Four Steps to Manage Obsessive-Compulsive Disorder

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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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6 Mistakes to Avoid in Your Recovery from Depression and Anxiety

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

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

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

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

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

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

Mistake two: Roaming outside the box.

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

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

Mistake three: Efficiencies before effectiveness.

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

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

Mistake four: Dysfunctional harmony.

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

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

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

Mistake five: Hoarding

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

Mistake six: Disengagement

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

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

6 Mistakes to Avoid in Your Recovery from Depression and Anxiety

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Why It’s Okay to Cry in Public

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I waited three months after I was discharged from the hospital for suicidal depression to make contact with the professional world again. I wanted to be sure I didn’t “crack,” like I had done in a group therapy session. A publishing conference seemed like an ideal, safe place to meet. A crowded room of book editors would certainly prevent any emotional outbursts on my part. So I reached out to colleague who had been feeding me assignments pre-nervous breakdown and invited her for a cup of coffee.

“How are you?” she asked me.

I stood there frozen, trying my best to mimic the natural smile I had practiced in front of the bathroom mirror that would accompany the words, “Fine! Thank you. How are you?”

Instead I burst into tears. Not a cute little whimper. A loud and ugly bawling — pig snorts included — the kind of sobbing widows do behind closed doors when the funeral is done.

“There’s the beginning and the end,” I thought. “Time to pay the parking bill.”

But something peculiar happened in that excruciating exchange: we bonded.

Embarrassment Leads to Trust

Researchers at the University of California, Berkley conducted five studies that confirmed this very phenomena: embarrassment — and public crying certainly qualifies as such — has a positive role in the bonding of friends, colleagues, and mates. The findings, published in the Journal of Personality and Social Psychology, suggest that people who embarrass easily are more altruistic, prosocial, selfless, and cooperative. In their gestures of embarrassment, they earn greater trust because others classify the transparency of expression (buried head, blushing, crying) as trustworthiness.

Robb Willer, Ph.D., an author of the study, writes, “Embarrassment is one emotional signature of a person to whom you can entrust valuable resources. It’s part of the social glue that fosters trust and cooperation in everyday life.”

Now public crying is even better than splitting your swimsuit in half during swim practice or asking a woman when her baby is due only to learn it was born four months ago (also guilty). Tears serve many uses. According to Dr. William Frey II, a biochemist and Director of the Alzheimer’s Research Center at Regions Hospital in St. Paul, Minnesota, emotional tears (as opposed to tears of irritability) remove toxins as well as chemicals like the endorphin leucine-enkaphalin and prolactin that have built up in the body from stress. Crying also lowers a person’s manganese level, a mineral that affects mood.

In a New York Times article, science writer Jane Brody quotes Dr. Frey:

Crying is an exocrine process, that is, a process in which a substance comes out of the body. Other exocrine processes, like exhaling, urinating, defecating and sweating, release toxic substances from the body. There’s every reason to think crying does the same, releasing chemicals that the body produces in response to stress.

Crying Builds a Community

Anthropologist Ashley Montagu once said in a Science Digest article that crying builds a community. Having done my share of public crying this last year, I think he is right.

If you spot a person crying in the back of the room at, say, a school fundraiser, your basic instinct (if you are a nice person) is to go comfort that person. Yeah, there’s the voice that says she’s pathetic for displaying public emotions, much like the couple fighting in the hallway; however, you want the crying to end because on some level it makes you uncomfortable — you want everyone to be happy, like the mom who pops a pacifier or a stick of butter into her 6-year-old’s mouth to shut him up.

The high sensitive types begin to swarm around this woman, as she divulges her life story. Voila! You find yourself with a group of new best friends in an Oprah moment, each person offering intimate details about herself. A women’s retreat has started, and there is no need for a lake house.

In a 2009 study published in Evolutionary Psychology, participants responded to images of faces with tears and faces with tears digitally removed, as well as tear-free control images. It was determined that tears signaled sadness and resolved ambiguity. According to Robert R. Provine, Ph.D., the study’s lead author and professor of psychology and neuroscience at the University of Maryland, Baltimore County, tears are a kind of social lubricant, helping people communicate. Says the abstract: “The evolution and development of emotional tearing in humans provide a novel, potent and neglected channel of affective communication.”

In a February 2016 study published in the journal Motivation and Emotion, researchers replicated and extended previous work by showing that tearful crying facilitates helping behavior and identified why people are more willing to help criers. First, the display of tears increases perceived helplessness of a person, which leads to a higher willingness to help that person. Second, crying individuals are typically perceived to be more agreeable and less aggressive and elicit more sympathy and compassion.

The third reason I find most interesting: seeing tears makes us feel more closely connected to the crying individual. According to the study, “This increase in felt connectedness with a crying individual could also promote prosocial behavior. In other words, the closer we feel to another individual, the most altruistically we behave towards that person.” The authors refer to ritual weeping, say, after adversity and disasters or when preparing for war. Those common tears build bonds between people.

I don’t LIKE crying. And certainly not in front of people. It feels humiliating, like I’m not in control of my emotions. However, I no longer practice smiling in front of the mirror or the sentiments that are packaged with the grin. I have learned to embrace my PDT — public display of tears — and be my transparent self, even if the result is more pig snorts.

Why It’s Okay to Cry in Public

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7 Simple Ways to Ease Anxiety

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Anxiety serves a life-saving role when we are in real danger. Adrenaline pumps through our system, and suddenly we can run like Usain Bolt and lift a 200-pound man without much effort. However, most of the time, anxiety is like a fire alarm with a dead battery that beeps annoyingly every five minutes when there is absolutely nothing to worry about. We experience the heart palpitations, restlessness, panic, and nausea as if a saber-toothed tiger were 20 yards away.

Thankfully there are a few simple gestures to communicate to your body that there is no immediate danger — that it’s a false alarm… yet again. I have used the following activities to calm down my nervous system that is ready for an adventure, and to ease symptoms of anxiety.

Exercise

We have known for decades that exercise can decrease depression and anxiety symptoms, but a 2016 study by researchers at the University of California at David Medical Center demonstrates how. They found that exercise increased the level of the neurotransmitters glutamate and GABA, both of which are depleted in the brains of persons with depression and anxiety. The study showed that aerobic exercise activates the metabolic pathways that replenish these neurotransmitters, allowing the brain to communicate with the body.

You need not commit huge amounts of time. Short, ten-minute intervals of intense exercise (such as sprints) can trigger the same brain changes as long, continuous workouts.

Drink Chamomile Tea

Chamomile is one of the most ancient medicinal herbs and has been used to treat a variety of conditions including panic and insomnia. Its sedative effects may be due to the flavonoid apigenin that binds to benzodiazepine receptors in the brain. Chamomile extracts exhibit benzodiazepine-like hypnotic activity as evidenced in a study with sleep-disturbed rats.

In a study at the University of Pennsylvania Medical Center in Philadelphia, patients with generalized anxiety disorder (GAD) who took chamomile supplements for eight weeks had a significant decrease in anxiety symptoms compared to the patients taking placebos.

Laugh

It’s difficult to panic and laugh at the same time. There’s a physiological reason for this. When we panic, we generate all kinds of stress hormones that send SOS signals throughout our body. However, when we laugh, those same hormones are reduced.

In a study done at Loma Linda University in California in the 1980s, Lee Berk, DrPH and his research team assigned five men to an experimental group who viewed a 60-minute humor video and five to a control group, who didn’t. They found that the “mirthful laughter experience” reduced serum levels of cortisol, epinephrine, dihydrophenylacetic acid (dopac), and growth hormone.

Take Deep Breaths

Every relaxation technique that mitigates the stress response and halts our “fight or flight or I’m-dying-get-the-heck-out-of-my-way” reaction is based in deep breathing. I find it miraculous how something as simple as slow abdominal breathing has the power to calm down our entire nervous system. One way it does this is by stimulating our vagus nerve — our BFF in the middle of a panic because it releases a variety of anti-stress enzymes and calming hormones such as acetylcholine, prolactin, vasopressin, and oxytocin.

Three basic approaches to deep breathing are coherent breathing, resistance breathing, and breath moving. But really, all you need to do is inhale to a count of six and exhale to a count of six, moving the breath from your chest to your diaphragm.

Eat Dark Chocolate

Dark chocolate has one of the highest concentrations of magnesium in a food — with one square providing 327 milligrams, or 82 percent of your daily value — and magnesium is an important mineral for calming down the nervous system. According to a 2012 study in the journal Neuropharmacology, magnesium deficiencies induce anxiety, which is why the mineral is known as the original chill pill. Dark chocolate also contains large amounts of tryptophan, an amino acid that works as a precursor to serotonin, and theobromine, another mood-elevating compound. The higher percentage of cocoa the better (aim for at least 85 percent), because sugar can reverse the benefits of chocolate and contribute to your anxiety.

Color

Use anything that can distract you from the fire alarm going off every five minutes in your head—from the distressing thoughts and ruminations. Many people I know use coloring books to divert their attention. I now see them in doctor’s offices and acupuncture centers. A study published in Occupational Therapy International demonstrated that activities such as drawing and other arts and crafts can stimulate the neurological system and enhance well-being. This is partly because they help you stay fully present and they can be meditative. They are especially helpful for people like me who struggle with formal meditation.

Cry

You have to be careful with crying, as it has the potential you feel worse. However, I’ve always felt a huge release after a good cry. There’s a biological explanation for this. Tears remove toxins from our body that build up from stress, like the endorphin leucine-enkephalin and prolactin, the hormone that causes aggression. And what’s really fascinating is that emotional tears — those formed in distress or grief — contain more toxic byproducts than tears of irritation (like onion peeling). Crying also lowers manganese levels, which triggers anxiety, nervousness, and aggression. In that way, tears elevate mood.

I like Benedict Carey’s reference to tears as “emotional perspiration” in his New York Times piece, The Muddled Track of All Those Tears. He writes, “They’re considered a release, a psychological tonic, and to many a glimpse of something deeper: the heart’s own sign language, emotional perspiration from the well of common humanity.”

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Psychology Around the Net: April 6, 2019

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This week’s Psychology Around the Net dives into how to stop worrying about what other people think of you, ways to defeat procrastination, why pets can help boost physical and mental health (especially in older adults), and more.

Enjoy!

Stop Worrying About What Others Think of You: 7 Tips for Feeling Better: The fear of rejection is at the root of caring what someone thinks of you. Learn how to understand what “rejection” really means, use rejection (when it actually happens) as a brilliant opportunity for growth, how to embrace your individuality, and more to overcome your fear of rejection and truly stop worrying what other people think about you.

How to Defeat Procrastination with the Psychology of Emotional Intelligence: A step-by-step guide to overcoming procrastination by using the psychology of emotion regulation and emotional intelligence, with some extra tips and tricks to boot? Sign me up! (Additionally, you might want to find out how anxiety affects procrastination.)

Here’s One Big Way To Help Working Mothers Thrive: This new study tackles how to reduce a mother’s work-family conflict and employment-related guilt.

Why It’s a Problem If ‘Joker’ Connects Mental Illness to Villainy: While most portrayals of The Joker have involved a character backstory that’s mysterious, if not outright nonexistent, there are hints that this new Joker will include not only a backstory, but a backstory that includes mental illness linked to becoming a violent criminal. However, shouldn’t we pause and determine whether the story links mental illness in general with violent and criminal behavior, or whether the story features one character who has a mental illness that drove him to violent criminal behavior?

Poll: Pets Help Older Adults Cope with Health Issues, Get Active, and Connect with Others: According to a recent national poll, pets can help older adults deal with physical and mental health issues; however, for some (18 percent of participants), pets bring various strains (for example, financial burdens and problems that arise from putting a pet’s needs before your own). Which is it for you?

What We Know and Don’t Know about How Mass Trauma Affects Mental Health: Researchers are working to figure out who is at most risk of suicide and other types of self-harm after mass trauma events such as wars and political violence, natural disasters, and — especially prevalent in today’s troubled climate — mass shootings, including school shootings.

Psychology Around the Net: April 6, 2019

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6 Ways to Use Mindfulness to Ease Difficult Emotions

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Mindfulness has become quite the buzzword these days, with impressive studies popping up in the news with regularity.

For example, research from the University of Oxford finds that mindfulness-based cognitive therapy (MBCT) is just as effective as antidepressants for preventing a relapse of depression. In MBCT, a person learns to pay closer attention to the present moment and to let go of the negative thoughts and ruminations that can trigger depression. They also explore a greater awareness of their own body, identifying stress and signs of depression before a crisis hits.

Four years ago, I took an eight-week intensive Mindfulness-Based Stress Reduction (MBSR) program at Anne Arundel Community Hospital. The course was approved by and modeled from Jon Kabat-Zinn’s incredibly successful program at the University of Massachusetts. I often refer to the wise chapters of Kabat-Zinn’s book, Full Catastrophe Living (which we used as a text book). Here are a few of the strategies he offers:

Hold Your Feelings with Awareness

One of the key concepts of mindfulness is bringing awareness to whatever you are experiencing — not pushing it away, ignoring it, or trying to replace it with a more positive experience. This is extraordinarily difficult when you are in the midst of deep pain, but it can also cut the edge off of the suffering.

“Strange as it may sound,” explains Kabat-Zinn, “the intentional knowing of your feelings in times of emotional suffering contains in itself the seeds of healing.” This is because the awareness itself is independent of your suffering. It exists outside of your pain.

So just as the weather unfolds within the sky, painful emotions happen against the backdrop of our awareness. This means we are no longer a victim of a storm. We are affected by it, yes, but it no longer happens to us. By relating to our pain consciously, and bringing awareness to our emotions, we are engaging with our feelings instead of being a victim to them and the stories we tell ourselves.

Accept What Is

At the heart of much of our suffering is our desire for things to be different than they are.

“If you are mindful as emotional storms occur,” writes Kabat-Zinn, “perhaps you will see in yourself an unwillingness to accept things as they already are, whether you like them or not.”

You may not be ready to accept things as they are, but knowing that part of your pain stems from the desire for things to be different can help put some space between you and your emotions.

Ride the Wave

One of the most reassuring elements of mindfulness for me is the reminder that nothing is permanent. Even though pain feels as though it is constant or solid at times, it actually ebbs and flows much like the ocean. The intensity fluctuates, comes and goes, and therefore gives us pockets of peace.

“Even these recurring images, thoughts, and feelings have a beginning and an end,” explains Kabat-Zinn, “that they are like waves that rise up in the mind and then subside. You may also notice that they are never quite the same. Each time one comes back, it is slightly different, never exactly the same as any pervious wave.”

Apply Compassion

Kabat-Zinn compares mindfulness of emotions to that of a loving mother who would be a source of comfort and compassion for her child who was upset. A mother knows that the painful emotions will pass — she is separate to her child’s feelings — so she is that awareness that provides peace and perspective. “Sometimes we need to care for ourselves as if that part of us that is suffering is our own child,” Kabat-Zinn writes. “Why not show compassion, kindness, and sympathy toward our own being, even as we open fully to our pain?”

Separate Yourself from the Pain

People who have suffered years from chronic illness tend to define themselves by their illnesses. Sometimes their identity is wrapped up in their symptoms. Kabat-Zinn reminds us that the painful feelings, sensations, and thoughts are separate to who we are. “Your awarenessof sensations, thoughts, and emotions is different from the sensations, the thoughts, and the emotions themselves,” he writes. “That aspect of your being that is aware is not itself in pain or ruled by these thoughts and feelings at all. It knows them, but it itself is free of them.”

He cautions us about the tendency to define ourselves as a “chronic pain patient.” “Instead,” he says, “remind yourself on a regular basis that you are a whole person who happens to have to face and work with a chronic pain condition as intelligently as possible — for the sake of your quality of life and well-being.”

Uncouple Your Thoughts, Emotions, and Sensations

Just as the sensations, thoughts, and emotions are separate from my identity, they are separate from each other. We tend to lump them all in together: “I feel anxious” or “I am depressed.” However, if we tease them apart, we might realize that a sensation (such as heart palpitations or nausea) we are experiencing is made worse by certain thoughts, and those thoughts feed other emotions.

By holding all three in awareness, we could find that the thoughts are nothing more than untrue narratives that are feeding emotions of fear and panic, and that by associating the thoughts and emotions with the sensation, we are creating more pain for ourselves.

“This phenomenon of uncoupling can give us new degrees of freedom in resting in awareness and holding whatever arises in any or all of these three domains in an entirely different way, and dramatically reduce the suffering experienced,” explains Kabat-Zinn.

6 Ways to Use Mindfulness to Ease Difficult Emotions

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What It Means to Be a Mental Health Advocate—And How to Become One

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Over the years, the stigma surrounding mental illness has significantly decreased. One of the biggest reasons?

Mental health advocates.

These are the individuals who tirelessly share their stories in all sorts of ways. They remind us that we’re not alone in our struggles—and there is real, tangible hope and healing. They shatter stereotypes and myths about mental illness, helping the public see that people with mental illness are just people.

As Jennifer Marshall said, “By showing the world that we’re your neighbor, your family members, your friends, and we are not only surviving with these conditions, but thriving, we’re educating the world and changing the world for the better.”

If you’re thinking about becoming a mental health advocate, you might be wondering what advocates actually do, and how to get started. We asked advocates who are doing all kinds of incredible work to share their insights.

What It Means to Be a Mental Health Advocate

Therese Borchard defines a mental health advocate as “anyone who is a voice for those suffering from depression, anxiety, or any other disorder—who hopes to disseminate a message of hope and support.”

Similarly, Marshall said it’s “someone who learns how to take the best care of their mental health and shares openly about their story to help others.”

According to T-Kea Blackman, an advocate is “a change agent,” “someone who educates his [or] her community on mental health, reduces the stigma and fights for change in the behavioral system.”

Sally Spencer-Thomas, PsyD, thinks of advocacy as a “spectrum of engagement” from allies to activists. An ally is someone who feels connected to challenging the discrimination and prejudice related to mental illness, but might not act on their feelings. An advocate uses their voice to encourage change. An activist “engages in intentional action to move change along—getting people organized, moving legislation, changing policy.”

What Mental Health Advocacy Looks Like

There’s no one way to advocate. It really depends on what’s important and inspiring to you—and what you feel comfortable with.

Borchard mostly writes and has created two online depression support communities: Project Hope & Beyond, and Group Beyond Blue, on Facebook. She also serves on the advisory board of the National Network of Depression Centers, speaks to different groups, and helps depression organizations spread their message.

Blackman hosts a weekly podcast called Fireflies Unite With Kea, where she gives “individuals who live with mental illness the opportunity to share their stories.” She hosts mental health events and speaks at workshops and conferences. She also works as a peer recovery coach for a pilot program, helping others with their personal and professional goals.

Years ago, Marshall started a blog at BipolarMomLife.com, after being hospitalized for mania four times in 5 years. Today, she’s the founder of an international nonprofit organization called This Is My Brave. They share stories of individuals who have mental illness and live full, successful lives through poetry, essays, and original music. This Is My Brave hosts live events, and has a YouTube Channel.

Spencer-Thomas is a clinical psychologist, and one of the founders of United Suicide Survivors International, “pulling together a global community of people with lived experience, lifting up their voices and leveraging their expertise for suicide prevention and suicide grief support.” She also advocates for workplaces to become involved in mental health promotion and suicide prevention; for providers to learn evidence-based clinical practices; and for innovation in men’s mental health through campaigns such as Man Therapy.

Gabe Howard, who believes that “advocacy must start with open and honest dialogue,” primarily does public speaking, and hosts two podcasts: The Psych Central Show, and A Bipolar, a Schizophrenic, and a Podcast. He’s also testified in front of legislators, served on boards and advisory councils, and volunteered for various initiatives.

Chris Love has shared his story of recovery from substance abuse all over North Carolina. He works as a counselor at a substance abuse treatment center, and with the nonprofit organization The Emerald School of Excellence, which is North Carolina’s first recovery high school for teens struggling with substance use.

Lauren Kennedy is an advocate who speaks to all kinds of audiences, including police officers, high school and college students, and healthcare professionals. She also has a YouTube channel called “Living Well with Schizophrenia,” where she talks about mental health and her own experiences with schizoaffective disorder.

The “Why” Behind Advocacy

“Being an advocate is important to me because I believe the only way we’re going to eliminate the stigma, judgment and discrimination surrounding mental illness and addiction is by putting our names and faces on our stories,” Marshall said. “This Is My Brave does this one person and one story at a time.”

For Kennedy, being an advocate is important because “people living with mental health problems are just that, people; and deserve to be treated with the same respect and compassion as anyone else.”

Similarly, Blackman’s mission is to “show that mental illness does not have a look,” and to “show those in the African American community that it is OK to attend therapy, take medication (if needed) and pray.”

“We do not have to choose our faith over our mental health, or vice versa. Every human deserves the right to have access to mental health treatment. Therapy is not a white or rich people issue; this is a myth that must be dismantled in my community.”

Spencer-Thomas views her advocacy work as her life’s mission after her brother died by suicide. “Every day I get up to prevent what happened to Carson from happening to other people. I feel that he walks alongside me, encouraging me to be courageous and bold. My fire in the belly is fueled by the process of making meaning out of my loss. I would do anything to have him back, but he’s not coming back, so my work is part of his legacy.”

Howard noted that as someone with bipolar disorder, he’s been unfairly judged and discriminated against. He’s had difficulty accessing care—and seen others experience difficulty, as well, because of their finances, where they live, and other circumstances.

“I just couldn’t sit by and do nothing. It seemed wrong to me. I tried to ‘hide in plain sight,’ so I could avoid the negative reactions—but it felt so fake to me.”

During Borchard’s lowest points, reaching out to others relieved some of her pain. “In those times when nothing, absolutely nothing worked, becoming an advocate for those who suffer from depression and anxiety, gave me a purpose to strive for, to get out of bed. Today, I continue to feel the benefits of service. It connects the random dots of life.”

How to Become An Advocate

Becoming a mental health advocate can include big and small actions—it all matters!

  • Advocate for yourself. As Blackman said, you can’t be an advocate for others if you don’t first advocate for yourself. For instance, she recently talked to her therapist and psychiatrist about discontinuing her medication. They collaborated on a specific plan, which includes continuing to attend weekly therapy sessions and calling her doctor and returning to medication if she notices any negative changes. According to Blackman, advocating for yourself means getting educated, understanding your triggers, developing coping skills and stating your needs.
  • Share your story. Start with family and friends, which also will reveal whether you’re ready for a wider audience, Borchard said. Love said if you’re comfortable, consider sharing your story on social media. “The beginning of ending stigma is being able to put it out there and talk about it.”
  • Educate your immediate circle. “There is a tremendous amount of power in reflecting on how you think and talk about mental health, and how you can help others in your life to take a more positive and accepting stance on mental health and mental illness,” Kennedy said. For instance, you can correct misinformation, such as using person-first language (“person with schizophrenia”), instead of “schizophrenic,” she said. Blackman also noted that you can text family, friends, and colleagues articles about mental health. In fact, she started by sharing articles and videos with loved ones to help them understand what she was going through.
  • Volunteer. Many of the advocates suggested joining local mental health organizations and assisting with their programs and events.
  • Get a mentor. “Like most things, getting the right mentor is about building relationships,” Spencer-Thomas said. She suggested noticing people you’d like to be like, reading their posts, leaving comments, and asking questions. “Volunteer for events or at meetings where [this person] is present…Ask them directly about being a mentor and set realistic expectations.”
  • Get trained in legislative advocacy. Spencer-Thomas noted that one way to do that is to become a field ambassador for the American Foundation for Suicide Prevention.
  • Find your niche. “[F]ind the thing that you are better at than most and that inspires you,” Howard said. This might be anything from public speaking to writing to fundraising to managing volunteers, he said.

Advocates who’ve been there also remind us that even though we can’t see past our pain right now that doesn’t mean this will be our future. As Blackman said, “…I am amazed at how I went from not wanting to live [and] attempting suicide [to] using my experience with mental illness to educate and reduce stigma.”

What It Means to Be a Mental Health Advocate—And How to Become One

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Don’t Force Gratitude

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

See credits below.


In his book What Happy People Know, Dan Baker argues that you can’t be in a state of appreciation and fear, or anxiety, at the same time. He explains:

During active appreciation the threatening messages from your amygdala [fear center of the brain] and the anxious instincts of your brainstem are cut off, suddenly and surely, from access to your brain’s neocortex, where they can fester, replicate themselves, and turn your stream of thoughts into a cold river of dread. It is a fact of neurology that the brain cannot be in a state of appreciation and a state of fear at the same time. The two states may alternate, but are mutually exclusive.

Other studies have also highlighted how gratitude can buffer you from the blues, protect you from illness, and heal your neuroses.

You Can Be Depressed and Grateful

While I believe gratitude can definitely contribute to emotional resilience and promote wellness, I disagree with Baker that you can’t be depressed and grateful at the same time.

Why? Even in my most severe depressive episodes, I was always cognizant of my blessings and appreciated the good things in my life. In fact, a section of my daily mood journal is dedicated to listing all the things I am grateful for each day. This exercise helps to create new grooves, or neural passageways, that lead to healing; however, it doesn’t have the horsepower to abort the brain entirely and start from scratch with a purely optimistic outlook.

Gratitude isn’t always the magical antidote that positive psychologists and celebrities like Oprah claim it to be.

When Gratitude Backfires

Sometimes gratitude can actually backfire, explains Dr. Margaret Rutherford, a psychologist in private practice in Arkansas. For persons with Perfectly Hidden Depression (PHD), a kind of depression where someone creates the façade of everything going well in his or her life, showing gratitude only contributes to the problem.

In her blog When Gratitude Backfires, Dr. Rutherford writes:

When [gratitude] has an intense, driven, being on a treadmill quality, with the speed slowly being turned up, and up, and up, and up. It can be tremendously self-destructive….It’s not that it’s insincere. It’s very real. But the giver is in pain that she or he isn’t talking about, and showing gratitude becomes a performance itself. The gratitude backfires.

Don’t Fake It

We’ve been told to fake it until we make it, but forced gratitude doesn’t seem to be any help to depression. In one study published in the Journal of Personal and Emotional Psychology in January 2001, two researchers at the University of California in Berkeley inspected yearbook photos from 1958 and 1960.

They distinguished genuine smiles from false smiles (the two smiles activate different muscle groups). Thirty years later, the students with the genuine smiles were found to be faring much better than those with the fake smiles: The genuine smilers had more satisfying marriages, greater feelings of well-being, and so forth.

Mindfulness and Emotional Agility

For those of us who battle chronic depression, I think it’s important to know that 1) we can be grateful and depressed at the same time, and 2) it’s okay not to be grateful. For me and for many others I know, it is much more helpful to approach feelings and thoughts with mindfulness — simply acknowledging them in a loving way and trying to stay present in the moment — or with emotional agility, allowing ourselves to feel our emotions, than to force any kind of optimism or positive psychology.

Gratitude may come.

And it may not come.

Either way, we are okay.

Don’t Force Gratitude

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Does Calling Depression an Illness Worsen Stigma?

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

See credits below.


I plead guilty to expounding on the biochemical vulnerabilities and abnormalities in neural wiring of depression to make the case that it is a legitimate illness alongside lupus, breast cancer, or psoriatic arthritis. I thought I was doing a good thing by quoting experts like Peter Kramer, M.D, who believes that because depression can be associated with the loss of volume in parts of the brain, it is the “most devastating disease known to mankind.”

My intention, like so many other mental health advocates I know, was to use science as a tool to lessen stigma. But is that really effective?

Proof of the Madness

I am relieved by clinical reports that explain why my efforts at cognitive-behavioral therapy aren’t enough to correct certain behaviors or thoughts — that brain imaging reveals the breakdown in normal patterns of processing that impedes the ability of depressed people to suppress negative emotional states and that high levels of activity in the amygdala part of the brain (the fear center) persist despite efforts to retrain thoughts. I would rather know that depression involves a problem in the wiring pattern of my brain than to know I simply wasn’t trying hard enough.

I get excited about the progress of finding genomic biomarkers for different types of mood disorders and about twin studies that show if one twin developed depression, the other twin also suffered from depression in 46 percent of identical twins. I am delighted that experts have found a common genetic mutation associated with a person developing clinical depression when faced with traumatic events in his or her life because it means that I’m not making this stuff up, that genetic variations exist that increase a person’s vulnerability to depression and other mood disorders.

No illness, please.

But apparently, people want their distance from those with illnesses or defined diseases. According to some research, concentrating on the biological nature of mood disorders can actually worsen stigma.

In his article, “Hyping biological nature of mental illness worsens stigma,” Patrick Hahn cites several studies that have shown public attitudes toward those who suffer from mental illness have worsened with the promotion of bio-genetic theories. One was a German study that found that between 1990 and 2001, the number of respondents who attributed schizophrenia to hereditary factors increased from 41 to 60 percent. In the same report, an increased number of respondents said they didn’t want to share a building, job, or neighborhood with a schizophrenic.

In the U.S. the General Social Surveys of 1996 and 2006 say pretty much the same. As the neurobiological explanation of mental illness gained approval, there was an increase in the number of people who didn’t want to be closely associated with someone with a mental illness, not as a co-worker, neighbor, friend, or in-law.

Extreme versus Sick

Hahn explains the two ways of looking at mental illnesses:

We could regard them as more extreme versions of the despondency, fear, wrath, or confusion that we all experience, as perfectly understandable reactions to overwhelming abuse and trauma. Or we could regard them as brain diseases, probably genetic in origin, requiring the sufferer to take powerful mind-altering drugs, quite likely for the rest of her life.

One approach emphasizes our common humanity, and the other seems to regard the sufferer as a mere biological specimen. One approach invites us the consider the societal and economic factors that lead individuals to feel despondent, fearful, wrathful, or confused, and to think about ways of changing them, while the other seems to regard society as basically sound, but unfortunately plagued by those individuals with faulty genes or guilty brains who can’t fit in.

I see room for both perspectives. While I regard some of my symptoms as exaggerations of the human condition — allowing me to explore the societal and psychological causes — I also recognize when my despair falls into the category of illness, an assessment that offers me a kind of relief — to know that my brain scans look different than the average Joe’s, and that there is a reason therapy and meditation and all my other efforts can’t fix it.

Embracing All Illness

Mood disorders are thorny and different from other biological illnesses in that some of their symptoms can be experienced by persons who are not diagnosed with them and their symptoms can overlap with a variety of conditions. For example, a person without major depressive disorder can feel lethargic, sad, and irritable.

But I’m not going to let the complicated nature of depression stop me from promoting research about biomarkers or genetic studies. I firmly believe that depression and all mood disorders need to be understood in their biological context. In my perspective, if the stigma increases with the acceptance of the bio-genetic model, then we need to work harder at embracing everyone who is ill, whether they have cancer, lupus, or depression.

Does Calling Depression an Illness Worsen Stigma?

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A Panic Attack, the Wrestle Within

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

See credits below.


Samantha felt overwhelmed by her school assignments, her relationships, and her job. She often felt like she was walking a tightrope while holding a pole that contained all of her “should” and “must” type of thoughts. “It’s not a matter of if, but when I’ll fall and crash!” she’d repeat.

She would imagine placing her thoughts and feelings in a bottle and shutting the lid tightly. “I place them there so I can cope,” she would declare.

She recognized her panic attack cycle: stress, anxiety, tension build up, and suppress until it shatters. Then starting all over again. She hated her panic attacks, but said she always felt better after experiencing one.

  • Do Samantha’s struggles sound familiar?
  • Do you wish you could extinguish anxiety from your life?
  • Do you believe you can “control” what happens in your body?
  • Is suppressing, stopping, ignoring, or fighting your emotions and sensations giving you temporary relief but not the long-lasting results you want?

The Wrestle Within

Like Samantha, you may believe that you can control those harrowing internal feelings and sensations. Most people who have not engaged in mental health treatment believe they can. Avoidance may be their “go to” coping skill, or they might do their best to resist the feelings and sensations when they appear.

During a panic attack, can you in that moment halt the blood surging out from your stomach, which is causing your abdominal distress? Can you immediately decrease the accelerated heart beats? When you’re sweating profusely, are you able to tell your glands to just stop?

The more you feel the trembling in your body, the more you may resist it. The shortness of breath, chest pain, and sense of choking cause you to feel trapped. As the fainting sensation and numbness take place, the urge to escape these sensations is irresistible.

When you feel detached from the present moment and fear losing control, your only option seems to listen to your mind when it says, “Fight! “Control!” “You can stop this!” Your anguish leads you to try harder — and why not? It makes logical sense, but as you have discovered, it does not work effectively.

Researchers have taught that Pain + Resistance = Suffering. Pain is universal, and we all experience it in various forms. But when we resist it, we drag it along in our lives, and the pain becomes suffering. When it comes to anxiety, it is the resistance to it, and the urge to replace it that makes the pain more lasting.

“What you resist, persists.” -Carl Young

When anxiety is present, your mind may say, “This is bad timing.” Your mind has set up rules and expectations. The moment you wish for something other than what is happening, that’s the moment your suffering begins.

The good news is there are better alternatives than fighting your emotions and sensations. Just like surfers ride 10-foot waves, you can learn to surf the natural swells within your body instead of fighting them.

Learning to Surf the Waves

Imagine seeing a giant wave forming in the ocean. The resistance between the wind and the water surface has created this wave. As the friction continues, the wave begins to swell. The energy is intense and is making the wave higher than usual.

See it reach its crest. Observe its force and notice that like any wave, it begins to break. The wave will crash on the shore like all waves do. That’s their nature and you can’t stop them.

The sensations in your body may feel like 30-foot waves. They are frightening and you may have the urge to build a solid rock or cement wall to prevent the waves. In the ocean, the force of the wind makes the waves crash fiercely against the barrier. A wall that’s constantly getting hit by waves will erode and become weak.

How do you feel when you resist the swells within you?

The elements that make the panic wave may be chemicals in your brain, thoughts, sensations, emotions, and urges. These are natural occurrences of the human body. As you become aware of the building up of tension, take deep breaths. During your out breaths imagine blowing that air into the area of your body where you feel that pressure. You do this to make room for it, and not to make it go away.

Continue to breathe in and out into the tightness you feel to allow the wave to crest. Then go with it as it reaches the beach. Ripples will form, the wave will subside, and another one will begin.

Try not to analyze the causes for the waves. Thank your mind for its protective efforts. Breathe in and as you breathe out, imagine surfing each wave. Let it descend. Remember, you can choose to allow the waves, or place barriers that will leave you exhausted.

Let the waves come and go. That’s what waves do. You don’t have to continue the wrestle within.

“You can’t stop the waves, but you can learn to surf.” – Jon Kabat-Zinn

A Panic Attack, the Wrestle Within

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