Tag Archives: mental health and wellness

Diabetes and Mental Health

37.3 million Americans—about 1 in 10—have diabetes.

About 1 in 5 people with diabetes don’t know they have it.

96 million American adults—more than 1 in 3—have prediabetes.

More than 8 in 10 adults with prediabetes don’t know they have it.

For the past three years, approximately 1.5 million new cases of diabetes were diagnosed each year. Many more go undiagnosed.

For people aged 10 to 20 years, new cases of type 2 diabetes increased for ALL racial and ethnic minority groups, especially Black teens.

This past week, the House of Representatives passed a bill capping the cost of insulin on Thursday night with unanimous Democratic support, a mere 12 Republicans voted for the legislation, with 193 voting against it (five didn‘t vote at all). The House (Democrats) voted to cap the price of insulin at $35. (The bill will go to the Senate after Easter).

FACT: The cost of insulin for patients WITH insurance ranges from $334 to $1,000 a month.
FACT: The manufacturing cost for a vial of insulin is approximately $10.
FACT: Many diabetes patients ration their medicines or discontinue them because of the cost.


  • uncontrolled diabetes is implicated in a threefold increase in vascular dementia
  • uncontrolled diabetes drastically increases the chance of stroke, which also brings an entire set of cognitive and physical consequences
  • untreated diabetes and prediabetes results in impaired attention and concentration, brain fog, fatigue, headaches, learning problems, and lethargy
  • diabetics have a much higher level of clinical depression and anxiety, medical related worries, financial hardship, and overall stress
  • diabetics are at higher risk for secondary events, such as car accidents, work disability, and falls
  • people with prediabetes are at far greater risk for long-term cognitive decline and memory problems because they most often walk around without any diagnosis or treatment
  • most people will have/will have a loved one, family member, colleague, or friend who suffers from diabetes and related sequela in their lives. As such, diabetes affects everyone
  • BIPOC individuals have a significantly higher rate of diabetes, with the highest group being Black men, women, and children
  • diabetic medical consequences that affect daily life include vision problems, neuropathy, chronic pain, kidney problems and possible renal failure, memory weakness, increased risk of hypertension, sexual dysfunction, tooth/gum problems, and foot/mobility problems
  • individuals with diabetes have a much higher chance of long-term consequences from COVID-19
  • the consequences of untreated or undertreated diabetes will create an added strain on the medical and mental health system, which is already under severe pressure. This, in turn, has a trickle-down effect on treatment of other conditions
  • as a psychologist, management of diabetes, medication regimen, diabetic self-care, nutrition, and related stressors are often a focus of treatment

(Data sources: Kaiser Health, WebMd 4/22, CDC, 1/22)

Ten strategies to cope with anxiety about COVID-19

In my upcoming book, Fight/Flight/Flow, I discuss the importance of anxiety. Anxiety is a natural human reaction that involves mind and body. It serves an important basic survival function: Anxiety is an alarm system that is activated whenever a person perceives danger or threat. Anxiety is both in the mind, or cognitive; and in the body, in the form of physical symptoms.

When the body and mind react to danger or threat, a person feels physical sensations of anxiety — things like a faster heartbeat and breathing, insomnia, tense muscles, sweaty palms, a queasy stomach, and trembling hands or legs. These sensations are part of the body’s fight-flight response. The fight response can make us angry and irritable. The flight response can make us avoidant and isolated. These are caused by a rush of adrenaline, cortisol, and other chemicals that prepare the body to make a quick getaway from danger. They can be mild or extreme.

My psychotherapy for anxiety involves what I call the flow response. It’s hunkering in place, but not in a passive way. It’s observing, holding, and waiting. It’s like floating in water. You’re still in it, but you’re not thrashing about.

The fight-flight response happens instantly when a person senses a threat. It takes a few seconds longer for the thinking part of the brain (the prefrontal cortex) to process the situation and evaluate whether the threat is real, and if so, how to handle it. If the cortex sends the all-clear signal, the fight-flight response is deactivated and the nervous system can start to relax. If the mind reasons that a threat might last, feelings of anxiety might linger, keeping the person alert. Physical sensations such as rapid, shallow breathing; a pounding heart; tense muscles; insomnia; gastrointestinal problems; choking sensation; trembling; and sweaty palms might continue, too. Lastly, anxiety is curvilinear. A little bit of it can motivate us to problem solve and take action. A lot can immobilize and sicken us.

Tips to manage anxiety during these challenging times:

1. Sense of community.
Being there for and with others lessens our solitary load. From virtual exercise classes, virtual classrooms, volunteering, and zoom cocktail hours, feeling connected decreases anxiety. We are social creatures, and separating has been very difficult for many.

2. The spiritual life.
From meditation and yoga, to a peaceful walk in nature, a personal home altar, or faith based activities, these pastimes help reduce our panic and sense of fear.

3. The foundations of self-care.
Keeping to good sleep hygiene habits, nutritious meals, and daily exercise. All three of these are potent medicine.

4. Reflect don’t react.
There are many choices within our control even when we feel out of control. Dr. Victor Frankl, who was incarcerated in a concentration camp and wrote “Man’s Search for Meaning,” stated everything can be taken from a man but one thing, the last of the human freedoms, to choose one’s attitude in any given set of circumstances, to choose one’s own way of being.

5. Place stones across the river.
This is my method that I teach to patients, that consists of piecing together the small moments that make each day meaningful and significant. Speaking with a great friend, playing or cuddling with your companion animal, enjoying the beauty of the spring time, having the perfect cup of coffee, taking a moment to connect with others online, listening to your favorite music. These seemingly insignificant things become a powerful gestalt when they are pieced together, and help make our brains create hopeful pathways.

6. You are not your day.
If you have a day where nothing feels hopeful, or an even an hour of despair, it does not define you. It will pass. Remind yourself of the times that you persevered through catastrophic times. Reboot. You can even make self statement index cards and read them to yourself. Remind yourself that this too shall pass.

7. Disconnect.
Sleep, rest your body, turn off the screens, don’t read the news. We can stay in formed but we can also inundate our brain with information and misinformation.

8. Question.
Not everything you read in the news or the Internet is accurate. Similarly, when we are having anxiety or depression, our brain is a trickster that tells us misinformation. We can learn to refute it.

9. Schedule.
Keep to a routine as much as possible. This should include the aforementioned exercises, meal prep and planning, sleep, work, outdoor time, social media time, and downtime.

10. Breath-work and grounding.
Strategies that I teach individuals with anxiety disorders can be used by anyone, you can take them with you anywhere. Using the power of your breathing, close your eyes, take a deep breath in through your nose, and exhale slowly through your mouth. Repeat. And again. Similarly, you can ground your body by progressive muscle relaxation, this is a series of moments of tightening and releasing your muscles starting at your feet and working all the way up to the top of your head. For example, clench your feet hold for five seconds, and release. Continue to your legs, and so on. There are many guided strategies on the Calm App or HeadSpace, on Apple and android, that can help you practice these methods.

If you feel that anxiety is trying to take over your life, please seek professional support. Embolden offices are now offering free 30 minute sessions to first responders.

Wellness in the Restaurant and Bar Industry

A few years ago, I participated in the opening of a well-known Italian eatery just outside of Washington DC.

During an extremely busy weekend shift, I walked into the kitchen and was struck by the Zen-like calm of numerous people working together to create, plate, and serve delicious meals and libations to hundreds of people that single evening. It was a mindful moment.

For a decade of my life, I worked full-time in the industry as a server, bartender, personnel trainer, and eventually an assistant general manager. The unique aspects of this industry have always stayed with me, and I like to say that it became part of my training as a mental health professional, working in restaurants and bars.

The term wellness broadly refers to a person’s overall mental health and physical well being.  Although the untimely death of Anthony Bourdain, and other celebrities who have passed away in the restaurant and bar industry, receives national attention, it’s likely that those in the industry all know somebody who has been impacted by mental health issues, addiction, or even suicide. In fact, statistics suggest that there are probably twice as many people who remain suffering in silence.

A unique industry
When you work in hospitality, you are on your feet for extended periods. You are carrying heavy plates, You are memorizing orders and ingredients. You have to play psychologist in reading your clients and their needs. You may not be serving people who feel the need to be kind.  You may be up long past midnight. You  are under time constraints and pressure. You are working on holidays, weekends, and evenings when many people are enjoying being with their family and friends. The industry is designed for unconventional people who like to stay on their feet, enjoy working long or late hours, can teamwork, and can’t stand the idea of sitting in a cubicle.

Three important studies regarding mental health
According to a 2015 study by the Substance Abuse and Mental Health Services Administration (SAMHSA), the food service and hospitality industry has the highest rates of substance abuse and third-highest rate of alcohol use of ALL industries.

Second, a 2018 study by the American Journal of Epidemiology reported that service workers who rely on tips are at significantly greater risk for depression, sleep problems, and stress, as compared to those in non-tipped, salaried  positions.

Racism and sexism are prevalent in the restaurant industry. According to a series of studies, summarized by Fortune magazine, in October 2015, the pervasiveness of race and gender bias in the restaurant industry is higher than found in the vast majority of jobs.

Work demands
The restaurant industry is unique in its demands. Very few jobs require a combination of physical, cognitive, and social acumen. A high-pressure job, staffing issues, fluctuations in income, long hours, customer service, and time pressure to serve. Many people in the industry have multiple jobs, in addition to their family and other obligations.

Back of the house workers are often immigrants. There is fearfulness regarding family members being discriminated against or even deported.

Many restaurant workers go out together after work or have shift drinks.  They may feel isolated from others, especially if they work weekends, holidays, and late night hours. Their coworkers often become family.

Other concerns may include social and economic inequities: restaurant workers often do not have easy access to insurance or medical and health care.

Finally, the industry continually habitually  requires workers to think about the other.  The care and feeding of others is the job.  How is your meal, is your drink right, are you happy as a consumer. We, when working, often don’t think about ourselves and our personal needs.  This can carry over into a habitual pattern of lack of self-care.

Promoting wellness
Here are ways to advocate for a healthier restaurant team and, in turn, a healthier restaurant, higher morale, and greater employee retention.  These were some of the ideas discussed at a recent Town-hall I led, in Washington DC.

1. Create a space for open, non-invasive dialogue
I was asked recently how should you open these conversations. I firmly believe they should be built into restaurant orientation, and training, including peer counseling. When a new employee comes aboard, they can be assigned a mentor or what I call a wellness coach or partner.  Having regular check-ins can become a familiar part of the job, rather than waiting for a potential mental health crisis.

2. Discretion is imperative.
Having a private space to speak to a supervisor or colleague, creating a dialogue in a Town-hall or small group setting, and never making personal statements or questions in front of others.  Make it clear that the conversation is not to scare or make assumptions about them. It’s to create the space for an ongoing dialogue around physical and mental health. The initial discussion will show your staff you care about their well-being and how it’s affected by the restaurant environment — and how their health impacts the whole restaurant team.

If you feel comfortable, as a manager or owner, share your own experience with these issues, or that of a friend, to start the conversation.

Teamwork is crucial. Restaurants usually have multiple managers. Different styles and ages require flexible dialogue.

While most restaurant managerial meetings involve menu and bar items, inventory, and financial matters, including personnel concerns, wellness, and mental health aspects in regular  meetings is good business practice.

3. Lean on other restaurateurs in your community 
Issues with wellness, mental health, and addiction are rampant in the restaurant industry, so you shouldn’t feel the need to go it alone. Lean on other restaurateurs in your community for support.

Kat Kinsman, Senior Editor of Food & Wine, founded the website Chefs with Issues where she invites “people involved in the industry (not just chefs) to share their stories and resources for dealing with the particular pressures of restaurant life, so that other people may feel less alone.” She believes that solving industry-wide issues such as these will only happen when people in the restaurant community share their stories and experiences.

No one can operate in a vacuum. The issues weren’t created by any one restaurant and won’t be solved that way. Talk to other restaurants and bars in your region or city and pool resources. Maybe they have located an affordable therapist, or do group health classes. They might have established a way to bring issues up during family meal, or come up with best practices for identifying and supporting people in crisis. The only way this is going to change is if individual operators are taking a good, hard, honest look at themselves and sharing what they’ve learned rather than focusing on rivalries.

DC is a small restaurant town. Most of your employees have worked for various companies or do so simultaneously. Sharing information and resources is how we all improve.

4. Use outside support systems.
Some members of your staff may trust you and feel comfortable touching upon what issues — if any — they experience with mental or physical health. That will not be the case for all your staff. Some will likely feel more at ease opening up to someone else. Make sure they know thats ok with you, and point them in the direction of external help.

In recent years, a number of national organizations have cropped up to help restaurant workers and openly address issues with mental health, addiction, and wellness in the industry. Here are a few of them:

    • Chefs with Issues: a website founded by Kat Kinsman, of Food and Wine, where she invites “people involved in the industry (not just chefs) to share their stories and resources for dealing with the particular pressures of restaurant life, so that other people may feel less alone.” There is also a social media page with lots of exchanges and support.
    • Restaurant Recovery: an organization that “wants to provide safe and confidential spaces for conversations about recovery, and support without judgment. The aim is to heal restaurant and bar culture, not by sanitizing or vilifying, but by encouraging resilience, community, and hope. We are all in this together.”
    • Mind Body Spirit(s): an organization “dedicated to supporting bar industry professionals in wellness and personal success for a long, healthy, fruitful career.”
    • Bar Harm: an organization founded and run by Brandi Estrada focused on “building stronger, safer communities, by bringing community resources, training, and education into our bars and restaurants.”
    • Mental Health America. This is a community-based nonprofit found in over 40 states. MHA focuses on prevention and intervention mental health treatments.
    • Crisis text line. This is a texting service that provides free, 24 hours per day crisis support with a trained counselor. Text HOME to 741741.
    • National suicide prevention Lifeline. This is a free 24 seven resource offering confidential support and crisis care for those experiencing suicidal thoughts and their family members. Call 1-800-273-8255 (TALK).
    • Employee assistance programs. Some employers do offer EAP’s, which among other things, provide free, short term, and confidential counseling as well as referrals to other providers and long-term treatment options.
    • In DC, my company, Embolden Psychology, is dedicated to serving the industry at all of our locations. This includes awareness and sensitivity to the hours, financial constraints, and career issues involved.

5. Remind your staff of the importance of self-care
In my seminars, I often refer to the restaurant industry as composed of elite warriors. A good warrior doesn’t go out on the field to get killed. They are primed by self-care: sleep, nutrition, social life, intimacy, exercise.  As anyone who’s worked in a restaurant will tell you, the hours are long, shifts run late, and schedules vary day to day. You spend most of your day standing, walking, lifting, pouring, stocking, cleaning. You’re working with your hands.

Emphasize the importance of rest and sleep. Promote stretching, exercising, and staying active. Remind them to catch some sunlight when they’re off-shift. Have water and fresh juices. Dehydration creates fatigue. Tell them to take time for themselves when they can. Introduce these ideas in the hopes that your staff will begin to create wellness routines for themselves, if they haven’t already.

Self care can include turning off your phone or notifications. Many industry employees and managers I’ve spoken with said there is always something going on. The shift is short staffed, menu items are 86ed, deliveries are late, the dishwasher broke. Being mindfully away from that on your days off can provide a real break.

6. Ask your team what they want out of wellness activities and programs
Before you dive in, go straight to the source. Ask your employees what they want to see out of wellness-based activities and programs. What fuels them. Even if some of the ideas are less achievable than others, it will give you a good place to start and shows you consider their input.

7. Seek resources for your people. Offer discounted access to yoga classes, gym memberships, meditation, or fitness classes 
A restaurant is an integral part of a community and neighborhood. The neighborhood resources cannot be ignored. Talk to other business owners. Offer discounts. Ask for discounts.Working at a restaurant leads to a lot of strain on a person’s feet and back. If an employee’s body hurts or aches, though, it’s going to make it hard for them to want to come in, feel inspired and excited, and do their best work.

To promote physical wellness, you may offer subsidized gym memberships or access to free monthly yoga and fitness classes.

For restaurants that are not able to afford such options, hold simple, in-restaurant group exercises or stretches with the staff. Another idea is to organize the team to participate in bicycle races or 5K races and runs.

8. Advocate for healthier, balanced food and drink habits
We feed people for a living. Your employees make and serve food and drinks, so it’s ironic that many probably have pretty erratic eating and drinking habits. It makes sense given that their jobs are to make others happy, but their own needs often fall to the wayside. I know some servers who bring their own food to the restaurant so they are not tempted to eat what’s readily available and may not be healthy for their diet plan and nutritional needs.

Many restaurant workers quickly eat a meal before going into work – often fast food – or sneak bites of food in once they get to the restaurant over the course of their shift. Some may be drinking tons of coffee all day and night. Hopefully they’re remembering to drink water. Then, at the end of the shift, they might cap it all off with a drink (or a few) with coworkers. They likely repeat this process the very next day.

To promote better daily food and drink choices for long-term health, ensure your team carves out time during their shifts to eat their own meals and snacks. Consider getting rid of shift drinks. Remind them to be aware of their energy levels and hunger/thirst as they work. A busy shift can cause anyone to completely tune out of their own physical needs.

At the very least, every kitchen worker should have a liter container filled with ice water on their station at all times.

9. Promote apps and online resources for yoga and meditation
Many facets of restaurant life can lead to stress, burnout, and mental exhaustion. Two of the best ways to combat these are through meditation and yoga. Make it clear to your staff that this is NOT a replacement for therapy or medication, but that they can make the day-to-day a little easier for anyone.

There are a growing number of apps dedicated to meditation and mindfulness. My personal favorites are Headspace and Calm.

As people in the U.S. continue to seek out new avenues for wellness, yoga and meditation offer your team healthy ways to de-stress. If yoga doesn’t appeal to your staff, form a running group or do another outdoor group activity.

10. Take a moment. You’re in a high stress environment and you’re always working. Anxiety can build up and be too much. Remind your people to take a mental break. A kind gesture, human connection, and encouragement can make a world of difference for anyone, even in the middle of a very busy shift.

11. Bottom line: Healthier Employees Make for Better Business 
Introducing programs and activities that promote staff wellness in your restaurant can only help in combating industry-wide struggles with mental health, medical problems, and addiction.

Outside of that larger mission, the benefits from shining a light on staff health can lead to fewer sick days, improved customer service, higher employee retention, and a more positive atmosphere overall.

Below is a screening measure for depression that is quick and easy. These questions can just be asked as part of a dialogue.

Town Hall: Mental Health and Self Care in the Restaurant Industry

Dr. Siddique will be presenting at two town hall events on mental health and self-care in the restaurant and bar industry, hosted by the Farmers Restaurant Group, Washington DC, on 2/19 and 2/27.

These are private events.

Embolden Psychology is committed to working with the hospitality industry and is available for consultation, screening, and seminars. Hospitality is a very high stress industry. Mental health awareness, screening, and treatment can increase productivity, morale, and teamwork, and reduces absenteeism and illness. Please contact us for more info.

A Discussion on Mental Health & Wellness in the Restaurant Industry

I am so pleased to give back to the restaurant and bar industry, who nourish us.

Lack of healthcare, high stress work environments, substance abuse, racism, misogyny, living off tips, wage theft, labor abuses, mismanagement, no breaks…. All of these things and more contribute to restaurant workers overall health and wellness.

Join me Monday, July 15th with Sakinah A Bramble-Hakim of Green Goddess Radio, Simone Jacobson of Thamee & Toli Moli and Brian Schwartz of DC Health Link for a discussion about challenges and best practices in caring for ourselves while working in the industry. 

This event is sponsored by the Restaurant Opportunities Center of DC (ROC-DC) as part of their Health and Wellness Fair.

Embolden Psychology

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.