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How to take care of your mental health during election weeks

How to take care of your mental health during election weeks

SCHEDULE
Remember to sleep, eat healthy, hydrate, exercise, ADLs, clean your house, and speak to your therapist. These things don’t change, the environment does.

NEWS
Define and create boundaries on your time exposed to news and social media.

Rather than watching or listening to coverage at random throughout your day, create a time block for catching up. This can be in the morning as you prepare for the day or in the evening as you wind down—whatever works best for your schedule.

Select your news sources beforehand so that you’re not bouncing around on the TV or scrolling Twitter or FB mindlessly. Find a few outlets you trust And always fact-check. Look for empirical evidence.
Then, turn it off. Absorbing constant news is not helpful, especially when the content is simply being repeated.

MINDFULNESS
Set aside a specific hour to journal or worry. Let your mind and your anxieties run full force, during this circumscribed time. If intrusive thoughts become prominent during the day, let yourself know that you will have this hour to let them have their reign.

CONVERSATIONS
The more involved you are with this election and results , the more likely you may disagree with family members or friends. Difficult conversations are inevitable; the important thing is that we know how to take care of ourselves in the aftermath.

I recommend using a breathing or relaxation app after engaging in these kinds of dialogues or getting outside for a walk and fresh air. Don’t bottle up your emotions or shame yourself for getting worked up—it’s okay to experience tears and anger. Rather than suppressing your feelings, nurture them. Breathe. Drink a glass of water. Allow yourself to rest. Please use meditation apps that have relaxation features, such as the Calm app,  which works well on Apple and Android. 

Holding feelings inside without ventilation can actually be harmful to our emotional AND physical health. When having these conversations with others, know your points and practice active listening. If the conversation begins to feel combative, consider bowing out or stepping away so that everyone can regain composure.

SELF-CARE
On the day of the election, start it with a moment of gratitude and self-care. This may look like journaling, exercise, a short meditation, or a morning walk. Election Day can feel cumbersome and stressful, so it’s even more important to put a self-care plan in place.

BOUNDARIES
When it comes to politics, I come from a family of divorce and strong opinions. I also have neighbors with varying political stances. Having these boundaries means offering one another the space to celebrate, mourn, and process feelings as needed.

FEEL
From anger to sadness or relief. It’s all to be expected, and these feelings are valid. Allow yourself to feel whatever it is you’re feeling. One of the greatest gifts we can give ourselves is to embrace these emotions and then move them through and out of our bodies. Tears, exercise, creative projects, and fresh air can all help with this.

PROCESS
In the days pre and post-election, we’re all going to have a lot to process. Be kind and carve out more space for self-care than usual. Consider taking time away from the news and social media. It is okay to take a break, to retreat to nature, and to spend a few days crying or celebrating virtually with friends. To avoid political fatigue and to keep fighting for the causes we care about, we must allow ourselves moments to step away and breathe.

#WorldMentalHealthDay

Today is #WorldMentalHealth day.

I grew up in a South Asian family that didn’t believe in mental health, even with numerous family members with generally undiagnosed eating disorders, depression, anxiety, ADHD, personality disorders, suicides, and PTSD.  Intergenerational trauma is a term that describes how oppressive events that impacted one generation and remain unaddressed are carried over to later generations.

BIPOC Individuals are much less likely to receive support for mental health awareness and treatment. Racism, stigma, financial hardship, unfamiliarity, and lack of trust make it much harder for people of color to receive or even seek mental health services. As a community dedicated to mental health, we must persevere to change this. #EmboldenPsychology is dedicated to making mental health more accessible. 

Black Americans have higher rates of depression, anxiety, learning differences, and sleep and digestive problems, studies have found. Racially discriminatory events have led Black people to be in a state of high arousal — which means a heightened level of situational awareness and vigilance. This hypervigilance is harmful, medically and psychologically, and has very similar effects as studies on PTSD on brain and developmental functioning.

Asian Americans are discriminated against for their looks, languages and culture. They also face a great amount of family and social stress by having to represent their family and embody two cultures: that of their heritage and being “American” in the US. Depression and anxiety have skyrocketed in the community. 
Native American communities are often geographically disconnected and are significantly underserved, with a disproportionate level of substance abuse, depression, anxiety, sexual assault, and domestic abuse.
Microaggressions for BIPOC individuals cumulatively take their toll, and so do emotional and physical responses to vicarious and direct experiences with racial violence and racism. In the mental health industry, there is a significant lack of education, availability, and research regarding serving people of color. In a 2015 national survey of the mental health professions, close to 90% of all therapists were white. Very few training programs integrate diversity training as part of their broad curriculum.

In this time period of COVID-19, a significant national uptick in mental disorders, and great unrest, mental health awareness is more important than ever.

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.

Mental health and Corona

Prior to the COVID-19 pandemic, nearly one in five of U.S. adults (47 million) reported having a mental illness in the past year, and over 11 million had a serious mental illness, which frequently results in functional impairment and limits life activities. Please remember that these are only the reported numbers, because many people do not seek help or endorse symptoms.

The COVID-19 pandemic and the resulting economic recession have negatively affected many people’s mental health and created new barriers for people already suffering from mental illness and substance use disorders, who were previously substantial in number. In polls conducted in mid-July, 53% of adults in the United States reported that their mental health has been negatively impacted due to worry and stress over the coronavirus. This is significantly higher than the 32% reported in March. Many adults are also reporting specific negative impacts on their mental health and wellbeing, such as difficulty sleeping (36%) or eating (32%), increases in alcohol consumption or substance use (12%), and worsening chronic conditions (12%), due to worry and stress over the coronavirus. As the pandemic wears on, ongoing and necessary public health measures expose many people to experiencing situations linked to poor mental health outcomes, such as isolation, health worries, evictions, and job loss.

Some takeaways:
A broad body of research links social isolation and loneliness to poor mental health, and data from late March shows that significantly higher shares of people who were sheltering in place (47%) reported negative mental health effects resulting from worry or stress related to coronavirus. In particular, isolation and loneliness during the pandemic may present specific mental health risks for households with adolescents and for older adults. The share of older adults (ages 65 and up) reporting negative mental health impacts has very significantly increased since March. Polling data shows that women with children under the age of 18 are more likely to report major negative mental health impacts than their male counterparts.

Research also shows that job loss is associated with increased depression, anxiety, distress, and low self-esteem and may lead to higher rates of substance use disorder and suicide. Recent polling data shows that more than half of the people who lost income or employment reported negative mental health impacts from worry or stress over coronavirus; and lower income people reported much higher rates of major negative mental health impacts compared to higher income people.

Poor mental health due to burnout among front-line workers and increased anxiety or mental illness among those with poor physical health are also concerns. Those with mental illness and substance use disorders pre-pandemic, and those newly affected, will likely require mental health and substance use services. The pandemic spotlights both existing and new barriers to accessing mental health and substance use disorder services.

In my practice, many people do not have access to consistent Wi-Fi or Internet service. During this unprecedented time of uncertainty and fear, it is likely that mental health issues and substance use disorders among people with these conditions will be exacerbated.

Embolden remains dedicated to providing access and services for medical professionals and front line personnel. The long-term effects that we are experiencing cannot be minimized.

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

COLLEGE STUDENTS AND MENTAL HEALTH

According to 2018 and 2019 student surveys from the American College Health Association (ACHA), about 60% of respondents felt “overwhelming” anxiety, while 40% experienced depression so severe they had difficulty functioning.

A 2019 Pennsylvania State University study noted that demand for campus mental health services increased by 35-40% during a period that saw only a 5% increase in enrollment.

Anxiety and depression represent only some of the prevalent mental health issues experienced by college students. Others include serious problems like suicide, eating disorders, abusive relationships, and addiction. Mental health professionals stress the importance of talking about such issues, but students may lack the time, energy, will, and/or money to seek the support they need. Outreach and education are vital.

DEPRESSION
Here are some signs of depression to look for in friends:
They are not enjoying activities they once loved
They no longer attend classes or social outings are experiencing extreme anger or sadness over a relationship in their life
They react negatively or with apathy to most things
They often talk about death or suicide

Words of encouragement show your friend you are a source of support. Avoid telling your friends to “cheer up” or “snap out of it.” Many people experiencing depression are aware of their condition, and telling them to get over it is not helpful.

If you feel your friend is at risk, gently encourage them to seek help and offer to accompany them to a student health center or a doctor’s appointment. While talking through their issues with you may be helpful, it is not a substitute for treatment.

People who have depression often feel as if they are alone and have no one to turn to. But it’s important to understand that isn’t the case, as people care and want to help. People with depression also have resources at their disposal that they may not know about.

For example, the following organizations are dedicated to providing resources for those living with depression.

ANXIETY AND DEPRESSION ASSOCIATION OF AMERICA
This organization promotes the prevention, treatment, and cure of anxiety, depression, and related disorders. Its website offers insight into understanding depressive mental illnesses, provides links for those seeking help, and identifies mobile apps designed to help people living with depressive illnesses.

ULIFELINE
This online resource is for college students seeking mental health wellness. It provides tips on how to help friends in crisis and ideas for developing better wellness habits.

AMERICAN COLLEGE HEALTH ASSOCIATION
ACHA promotes healthy campus communities and is a principal leadership organization for advancing the health of college students. The organization’s website provides helplines, brochures on different types of depression, and external links.

THE JED FOUNDATION
This foundation offers online resources designed to promote emotional health and prevent suicide among college students.

HELP A FRIEND IN NEED
This initiative identifies warning signs through social media. The Half of Us campaign promotes mental health awareness nationally through on-air and live events and connects students with healthcare providers.

ANXIETY DISORDERS
Your friend may have an anxiety disorder if they display these behaviors:
Have experienced a tragic event and do not develop healthy coping habits
Appear to live in constant fear of failure — academically or socially
Are uncomfortable and extremely anxious in social atmospheres
Have trouble concentrating or seem to have a blank mind
Seem plagued with guilt or stress
Have visible panic attacks

Avoid criticizing or belittling the severity of your friend’s symptoms and encourage them to try coping strategies that avoid causing further anxiety. Encourage your friend to visit a campus healthcare or counseling center and discuss their troubles with a professional. With their permission, you might be able to contact their parent. Some of the college student referrals I receive come from friends and roommates who got worried and told their friend’s parents about their concerns.

The following organizations are excellent resources for students with anxiety disorders.

ANXIETY AND DEPRESSION ASSOCIATION OF AMERICA
ADAA promotes the prevention, treatment, and cure of anxiety, depression, and related disorders. The association’s website offers insight into how to better understand depressive mental illnesses. Additionally, it suggests several mobile apps that cater to users with depressive illnesses.

AMERICAN PSYCHOLOGICAL ASSOCIATION
APA is dedicated to advancing the creation, communication, and application of psychological knowledge to benefit society. Its website offers insight into the differences between anxiety disorders and depression, as well as tools to help you locate a psychologist.

ANXIETY RESOURCE CENTER
ARC is a nonprofit dedicated to offering assistance to those who have anxiety disorders. Its website features a lengthy list of education materials, a newsletter, and a blog to help visitors stay updated on breakthroughs in research and trends.

SOCIAL ANXIETY ASSOCIATION
This nonprofit maintains resources for people with social anxiety. Its website provides links to support groups, information on how to find health professionals, news and updates on the disorder, and extensive information on treatment options.

STUDENTS AND SUICIDE
Suicidal people may talk about feeling trapped, feeling as if they are a burden to others, feeling like they have no reason to go on, and ending their lives.

What to watch for if you feel your friend or roommate is at risk:
If a person talks about:
Being a burden to others
Feeling trapped
Experiencing unbearable pain
Having no reason to live

Specific behaviors to look out for include:
Increased use of alcohol or drugs
Looking for a way to kill themselves, such as searching online for materials or means
Acting recklessly
Withdrawing from activities
Isolating from family and friends
Sleeping too much or too little
Visiting or calling people to say goodbye
Giving away prized possessions
Aggression

People who are considering suicide often display one or more of the following
Depression
Loss of interest
Rage
Irritability
Humiliation
Anxiety

ADAA recommends these steps to take if you suspect someone you know is suicidal:
Ask them directly, “Are you considering killing yourself?” This may seem blunt. However, according to ADAA, studies show that this question does not increase the likelihood of suicidal thoughts, and it’s an important foundation for the next steps.

Make safety a priority. If they answer positively to step one, ask them if they have a plan. While it may not be easy, removing lethal objects and items in the dorm or home, such as guns, can also make a big difference.

Be there for them. Sometimes the most you can do for someone is simply to be there for them when they need you. Listen to what they have to say. Acknowledge and talk to them about the realities of suicide. According to ADAA, this can reduce suicidal thoughts.

Give them the tools to help themselves. Save the National Suicide Prevention Lifeline’s number — (800) 273-8255 — in your phone. If possible, also save this number in your friend’s phone.

Remain in contact. Staying in contact makes a big difference and can potentially save the life of an at-risk person.

Reopening: Community Mental Health Clinic

Dear Friends:

This week, I reopened the community mental health clinic I’ve been running for over 18 years, started by my previous beloved mentor, Dr. Neil Schiff. We have been closed since March for safety reasons. I am indebted to the community in Washington DC and Maryland for giving me the trust that they have all of these years. As we maintain extreme precautions, I am also grateful for again seeing the local community that I care for deeply.

While gratitude helps me through each day, my gratitude is tempered with outrage. Longstanding and deeply rooted health care inequities—based on race, ethnicity, and income—have been thrown into relief by the COVID-19 pandemic that cannot be minimized. Everyone is suffering, but communities of color are suffering more. The shortcomings of our system with respect to caring for the elderly are painfully visible. The risks associated with incarceration are vivid. While none of these problems originated with this pandemic, the crisis has exacerbated these injustices in devastating and tragic ways.

I am striving in joining with others to do the urgent work needed to dismantle the barriers to health that persist for so many. As you know, while this has been a long-term focus of mine, this crisis presents an opportunity to design and demand real change. These barriers threaten all of us, not just those who face them directly. COVID-19 has indubitably demonstrated that fact. None of us are untouchable.

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.

8 Ways to Support Others During Tough Times

Life is vulnerable; uncertainty is the only certainty. Pema Chodron has written a great book about this, the places that scare you, that I highly recommend. At one time or another, we will all go through a difficult time, whether we deal with financial hardship, health problems, death of a loved one, catastrophe, crisis, or relational breakdown. In psychology, we have a list of psychosocial stressors that include bereavement, breakups, housing problems or transitions, health problems, financial troubles, loss of work identity, and domestic or other abuse. Often people may experience more than one area of hardship simultaneously.

In those times, we need each other more than ever, but it’s not just enough to be surrounded by people. We, as supporters, need to be educated in the best way to love our friends and family through tough times.

How do we reach out to others? In tough times, circling the wagons and looking out for yourself and your immediate family becomes instinctual for many people. However, more than ever, we actually need each other. Often people don’t know what to do. They may even cause great harm by saying do not cry or just get over it.

1. Silence speaks louder than words misspoken.
Don’t ignore them. Plain and simple. If you don’t know what to say, don’t avoid them. Say something. Ninety nine percent of what you could say is better than saying nothing at all. I tell my clients to speak as close to the truth as possible. Which means sharing process. You could say, I don’t know what to say, but I really love you and I just want you to know that.

2. Don’t make them ask you for help.
Do they need help? Absolutely. Do they want to ask? Absolutely not. There is nothing more humbling than having to admit that you don’t have your life under control, and for all the people pleasers out there, asking people for something as simple as meals or free babysitting is something we’d rather avoid. We’d rather tough it out than beg.
Instead, offer your help, and offer specific ways that you would like to help.

3. Don’t rush them through their pain.
Saying things like “I know exactly how you feel” or telling me a story of your cousin’s boyfriend’s aunt’s struggle and how she made it through. While we may say things with good intentions, it can also serve to minimize their issues and urge them to stifle their pain. Yes, what they are going through has probably been faced before. Yes, people do survive. Yes, things might get better. Yes, to all the things. People need to know that the pain they feel is real and they need to move through it. They need to get a little messy and be a little more honest and feel a little more, because if they move through it too quickly or try to avoid their feelings, they might not heal just the right way.

A doctor doesn’t just give a sling with no cast to someone who has severely broken their arm. The doctor gives a cast. The doctor prescribes time for healing, because they know that if the healing is rushed, the bone may also not heal properly. In the same way, we need to give time for others to move through their pain rather than rush them. Instead, sit with them. Listen. Let them be honest when life is hard. Let them be angry. Let them be whatever they need to be, and resist the urge to fix them, heal them, or placate them. Just be with them.

4. Don’t give unsolicited advice.
Even if you have been in the situation before, support, but don’t preach. This includes all cliche and trite phrases and platitudes. You may have heard them said before, but that doesn’t mean they are helpful. Instead, listen, love, give. Give time, energy, resources… give yourself. Just don’t give advice when they haven’t asked.

5. Don’t give them magic formulas.
If they stand on their head, count to 30, twice and backwards, confess everything they have ever done, change their past mistakes, then this tough situation would no longer be happening to them. There is no magic formula. Life is hard and messy and it doesn’t negate the goodness in this world, but it does assign blame and guilt to the situation, one of the last things that someone who is suffering needs is to be shamed. Instead, let them know you are thinking of them, praying for them, loving them, and cheering them on.

6. Don’t make it about yourself.
Essentially, don’t complain about how your friend’s tough time makes you feel. If you are close, you will be affected, but if they are closer to the problem than you, then they are not the person to whom you should vent. Instead, you should offer them support. Check on them. Love them. Let someone else support you to stay on track.

7. Don’t forget the person.
With all of the above tips, don’t just follow them in a rote fashion. The beauty in each of us is that we are unique individuals with different backgrounds, personalities, experiences, and circumstances. Instead, consider the recipient. Some people want hugs. Some people aren’t touchy-feely. Some people want company. Some people prefer to sit alone. Some people want you to do things without asking, some people want you to run it past them first. Some people want someone to cry with and talk to, some people reserve that trust for a select few. Consider who they are before you act, and support them accordingly.

8. There is no timeline for grief and loss.
People may return to a place where loss feels fresh again. It’s not linear. Let people have whatever time they need. There’s no time limits or quotas.

Say a little less. Love a little more.
Life is messy, but with love, we can help each other survive even the toughest times.
#SpiralUp

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.

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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