The Comorbidity Of Anxiety And Depression

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When a person experiences two or more illnesses at the same time, those illnesses are considered “comorbid.” This concept has become the rule, not the exception, in many areas of medicine, and certainly in psychiatry. Up to 93% of Medicare dollars are spent on patients with four or more comorbid disorders. The concept of comorbidity is widely realized but unfortunately not well-defined or understood.

In mental health, one of the more common comorbidities is that of depression and anxiety. Some estimates show that 60% of those with anxiety will also have symptoms of depression, and the numbers are similar for those with depression also experiencing anxiety.

While we don’t know for certain why depression and anxiety are so often paired together, there are several theories. One theory is that the two conditions have similar biological mechanisms in the brain, so they are therefore more likely to “show up” together. Another theory is that they have many overlapping symptoms, so people frequently meet the criteria for both diagnoses (an example of this might be the problems with sleep seen in both generalized anxiety and major depressive disorder). Additionally, these conditions often present simultaneously when a person is triggered by an external stressor or stressors.

While clinicians can typically recognize one mental illness relatively easily, it’s much more difficult to recognize comorbid disease. They must pay careful attention to symptoms that could suggest other disorders such as bipolar disorder and look for other factors such as substance abuse. This requires time with the patient, possibly their families and other collateral sources of information. The health care system today makes this level of assessment difficult, but not impossible.

Unfortunately, most research today focuses on patients with one illness, and treatments are then guided by this research. In result, there are many well-researched treatments available for mental illnesses, but not for comorbid mental illnesses. There is a lot that we still need to understand about how we recognize and treat conditions when they present at the same time.

There are several things we do know about comorbid anxiety and depression, however, and they underscore this need for accurate assessment. When anxiety and depression present together, these illnesses can often be harder to treat. This is because both the anxiety and depression symptoms tend to be more persistent and intense when “working” together.

This means that those experiencing both anxiety and depression will need better, more specialized treatments. Professionals and caregivers providing treatment may need to get creative, like adding one treatment onto another to make sure that both underlying disorders are responding. For example, if antidepressants are helping improve a person’s mood, but not their anxiety, a next step would be to add cognitive behavioral therapy to the treatment plan.

More research is needed to fully understand why some patients experience comorbid conditions and others do not. Until then, it is vitally important that those experiencing one, two or multiple mental illnesses engage in treatment early, and find a provider they can work with to reach their goals. While treatment may have more challenges when dealing with comorbidity, success is possible.

By Beth Salcedo, MD

https://www.nami.org/Blogs/NAMI-Blog/January-2018/The-Comorbidity-of-Anxiety-and-Depression

The Impact of Music Therapy On Mental Health

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When I worked at a psychiatric hospital, I would wheel my cart full of instruments and musical gadgets down the hallway every morning. Patients lingering in the hall would smile and tap on a drum as I passed by. Some would ask me if I had their favorite band on my iPad. Some would peek their heads out of their rooms, and exclaim, “Molly’s here! It’s time for music therapy group!” Oftentimes, I would hear about patients who were asleep in their rooms when I arrived, but their friends would gently wake them with a reassurance: “You don’t want to miss this.”

Music to My Ears

I’ve been lucky to serve many children and adults in various mental health settings as a music therapist. I’ve heard stories of resilience, strength and adversity. I’ve worked with individuals who have experienced trauma, depression, grief, addiction and more. These individuals have not come to me in their finest hour, but despite feeling lost or broken, music provided them with the opportunity for expression and for experiencing safety, peace and comfort.

Research shows the benefits of music therapy for various mental health conditions, including depression, trauma, and schizophrenia(to name a few).  Music acts as a medium for processing emotions, trauma, and grief—but music can also be utilized as a regulating or calming agent for anxiety or for dysregulation.

There are four major interventions involved with music therapy:

  1. Lyric Analysis

While talk therapy allows a person to speak about topics that may be difficult to discuss, lyric analysis introduces a novel and less-threatening approach to process emotions, thoughts and experiences. A person receiving music therapy is encouraged to offer insight, alternative lyrics and tangible tools or themes from lyrics that can apply to obstacles in their life and their treatment. We all have a song that we deeply connect to and appreciate—lyric analysis provides an opportunity for an individual to identify song lyrics that may correlate with their experience.

  1. Improvisation Music Playing

Playing instruments can encourage emotional expression, socialization and exploration of various therapeutic themes (i.e. conflict, communication, grief, etc.).  For example, a group can create a “storm” by playing drums, rain sticks, thunder tubes and other percussive instruments. The group can note areas of escalation and de-escalation in the improvisation, and the group can correlate the “highs and lows” of the storm to particular feelings they may have.  This creates an opportunity for the group to discuss their feelings further.

  1. Active Music Listening

Music can be utilized to regulate mood. Because of its rhythmic and repetitive aspects, music engages the neocortex of our brain, which calms us and reduces impulsivity. We often utilize music to match or alter our mood. While there are benefits to matching music to our mood, it can potentially keep us stuck in a depressive, angry or anxious state. To alter mood states, a music therapist can play music to match the current mood of the person and then slowly shift to a more positive or calm state.

  1. Songwriting

Songwriting provides opportunities for expression in a positive and rewarding way. Anyone can create lyrics that reflect their own thoughts and experiences, and select instruments and sounds that best reflect the emotion behind the lyrics. This process can be very validating, and can aid in building self-worth. This intervention can also instill a sense of pride, as someone listens to their own creation.

On Another Note

When I worked at a residential treatment center, I was notified that a child refused to continue meeting with his usual therapist. Even though he was initially hesitant to meet with me, he soon became excited for our music therapy sessions.

In our first session, we decided to look at the lyrics of “Carry On” by FUN. I asked him to explain what it means to be a “shining star,” which is mentioned several times in the song.  I was expecting this 8-year-old to tell me something simple, like “it means you’re special.” But he surprised me when he stated, matter-of-factly: “It means that you are something others notice. It means you are something to look up to, and you are something that helps others navigate.”

And just like that: This lyric offered the opportunity to discuss self-worth, resilience, and strength. Music provided him with the structure and opportunity to process in an engaging way. Soon, his therapist began attending our sessions to help build a healthier therapeutic relationship. His family and teachers reported improved emotion regulation and social interaction skills. Music therapy had provided countless opportunities for building healthy relationships, just as it has for thousands of others.

By Molly Warren, MM, LPMT, MT-BC

https://www.nami.org/Blogs/NAMI-Blog/December-2016/The-Impact-of-Music-Therapy-on-Mental-Health

Mental Health Starts With Listening

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When was the last time you considered how sound might impact your health?  Most of us only think about sound pollution when there’s a jackhammer outside our bedroom window, but it turns out what you listen to all day can affect your wellness. And since music is the most complex sound system you encounter in daily life, it may be worth pausing to consider what the next song on your playlist may do to your health.

My research team at Genote discovered just how true this was when we were running some tests with premature infants in a neonatal intensive care unit. The sounds premature babies hear can cause stress or even cause pain because their ears are very sensitive. We wanted to see if we could use music to help them cope with stress, anxiety and development issues that come from living out of the womb too early.

Music is made up of hundreds of different components, such as melody, harmony and rhythm. Songs combine these elements to produce certain styles and emotions. But these musical elements also trigger reactions from the mind and body. After studying these interactions for more than twenty years, our team learned how to produce music that targets specific health goals.

We used a program of our specially prepared music to help the babies sleep better and to relax when they showed signs of discomfort—which worked almost immediately. In some cases, this improvement had significant health improvements for the babies, such as restoring oxygen levels in the blood.

After seeing how music could improve health in premature infants, we wanted to know if we could improve the lives of other groups of people. So, we partnered with a special education school that worked with young, blind students. We were hoping to help them improve focus, sleep, relationships and decrease anxiety through music.

By applying a special music-listening program at home and school, we saw improvement in nearly all the areas we were studying, including the students’ ability to focus, relax and sleep deeply and consistently. One student’s mother told us that the music made her son more playful and she could tell he slept more deeply and woke up in a happy mood, setting the tone for a positive day for learning.

Using Sound To Promote Mental Health

The biggest takeaway from these studies is the impact our sound environment has on our emotional wellbeing. Unfortunately, negative sound pollution can also have a significant detrimental impact on mental health, such as increasing stress, anxiety and even blood pressure. Many studies also link certain types of music to negative emotional conditions like depression.

The sounds around you right now are influencing the state of your mental health. If you’re interested in seeing how your sound environment is affecting you, experiment with the following:

    1. Keep a sound journal. At the end of each day, write down all the sounds you remember hearing. See if you can identify how any given sound affected you and make a note. Make a note describing how you felt that day.
    1. Experiment with music. In your sound journal, pay close attention to what music you listen to and the effect of any given song or genre.
    1. Make adjustments. Try to add more of the sounds that bring a positive change to your day and avoid the sounds that cause stress or anxiety.
  1. Re-evaluate. After a week, evaluate how your experiment went and assess how your mood changed because of the changes you implemented.

My dream is for people everywhere to become more aware of how sound, and especially music, can be a measurable, impactful tool for healthy living. By better harnessing the power of music to improve mental health and stability, we have a powerful tool at our disposal that we can use before considering more invasive means of correction. A careful approach to music can change the game for mental health. It just starts with listening.

By Kenny Baldwin

https://www.nami.org/Blogs/NAMI-Blog/June-2017/Mental-Health-Starts-with-Listening

The Best Movies About Mental Health

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It’s becoming increasingly more common for Hollywood to highlight mental health conditions in films. Because mental illness affects millions of Americans, it’s an extremely relatable theme. Sometimes, these movies show mental illness in a way that is inaccurate or stigmatizing. For those in “the business” who don’t have lived experience, it can be difficult to depict.

However, there are some movies that realistically show what it’s like to experience mental illness. Here’s a list of a few movies that get it right.

A Beautiful Mind (2001)

This movie, based on a true story, highlights the life of John Forbes Nash, Jr. (Russel Crow), a mathematical savant who lived with schizophrenia. The movie beautifully captures the challenges John faced throughout his life, including paranoia and delusions that altered his promising career and deeply affected his life. Through the magic of film, viewers can live John’s hallucinations with him, which feel as real to the audience as they did to him.

Matchstick Men (2003)

Roy (Nicolas Cage) is a con artist working with his protégé to steal a lot of money. While he may be confident in his ability to steal from the rich, he struggles in other aspects of his life. His debilitating Obsessive-Compulsive Disorder (OCD), agoraphobia and panic attacks make it difficult for him to leave his apartment or even open a door. When he discovers he has a 14-year-old daughter, he’s forced to evaluate his career choices and isolated lifestyle. Matchstick Men is an honest depiction of the rituals and behaviors of someone living with OCD.

It’s Kind Of A Funny Story (2010)

You wouldn’t think a movie set in a mental health hospital could be a comedy. However, this well-crafted film tells the story of 16-year-old Craig (Keir Gilchrist) who checks himself into a psychiatric ward because of his depressionand suicidal ideation. He ends up staying in the adult unit because the youth wing is under renovation. The hospital is not a scary place and the patients are not portrayed as “mad” or “insane”—it’s a safe place where people struggling are getting help, and using humor as a relief from the serious conditions that brought them there. This Hollywood approach to a psychiatric unit may be more comical than any real-life scenario, but it helps normalize the fact that sometimes people need this level of care.

Silver Linings Playbook (2012)

After a stay in a mental health hospital, Pat Solatano (Bradley Cooper) is forced to move back in with his parents. His previously untreated symptoms of bipolar disorder caused him to lose both his wife and job, and he is determined to get his wife back. In his efforts, Pat meets Tiffany (Jennifer Lawrence), who offers to help him in exchange for Pat being her ballroom dance partner. Silver Linings Playbook represents the range of emotion that often occurs with bipolar disorder in a real and riveting way.

The Perks Of Being A Wallflower (2012)

Socially awkward Charlie (Logan Lerman) starts high school isolated and anxious. Luckily, he becomes friends with a group of charismatic seniors, including Sam (Emma Watson) and Patrick (Ezra Miller). His friends bring joy to his life, but his inner turmoil reaches a high when they prepare to leave for college. As the film goes on, we learn more about Charlie’s mental health journey—from his stay in a psychiatric hospital to the details of a childhood trauma. This coming-of-age movie does an exemplary job of showing the highs and lows of growing up with mental illness.

The Skeleton Twins (2014)

The opening scene of Skeleton Twins shows the film’s main characters, Milo (Bill Hader) and Maggie (Kristen Wiig), both attempting suicide. Milo’s attempt lands him in the hospital, which reunites the brother and sister after 10 years of estrangement. Both characters express their depression in candid and humorous ways as they learn to accept each other and themselves.

Infinitely Polar Bear (2015)

Cam (Mark Ruffalo), a father with bipolar disorder, becomes the sole caregiver for his two daughters while his wife (Zoe Saldana) goes away to graduate school. Throughout the movie, Cam faces many challenges that make it difficult for him to take care of his daughters. However, despite the severity of his condition (and some unique parenting methods that accompany it), Cam learns that he is a good father who cares deeply for his family. Infinitely Polar Bear is a very meaningful portrayal of how families can be impacted by mental illness.

Welcome To Me (2015)

Alice (Kristen Wiig) has just decided to go off her medications for Borderline Personality Disorder (BPD) when she wins the lottery. She impulsively buys her own talk show with the money, in which she shares her opinions with the world. Although portrayed in a humorous way, Alice shows many of the traits of BPD, including mood swings and unstable relationships. As her behavior pushes away the people closest to her—including her therapist—she starts to take her mental health condition more seriously and works to keep her loved ones in her life. In the process, she falsifies the myth that a person with BPD is selfish.

Inside Out (2015)

This quirky animation personifies the different emotions inside a young girl’s mind. Characters Joy, Sadness, Anger, Fear and Disgust try to help Riley through her family’s move to San Francisco. The emotions learn to work together to help Riley process the turmoil of adjusting to her new life. Inside Out is a clever, modern and well-made film that puts mental health into a new context.

Hopefully, as we continue to spread awareness and education, Hollywood will continue to make movies like the ones in this list that show what mental illness is really like.

By Laura Greenstein

https://www.nami.org/Blogs/NAMI-Blog/December-2017/The-Best-Movies-About-Mental-Health

Millennials And Mental Health

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As a mother of two Millennials, I’ve noticed differences between their generation and mine. Like how they prefer to spend money on travel, amazing food and experiences rather than physical things like homes and cars. These aren’t negative qualities—just different.

There is one difference I’ve noticed that is extremely positive: how they view mental health. I recently had a conversation with my oldest daughter, Mackenzie, who struggles with anxiety.

“Mom, you wouldn’t believe how many people my age talk about mental health,” she said. “It’s not a taboo subject anymore. I know a lot of people at work and friends outside of work who see therapists or take medication for anxiety and depression.”

I couldn’t hide my smile. Obviously, I’m not happy they’re dealing with mental illness, but I’m glad they’re not afraid to bring up the subject. My experience growing up was completely the opposite. I felt totally alone. My panic attacks began when I was 10 and I kept it a secret. I didn’t want to be seen as strange or different. By the time I was in my 20s, I panicked every time I drove or went to the grocery store. I knew my symptoms weren’t normal, but I still said nothing. Stigma and fear kept me quiet.

Meanwhile, Mackenzie was 23 when symptoms of anxiety first started to show. At first, I don’t think she wanted to admit she was having problems. She spent hours at the office, working her way up; she rarely took time to relax, never thinking much about her mental health. She blamed her lack of sleep on her motivation to get ahead, and her lack of appetite on acid reflux. But there was a deeper problem.

Mental health conditions run in our family. My mom had depression. My youngest daughter and I have recovered from panic disorder. Mackenzie was aware of our family history, and maybe that made it easier for her to talk about her symptoms. But I think the main reason she was encouraged to get professional help was that she heard her friends and coworkers openly discuss their mental health issues. Mackenzie didn’t feel ashamed or alone.

Millennials are often referred to as the “anxious generation.” They were the first to grow up with the constant overflow of the Internet and social media. The Internet can make life better, but it can also make life complicated, as Millennials often compare their personal and professional achievements to everyone else’s. This can result in low self-esteem and insecurity.

The world is at Millennials’ fingertips, but they also feel its immense weight. “Everything is so fast-paced and competitive. Part of that is social media,” Mackenzie told me. “The sense of immediacy—everything has to happen right away, at the click of a button. There’s pressure to constantly be ‘on.’ To look and sound perfect, and act like you have it all together. But you don’t.”

She continued, “I’m relieved my friends and I talk about being anxious and depressed. I don’t have to pretend anymore.”

A 2015 study by American University said that Millennials grew up hearing about anxiety, depression, eating disorders, and suicide, and they are more accepting of others with mental illness. Millennials are more likely to talk about mental health than their parents or grandparents. As more people speak out, the stigma surrounding mental illness is beginning to lessen.

Word is spreading through social media that mental health is an important part of overall well-being. Celebrities are openly sharing their struggles. The younger generation is learning about mental illness at an earlier age (thanks to programs like NAMI Ending the Silence).

It’s still difficult for many people to be open about their mental health issues—I’m not saying stigma is completely gone. But at least it’s not a totally taboo subject, like it was when I was growing up. I’m thankful Millennials are helping to break that stigma barrier a little further. I’m so glad my daughter doesn’t feel alone.

Jenny Marie is a mental health advocate and blogger. Jenny is married and has two daughters. Her blog is called Peace from Panic.

https://www.nami.org/Blogs/NAMI-Blog/December-2017/Millennials-and-Mental-Health

In Depth: Eating Disorders in Men

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People often think “Eating disorders are a woman’s disease.” This myth is constantly reinforced by character portrayals on television, targeted advertisements, and even studies and articles that draw from exclusively female samples. The sad reality is that eating disorders affect any and all genders, and those who do not identify as female may even suffer more with the very diagnosis of their disease due to the stereotype that eating disorders are feminine. Therefore, although eating disorders affect each individual differently, it is important to consider one’s gender identification in order to increase efficacy for prevention, detection, and treatment of the disease.

Why do men get eating disorders?

While beauty standards for women emphasize thinness, men are taught to prioritize muscle gain. Similar to women’s beauty standards, this fixation on strength derives from cultural gender norms and is perpetuated at a very young age. Throughout the past five decades, the muscles on action figures have been getting significantly larger. Comparable to the physically impossible size measurements of Barbie, the 1998 Wolverine doll had a waist the size of its bicep and half the size of its chest.1 One study confirmed that male college students who were assigned to play with the most unrealistic action figure dolls then reported the lowest levels of self-esteem.2 Another study found that men’s confidence surrounding their physique plummeted after watching music videos that featured hyper-muscular stars. Even more fascinating—researchers still observed this drop in self-esteem after the male participants watched music videos in which the main star did not have outrageous bulging muscles, but rather, was a more realistic depiction of an average (white) American male.3 These unanimous declines in body image indicate that men are deeply susceptible to ingesting harmful media standards, and these standards can take a lifelong toll on their body image.

What do eating disorders look like for men?

These dips in body image can oftentimes lead men to develop an unhealthy fixation on their build or, in some cases, an eating disorder. The estimated rates of men with eating disorders vary. Some studies cite that for every 10 women with an eating disorder there is 1 man with the disorder1, 4, while other studies indicate that 25% of eating disorders occur in men5. The discrepancy in these statistics is due to the fact that many men with eating disorders do not report their disease, due to shame and fear of suffering from a “female” issue. Another stereotype is that the men who are diagnosed with eating disorders are predominantly homosexual. This assumption has been widely disproved, and in fact 80% of men with eating disorders are heterosexual.4 That being said, confusion surrounding sexual orientation can be a contributing cause for eating disorder in some men, so it is important to acknowledge sexuality during the treatment process.

Men can suffer from any and all types of eating disorders, but some of the most prevalent eating disorders among men are binge eating disorders or exercise addictions. As for the former, American culture is actually more accepting of men with binge eating disorder than their female counterparts. This acceptance is positive for men who may avoid emotional scarring from fat shaming, but it is negative for men who are enabled to continue binge eating because their symptoms are not validated as being disordered eating, and therefore they are significantly less likely to seek treatment. However, the severity of binge eating disorder among men should not be minimized. A recent article, which profiled men with binge eating disorders, included testimony from a man whose early life traumas caused him to weigh 724 pounds by the time he was 34 and from another man who gained and lost 100 pounds 4 times throughout his life.4

Exercise addiction, sometimes called Anorexia Athleticism, is also prevalent among men with eating disorders.1 These addictions usually stem from a cultural aversion to softness, particularly in men.6 Many of the behaviors characteristic of this addiction are similar to those of anorexia, including restlessness, physical over-activity, and self-starvation.1 This addiction can also lead men to develop substance abuse problems, particularly with steroids. Over two million men in the United States have reported using anabolic steroids at some point in their lives, and while these drugs do not have any immediate effects, they can have disastrous physical and emotional long-term effects, such as high cholesterol, depression, and prostate enlargement.1

How do we treat men with eating disorders?

Because there are so few studies on men with eating disorders, there is not enough substantive literature that indicates how (or if) eating disorder treatment should vary between men and women. However, there are some known factors to bear in mind when treating male eating disorder clients. While women are more susceptible to developing eating pathology if they have a history of feeling fat, men have a much greater risk of developing an eating disorder if they were actually obese during childhood.1 Additionally, men who have a history of sexual trauma are more prone to develop an eating disorder due to the body image disturbance that can occur as a result of their abuse.1 Men who experience a sexual assault can also develop a drive to build their muscle mass because they believe that becoming stronger and more masculine will make them more prepared in the event of a future threat.1 Additionally, depression can be a major cause of eating disorders, but since depression is also stigmatized as a “feminine” disease, it can go severely underreported.1

Men who have confusion surrounding their sexuality may find comfort in starvation, especially because anorexia can lower their testosterone levels and lead to asexuality, so by wiping out their sexuality altogether they no longer have to cope with the internal worry.1 However, this can make treatment much more difficult because regaining weight will unleash any sexual feelings they may have been repressing, which restarts the sexual discovery many men dread. Eating disorders are also common among men who identify with an “undifferentiated” or “feminine” gender role. Therefore, understanding the sexuality and gender of a male patient is imperative in order to grasp the underlying influences for one’s eating disorder.

Finally, many male eating disorder clients who engage in excessive exercise have Muscle Dysmorphia, which is categorized as an obsession with one’s body or muscle size.1 However, since there are no official diagnostic criteria relating to food or diet, it is not technically considered an eating disorder, even though the symptoms and treatment suggestions are almost identical to those for eating disorders.1 Therefore, treatment practitioners must be able to identify the ways in which Muscle Dysmorphia manifests and may contribute or cause an eating disorder.1

Although there is still major progress to be made in the depiction of eating disorders as diseases that affect all genders, there is promising evidence to suggest that men can successfully recover from eating disorders. However, because men are taught a completely unique set of beauty standards, their eating disorders manifest in many different ways and they require specialized treatment that reflects these cultural gender differences. The sooner we abandon the stereotypical notion that eating disorders exclusively affect one group of people, the quicker we can pave the way for reduced stigma, access to recovery, and a bright future for all eating disorder clients.

http://www.emilyprogram.com/blog/eating-disorders-in-men

Tips For Managing The Holiday Blues

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Many people can experience feelings of anxiety or depression during the holiday season. People who already live with a mental health condition should take extra care to tend to their overall health and wellness during this time.

Extra stress, unrealistic expectations or even sentimental memories that accompany the season can be a catalyst for the holiday blues. Some can be at risk for feelings of loneliness, sadness, fatigue, tension and a sense of loss.

A lot of seasonal factors can trigger the holiday blues such as, less sunlight, changes in your diet or routine, alcohol at parties, over-commercialization or the inability to be with friends or family. These are all factors that can seriously affect your mood.

However, there are certain things you can do to help avoid the holiday blues. Ken Duckworth, M.D., NAMI’s medical director, shares advice for managing your health—both mental and physical—during the holiday season in this video.

Download

By Laura Greenstein

https://www.nami.org/Blogs/NAMI-Blog/November-2015/Tips-for-Managing-the-Holiday-Blues

Navigating the Holidays

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Trigger Warning: Eating Disorders

The holidays can be stressful for someone who is struggling with an eating disorder. We get it. A lot happens this time of year—extra family time, busy schedules, social gatherings—and most of it centers on food.

To help you prepare for the upcoming holidays, our staff has come up with some tips and words of encouragement. Add any or all of them to your recovery tool box for Thanksgiving and other upcoming holiday events.

  • Continue doing what works for you despite the fact that your schedule may change, stress may increase, and time may be short.
  • Remember: it’s progress, not perfection.
  • Have a plan for food and skills to use during the day.
  • Keep practicing self-care by feeding yourself, getting enough water, moving when/if/how it makes sense for your body, resting when you need to, and connecting with others.
  • All foods fit, and your body knows how to use them.
  • Allow yourself to ask for more support from others you trust, whether that be family, friends, or treatment team members.
  • Remember that although it may seem like everyone is sharing happy memories with their loved ones, not everyone is and it’s okay since that is often real life. Stay away from social media if it allows you to have a more realistic picture of the world.
  • Consider what would make you enjoy the holiday season more, whether that be doing something traditional, such as baking or going to church, or something less traditional, such as getting a pedicure or volunteering. Make the holiday season your season, not something that you think it should be.

Wishing you all a happy holiday season!

Navigating the Holidays

Exercise For Mental Health: 8 Keys To Get And Stay Moving

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Mental illness has deeply impacted my life. I have experienced the flooding of anxiety and the drowning of depression. I have waged, and won, several battles with postpartum depression and been through loss and grief. I know how painful it can be to find oneself in the throes of mental illness and how helpless it can feel when a loved one is caught in its grasp. As a clinical psychologist, I have witnessed the sting of mental illness and the struggle to find healing. People come desperate to learn the tools that can break the chains of mental and emotional symptoms. Too often, individuals and their friends and family are ready to seek and find help, only to find barriers halting their progress.

Barriers To Mental Illness Treatment

An astonishing 60% of American adults, and almost half of children ages 8–15, receive no treatment for their mental illness diagnoses. Though valid treatments—like mental health medications and psychotherapy—are available, too many people encounter barriers to treatment. This occurs for many reasons, but the most common are the stigma of mental illness and its treatments, like medication and therapy; the side effects  of medication treatments; and the cost  of long-term therapy or medical interventions.

Benefits Of Exercise For Mental Health

Exercise has been researched and validated for treating a variety of mental issues and mental health conditions, including depression, anxiety, eating disorders, bipolar disorders, schizophrenia, addictions, grief, relationship problems, dementia and personality disorders. Additionally, exercise alleviates such conditions as bad moods, stress, chronic pain and chronic illnesses.

Exercise is not only free from negative stigma, it is safe when done appropriately, with a doctor’s approval. Any side effects are ultimately positive, and even better, exercise is free of charge, easy to access and available for everyone. Exercise can be used as a stand-alone treatment for some mild-to-moderate conditions or, more effectively, in conjunction with other mental health treatments.

Like medicine in the treatment of mental illness, exercise can increase levels of serotonin, dopamine and norepinephrine in the brain. It improves and normalizes neurotransmitter levels, which ultimately helps us feel mentally healthy. Other important benefits include enhanced mood and energy; reduced stress; deeper relaxation; improved mental clarity, learning, insight, memory and cognitive functioning; enhanced intuition, creativity, assertiveness and enthusiasm for life; and improved social health and relationships, higher self-esteem and increased spiritual connection.

8 Keys To Mental Health Through Exercise

If exercise is so good for physical and mental health, why aren’t more of us exercising for mental health? Why aren’t medical and mental health practitioners not only recommending exercise but also showing us how to safely start and continue exercising for mental health? The following overview of my 8 Keys to Mental Health Through Exercise can help you, your loved ones and those who provide medical and mental health care tackle underlying beliefs about exercise, change exercise-related thinking, overcome barriers and implement an effective exercise program.

1. Heal Your Mind and Body with Exercise

If you struggle with a particular mental illness, exercise has specific abilities to help you, too. From calming the anxious mind to regulating mood swings in bipolar disorder, exercise may be the best thing we can do for mental, physical, emotional, social and spiritual well-being. To receive the benefits of exercise, however, we must first believe that exercise can heal body, mind and soul.

2. Improve Your Self-Esteem with Exercise

Exercise improves self-esteem, which is associated with greater mental health. Exercise has also been shown to increase self-confidence, self-efficacy, self-acceptance and self-concept. When we exercise, we feel more loving, positive and confident.

3. Exercise as a Family

Family has a big influence on how we perceive exercise and mental health. Family beliefs can either promote or impair mental health. Exercising as a family not only gets the entire family moving to reap the benefits of exercise but also models healthy beliefs about physical activity and improves family relationships.

4. Get Motivated

Motivation, or rather lack of it, is probably the biggest block to exercise for mental health. We know we should exercise. We may even want to exercise, but we often can’t make ourselves do it. Remember that motivation is a skill that can be learned and improved upon.

5. Change How You Think about Exercise

What thoughts do you have about exercise? What promotes physical activity? What holds you back? As we identify these thoughts, we can choose to change them. One tool for this is called a “thought record.” As we list our thoughts and feelings about exercise on a thought record, we have the power to question and change our thoughts. We can put new, healthier thoughts into our brains—thoughts like, “I know if I go for a walk, I will feel more energized and less depressed.”

6. Overcome Roadblocks

While exercising can be physically challenging, exercise is just as much, or even more, about mental fortitude. What are your biggest roadblocks to exercise? If you look carefully, you’ll see that almost all of them have to do with mental perceptions and beliefs. Lack of time or energy? Not being able to get to the gym? Perhaps you face the challenge of having young children, or a job that’s taking over your life. Whatever the roadblocks, you can overcome them as you acknowledge and challenge them.

7. Get FITT—Physically and Mentally

To stay with exercise for mental health, you must first build mental fortitude. That’s why I’ve waited until Key 7 to discuss how to set up an exercise program. The FITT Principle shows how. FITT stands for Frequency (how often you exercise), Intensity (how hard you exercise), Type (of exercise you’re doing) and Time (how long you exercise). Through FITT, you can create a tailored program for your unique needs.

8. Implement Your Vision and Flourish

Finally, we need a long-term vision of health and wellness to keep exercising for mental health for the rest of our lives. Exercise is beneficial at all ages and stages; as we look to the future, we find that by exercising for our mental health, we can help overcome mental illness and become who we are meant to be. We will flourish.

Christina G. Hibbert, Psy.D. is a clinical psychologist specializing in women’s mental health, motherhood, grief/loss, selfesteem and personal growth. She is the author of This Is How We Grow, Who Am I Without You?  and 8 Keys to Mental Health Through Exercise , and host of the weekly series “Motherhood” on WebTalkRadio.net. For more on this topic, visit www. DrChristinaHibbert.com and www.Exercise4MentalHealth.com.

https://www.nami.org/Blogs/NAMI-Blog/May-2016/Exercise-for-Mental-Health-8-Keys-to-Get-and-Stay

Opening Up To Others About Your Mental Health

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Have you ever had a conversation with someone that tempted you to open up about something incredibly personal, but you hesitated due to the fear of that person’s reaction? Were you worried that telling them would alter their perception of you? Many people experience this feeling as they attempt to determine whether or not to be forthright about their symptoms and their struggle.

If you are considering opening up about your mental health condition, here are some tips.

Deciding Whether You Should Say Anything

Before telling someone, be certain that the decision is right for you. Making a list such as the following can help you determine if the pros outweigh the cons.

Pros:

• The person may be supportive and encouraging.

• The person can help me find the treatment that I need.

• I may gain someone in my life to talk to about what I’m going through.

• I may have a person in my life who can look out for me.

• If a crisis were to happen, I would have someone to call.

Cons:

• The person may be uncomfortable around me after I tell them.

• The person may not want to associate with me after I tell them.

• The person may tell other people that I know, and I could be stigmatized.

Dr. Patrick Corrigan, principal investigator of the Chicago Consortium for Stigma Research and Distinguished Professor of Psychology at the Illinois Institute of Technology, leads the Honest, Open, Proud program, which offers advice for talking about mental health conditions. He encourages people to open up about their mental health condition but to do so in a safe way. “Be a bit conservative about the process,” he says. “Once you’re out, it’s hard to go back in, but the important thing is that the majority of people who come out and tell their story feel more empowered.”

Also consider the potential benefits of telling someone. Perhaps being open would help your loved ones understand why you can’t always spend time with them, or you might ease their concerns by making them more aware of what’s going on in your life. Or maybe you need special accommodations at work or elsewhere. To learn more about accommodations at work, visit www.nami.org/succeeding-at-work

Deciding Whom to Tell

Once you feel confident in your decision to share, you should consider how the person you confide in might react. Think about what kind of relationship you have and whether it’s built on trust. If you still have concerns, try a test conversation. Mention a book or movie that includes mental illness and ask their opinion about it in a context that doesn’t involve you.

Deciding When You Should Tell

Once you feel comfortable about confiding in someone, start to think about when to tell them. It may be important to tell someone to receive help and support before you reach a point of crisis. That way you have a calm environment in which to be open and learn who in your life is most willing and able to help if you need support.

Initiating the Conversation

You have a few different options for telling someone about your mental health. Perhaps scariest is to come out with it without setting up the conversation because you might catch the person off-guard. Another option would be to let the person know in advance that you want to talk about something significant so they can prepare for a serious conversation. Once you have told them that you live with a mental health condition and experience certain symptoms because of it, use examples to help them understand what it’s like. For example, “Everything I do every day, even something simple like taking a shower, is exponentially harder when my symptoms are more serious.”

Share only what you’re comfortable with. Dr. Corrigan states, “You can disclose in steps, start with safe things and see how you feel, and going forward you can choose to disclose more. Anything that’s still traumatizing, you should consider keeping private.”

If someone is supportive and encouraging, let the person know how to help you, such as if you need a ride to an appointment or someone to listen. Tell them that you’ll let them know if you want advice and that you would prefer support rather than counseling.

Refer them to resources to learn more, such as information from NAMI. The more people who talk about their mental health, the more acceptable it will be for people to be more open about the topic. “The best way to change stigma is not education—it’s contact,” says Dr. Corrigan.

Laura Greenstein is communications coordinator at NAMI.

https://www.nami.org/Blogs/NAMI-Blog/January-2017/Opening-Up-to-Others-about-Your-Mental-Health