Talking about mental health in an effort to reduce stigma should be a year-round pursuit, but driving awareness during Mental Health Awareness Week is important, too. With this in mind, we spoke to experts in the field to find out the most frequently discussed topics and questions they hear when they are one-on-one with patients to share their pro intel with you, too.
1. “How do I control my anxiety?”
Kimberly Leitch, LCSW-R, licensed social worker and Talkspace therapist: “I have had clients who tell me that they will often develop these feelings of someone sitting on their chest or they are having difficulty getting up for work in the morning. They don’t always associate their physical experiences with anxiety, but when identified that this is indeed anxiety, this label can offer some relief.”
Sanam Hafeez, a neuropsychologist in New York City: “Some people can function through anxiety and employ healthy coping mechanisms to reduce the effect of their anxiety on their everyday activities and relationships. Other people can be in the opposite extreme of anxiety, suffering constant panic attacks over daily interactions. For people with anxiety disorders, seemingly mundane tasks can be hindered by their condition.”
Caroline Rasmussen, founder of Antara, trained herbalist and member of the International Association of Counselors and Therapists: “Anxiety concerns are definitely what I encounter the most, and what it almost always comes down to is the subconscious fear that they’re not going to be OK. If you were to go back to their childhood, usually there is something there that underlies it, which over time accumulates. The fear is then exacerbated by a world that places very high demands on us and conditions us to believe that if we don’t meet these demands, we won’t be OK. Both anxiety and depression are activated primarily in the right hemisphere of the brain, so a quick tip to disable that circuitry is bilateral stimulation. Take a water bottle and rhythmically pass it back and forth between your hands across your midline and keep passing it back and forth until you feel calm — obviously, it won’t solve life’s big questions, but it can help take anxiety from a ten to a six so you can start to think again.”
What you can do: Identify the stressors that may be causing your anxiety, as well as be aware that the feelings you are experiencing are in fact anxiety. The unhealthy response: self-medicating with drugs or alcohol, suppressing your emotions and deflecting your emotions onto others. Positive anxiety coping mechanisms include talking to someone about the root of your anxiety, relaxing techniques, self-care and so on.
2. “What do I do if my loved one threatens suicide?”
When you are talking about a
high-risk situation then your role is no longer to be supportive and must turn directive.
Deborah Rasso, LMHC, MCAP, QS, ICADC, and primary therapist at The Palm Beach Institute: “This question is common because we see frequent threats of suicidal ideation in the current population. The suicide rates among veterans as well as children, possibly due to bullying, social media, or high anxiety seem to be the highest. Often those who seek my services are loved ones of those who are suicidal and I aim to educate the family that they can provide support, but trying to ‘manage’ the loved one to keep them alive is not a good course of action. I also always advise that the family and friends of those in need seek assistance from a medical professional, as well as use suicide hotlines (such as the National Suicide Prevention Lifeline) and of course 911 if needed.”
Hafeez: “Red flags to look out for are suicidal thoughts and behaviors such as thinking about ending your life, talking about it, or showing early signs of suicidal tendencies such as harming yourself or partaking in self-destructive activities, should be considered a psychiatric emergency. Many people know that they need to keep a person talking if they are suicidal and encourage them to seek help from a counselor. But many people never see suicide coming and are shocked and grief-stricken when someone in their life makes that decision.”
Adam Saenz, Ph.D., a psychologist based in College Station, Texas: “When you are talking about a high-risk situation, such as the potential for suicide or any physically harmful behavior, then your role is no longer to be supportive and must turn directive. You are telling them: this is what I am going to do, whether it is calling 911 or their therapist. And it is going to piss them off, but you can sort through that later because if they are a threat to themselves or somebody else, then all bets are off and you need to take control.”
3. “Why can’t I get motivated to do anything?”
Leitch: “The most common indicators that a client is experiencing some form of depression are that they don’t feel like going out with their friends, they avoid social situations or they start missing work. Experiencing symptoms of depression or sadness is a normal response to some life events or situations. Like with anxiety, which can go hand-in-hand with depression, it really becomes an issue when it affects your ability to function in everyday situations. Even with normal bouts of depression, it is important to speak with someone and work out those issues in order to better cope with them.”
Rasso: “This question indicates that the client may not realize they are struggling with depression. That is because some may experience acute depression as a result of a specific life situation. Perhaps someone has died, or a relationship is ending, there is a job loss or any other type of adjustment. In that case, I will aim to probe further into when this feeling began and what might have precipitated the feeling and if needed, recommend a short course of antidepressants.”
Hafeez: “Like anxiety, depression has a spectrum of severity. Some people can learn how to navigate their depression in a way that is conducive to them, leading a healthy and happy life but others are sidelined by their condition. For mild depression, I will suggest that they engage in activities that they find enjoyable: exercise, eat right, connect with family or friends or join a support group. Sometimes patients feel like asking for help with their depression means admitting they are crazy but this could not be further from the truth — this is a negative stigma that can prevent people from looking for help that they need to feel better and lead a life that makes them happy. Depression is a challenge, but it is not insurmountable, and it is not the patient’s fault that they are suffering through this.”
Rasmussen: “Dedicate more time to having new positive emotional experiences and doing things that inspire you, like reading spiritual books, being in nature, or travel. Inspiration and breaking from routine help change the way we think and breed more inspiration. Our brains can’t manufacture the chemicals required for happiness and creativity and those for fight and flight at the same time, so building novelty and experiences that we enjoy our days is important for mental health, whether we are dealing with anxiety or depression or not. When we are depressed or anxious, the mind is trying to tell us something, and most of us are so busy we are not able to pay attention. Whatever you can remove from your plate, remove it at least temporarily, and give yourself space to process and reprogram. When we activate the parasympathetic nervous system by relaxing, we actually become less prone to stress and negative thinking.”
Saenz: “One of the main questions professionals ask diagnostically is: ‘To what degree are the symptoms impacting your life functioning — are you able to sleep, eat, do your job and have good relationships?’ When you start getting to a point where two or three or four of those are impaired, not just for a day or not just a week, but when that becomes your normal, then certainly that would be considered clinical depression. Apart from going to a mental health professional for therapy or a medical professional for medication, one of the most important coping factors with any stressor, but certainly, mental illness, is a relationship. So as soon as you can, whether it is your spouse or your parent or a friend, invite them into the process. Don’t do it alone.”
4. “Why am I not as social as everyone else?”
Leitch: “Issues with being anti-social or withdrawing can stem from depression, anxiety, stress and trust issues. They can lessen your desire or motivation to put yourself into social situations. It is a hard task to be happy and social in a setting when you are feeling sad, depressed, stressed or just not feeling yourself. Social media can allow us to interact without having to be physically present. This can be a wonderful way to connect, and yet for those individuals who struggle socially, it can make it increasingly difficult to practice these skills. I have had clients not want to participate in social events but are afraid of judgment if they do not. The work is finding the balance between pushing ourselves to increase our comfort level and ability to connect in real-time, and yet allowing ourselves personal freedom.”
5. “How can I trust people when they continue to hurt me?”
Rasso: “This concern arises most frequently after a person has been through an abusive relationship, but I also tend to see a lot of issues with trust in the addiction field. Trust issues often begin early in development — if the family system was dysfunctional, we see adults who are unable to build a connection with someone and may enter a relationship with fear. But often a client has developed codependency issues or lack of boundaries and they trust the wrong people, such as those who take advantage or they trust too quickly and lose relationships due to the clinging behaviors. If you seek out therapy, it will likely begin with psychoeducation about family systems and family roles so you can gain insight into why they lack trust or make poor choices.”
Leitch: “Having trust issues can affect your ability to form meaningful relationships and enjoying and building a life with someone, therefore it’s crucial to learn how to communicate how you feel and what you need to help build your trust.”
Hafeez: “Many people want to know how you can move past your trust issues, and the answer is: deconstructing the root cause of the condition, for example, in a relationship that is affected by the trust issues of one or both the partner, retracing the footsteps of the relationship and the individuals themselves can lead to a better understanding of why the problems have arisen. This insight can give empathy to both partners and help address some of the problems overwhelming a relationship.”
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