Category Archives: strategies for self-care

Indigenous Americans, youth, and mental health.

Indigenous/tribal communities face significant behavioral health challenges and disparities. For Indigenous Americans, multiple factors influence health outcomes, including historical trauma and a range of social, policy, and economic conditions such as poverty, under-employment, lack of access to health care, lower educational attainment, housing problems, and violence.

These disparities have important consequences. Suicide is the second leading cause of death among Native American youth ages 8 to 24. Also, while there is general awareness that Native Americans experience higher rates of alcohol and substance use, the scope of these behavioral health problems is not fully understood.

With 564 federally recognized American Indian and Alaska Native (AI/AN, is the designation currently used by the Census Bureau) tribes, 100 state recognized tribes, and over 200 languages, there is a great need for the development of mental health programs aimed at AI/ANs that center culture as a dominant aspect of treatment. The deficit in culturally relevant treatment programs aimed at Indigenous Americans people living with mental illness is glaring. These communities cope with intergenerational trauma which has a historical context, occurring when exposure to trauma takes place in an earlier generation and continues to affect subsequent generations. The stress of intergenerational trauma contributes to the erosion of family structure, tribal structure and even spiritual ties. It can affect one’s identity, relationship skills, personal behavior, transmission of traditions and values, and attitudes and beliefs about the future. The stress of these traumas combined with the complex and ongoing mistreatment of AI/AN citizens contributes to the rates of mental illness in AI/AN communities and can manifest in a high rate of substance abuse disorder, PTSD, anxiety and depression.

Additional stressors such as a lack of access to health insurance, pervasive poverty and unemployment, and higher suicide rates exacerbate these issues.

I have compiled this list of resources for indigenous clients. Please note that the hours of availability may have changed, but they are all in service at the present time.

Mental Health Resources For Native And Indigenous Communities:
–  Indigenous Story Studio creates illustrations, posters, videos, and comic books on health and social issues for youth.

–  Suicide prevention.
–  National Alliance on Mental Illness.
–  One Sky Center: The American Indian/Alaska Native National Resource Center for Health, Education, and Research; mission is to improve prevention and treatment of mental health and substance use problems and services among Native people.
–  WeRNative: a comprehensive health resource for Native youth by Native youth, promoting holistic health and positive growth in local communities.
–  Ask Auntie: similar to an advice column – type in your question and it will pull up similar ones; if none answer what you’re asking, Auntie Amanda will write up an answer and notify you when it is posted.
–  StrongHearts Native Helpline: The StrongHearts Native Helpline (1-844-762-8483) is a confidential and anonymous culturally-appropriate domestic violence and dating violence helpline for Native Americans, available every day from 7 a.m. to 10 p.m. CT.

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. 

How to beat the Monday morning blues

1. Be with loved ones. Set aside some time over the weekend to enjoy your social connections. That could be hanging out with your family, watching a movie with a loved one, going for a walk with a friend, or meeting your bestie for a picnic or brunch. The trick is to do something that is socially oriented, and carving some time in the day to accomplish that. This creates good feelings, that spill over into Monday.

2. Sweat. Even 10 minutes of high interval intensity training will give you the energy you need. You can also go for a hike, or a nice brisk walk. A dose of nature or fresh air is relaxing to body and spirit.

3. Do not sleep in. Sleeping late one day, and having to get up early the next day is very dysregulating to our biorhythms. Sleeping in sounds great, especially on a lazy Sunday morning. Don’t be tempted to sleep in for more than an extra hour, otherwise you will get up feeling rushed and anxious with everything rolling around in your mind about what errands need to be done, on top of family and work obligations. The last thing you want or need is an extra undesirable shot or two of the stress hormone cortisol beyond what is needed to get you truly motivated to accomplish the things you need to do. Getting up at pretty much the same time seven days a week actually helps your body run better.

4. Set intentions for the week. An intention could be any particular phrase or mantra that can help to quite your mind. It can be something like ‘I will have a peaceful day ahead of me,’ ‘ I can get this done,’ or ‘I am grateful for my friends and family’.

5. Meditate. Even for ten minutes every morning before you start your day. Research benefits demonstrate positive changes in the brain even up to 2 to 5 minutes of meditation a day, done on a consistent basis. Learning how to breathe properly can help you feel calmer, center your mind, and maintain a sense of focus.

6. Work. If you must work, aim to set between 1-2 hours over the weekend to organize your emails, respond to only urgent work related matters, and write a list of your work/personal goals for the week ahead with a detailed plan of how you will tackle them. This does not have to be all in one shot. Breaking the time up will be quite easier. Designating some work time will prevent you from feeling more blue, or anxious later on in the day on Sunday, so you can truly relax. That sense of control can be quite powerful, and uplifting.

7. Read. Read something that is not work oriented, preferably before bed, or early in the morning if you are one of the first to wake up in your household. It is a healthy escape to indulge in, and might subconsciously help you relax as an alternative to screen time.

8. Meal prep on Saturday/Sunday. This makes planning your meals throughout the week a lot more manageable, less time consuming and more economical as well. Even something as chopping up many vegetables to be sautéed, or added to any side dish to a weeknight meal will be quite helpful for your meal planning strategies throughout the week.

9. Organize for the week ahead. Finish laundry, do online shopping, pay bills, clean the house. That way those things will not be in the back of your mind as the week starts.

10. Explore. At least once or twice a month, plan something that is out of the ordinary. Getting out of your mental set, going somewhere new, trying new food, hiking somewhere novel, going to an art show. Try activities that you don’t normally do. It recharges the brain.
(Art: G. Benson)

Small but mighty hacks to improve your mental health

According to the World Health Organization “mental health is an integral part of health; indeed, there is no health without mental health.”

Here are a few small but mighty hacks to improve your mental health.
1. Open up and depend on others more emotionally, sharing vulnerable feelings, like sadness or fear or loneliness.

2. Check in with others regularly. Having connections, even sending or receiving a simple text or a good morning, has been shown to improve mood and decrease anxiety.

3. A change of scene or a change of pace is good for your mental health. It could be a five-minute pause from virtual learning or zoom office meetings to stretch, a half-hour lunch break at work, or a weekend exploring somewhere new. A few minutes can be enough to de-stress you. Give yourself some ‘me time’.

4. Do something you’re good at. What do you love doing? What activities can you lose yourself in? Enjoying yourself can help beat stress. Doing an activity you enjoy probably means you’re good at it, and achieving something boosts your self-esteem.

5. Helping others. Volunteering, helping an elder or neighbor, even taking the time to help a friend with tech support, pet sitting, or picking up groceries: caring for others boosts our mood, a win-win.

6. Emotional eating, in a good way. Boost brainpower by treating yourself to a couple pieces of dark chocolate every few days. The flavanoids, caffeine, and theobromine in chocolate are thought to work together to improve alertness and mental skills. Marine based omega-3 foods are also great for mood, attention, and alertness.

7. Spend some time with a furry friend. Time with animals lowers the stress hormone – cortisol, and boosts oxytocin – which stimulates feelings of happiness.

8. Set your morning foundations. Meditate, yoga, work out, check in with loved ones, check your to do list, pray, read. It creates the tone for the rest of the day.

9. Let it all out…on paper. Writing about upsetting experiences can reduce symptoms of depression. The psychologist James Pennebaker did a series of elegant studies that found that writing stream of consciousness in a journal even 10 minute a day, reduced acute symptoms of depression commensurate with taking an antidepressant.

10.  Relax in a warm bath once a week. Try adding Epsom salts to help soothe aches and pains and help boost magnesium levels, which can be depleted by stress. Taking a hot shower or a warm bath before bedtime, followed by the cooling of the body, actually mimics REM sleep, during which time your body temperature drops and creates a sense of relaxation.

11. Take time to laugh. Hang out with a funny friend, watch a comedy, or check out cute animal videos online. Laughter helps reduce anxiety.

12. Go off the grid. Leave your cell phone at home for a day and disconnect from constant emails, alerts, and other interruptions. Spend time doing something fun with someone face-to-face or alone time.

13. Take 30 minutes to go for a walk in nature – it could be a stroll through a park, or a hike in the woods. Research shows that being in nature can increase energy levels, reduce depression and boost well-being. Sunlight synthesizes vitamin D which is not naturally stored in the body. When it is depleted, it can contribute to feelings of depression.

14. Practice planning.  Try meal prepping or picking out your clothes for the work week. You’ll save some time in the mornings and have a sense of control about the week ahead. 

15. Organize. I have my clients keep a master day planner, not just Google Reminders and calendars. Using different colored pens, account for all of your activities: work, academic, social, medical, family, recreation, and self care. Having it all in one place is powerful, and a reminder to be mindful to all different aspects of life.

16. Practice my clinical strategy, stones across the river. Pay mindful attention to the small things that happen every day that can bring moments of satisfaction or joy. When they are strung together, they provide a path that doesn’t seem obvious at first, but can ford the rapids.

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.

6 Big Takeaways Regarding the Restaurant and Bar Industry

This morning I had the pleasure of meeting with government officials from the DC Department of Health and the DC Council. We discussed anxiety and coping strategies for the many service Industry employees heading back to work. Also included were local restaurant leadership/owners, business leaders, and legal experts. It was very informative, and more info to come.

Virginia is starting phase 2, Maryland is 1.5, and DC is taking a slower and more measured approach, even though throngs of protesters certainly make that a challenge.

6 Big Takeaways Regarding the Restaurant and Bar Industry

1. You can and should call in sick if you need to. You cannot be penalized or retaliated against by employers.

2. Similarly, if there are health practices in your business establishment that make you uncomfortable, you are protected as a whistle blower.

3. My point: Restaurant leadership needs to inform patrons about the procedures and protocols. Often, people who seem to have bad behavior, simply don’t know what they are supposed to be doing and not doing. Information needs to be readily available on websites and in restaurants.
People are excited to go back to restaurants, but this is not a one-sided deal. Respect those who feed you. 

4. The biggest concerns that front line restaurant and bar workers expressed to me:
–  The trade-off between potential financial hardship and risking your life and your family’s on a daily basis to do your job. Remember, that patrons do not wear masks while eating, talking, and drinking. There is inherent risk.
–  The complete uncertainty of what’s going to happen next. There could be another shut down in the near future, and there is no way to predict what’s going to happen. Business is certainly going to proceed at a lowered capacity.
–  The porous lines between Virginia, Maryland, and DC. Workers and patrons going back-and-forth, making it harder to control safety regulations. 
– The pivot. 20% of restaurant jobs, and likely restaurants that are privately owned, will be gone. How does one transfer the considerable skills that restaurant folks have to other fields?
– The importance of communication and feeling heard. I suggested that every restaurant have a team of people that are assigned to work with front of the house and back of the house workers as emotional coaches.

5. Mental health is just as important as physical health. During the pandemic, clinical depression hit the highest national average recorded, in May 2020. That month, 50% of Americans met the criteria for major depression. ( US Census Bureau)

6. Self-care is crucial. In the best of times, the industry is one of the highest for levels of stress. Sleep well, eat healthy, exercise, meditate or follow personal spiritual practices, rest, and have a strong social support network.

Seek therapy or teletherapy when needed. Resources are available.

8 Scientifically-Backed Ways to Beat the Winter Blues

When your mood is falling as fast as the thermometer, these small lifestyle changes may help boost your spirits.If you’re starting to feel like nothing but a very full, very strong pot of coffee will get you out of bed, join the club. Holiday bills are high, temperatures are low, and the days are way too short. Here, scientifically proven ways to lift your spirits and ease the mid-winter doldrums.

Note: Cuddling, sexual intimacy, and touch in general are great for you, ANY time of year.

1. Make your environment brighter.
When your body is craving more daylight, sitting next to an artificial light—also called a light box—for 30 minutes per day can be as effective as antidepressant medication. Opening blinds and curtains, trimming back tree branches, and sitting closer to windows can also help provide an extra dose of sunshine.

2. Eat smarter.
Certain foods, like chocolate, can help to enhance your mood and relieve anxiety. Other foods, like candy and carbohydrates provide temporary feelings of euphoria, but could ultimately increase feelings of anxiety and depression.

3. Simulate dawn.
People with Seasonal Affective Disorder (SAD), a form of depression that usually begins in late fall or early winter and fades as the weather improves, may feel depressed, irritable, lethargic, and have trouble waking up in the morning—especially when it’s still dark out. Studies show that a dawn simulator, a device that causes the lights in your bedroom to gradually brighten over a set period of time, can serve as an antidepressant and make it easier to get out of bed.

4. Exercise.
A 2005 study from Harvard University suggests walking fast for about 35 minutes a day five times a week or 60 minutes a day three times a week improved symptoms of mild to moderate depression. Exercising under bright lights may be even better for seasonal depression: A preliminary study found that exercise under bright light improved general mental health, social functioning, depressive symptoms, and vitality, while exercise in ordinary light improved vitality only. Try these mood boosting workouts.

5. Turn on the tunes.
In a 2013 study, researchers showed that listening to upbeat or cheery music significantly improved participant’s mood in both the short and long term. Make your playlists personal.

6. Plan a vacation.
Longing for sunnier days at the beach? Research shows that the simple act of planning a vacation causes a significant increase in overall happiness.

7. Help others.
Ladling out soup at the local shelter, fostering an animal, or volunteering your time can improve mental health and life satisfaction.

8. Get outside.
Talking yourself into taking a walk when the temperatures plummet isn’t easy, but the benefits are big: Spending time outside (even when it’s chilly!) can improve focus, reduce symptoms of SAD, and lower stress levels.

You Can’t Pour From An Empty Cup

You Can't Pour From an Empty Cup: Self-Care and Practical Sobriety

I was honored to be asked to participate on a panel at Tales of the Cocktail. The theme of the presentation was self-care and sobriety in the bar industry, a subject that lines up well and builds on my recent presentation for ROC-DC on Mental Health and Wellness in the Restaurant Industry.

The name of our TOTC panel was You Can’t Pour From an Empty Cup: Self-Care and Practical Sobriety. My notes and comments, from the psychology perspective were integrated with the contributions of two leading bar industry leaders, and moderated by Brenna McHugh, who is both an industry leader and a mental health counselor.

You Can't Pour From an Empty Cup: Self-Care and Practical Sobriety

Some highlights:

  1. “Family Dynamics”  –  The restaurant business is a family: functional versus dysfunctional families; social psychology, and the industry.
  2. The importance of carving out routines and following through. Because your schedule can change arbitrarily, long hours, and other unforeseen events, making your own routine and following it for sleep, meals (shift food is not mindful), self-care, fiscal practices (paying yourself every two years, rather than tips being being seen as more random income), and consistent exercise is important.
  3. Realizing that the industry is your job. It’s good to have great colleagues, but having friends, family, and loved ones outside of the profession is healthy and necessary.
  4. Discovering medical resources: community mental health centers, and low fee or reduced fee mental health.
  5. Awareness of drinking culture and avoiding substance-abuse in a conscious manner, such as being sober curious, letting colleagues know that you may not want to drink excessively. More risk for younger members of the industry.
  6. Embracing the unique aspects of the industry: teamwork, dealing with a wide range of clients, high-pressure shifts, variable hours and shifts, the ups and downs of being a tipped employee. Alcohol temporarily reduces anxiety. BUT: Alcohol in excess increases anxiety and depression long-term because of dopamine and serotonin receptor depletion.
  7. Buddhist perspective  – Unlearning desire. In Buddhism, this kind of desire is called Tanha, which literally means thirst. How to allow a desire without acting on it, is the premise of both Buddhism and positive psychology.  Question: What is the desire?  Answer: Blowing off steam, decreasing stress after work, Pattern/routine, Being with work family.
  8. Strategies for how to stop or reduce drinking:
    1. Meditation and mindfulness. 10 to 15 minutes a day of sitting with yourself and connecting with yourself with love and acceptance. Make this a daily practice in your schedule.
    2. Plan and prepare: every single morning think about situations that might crop up throughout the day were you would ordinarily drink. Make a note of them. Being prepared and knowing what you’re going to do in advance gives you control and confidence, you can even practice what you might say to someone who might be expecting you to drink or even put pressure on you.
    3. Visual imagery and rehearsal. Athletes, coaches, business people do this all the time. They imagine being successful in a specific situation or challenge, with extreme detail.
    4. Stay home if you have to. Keep a list of things to nurture and indulge yourself. With my clients, I call this the relaxation box. You pull it out, and it might have your favorite soft throat, candle, music, bath salts, journal, favorite book, and personal notes from loved ones, or, from you to you.
    5. Go easy on yourself. You’re learning a new skill, and it takes time and practice.
    6. Focus on the gains. I always tell clients, add something to your life. Don’t think about or talk about deprivation. Success comes from adding positivity.
    7. Get some support. If you feel your friends, family, colleagues cannot provide that, get online and find a support group, community, forum, or referral to a therapist you feel comfortable and safe. Checking in regularly helps you stay accountable and feel not alone.
    8. Increased access to mental health services (my program for independent restaurant workers in DC, launching this summer). Changing our thoughts and feelings about drinking is what leads to sustainable change. Lack of info, stigma, and worries about being diagnosed with substance abuse keep many tipped workers without coverage. Embolden provides free screening, diagnosis, and recommendations/referrals, as well as low fee treatment where needed.
    9. Safety concerns: How will you get home after post shift drinking? In DC, Metro ends at 11 or 12. Uber is expensive. MANY drive home drunk. Employers can be held responsible (liability) if something bad happens.
    10. Mindful drinking: Planning all of your drinking 24 hours ahead of time. Having a friend as a sponsor.
    11. My approach as a therapist: you CANNOT take things away abruptly. You ADD things. Someone just asked at a DC restaurant and bar wellness panel; “I am stressed, drinking more after shifts; working six days a week. Cut back on one drink per week.
    12. Have a personal post work routine: Music, Candle or aromatherapy, podcasts, self-pleasure, take a bath, journal.

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.