I sleep much better.” Going to bed around the same time and waking up around the same time helps her get consistent rest. “When I am not well rested, I am unable to function throughout the day.”

Exercising. “I make myself exercise even if I don’t feel like it,” said Mary Cregan, author of the memoir The Scar: A Personal History of Depression and Recovery. “If my mind is troubling me, I’ll try using my body instead.”

If Cregan’s energy is really low, she goes for a walk. And these walks have a powerful benefit: She gets to see other people—“little kids in playgrounds, old people walking with their shopping bags, teenage girls all dressed alike. People can be interesting or amusing, and help me get out of my own head.”

Cregan, who lives in New York City, also likes to walk along the Hudson or around the reservoir in Central Park, and admire the water. She likes to look at the plants and trees, too. “If the sun is out, I’ll sit on a bench with the sun on my face.”

Tidying up. Cregan also regularly makes her bed and cleans up the kitchen. This way, she said, “things don’t feel messy or ugly, because that would be depressing in itself.” Sometimes, she buys flowers for her home, since looking at them cheers her up.

Having downtime. Blackman prioritizes downtime to help her unplug and recharge. Sometimes, this looks like listening to water sounds—waves crashing onto the shore, water hitting the rocks—and putting on her essential oil diffuser as she listens to a podcast or reads a book. Other times, it looks like lying in bed and letting her mind wander, as she listens to the water sounds and breathes in the essential oils.

Wearing comfortable clothes. Fiona Thomas, author of the book Depression in a Digital Age: The Highs and Lows of Perfectionism, regularly tunes into her inner dialogue. When she notices the chatter is negative—“you’re so lazy”—she decides to actively challenge the voice and be kind to herself instead.

“One small way that I’m kind to myself every day is by wearing clothes that I feel comfortable in as opposed to what I think people expect me to wear. If I want to wear leggings and a baggy jumper to the supermarket, then I do it.”

Creating small moments of self-care. Another way that Thomas is kind to herself is by going out for coffee, or taking several minutes to stand by a canal and watch the ducks go by.

Practicing self-compassion. In addition to depression, Leah Beth Carrier, a mental health advocate working on her master’s in public health, also has obsessive-compulsive disorder and PTSD. When her brain tells her that she isn’t worthy, doesn’t deserve to take up space, and won’t ever amount to anything, she gives herself grace. “This grace I give myself allows me to be able to hear these old tapes, acknowledge that they are fear based and my fear has a purpose, and then continue to go about my day.”

Taking a shower. “I try my hardest to take a shower every day even though I find this really difficult with depression,” Thomas said. “Even if [showering is the] last thing [I do] at night, I know it helps me feel healthier in the long run.”

Looking in the mirror. “I have also found that the simple act of looking at myself in the mirror, eye to eye, each morning and making a point to say hello to myself—as silly as it sounds—keeps me grounded,” Carrier said. “It is also a little reminder that my existence here on earth is allowed and OK, maybe even something to be celebrated.”

Of course, the specific small actions you take will depend on the severity of your depression, and how you’re feeling that day. The above actions are examples that speak to the power of small. Of course, it’s also vital to get treatment, which might include working with a therapist and/or taking medication.

Ultimately, it’s important to remember that the pain isn’t permanent, even though it absolutely feels permanent in the moment. You won’t feel this way forever. “Having lived with depression since I was a teenager, I’ve discovered that even at my lowest points, I can still survive and it will get better,” Stevens said. “It always gets better. May not seem like it at the moment, but those feelings are only temporary.”

“I never believed it when people told me it would get better when I was in my darkest days and attempted suicide, but I remained committed to my recovery…,” Blackman said. She’s made various changes, and has seen a huge improvement in her mental health.

Don’t discount the power of small daily acts and steps. After all, before you know it, those small steps have helped you walk several miles—a lot more than had you been standing still. And if you do stand still on some days, remember that this is OK, too. Try to treat yourself gently on those days, to sit down, and extend yourself some compassion.

Small Things I Do Every Day to Manage My Depression

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Small Things I Do Every Day to Manage My Bipolar Disorder

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Living with bipolar disorder can feel overwhelming. Maybe you’re tired of the ups and downs of different episodes—the soaring energy, the debilitating fatigue, the racing I-need-to-do-everything-and-I-need-to-do-it-now thoughts, and the dark, decelerated, bleak thoughts.

Maybe you’re exhausted from struggling with an especially stubborn and deep depression, which makes it tough to concentrate on anything, and feels like you’re walking through a river of waist-high molasses in a fog.

Managing bipolar disorder can feel overwhelming, too. What can make it much easier is getting effective treatment. Bipolar disorder is highly treatable—but a lot of people with the illness don’t get professional help.

Author Charita Cole Brown pointed out that “Of the estimated 5.7 million Americans living with the disorder, over 50 percent won’t seek treatment.” She wrote the memoir Defying the Verdict: My Bipolar Life “to reduce the stigma surrounding mental illness in general and bipolar disorder in particular. People need to understand how important it is to seek appropriate treatment.”

“My recovery is no anomaly,” Brown said. “By sharing my story, I want people to understand that mental illness is physical illness, therefore we must seek treatment as we would for diabetes or a broken arm.”

In addition to seeking treatment, there are small things you can do every day. Below, alumni from This Is My Brave share the small and significant ways they manage their bipolar disorder. This Is My Brave is an international nonprofit organization that hosts live events and publishes essays on their website written by people who are living with mental illness and living well.

Checking in. Amy Gamble is a speaker, executive director of NAMI Greater Wheeling, and a former Olympian. Every day and throughout the day, Gamble checks in with how she’s doing: “’Are my thoughts racing a little or do I just have a lot of creativity going right now?’ If I find I’m a little charged up or anxious, maybe even hypomanic, I take extra precautions not to make a lot of decisions.”

Gamble monitors her behavior, too. “I think about what is typical for me when I’m balanced. I am a very deep thinker and don’t typically make impulsive decisions. If I start acting on impulse, I reel myself back in. I don’t always notice a change in my behavior right away, but I monitor with hypervigilance.”

Suzanne Garverich also carves out time to pause and do a “self-inventory.” “I assess quickly how I am doing emotionally, physically, mentally, and spiritually,” said Garverich, a public health advocate who is passionate about fighting mental health stigma through her work on suicide prevention as well as telling her story. This helps her identify her needs—“before I go too far down the rabbit hole”—and meet them.

For instance, if Garverich determines that she’s feeling emotionally low and having dark thoughts, she figures out what she needs to do to “help me not go deeper into the dark thinking and depressive feelings.” She might call a friend or take a 10 to 15-minute walk. “It could be as simple as walking to the water fountain and drinking some water—just moving a muscle to change a thought. It could also be that I need to do some redirection of my thinking using my CBT and DBT skills…”

Having an effective bedtime routine. “The major thing I do is to make sure I get 8 hours of sleep a night,” Garverich said. “This really helps in keeping me balanced—sleep has a huge effect on my bipolar.”

To help herself get restful sleep, Garverich maintains a routine. Two to 3 hours before her bedtime, she stops doing anything work-related. She usually watches 30 minutes to an hour of TV. Then about an hour before her bedtime, she takes her nighttime medication, and gets into bed to read. Some nights she also takes a shower or bath.

“I also spend time before I go to bed breathing on my back and reviewing my day—seeing what I have done well, what I would like to improve, and if there is anything I need to share with anyone.”

She sets her alarm for the same time every morning. After she wakes up, she meditates in bed for 30 minutes. (More on meditation below.)

Practicing mindfulness and meditation. Gamble, also author of the book Bipolar Disorder, My Biggest Competitor: An Olympian’s Journey with Mental Illness, practices meditation, deep breathing, and mindfulness. “Staying in the present moment keeps me from getting down about how my illness has limited me.” (She also reminds herself that “everyone has something they are dealing with.”)

Every day Gamble listens to a playlist of her favorite meditation songs. “I put on my headphones and attempt to quiet my thoughts. I focus on slowing my mind down and paying attention to my breathing.”

Garverich also finds it helpful to practice deep breathing throughout the day, especially if she’s overwhelmed. For instance, at work, she usually takes a break and goes to the bathroom to take deep, slow breaths.

Connecting with others. “For me what is really important to achieve daily, to manage my illness and nourish my well-being, is feeling connected and not alone in my thoughts,” said Susie Burklew, who shared her story at the 2018 This Is My Brave show in Arlington, and co-produced the fall 2018 show. Eight years ago, for the first time, Burklew told her therapist that she thought she had a problem with alcohol. Her therapist suggested Alcoholics Anonymous (AA).

“I went to my first meeting that evening and I haven’t had a drink since. For the first time in my life I felt like I wasn’t alone. I connected and was inspired by people who had been through the same struggles and were living a happy life in recovery. I formed a strong network of people in AA and became comfortable opening up about my addiction to alcohol.”

For the past 6 years, Burklew has worked as a behavior specialist and counselor at a government residential rehab that specializes in co-occurring disorders.

Today, reaching out to someone on a regular basis—such as someone from her recovery network—helps her to stay in the moment, instead of getting “caught up in the stress of something that’s happened in the past or the fear of what’s ahead.”

Garverich connects with at least one person in her support system every single day. She might talk to this person over the phone, or they might simply text. Either way, this helps her know she’s not alone—something her illness wants her to feel, she said.

Sivaquoi Laughlin, a writer, blogger, and mental health advocate with bipolar II disorder, makes sure she spends time with her grandson and her dogs every day. “The energy from both provide me with a level of joy that I’m constantly yearning for.”

At the end of the day, Laughlin also sits down with her “16-year-old daughter and [we] discuss our day and name something good/great that happened. Even if it’s been a hard day or we haven’t had time to really connect, I make sure she knows that every day has a highlight.”

Engaging in art projects. “I undertake artistic projects daily. I am no good at it, but I can feel like I can breathe,” said Teresa Boardman, who has treatment-resistant bipolar I disorder with PTSD, OCD, suicidal ideation, and hypersomnia. Her latest project is a birdbath. “It is quite discombobulated that I decided to go with a steampunk theme. Now it is beautiful because I changed how I see it.”

Reducing the to-do list. Every morning, Laughlin lets her dogs out, and immediately makes a cup of tea. Next, she looks at the day ahead and jots down three things she’d like to accomplish. “They could be simple, such as returning a library book or dropping off dry-cleaning to bigger projects like organizing my closet or mowing the lawn. I’ve found that by committing to only three things, it keeps me from being overwhelmed and being triggered by ‘voices’ telling me I can’t do something.”

Boardman makes notes on her bathroom mirror of things she needs to do. For instance, she might list her exercise routine (e.g., 20 minutes of cardio, 20 minutes of yoga), and that she needs to take her morning medication and her evening medication. Boardman noted that she tries to work with her illness and its varying moods. After having over 20 electroconvulsive treatments (ECT), she realized she needed to take a different approach and embrace her illness.

It’s understandable that living with bipolar disorder can feel overwhelming and frustrating. But remember that there are 5.7 million Americans struggling alongside you. Remember that this illness, though difficult, is also highly treatable.

“Don’t give up hope,” Gamble said. “Things will get better, and you can learn how to manage the symptoms. They might not go away completely, but you can learn how it affects you. You can learn how to beat bipolar disorder.”

Small Things I Do Every Day to Manage My Bipolar Disorder

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How an Innovative Therapy Technique Made Me Feel like a Superhero When I Was at My Worst

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

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“Take another deep breath, hold it, and let yourself feel like you’re drifting and floating.”

The voice overtook me as I felt my body slip into that weightless feeling between consciousness and sleep. It was as if someone wrapped my body in memory foam and filled every corner of my mind with white noise.

“My jaw is slack.”

“My shoulders are relaxed.”

“My neck is loose.”

These were some of the phrases that I was told to repeat to myself in a recording made by my therapist and given to me during our first session together. Each one focused on a different body part, meant to make me feel warm, heavy, and unconstrained. This was the beginning of my biofeedback training.

Just Relax

I chose my therapist because he’s an expert in biofeedback, a psychology technique where a patient learns to control their body’s functions, like heart rate or palm sweating. Biofeedback was first introduced in 1969 as the crossroads of traditional whitecoat psychologists and those interested in a higher consciousness.

Before I could reach a higher consciousness though, I had to master just being relaxed.

A few weeks prior to my first appointment with him, I was trapped in a horror movie in my own mind. I couldn’t shake this one single thought that replayed itself incessantly for a week straight: that of the top knuckle on my right ring finger snapping backwards and breaking.

It’s a disturbing thought on its own to anyone who prefers their fingers in tact, but imagine it popping into your mind over and over — and over and over — until you want to check yourself into a psych ward. I was consumed. I could barely talk or sleep or work without wanting to slam my head against a wall. I was desperate for any advice, so when my dad recommended biofeedback, I made an appointment immediately.

The technique he employed in the recording is called autogenic relaxation. Through the self-induced relaxation akin to hypnosis, my doctor coaches his patients to cure themselves of ailments like depression, migraines, irritable bowel syndrome, high blood pressure and anxiety — my personal woe. Learning to relax your body was just the first part, though.

Anxiety by the Numbers

At my next appointment with my therapist, he hooked me up to a slew of sensors as I reclined in his plush leather chair. Three cold metal circles stuck to my forehead measured my muscle tension in millivolts, a small wire taped to my pointer finger took my skin temperature, and two more sensors on other fingers measured my sweat production. Once I was connected, the doctor quizzed me.

“Alright, count backwards from 1,000 by 3s. If you mess up, you have to start over. If you don’t get to 940 in 30 seconds, you have to start over. Ready, go.”

I’m sure my measurements immediately spiked. I’m terrible at math and to add a time pressure to them was beyond stressful. But I got through it. He did it again, but with higher stakes.

“Okay, now you’re going to count backwards from 1,000 by 6s and you have to get to 860 in 30 seconds. Ready, go.”

To prepare for my biofeedback training, my therapist was simulating an anxiety-inducing situation to see what my normal and stressful levels were.

During the following appointment, he again hooked me up to the muscle tension sensors, but this time instead of stressing me out, he walked me through the autogenic relaxation phrases from the recording. But this time, the machine I was hooked up to was now emitting a pulsing sound that correlated with my muscle tension level. The more tense I was, the faster the pulses.

As his voice coached me through the phrases, and then in the next appointments as I walked myself through them, I learned to listen to the pulsing and to my body to see what slowed the tempo. My muscle tension level started at around 4.0 millivolts and he told me some of his patients start out at as high as 10 millivolts. Each appointment, he set the threshold lower and lower on the scale and once I reached it, the pulsing turned off. Each appointment, I was learning to bring myself to a more relaxed state than the time before.

By focusing on the pulsing, I experimented with what autogenic relaxation phrases worked best for me, what my ideal relaxed breath is like, and even how to position my head and arms for optimal relaxation.

Put to the Test

I’ve struggled with anxiety for as long as I can remember.

As I walked into the doctor’s office during my fourth session, I laid eyes on someone from my past who brings me a great amount of anxiety. My heart rate spiked and my chest tightened. Suddenly, breathing became a difficult task. I immediately turned on my heels and hid in my car until the person left, but the anxiety followed me into my appointment. My newfound relaxation technique was about to be tested.

As I cleared my mind during the biofeedback training, I was able to turn the pulsing off, meaning I brought my muscle tension down to the threshold set by the doctor, but the second the stressful person popped back into my mind, the pulsing turned back on. Over and over I emptied my mind and filled it with the autogenic relaxation phrases and turned the pulsing off, but, again, it’d spike back up once I thought of the person.

Running into my past turned out to be a blessing in disguise; I was learning to control the stressful thoughts and ensuing physiological response with just my mind. It was hard work, but I knew it would be a skill I could turn to my whole life. If I could control my heart racing, maybe it’d be easier to quiet my disturbing thoughts.

In the sessions that followed, I learned to relax myself instantaneously and in any situation without the autogenic phrases, getting my muscle tension level from the original 4.0 down to just 1.7. I’m now able to take a deep breath, let it out, hold it, and find that perfect state of relaxation — like magic.

Biofeedback empowered me during a time when I felt shaken down to my core. I walked away from each appointment feeling like I have a superpower and for the first time in years, I feel like I can finally control the anxiety that seems to rule my life.

How an Innovative Therapy Technique Made Me Feel like a Superhero When I Was at My Worst

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What It Takes to Be a Mental Health Advocate: An Interview With Christina Huff

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

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Christina Huff

At one point Christina Huff was living her dream: thriving as a paralegal in Chicago and newly in love. Five years and one divorce later, she’s still piecing together the debris – living with bipolar disorder and accepting a different kind of life. She has translated her passion for law to mental health advocacy, helping others rise from difficulty with gracefulness and determination, and is a beautiful model of turning pain into service.

Living with bipolar, anxiety, eating disorders, and chronic pain, she beautifully weaves bits of her life and advice from other warriors on her site, Bipolar Hot Mess, ranked number five out of the top 100 bipolar blogs on feedspot, and on her other site is Askabipolar.com. I asked Christina about her life as an advocate, advice for persons for bipolar, and where she finds the strength to overcome her many challenges.

Therese: What made you want to become a bipolar advocate?

Christina: When I was first diagnosed in 2006, I didn’t know anyone who had bipolar and I didn’t know anything about the illness. My immediate response was turning to the internet to look and search for information and first-person accounts so I knew what to expect. But, to my disappointment, I found very little. I did find a website called Ask A Bipolar and so I followed it for a few days and searched it. They put up an ad that they were looking for new authors and one of the qualifications was that you had to have bipolar. I applied, and then within a few months, I was learning so much, I was helping the site grow. The site owner and I became partners and off we went.

It sort of happened by accident that I became an advocate. Since the site was such a strict Q & A format, I wanted to be able to write more freely about my life and about bipolar and such, so I started my own website Bipolar Hot Mess. It started slow then one day just took off and now, if you google “bipolar hot mess” I fill the page. It amazes me every single day!

Therese: What is most challenging/rewarding about it?

Christina: The most challenging is that I do still have the illness that I’m an advocate for, so there are times that I crash. I still have the side effects and have to take care of myself the same way I advocate and help people to realize they need to do to take care of themselves too. The rewarding part is when I’m mentoring someone and I see how much progress they make, or when someone sends me an email saying how much a post, or an interview, or something I’ve done or said has helped them. Those are the things that make it all worthwhile. Or when someone was so down and was suicidal and the next time you speak they are doing well, have their life back on track, and have found happiness. Just knowing you helped that person find the light or find the path they needed, sometimes all they need is a nudge.

Therese: What would your advice be to people just diagnosed with bipolar?

Christina: Make sure you see your psychiatrist as frequently as they suggest and take ALL MEDICATION AS DIRECTED! That is super important. If your meds aren’t correct, everything else isn’t going to help properly.

Next, find a therapist. They are going to help you sort things out. When you are first diagnosed things are so confusing, they help a lot.

Work with your family and try to explain what is going on. This is a hard one, but if you are living with them, they are going to see the ups and downs everyday, so they should have a general idea of what to expect. If you have a spouse, I highly recommend the book Loving Someone With Bipolar Disorder, by Julie Fast. It’s a very good book for your spouse to read to let the, know what to expect, how they could handle things etc. In addition to some great websites, there are now a lot of books you can purchase for more information. Facebook has a lot of “private” support groups that you could try out. NAMI.org will give you info and you can find your nearest support group or events like book readings and signings etc. DBSAlliance.org will do the same.

Therese: What keeps you going during the really hard stretches where you want to give up?

Christina:My family, friends, and boyfriend. They help me see that this is just another bump in the road and I am going to make it out again alive. They show me that they still love me and will still love me on the other side and on the other side, I’m going to be even stronger than I was when I crashed. Each time I crash, I come out stronger and more aware of my symptoms, how to combat them and fight back. Granted, not every time can be a fight back moment and sometimes we just have to let it take its course, but if we know that and are aware of that ahead of time, we can at least be prepared to settle in to acceptance that we have an illness that sometimes we can control but sometimes we just have to accept we can’t control.

Therese: Do you have things you do every day to stay well?

Christina: I need to take my medication in the morning and evening, need to maintain a regular sleep schedule, eat regularly (that is for my eating disorder recovery), try to get a decent amount of sun, and try not to isolate and make contact with friends or family daily, and try to accomplish at least one task a day so I don’t sit in bed all day which could spark a depressive cycle.

The medication part though is absolutely key though. If I miss my medication even one day, it affects not just my brain chemistry but my body and takes days or weeks to even get back to normal.

Therese: What is your biggest work challenge due to bipolar disorder?

Christina:Well, I was able to work for over four years in corporate America as my dream job as a paralegal at a prestigious Chicago law firm, but unfortunately, life got in the way and triggered my bipolar symptoms and I was put on disability. It amazes me now how many are on disability. I never really thought about it until it happened to me. I guess that’s true for a lot of us for a lot of things.

Now, I work on my website bipolarhotmess.com and sell things on eBay. It’s tough most days because of my concentration and sometimes lack of motivation, but I know that if I don’t do anything, I’m going to get into the depressive slump. It’s so much easier to get IN the slump than get OUT. If I don’t work on the website I feel like I’m letting my followers down and I have to list items on eBay because the site is funded only by me. Those are some great motivators.

To conquer the concentration issue, I try different working areas and try taking more frequent breaks. That seems to help. I also make sure to keep my projects at a reasonable size. I used to make a to do list a mile long and beat myself up for not getting it done. Now I create one that is more manageable and that I know I can complete so I feel better at the end of the day, not defeated. That tip took a very long time to master!!! I’m an overachiever so it was so difficult, but if I could do it, so can you!

What It Takes to Be a Mental Health Advocate: An Interview With Christina Huff

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Five Facts About Atypical Depression You Need to Know

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

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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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How Writers Write About Heartbreaking Things and Care for Themselves in the Process

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

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For more than 20 years, Mary Cregan wanted to write her recently published memoir The Scar: A Personal History of Depression and Recovery, but she felt that she couldn’t. It’s primarily because she wasn’t ready to face the exposure required to be so honest about such a devastating, difficult part of her life.

Because that’s the thing about writing: We let readers into our innermost thoughts and feelings, into our souls, and that can be scary.

We tackle topics we’d never bring up with a close friend, let alone a stranger, and yet that’s exactly what we do. We share our stories with thousands of strangers.

Writing about heartbreaking things and publishing that work makes the private very, very public, a process that we, of course, can’t reverse. This is especially difficult if you were taught to keep your stories to yourself, behind closed doors. As Cregan writes in The Scar, “In my large Irish Catholic family, the tacit understanding was that it was best not to draw attention to oneself.”

Nita Sweeney thought she was writing a memoir about running, but after many, many drafts realized that she was writing a memoir about how running saved her life—from depression, bipolar disorder, panic attacks, agoraphobia, and alcoholism.

“The fact that I’d gone from a woman who could barely walk around the block into a marathoner was important, but the real story was that I’d gone from a woman who wanted to kill herself into one who wants to live,” said Sweeney, whose forthcoming memoir Depression Hates a Moving Target: How Running with My Dog Brought Me Back from the Brink will be published mid May.

Mental health advocate and writer Hannah Blum regularly writes about her experiences living with bipolar disorder on her blog “I’m Bipolar Too” and her website Halfway2Hannah.com. While there are many parts of her story she’s not ready to share, writing about difficult things actually isn’t that difficult for her.

“Turning my pain into art gives power to any of the challenges I have faced throughout my life.”

“It’s when I am writing about the people I have met along my journey who were not given a chance because of their mental illness that I struggle to write about the most,” Blum said.

Author, mental health advocate, and Psych Central editor Therese Borchard has been writing online about her experiences with mental illness for many years (and before that she shared her story in her print column). But that doesn’t make sharing any easier.

“It’s extremely difficult to share the more personal posts. My index finger hovers over the publish button sometimes for an hour before I have the courage to press it,” Borchard said.

Why Write About Such Hard Things?

When a friend asked Cregan why on earth she’d want to revisit the worst days of her life—the death of her infant daughter, and her descent into a deep, unrelenting, suicidal depression—Cregan realized that it was because she’d spent decades trying to conceal that time. “…I wanted to turn to the past and face it squarely,” she writes in her memoir.

Cregan also wrote her story as a way to reject the stigma and shame surrounding mental illness. She wrote it for her younger self, and for the young women in her family who, too, live with depression.

“It is also for the countless people who find themselves struggling to cope with internal forces that feel overwhelming but—as I try to show in these pages—are survivable,” she writes.

She writes at the end of her book: “Most importantly, I want to encourage people in the depths of hopelessness to believe that they can come through, and to find help from a compassionate, responsible professional who will care for them until they do. People in the grip of severe depression might take as their mantra a line from Rilke so relevant to all kinds of human trouble that it has become an Internet meme: ‘Just keep going. No feeling is final.’”

Sometimes after publishing a vulnerable post, Borchard feels like she’s “walking around naked,” and wonders if it’s really worth it. “However, then I will get an email or comment from a reader who tells me she feels less alone because I shared it, and it makes it worth it.”

Blum, too, is propelled by the people who read her work, along with the mental health community in general. “Knowing that I may help someone not feel so alone or encourage them to accept themselves is a gift to me. Relating to people emotionally through words inspires me every day to write.”

For Borchard, writing about the more challenging parts of her recovery helps her in another powerful way, as well: “I get to recognize the voice within me that doesn’t necessarily come out in casual conversation with friends or even in therapy. There is something about writing about your experience that clarifies it…”

Self-Care During the Writing (and Publishing) Process

After Borchard pens a difficult piece, she’ll often walk in the woods or over to the creek by her house. This is when she processes what she’s written—and tells “myself that should I get scathing responses, it doesn’t detract from my truth—that I am a good person who speaks from the heart, even if that truth isn’t received well.”

Blum finds it helpful to sit with her thoughts, and journal what she feels. She also reads books by Hemingway along with pieces from modern-day poets, such as April Green, Lang Leav, and JM Storm.

For Cregan, when the writing became especially difficult, self-care looked like refocusing her attention toward researching or writing less personal sections of her book. On the days it felt unbearable, she’d schedule several sessions with her psychiatrist.

She also found it helpful to “change the channel” in her mind, something she still does today when she’s getting depressed. “I read or watch a movie or see a friend—anything, really, to get my mind out of the track it’s stuck in.”

Exercise is equally critical for Cregan’s well-being, which she does regularly, whether it’s indoor cycling or yoga.

For Sweeney, self-care while writing includes: hugging her husband, cuddling her dog, running, spending time with a supportive community, meditating, taking medication, going to therapy, not drinking, and calling her sister.

Because Sweeney writes regularly, the actual process isn’t so difficult (more on that below). But the after is.

“My mindfulness meditation practice helps with the aftermath, the ‘post-writing’ emotional hangover…During the time I’ve allotted for this practice, the huge rock in the pit of my stomach or the noose tightening around my neck becomes the object on which I focus. Awareness and a non-judgmental attitude transform these unpleasant sensations into something more neutral. It might sound like hocus pocus, but it’s quite intensely practical and for me, effective.”

And sometimes, Sweeney said, she needs a good “scream-cry.” “I do my best to experience heaving chest, stinging tears, and howling, with awareness and equanimity. If I find myself judging any of this, that becomes the object of meditation.”

The Power of a Regular Writing Practice

Sweeney also has developed a consistent, strong writing practice. Thanks to studying with Natalie Goldberg, she’s learned to “shut up and write,” and “go for the jugular.”

“Following [Goldberg’s] suggestion, I’ve spent years, no, decades, pushing my pen or pounding keys into painful and unpleasant memories. Hours reading aloud to small groups of people then listening to others who are also sharing their difficult situations by reading aloud, developed my spine.”

Plus, Sweeney has participated in National Novel Writing Month every year for a decade, writing or revising nonfiction. “Producing 1667 words a day during the 30 days of November, trained me to write on a regular schedule the rest of the year.”

Because she’s always writing, nearly every day since 1994, she doesn’t think about it. “It’s just what I do. If I thought about it too much, I’d never do it.”

Borchard views writing from the heart as “just another way of living sincerely, or with integrity.”

“It’s not for everyone, but I’ve found that the more transparent I can be in my life, the more I create opportunities to bond with readers and others on their journey. You are like a travel guide of sorts. So it’s also a privilege and one I take seriously.”

How Writers Write About Heartbreaking Things and Care for Themselves in the Process

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Four Steps to Manage Obsessive-Compulsive Disorder

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

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When I was a young girl, I struggled with obsessive-compulsive disorder. I believed that if I landed on a crack in the sidewalk, something terrible would happen to me, so I did my best to skip over them. I feared that if I had bad thoughts of any kind, I would go to hell.

To purify myself, I would go to confession and Mass over and over again, and spend hours praying the rosary. I felt if I didn’t compliment someone, like the waitress where we were eating dinner, I would bring on the end of the world.

What Is OCD?

The National Institute of Mental Health defines OCD as a “common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over.” OCD involves a painful, vicious cycle whereby you are tormented by thoughts and urges to do things, and yet when you do the very things that are supposed to bring you relief, you feel even worse and enslaved to your disorder.

The results of one study indicated that more than one quarter of the adults interviewed experienced obsession or compulsions at some point in their lives — that’s over 60 million people — even though only 2.3 percent of people met the criteria for a diagnosis of OCD at some point in their lives. The World Health Organization has ranked OCD as one of the top 20 causes of illness-related disability worldwide for individuals between 15 and 44 years of age.

Whenever I am under considerable stress, or when I hit a depressive episode, my obsessive-compulsive behavior returns. This is very common. OCD breeds on stress and depression. A resource that has been helpful to me is the book Brain Lock by Jeffrey M. Schwartz, M.D. He offers a four-step self-treatment for OCD that can free you from painful symptoms and even change your brain chemistry.

Distinguishing Form from Content of OCD

Before I go over the four steps, I wanted to go over two concepts he explains in the book that I found very helpful to understanding obsessive-compulsive behavior. The first is knowing the difference between the form of obsessive-compulsive disorder and its content.

The form consists of the thoughts and urges not making sense but constantly intruding into a person’s mind — the thought that won’t go away because the brain is not working properly. This is the nature of the beast. The content is the subject matter or genre of the thought. It’s why one person feels something is dirty, while another can’t stop worrying about the door being locked.

The OCD Brain

The second concept that is fascinating and beneficial to a person in the throes of OCD’s torture is to see a picture of the OCD brain. In order to help patients understand that OCD is, in fact, a medical condition resulting from a brain malfunction, Schwartz and his colleagues at UCLA used PET scanning to take pictures of brains besieged by obsessions and compulsive urges. The scans showed that in people with OCD, there was increased energy in the orbital cortex, the underside of the front of the brain. This part of the brain is working overtime.

According to Schwartz, by mastering the Four Steps of cognitive-biobehavioral self-treatment, it is possible to change the OCD brain chemistry so that the brain abnormalities no longer cause the intrusive thoughts and urges.

Step One: Relabel

Step one involves calling the intrusive thought or urge exactly what it is: an obsessive thought or a compulsive urge. In this step, you learn how to identify what’s OCD and what’s reality. You might repeat to yourself over and over again, “It’s not me — it’s OCD,” working constantly to separate the deceptive voice of OCD from your true voice. You constantly inform yourself that your brain is sending false messages that can’t be trusted.

Mindfulness can help here. By becoming an observer of our thoughts, rather than the author of them, we can take a step back in loving awareness and simply say, “Here comes an obsession. It’s okay … It will pass,” instead of getting wrapped up in it and investing our emotions into the content. We can ride the intensity much like a wave in the ocean, knowing that the discomfort won’t last if we can stick in there and not act on the urge.

Step Two: Reattribute

After you finish the first step, you might be left asking, “Why don’t these bothersome thoughts and urges go away?” The second step helps answer that question. Schwartz writes:

The answer is that they persist because they are symptoms of obsessive-compulsive disorder (OCD), a condition that has been scientifically demonstrated to be related to a biochemical imbalance in the brain that causes your brain to misfire. There is now strong scientific evidence that in OCD a part of your brain that works much like a gearshift in a car is not working properly. Therefore, your brain gets stuck in gear. As a result, it’s hard for you to shift behaviors. Your goal in the Reattribute step is to realize that the sticky thoughts and urges are due to your balky brain.

In the second step, we blame the brain, or in 12-step language, admit we are powerless and that our brain is sending false messages. We must repeat, “It’s not me — it’s just my brain.” Schwartz compares OCD to Parkinson’s disease — both interestingly are caused by disturbances in a brain structure called the striatum — in that it doesn’t help to lambast ourselves for our tremors (in Parkinson’s) or upsetting thoughts and urges (in OCD). By reattributing the pain to the medical condition, to the faulty brain wiring, we empower ourselves to respond with self-compassion.

Step Three: Refocus

In step three, we shift into action, our saving grace. “The key to the Refocus step is to do another behavior,” explains Schwartz. “When you do, you are repairing the broken gearshift in your brain.” The more we “work around” the nagging thoughts by refocusing our attention on some useful, constructive, enjoyable activity, the more our brain starts shifting to other behaviors and away from the obsessions and compulsions.

Step three requires a lot of practice, but the more we do it, the easier it becomes. Says Schwartz: “A key principle in self-directed cognitive behavioral therapy for OCD is this: It’s not how you feel, it’s what you do that counts.”

The secret of this step, and the hard part, is going on to another behavior even though the OCD thought or feeling is still there. At first, it’s extremely wearisome because you are expending a significant amount of energy processing the obsession or compulsion while trying to concentrate on something else. However, I completely agree with Schwartz when he says, “When you do the right things, feelings tend to improve as a matter of course. But spend too much time being overly concerned about uncomfortable feelings, and you may never get around to doing what it takes to improve.”

This step is really at the core of self-directed cognitive behavioral therapy because, according to Schwartz, we are fixing the broken filtering system in the brain and getting the automatic transmission in the caudate nucleus to start working again.

Step Four: Revalue

The fourth step can be understood as an accentuation of the first two steps, Relabeling and Reattributing. You are just doing them with more insight and wisdom now. With consistent practice of the first three steps, you can better acknowledge that the obsessions and urges are distractions to be ignored. “With this insight, you will be able to Revalue and devalue the pathological urges and fend them off until they begin to fade,” writes Schwartz.

Two ways of “actively revaluing,” he mentions are anticipating and accepting. It’s helpful to anticipate that obsessive thoughts will occur hundreds of times a day and not to be surprised by them. By anticipating them, we recognize them more quickly and can Relabel and Reattribute when they arise. Accepting that OCD is a treatable medical condition — a chronic one that makes surprise visits — allows us to respond with self-compassion when we are hit with upsetting thoughts and urges.

Four Steps to Manage Obsessive-Compulsive Disorder

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