Eating Disorders Awareness Month

In Many Minneapolis Schools, the Therapist is Just Right Down the Hall

When Cathy Moen’s son, Elijah, was in first grade, he was diagnosed with attention deficit hyperactivity disorder. She took him to the pediatrician, who put him on medication and suggested therapy.

The medication part was easy. But getting him therapy proved more difficult — not because Moen couldn’t find a therapist or didn’t have insurance, but because of logistics.

The appointments were always during the day, and between her work schedule and the traffic, it was nearly impossible for them to make it.

But she soon learned Elijah was able to see a therapist in his Bloomington school. More than 15 years ago, Minneapolis Public Schools helped pioneer a national model of bringing community mental health care directly to its students. Today, most of the public schools in Minneapolis — more than 50 of them — have a therapist on site, and many other districts, like Elijah’s, have followed suit.

These days, Elijah’s therapist simply walks down the hall and pulls him from class.

“This is like a godsend,” said Moen.

The family’s health insurance pays for the care the same way it would if the student were being seen in the clinic. The school program was designed so that no student in need will be turned away for lack of insurance.

The Minneapolis program has also provided a road map for schools across the country as more administrators realize that mental health is as important to students’ future success as academics. Studies have shown that students are more likely to show up for appointments when the therapists are on-site.

More and more states are making mental health care in schools a priority. At least two states have recently passed laws that require schools to teach mental health. And more are considering it.

But the benefit of having a therapist on-site goes beyond just getting students to see a therapist. In Minneapolis, it’s also helped make mental health a school-wide priority — and helped get counselors, teachers and others more involved, said Mark Sander, who helped start the district program.

A man wearing a button down shirt.
Mark Sander is the director of school mental health at Hennepin County and Minneapolis Public Schools.
Christine T. Nguyen | MPR News

“Those teachers start learning more and more [about mental health],” said Sander, who directs school mental health for the district and the county.

He said as they learn more about mental health, teachers are feeling like, “‘OK, I get it. And now, you know, I’ve got this other student who’s not diagnosed with anxiety but has some of those anxiety features. And now I know how to better support them.”

At South High School in Minneapolis, the therapists sit in the school clinic, the same one where students go if they feel sick during the day or to get a physical so they can play sports.

The issues the students bring to the therapist run the gamut from stress about grades and colleges to anxiety related to a bad situation at home.

Farah Hussein is a therapist at South. She said it’s hard being a teenager, and she tries to help.

“There’s a lot of conversations about, ‘Who am I? Where do I fit in the world? Where do I belong?’ and just a lot of distress in exploring that,” she said.

All of this has important implications for the students’ well-being beyond just their mental health.

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A group of people sit around a conference table in a school.
Collaborative mental health meetings at South include the school’s social workers, counselors, nurses, psychologists, school-based clinic therapists and occasionally administrators.
Christine T. Nguyen | MPR News
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A sign reads "Mental Health" on a wooden shelf with books.

 

Sharon Hoover, who co-directs the National Center for School Mental Health at the University of Maryland School of Medicine, said more schools are collecting data on outcomes of in-school mental health programs, and the results are clear.

“They are more likely to have good attendance and to graduate and to get improved grades. We even have documentation of having better standardized test scores when you put universal systems in place like classroom-wide social emotional learning,” she said, all of which makes for happier, better adjusted students.

Cathy Moen, the mother whose son, Elijah, is in therapy in school, said she doesn’t know if it’s the medicine, or the therapy, or just that he’s growing up, but she — and his teachers — are already seeing a difference.

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Don’t let tech safety slip

The group of parents now raising tweens is the last to grow up — basically — without the Internet.

The good news is that, having received our first email addresses on dinosaur systems as college students, we DO know how the web works.

We all have Facebook (well almost all of us), plus most of its cousins. We’re hooked on getting answers to questions instantly as well as the ease of texting versus calling or — oh, please — talking face to face.

We know, too, of the web’s dark corners — limitless pornography, angry gamers, false information, lurkers and trolls.

This puts today’s parents in a crazy sort of limbo: I get it, I use it, I’m scared to death of it when it comes to my kids.

There’s also inappropriate content, predators, cyberbullying and technology addiction. And that’s not to mention the risk of growing up without knowing how to communicate verbally and always needing to know an answer or order that product — instantly, now, yesterday, if possible.

What’s a parent to do?

While you can and should limit use of the Internet in a way that’s age-appropriate and encourages other activities — such as participating in sports, reading books and playing outside — you can’t keep your child from going online forever.

In fact, complete avoidance could do more harm than good.

“Parents shouldn’t focus on instilling fear of the Internet in the child. Instead, start a conversation about technology and the Internet in today’s world,” said Karina Hedinger, a training and education coordinator for the Minnesota Crimes Against Children Task Force, a group led by the Minnesota Bureau of Criminal Apprehension.

Much like your family rules for exploring the neighborhood, true online safety comes from preparation and communication. (Check out the AAP’s new screen-time recommendations in this article’s sidebar.)

Tips for parents

Don’t freak out. Teaching your kids to fear the Internet isn’t going to keep them safe.

Do talk. Discuss the proper use of websites and what behaviors are inappropriate. Discuss the dangers in a non-threatening way.

Ask. Get your kids talking, too, so you’re not just in boring lecture mode. What do you most like to do online? What if someone online asked you to meet?

Befriend! Sure, you can have a Facebook or Instagram account … if you make me your first friend.

Be a watchdog. “Monitor, monitor, monitor. Monitor what your children are doing on all technology. Have daily conversations about being safe and keeping information safe,” Hedinger said. Be aware that you can set up “restrictions” on various devices (under Settings) to block or allow specific websites or types of content. You can also set blanket permissions based on age ranges. Also know that the top three internet browsers — Mozilla Firefox, Google Chrome and Apple Safari — offer settings and add-ons to help make your kids’ online experience’ more age-appropriate. There are even kid-safe browsers for a variety of age ranges. (See Page 33 to learn more.)

Limit locations. Keep the family computer in a communal space in the home. Insist that all phones go to charge or “rest” in a designated location at a certain time each night (not your kid’s bedroom).

Get an all-access pass. Though most parents wouldn’t read a child’s diary (at least not without cause for concern), many parents today reserve the right to read their kids’ phones each night after they’re placed in a designated “rest” location. Why? A diary is private by nature, and one might argue that everyone is entitled to his or her own private thoughts. But when it comes to living life on Instagram — where children can easily “go public” with things that perhaps should be private — the rules are bit different. Phone reading not only keeps parents involved, but it also helps kids practice better behavior (or self-censoring) if they know Mom or Dad might take a peek.

Research and explore. The list of apps you should know (and perhaps even know how to use) is honestly too long to name and goes beyond what you might think (SnapChat, Tinder, Musical.ly, Kik and the like). Did you know there are actually apps to hide apps? Yep. And there’s also a whole language developed to keep parents clueless. Deep breath. It’s going to be OK. But do study up! Talk to other parents as often as you can (ideally with kids a bit older than yours) and make friends with commonsensemedia.org, an indispensable website and app for evaluating all media.

Think beyond your home. Which friends have smartphones? Which friends use SnapChat? Would your child’s friends be willing to create an account in your child’s name to get around your rules? What are the rules at the neighbors’ house, where your kid spends half his time?

Make your expectations clear. Setting up formal house rules can help you stand firm in your decisions around digital media. Check out the new, free Family Media Plan tool from the American Academy of Pediatrics — at healthychildren.org — for help creating written guidelines for your entire family. If your child is receiving a smartphone this year for the holidays, you might want to customize one of the many mobile phone contracts online such as those at connectsafely.org and joshshipp.com as well as Gregory’s iPhone Contract written by author Janell Burley Hofmann for her 13-year-old son. Hofmann is the author of iRules: What Every Tech-Healthy Family Needs to Know About Selfies, Sexting, Gaming and Growing Up (janellburleyhofmann.com).

Tips for teens and tweens

Be discrete. The saying goes, “If you would feel uncomfortable with something plastered on a billboard, don’t share it on the Internet.” Personal information should never be shared in public forums. Turn off location services for most apps, and set them to “On While App is Running” for things that make sense, like navigation programs.

Be private. Gaining scores of fans and followers might feel like popularity — but it’s really just broadcasting a bunch of stuff that could embarrass you someday. Would you invite your whole block over to watch you lip sync in your pajamas? If the answer is “no,” reevaluate your public social media “brand.”

Know real people. You should be friends with someone in real life before being friends online. And you should spend screen-free time with your real-life friends.

Trust your gut. If something feels scary, weird or inappropriate, it probably is. If you feel tempted to hide something on a technological device from your parents, you probably shouldn’t.

Tell. If you see something inappropriate, violent, suspicious or mean online, talk to your parents or another adult you trust.

Be skeptical. It might be normal for an adult to mentor a child or teen, but it’s never normal for an adult to seek a relationship as a peer or romantic partner with a child or teen. Also note that online, a person can say they’re anyone or anything. An adult can easily claim to be 15.

Shut it down. In cases of cyberbullying, be a heroic bystander and report bad behavior when you see it. If you’re the victim of cyberbullying, shut down your device, walk away and talk face to face with someone who cares about you.

 

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7 Ways to Help an Angry Child

It’s tough to know how to help an angry child. But some children—despite their small size—seem to have an endless supply of anger buried inside them.

They grow frustrated easily. They yell. They might even become aggressive. But, they usually blow up over seemingly minor events.

If you’re raising a child whose angry outbursts have become a problem, it’s important to teach him the skills he needs to deal with his feelings in a healthy way. Here are seven ways to help with anger:

1. Teach Your Child About Feelings

Kids are more likely to lash out when they don’t understand their feelings or they’re not able to verbalize them. A child who can’t say, “I’m mad,” may try to show you he’s angry by lashing out. Or a child who isn’t able to explain that he’s sad may misbehave to get your attention.

Help your child learn to identify and label feelings.

Begin teaching your child basic feeling words such as mad, sad, happy, and scared. Label your child’s feelings for him by saying, “It looks like you feel really angry right now.” Over time, he’ll learn to label his emotions himself.

As your child develops a better understanding of his emotions and how to describe them, teach him more sophisticated words such as frustrated, disappointed, worried, and lonely.

2. Create an Anger Thermometer

Anger thermometers are tools that help kids recognize the warning signs that their anger is rising. Draw a large thermometer on a piece of paper. Start at the bottom with a 0 and fill in the numbers up until 10, which should land at the top of the thermometer.

Explain that zero means “no anger at all.” A 5 means “a medium amount of anger,” and 10 means “the most anger ever.”

Talk about what happens to your child’s body at each number on the thermometer. Your child might say he’s smiling when he’s at a level 0 but has a mad face when he reaches level 5 and by the time his anger gets to a level 10, he may describe himself as an angry monster.

Talk about how his body feels when he grows angry. He might feel his face get hot when he’s a level two and he might make fists with his hands when he’s a level seven.

When kids learn to recognize their warning signs, it will help them understand the need to take a break, before their anger explodes at a level 10. Hang the anger thermometer in a prominent location and refer to it by asking, “What level is your anger today?”

3. Develop a Plan to Help Your Child Calm Down

Teach children what to do when they begin to feel angry. Rather than throw blocks when they’re frustrated or hit their sister when they’re annoyed, teach them healthier strategies that help with anger.

Encourage children to put themselves in a time-out when they’re upset. Show them that they don’t need to wait until they make a mistake to go to time-out.

Instead, they can go to their room for a few minutes to calm down when they begin to feel angry.

Encourage them to color, read a book, or engage in another calming activity until they’re calm enough to resume their activity.

You might even create a calm down kit. A kit could include your child’s favorite coloring books and some crayons, a fun book to read, stickers, a favorite toy, or lotion that smells good.

When they’re upset, you can say, “Go get your calm down kit,” and encourage them to take responsibility for calming themselves down.

4. Teach Specific Anger Management Techniques

One of the best ways to help an angry child is to teach specific anger management techniques. Taking deep breaths, for example, can calm your child’s mind and his body when he’s upset. Going for a quick walk, counting to 10, or repeating a helpful phrase might also help.

Teach a variety of other skills, such as impulse control skills and self-discipline. Angry kids need a fair amount of coaching to help them practice those skills when they’re upset.

5. Make Sure Angry Outbursts Aren’t Effective

Sometimes kids exhibit angry outbursts because it’s an effective way to get their needs met. If a child throws a temper tantrum and his parents give him a toy to keep him quiet, he’ll learn that temper tantrums are effective.

Don’t give in to your child to avoid a meltdown. Although that may be easier in the short-term, in the long run giving in will only make behavior problems and aggression worse.

6. Follow Through With Consequences When Necessary

Consistent discipline is necessary to help your child learn that aggression or disrespectful behavior isn’t acceptable. If your child breaks the rules, follow through with a consequence each time.

Time-out or taking away privileges can be effective discipline strategies. If your child breaks something when he’s angry, make him help repair it or make him do chores to help raise money for repairs. Don’t allow him to have his privileges back until he’s repaired the damage.

7. Avoid Violent Media

If your child struggles with aggressive behavior, exposing him to violent TV shows or video games isn’t going to be helpful. Prevent him from witnessing violence and instead, focus on exposing him to books, games, and shows that model healthy conflict resolution skills.

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How to Address Your Teen’s Issues with Poor Motivation

Getting your teen to improve his or her focus.

“If the eye is patient enough, it will get a clear view of the nose.” – Anonymous

When people think about issues related to poor concentration, they immediately think about distractions. This is even more the case when it concerns teens. Things that come to the mind of the casual observer, are smart phones, social media and troubled peers.

A quick Google search for how to improve your teen’s lack of focus, will bring up issues like attention deficit hyperactivity disorder (ADHD/ADD), depressionnutrition and strategies for developing a more efficient schedule. These topics and recommended strategies are appropriate and effective for helping your teen improve his or her issues with focus, but they cannot be effectively applied until one important issue is addressed.

Motivation.

That’s right. The primary reason young people struggle with poor focus and concentration is a general lack of motivation to do anything meaningful. The teen who lacks motivation will often gravitate towards activities which greatly stimulate neuro-chemicals associated with the brain’s reward system.

Activities such as video games, food, mind altering substances, alcohol and sex. These are things bored teens are likely to engage in habitually, in order to feel alive. This is because, in the absence of motivation to succeed, the teen is faced with a difficult reality consisting of a monotonous chore and a daily schedule. Even things like daily showers can seem time consuming and tiring to a teen who struggles with low motivation. It is also important to note that these issues are also symptoms of depression with a teen.

Before we begin processing on how to get teens more motivated, it is important to come to an understanding on what motivation is. According to Wikipedia, the term motivation is derived from motive. Motive means a need that desires satisfaction. So, for a teen to be motivated, he or she must be actively pursuing a need which desires satisfaction.

Saul McLeod/Simple Psychology
Maslow’s Hierarchy of Needs Chart
Source: Saul McLeod/Simple Psychology

Maslow’s Hierarchy of Needs.

Typically, we understand needs to be intrinsic materials necessary to keep us alive, such as food, water and shelter. However, an expanded discussion on the issue of needs would be based on the famous work of Abraham Maslow, regarding his hierarchy of emotional needs.

According to Dr. Maslow’s theory, there are two types of needs people strive for. They are deficiency needs and growth needs. Deficiency needs are comprised of basic needs and psychological needs. These are physiological needs, which have to do with food, water and shelter. Followed by the need for safety and security. The physiological needs and the safety needs are known as basic needs.

Next are the psychological needs, which have to do with the needs for a sense of belonging and feeling accepted. This is also followed by the need for esteem, which has to do with prestige and status in society. According to Dr. Maslow, people are only motivated to get these needs met, when these needs are deficient in their lives. Once these needs are met, people are no longer motivated in getting them met, which opens the door for addressing growth needs.

Then there are the self-fulfillment needs, which Dr. Maslow describes as self-actualization coming from having achieved one’s full potential. He also describes this as growth needs. Unlike deficiency needs, people become more motivated as their growth needs are met.

So, a teen who practices the courage to do his best in understanding calculus, becomes more motivated the more he succeeds and subsequently more focused. Further, teens who are experiencing success in achieving their potential, are also very disciplined in their home life. For example, they are disciplined in following through consistently with their assigned chores and personal hygiene.

It has been theorized that teens who struggle with depression, have experienced very little success in effectively getting their psychological needs met. This topic will be addressed in another post.

Often Motivated.

Upon examining Maslow’s hierarchy of needs, it is easy to conclude that most teens don’t have low motivation. Rather, most teens are preoccupied to getting their deficiency needs (acceptance and recognition) met, rather than their growth needs (success in academia) met.

Such a phenomenon is easy to witness with teens from low socio-economic backgrounds, such as an obsession in getting their physiological and safety needs met. However, with teens from middle class backgrounds and up, their focus is often on their psychological needs. For example, relationship with friends, close friendships and status among peers.

When teens are focused on getting their deficiency needs met, they are not going to be focused on issues regarding self-discipline and mastery. For a parent to help his or her teen become more focused on growth needs, he or she will have to teach his or her teen how to effectively get their deficiency needs met.

Conflict of Beliefs and Values.

This may be easier said than done, as today’s teenager is often exposed to new values and beliefs through social media. Meaning, that these values and beliefs are often in conflict with the teaching of the parents.

So, efforts to help the teen address his or her deficiency needs may result in a stalemate between parent and teen. Which then leads to a recurring problem with a lack of focus due to poor motivation with issues like school work, personal hygiene and chores.

The solution for a situation like this will be for parents to seek therapeutic services to assist their teen in effectively getting their deficiency needs met, in order to focus on his or her growth needs.

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The Burnout We Can’t Talk About: Parent Burnout

New research demonstrates parental burnout has serious consequences.

Parents Admitting to Burnout: That’s New

New research published in Clinical Psychological Science suggests that parental burnout can have serious consequences. In two longitudinal studies, 918 and 822 participants were analyzed, respectively. The studies involved the completion of three online surveys per year.

Results indicated that parental burnout has much more severe implications than were previously thought. Burnout was associated with escape ideation—the fantasy of simply leaving parenting and all its stressors—as well as with neglectful behavior and a “violence” category that included verbal and psychological aggression (e.g., threats or insults) and physical aggression (spanking or slapping) directed at children.

The truly remarkable result of this study is that parents responded honestly at all. In earlier research on this topic, the researchers grappled with whether parents would ever respond honestly to questions related to burnout, and whether the construct has any validity if no one will admit to it. It’s human nature to avoid responding honestly to questions that make you look bad, even anonymously! We call this the impression management bias.

What is Burnout?

As defined by the study, burnout is an exhaustion syndrome, characterized by feeling overwhelmed, physical and emotional exhaustion, emotional distancing from one’s children, and a sense of being an ineffective parent. Freudenberger (1974) first coined the term in reference to staff workers. Proccacini and Kiefaver wrote about it in 1984, and then the concept kind of disappeared. Until recently, however, parental burnout hasn’t been systematically studied. I think that’s because the entire concept is taboo.

The thing is, parents aren’t supposed to be able to burn out! We are taught, both explicitly and implicitly, that parenting is so rewarding, fulfilling and wonderful that one smile from a beloved child will instantly fulfill a parent, that the task is so joyful that the occasional difficulties (Meltdowns! Dirty diapers. 2 AM wakeup calls. Dirty diapers at 2AM!) are barely noticed. That’s just plain untrue, and it’s a myth that can harm parents.

Imagine working for this kind of boss: The demands seem to exceed the capacity to satisfy them, and the standard for success is always shifting, with high stakes and a lot of emotional pressure, and no real standard for success. Tasks with no end-date, where the finish line is always shifting, and tasks you can’t escape – those are the perfect conditions for burnout. Teachers experience it. Entrepreneurs experience it. And parents definitely experience it, but they haven’t been able to talk about it.

Oh sure, parents can talk about how work-life balance burns them out, we can talk about the gender gap regarding the mental load of running a home and parenting kids, we can talk about how being a working parent is stressful. But until recently, we haven’t been able to talk about how parenting itself can burn the parent out.

It’s not accidental that burnout makes us think of a depleted battery. When we’ve burned through all of our emotional fuel, there’s no more left. We all know the “supposed to-s” and the “should-s”. Parents are “supposed to” love the act of parenting so much, it recharges them on its own. Parents “shouldn’t” mind being woken up at 2AM, coming late to work, being passed over for promotion because of split priorities, or being the target of teenage angst.

You Can’t Give What You Don’t Have:

It’s true. Our kids rely on us and are frequently helpless. The parenting relationship is crucial to children’s psychological development. Attachment, or the lack thereof, can be damaging. That’s why it’s so threatening to even consider the possibility that parents can burn out. But if we can’t think about it, we can’t do anything to address it.

The thing is, we can’t give what we don’t have. If we’re disconnected from ourselves, we can’t give attachment, love, and nurturing. If we’re under stress, we can’t always respond with patience and model compassionate caring in the face of challenges. Since we are the parents, it’s up to us to know when that’s happening, when burnout is reaching critical levels, and what to do about it.

Neurodiverse Children and Burnout:

The problem is particularly severe when parenting a challenging child. In my practice, I treat parents and families of children with psychological diagnoses. When you’re parenting a child whose presenting problem is anxietyOCDADHDdepression or an Autism Spectrum Disorder, the potential for burnout is so much higher. (For more on parenting a neurodiverse child, click here.)

The world misunderstands challenging children, and it’s up to us to explain them to everyone. Simple tasks, like getting our kids on the school-bus, to brush their teeth, or to eat dinner become massive jobs requiring Herculean effort. Homework time with kids isn’t anyone’s idea of a good time. Try doing homework with a child who erases every letter that isn’t shaped perfectly, or who can’t stick to a task for more than three minutes straight. Then multiply a few siblings, who just have the neurotypical struggles and life demands. Add in some soccer practice, maybe a boss asking for some at-home work and throw in a toothache for good measure. For some people, this would be a nightmare. For others, it’s just called “Tuesday.”

Self-Care IS Child Care:

So many times, when I’m teaching parenting classes, I ask the participants what their self-care was that week. I get responses like this:

Self-care? Who has time for that? I am so consumed dealing with my son. Besides, he needs so much. How can I justify taking time away from something he needs, just to pursue something I like?

Based on this research, I ask parents how often they have escape fantasies, and all agree that they fantasize about their parenting load being lightened. Because this is an interactive class, we’ve already all spoken about the times that stress has led to less-than-optimal parenting strategies, like yelling, or a harsh consequence. (To learn about strategies to predict child behavior, click here. To learn more about using science to inform parenting, click here. To learn more about effective parenting strategies, click here.)

I point to the cell phones recharging on my power bank.

Every parent in this room has a cell phone currently recharging on that power bank. Just like we all know that the cell phones need to be recharged, so do we. When our batteries deplete, we have to refill them. 

 Jrg Schiemann/123RF
We have to recharge our own batteries, before our kids can recharge from us!
Source: Jrg Schiemann/123RF

Personally, I ask myself each week about certain “banks” that need to be filled. Before others can recharge from me, I need to fill up my banks.

I tell my own children when my “cuddle bank” is empty, and I want them to come to me to help refill theirs. I have a “play” bank, a “nurturing food” bank, and “engaging/interesting pursuits” bank, a “sleep” bank, and an “unscheduled time” bank. When one of these banks is running low, I’ve learned to refill it. Let’s not call that self-care. Let’s call that the highest form of child-care – being present. Ironically, it’s that sense of a present parent, that connection, and that attachment, that is associated with the healthiest outcomes. The scariest finding in the research above – burnout prevents parents from being emotionally present with their children. (To learn more about being present and using mindfulness in parenting, click here.)

In 1953, child psychoanalyst D.W. Winnicott spoke about being a “good enough” mother. Ironically, in the pursuit of being a “perfect” parent, we tend to burn ourselves out. Social media, with all the images of bento box lunches, Pintrest boards of “fun” braided hairstyles, and moms who brew their own homemade keffir don’t help. Let’s not be “perfect,” or even “great.” Let’s serve peanut butter and jelly for dinner, but have the energy for a cuddle! Let’s be real, because we can burn ourselves out on the path to ideal.

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This Is When to See a Mental Health Professional About Your Anxiety

It seems everyone is talking about anxiety these days, and that’s not a bad thing. Shining a light on mental health helps reduce the stigma that keeps many people from seeking support.

At the same time, it can be hard to know if the worries and racing heart you experience at the thought of, say, meeting new people, is run-of-the-mill stress, or if you’re actually experiencing some level of anxiety and could benefit from seeing a professional.

“I can’t tell you how many people I see who say, ‘I don’t know if I should be coming in here,’” clinical psychologist Robert Duff, Ph.D., author of Hardcore Self Help: F**k Anxiety., tells SELF. “On a broad scale, [talking about anxiety] is positive, but I don’t blame anyone for the confusion.”

Figuring out how serious your anxiety is can be tough because anxiety is a normal and essential part of being a human.

“Anxiety is a reaction to a situation we perceive as stressful or dangerous,” Monique Reynolds, Ph.D., licensed clinical psychologist at the Center for Anxiety & Behavioral Change in Rockville, Maryland, tells SELF. This produces a stress response in your body—specifically, your brain’s hypothalamus triggers your sympathetic nervous system to release norepinephrine (aka adrenaline) and cortisol (a stress hormone) to get you out of harm’s way.

This is actually a good thing when there is a real threat of danger present. “A major part of our brain’s job is to keep us alive, and fear and anxiety are a big part of that,” Reynolds says. For example, the anxiety you would feel at seeing a truck hurtling towards you would make you move from its way more quickly.

But if you have anxiety, that stress response can kick in when it shouldn’t. “You feel very much the way you do when in a dangerous situation…[but] there’s no real danger there,” Duff says. Instead of being helpful, this misfiring of your fight or flight reaction can hinder you.

While a little anxiety can also help you to perform at an optimal level under stress, giving you a burst of adrenaline and hyper-focus to finish a business proposal before deadline or nail that dance number at a performance, living in a constant heightened state of anxiety can be distracting at best and debilitating at worst. When anxious thoughts are interfering with your life and causing you significant distress, that isn’t something you should just chalk up to nerves and push through. That’s something you can get help with.

Anxiety is the most prevalent mental illness in the United States, and it comes in various forms.

Anxiety affects about 40 million American adults each year, according to the Anxiety and Depression Association of America (ADAA). But it’s not as cut-and-dry as saying that anxiety is simply when you feel nervous all the time. This mental health condition comes in many forms.

Generalized anxiety disorder (GAD) is characterized by having excessive worries and fears for months, according to the National Institute of Mental Health (NIMH). Per the ADAA, GAD affects 6.8 million U.S. adults each year. Panic disorder involves spontaneous bouts of debilitating fear known as panic attacks, along with intense worry about when the next attack will come, according to the NIMH. Per the ADAA, it affects 6 million American adults each year. Social anxiety disorder (also known as social phobia) happens when you have a marked fear of social situations in which you might be judged or rejected, as well as avoiding these situations or experiencing symptoms like nausea, trembling, or sweating as a result.

Then there are other issues that are closely related to anxiety, like obsessive-compulsive disorder, which involves intrusive thoughts and urges, and posttraumatic stress disorder, which happens when people have a prolonged stress response to harrowing situations.

These are just some of the various anxiety and anxiety-adjacent disorders out there. That these issues can present in myriad ways can make it even harder to know if what you’re experiencing is anxiety that could benefit from outside help.

“Some people feel they can control their anxiety, some feel it’s something they ‘should’ be able to manage, some feel shame, some fear they might be ‘crazy,’ and others downplay how much their anxiety is impacting them,” Reynolds says.

If anxiety interferes with your daily life—whatever that might look like to you—that’s reason enough to see a mental health professional.

“When your world starts to become limited because of anxiety, that is a good signal that it’s time to seek treatment,” Reynolds says. “What is it doing to your life, your relationships, your sleep, health, work, and ability to learn and pursue things that are important to you?”

This “functional impairment,” as Reynolds calls it, can show up in different ways in different people. Is anxiety making you avoid doing things with loved ones because you’re too nervous to go outside? Do you skip school or work out of fear of what people may think of you? Can you not get enough sleep because you’re up all night worrying about the next day? Is your anxiety over certain tasks, like paying bills, leading to procrastination so extreme it comes with consequences, like getting your lights turned off?

Keep tabs on whether you’re blowing up at people, too. Anger and irritability can sometimes be a sign of anxiety. “We often forget that fight or flight includes ‘fight,’” Reynolds says. “If you have a shorter fuse or are always on edge for triggers, it could be related to anxiety.”

So, too, could physical issues. “We think of ourselves as these disembodied heads floating around,” Reynolds says. “We forget that there is a big feedback loop between the nervous system and the body.” Every part of you, from your head to your stomach to your feet, has nerves to regulate important processes, which is why your sympathetic nervous system’s stress response can be so far-reaching. You even have an entire nervous system reserved for gastrointestinal function, known as your enteric nervous system, which may help explain why there’s such a strong link between issues like irritable bowel syndrome and anxiety.

Constant fatigue can also kick in if your anxiety is in overdrive. “The physical reaction to anxiety, by nature, is supposed to be short-term. The body is supposed to come back down to baseline,” Duff says. “But a prolonged period of anxiety depletes your resources and exhausts you.”

“If your anxiety is bothering you and you are suffering, you deserve to get help,” Duff says. That’s true whether or not you think your anxiety is serious, whether or not you think you meet diagnostic criteria you read online, and whether or not your friends and family treat your anxiety with the weight it deserves. And if your anxiety is getting to the point where you’re worried for your safety, call 9-1-1 or the National Suicide Prevention Lifeline (it’s available 24 hours a day, seven days a week at 1-800-273-8255), or go to the emergency room, Reynolds says.

Seeing a therapist can be anxiety-inducing on its own, but it’s worth it. Here are a few ways to make it easier.

Knowing what to expect at your first therapy session may make the experience less scary. Although every professional is different, you’re likely to get a lot of questions at the first visit. Ultimately, your psychologist or therapist’s goal is to learn what troubles you’re having so that they can create a plan to help you build the skills you need to address your anxiety.

They’ll also want to figure out which kind of therapy best matches your needs. Different forms, like cognitive behavioral therapy, which aims to help people change negative thought patterns, work for different people.

Since the cost of therapy can be prohibitive, know that there are resources to help you find affordable treatment, like the National Alliance on Mental Health’s HelpLine at 1-800-950-6264. The HelpLine is available Monday through Friday, from 10 A.M. to 6 P.M., and you can explain your specific situation to the staffer or volunteer who answers. They may be able to refer you to local organizations that offer more affordable treatment. You can also try the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locator tool, which can help you find mental health providers who take various forms of insurance, offer payment assistance, or use a sliding scale. Resources like GoodTherapy also allow you to limit search results to therapists who use sliding scales.

And don’t stress about meeting some arbitrary threshold of anxiety for your appointment to be worth the effort. “Somebody with anxiety [may] think there is a risk to seeing someone. ‘If I go and don’t have an anxiety disorder, there’s something bad about that,’” Duff says. “That’s not true. If you are suffering and seeing some of these signs, that’s enough.”

It may be that all you need is a few sessions, or you may meet weekly for months or years based on your goals. Your psychologist or therapist might decide medication would help you live your healthiest, happiest life, or just having someone to talk to might work for you. Also, if you decide you’re not really into the person you’re seeing but you still want help, there’s absolutely nothing wrong with trying someone else, Duff says.

Ask yourself what kind of life you want to live and what’s holding you back from achieving it, Reynolds says, adding, “If there’s anything related to fear and anxiety, it’s a great sign that maybe you need support around those things.”

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Family relationships and Type 1 diabetes

A diagnosis of Type 1 diabetes can affect the whole family. It’s important to listen to, and communicate with, all members of your family – especially any other children – and get help and support if you or anyone else needs it.

Sibling rivalry

While you’re getting to grips with your child’s diabetes, it’s easy to forget about the needs of your other children. But, they, too, will be affected by their sibling’s diagnosis. They may feel that their brother or sister is getting special treatment, worry that their sibling will get really sick or be scared that they’ll develop diabetes themselves.

Rivalry and jealousy are common in most families, and a child with diabetes can cause upset between siblings. In the early days, after diagnosis, it’s only natural for you to be anxious and focus your attention and care on your child with diabetes. But, regular hospital visits, attention to diet and everything else that goes with diabetes has a longer-term impact on all the family.

Advice for coping with sibling rivalry

  • Try to listen to both sides equally and be sensitive to their claims that it’s ‘not fair’.
  • Be clear about what you expect from each of them.
  • Try to give them the same amount of attention.
  • If you feel it’s appropriate, get siblings involved with diabetes management, so that they feel part of it.
  • Try not to put family life on hold.

Separated parents

It can be a challenge to manage a child’s diabetes when they go from one home to another. Whatever your feelings about your ex, the two of you need to work together to make sure your child’s diabetes is well managed.

  • making sure both of you learn about managing your child’s diabetes from your paediatric diabetes team – second-hand information can be confusing or inaccurate
  • how you’ll keep each other updated about any changes to your child’s treatment or routine
  • how you’ll involve new partners.

Lone parents

As a lone parent, you may have particular difficulties because all the pressures fall on you alone.

  • who you can call if you need help
  • who can help you in an emergency
  • who can support you when you’re struggling emotionally
  • who can babysit when you need time off
  • involving siblings in your child’s care, being careful not to give them too much responsibility.

Extended family

When your child is diagnosed with diabetes, it’s natural for grandparents, aunts and uncles, etc to be as upset and worried as you are. They may be in constant contact, asking for updates or how they can help – or they may leave you alone to concentrate on your child.

Advice for dealing with extended family:

  • Keep one person up to date. This person can then update everyone else: group texts and emails work well for this.
  • Ask for the help you need. Perhaps you’d like someone to look after your other children, do a bit of shopping for you or walk the dog? People often want to help, but don’t know what to do.
  • Think about the future. Your family will be living with Type 1 diabetes from now on, so how can your extended family best support you? If your child is used to staying over with relatives, it’s important that they still do so. If grandparents and other family members are worried about looking after them, try involving them in your child’s diabetes care. You could also bring them to clinic appointments to help them learn more about diabetes and ask questions for themselves. Most of all, be honest with them, tell them how you feel and ask them to help you keep your child’s life as normal as possible.

Is Type 1 diabetes hereditary? Will my other children get it?

Research has shown that Type 1 diabetes is caused by a combination of genetic and environmental factors. If one family member has Type 1 diabetes, there’s a slightly increased risk of another family member developing it, too. But, many people diagnosed have no family history of diabetes. It’s natural to worry that your other children will also develop Type 1 diabetes, but try not to let this worry affect you too much. Talk to your diabetes team or contact theDiabetes UK Carelinefor support.

Diabetes support for you and your family

If you’d like some diabetes help, you can:

 

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In the Spotlight: Sports and Type 1 Diabetes

Sports used to be a big part of Jonathan Tengi’s life. The 14-year-old from Allendale, NJ, played soccer, basketball and baseball, and swam on a team during the summer. Then Jonathan was diagnosed with type 1 diabetes. His active schedule came to a complete halt — he even missed the last soccer match of the season.

Three weeks later, with his blood sugar levels under better control and a diabetes management plan in place, Jonathan was back in the game again, in time for basketball season. He was hitting his stride, learning to live with diabetes — something he says he couldn’t have done without his teammates.

“Playing sports was a huge help physically and mentally, because when I was diagnosed, it threw everything off. Being able to get back into sports really helped me keep my mind off my diabetes and feel more normal,” he says.

Diabetes experts agree: Physical activity is vital to staying healthy for all kids, including those with type 1 diabetes. Here’s why and what you need to know to even the playing field for your child.

Strong Minds and Bodies

Exercise helps kids concentrate in school. It’s good for their hearts, for building muscles, and for controlling weight and stress. The optimal amount of exercise for children with type 1 diabetes — about an hour per day — isn’t any different than for other children, says Sheri Colberg, Ph.D., an exercise physiologist and Professor of Exercise Science at Old Dominion University in Norfolk, VA.

Improved Self-esteem

“A chronic disease can have a negative influence on how children view themselves, but being physically active may help counteract that by increasing self-confidence,” Colberg says.

Participating in team sports had an added bonus: It gave Jonathan a chance to educate his friends about his diabetes. His friends could get help if they saw Jonathan experiencing signs of low blood sugar, such as dizziness, confusion, excessive sweating, or weakness.

“Most of my friends were playing sports with me, so they were able to learn and tell other friends and teammates about it, and by word-of-mouth, it helped everyone,” Jonathan says.

Your child doesn’t have to be on a team to be physically fit, though. Playing tag, riding bikes, or walking are great ways to work in some daily exercise. Keep it interesting by suggesting new hobbies from time-to-time, such as hiking, karate, or hip-hop dancing.

“Learning skills and doing a new activity helps kids develop,” Colberg says. “The more things they learn, the more well-rounded they become.”

Your Game Plan

TALK ABOUT DIABETES. Because the length and intensity of exercise can affect blood sugar levels, coaches and teachers need to know how to handle an episode of hypoglycemia (low blood sugar). It can be helpful if teammates are aware as well. Talk with your child’s diabetes care team before he or she starts any new exercise program. It’s important to monitor how physical activity affects blood sugar; adjustments to food and insulin may be necessary.

KEEP SNACKS HANDY. Keep a variety of snacks available that your child likes, such as an energy bar, fresh fruit, yogurt, or cheese and crackers. Depending on the type and duration of the sport, you may want to carry food for before, during, or after the activity.

ROOT, ROOT, ROOT! As for Jonathan, he continues to play several sports and to root for his favorite team, the New York Mets. “They were really bad last year, but they’re picking themselves up, just like I had to do with my diabetes, and I hope the same good things happen for them,” he says.

Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the “typical” experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.

 

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