For years, the acronym ‘OCD’ has been widely misused by people to describe their organizational skills or how neat they keep all of their belongings. To be technical, Obsessive Compulsive Disorder (OCD) should be defined as the presence of obsessions as well as compulsions. Obsessions being characterized by “recurrent & persistent thoughts, urges, or images that are experienced as intrusive or unwanted..” and compulsions being characterized by “repetitive behaviors or mental acts that that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly,” (APA, 2022). What I hope to voice is that OCD is not something that is a personality trait, it is a mental health disorder as it states in its name.
It is actually believed that OCD can be dated back to the 14th century. Researchers believe that some religious depictions and works depicted signs of OCD-like behaviors. Of course, the term OCD was not around during this time and it was referenced as scrupulosity (a term to reference fear of sins and compulsions to be devoted). During the 19th century, a time when psychology as well as medical advances were being made, French psychologists attempted to understand what they came to know as compulsions and obsessions by separating them into different categories. These conditions include that of phobias, panic disorders, as well as manic behaviors.
What we have come to know now within the world of psychology, is that there really is no particular cause for OCD. There are current theories that state that biological, environmental, as well as learned behaviors can trigger the onset of OCD behaviors. However, what we do know is that those who have OCD have a larger sense of responsibility to tend to their intrusive thoughts as well as may misinterpret these intrusive thoughts. This sense of responsibility and repetitive behaviors lead to the obsessive thoughts regarding the stressor, leading the individual to engage in compulsive behaviors to rid themselves of the intrusive thoughts.
Obsessive-compulsive and related disorders is now its own section within the DSM. OCD used to be categorized as an anxiety disorder, however with the recent DSM-V edition it has been separated into its own section for obsessive-compulsive and related disorders. There are several disorders that fall under this category: Obsessive Compulsive Disorder, Body Dysmorphic Disorder, Hoarding Disorder, Trichotillomania, Substance/Medication Induced OCD, Excoriation Disorder, as well as Other/Unspecified Obsessive-Compulsive disorders.
Body Dysmorphic Disorder occurs when an individual has a preoccupation with perceived flaws or defects in their appearance. Any part of the body can be the area of concern for the individual; even if these flaws are not observable to anyone else. Because of the obsession over these perceived flaws, the individual likely will engage in compulsive behaviors in order to keep themselves in check.
Hoarding Disorder is probably one that you may know well due to TV shows like Hoarding: Buried Alive, I came to know it because of my grandparents. My grandparents were excessive hoarders, with their house being filled with countless knick-knacks, books, clothes, and even hundreds of mason jars. After my grandparents passed, it was up to my family to clean out their house and that was a project! After, most likely, 10 full dumpsters and a week of work we were able to clean out the house that they once lived in. Hoarding is the characteristic that an individual has a hard time letting go of items, regardless of their perceived and actual value. The difficulty that comes with letting go and releasing these items is the aesthetic and/or sentimental value that the item may have. Even though my grandparents were victims of hoarding, we were able to donate many things from the house we were able to salvage.
Trichotillomania is a disorder where the individual compulsively pulls hair out from any part of the body. The distress that can be experienced by those with a hair-pulling disorder is one that can be described as shame, embarrassment, or even just feeling as though they have lost control. Hair-pulling may bring one gratification and satisfaction with each pull of a hair. Whereas, excoriation is the picking of the skin. Individuals who actively pick at their skin throughout the day, may experience similar emotions and feelings; feeling embarrassed, ashamed, as well as loss of control. The preoccupation with the intrusive thoughts of wanting to pick at your skin, or the struggle to fight the urge to not pick off a healing scab can leads to the compulsive behavior of removing that part of their skin.
Still think that OCD is just a cliche personality trait?
There are ways to live with symptoms falling under the umbrella of obsessive-compulsive related disorders. A common modality that is used is Cognitive Behavioral Therapy, which is oftentimes used for many mental health concerns in therapy today. For a brief explanation of CBT, it essentially involves regular talk therapy about problems causing distress in the here and now. One of the key targets for CBT are intrusive thoughts, which we can also call OCD obsessive thoughts and need to act on compulsions as intrusive thoughts. Unfortunately, intrusive thoughts are something that cannot be completely eliminated because intrusive thoughts are simply unwanted or distressing thoughts, urges, or impulses.
Additionally, there is an approach termed Exposure & Response Prevention that is specifically geared towards challenging one's fears, obsessions, and compulsions. The idea of ERP is not to scare the individual, but to allow the individual to confront their fears in a comfortable setting that does not cause further distress. A major part of ERP is for the individual to be confronting these fears, but minus the act of the compulsions to “make it right.” Similar to regular talk therapy, with ERP the initial targets are small and are ones that don’t cause too much distress. This is because it is easier to challenge minute fears and be able to comprehend your ability to overcome them when first starting out.
Let’s say that your fear is that everything around you is covered in germs and you are fearful that these germs will cause you to become infected or die. Here is an example of what can be done to challenge and confront these fears over the course of treatment. Also notice that these steps are broken down into simple achievable steps, as to not be pushing the fear too far.
With each step being broken down and with each step gradually working up the fear ladder, an individual can become confident with facing their fears. However, it should also be stated that the person seeking treatment determines their hierarchy of fears and what they feel comfortable confronting and in what order.
OCD can be a debilitating illness, although it doesn’t have to stay that way. OCD is not making sure your desk is organized, or your kitchen is always clean. It’s more so about what these obsessions and compulsions do to you and how they impact you. Also, OCD is not the only disorder that comes with this family sized pack of obsessions and compulsions. If you feel like you're struggling with any of these, there is a way to regain control. Obsessions and compulsions will not write your life story.
At the start of any romantic relationship, everything is fresh, new, and exciting. We tend to idealize the person we are dating, feeling that they can do no wrong and would never do anything to hurt us, ever! Sound familiar? It’s because these feelings get the best of us and many times, these idealized traits can very well be true (with hints of reality that we won't always agree and/or be “lovey-dovey” 24/7). However, sometimes we may start to notice that we have polar opposite experiences in our relationship, depending on the day…never knowing what’s to come. We have some days where we are honeymooning followed by days of emotional turmoil. When we start seeing this pattern continue over time in the relationship, it's time to start thinking about whether we may be dealing with a partner who is emotionally manipulating you, whether they even realize what they’re doing or not.
Of course, it can be very difficult to tell if you have a manipulative partner and even more difficult to admit this to ourselves once we see all the clear signs that this could be true. Oftentimes, we may see that our partners are incredibly loving, affectionate, and make us feel like we are the most important thing on this planet. It's a wonderful feeling, something to be cherished, and oftentimes we become addicted to the feelings of elation that come with this affection from our partner. Then, maybe there's some kind of disagreement where we are then ignored, avoided, and made to feel that we are a burden. Often, we are made to feel that we are in the wrong, confused, or not paying enough attention. The constant cycle of honeymoon phases followed by conflicts, anger and confusion makes it difficult to know whether we are genuinely in the wrong or if we are being manipulated.
There are many signs of manipulation that one can show if we know what to look for in our interactions with not just our romantic partners, but anyone in our lives. Here, we will go over just a few of the big manipulating skills that we often see in romantic relationships that maybe you’ve noticed too.
First, there’s gaslighting. Do you ever notice that you become more confused and feel like you're losing your mind in your relationship? Your partner may make you doubt yourself constantly and that you are always in the wrong. An example may be that your version of events often differs from theirs and they make you believe that you are confused or maybe even accuse you of lying and/or being manipulative.
Another tactic is called stonewalling. When your partner and yourself have a disagreement, do you find that you are then being ignored and avoided for several hours, maybe even a day or two? This is called stonewalling and manipulators use this tactic to make you feel emotionally isolated, it's all your fault, and that you are the problem.
Also, you may notice that there are ever changing and unclear boundaries in your relationship. Manipulators will often change the rules and flip the script on you to fit their own agenda. They are flexible in the way they represent themselves to you and others around them to ultimately get what they want from whoever they can, which would mean manipulating a lot of people throughout their lives.
Do you notice that you are always painted to be the monster while your partner is the victim to your constant wrongdoings? Maybe your partner is always saying that they are being wronged somehow without having any willingness to look at their own behaviors. Maybe they are unwilling to reflect on how their actions may impact your relationship. They want sympathy and the best way to get it is to make you feel bad and that this is all your fault. An example may be that your partner tells you that they are drinking excessively because of the stress you bring them.
Maybe you have also noticed that there are elements of blaming language and sarcasm interwoven into your regular interactions with your partner, whether they are positive, negative, or neutral conversations. When manipulative partners use sarcasm and/or blaming language, they may downplay your problems, feelings, and make you feel like you are just being dramatic and/or overreacting. They may even make a joke of the issues and your feelings. Infuriating, right?
If you determine that your partner is manipulating you, it is essential to first develop and solidify strong boundaries for yourself. Talk with your partner about some of the behaviors you notice from them in a calm and neutral manner. Do not use blaming language and avoid any angry tones or raising your voice. Knowing what your own values and expectations are in your relationship will help you hold boundaries and immediately address any manipulative behavior as they happen.
When one partner notices emotional manipulation, they are hurt but still in love and often will look into anything they can to remedy the relationship. They may ask, would couples counseling help? Well, it could potentially help, but not always. A couples counselor could help to highlight behaviors from both parties in a relationship that may be maladaptive and contributing to emotional tensions and conflicts. Afterwards, they would likely discuss conflict resolution skills to promote transparency and constant constructive communication between both parties. Sometimes if the manipulative partner is not willing to acknowledge their behaviors and how they impact the relationship, individual counseling may be recommended. However, manipulators are not always willing to make change because their manipulating ways work to their benefit, so why change? Often in these circumstances, couples counseling could be beneficial in that the ever-rising conflicts are highlighted so that the manipulated partner may gain additional insight and strength to leave this toxic relationship.
If you feel you are in a relationship with a partner who is emotionally manipulating you, talking to someone about what's going on, whether it be a therapist or trusted loved one, this can help you have additional objective insight into what is happening so you can make the best choice regarding next steps for your own wellness and what next steps you’d like to take in your romantic relationship. Much easier said than done, but you can do it. You have the strength, wisdom, and resilience. You’ve got this.
- Jackie Martinez, LMSW (NY), LCSW (NC)
The word trauma is used in many different contexts, and it has recently been more of a topic of conversation in recent years. When people think of trauma, the typical images that may run through their heads are of war veterans, sexual abuse survivors, or even other kinds of abuse experienced. However, I believe that the population of caregivers as well as loved ones of those who are battling a deadly disease or severe medical conditions experience a trauma that does not get noticed enough. This is what can be termed secondary trauma, when one learns about the traumatic experiences of a loved one. Try painting this picture in your head: sitting in a hospital room beside the hospital bed for days in and days out with no end in sight, having not much to do other than observe your loved one in pain while they are in the hospital or at home, as well as even possibly having to dedicate all your time to care for your loved one.
Unfortunately, my family recently experienced a significant loss. My stepbrother, who was battling cancer since November of 2015, had passed away on Christmas Day. His battle with cancer is one that will never be forgotten by those who surrounded him. My stepmom and dad were his caregivers throughout the whole process. As a mental health counselor, I was keen on observing the impacts his battle with cancer had on them. For the sake of their privacy I won’t divulge, however the countless sleepless nights as well as hospital visits speak for themselves.
Our reactions to bereavement vary from person to person, everyone has their own way in which they react to the loss of a loved one. Grief disorders come into play when an individual is experiencing prolonged as well as complex grief symptoms, these symptoms are typically more challenging for the individual to live with as well as may cause significant impairments to your normal functioning.
Some symptoms that are consistent with complex grief are: excessive irritability, consistent insomnia or sleep difficulties, intrusive thoughts about the loss, feelings of futility, as well as having a strong sense of responsibility for the loss. These are just a few of the symptoms that correlate with complex grief; it should be noted that if you are experiencing these symptoms and if they are lasting more than two months after the loss, it can be a signal of a prolonged grief disorder.
It can go without saying that in these kinds of circumstances, we have someone who is ill and may be getting traumatized in the process as well as a caregiver or family member watching all of this play out in front of them, can have a significant impact on how we are perceiving this kind of trauma. I believe that this statement describes the experience of caregivers and loved ones during this time, “for some caregivers and loved ones, watching the death of someone close to them, while making no attempt to stop it, can be excruciating and lead to shock and extreme emotional distress,” (GoodTherapy).
Intrusive thoughts are common when talking about mental health and discussing our emotions. Intrusive thoughts are simply thoughts that enter the mind unwillingly that cause some sense of discomfort, or they can be images or impulsive urges that pass through your mind. In a situation like this, it is common for people to have constant intrusive thoughts about the person who has passed. Those who have a history of addictive behaviors may resort back to old unhealthy habits, and it's even possible for one to develop a fear that is related to the loss in some way (i.e. if the death was caused by a car crash, a fear of driving may develop).
The history of it all. It’s true, the history that one has with the one who has passed can impact the way that they experience grief. Whether that history is traumatic, joyful, distressful, or filled with unforgettable memories, each has a unique way of causing a domino effect. For example, if the one you have lost was a significant factor in your trauma history it may be difficult for you to wrap your head around how to grieve this individual. Feelings of confusion, conflicting emotions, feeling alone in the grief, as well as feeling guilty for holding negative feelings/thoughts towards who has passed. We see you, and it’s okay to be going through all of these emotions and barriers.
Ultimately, it is up to you to decide how you want to experience grief and how you would like to progress on the path of healing, if needed. Your family may have their own words and ways of going about the loss, but this is not something that needs to be conformed to or feel as though you should be matching the level of emotions of your family members. No. It is your journey. It is your life to drive forward. It is your time to take care of yourself, and if you start questioning the reality of you being able to take care of yourself or if you have hesitations about doing so; just remember how much you have cared for your loved one and pull that energy inwards and direct it towards you.
Grief and loss is unfortunately something that we all come to know all too well. Even with that, it still feels like getting hit with a ton of bricks whenever it happens. Throughout our lives, we make connections, friendships, relationships with people that are not forgotten. It is important not to remember your loved one as they were during their last struggling moments, but to remember them by how they were around you.
Moral injury has been defined as, “In traumatic or unusually stressful circumstances, people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations” (United States Department of Veteran Affairs).
Essentially, moral injury can occur when someone either engages in or witnesses an event and/or action that goes against their own personal values, ethics, and beliefs. There are two types of acts that can lead to moral injury; acts of commission and acts of omission. Acts of commission refer to actions people take that go against their own morals and/or belief systems. While acts of omission highlight when someone intentionally does not take action on something that leads to an adverse event that goes against their own morals and ethics.
To clarify, an example of an act of commission may be that a military member kills civilians in the midst of performing combat related duties. An act of omission might be a physician not taking someone off of life support despite patient suffering due to the patient's family making the decision to keep the patient on life support.
Well, oftentimes we tend to associate the term “moral injury” with military personnel and military related tasks/traumas. However, moral injury extends to multiple life experiences in addition to the military experience. For example, those who are in the healthcare and/or mental health care field, first responders, survivors of crime, and survivors of intimate partner violence may also deal with the negative thoughts, feelings, and even potential decrease in functioning related to traumas associated with moral injury.
While we can take an educated guess that engaging in and/or bearing witness to a violent war event is traumatic and will create moral injury in most of us, there are other scenarios in the civilian world that can also inflict moral injury.
For example, during the height of the COVID-19 pandemic, healthcare workers across the world were stretched incredibly thin; working longer hours, having to isolate from their families for extended periods, seeing a high volume of patients, and not always being able to help dying patients see their loved ones one last time before they left this world. The unimaginable stress of working in healthcare at the height of the pandemic led to unavoidable moral injury on various fronts, given there was so much out of our control and so many difficult decisions had to be made. There are even people who blame themselves for others' deaths after unintentionally and/or unknowingly exposing people to the disease, healthcare workers or not.
Then, there are those who are survivors of violent and/or sexual crimes that often suffer with depression, anxiety, social isolation, grief, and resentment towards themselves, others, and the world based on their own traumatic experiences and moral injuries sustained. They might blame themselves for what happened to them, whether that be rape, sex trafficking, or assault. They may know their assailant and still have love and/or affection for them, which creates an internal storm of emotions and confusion.
People who suffer with moral injury often deal with bouts of depression, shame, anger, disgust, distrust, and self loathing. Such feelings can compound with clinical depression, anxiety, or even post traumatic stress disorder that makes moving forward in our lives that much harder. Maybe we notice ourselves to “shut ourselves off” to others, the world, and ourselves…we just can’t trust anything or anyone anymore which creates negative bias that impacts how we live our lives. We feel more isolated because we feel shameful or disgusted by what happened, so we disengage which ultimately fuels the anxiety, anger, sadness, poor sleep, helplessness, and hopelessness that may come with moral injury.
Much like any emotional wound, it is important to be able to have the felt safety to talk about our moral injury without being judged. Simple, right? No! Dealing with the dissonance that comes with moral injury is hard enough for the sufferer, but it is discouraging when we think about telling a trusted loved one with fear of being met with “well, why didn’t you just do this?” or “Oh, I would have handled that way differently” or “You could’ve just said no”. Sometimes we may be met with such responses; or, sometimes we may have unconditional love and nonjudgmental support. But we can’t know until we put ourselves out there as a first step in healing. Again, I acknowledge that this is far from easy.
Research also points to forgiveness and self compassion as means of coping and healing from moral injury. How is that done? Well, therapists can help you talk about the event(s) leading to your moral injury followed by discussion of negative beliefs you hold about yourself, others, and/or the world as a result. From there, your therapist can help you find ways to accept the reality of the occurrence and forgive yourself to release the hold of self hatred and condemnation. Your therapist can teach skills to reinforce self compassion, such as learning self empathy and acceptance to lift the burden as well. This work is nowhere near easy, but with time and dedication, the wounds of moral injury can be healed so that you can live your life again.
- Jackie Martinez, LMSW (NY), LCSW (NC)
So…taking the first step to engage in mental health therapy can be jarring enough, especially when experiencing suicidal thoughts. If you have already taken this step, you should be so proud of yourself because this is a difficult step to take!
Sometimes when we are seeking therapy, we have more on our minds than the day to day stressors and/or desire to vent to a neutral source. Sometimes, we are dealing with suicidal thinking, whether we realize it or not. And this can be quite frightening for some, while it feels fairly normal for others. So as a therapist, when I hear someone say something that may indicate suicidality, it is essential for me to take a closer look at what’s happening.
Also, side note…if anyone in your life makes what you feel may be a suicidal statement, please make sure that you are asking questions, supporting them, and/or getting them connected to the appropriate professionals. Whether it is yourself suffering with suicidal thinking or a loved one, it is best to call the suicide hotline at 988 (press 1 for veterans) and/or call 911 or get to your nearest emergency room in the event that you or a loved one feels unsafe regarding suicidal thinking. Click here for additional resources.
I want to clarify the different types of suicidal thoughts that can happen for people so we all have a better understanding of varied experiences with suicidal thinking.
First, there is passive suicidal thinking. This type of thought is passive in nature, hence the name. When people have thoughts like this, such statements and/or questions may run across their mind like, “Maybe it would be better for everyone if I weren’t here”; “I wish I were dead”, “I want to die”, “why am I here?” or “I wish I could go to sleep and not wake up”. When people are dealing with passive suicidal thoughts, this tends to mean that there is no plan or intent to harm or kill themselves in place. In therapy, if we as clinicians have determined that you are safe at the time that passive suicidality is discussed, then we discuss creating a safety plan together and talk about safety contacts (trusted people and/or emergency contact) in case one no longer feel safe and they feel they cannot safely utilize their safety plan.
A safety plan is a tool that is created in a therapy session with one’s therapist for the purpose of having it at their disposal when suicidal thoughts creep back up. A safety plan will prompt one to list out triggers that contribute to suicidal thinking, plan, and/or intent; ways one can remain safe independently (go on a walk, read a book, spend time with a pet); who the trusted people in their lives are and who can be called by client for distraction (not discussing the problem) or for help (discussing the problem); listing out places that bring one a sense of peace and/or distraction, where they can go when feeling upset and/or overwhelmed; listing out emergency contact in safety plan (who can a therapist call in the event thatthere are concerns for safety and client is not reachable); listing out Suicide Crisis Line Phone Number- 988 (press 1 for veterans); list out 911 on safety plan; and list out nearest emergency room closest to client’s home where they may go in the event of a suicidal crisis/emergency.
Another kind of suicidal thinking is referred to as active suicidal thinking. With this comes thoughts of not only wanting to die and/or “not be here” anymore, but this has escalated to the point of the sufferer wishing to take their own lives, having formulated a plan and/or has intent to harm or kill themselves. For example, someone may tell you that they are feeling depressed, worthless, and life is no longer worth living. They then go on to say that they are ready to exit this world and plan to jump off of a bridge that very night. When something like this is said, immediate action should be taken. By immediate action, I mean calling the Suicuide Crisis Line and/or 911 or bringing your loved one to the emergency room. There is no tip toeing around this. If someone with active suicidal thinking has a plan and/or intent to harm or kill themselves, they need immediate safety and stabilization. No ifs, ands, or buts about it. They may be upset with you for calling the crisis line, the police, and/or taking them to the emergency room, but this is for their own safety and well being.
Often times, those who survive suicide attempts are grateful they did and are more motivated to start a new chapter in their lives. Suicide is a permanent solution to a temporary problem. Suicidal thoughts are treatable! Therapy can help those who suffer with suicidal thinking to learn healthy coping skills,learn to reframe negative thinking and find news ways to navigate their lives in a way that feels worth while and meaningful.
If you tell your therapist that you are suicidal, much more questioning needs to occur first before anything else. So you may get a slew of questions that seem redundant, but they are necessary to have the best grasp on what your clinical and safety needs are at that time. Oftentimes, we as therapists are able to formulate safety plans together and check in on this together regularly. However, there are some times when we need to call 911 and/or get you to an emergency room. Sometimes, this may result in a psychiatric inpatient hospitalization in order to keep you safe and have another treatment team in the hospital evaluate your safety and needs. This is all done in the name of safety and genuine care for our clients. We’d rather you be upset with us and get help than not be here tomorrow.
The concept of psychiatric hospitalizations seems scary to some people, especially if you have never been hospitalized this way before. As someone who used to work in inpatient psychiatric hospitals, I can confidently confirm that the first goal at intake is discharge. Inpatient treatment teams seek to quickly stabilize and get patients out of the hospital safely with plans in place in the community to prevent future hospitalizations.
We as therapists are here to support you no matter what. We just ask because it can save a life. Please see our emergency resources page if you are struggling with suicidal thinking.
Doesn’t it drive you nuts when people tell you to “calm down” when you’re upset, anxious, panicked, or afraid? It drives me insane. I just think to myself, “Okay great…and how do I accomplish that without putting you through a wall?” Of course I don’t act on such thoughts! But I understand the frustration of feeling stuck in a dark, deep hole of anxiety while the bystanders at the top of the ditch are yelling down to me, “calm down!” or “it’ll be fine!” or “you’re overreacting!”. Which is why grounding techniques can be so beneficial when no one else can.
First, we should go over some basics of what anxiety and panic look like so we can better spot them before we feel completely unraveled in our experience with such symptoms.
First, quick side note/science lesson…our bodies yield both the Sympathetic and Parasympathetic nervous systems. Housed in the Sympathetic nervous system is our “fight or flight” that prepares us to respond to danger. While fight or flight has always been essential to survival, the body can’t always tell what is a genuine danger versus when we are just emotionally uncomfortable or going through something. The Parasympathetic nervous system helps our bodies restore back to a state of calm when fight or flight is no longer needed. This information is important because it plays a GIGANTIC ROLE in anxiety, panic, as well as other mental health struggles.
So when we have anxiety, there is constant worry that we can’t seem to shake most of the time in addition to maybe feeling restless, on edge, having a hard time focusing, feeling more irritable, physically tense, having a tough time sleeping and feeling easily fatigued quite a bit. I go through this myself and I can tell you firsthand that ignoring these symptoms will lead to feelings of anger and irritability, scatteredness, constant exhaustion, and like every little thing is an insurmountable task which will negatively affect your life across the board. Trust me, I know.
Panic is a bit different and more intense than your typical anxiety monster impeding on your day to day life. With panic, we actually feel like we’re having a heart attack or like we’re going to die! That’s right…there are instances when people have had to go to the Emergency Room because they thought they were having a medical emergency. Completely understandable given the symptoms of panic. If we look at symptoms of panic that include accelerated heart rate/palpitations, sweating, trembling/shaking, shortness of breath, feelings of choking, chest pain/tightness/discomfort, chills or heat sensations, numbness or tingling, feeling detached from ourselves or reality, fearing we are losing control, and fears of dying….it’s no wonder people may want to seek out a medical professional real quick.
While I have never experienced a panic attack myself…I am willing to bet that if I ever do, I’m getting my butt straight to the Emergency Room because as humans, what are we supposed to think when all of that is going on without any clear medical explanation? I highly encourage anyone experiencing such symptoms, especially if this has never happened before, to seek medical attention immediately and rule out medical concerns before chalking this all up to panic!
However, once we rule out medical concerns and have an understanding of panic symptoms, we can better manage them without seeking unnecessary medical attention or escalating our anxiety/panic due to fear of the unknown. It is essential to understand that panic attacks are just that, panic. They cannot physically harm you and they tend to last about 10 minutes (while I’m sure it feels like forever!). So, we have to remember that it will pass and getting comfortable with discomfort is one of the first steps to getting through panic attacks. I’m sure that’s obnoxious to hear, but it’s true.
Much of the time, what I’ve caught myself doing to alleviate my own generalized anxiety is to avoid, avoid, avoid. Whether it be avoiding a deadline or an uncomfortable conversation, dodging obligations/tasks all together feels good in the moment, for sure. While my education tells me that avoiding my anxiety like the plague only makes things worse, I admittedly engage in this behavior. And trust me, the education is correct…avoidance only feeds the anxiety monster that lurks beneath.
Well, a form of coping called grounding skills seems to help many, including myself, to feel more centered in the present moment and ultimately activate my parasympathetic nervous system (that’s what we want). With grounding, we are essentially turning our attention to the present moment so that we can ultimately feel more calm and address potentially anxious triggers.
In grounding, we use our five senses to return to the present moment when feeling overwhelmed and like everything is on top of us. Grounding equips us with several skills to utilize healthy detachment from emotional pain with use of distraction until we feel ready to return to any given problem. The following 5 skills that I will list below can be used any time, in any place, and can be completely discreet. There are many more ways of grounding that will not be covered here but I encourage you to explore ways of grounding with your therapist to find the right fit for you.
This skill invites us to observe 5 things we can see, 4 things we can feel, 3 things we can hear, 2 things we can smell, and 1 thing we can taste. For example, if I am feeling overwhelmed I will stop and look around me, engaging in this technique to focus on something aside from my stressor for a few minutes until I can collect myself and face my problems with my head screwed on right.
Here, we are encouraged to focus our attention on sensations in the body and feeling of calm after the exercise is over. Below, you will find an example cited from Therapistaid.com.
When having anxiety or panic, a way to cultivate acceptance of discomfort and better managing symptoms, we can be kind to ourselves. Does it seem ridiculous? Maybe… but it can work! Focusing on positive words you say to yourself over and over in the midst of anxiety or panic can help you remember that you are strong, resilient, and can overcome difficult things in this life. Some examples of what you might say to yourself would be, “This is uncomfortable but I can accept it”, “I will let my body do its thing and it will pass”, “I survived this before and can do it again”, “this isn’t dangerous”, “no need to push myself, I can take a small step forward as I choose”, “these are just thoughts, not reality”, or “don’t worry, be happy”.
I’m sure mostly everyone has heard of some form of deep breathing and I often hear clients tell me, “this doesn’t work for me”. Upon closer inspection, I find that people may try this once or twice, and when it's not instantly working, they chuck it out the window. However, this form of deep breathing should be given a fair shot! Let me explain a bit more about how to engage in this skill, then I’ll explain why I feel so strongly that deep breathing really needs to be given a chance.
So, how do we do this one? We put one hand on our chest and the other on our belly. Then, we inhale slowly through our nose, hold briefly, and exhale through our mouth. Some follow a formula of 4-6-4; ie. inhale 4 seconds, hold 6 seconds, exhale 4 seconds). Adjust to your comfort level. Make sure that upon breathing in, your belly is expanding out. Notice how your belly expands and falls with each breath. It is recommended to engage in this skill for at least 2-5 minutes daily.
The reason deep breathing works is because it levels out the oxygen and carbon dioxide in your blood. When you have anxious breathing, your oxygen and carbon dioxide levels are uneven, leading to the physical manifestation of anxiety that we talked about earlier. So to help activate the parasympathetic nervous system (the one we want) and ease the physical parts of anxiety, diaphragmatic breathing is a great one to try. Let me know how it goes!
It has been found that in anxiety as well as trauma, the sense of smell is largely connected to the emotional part of our brains. If you think about it, maybe something that smells oddly familiar to you but you can’t put your finger on it brings a sense of comfort and calm. I know for me, whenever I smell anything that resembles Thanksgiving dinner, I have a sense of ease thinking back to fun childhood memories, enjoying my grandmother’s cooking for Thanksgiving dinner. Her food is always on point!
So when we are feeling anxious and/or triggered in any way, we can use sense of smell to quickly return to the present moment. Ideas that some of my clients have found helpful over time is to keep a perfume and/or cologne soaked handkerchief on them, an essential oil bottle on them, or maybe a favorite kitchen spice. Candles and/or wax warmers at home can also bring a sense of peace and calm using pleasant scents.
While anxiety can sometimes make us feel like we’re in a moving car with no driver, there are ways we can safely get back into the driver’s seat and navigate our symptoms safely, securely, and happily. Your therapist can help you navigate these tools and find out what may be the best suited for you and your needs. Anxiety will not get the best of us!
For some people dealing with the death, illness, or absence of a *significant person, the holidays can be a time of mixed emotions like sadness, guilt, grief, as well as hopelessness. On one hand, we are expected to be festive and merry; on the other, we are reminded that person is no longer here or in the capacity they once were. It can be exhaustive to cope or grieve. Unlike an anniversary or birthday, where the day itself can be dreadful but otherwise there are limited triggers about it, the holiday season is different. The sights, sounds, activities, and gatherings go on for weeks.
Note: I use the term “significant person” rather than “loved one” in recognition that grief is complex. Not all people had loving, supportive relationships with the person who died, but regardless that relationship was still of profound importance. “Significant person” is thus an inclusive term.
Unquestionably, some holidays during other times of the year can be bittersweet, such as Mother’s Day or Easter. Yet as a culture, the holiday season seems to be the most profound in its importance for its emphasis on family gatherings. Thus, it is not surprising that for many people Thanksgiving through New Year’s Day can be especially hard.
A long time ago, I was close to someone who detested Christmas. He was a classic Grinch. From around September and onward, he would be triggered by reminders. It could not be avoided – every store was already getting decked out with Christmas decorations and toys to sell. By the end of October or perhaps early November, Mariah Carey was already bleating over the speakers at every store. This despair from September through January went on for years, with me making every effort to try to make the months more tolerable for him. Eventually, though, I realized he was too caught up in his grief. I told him that he has no control over the holiday season; that he must radically accept it will come every year no matter what, and that the more he fought against it the more it would breed misery for him. I encouraged him to instead honor his losses, truly grieve, but to still try to enjoy other aspects of the season. He insisted he wanted to avoid it. I asked him to consider, “how exactly would you avoid Christmas?” and he said he would lock himself in his room. My response: “Which would mean you would need to sleep for months. You wouldn’t be able to turn on the TV, go on the internet, listen to the radio, really… anything. Because the point is that no matter how much you try to ignore Christmas, it will come anyway.” I don’t know why, but somehow that dry, matter-of-fact response got him to begin thinking differently – he finally stopped fighting the “hatred” which in truth was grief. He was avoiding his grief.
While by no means a complete list, the following are tips you may use to help you get through the holiday season if caught in grief.
Yeah, I know. I just got done writing about that person where I gave him the exact opposite advice. Hear me out.
The holidays are stressful enough. Compounded with grief, they can feel downright unbearable. The traditions, shopping, cooking, family, parties… all of it can feel tiring even when thinking about it. I want you to know it is okay to skip the holiday season. You may face backlash for saying no to Thanksgiving dinner, but your self-care comes first.
Remember these points before canceling your holiday season:
1) The holidays will come again. This year you may not have the energy to deal with the holidays, but next year may be different. At that time, you may feel ready to engage again. Do not think you have to be in a rut each year. That is unfair to you.
2) Ask yourself, “am I skipping the holidays to help myself or just to avoid the pain?”. If you need to, take your pen to paper to come to this answer. You may truly want to skip the holidays, or maybe you are feeling pressured by others (family, society, etc.) to celebrate.
Additionally, ask yourself if you are prioritizing your self-care versus having avoidance. In psychology, avoidance coping is a maladaptive coping mechanism (in other words, an unbeneficial or unhelpful technique) that means to avoid processing the thoughts, feelings, and stressors associated with an issue. In grief, this can mean you are refusing to process the loss of the significant person, procrastinating things that need to be done that remind you of the person, or being in denial of emotions you are feeling. While this seems helpful in the present moment, it only intensifies the anxiety. It festers like an untreated wound.
3) Decide what you will do for the holidays, rather than only what you will not do. Remember that if you say no to going to dinner at Uncle Joe’s house, ultimately the rest of the family will be there. Then what? What is your plan? Before that day springs up on you, plan accordingly. If your idea of self-care is to binge-watch Cobra Kai in your bedroom on Thanksgiving, do so! But do not wait until the holiday arrives to try to plan as that may increase your negative emotions; you may make yourself feel unintentionally worse.
4) You may have regret or sadness if you skipped the holiday. On that day, you may go on social media only to notice the get-together at Uncle Joe’s house looked fun. Maybe there is a funny video of your younger cousin making a snide comment on TikTok. Maybe your sister posted a Facebook video of your three-year-old nephew unwrapping presents with a big smile. Ask yourself if it is worth you skipping the holiday or instead if you may find happiness in being with others.
Did you watch A Muppet Family Christmas special when you were younger? If so, remember when Fozzie Bear and his friends drove to Fozzie’s mother’s house with the intention of spending Christmas with her, only to find out she rented out the home to a man and his dog who wanted to avoid everyone for Christmas while she ran off to Malibu? Although the man was upset at first that his holiday did not go as planned, he ended up having an even better time because he allowed himself to join in the festivities.
5) Or you may have an even better day if you put yourself first! In that same special, Fozzie Bear’s mother was having the time of her life on the beach in Malibu.
It is tempting to see other individuals or families enjoying festivities and comparing their experiences to your grief. You may feel worse, like you “should” feel merry.
It is important to remember that even under the best of circumstances, the holidays are stressful for most people and families. The sappy, magical events shown on television and captured in greeting cards are rarely the reality. For instance, you do not know if the hostess of the dinner was in a vicious argument with her spouse only minutes before the guests arrived, only to hide it all behind a beaming smile. You do not know if the parents are struggling to buy presents for their children. Instead, think about what you do have – you may feel more gracious!
If you have the time, consider volunteering your time to someone who needs the extra support (Long Island Volunteer Opportunities). This could be spending the holidays at a hospice, nursing home, hospital, soup kitchen, or shelter. Your love and support toward a stranger may make their holiday memorable and bright, while benefiting your own mental health by taking your focus off the grief. Volunteering is very helpful in the healing process of grief!
Alternatively, reach out to a family member or friend who may need some help right now.
In my work as a grief therapist and as someone who has experienced significant losses, I have noticed the phenomenon of anticipation being worse than the holiday itself. My hypothesis is that by experiencing the surge of emotions beforehand, we are thereby allowing ourselves to think the day itself will be awful, which will make us feel better when that day arrives, and we find we are okay. In essence, it is making us “cope ahead” by going through the storm beforehand.
You may reach out to friends and family for emotional support with your grief, but are worried about doing so because they may be preoccupied with the holiday season. Consider joining a grief support group.
Your emotions are valid. Do not think you must feel happy because it is the holidays or otherwise there is something “wrong” with you. If you feel angry, let yourself vent. If you feel sadness, allow the tears to flow. If you feel lonely, reach out to a friend.
We as a culture tend to be cautious of asking those who are grieving if they need help. We may assume it would be an unwanted reminder or we simply do not know what to say. Other times we may think that the bereaved are doing okay.
Please speak up if you need help from a friend, neighbor, or family member. Perhaps that entrusting someone else to make a particular favorite dish, cleaning up the house, or getting some other tasks done. People tend to feel satisfaction when they know they are caring for someone they love.
Are you looking for more ideas for coping through the holiday season? If so, go here.
After a long day, rushing to get your work done, put dinner on the table, and solve the crises everyone runs to you for, you finally get a moment of peace while laying down to sleep. Unfortunately, for many of us, this time can be full of distressing thoughts including memories of the past, fears for the future, and analysis of ourselves. Some even find themselves unable to fall asleep due to these ruminations, making their next day even more tiresome.
Our nighttime thoughts are often a reflection of our daily lives. To a degree, thinking at night is our mind’s attempt to reflect, adapt, and prepare for challenges to come. What this means is that if our days are full of stress then our minds will try to anticipate future stress and prepare us for that stress in our only moment of respite.
Some people find that giving themselves a time, during their waking hours, to feel their stresses and accept them, have less of a tendency to think of these thoughts later on. This can be a difficult task to do, but a number of clinicians at Long Island EMDR can be there to help you get started. Learn about them here.
People who suffer from overwhelming life stress, anxiety, depression, and associated insomnia will often say that their unwanted thoughts make it harder for them to get to sleep each night. This insomnia can lead to decreased work or academic performance, depleted mood, low energy and fatigue, or many other functional impacts.
As silly as it may seem: count sheep. More specifically, there is research that suggests repeating a word or phrase at specific rates (usually 3-4 repetitions a second) can impact our brain’s ability to think of other thoughts. This is called articulatory suppression. This phrase should be neutral so that it doesn’t trigger thoughts of other things to come to mind. Some people find syllables or articles (“the”, “an,” or “a”) as helpful choices.
Others find imagery to be exceptionally helpful in maintaining sleep and getting to sleep. Try this exercise: in your mind, craft a story around yourself doing something that you enjoy most. Do your best to picture the details: sights, sounds, smells, or tastes. By practicing this imagery, you are training your brain to use your imagination to distract yourself from your thoughts. If those intrusive thoughts come to mind, accept that they are there, and push them aside as you author your tale.
Remember, this is a learned skill. It may not come naturally and it may not work the first few tries.
Other things that you may be able to do to focus on your sleep include:
Our brains are very much like a river: the water represents our thoughts and the land represents our mind. If we can place ourselves firmly in the river, and not get carried away with the current, then we can improve our wellbeing. For some, the current, or our intrusive overthinking, will carry us into anxiety, depression, and other negative mental places. So, we look to take some control back and stand up.
Some brief activities can help us to control our thoughts and thus improve our nighttime routines.
Everyone ruminates. Whether it’s thinking about something we said to someone, something we did wrong, or some recent event that is stuck in our mind. Ruminating thoughts can be defined as repetitive and recurrent, negative, thinking about past experiences and emotions (Michael, et al., 2007). However, while everyone experiences ruminating thoughts at some point in their life, for some, rumination can be distressing, difficult to stop, and can lead to dysfunction in their day-to-day lives.
When we think about ruminating, it’s important to acknowledge that it often comes from an effort to cope with distress. For instance, analyzing an experience can better prepare us to encounter a similar experience in the future. Or it can help us mend some relationships that were negatively impacted by an event in the past. But, when these thoughts aren’t leading to any productive change we can see individuals obsess over these thoughts, become anxious and depressed, isolate, or begin using / increasing their use of mind-altering substances.
Ruminating thoughts can be very diverse. For some, they may ruminate about their hands being dirty and that they may get sick. Others may ruminate about suicidal thoughts, including existential themes about the meaning of life. Some may continually think about a traumatic experience, like an assault or some form of abuse. As well, some of these ruminating thoughts may be untrue distortions of events. For example, repeatedly thinking about being sexually assaulted may come with false thoughts that the victim somehow provoked their assailant or deserved to be assaulted.
Our experiences mold our self-esteem, or the way we perceive our behaviors, abilities and traits. A traumatic experience can leave individuals with warped perceptions of themselves that can have a detrimental effect on their day-to-day lives. Especially the formation of a negative self-esteem, or negative self-concept, is associated with feeling disempowered, hopeless, and helpless. Ruminating on these experiences, or even these self-beliefs, has been shown to exacerbate and prolong negative moods, and hinder social interaction and problem-solving skills (Wang, et. al, 2018).
Ruminating thoughts can be associated with a number of mental health diagnoses, including:
● Depression
● General and social anxiety
● Substance abuse disorder
● Bulimia
● Binge eating disorder
● Obsessive-compulsive disorder
● Post-traumatic stress disorder
● Personality disorders, like borderline personality disorder
Ruminating thoughts are treatable and manageable. Treatment often aims to interrupt the thought processes and improve coping skills to replace rumination. Some individuals find relief from medication management, cognitive-behavioral therapies, and mindfulness techniques.
If you experience ruminating thoughts and are looking for a way to move forward, please call our office and schedule an appointment. Our licensed clinicians and therapists on staff would be more than happy to work with you.
-Nicholas Costa, SFT Social Work Intern
When we experience trauma, our brains don’t function like they normally do. We go into survival mode: think fight, flight, or freeze. Our brains automatically direct all of our energy toward dealing with this immediate threat until it’s gone. In most situations, this feeling of being in danger fades over time. Maybe it takes a few hours or a few days but you eventually start to feel better and less on edge.
But sometimes that initial trauma sticks, and you just can’t seem to shake the feeling that you’re still in survival mode. Trauma can change the way we think, act, and feel for a long time after the initial event occurred. Things like flashbacks or nightmares, constantly feeling on edge, anger, intrusive thoughts, and self-destructive behaviors are all very normal responses to trauma. You might feel as if you’re stuck living with these symptoms for the rest of your life, but the good news is these patterns can actually be reversed. With the right approach and knowledge, you can shift your brain towards overcoming past trauma and begin your healing journey.
Trauma’s impact on the brain is complex. Let’s talk science for a minute to review some parts of the brain. Trust me, I’m not a fan of science either. But I promise this is helpful to know in terms of healing, so stick with me.
To simplify things, let’s break it down into two parts: the subconscious system vs. the conscious system. Do those terms sound familiar? Your subconscious mind is responsible for any involuntary actions, and your conscious mind is responsible for rationalizing and logical thinking.
Okay, let’s take this one step further. The subconscious part of your brain involves the Limbic System (think automatic) and the conscious part of your brain involves the Frontal Lobe (think choice). Both of these systems work together to help you survive and stay safe. If you’re in trouble, the frontal lobe says, ‘yes, this is dangerous’ and allows the limbic system to react in either a fight, flight or freeze response. On the other hand, if your frontal lobe realizes you are not in any danger, it works to calm down the limbic system’s reaction.
You might be asking why this is relevant. Well, here’s why. Trauma can disrupt the ability of your limbic system and frontal lobe to work together, and this causes you to either go numb or into overdrive.
When we talk about feeling ‘triggered’ in terms of trauma, we are referring to the subconscious response. The limbic system becomes extra sensitive to our triggers (sights, sounds, smells, feelings, etc.). And even though you aren’t in any current danger, the limbic system overreacts and overwhelms the frontal lobe by triggering survival mode. As a result, your frontal lobe either undercompensates or overcompensates (cue feelings of numbness or going into overdrive). You do not know how to move forward and stay safe at the same time.
There are many different ways these two parts of the brain work together when we talk about trauma and healing. Everyone’s experience is different, but many of the changes we see in the brain are similar. Here’s one common example.
Jane is out shopping and passes someone in the store who is wearing cologne. The smell of that cologne reminds her limbic system of her past trauma, and the limbic system now believes Jane is in danger. Jane feels her heart race, her mind starts spinning, and she feels like she wants to run away to be anywhere but here.
This is a completely normal reaction for Jane’s body and brain to have to a potential threat, even though she wasn’t in any danger. It’s an automatic reaction. And that’s not necessarily a bad thing. In the past, the smell of cologne was associated with a threat, so the brain triggered a response thinking it had to do something to keep Jane safe. If you think about it, your brain is doing exactly what it should be doing. It’s just still thinking the smell of that cologne means danger, even though Jane knows otherwise.
You might be thinking, ‘great, so I’m stuck like this?” In short, no you’re not! It is possible to help your frontal lobe and limbic system heal and work together more efficiently.
You may have heard the term neuroplasticity before. This simply means our brains are able to modify, adapt, and change throughout life. Some things changed in your brain when you experienced trauma, and we can appreciate that as it was necessary for survival at the time. But now that that experience is behind you, you probably want to leave it there and stop feeling such strong emotions at simple reminders. And I don’t blame you! The good news is, that is very possible. Maybe your triggers are similar to Jane’s triggers, or maybe it’s completely different for you. Either way, it is possible to rewire and retrain your brain again.
So, where do you begin? For starters, it’s always a good idea to process any past trauma in therapy. If you haven’t already, find yourself a trusted therapist to support you through your healing journey.
The next step here is really going to be identifying where you’re having difficulty. Is it similar to Jane’s experience where you see or smell something that triggers you? Or maybe your past experiences are affecting your ability to focus, make decisions, and resist impulses. These are all things that can be worked on and improved with practice.
During the healing process, your brain can create new pathways, increase function in some areas (like your frontal lobe!!) and strengthen connections. There are many different ways you can work on improving brain function. I’m sure you’ve heard of ‘brain games’ before, right? They’re basically games that stimulate your mind and help you practice certain cognitive functions like memory, problem solving, or critical thinking.
There are similar exercises you can do on a daily basis that will be ‘training’ one or more parts of your brain. Here’s one example. We’ll call this exercise ‘Planning Ahead’.
Is there something you want or need to get done this week? Picking a day or time to sit down and accomplish that task can help to actually push yourself to do it, but it’s also a really simple exercise for your brain. When you write down even one reminder of what you want to focus on, you’re strengthening the connection between your limbic system and frontal lobe.
You can practice this by using the calendar or reminder app in your phone, or print out a good old-fashioned calendar from google. Maybe start by penciling in any appointments you have, and scheduling some of your household chores around them. Or maybe you want to schedule some time to sit down and read a book. Whatever it is, make a plan to do it, and follow through with that plan.
When you make conscious choices by planning, tracking, and following through, you’re strengthening your frontal lobe. This added strength builds new connections in your brain and creates positive experiences for you to look back on and feel proud of.
With time and practice, these connections will get stronger and you’ll continue to feel empowered to act on your plans and dreams. And if those plans and dreams include overcoming your past trauma, you’ll feel empowered to take continued steps towards healing.
If you’re interested in learning more about how to reverse the impacts of trauma, I’m facilitating a group called Finding Hope for women survivors of childhood sexual abuse this fall. Visit our website or call (631) 503-1539 for more information!
