Category Archives: anxiety

Psychosomatic Symptoms: The Mind-Body Connection

I was recently asked by a patient to explain psychosomatic symptoms.  A psychosomatic illness originates from or is aggravated by emotional stress and manifests in the body as physical pain and other symptoms. Depression can also contribute to psychosomatic illness, especially when the body’s immune system has been weakened by severe and/or chronic stress. Symptoms that my patients have experienced include unexplained swelling and pain in feet or hands, difficulty moving limbs, neck and back pain and spasms, difficulty walking, and non-epileptic seizures, which used to be known as pseudo seizures.

A common misconception is that psychosomatic conditions are imaginary or “all in the head.” In reality, physical symptoms of psychosomatic conditions are real and require treatment just as any other illness. When you go to your doctor with physical symptoms, they will generally look first for a physical explanation for your pain, which may include physical examination, MRIs, and lab tests/bloodwork. If there is no obvious physical cause that they can easily test for, coming up with a diagnosis and plan of treatment may be complex.

One of the most hurtful thing for patients who experience somatic complaints is being told that their very real distress is not based on any actual facts. When this happens, people might feel like their doctor is not taking their symptoms seriously, thinks the person is making it up (malingering), or that it’s “all in their head.” When your doctor can’t find a clear physical cause for your pain (such as an injury or an infection), they may ask you about how you feel emotionally. The hope is that if a source of stress can be identified, it can be treated (just as you would get treated for an injury or illness).

Symptoms caused by stress that you feel in your body are very REAL, they are just caused by a different mechanism that, say, if you broke a bone. For example, people with somatic, non-epileptic seizures, are often prohibited from driving. Your doctor may want you to talk to a mental health professional, but that’s not to say that your physical symptoms only need psychological treatment. It is important to learn how to effectively manage stress, but that is often a process and can take time. In the meantime, you need to treat your physical pain and other symptoms. For example, if you have severe pain in your neck or back, learning to cope with stressful triggers can certainly help prevent from happening—but the pain is not only in your mind. It’s entirely real.

While it might start in your brain, stress causes a cascade of neuro chemicals in your body that produces inflammation in the muscles of your neck, which in turn causes you pain. You may need anti-inflammatory medications, muscle relaxers, or another type of treatment, such as massage and physical therapy to manage your pain. The mind and body are inextricably and reciprocally interactive. 

What is social anxiety disorder?

My patient is sobbing in the office, stating she could not order her meal in a restaurant, and felt tongue-tied. She was on a date, which also took immense courage. Social anxiety disorder (also called social phobia) is a mental health condition. It is an intense, persistent fear of being watched and judged by others. Being embarrassed, or feeling foolish becomes a pervasive fear. This fear can affect work, school, and your other day-to-day activities. It can even make it hard to make and keep friends.

Social anxiety disorder is a common type of anxiety disorder. A person with social anxiety disorder feels symptoms of anxiety or fear in social situations, such as meeting new people, dating, being on a job interview, answering a question in class, or having to talk to a cashier in a store. Doing everyday things in front of people—such as eating or drinking in front of others or using a public restroom—also causes anxiety or fear. The person is afraid that he or she will be humiliated, judged, and rejected.

The fear that people with social anxiety disorder have in social situations is so strong that they feel it is beyond their ability to control. As a result, it sometimes gets in the way of going to work, attending school, or doing everyday things. People with social anxiety disorder may worry about these and other things for weeks before they happen. Sometimes, they end up staying away from places or events where they think they might have to do something that will embarrass them. Avoidance creates comfort, but keeps the person from learning the skills to manage the situation.

Social anxiety disorder is not uncommon; research suggests that about 7 to 10 percent of Americans are affected. Without treatment, social anxiety disorder can last for many years or a lifetime and prevent a person from reaching his or her full potential.

What are the signs and symptoms of social anxiety disorder?
When having to perform in front of or be around others, people with social anxiety disorder tend to:

  • Blush, sweat, tremble, feel a rapid heart rate, or feel their “mind going blank”
  • Feel nauseous or sick to their stomach
  • Show a rigid body posture, make little eye contact, or speak with an overly soft voice
  • Find it scary and difficult to be with other people, especially those they don’t already know, and have a hard time talking to them even though they sometimes wish they could.
  • Be very self-conscious in front of other people and feel embarrassed and awkward
  • Be very afraid that other people will judge them
  • Stay away from places where there are other people

Patients often ask me what causes social anxiety. Social anxiety disorder sometimes runs in families, but no one knows for sure why some family members have it while others don’t. Researchers have found that several parts of the brain are involved in fear and anxiety. Some researchers think that misreading of others’ behavior may play a role in causing or worsening social anxiety. For example, you may think that people are staring or frowning at you when they truly are not. Underdeveloped social skills are another possible contributor to social anxiety. For example, if you have underdeveloped social skills, you may feel discouraged after talking with people and may worry about doing it in the future. By learning more about fear and anxiety in the brain, mental health professionals can treat symptoms and help build strategies. 

Social anxiety disorder is generally treated with psychotherapy (sometimes called “talk” therapy), medication, or both. A type of psychotherapy called cognitive behavioral therapy (CBT) is especially useful for treating social anxiety disorder. CBT teaches you different ways of thinking, behaving, and reacting to situations that help you feel less anxious and fearful. It can also help you learn and practice social skills. CBT delivered in a group format can also be helpful. Don’t give up on treatment too quickly. Both psychotherapy and medication can take some time to work. A healthy lifestyle and self care can also help combat anxiety. Make sure to get enough sleep and exercise, eat a healthy diet, and turn to family and friends who you trust for support.

How to help a loved one who is having mental health problems

We all go through tough times and people help us through them. Other times we have been worried about other people’s mental health. Whether they are a friend, family member, significant other, neighbor, or colleague, there are many ways to support somebody you care about.

1 in 6 people experienced a common mental health problem such as anxiety or depression in the past week.

Talking about mental health
If you are worried about someone it can be difficult to know what to do. When you are aware there is an issue, it is important not to wait. One of the saddest components of depression is that it is immobilizing. You can simultaneously know that you desperately need help, and have absolutely no energy or desire to seek it.

Waiting and hoping others will come to you for help might lose valuable time in getting them support. Openly talking with someone is often the first step to take when you know they are going through a hard time. This way you can find out what is troubling them and what you can do to help.

Eight tips for talking about mental health:

  1. Set time aside with no distractions. It is important to provide an open and non-judgemental space.
  2. Let them share as much or as little as they want to. Let them lead the discussion at their own pace. Don’t put pressure on them to tell you anything they aren’t ready to talk about. Talking can take a lot of trust and courage. You might be the first person they have been able to talk to about this.
  3. Don’t try to diagnose or second guess their feelings. You probably aren’t a medical expert and, while you may be happy to talk and offer support, you aren’t a trained counsellor. Try not to make assumptions about what is wrong or jump in too quickly with your own diagnosis or solutions.
  4. Keep questions open ended. Say “Why don’t you tell me how you are feeling?” rather than “I can see you are feeling very low”. Try to keep your language neutral. Give the person time to answer and try not to grill them with too many questions.
  5. Talk about wellbeing. Exercise, having a healthy diet and taking a break can help protect mental health and sustain wellbeing. Talk about ways of de-stressing and ask if they find anything helpful.
  6. Listen carefully to what they tell you. Repeat what they have said back to them to ensure you have understood it. You don’t have to agree with what they are saying, but by showing you understand how they feel, you are letting them know you respect their feelings.
  7. Offer them help in seeking professional support and provide information on ways to do this.
  8. Know your limits. If you believe they are in immediate danger or they have incurred injuries that need medical attention, you need to take action to make sure they are safe. More details on dealing in a crisis can be found below.

How do I respond in a crisis?

People with mental health problems sometimes experience a crisis, such as breaking down in tears, having a panic attack, feeling suicidal, or experiencing a different sense of reality (dissociation). This may include even losing a sense of time and place. You may feel a sense of crisis too, in response, but it’s important to stay calm yourself.

There are some general strategies that you can use to help:

    • Listen without making judgements and concentrate on their needs in that moment.
    • Ask them what would help them.
    • Reassure and help point them to practical information or resources.
    • Avoid confrontation.
    • Ask if there is someone they would like you to contact.
    • Encourage them to seek appropriate professional help.
    • If they have hurt themselves, make sure they get the first aid they need.

Seeing, hearing or believing things that no-one else does can be the symptom of a mental health problem. It can be frightening and upsetting. Gently remind the person who you are and why you are there. Under extreme stress, people can dissociate. Don’t reinforce or dismiss their experiences, but acknowledge how the symptoms are making them feel.

How do I respond if someone is suicidal?
If someone tells you they are feeling suicidal or can’t go on, or if you suspect they are thinking of taking their own life, it is very important to encourage them to get help.

National Suicide Prevention Lifeline
Hours: Available 24 hours. Languages: English and Spanish
1-800-273-8255

On the Power of the Self-Hug

Hugs are good medicine. During times of stress, they provide an immediate release and relief. Yet in the time of social distancing and pandemic, we may have much LESS access to touch, even when we might need it the most.

Hugs boost oxytocin levels. Elevated oxytocin levels lead to lessening of feelings of anger, loneliness, and isolation.

Hugs raise serotonin levels. Elevated Serotonin levels improve your mood, create a sense of well being, and help to regulate your sleep cycle.

Hugs release endorphins. Endorphins are the body’s natural pain relievers, so getting a hug will actually help soothe aches and pains.

Hugs increase production of dopamine. Dopamine is produced in the reward center of the brain and makes you feel happy, relieves depression, and just makes you feel good.

Hugs reduce levels of circulating cortisol in the blood. Cortisol is known as the stress hormone. By reducing the amount of cortisol circulating in the blood, hugs can alleviate stress and calm the mind.

Hugs lower blood pressure. Hugs activate pressure receptors in the skin called pacinian corpuscles, which send signals to the part of your brain responsible for lowering blood pressure.

Hugs strengthen your immune system. Hugs can help stimulate the thymus gland which regulates the body’s production of white blood cells, which fight off disease.

Hugs relax your muscles. Hugs relieve tension in the body and soothe pain. As a result, they increase circulation to the soft tissue and alleviate bodily tension.

So what happens, during periods of physical distancing and social isolation? Using the findings, I just described about the neuropsychology of hugs, we can actually learn to hug ourselves. What does someone do when they want to comfort another in distress? They may place their hand on their shoulder or rub their arm. This starts the beginning of a cascade of dopamine and another neurotransmitter called GABA. 

GABA is found throughout the brain (cortex). It functions to regulate anxiety using all of your senses, including touch, sound, and vision. Wrap your arms around yourself, crossing them across your chest. Slowly, stroke up and down your arms and shoulders. If you do this as part of a self soothing practice, the brain starts simulating the same effects as if someone you care for is actually hugging you. Someone you care for IS hugging you. You.

Anxiety Toolkit

1.  Mindfulness Exercise
Start by taking a few deep breaths … breathing in through your nose … and then out through your mouth … in through your nose … and then out through your mouth. Then, while you continue to do so, gradually try to make yourself aware of:

  • 5 Things You Can See:  For example, the table in front of you, the nice painting on the wall, the fridge magnet that your daughter made, the clear blue sky outside, and the leafy green tree across the road.
  • 4 Things You Can Feel:  Once you’ve gotten in touch with five things you can see, then – while you continue breathing in through your nose, and out through your mouth – try to bring awareness to four things you can feel. For example, the chair that’s holding up your weight, your dress against your legs, the soft carpet beneath your feet, or a loose strand of hair brushing against your face.
  • 3 Things You Can Hear:  Next, bring awareness to three things you can hear. For example, the ticking of a clock, a bird chirping outside, or the sound of your children playing in their bedroom.
  • 2 Things You Can Smell:  Then, try to get in touch with two things you can smell. If you try but don’t find yourself able to smell anything, then try to summon up your two favorite smells. For example, the scent of freshly cut grass, or the aroma of a steaming mug of hot chocolate.
  • 1 Emotion You Can Feel:  Lastly, be mindful of one emotion you can feel.

Put all together, this 5-4-3-2-1 grounding exercise is really helpful for when you’re trapped in the “depression fog” and sinking deeper and deeper. It does this by getting you out of your head and in touch with your surroundings – thereby creating some separation between you and your racing thoughts and thus calming you down. Not only that, but it can be used as a preventative exercise too, for the purpose of helping you relax a little bit before something difficult – such as a job interview you’re really nervous about, or meeting someone who’s capable of triggering your depression or anxiety.

2.  Grounding Exercise with Picture Frames
If you find yourself somewhere, where you cannot do a full mindfulness exercise, this is a strategy that works almost anywhere. Find a picture on the wall, or any rectangular framed objects, such as a mirror. In school, and office, classroom, or home, you will usually be able to find something. Walk over to the framed picture. Look at the framed object, and note  the four corners.  While breathing in through your nose slowly, and out through your mouth slowly, mentally count the four corners of the picture. Keep repeating until you find yourself feeling calmer.

3.  Give yourself a timeout
When you’re trapped in the “depression fog”, it’s extremely helpful if you can calm yourself down and put a stop to your racing thoughts. As an alternative to a grounding exercise, another effective way of achieving this is through relaxing self-care practices – for example, by going for a walk, getting lost in your favorite video game, playing with your dog, taking a hot bubble bath, listening to your favorite playlist, reading a good book, watching your favorite series on Netflix, or doing anything else that mellows you out.

4.  Journaling
When you feel yourself suffocated by negative thoughts, worry, fear, or any other difficult emotions associated with “depression fog”, then another way of dealing with them is to try to “release” them. This is not only extremely cathartic – and therefore likely to calm you down – but also, when you have a healthy way to release your pent-up emotions, you’re also able to distance yourself from them, which makes it much easier for you to be able to gain clarity over those thoughts and be able to work through them.

A great way to do this is by journaling. Start with a pen and a blank piece of paper, take a few deep breaths, and then, just write what you feel (you could type your thoughts up on a computer as well, but using a pen and paper is generally recommended since it doesn’t come with distractions like Facebook and your email). Like I said, the process of writing down your thoughts is likely to relax you a little bit, and by “getting them out there” instead of keeping them trapped inside your head, you’ll find it easier to sort them out and gain some control over them.

Write down your thoughts without editing. It’s been shown to be very cathartic.

5.  Talk to an emotion buddy or coach
Just like journalling, talking to someone who you feel comfortable with and trust can also be really cathartic when you’re experiencing “depression fog”. Not only that, but someone you’re close with can also give you a new perspective on the thoughts or the situation that you’re struggling with. This can be particularly helpful, because when you’re in the midst of “depression fog”, your perspective is often negatively distorted, so talking with someone can often result in you seeing things in a more positive or less catastrophic light.  Find one or two trusted people you can talk to in times of trouble.

Relaxation Place

I have anxious clients learn a visual imagery exercise I call the relaxation place. It involves using all of their senses to mindfully recall the details of a place “that you love, that makes your heart peaceful”.

    • What does it smell like
    • Sound like
    • Taste like
    • What are the colors you see and the feelings you have there….

With repeated practice, the place or moment can be visualized with deliberation during times of deep stress and distress. It’s a great tool that you can take anywhere with you.

This is MY relaxation place.

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.

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