Category Archives: depression

When You Are Always Tired

Sleepiness, fatigue, and depression interact and overlap a lot. We often use interchangeable terms to describe how tired we are. Far from exhaustive, there are some major differences.

Sleepiness
Sleepiness is an overwhelming desire to fall asleep. Sleepiness can look like:

  • struggling to keep eyes open
  • microbursts of sleep (the head bob)
  • low energy
  • heaviness in limbs
  • lapses in alertness
  • slower reaction time
  • difficulty making decisions
  • eyes tearing
  • ability to easily sleep when given the chance
  • feeling like you can fall asleep anywhere, on the sofa/ sitting on the toilet/at your desk 

Sleepiness can be caused by:

  • being awake for a long enough period of time
  • an underlying sleep disorder (narcolepsy, circadian rhythm disorders, etc)
  • lack of quality sleep
  • a medication side effect
  • drinking alcohol

Fatigue
Fatigue is a lack of both physical and emotional energy and motivation (tiredness, exhaustion, and low energy).

Fatigue can look like:

  • sluggishness
  • weakness
  • difficulty with concentration or memory
  • struggling to start or complete tasks
  • inability to complete regular chores
  • variable ability to fall asleep even when given the opportunity

Fatigue can be caused by:

  • physical and mental exertion
  • stress
  • depression
  • experiencing micro-aggressions
  • sleep disturbances
  • physical illness
  • medications
  • dehydration
  • poor nutrition
  • lack of physical activity
  • boredom

Fatigue is relieved by:

  • rest
  • activity reduction
  • mind-body activities (i.e. yoga, meditation, pranayama, mindfulness)
  • hydration
  • eating nutritious food
  • regular exercise

Fatigue after mental or physical exertion is normal. Ongoing fatigue for 6+ months with no known cause, that’s not improved with sleep or rest, and that worsens with physical or mental activity may indicate an underlying medical or mental health condition, such as chronic fatigue syndrome.

Depression
Depression involves persistent feelings of sadness, disappointment and hopelessness, along with other emotional, mental, and physical changes that interfere with daily activities.

Depression can look like:

  • a lack of interest and pleasure in most activities
  • restricted schedule; doing the bare minimum
  • easily irritable or frustrated (especially in children and teens)
  • feelings of worthlessness, excessive guilt, or hopelessness
  • constant low self-esteem
  • significant weight loss or gain
  • insomnia or excessive sleeping
  • lack of energy
  • inability to concentrate
  • physical problems like headache, stomachache, body aches and pains, or sexual dysfunction
  • recurrent thoughts (ideation) of death or suicide
  • diminished ADLs (not changing clothing, showering, or keeping up with daily chores)

Depression can be caused by:

  • a personal or family history of depression
  • major stressors or traumas
  • certain medications
  • specific illnesses

Depression is relieved by:

  • psychotherapy
  • medication
  • lifestyle management (regular exercise, quality sleep, a healthy diet, social support, avoiding alcohol)

We all experience sadness every now and then. When feelings of sadness continue for 2+ weeks and are felt nearly all day, nearly every day, they may indicate clinical depression. If you are experiencing symptoms of depression, it’s important to seek help from your doctor or mental health professional.

Also see my post on high functioning depression.

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.

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…

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.

Depression Is:

Depression Is:
Emotional: Your baseline enjoyment of life decreases. In other words, you start constantly feeling a sense of suffering, or emotional pain, for no clear reason. Your are more negatively impacted by set-backs, and find it harder to enjoy the things that bring you pleasure and joy.

Physical : You have less energy. Just about anything feels like a tiresome undertaking, and you often feel like just lying down and doing nothing. It may seem impossible to do the smallest of tasks. Getting out of bed, taking a shower, brushing your teeth, cleaning up, or checking your email can feel like Herculean tasks.

Mental: Your thinking becomes distorted and negative. Your self esteem decreases, so that you feel worthless. Thinking and concentraing becomes harder, as if trying to see something through a fog. It’s hard to imagine things becoming better, or to form a positive idea of the future in general. You have a variety of intrusive negative thoughts; these thoughts can happen regardless of however much you believe or agree with their content.

Additional resources:

What Not to Say to Someone with Depression.

National Emergency Helpline

 

Anxiety is Bone Tiring Exhaustion

Anxiety and exhaustion go hand-in-hand.

Anxiety is a feeling of fear, dread, or apprehension. It can be brought on by a stressful event or by the way you think about an event. Sometimes people feel anxious even when there doesn’t seem to be an external trigger at all.

When you perceive a threat, your hypothalamus, pituitary, and adrenal glands release a torrent of hormones to prepare you to fight, flee, or freeze. In response, you might feel any or all of these physical symptoms:

  • shaking
  • quickened heart rate
  • fast, shallow breathing
  • dry mouth
  • muscle tension
  • dizziness
  • nausea
  • diarrhea

Reasons for Anxiety Fatigue

  • Post-Anxiety Crash
    One reason has to do with the crash you feel after your adrenaline runs out. The name for this phenomenon is adrenal fatigue. Anxiety is like being on high alert. Your body is preparing you to fight or flee; and so it is flooded with energy so that you can respond to a threat. Then, when that adrenaline runs its course, your body goes through a crash that can leave you feeling drained.
  • Muscle Tension
    Anxiety causes profound muscle tension throughout the day, and this often results in a similar drained feeling: your body feels tired. Many people who are anxious clench their jaw in their sleep, waking with headaches and facial pain.
  • Mental Tiredness
    Some of that tiredness is mental simply because your brain can run out of strength. Anxiety is linked to ongoing, stressful thoughts and an overactive brain. It taxes your cognitive capacities, leading to a drain on your ability to think and react. It also increases your emotional load, which means you can end up emotionally and mentally drained.
  • Coping
    Becoming tired is sometimes a coping mechanism that your body uses to prevent you from experiencing severe stress. Tiredness motivates you to take a break and rest rather than exposing yourself to more anxiety, which could become even more overwhelming. Fatigue is an attempt by the body to reset itself.
  • Naps
    Napping can help you overcome fatigue and reduce anxiety, making it a useful habit in many ways. But too much napping makes it harder to sleep at night, which in turn may increase your anxiety. Naps should ideally last less than 20-30 minutes to avoid sleep difficulties at night.
  • Sleep Issues
    Many people with stress and anxiety also develop serious problems sleeping, for instance, difficulty falling asleep, nocturnal waking, and reduced quality of sleep. All of this contributes to an overall lack of sleep, which causes tiredness.
  • Depression
    Finally, anxiety can cause depression. Depression is linked to a huge loss of energy; and that makes it extremely hard to stay alert throughout the day.
  • See also: Seven Subtle Signs of an Anxiety Disorder.

How to Manage Anxiety Fatigue

  • Sleep
    Protect your sleep fiercely: a cool, quiet, dark sleeping space, a regular bedtime, limited naps, and relaxation techniques are key, along with curbing your caffeine and powering down your screens an hour before bed. Even if you don’t get the ‘ideal’ amount of sleep each night, keep it consistent. Go to bed and wake up around the same time each day.
  • Get regular exercise
    Exercise reduces anxiety sensitivity and promotes healthy and restorative sleep.
  • Meditate
    Relaxation techniques like meditation and mindfulness can help quiet your mind, regulate your breathing, and lower the amount of stress hormones in your bloodstream.
  • Pacing
    Balance and allocate energy to the highest priority tasks can help cope with limited energy. Learning to pace ourselves and to manage our energy can be frustrating; it’s difficult when we don’t have the energy to do the things that we want or need to do. But it is an essential part of managing anxiety without burning out.
  • Nutrition
    Whole, unprocessed foods, such as lean proteins, fruits and veggies, legumes, nuts, seeds, and complex carbs, can give you sustained energy. Foods high in saturated fat and sugar are associated with higher anxiety levels.
  • Therapy
    A psychologist or counselor may be able to help you identify your anxiety triggers and develop coping skills that lead to less anxiety and greater relaxation.
  • Medication
    Talk to your healthcare provider or mental health counselor about whether symptoms may benefit from treatment with anti-anxiety medication.

Depression in the Workplace

Last year, I had the opportunity to teach a seminar to the upper level management of a large East Coast restaurant company, on mental health in the workplace. More and more, it has become imperative for employers to address mental health problems in the workplace. One in five adults experience depression during their lifetime. And yet, a distinct stigma still exists around the topic, especially in the workplace. Employees may be hesitant to speak up about mental health issues for fear of being unfairly judged, or worries that it may lead to a reduction in job status, loss of future opportunities or even termination.

The World Health Organization lists depression as the leading cause of disability worldwide. Calling in sick to work because of depression is a common occurrence. In fact there’s been an uptick in depression in the workplace since the pandemic. Many people are struggling to meet their deadlines, not logging on, skipping meetings, struggling with technology glitches, and the added stress of distractions and responsibilities in the household.

But beyond the negative personal impacts that stress, anxiety, or depression can cause, it can actually take a toll on the business itself. Depressed, anxious, stressed, sleep-deprived, or substance using workers can be unproductive, forgetful, and accident-prone. If it’s a service organization, they may not be able to work effectively with customers or they may call out more, which can interfere with scheduling and productivity.

Signs of Workplace Depression
Depression in the workplace can be invisible and go undetected. However, there are noticeable signs that could initiate a conversation. Perhaps you’ve noticed a colleague who’s been keeping to themselves lately, or an employee who’s been coming late to meetings or missing them entirely. Other signs include becoming easily frustrated, irritable, or overwhelmed.

Tips for Supervisors:
*Be a listener and sounding board.
Managers/supervisors should create opportunities for confidential, nonjudgmental conversations, like weekly or biweekly one-on-ones, where they can openly ask the individual what’s going on and how they can help, while assuring them it’s a safe place to chat. While some people may not open up to their supervisors for fear of judgement and job security, kindness from a manager could shift the trajectory of someone’s day.

*Maintain an open-ended conversation
Employees should feel supported by their colleagues and bosses, especially during personal hardships. These should be ongoing conversations. Offering a book, or sharing an article or mental health website are also indirect helpful ways to maintain a conversation.

*Provide effective mental health resources at work
Now’s the time to review what mental health resources are available at your company, regardless of whether you’re employed at a large corporation or a small local business.

Every organization needs to look at itself. Are there regular educational seminars or information being made available online or in pamphlets, guest speaker events or trainings, or other ways employees can get information on physical and mental health issues? This can include employee assistance programs, maintaining a list of mental health resources, and establishing connections with community services, such as mental health workers and clinics.

Sometimes one company can help shift an entire culture. If you see that your company or organization is lacking in support of those dealing with mental health issues, be the person to help change the stigma and impact your work’s environment.

The powerful first step: “Are you OK?”

Tips for Employees:
If you’re too depressed to work:
First and foremost: If you’re having trouble working during a depressive episode, don’t beat yourself up over it. This is not something you can “snap out” of with willpower. Many people become depressed or anxious about being depressed or anxious.

  • Take short breaks with a meditation app when you need them.
  • Get outside for a walk in the fresh air.
  • Go to the gym on your lunch breaks.
  • Pack or prep a nutrition-filled lunch.
  • Maintain good sleep hygiene. It will help you stay rested, regulate mood and your mental state.
  • Check in regularly with a trusted friend or colleague. I call this an emotion buddy or coach.

What to do if you can’t work
*Disability benefits are an option.
Some states offer this on a temporary basis. On a federal level, the Social Security and Supplemental Security Income disability programs will provide your retirement benefits early (including Medicare). Many companies also offer short term and long term disability possibilities. Depression and anxiety disorders are an illness, not a weakness.

*Remember that you’re not alone.
Dark thoughts can be especially heavy during this time, so reach out to family and friends for support. The Suicide Prevention Lifeline has a website and can be reached 24/7 at 800-273-8255, should you need it. Seeking professional counseling can also make a world of difference.

*If you don’t feel like your work is meaningful and/or the environment is dreadful, you’re not in a good place. It may be time to move jobs. Again, it’s important to note that depression is the leading cause of disability worldwide.

*For those returning to work, you could talk to your supervisors about working from home options to avoid some triggers.

*You can obtain a note from your treating psychologist or physician documenting your treatment. Under ADA law, companies cannot harass or terminate people for absences due to medical treatment.

For additional resources see, Wellness in the Restaurant and Bar Industry.

 

How to ask for help without feeling weird

‘I Have Your Back’

Reaching out for support is a skill we’re somehow expected to know, yet it’s never taught and rarely modeled for us. When you need help -no matter the kind of help you need, or the person you need it from -to simply state “Can you help me?” can be fraught with tension.

A seemingly simple request for help can bring huge implications with it. You may have been raised in a family where asking for help, or letting others know that you need support, was considered a sign of weakness and was frowned upon for suggesting a lack of privacy regarding personal difficulties.

Asking family members, colleagues, friends, community, and partners for help may reflect a larger cultural dynamic of communication and give-and-take.

Saying, “Can you help me?” speaks powerfully to an instinctive desire to be of service to other people and to receive reciprocal attention. But “Can you help me?” also makes you vulnerable.

What I say to patients: please practice asking for help.
For many, it’s a new activity, and it feels rusty, like anything novel.  Yet, so many people have recently lost their livelihood, had physical health problems, financial hardship, and even loss of home and identity. More than ever, asking for help is an art form that we need. As a society, we don’t always have the experience to ask for help. In my belief, that needs to change, but requires self compassion and practice.

Where to start:
1. Make a list of what you need help with: particular errands, chores, some cooking, walking the dog, getting food or groceries, yard work, job recommendations, assistance with letter or email writing, changing filters, moving furniture, tech support, maybe even a shoulder to cry on.

2. Write down the names of friends, colleagues, and relatives who have offered to help in the past.

3. Match people with tasks based on their interests, their strengths, their time flexibility and your comfort level with them, given the intimacy of the particular task. One friend may really enjoy cooking, another may check in on you via regular texts, another might upgrade your computer, or walk your dog.

4. Pick just one thing off the list and contact the person you’ve chosen. Be direct. See the next few points, below.

5. I always talk about timing and dosage. If you’re not sure whether or not it is a good time, just ask. You can say, “I’ve love to ask for your help with something. Is there a time that’s good for you to talk?”

6. Don’t be defensive. Instead, say what you can’t do.
Instead of saying, “I need to add a few graphic elements for a major key point power point presentation, say, “I’m concerned a few of my slides for my seminar look terrible.” You don’t have to emphasize how ‘important’ you are. Just ask for the help that you need.

7. Show respect. Without actually saying it, you’ve already said, “You know more than I do.” You’ve said, “You can do what I can’t.” You’ve said, “You have experience (or talent or knowledge) that I don’t have.”

Learning is not diminishing yourself.

8. Show trust. You’re vulnerable. You admitted to a weakness.And you’ve shown the other person that you trust them with that knowledge. You’ve already said, “I trust you.”

9. Show you’re willing to listen. Instead of saying exactly how the other person should help you, you give them the freedom to decide.

By showing you respect and trust other people and by giving them the latitude to freely share their expertise or knowledge, you don’t just get the help you think you want. You get more.

10. Be grateful. Acknowledge the help you received. Even though you might feel embarrassed that you needed help, don’t pretend like it never happened. Directly acknowledge that you appreciate what the other person did for you.

11. Be sincere. When someone is helping you, it’s okay to be a little bit vulnerable. The other person might appreciate knowing that they are genuinely helping you during a difficult time.

12. Gain credibility by helping others. People will be more likely to agree to help you if you have been known to help others. Build a reputation as a helpful person. You will draw others to you who share that same sentiment.

Least Helpful Things to Say to Someone With Depression

Sackler Gallery, Washington DC, 2019

Lighten Up!
Why can’t you just act happy. You’ll feel better.
Things are not that bad.
You become what you think.
You do not need to take those pills. You’ll just get addicted to them.
Just chill, bruh.
Just have gratitude.
A hot bath always helps.
Get a job. It will keep you busy.
Smile and the world smiles with you.
Your face looks like you’re upset all the time.
You don’t look depressed.
You have gained weight.
You have lost weight.
You always think about yourself.
Your life is so easy.
You are being selfish.
Everyone goes through depression, it is not a big deal.
You are an attention-seeker.
Everyone goes through a rough patch, so that is normal.
Depression is not a disorder, it’s in your head. 
A person of your age should be having fun right now.
You know, you become what you think.
You brought this on yourself.
Stop acting like a child.
Think about others who are really suffering.
This bad attitude won’t help.
Stop thinking about it.
Just stay busy.
Get a life.
Your face is so sad that it makes me depressed.
You need to give yourself time.
Have you prayed on it?

Emergency Hotline

Eight tips to fight loneliness during holidays

Tis the season when we presumably spend our days sipping hot cocoa, eating delicious food, gifting, and doing all sorts of holiday fun-ness with our loved ones, these days, virtually. It’s the jolliest time of year. At least, that’s the lovely picture we’re all marketed for the holidays. The unfortunate reality is this sentimental holiday scenario is anything but the norm.

For many people, this time of year can be a painful reminder of the things they’re not surrounded by. Loneliness happens. And the painful feeling may grow, until you’re convinced you’re destined to be a lonely hermit whom no one wants to be around.

Part of that reason is simply because of our cultural expectations around what the holidays SHOULD be like. When we set our expectations to be one thing, and the reality is something different, we can see it as less than.

Think, for instance, about all of those holiday Hallmark family films that focus on the heartwarming ~feels~ that come from quality time with the fam.

The reality is, though, your IRL or virtual version could easily not match what you see on the screen or with what your neighbors with their beautiful lights and decorations might be experiencing. Coping with the loneliness and holiday blues can be challenging.

Mental health tips:

Recognize how much stress you might be under
Since the holiday season is short and goes quickly it creates a sense of urgency and overwhelm, making you feel like there’s so much to do and so little time to get everything done. Expectation is also a huge cause of stress during the holidays. Everything from holiday decorating to shopping and gift giving come with expectations that are most often unrealistic which causes you to stress about measuring up to those expectations whether they are your own or ones held by family and friends. When people get stressed or feel overwhelmed they can begin to feel alone in their struggles.

Comparison is the thief of joy
People can feel less than, especially when they see everyone else seemingly ‘happy’ and having everything under control. Social media can be a huge culprit of making it seem that everyone else has it all together except you with those happy/perfect pics. Even though social media is for “connecting” with others it can actually do the opposite and make you feel less connected and more alone especially when you compare your life to those you see. Try limiting time on social media.

Don’t isolate yourself, no matter how tempting
When people feel lonely, sad or are struggling they may tend to isolate themselves or feel unmotivated to reach out or interact with others. They may also feel unworthy of someone’s time and that they would burden or inconvenience others by asking them to participate in an activity or by sharing their feelings. They get caught up in their low self-esteem and negative thoughts, and choose to isolate instead of virtually socialize or reach out. The best way to stop and change negative thoughts is by choosing to see them for what they are-as mental distortions, rooted in fear, self-doubt and low self-esteem. Their purpose is to keep us from pursuing relationships and opportunities.

Self compassion
Please ask yourself if this is a kind thought you are telling yourself. Flip the negative self statement to a positive thought, for example if you are struggling with worth and feelings of deserving ask yourself “Who am I not to deserve this?” Start repeating “I am worthy” multiple times throughout the day and you will begin to believe it and act from a place of feeling worthy and deserving. The more you practice positive thinking, the more empowered and less lonely you will feel. I actually have my patients write this down on index cards and carry it around to look at throughout the day. 

Process and be in your feelings
It’s okay to feel sad and to let yourself feel lonely. Everyone has bouts of loneliness at times and often it’s because family may be far away or maybe right now you don’t have a significant other or kids. Spend some time fully feeling your feelings until they dissipate. You can do this by practicing mindfulness. Mindfulness teaches you how to be aware of your feelings, to feel them in your body and to allow and accept them without creating a narrative around them. It is OK to cry or feel an intensity of emotions, and in accepting and inviting these feelings to be present they dissipate and more calm and peace prevails.

Engage in the practice of opposite action/emotion
Practice opposite emotion and action, derived from Buddhism, to change your mood by engaging in behavior that is opposite to what your current emotion is pulling from you. For example, if you are angry and feel yourself tensing up, then try to open your posture and uncross your arms. Stretch your body for release. Similarly, if you are feeling sad and lonely and want to withdraw, then make a point to reach out to friends or watch a funny or well loved movie to help mitigate sadness.

The theory behind the skill I teach in my clinical practice to patients that I call OPPOSITE EMOTION is that every emotion is accompanied by an urge to engage in certain behaviors and these behaviors perpetuate the emotion. For example, the most common action urge for anxiety is avoidance. The more you avoid something you fear, the more intense your anxiety will become, and so approaching what you fear will help reduce anxiety both because you learn the situation is okay and because you aren’t continuing to reinforce your fear by avoiding the situation. It is important to note that the goal is not to push away your emotion or suppress it, but rather to work on cultivating another emotion.

Community service and volunteering
Use your energy and resources on behalf of people who need your help. Volunteer to tutor students, as many are struggling with virtual learning; help at a homeless shelter or soup kitchen, make food for an elderly neighbor, or volunteer at an animal shelter.

Appreciate what you have
Send cards or a personal note to everyone who means a lot to you. Thanksgiving is about showing gratitude. Make your holidays a spiritual growth time, such as creating a personal ritual, prayer, meditation, or virtual gathering with close friends. I have several friends who have a personal altar at home, and engage in prayer to their ancestors and loved ones who are not present. Find something for you that is meaningful. 

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.