Category Archives: anxiety

The Late Night Call

For many of us in psychology/mental health, when the phone rings or a text pings late night, there is an immediate frisson of worry and concern. It’s a cold shiver in your spine. Bad news is going down. I work with a lot of young people, teens through 30s, and I am readily accessible most of the time. No one abuses this. When people call you late at night, it’s usually not to say hello.

One of my mentors is a top authority in suicide research in the world. When I asked him, as a doctoral student, why he got into this painful area where he has done so much to help, he said we pursue what we fear. It might seem counterintuitive but there is no greater courage than facing the fears we have by helping others with theirs.

I started my own company several years ago after being Clinical Director elsewhere because I believe that mental health is for all. It is often excluded for many people because of financial constraints, stigma, lack of cultural competence, lack of hours to actually go see someone, and a potentially ‘authoritative’ relationship that is anathema to many.

I will tell you this.
NO doctor or therapist can do anything without their team. The team is: found or biological family or parents, other medical providers, friends and social supports of the person that you are working for and with, chosen spiritual beliefs, community, teachers (as burdened as they are are, they are very often the person that young people turn to), genuine Internet connections, ancestry/culture, companion animals, and fostering self-compassion relentlessly.

We are always so shocked and horrified to hear about someone taking their life. But when most ask people how they’re doing, they expect to hear ‘fine’.

We need to facilitate conversation where somebody can say they feel absolutely lousy. It’s been a terrible day. Right now, people at your job, your neighborhood, your home, feel absolutely lousy.  They don’t know what to do. We need dialogue about mental health so it becomes a natural thing.

It takes a village, the most trite and true statement.

Self-Commitments

Kanji: Gratitude as Action

The philosophy we follow at Embolden is to add seemingly small but significant things to your life. Instead of taking things away; which actually leaves a vacuum that often fails to be sustained. Our strategy is Stones Across The River. Adding a few small things every day, every week, every month creates new ways of being (neural pathways). It’s important to think of things that personally speak to you.

Here are some ideas for our New Year:
-Drink more water. Most of us are more dehydrated than we know.
Not drinking enough water causes fatigue, headaches, muscle tension, attention and concentration difficulties, even hunger pangs. Get a water bottle that you love. You can prepare it in the morning and add fresh sliced fruit, lemon, lime, or cucumber if desired. Start with drinking that throughout the day. Once it becomes more of a habit, you can even refill it halfway through the day.

-Support local restaurants. If you’ve always been drawn to the familiarity of larger or chain restaurants, get to know your neighborhood businesses. You will meet some great folks, and probably establish relationships, not to mention eating some delicious food that you may not have experienced otherwise. You can try new spots every month. As a bonus, you are helping sustain businesses that may need it.

-Make specific playlists. This is actually a mindfulness exercise. What songs or music make you feel energized? Sleepy? Relaxed? What helps you work? Music is a very powerful medium that can evoke different moods and activities. When you use specific playlists, your brain goes into a certain mode, from working out to unwinding. Listening to music actually makes you exercise or work for a longer duration.

-Journal. If you dislike writing, there is a new strategy that I’ve been recommending called one line a day. Buy a journal or notebook that speaks to you; whether it’s a sleek black leather-bound one, pictures of cats or dogs, or just beautiful photos/art. At the end of the day, write a sentence or three about how you’re feeling or what’s on your mind at that moment. Doing this consistently is good for your mental health.

-Go outside. Go for a stroll or even a hike. You can pick a time of day that works for you. Do you like sunrises or sunsets, do you prefer to be alone or with somebody? You can find a walking partner, canine or human. If you don’t love being outside, start by simply being on your own street or block, and back.

-Compliment someone. This actually neurologically creates a boost in endorphins both for the giver and the receiver. It doesn’t have to be creepy. Just think of something you genuinely admire or observe about that person and try it out. Very often we are trained not to speak to somebody’s traits or strengths because we will “turn their head, seem fake or a brown-noser, or make them vain.” A compliment given properly is a gift and can actually make somebody’s day better. Yours and theirs.

-Clean/organize one thing. If a closet or an entire room is too daunting, start with a drawer, a cupboard, or your car. This is an area where people become easily overwhelmed especially if they haven’t cleaned or organized in a while. Each time you accomplish one goal, it builds self-efficacy. Self-efficacy expectations are your own ability to believe that you can accomplish something. Like working out, it requires one step at a time. You literally build your own confidence.

-Grow or tend something. If you are daunted by gardening, start with a house plant or two. Many are low maintenance. If you like to cook, you could start a small kitchen herb container garden.

-Read. Start with one book a month. It can be a graphic novel, fiction, or something that you’ve wanted to learn more about. You can have a reading buddy if you don’t believe that you can sustain being in a larger book club.

-Do as you go. If you are someone who ends up with large piles of laundry, a sink full of dishes, and copious amounts of pet hair on your floors, it often becomes a Herculean task. Taking care of a few dishes after a meal, putting things back where they should go, and completing and folding laundry regularly actually ultimately saves time and helps unclutter your mind.

-Pay off one bill at a time. As you notice your interest rates and penalties going down, it increases mental flexibility and a sense of freedom.  For three months at a time, see what it’s like if you give up one thing, whether it’s Starbucks or saying no to that extra pair of shoes, and pay off a bill instead.

-Keep in touch. From a group chat, to a couple of friends that you care about or text/email regularly, connection decreases anxiety and depression. If you don’t have the energy for a phone call, keeping in touch even briefly creates a sense that you’re not alone.

-Pick your battles. Although it might create a brief adrenaline rush when you vent online, argue with relatives, or comment on somebody’s seemingly astounding content, you just lost an hour of your life, probably raised your blood pressure, and the psychology research indicates the chances are extremely low that you made a dent in their thinking. If you want to vent, get an online therapist, commiserate with friends, or journal.

-Ask for help. This is often something that’s very hard to do. Vulnerability is not easy. Like anything else, practice helps. Here are some practical tips: How to Ask For Help Without Feeling Weird.

-Rest. People have reported feeling unusually tired. It’s a pandemic. We have an all time high allostatic load (elevated stress levels and hormones, without sufficient alleviation). We require sleep for consolidation of memory. We use REM and deep sleep for metabolizing experience (day residue). We must have rest for muscle recovery, no matter how fit we are. We need downtime from work or else our attention is going to wander anyway. We can’t focus efficiently without rest. Yes, we can muscle through temporarily, or take medication. When it wears off, you will be completely worn out. Sleep disorders are at an all-time high. Your body is going to force you to rest eventually. Make it a conscious decision.
See Making Sleep Your Best Friend for more info.

-Ride your best horse first. I learned this from a friend of many years. She emphatically believes you should always use your good candles, your best lotion or skin products, drink your favorite wine, use the gorgeous glasses or mugs, buy that great food at the market, enjoy your softest blanket/wear your fancy outfit/get that massage/ use the special jewelry, use the stunning purse you generally store in its bag. As humans, we want to hoard what feels special. For what?

-Where you can, make your life easier. One client who is very frugal, struggled with his laptop that was creating a lot of problems in his daily schedule. He spent hours daily fixing kinks and slow speeds, leading to frustration and even tears. He finally invested in a fairly modest but extremely updated life machine, as I term it. Not everyone can afford it, but where you can without creating hardship, make life a bit easier. If you truly despise cleaning bathrooms and you can afford to have somebody clean for you once a month, the mental relief is worthwhile.

Small but powerful.

See Stones Across the River, Or Mindfulness As Practice

The Power of Texting

Beautiful artwork, P. Cochrane

Sending a supportive text has been shown to be of significant benefit for someone struggling to cope.
What to say to a loved one:

8 Texts For Mental Health Support

  • The specific offer of help text
    Hey, I’m going to the store shortly, what are some things I can pick up for you? I’m taking the dog to the park later, can I come by and pick up yours to take with us?
  • The you are not alone text
    Why don’t we go for a walk this afternoon? Would you like to watch a movie together tonight from our own homes? Let’s FaceTime later today.
  • The checking-in text
    Just wanted to check on you, no rush to reply. I’m here.
  • The gratitude text
    I really appreciate you and having you in my life.
  • The thoughtful gift text
    I wanted to let you know I swung by and left some beer/wine/coffee and snacks at your front door.
  • The timing and dosage text
    I’m here to talk when you feel like it and as little or as much as you want to say. Or, I can come by and we can both sit quietly together.
  • The photo text
    Here’s a picture of this beautiful beach… It’s so soothing to imagine being there with you.
  • The solidarity text
    You are not alone.  I can come with you to…

Seven Natural Anxiolytics We Love

What do psychologists personally use to manage stress and anxiety?
Like any other strategy or tool, individual preference matters.

Weighted Blanket
I use one that is 20-25 lbs. It’s for grounding through weight and pressure. Pressure preferences are highly variable. Start low.

Vibrating Foam Roller
I use one that’s blue tooth enabled. Releases muscle tension with a variety of massage routines included in an accompanying app.

Leather-bound Writing Journals.
Moleskine is a brand that holds up well over time, no matter how many times you stuff your notebooks in your tote or suitcase.

Soothing Playlists
I like piano and trip hop. Find what clears your head. Important: only use the specific anxiety coping playlist you put together when you are in self-soothing mode. This creates neural associations.

Acupressure/Acupuncture Mat
Lying on a spiky mat may sound more like torture than treat, but once you get past the initial discomfort, the ancient relaxation of acupressure creates deep well-being. I like the Shakti mats.

Brown Noise Machine
We are all familiar with white noise machines. Brown Noise is a deeper version of sound, one that has a much lower pitch. Think of a heavy waterfall or distant thunder.

Golden Milk
Golden milk, also known as ‘haldi doodh’ in Hindi/Urdu or as turmeric milk in western cultures, is a drink with a lot of history. The basic recipe involves combining warm animal or plant milk (coconut, almond, cashew), turmeric, cinnamon, ginger, and some kind of sweetener. It has soothing properties that range from the gastrointestinal to the soporific.

(*Embolden Psychology has no third party interest or financial stake in any of these products).
Coming next week: top meditation and relaxation apps, based on the research from neuropsychology.

Also see:
Making Sleep Your Best Friend.
Anxiety toolkit

When you have anxiety AND depression

Sculpture: Warriors’ Circle, National Museum of the American Indian, Washington, DC, 2019

Anxiety and depression have a complicated relationship. The chances of acquiring depression is much higher when an anxiety disorder already exists. Nearly half of those with major depression also suffer from severe anxiety. A biological vulnerability for both of these conditions is often present. Depression and anxiety are caused by a combination of genetic, biological, environmental, and psychological factors.

Symptoms that might indicate that both anxiety and depression are present:

  • Persistent worries or fears that won’t go away.
  • Physical symptoms including fatigue, headaches, gastrointestinal distress, and muscle aches and pains.
  • Difficulty relaxing.
  • Trouble going to sleep or staying asleep.
  • Intermittent eating habits- might be too much or too little.
  • Loss of interest in activities or previous pastimes.
  • Feeling overwhelmed or having a sense of losing control over things.
  • Trouble concentrating, making decisions, or remembering things.
  • Feeling irritable and cranky including about seemingly little things.
  • Constant feelings of sadness or worthlessness.

Having both anxiety and depression can mean

  • Fearing failure, but no motivation to be productive.
  • Wanting to be left alone, but not wanting to feel lonely or abandoned.
  • Avoiding social situations, but desiring close connections.
  • Being afraid and exhausted at the same time.
  • Feeling restless, but immobilized.
  • Feeling everything acutely, but feeling numb.

See also my post on how to talk to loved ones about depression and anxiety.

What is Low Self-Esteem?

Your self-esteem is the opinion you hold of yourself. When you have healthy self-esteem, you tend to think positively about yourself, and optimistically about life in general. When you encounter challenges, you feel confident that you will be up to the task. People with healthy self-esteem know that they are valuable and will be able to name at least some of their positive characteristics such as “I am a good friend”, “I am kind”, “I am honest”, or “I am a good parent”.

When you have low self-esteem, you tend to see yourself, the world, and your future more negatively and critically. When you encounter challenges, you doubt whether you will be able to rise to them, and you might avoid them. You might talk to yourself harshly in your mind, such as telling yourself “You’re stupid”, “You’ll never manage this”, or “I don’t amount to anything”. Individuals with low self-esteem often feel anxious, sad, overwhelmed, or unmotivated.

Nobody is born with low self-esteem – it develops as a result of experiences throughout our lives. At the center of low self-esteem are the internalized beliefs and opinions we hold about ourselves.

Longterm Effects of Low-Self-Esteem
The cycle of self-criticism can sap a person’s joy in life. They may stop doing hobbies they once enjoyed for fear of judgment. Feelings of anger, guilt, or sadness may keep them from enjoying what activities they do try.

Self-doubt can interfere with productivity at work or school. A person may worry so much about others’ opinions that they don’t focus on the task at hand. They may avoid taking risks or making goals out of a certainty they will fail. A person with low self-esteem may lack resilience in the face of a challenge.

Self-esteem issues can also impact one’s social life. Someone with low self-esteem may believe they are unworthy of love. They may try to “earn” the love of others and accept negative treatment. Others may bully and criticize others to compensate for their own insecurities. A fear of rejection can prevent people from seeking relationships at all. Social isolation can further feed into a negative self-image.

Forms of Low Self-Esteem
Imposter Syndrome: A person uses accomplishments or false confidence to mask their insecurities. They fear failure will reveal their true, flawed self. The person may use perfectionism or procrastination to deal with this anxiety.

Rebellion: A person pretends they don’t care what others think of them. Their feelings of inferiority may manifest as anger or blame. They may act out by defying authority, confrontations, or breaking laws.

Victimhood: A person believes they are helpless in the face of challenges. They may use self-pity to avoid changing their situation. They often rely on others to save or guide them.

What Causes Low Self-Esteem?
Negative early experiences are very important for the development of low self-esteem. Some of the factors that make it more likely that a person will develop low self-esteem include:

  • Early experiences including punishment, neglect, or abuse.
  • Children who suffer these kinds of experiences often form the belief that they are bad and must have deserved the punishment. Shame is often a companion of low self-esteem.
  • Failing to meet other people’s expectations. People may feel that they are not good enough because they failed to meet someone else’s expectations – this might have meant your parents’ unrealistic standards – note that this does not mean that the expectations were fair or balanced in the first place.
  • Failing to meet the standards of the peer group. Being different or the ‘odd one out’ during adolescence, when identity is forming, can powerfully impact self-esteem.
  • Not receiving enough warmth, affection, praise, love, or encouragement.

It is possible to develop low self-esteem even without overt negative experiences, but just through a deficit of enough positive ones. Without enough reinforcement that they are good, special, or loved, children can form the impression that they are ‘not good enough’.

What Keeps Low Self-Esteem Going?
Dr. Melanie Fennell, clinical psychologist, developed a cognitive behavioral model of how low self-esteem is maintained. Fennell’s model posits that throughout life, people form negative beliefs about the self, called the ‘bottom line’. The bottom line is a description of self and might be summarized as something like “I’m worthless” or “I’m no good”. For a person with low self-esteem, the bottom line is always there, dormant, but becomes activated in particular situations. When it is activated you are more likely to use some maladaptive strategies:

  • Speaking to yourself in a critical way. Often intended as a way to motivate yourself, more often this ends up paralyzing you, and it reinforces your bottom line.
  • Setting inflexible rules about how you should be. People may set personal rules that are not very flexible, and breaking the rules can lead to more self-criticism.
  • Making anxious predictions about what might happen. When people don’t see themselves as competent and capable, the world often feels full of danger. The anxious mind tries to help by predicting potential threats, but this just makes us feel even more incapable.
  • Avoidance and escape.  Avoidance is the hallmark of anxiety. People with low self-esteem often refuse to put themselves in positions where things could go poorly and their failures would be potentially exposed. By not taking a chance, they remain ‘safe,’ but their capabilities remain untested.

Psychological treatments for low self-esteem
A number of psychological treatments have been developed which directly target low self-esteem. These include cognitive behavioral therapy (CBT), Mindfulness, and Acceptance and Commitment Therapy (ACT).

Strategies include:

  • Testing your anxious predictions, approaching situations that you have been avoiding, reducing your safety behaviors (behavioral experiments)
  • Identifying and challenging your self-criticism (thought records)
  • Retraining yourself to focus on the positive (self-statements)
  • Challenging your bottom line and building a new one. If your bottom line is “I’m a failure” then you are much more likely to pay attention to your struggles than your successes
  • Using mindfulness strategies to calm the anxious mind
  • People with low self-esteem often have a harsh and critical inner voice.
  • One way of overcoming low self-esteem is to change the way we speak to ourselves, or to have a different relationship with your inner voice (self-talk)
  • Embracing all aspects of the self without judgment (self-compassion)

Also see Brain Lies: Internalized Negative Thoughts.

Anxiety as a Warrior

I teach my teen and kid clients about the purpose of Anxiety. The amygdala is a part of the brain that sets anxiety in motion. It’s actually an Ancient Warrior trying to protect you. Sometimes it becomes overly protective and gives you a turbo boost. This is fuel that is meant to keep you strong, fast, and powerful in case you need to take action. Sometimes you need it, and sometimes just in case. We can work together on that ‘just in case’ part. 

How to help someone having a panic attack

A panic disorder is characterized by recurring panic attacks. These attacks are best described as moments of intense fear. Panic attacks differ from a typical fear response because there’s often no actual threat involved in the immediate vicinity. The body may be saying there’s danger, when in reality there may not be any threat present in the moment. For the person having a panic attack, the danger feels no less than if a predator is literally about to pounce on them. It feels REAL.

There are many panic attack warning signs to look out for, including some of the most common physical signs. Many people experience dizziness, body tension, gastrointestinal distress, shortness of breath, sweating or chills, a rapid heartbeat, and trembling, during a panic attack.

A looming fear of death is another familiar feeling. While having a panic attack, many people feel like they’re not going to be able to make it through.  Panic attack triggers aren’t always easy to identify, so people who have one attack often worry about having more, especially in public. Recurring panic attacks may lead to isolation and loneliness. Often, it may be difficult to leave the house.

What to do :
You Might Need to Get Help
If an individual requires emergency assistance, get help. Panic attack symptoms can be similar to heart attack symptoms. If they are experiencing chest pain and hasn’t had a panic attack before, you should call 911. While most panic attacks are short, some of them can last hours. One panic attack can lead to another.

Recognize the Symptoms
If you haven’t already, take some time to familiarize yourself with the early signs of a potential panic attack.

Panic attacks commonly begin with:
a feeling of terror or dread
hyperventilation or shortness of breath
feelings of choking
a pounding heart
dizziness and shaking

Reassure
Panic attacks can be confusing as well as scary. People generally can’t predict them and there’s often no clear cause. They can happen in stressful situations but also during calm moments or even during sleep. Your ability to offer empathy and recognize their distress as real and significant is important.

Validate their distress
People often have a hard time sharing their experiences with mental health issues, including panic attacks. Some avoid talking about mental health issues because they believe others won’t understand what they’re going through. Others worry about being judged or told what they experience isn’t a big deal. But the response is real, and the person experiencing the attack can’t control it. An empathic response can be as simple as, “That sounds really tough. Let me know what I can do to support you.”

Key Points
-reassuring them you won’t leave
-reminding them the attack won’t last
-telling them they’re safe

Stay Calm Yourself
People with anxiety are experiencing very intense feelings and symptoms during a panic attack. One easy way to help ground them through that experience is to remain calm. While you might feel scared yourself, showing that you’re afraid can worsen the person’s panic attack. Remaining steady by their side can help them stay present and know that they can get through what they’re feeling. They’ll feel protected knowing someone is there to emotionally hold them through this experience.

Help them stay grounded
Grounding techniques can have benefit for a range of anxiety issues, including panic attacks. These techniques help the person focus on what’s actually happening, not their fear of the attack. Remember that grounding can be highly personal for each person. Some people prefer to pace or move; others want to hunker down, often in a corner or curled up in a ball; some want to be outside, others don’t want to leave the room. I always tell patients to listen to what their body wants to do in that moment; it has wisdom.

Quick grounding tips
To help someone ground themselves, you can try:
-physical touch, like holding their hand (if they’re okay with it)
-giving them a textured object to feel
-encouraging them to stretch or move
-encouraging them to repeat a soothing or helpful phrase, like “this feels awful, but it’s not going to hurt me”
-talking slowly and calmly about familiar places or activities
-have them lie on the ground, floor, or grass; being close to the earth can be reassuring

After the panic attack
When someone chooses to tell you about their panic attacks, take this as a sign of trust. Many people feel embarrassed and vulnerable after a panic attack.  It’s pretty common to worry about having a panic attack, especially in front of strangers, or believe the attack might annoy or inconvenience friends or loved ones.

To show respect for their experience and honor this trust:
-Respond with compassion. Be mindful of your words and actions, during an attack and at any other time. You might have all the best intentions, but it’s entirely possible to make someone feel bad without realizing you’re doing so.
-Don’t compare normal stress and fear to panic
-You might even have anxiety yourself. Avoid trying to draw comparisons between your different experiences.
-If you have experienced extreme fear, let that memory inform you. Remind yourself they aren’t just afraid or stressed. They may also feel helpless, unable to manage what’s happening, out of control, physical pain or discomfort. You might not intend to make your friend feel ashamed, but denying the reality of their distress can certainly have that effect.
-Avoid saying things like:
“Just relax. There’s nothing to be afraid of.”
“You’re upset over that?”
“What’s wrong with you?”
“Are you sick?”
“Did you forget your meds?”
-Don’t give advice

Not every coping technique works for everyone. Deep breathing and other relaxation techniques can have benefit, but they often help most when practiced regularly, not just during a panic attack.  When these techniques are only utilized during moments of panic, they may wind up backfiring. Deep breathing can turn into hyperventilating and the mind may become too overwhelmed to focus.

In short, avoid telling someone how to manage symptoms.
Sure, you may have heard yoga, meditation, or giving up caffeine can help. But you don’t know what the person has already tried unless they’ve told you.
Listening and holding space with the power of your presence can go a long way.
Also see Ways to Stop a Panic Attack.

On Emotion Regulation: Equipoise

Equipoise. It refers to a balance of interests or forces. It doesn’t diminish the importance or impact of the other. These are just a few examples of how you can actively hold and honor opposing emotional experiences with therapeutic effects.

Feeling:

  • Loneliness: Video call or meet with someone that you love and care about.
  • Unneeded: Care for your companion animal. With affection, massage them, groom them, validate how special they are to you.
  • Unwanted: Spend an evening or a full day nurturing yourself. Make yourself something nourishing to eat, curl up in your softest pajamas, watch a movie that brings you joy.  See On The Power of the Self-hug.
  • Anxious: Do mindful breathing to self-soothe, visual imagery, and progressive muscle relaxation. See our Anxiety Toolkit for more info.
  • Not good enough: Remind yourself of your strengths. Coming soon –  The Self Resume: The CV that Counts.
  • Down/Blue: The Reboot: Call it a night. Or day. Sleep, watch your favorite movie or show, unplug. If you have to do something, focus on a mindless chore. Fighting our feelings is exhausting. Replenish first and come back to fight another day.

Equipoise, a momentary counterbalance with cumulative effects.

Deep breathing and anxiety

When you feel a wave of anxiety, these are tools that you can use wherever you are.

Your breath is your friend.

  • Acknowledge to yourself that anxiety is occurring.
  • Remember that you’ve dealt with this before, and you made it through.
  • EXHALE a long breath. Yes, exhale. You’re letting it out first.
  • Give yourself a self statement. I’ve done this before, and I will be OK.
  • Breathe in deeply.
  • Exhale. Repeat.
  • Place your hand on your belly. Feel the air going in and out. You are solidly being there for yourself.

Deep breathing lowers your heart rate, reduces stress hormones, and lowers your blood pressure.
Your breath and you: Allies.

Also see: The Anxiety Toolkit.

Embolden Psychology
Embolden

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

Thank you for contacting us.