Tag Archive for: Anxiety

How Depression Made Me A Man

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“Be strong!”

“Toughen up!”

“Don’t cry!”

Never did someone stand over me as a kid and yell, “Let it out! It’s okay to cry! It’s human to hurt!” From my football coaches to my own father, it seems as though the social norm for men is to be some kind of impenetrable mountain of muscle that feels no pain and has no emotion. If we’re not hunting or fighting or eating a bloody, rare steak, then we’re not men. As a kid, I idolized the manly behemoths on TV. From Arnold Schwarzenegger to Dwayne “The Rock” Johnson, I wanted to be just like them. And I didn’t only want to mimic their physical appearance, but I wanted to be as happy and carefree as they seemed.

Our culture depicts men as heroes and symbols of strength and popularity, almost to the point of being invincible. Every little boy wants to be invincible. When my parents fought—yelling and breaking things in the house—all I wanted to be was invincible against how sad they made me feel. I wanted to be invincible against the feelings I had when that girl I had a crush on in 5th grade said, “No thanks, you’re too fat for me” after I finally worked up the courage to ask her to be my girlfriend; instead, I ran away and cried in the boy’s bathroom during second period. I wanted to be invincible when my youth football coach called me a “pussy” because I got hit and I said it hurt; instead, I questioned why feeling pain made me less of a man.

All these feelings, emotions and a twisted view of masculinity had a hold on me. Rather than accept and process my emotions, I learned to ignore and compartmentalize them. I kept my issues and pains to myself and tried my hardest to push them down as deep and far away from the surface as I could.

Then, the day came when the flood couldn’t be held back any longer and the levees broke. For so long I had hidden my pain, my confusion, my depression and I had become good at pretending to be “okay” with everything life was throwing at me. But one day it was not “okay” anymore. My mental illness had been ignored for so long and it would not be quieted any longer.

I couldn’t find any more strength or courage or fight just to keep those around me from finding out how bad I truly felt. I was so conditioned to “man up” that when the pain, sorrow and thoughts of suicide ran through my mind, I had no answer. I couldn’t yell or puff my chest at depression. Depression didn’t care how much I could lift or what car I drove or how many girls I had been with. Depression knew the real me. It knew the little boy who could never face his real problems head-on because the society in which he grew up wouldn’t let him. He was too busy pretending to be strong, too busy pretending to be a “man” to admit he lived with depression.

After my attempted suicide and rehabilitation, things started to become clearer. I learned that pain, sorrow, anger and sadness are a part of life—emotions don’t care if you are a man or woman or household pet. For the first time, I could accept and acknowledge my weaknesses and my pain. Finally, I found myself and have never felt stronger or more of a man.

Coming out about my depression was one of the most freeing and courageous things I have ever done. No longer am I silent or fearful about who I really am. I am comfortable and confident enough in myself to accept and face my demons. I’m no longer ashamed of my depression. And being self-aware and brave enough to face my emotions fills me with more manly strength and pride than any action hero ever did.

I can now step in front of my mental illness and accept it as a part of me, instead of always living in its shadow. And I’m here to tell you fellas to be bold and fearless about who you are. Be strong enough to admit your pains. Be courageous to acknowledge your struggles—regardless of how “un-manly” they may seem.

Depression affects 6 million men per year. So, next time you’re in the locker room talking, I hope that the conversation becomes deeper than football plays and girls. For being a man is what we men make it.

 

Rob “Roro” Asmar is a chef and restaurateur in the DC area. He passionately advocates for mental health through his volunteer and awareness raising efforts and seeks to break the stigma surrounding mental health & men. His open and positive attitude are expressed through his social media platform @RoroMeetsWorld where you can find his cooking and refreshing take on life. 

https://www.nami.org/Blogs/NAMI-Blog/March-2018/How-Depression-Made-Me-a-Man

Record Numbers of College Students Are Seeking Treatment for Depression and Anxiety — But Schools Can’t Keep Up

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Not long after Nelly Spigner arrived at the University of Richmond in 2014 as a Division I soccer player and aspiring surgeon, college began to feel like a pressure cooker. Overwhelmed by her busy soccer schedule and heavy course load, she found herself fixating on how each grade would bring her closer to medical school. “I was running myself so thin trying to be the best college student,” she says. “It almost seems like they’re setting you up to fail because of the sheer amount of work and amount of classes you have to take at the same time, and how you’re also expected to do so much.”

At first, Spigner hesitated to seek help at the university’s counseling center, which was conspicuously located in the psychology building, separate from the health center. “No one wanted to be seen going up to that office,” she says. But she began to experience intense mood swings. At times, she found herself crying uncontrollably, unable to leave her room, only to feel normal again in 30 minutes. She started skipping classes and meals, avoiding friends and professors, and holing up in her dorm. In the spring of her freshman year, she saw a psychiatrist on campus, who diagnosed her with bipolar disorder, and her symptoms worsened. The soccer team wouldn’t allow her to play after she missed too many practices, so she left the team. In October of her sophomore year, she withdrew from school on medical leave, feeling defeated. “When you’re going through that and you’re looking around on campus, it doesn’t seem like anyone else is going through what you’re going through,” she says. “It was probably the loneliest experience.”

Spigner is one of a rapidly growing number of college students seeking mental health treatment on campuses facing an unprecedented demand for counseling services. Between 2009 and 2015, the number of students visiting counseling centers increased by about 30% on average, while enrollment grew by less than 6%, the Center for Collegiate Mental Health found in a 2015 report. Students seeking help are increasingly likely to have attempted suicide or engaged in self-harm, the center found. In spring 2017, nearly 40% of college students said they had felt so depressed in the prior year that it was difficult for them to function, and 61% of students said they had “felt overwhelming anxiety” in the same time period, according to an American College Health Association survey of more than 63,000 students at 92 schools.

As midterms begin in March, students’ workload intensifies, the wait time for treatment at counseling centers grows longer, and students who are still struggling to adjust to college consider not returning after the spring or summer breaks. To prevent students from burning out and dropping out, colleges across the country — where health centers might once have left meaningful care to outside providers — are experimenting with new measures. For the first time last fall, UCLA offered all incoming students a free online screening for depression. More than 2,700 students have opted in, and counselors have followed up with more than 250 who were identified as being at risk for severe depression, exhibiting manic behavior or having suicidal thoughts.

Virginia Tech University has opened several satellite counseling clinics to reach students where they already spend time, stationing one above a local Starbucks and embedding others in the athletic department and graduate student center. Ohio State University added a dozen mental health clinicians during the 2016-17 academic year and has also launched a counseling mobile app that allows students to make an appointment, access breathing exercises, listen to a playlist designed to cheer them up, and contact the clinic in case of an emergency. Pennsylvania State University allocated roughly $700,000 in additional funding for counseling and psychological services in 2017, citing a “dramatic increase” in the demand for care over the past 10 years. And student government leaders at several schools have enacted new student fees that direct more funding to counseling centers.

But most counseling centers are working with limited resources. The average university has one professional counselor for every 1,737 students — fewer than the minimum of one therapist for every 1,000 to 1,500 students recommended by the International Association of Counseling Services. Some counselors say they are experiencing “battle fatigue” and are overwhelmed by the increase in students asking for help. “It’s a very different job than it was 10 years ago,” says Lisa Adams Somerlot, president of the American College Counseling Association and director of counseling at the University of West Georgia.

As colleges try to meet the growing demand, some students are slipping through the cracks due to long waits for treatment and a lasting stigma associated with mental health issues. Even if students ask for and receive help, not all cases can be treated on campus. Many private-sector treatment programs are stepping in to fill that gap, at least for families who can afford steep fees that may rise above $10,000 and may not be covered by health insurance. But especially in rural areas, where options for off-campus care are limited, universities are feeling pressure to do more.

‘I needed something the university wasn’t offering’

At the start of every school year, Anne Marie Albano, director of the Columbia University Clinic for Anxiety and Related Disorders (CUCARD), says she’s inundated with texts and phone calls from students who struggle with the transition to college life. “Elementary and high school is so much about right or wrong,” she says. “You get the right answer or you don’t, and there’s lots of rules and lots of structure. Now that [life is] more free-floating, there’s anxiety.”

That’s perhaps why, for many students, mental health issues creep up for the first time when they start college. (The average age of onset for many mental health issues, including depression and bipolar disorder, is the early 20s.)

Dana Hashmonay was a freshman at Rensselaer Polytechnic Institute in Troy, New York in 2014 when she began having anxiety attacks before every class and crew practice, focusing on uncertainties about the future and comparing herself to seemingly well-adjusted classmates. “At that point, I didn’t even know I had anxiety. I didn’t have a name for it. It was just me freaking out about everything, big or small,” she says. When she tried to make an appointment with the counseling center, she was put on a two-week waitlist. When she finally met with a therapist, she wasn’t able to set up a consistent weekly appointment because the center was overbooked. “I felt like they were more concerned with, ‘Let’s get you better and out of here,’” she says, “instead of listening to me. It wasn’t what I was looking for at all.”

During her freshman year, Hashmonay sought out help on campus after she started having anxiety attacks before her classes and crew practices.
Eva O’Leary for TIME

Instead, she started meeting weekly with an off-campus therapist, who her parents helped find and pay for. She later took a leave of absence midway through her sophomore year to get additional help. Hashmonay thinks the university could have done more, but she notes that the school seemed to be facing a lack of resources as more students sought help. “I think I needed something that the university just wasn’t offering,” she says.

A spokesperson for Rensselaer says the university’s counseling center launched a triage model last year in an effort to eliminate long wait times caused by rising demand, assigning a clinician to provide same-day care to students presenting signs of distress and coordinate appropriate follow-up treatment based on the student’s needs.

Some students delay seeing a counselor because they question whether their situation is serious enough to warrant it. Emmanuel Mennesson says he was initially too proud to get help when he started to experience symptoms of anxiety and depression after arriving at McGill University in Montreal in 2013 with plans to study engineering. He became overwhelmed by the workload and felt lost in classes where he was one student out of hundreds, and began ignoring assignments and skipping classes. “I was totally ashamed of what happened. I didn’t want to let my parents down, so I retreated inward,” he says. During his second semester, he didn’t attend a single class, and he withdrew from school that April.

For many students, mental health struggles predated college, but are exacerbated by the pressures of college life. Albano says some of her patients assume their problems were specific to high school. Optimistic that they can leave their issues behind, they stop seeing a therapist or taking antidepressants. “They think that this high school was too big or too competitive and college is going to be different,” Albano says. But that’s often not the case. “If anxiety was there,” she says, “nothing changes with a high school diploma.”

Counselors point out that college students tend to have better access to mental health care than the average adult because counseling centers are close to where they live, and appointments are available at little to no cost. But without enough funding to meet the rising demand, many students are still left without the treatment they need, says Ben Locke, Penn State’s counseling director and head of the Center for Collegiate Mental Health.

The center’s 2016 report found that, on average, universities have increased resources devoted to rapid-access services — including walk-in appointments and crisis treatment for students demonstrating signs of distress — since 2010 in response to rising demand from students. But long-term treatment services, including recurring appointments and specialized counseling, decreased on average during that time period.

“That means that students will be able to get that first appointment when they’re in high distress, but they may not be able to get ongoing treatment after the fact,” Locke says. “And that is a problem.”

‘We’re busier than we’ve ever been’

In response to a growing demand for mental health help, some colleges have allocated more money for counseling programs and are experimenting with new ways of monitoring and treating students. More than 40% of college counseling centers hired more staff members during the 2015-16 school year, according to the most recent annual survey by the Association for University and College Counseling Center Directors.

“A lot of schools charge $68,000 a year,” says Dori Hutchinson, director of services at Boston University’s Center for Psychiatric Rehabilitation, referring to the cost of tuition and room and board at some of the most expensive private schools in the country. “We should be able to figure out how to attend to their whole personhood for that kind of money.”

At the University of Iowa, Counseling Director Barry Schreier increased his staff by nearly 50% during the 2017-18 academic year. Still, he says, even with the increase in counseling service offerings, they can’t keep up with the number of students coming in for help. There is typically a weeklong wait for appointments, which can reach two weeks by mid-semester. “We just added seven full-time staff and we’re busier than we’ve ever been. We’re seeing more students,” Schreier says. “But is there less wait for service? No.”

The university has embedded two counselors in dorms since 2016 and is considering adding more after freshmen said it was a helpful service they would not have sought out on their own. Schreier also added six questions about mental health to a freshman survey that the university sends out several weeks into the fall semester. The counseling center follows up with students who might need help based on their responses to questions about how they’d rate their stress level, whether they’ve previously struggled with mental health symptoms that negatively impacted their academics, and whether they’ve ever had symptoms of depression or anxiety. He says early intervention is a priority because mental health is the number one reason why students take formal leave from the university.

As colleges scramble to meet this demand, off-campus clinics are developing innovative, if expensive, treatment programs that offer a personalized support system and teach students to prioritize mental wellbeing in high-pressure academic settings. Dozens of programs now specialize in preparing high school students for college and college students for adulthood, pairing mental health treatment with life skills classes — offering a hint at the treatments that could be used on campus in the future.

When Spigner took a medical leave from the University of Richmond, she enrolled in College Re-Entry, a 14-week program in New York that costs $10,000 and aims to provide a bridge back to college for students who have withdrawn due to mental health issues. She learned note-taking and time management skills in between classes on healthy cooking and fitness, as well as sessions of yoga and meditation.

Mennesson, the former McGill engineering student, is now studying at Westchester Community College in New York with the goal of becoming a math teacher. During his leave from school, he enrolled in a program called Onward Transitions in Portland, Maine that promises to “get 18- to 20-somethings unstuck and living independently” at a cost of over $20,000 for three months, where he learned to manage his anxiety and depression.

Another treatment model can be found at CUCARD in Manhattan, where patients in their teens and early 20s can slip on a virtual reality headset and come face-to-face with a variety of anxiety-inducing simulations — from a professor unwilling to budge on a deadline to a roommate who has littered their dorm room with stacks of empty pizza boxes and piles of dirty clothes. Virtual reality takes the common treatment of exposure therapy a step further by allowing patients to interact with realistic situations and overcome their anxiety. The center charges $150 per group-therapy session for students who enroll in the four-to-six-week college readiness program but hopes to make the virtual reality simulations available in campus counseling centers or on students’ cell phones in the future.

This virtual reality program — developed by Headset Health in partnership with the Columbia University Clinic for Anxiety and Related Disorders — allows students to confront their anxiety in a simulated college scenario.
Courtesy The Headset Health

 

Hashmonay, who has used the virtual reality software at the center, says the scenarios can be challenging to confront, “but the minute it’s over, it’s like, ‘Wow, OK, I can handle this.’ She still goes weekly to therapy at CUCARD, and she briefly enrolled in a Spanish course at Montclair State University in New Jersey in January. But she withdrew after a few classes, deciding to get a job and focus on her health instead of forcing a return to school before she is ready. “I’m trying to live life right now and see where it takes me,” she says.

Back at the University of Richmond for her senior year, Spigner says the attitude toward mental health on campus seems to have changed dramatically since she was a freshman. Back then, she knew no one else in therapy, but most of her friends now regularly visit the counseling center, which has boosted outreach efforts, started offering group therapy and mindfulness sessions, and moved into a more private space. “It’s not weird to hear someone say, ‘I’m going to a counseling appointment,’ anymore,” she says.

She attended an open mic event on Richmond’s campus earlier this semester, where students publicly shared stories and advice about their struggles with mental health. Spigner, who meets weekly with a counselor on campus, has become a resource to many of her friends because she openly discusses her own mental health, encouraging others not to be ashamed to get help.

“I’m kind of the go-to now for it, to be honest,” she says. “They’ll ask me, ‘Do you think I should go see counseling?’” Her answer is always yes.

By Katie Reilly

http://time.com/5190291/anxiety-depression-college-university-students/

Writing Tips That Can Reduce Symptoms

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In 1985, psychologist James W. Pennebaker theorized that the effort it takes to hold back our thoughts and feelings serves as a stressor on our bodies. By confronting these thoughts and acknowledging our emotions, we can reduce the stress and negative impact on our bodies. The result? We feel better.

One of the best ways to confront our feelings is through writing. Decades of research have suggested that expressive writing can help improve mood, increase psychological well-being, reduce depressive symptoms, decrease PTSD avoidance symptoms, reduce days spent in a hospital and improve immune system functioning (to name a few).

Writing a letter or journaling is not a new concept; in fact, for many, it’s a fading art form. With all the recent technological advancements, individuals are no longer opting for the standard pen-and-paper means to express feelings, ideas and thoughts. Instead, it’s become much more common to use social media to express “tip-of-the-iceberg” feelings.

For someone with mental illness, taking time beyond a social media post to write expressively can be very helpful to your well-being. Below are a few ways you can use expressive writing practices to reduce mental health symptoms and improve overall well-being.

Focus On A Specific Subject

A study conducted by the University of Los Angeles found that participants who wrote in detail about a particular stressor showed the most improvement versus writing about general facts of a stressful event. Participants who did not just recount events but rather wrote about how they felt about the event had marked improvement in their health.

This means: You should write about a specific experience and all its features—how it made you feel, and any thoughts or ideas you had as result. Don’t just rehash what happened.

Give Yourself Time

By dedicating a set amount of time to write, you can dive deeper into your feelings and experiences rather than just brush the surface. Studies have reported that short writing sessions have less impact on improved feelings/emotions in the long run. Giving yourself a focused time, day and schedule to write improves the ability for your mind to dive deeper into processing your feelings.

This means: Try to set aside at least 15–20 minutes a day to write, and try to do it consistently for two to three days in a row. Allow time after writing to collect yourself before moving on to other tasks.

Don’t Worry About Grammar Or Spelling

When writing a research paper or dissertation, spelling and grammar are crucial. However, this isn’t the case for expressive writing exercises. Worrying about grammar and spelling tends to pull an individual’s mind out of the free, conscious “space” they are trying to experience.

This means: Ignore the rules and write without stopping to re-read or edit what you have so far.

Use Positive Words

Using words like “because,” “realize” and “understand” helps increase the positive effects of the exercise. Studies found that writing that included “positive-emotion” words had higher rates of improved health. Words such as hope, love, anticipation and awe are also good words to consider using.

This means: The words you use matter. After writing, identify the number of positive words in your writing. You can also visit www.liwc.wpengine.com and paste your text into their system and see how your writing is translated in a positive or negative sense.

Seek Support

While extensive studies have been conducted, there is still much to learn about the implications of writing about emotional topics such as PTSD, anxiety or depression. Therefore, if possible, seek support from a mental health professional to help you through any challenges that may arise during these exercises. It’s important to have resources available while you uncover feelings and emotions through the writing process.

The art of expressive writing has been researched and studied for decades, and the findings demonstrate that it has a positive impact on symptom reduction and overall well-being for participants who use the process as it was intended. Consider the above five tips when beginning your “writing to wellness” journey.

 

Steven Swink has his Master’s degree in counseling psychology and has been working in the field of mental health since 2009. He has provided direct counseling services and provides supervisory-level work in the mental health field overseeing various programs and service delivery to consumers. In addition to his mental health experience, Steven is co-founder and CEO of www.Letyr.com, a platform for people to anonymously share their ideas, beliefs and feelings in a safe and confidential way.

https://www.nami.org/Blogs/NAMI-Blog/February-2018/Writing-Tips-that-Can-Reduce-Symptoms

Being The Person My 13-Year-Old Self Needed

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It started when I was 13; unbeknownst to me, I was dealing with depression and anxiety. During seventh grade, I was bullied quite a bit. I can clearly remember one time—a few girls were verbally ganging up on me at a lunch table in the cafeteria. Since I was cornered at the table, it was on the brink of getting physical.

Luckily, I had a friend who wasn’t afraid to stick up for me. She was so upset that she slammed the lollipop she had in her mouth on the lunch table and said, “You aren’t going to talk to Brooke like that!” She started arguing with the group of girls and I got up and ran down the hallway into the bathroom and started sobbing. For a week after, I stayed in my favorite teacher’s room, too scared to go back to lunch with everyone else.

When I was 13, I started to harm myself. This lasted for a few years between middle school and high school. Many people ask me, “How could you do that to yourself? How did that make you feel better?” Well, I was hurting so much inside. I didn’t know how to come up from that dark place. I lost interest in everything. I was constantly feeling guilty about everything I did. I felt inadequate. I had negative thoughts racing through my head every second of every day. I didn’t know how to stop it. So, to me, outside pain was the only pain I could control.

There’s a behavioral health center for young adults in my town. I can remember the time I took a pamphlet to an adult hinting that I should go there for help. They said, “You’re too young to be depressed.” I had taken a “Do you think you’re depressed?” test online, and I had checked yes to many of the listed symptoms. I printed the paper off and showed that to them as well. To no surprise, they expressed that I was being dramatic.

Later on, I made an appointment with my guidance counselor. I was crying as she asked me if I ever had suicidal thoughts or if I had ever harmed myself. I said “no” because I felt that if I told her “yes,” I would get in trouble. I didn’t feel safe telling her everything. I left and went back to class with dried tears and a sense of hopelessness.

See, I’m known for having a very outgoing personality. I was always the student who participated in many activities, volunteered, played sports, led the cha-cha slide at the school dances—a social butterfly. So, to other people, I didn’t “fit the mold” of someone who was depressed.

Fast-forward six years: I was diagnosed with depression and anxiety. It was six years of feeling completely alone. Six years of feeling like I was the only person that felt the way I did. Six years of feeling helpless.

I couldn’t sit still without answers, so I dedicated time to research how chemical imbalances in the brain affect us. I learned that so many other people are affected by mental illness as well. Then I thought, “If there are so many people with similar issues, why aren’t more people talking about it?!”

So, I started a project called Crowning Confidence, geared towards young adults experiencing mental health issues and bullying. It all started after I saw a Facebook post by a mother of a 7-year-old girl named Hayden who was being harshly bullied. As Miss Alaska USA, I felt I couldn’t have this go unnoticed. I reached out to her mother and asked if there was anything I could do to lift Hayden’s spirits. She expressed that her daughter loved princesses. Taking that as inspiration, I made her a video message with affirmations and tips on how to deal with bullies. I then proclaimed her honorary Queen Hayden and sent her a crown. I told her that whenever she felt down, she could always put on her crown to bring herself up.

My experience with Hayden propelled me to become the person my 13-year-old self needed, and start Crowning Confidence for all the amazing girls out there in similar situations. This project came full circle for me when I had the opportunity to bring it into my old middle school. In my favorite teacher’s class that I used to hide in all those years ago, I was able to speak to young ladies about self-esteem, mental health and give them all their own crowning moment. I want to do the same in as many schools and organizations as possible.

Ultimately, no one is to blame for my experience. I tried to reach out when I was younger, but they just didn’t know what to do, or the signs or symptoms of mental illness. That is why I am here. I want to make a positive and open space for people to speak and ask questions about mental illness. Increasing awareness and opening up conversations will allow more people to have access to necessary mental health information.

With more information, people can receive the proper help they need, no matter how old they are. I sometimes think of how different my life would have been if I had more information, but then again, I was supposed to go through this journey, because now I know how it feels and I can use my experiences and platform to help people—especially young adults—who feel they have no one to reach out to.

Brooke Johnson is Miss Alaska USA 2018, a NAMI Ambassador and an actress. You can keep up with everything she’s up to at www.brookej.com. She recently started a YouTube channel for people to follow her Crowning Confidence Project, Mental Health Awareness Platform and her journey to Miss USA. Follow her blog/vlog here.

https://www.nami.org/Blogs/NAMI-Blog/January-2018/Being-the-Person-My-13-Year-Old-Self-Needed

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 Power Of Pet Therapy

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I remember when I was seven, my Great-Uncle Benji said to my parents, “Allison needs a dog.” It was at that time, my life changed. I was a very quiet, reserved kid, but dogs brought me out of my shell. They were with me during good times, painful times and major life events—and loved me no matter how I reacted to these situations. They remained stable forces in my life, even during the darkest turmoil.

Nowadays, I work with clients who live with depression, anxiety and addictions, and they don’t always feel like there is hope. It’s hard for them to see light in the midst of their darkness, and peace seems so far away. But when I use my dogs during pet therapy visits, I see how animals brighten up a person’s mood, even if it’s for a short time. That moment allows a small trickle of light into that person’s heart, which may not have been there before.

During one session in particular, a client asked if she could get on the floor because she wanted to talk to my therapy dog about something “very important.” She buried her head into my dog’s fur and talked about the horrible week she had endured. Stroking my dog’s fur, my client was overcome with a sense of calm in a way I could not have accomplished by merely talking with her. No judgments, no expectations—just a furry hug.

When we’re facing despair, loneliness, chronic health issues, depression, addictions, or anything beyond our ability to cope, a pet can help ease the pain. He or she can give us a reason to get out of our thoughts to focus on a sense of purpose. The relationship we have with our pets is real and symbiotic—what I give to my pets comes back to me in ways that can’t be measured.

Research shows the benefits of pet therapy (in fact, its first known use dates back to the 9th century!). Boris Levinson was the first clinician to truly introduce the value of animals in a therapeutic environment. In the 1960s, Levinson reported that having his dog present at talk therapy sessions led to increased communication, increased self-esteem and increased willingness to disclose difficult experiences. Ever since, people have been turning to pets for comfort and support during periods of emotional turmoil. Hugging and speaking with a pet who won’t judge you for your feelings or thoughts is cathartic and helps people get through rough times. Pets also reduce symptoms of anxiety or depression, giving people a reason to get up in the morning. Other benefits are unconditional love, acceptance, a “buddy” that encourages physical activity, which leads to healthier lifestyles.

If you’re unable to own a pet, there are many ways to reap the benefits of a pet relationship. Volunteering at a local shelter or helping rescue groups or pet therapy organizations such as Pet Partners (a national organization that promotes positive human-animal interactions) are ways to save pets’ lives, and possibly your own.

By Allison White, ACSW, LCSW, CCDP-D

https://www.nami.org/Blogs/NAMI-Blog/November-2016/The-Power-of-Pet-Therapy

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

10 Soothing Self-Care Tips Straight From Therapists

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Therapists spend so much time helping other people with their mental health, it kind of begs the question: how do they look after their own?

Like, on the one hand, they’re obviously well-equipped with the mental health know-how to look after themselves, but on the other, spending all day sitting with people and their mental health problems can’t be easy.

To get some answers, BuzzFeed Health asked 10 therapists what self-care means to them. Here’s what they shared:

Cathryn Laverly / Unsplash

1.

“I keep thinking about how different self-care would be depending on what therapist you ask. My coworker who has three children to go home to is going to have a different version of self-care than my coworker who runs her own side business on top of a full-time job. For some, self-care means quality time with family, unwinding from mindless television at the end of a long day, planning vacation times, and participating in social activities outside of work, all offering a different reward.

For myself, I have always found most of my self-care — my refueling — in more introverted activities. I do my best when I get to listen to meditations that ground me on a daily basis, step out into nature, spend time taking care of my own personal to do list, etc.”

—Beth Rue, MSS, LSW, primary therapist at Summit Behavioral Health

2.

“I think a lot of helping professionals find it second-nature to guide and support others on their life journeys while we can easily lose ourselves in the mix. What helps me immediately during and after an emotionally challenging day is to use humor to lighten things up for myself. Sometimes that means cracking jokes with colleagues to lessen the stress felt that day, or having a light-hearted and humorous conversation with someone who ‘gets me’ and my sense of humor, or watching a show or film I know I will get a kick out of to make myself laugh. Laughing out loud is a powerful antidote to emotional distress that always helps me lift my spirit.”

—Gabriela Parra, LCSW, California-based clinical social worker

HS Lee / Unsplash / Via unsplash.com

3.

“Most important to me is being aware of what’s going on for me at any given time. Being honest with myself about where I am emotionally, and what might make me more sensitive or less objective than usual — what might make me not be able to do my best work. I accept that I am human and may have humanly imperfect reactions to things, but I have to stay on top of them to keep them from getting in the way.

I also like to create a buffer between work and home: taking some time after my sessions just to decompress and clear my mind, even if brief, before I immediately sail into Mom/Wife/Friend mode with the people in my life. And of course, above all, I have to keep taking care of myself: practice what I preach in terms of having hobbies, being active, getting outdoor time, prioritizing sleep (this one can be tough!) and staying social with the people whose company I enjoy.”

—Andrea Bonior, PhD, clinical psychologist and author of Psychology: Essential Thinkers, Classic Theories, and How They Inform Your World

4.

“I try to take care of myself physically by going to the gym regularly and exercising. Working out gives me a tremendous boost in how I feel physically and mentally. I also practice what I preach, which is not to compare myself to others. It is important not to project onto other people thoughts that their lives are so much better than my life or that I have am not successful because I have not accomplished what others may have achieved.”

—Marc Romano, PsyD, director of medical services at Delphi Behavioral Health

Autumn Goodman / Unsplash / Via unsplash.com

5.

“Quite similar to self-care for everyone else. A multi-vitamin is incredibly important for self-care for me. Work-wise, mixing my daily tasks with learning and upgrading my skills. Going for an evening walk is really important for me too. I take my child to the park for a run around and then put her in the stroller and do my own walk.”

—Alice Boyes, PhD, former clinical psychologist and author of The Anxiety Toolkit

6.

“A go-to for me in order to decompress and recharge is getting out in nature. Nature-therapy, as I like to call it, allows me to be in the moment, check in with myself, connect with the world around me, and get some much needed fresh air. The benefits of spending time in nature are unbe-leaf-able (!) as it is a proven way to calm the mind and body!”

—Joanna Boyd, MCP, RCC, Vancouver, Canada-based clinical counsellor

Matt Aunger / Unsplash / Via unsplash.com

7.

“For me, self-care means being fully engaged with a client when we’re together, giving all I can through my attention, care, and planning, and then letting them return to their life when the day is done as I turn my attention back to my own needs. Many years ago I realized that taking my work home stemmed from a lack of trust. I felt I didn’t give enough in the sessions and needed to worry to make up for it. But this wasn’t true. I found that I needed to trust that I’m giving all I can to my clients, trust that they are capable of healthy growth and self-care, and trust in the therapeutic process; that our collaboration is a force for good.

Of course, there are exceptional cases that require work beyond the session, and I often think of my clients when I’m off the clock, but I’m able to enjoy my down time more when I embrace trust. When I have trust in myself, my clients, and therapy, I can pivot to enjoy time with my family, working out, playing in my rock band, and continuing my weekly quest to create the world’s best spaghetti sauce.”

—Ryan Howes, PhD, clinical psychologist and professor at Fuller Graduate School of Psychology

8.

“Much of my self-care involves activities that help me to feel calm, strong, and connected – all important things in my line of work. I spend a lot of quiet time in nature, which helps me to slow things down and calm both my body and my mind. I also really love group fitness classes, which help me to feel strong both inside and out, and ready to support my clients through the most challenging of moments. Perhaps most importantly, I spend time with friends and family, with whom I feel loved and supported. When things become difficult or overwhelming, they help me find perspective, sometimes simply with a much needed laugh.”

—Amanda Zayde, PsyD, New York City-based clinical psychologist

Alice Hampson / Unsplash / Via unsplash.com

9.

“It’s so important for us to practice what we preach! Namely, having a balanced life that includes time with friends and family, getting a good night’s sleep and eating well, exercising, and doing things just for me (e.g., reading a good summer novel, cheering on my Tennessee Titans games, etc.). It’s also incredibly valuable to have a trusted mentor or two to seek guidance from when things have been particularly stressful.”

—Simon Rego, PsyD, chief psychologist at Montefiore Medical Center/Albert Einstein College of Medicine

10.

“I try to practice exactly what I recommend my clients: at least a few minutes of daily mindfulness practice, a daily gratitude minute, regular exercise (like 4-5 times/week), and time with people. There are so many incredible benefits to learning to enter the moment, turn towards the positive, develop a sense of accomplishment, and experience connections.

People do ask me about the difficulty of sitting with people in pain. Of course I empathize and it is hard to hear about how deeply some of my clients are struggling. That said, I find my job to be an opportunity. I totally believe evidence-based tools can change people’s lives so generally feel lucky and hopeful that people are courageous and that the science of psychology has evolved in a significant way.”

—Jennifer L. Taitz, PsyD, LA-based clinical psychologist

By the way, if you’re feeling curious about therapy yourself, you can learn more about how to start here, since pretty much everyone can benefit from talking to a professional. For more information on free and affordable mental health care options, check out this guide.

By Anna Borges

https://www.buzzfeed.com/annaborges/therapist-self-care?utm_term=.rsy887jd15#.yo5kk1OXvL

How Invalidating My Bipolar Disorder Invalidates Me

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It has been almost two years since I was diagnosed with schizoaffective disorder, bipolar disorder, ADHD and generalized panic disorder. I can be pretty open about mental health and my diagnosis. However, I almost never share the more extreme parts of my illness, or I hide it completely due to the stigmas attached to it.

After years of being misdiagnosed and going on and off antidepressants, I was finally given the diagnosis of bipolar disorder. That was a huge breakthrough for me. It made the way I felt and the severe mood swings I would experience feel validated. There was a reason. I now had words to explain what I was going through: mania, depression, hypomania.

I now know why all of the medications I’ve tried over the years never worked for me. Like most people with bipolar, I had been diagnosed consistently with depression and anxiety disorder. The reason for this common misdiagnosis is due to the fact that most people with bipolar don’t acknowledge or recognize the mania. For many—not all—mania is relief from the depression. You feel good, productive, accomplished, unstoppable. However, the mania can also be dangerous and is always met with an inevitable crash because your body can’t withstand that type of exertion without rest. So, when I would plunge into severe depression and couldn’t take it anymore, I would go see a doctor.

The antidepressants never worked, and the antianxiety medications made me a zombie. Often times, I would get worse, but the doctors always told me it was because I stopped taking the medications. I found out recently that antidepressants can actually throw someone with bipolar into mania or depression. Again, I finally felt validated.

Still, I found that the validation I felt, or the acceptance of this diagnosis, was not felt by everyone. There are many reasons for this: lack of knowledge, bias, misconceptions, etc. Below are some of the responses I have received after telling people about my bipolar diagnosis. Some people have been supportive, some well-intentioned, others ignorant, or just plain hurtful. A few of the responses I have received are listed below.

“You don’t have bipolar.” “You seem normal.” You don’t seem crazy.”

I’m not crazy. I have a mental illness. I don’t announce it to the world when I can’t get out of bed for 48+ hours or that the reason I have recently taken up so many hobbies or work so many hours is actually one of the many, many symptoms of a manic episode.

“You didn’t seem like you had bipolar until you were diagnosed.”

This one hurts a lot. I have finally, for once in my life, had my feelings and emotions validated. I understand better why I am the way I am, and for the first time, I can actually work towards a proper plan to treat it, or minimize it. I was also very good at hiding it most of the time. This response completely crushes that feeling.

My mania was controlled by being massively sedated, and I learned that no one wants to talk to you when you’re depressed, so I would just disappear during those times. Now, I am learning to cope and experience the emotions and moods that come with my illness.

Now, I must learn to cope and experience the emotions and moods that come with my illness. I am experiencing a lot mentally, emotionally, and physically due to new medications, quitting antianxiety medications and actually being allowed to claim bipolar and feel it’s heavy full weight and the burden it bears. This means those mood swings, emotions and deceptive thoughts must be felt for the first time in a long time and that’s extremely challenging to say the least.

I talk about it because I trust you, I need support, or I want to explain why I have been acting the way I have lately. Having bipolar disorder can put a massive strain on relationships. There’s nothing worse than seeing its effects and not knowing how to stop it.

“I feel like bipolar is just an excuse.”

I am responsible for my actions. I will own up to those actions, accept that I am accountable, and work as hard as I can to fix it. It’s not an excuse, but it is a cause. A lot of times, especially in the past, everything is blurred by the mania or depression, and I don’t see the effects of my actions until clarity returns.

Believe me, it’s as frustrating for me as it is for you. The guilt, shame and self-hate can be so real. This is why many of us end up isolating ourselves. Sometimes I feel that all I do is apologize, even if I don’t know why. I know that this makes it seem less sincere, but I can’t control the intense feelings of guilt. Don’t be afraid to tell me when I’m doing something wrong or if my moods are affecting you. I don’t want to make you feel the way that I do. But don’t tell me that bipolar is just an excuse. It’s a reason, and I want you to know that sometimes the bipolar causes me to act in a way that is not me. I have been working on it desperately.

“That’s the bipolar talking.” “Have you taken your meds?” “Maybe you’re just imagining it.”

My feelings are real and not always a symptom of my mental health condition. Everyone gets angry, sad, excited, passionate, etc. Believe it or not, my emotions are not always synonymous with my illness.

“You don’t need medication.” “Just think positive.” “Just calm down.” “You need to do yoga.”

You have no idea how frustrating and exhausting the years of trial and error in medications and treatment are, or how frightening the side effects of certain medications can be. Still, I continued to seek treatment because the symptoms of not treating the illness were far worse. I held that mentality before. “I don’t need meds. I feel fine.” This was typically when manic. I was wrong. Even though there are many other things I do to help manage, I do also need medication.

A lot changed for me after coming off of antidepressants and benzodiazepines. I had more energy. I talked faster than I already did. I wanted to do and accomplish more. I was more excitable. I was more agitated. I would get easily frustrated. For good and for bad, a lot of the symptoms haven’t and will never completely go away. I would take things out on my husband, my mom, my family, and my friends without realizing it, or I completely isolate myself when I do.

I was prescribed medication to treat my ADHD. Now, not only was I dealing with the stigma of having bipolar, but now I had to deal with the stigma of the medication to anyone who knew. People started looking at me differently and attributing a lot of my actions, and even accomplishments, to either the illness or my medication. “That’s why you’re so productive.” “That’s why you’re so sped up.” “You don’t need that.”

Actually, I do. It doesn’t affect me in the same way that it affects people who don’t have ADHD. I’ve always had a hard time focusing, sitting in one place, being on time, staying on task. This gets even worse when I’m manic. Medication isn’t a cure all, but it can help manage the extremes of my condition. You’re not in my head.

Before my medication, there were times that I would self-medicate. I would drink too much, or make reckless decisions. The guilt that would follow would be unbearable. All I would feel is shame. Then the cycle would repeat until periods of stability. This is an impulse and cycle that I do not miss.

For the first time in a long time, I am learning to deal with my feelings, emotions and moods. It hasn’t been easy for me and it hasn’t been easy for those close to me. For that, I am sorry. The ones that stuck around, were there to listen, or to offer support, have been critical in this journey. Mental illness can be extremely lonely.

I am particularly grateful for my husband. He bears the brunt of my illness the most and it kills me. He does it graciously. He’s understanding. He doesn’t take it personally when I’m in a mood. He doesn’t judge. He listens. He encourages me to get better. He has had such a positive impact on my life, my health, and my happiness along this journey. I am in awe of his patience, supportiveness, and kindness. I appreciate him more than he will ever know.

“I wouldn’t tell anyone you have it. They’ll judge you and treat you differently.” “I wouldn’t tell your boss. It could affect your job.”

Sadly, this is often true. I’ve experienced it first hand and usually the ones who give this response are others that have dealt with the repercussions of disclosing their mental illness. I’ve done this many, many times. I’m quite good at it. I push through it. I smile when I am miserable. I slink off somewhere to manage an anxiety attack. I don’t talk to anyone when I am depressed.

When I reveal it, it is often not met kindly. However, that’s the reason I have decided to talk about it even more. The stigma is there because most keep quiet. This is what emboldens me to share my experiences. You never know who is suffering mentally. You can say you have a physical disease and most often, you are treated with concern or empathy. If you mention a mental disorder, the subject gets changed or the conversation get quiet. It’s an isolating experience.

Bipolar disorder doesn’t define me. There are also many good qualities that I have. I am passionate. I am adventurous. I am inquisitive. I am empathic. I am creative. Most importantly, I am strong.

https://www.nami.org/Personal-Stories/How-Invalidating-My-Bipolar-Disorder-Invalidates-M#

Fear and Anxiety – An Age by Age Guide to Common Fears, The Reasons for Each and How to Manage Them

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It is very normal for all children to have specific fears at some point in their childhood. Even the bravest of hearts beat right up against their edges sometimes. As your child learns more about the world, some things will become more confusing and frightening. This is nothing at all to worry about and these fears will usually disappear on their own as your child grows and expands his or her experience.

In the meantime, as the parent who is often called on to ease the worried mind of your small person, it can be helpful to know that most children at certain ages will become scared of particular things.

When is fear or anxiety a problem?

Fear is a very normal part of growing up. It is a sign that your child is starting to understand the world and the way it works, and that they are trying to make sense of what it means for them. With time and experience, they will come to figure out for themselves that the things that seem scary aren’t so scary after all. Over time, they will also realise that they have an incredible capacity to cope.

Fears can certainly cause a lot of cause distress, not only for the kids and teens who have the fears, but also for the people who care about them. It’s important to remember that fears at certain ages are completely appropriate and in no way are a sign of abnormality.

The truth is, there really is no such thing as an abnormal fear, but some kids and teens will have fears that are more intense and intrusive. Even fears that seem quite odd at first, will make sense in some way.

For example, a child who does not want to be separated from you is likely to be thinking the same thing we all think about the people we love – what if something happens to you while you are away from them? A child who is scared of balloons would have probably experienced that jarring, terrifying panic that comes with the boom. It’s an awful feeling. Although we know it passes within moments, for a child who is still getting used to the world, the threat of that panicked feeling can be overwhelming. It can be enough to teach them that balloons pretend to be fun, but they’ll turn fierce without warning and the first thing you’ll know is the boom. #not-fun-you-guys

Worry becomes a problem when it causes a problem. If it’s a problem for your child or teen, then it’s a problem. When the fear seems to direct most of your child’s behaviour or the day to day life of the family (sleep, family outings, routines, going to school, friendships), it’s likely the fear has become too pushy and it’s time to pull things back.

So how do we get rid of the fear?

If you have a child with anxiety, they may be more prone to developing certain fears. Again, this is nothing at all to worry about. Kids with anxiety will mostly likely always be sensitive kids with beautiful deep minds and big open hearts. They will think and feel deeply, which is a wonderful thing to have. We don’t want to change that. What we want to do is stop their deep-thinking minds and their open hearts from holding them back.

The idea then, isn’t to get rid of all fears completely, but to make them manageable. As the adult in their lives who loves them, you are in a perfect position to help them to gently interact with whatever they are scared of. Eventually, this familiarity will take the steam out of the fear.

First of all though, it can be helpful for you and your child to know that other children just like them are going through exactly the same experience.

An age by age guide to fears.

When you are looking through the list, look around your child’s age group as well. Humans are beautifully complicated beings and human nature doesn’t tend to stay inside the lines. The list is a guide to common fears during childhood and the general age at which they might appear. There are no rules though and they might appear earlier or later.

Infants and toddlers (0-2)

•   Loud noises and anything that might overload their senses (storms, the vacuum cleaner, blender, hair dryer, balloons bursting, sirens, the bath draining, abrupt movement, being put down too quickly).

Here’s why: When babies are born, their nervous systems are the baby versions. When there is too much information coming to them through their senses, such as a loud noise or being put down too quickly (which might make them feel like they’re falling), it’s too much for their nervous systems to handle.

•   Being separated from you.

Here’s why: At around 8-10 months, babies become aware that when things disappear, those things still exist. Before this, it tends to be ‘out of sight, out of mind’. From around 8 months, they will start to realize that when you leave the room you are somewhere, just not somewhere they can see you. This may be the start of them being scared of being separated from you, as they grapple with where you’ve gone, and when you’ll be coming back. During their second year, they begin to understand how much they rely on your love and protection. For a while, their worlds will start and end with you. (Though for you in relation to your little heart stealers, it will probably always be that way.)

•   Strangers.

Here’s why: An awareness of strangers will peak at around 6-8 months. This is a good thing because it means they are starting to recognize the difference between familiar and unfamiliar faces. By this age, babies will have formed a close connection with the ones who take care of them. They will know the difference between you and the rest of the world, not only because of what you look like or the sound of your voice, but also because of what you mean for them. For many babies, strangers and ‘sort of strangers’ – actually anyone outside of their chosen few – will need to move gently. Babies will be sensitive to their personal space and will be easily scared by anyone who quickly and unexpectedly enters that space.

(At this age, separation anxiety and stranger anxiety can be a tough duo for any parent. Your little person doesn’t like being away from you, but they might not be too fond of the person you leave them in the care of. It can be tough, but hang in there – it will end.)

•   People in costume.

Soooo lemme get this right – you’re putting me in front of a big man in a red suit with a white beard the likes I’ve never seen before and you want me to sit on his lap? Nope. Not today. Probably not until I’m like, five. Or 72. Or when I figure that out he brings stuff. Then I might get close enough to tell him want I want, or maybe I’ll throw him a letter or something. And I don’t get the point of the big people-sized rabbits that carry baskets of shiny wrapped thin- … actually, wait. No to the rabbit people. Yes to the shiny wrapped things. Just put them where I can reach them and leave. K?

•   Anything outside of their control (exuberant dogs, a flushing toilet, thunder).

Here’s why: At around age one when your child starts to take little steps, he or she will start to experiment with their independence. This might look like moving small distances away from you or wanting to play with their food or feed themselves. With this, comes an increasing need for them to have a sense of predictability and control over their environment. Anything that feels outside of their control might seem frightening.

Preschoolers (3-4)

•  Lightning, loud noises (the bath draining, thunder, balloons bursting, fireworks, loud barking dogs, trains) and anything else that doesn’t make sense.

Here’s why: They will become very aware of their lack of control in the world. Because of this, they might show a fear of things that seem perfectly innocent to the rest of us to make no sense at all to a grown up. It can be a scary world when you’re new to the job of finding your way in it!

•  Anything that isn’t as it usually is – (an uncle who shows up with a new beard, a grandparent with different colored hair).

Here’s why: It’s hard enough when strangers are strangers, but when favorite people look like strangers … whoa! Familiarity is the stuff of happy days. There’s so much in the world to get used to when you’re fairly new to the job. When things change unexpectedly, it can feel like being back at the beginning and having to get comfortable all over again. Massive ‘ugh’.

•  Scary noises, Halloween costumes, ghosts, witches, monsters living under the bed, burglars breaking into the house, burglars making friends with the monsters living under the bed and ganging up  – and anything else that feeds their hardworking imaginations.

Here’s why: Their imaginative play is flourishing and their imaginations are wonderfully rich. At this age, they will have trouble telling the difference between fantasy and reality.

•  The things they see on television or read in books might fuel their already vivid imaginations and come out as scary dreams. This might bring on a fear of the dark or being alone at night.

Here’s why: At this age, kids can struggle a little to separate fantasy from reality. If they hear a story about a pirate for example, as soon as the lights are out they might imagine Captain-Russell-With-The-Boat-Who-Steals-Toys-From-Sleeping-Kids is waiting under their bed, ready to cause trouble. A calming bedtime routine and happy, pirate-free stories can help to bring on happy zzz’s.

•  People in costume (Santa, the Easter Bunny, story or cartoon characters.)

Here’s why: At this age, grown-ups in dress-ups are no more adorable than they were in the baby days. If Santa doesn’t know what they want, he might just have to work harder, because there’s no way they’ll be telling him in person. Lucky he’s magic and has people on the ground who know the important stuff.

•  Being separated from you or being away from the people or pets they love.

Here’s why:  They might worry that something will happen to themselves, the people they love or a pet, particularly if something happens to someone close to them.

•  The dark and being on their own at night, particularly if they hear a strange sound or see lights or shadows on the wall.

Here’s why: The dark can feel scary at this age. With their imaginations running wild and free, they might put their own explanations to strange night-time noises or shadows on the wall. They might convince themselves that the sound of a moth hitting a light bulb is definitely a robber, because no other explanation makes any sense.

5-6 years.

•  Being separated from you.

Here’s why: At this age, children might show a strong reaction to being separated from one or either or their parents. This comes as they start to see outside of themselves and realize that bad things can happen to the people they love. They might want to avoid school or sleepovers so they can be with you and know that you’re safe and sound.

•  Ghosts, monsters and witches – and anything else that bumps around in their wonderfully vivid imaginations. This can also show itself as a fear of the dark – because we all know the spooky things love it there.

Here’s why: Their imaginations are still hard at work so anything they can bring to life in there will be fuel for fear.

•  The dark, noises, being on their own at night, getting lost, getting sick.

Here’s why: As well as being scared of things that take up precious real estate in their heads, they might also become scared of things could actually happen. These are the sorts of things that might unsettle all of us from time to time.

•  Nightmares and bad dreams.

Here’s why:  Because of the blurred line between fantasy and reality, bad dreams can feel very real and are likely to peak at this age.

•  Fire, wind, thunder, lightning – anything that seems to come from nowhere.

Here’s why: They are still trying to grasp cause and effect and their minds are curious and powerful. They might scare themselves trying to explain where scary things come from. Lightning might mean the sky is about to catch fire. Thunder – who knows – but anything that loud surely doesn’t come in ‘cute’ or ‘chocolate coated’.

7-11 years.

•  Monsters, witches, ghosts, shadows on the wall at night.

Here’s why: Though their thinking is more concrete, children at this age will still have a very vivid imagination.

•  Being at home alone.

Here’s why: They’re still learning to trust the world and their capacity to cope with small periods of time on their own, without you. Staying at home alone might be exciting, scary or both – then there’s that imagination of theirs that might still ambush them at times.

•  Something happening to themselves or the people (or pets) they care about.

Here’s why: They start to understand that death affects everyone at some point and that it’s permanent. They might start to worry about something happening to themselves or the people (or pets) they care about.

•  Being rejected, not liked, or judged badly by their peers (buckle up – this one might stay a while).

Here’s why: This can show up at any age but it might ramp up or towards the end of these years. This is because they will start to have an increased dependence on their friendships as they gear up for adolescence.

Adolescents (12+)

•  What their peers are thinking of them.

One of the primary developmental goals of adolescence is figuring out how they are and where they fit into the world. As they do this, they will start to worry about what other people think. They also have the job of moving towards independence from you. What their friends think will take on a new importance as they start to make the move away from their family tribe and towards their peer one. They will always love you (though it might not feel that way if you’re weathering one of the storms that comes with adolescence!), but their dependency on you will shift. This is healthy and important and the way it’s meant to be. It’s all part of them growing from small, dependent humans into capable, independent, thriving bigger ones.

•  Themselves or someone they care about getting hurt, becoming sick or dying.

Here’s why: They will be very aware that accidents happen, people get sick, and sometimes you just can’t see it coming. This fear will probably have more muscle if they hear of someone around them becoming sick or getting hurt. Realising that people can break isn’t all bad for them. During adolescence, they will be particularly prone to taking silly risks. It’s all part of them extending into the world and learning what they are capable of. What’s important is keeping their fear at a level that it doesn’t get in the way of them being brave, learning new things, and finding safe ways to discover what they’re capable of.

•  how they’re doing at school, exams, failure, getting into college or university, not being able to ‘make it’ after school.

Here’s why: They’re thinking about life after high school . They want to do well, live a good life, and chase the dreams they’ve been dreaming.

•  Strangers getting into their room at night, war, terrorism, being kidnapped, natural disasters – and any other frightening thing they might hear about in the news.

Here’s why: They realize that bad things happen sometimes but don’t understand the likelihood and the rarity of such events. With their increasing time on social media, they will tend to hear about bad news more often and come to believe that the risk of it happening to them is greater than it actually is.

•  Talking to you about important personal issues.

Here’s why: It’s their job during adolescence to learn how to need you less. Adolescence isn’t always gentle with it’s developmental tasks and needing you less might be felt as ‘loving you less’. It’s not this – they love you as much as ever and however they might act towards you, what you think really does matter to them. They want you to be proud of them and they don’t want to disappoint you.

•  Fear of missing out.

Here’s why: Being connected to their friends and being a part of what’s going on in their friendship group can feel like a matter of life or death. It sounds dramatic and for them, it is – but there is a good reason for this. For all mammals throughout history (think cave-people) and in nature, exclusion from the tribe means has meant almost certain death. For our adolescents, that’s how it feels when they feel on their outside of their tribe – it feels like death. In time they will learn that they will still feel connected to their friends even if they aren’t a part of everything that happens.

What to do:

For babies.

•  Play peek-a-boo.

It will start to teach your baby that even when your face disappears, you’re still there. (That, and because the way their face lights up when they see you is gorgeous.)

•   Teach them that separation is temporary, but go gently.

Practice leaving the room for short periods at a time so your baby can learn that you will always come back. Start with a minute, then, when your baby is ready, move up from there. When you are ready to leave them in the care of others, start with people they are familiar with for short periods, then work gently up from there.

•  Always say goodbye.

Saying goodbye is the most important thing to do when you leave them. Making a quick dash while they are distracted might make things easier in the short term, but it will risk your baby being shocked to find you’re not there. This can add to their fears that you’ll disappear unexpectedly and it also runs the risk of chipping away at their trust. Have your ‘kiss and fly’ routine ready – tell them you’re leaving, a quick kiss, and let them know you’ll be back soon – or whatever works for you. It will be worth it in the long run.

For kids and adolescents.

•   Give them plenty of information.

Even though kids at this age are aware of their environment, they don’t understand all of the things that go on in it. Thunder feels really scary – it’s unpredictable, it’s loud, and for a curious, powerful, inquisitive mind, it can surely feel as though the sky is breaking. For the child who is still getting used the world, it’s not so obvious that they won’t be sucked down the plughole when the bath drains. Point out what they can’t see. (‘Water fits down the plughole, but my arm won’t fit, neither will this boat, or the vacuum cleaner, or the car, or a hippo, or my foot, or my elbow. An ant would fit – wait – maybe that’s why ants don’t have baths! If I’m away from the plughole, nothing happens to me. See?’)

Give them all the information they need to put their scary things in context, where they belong. There’s no such thing as too much talk and at this age, they’re so hungry to learn. Make the most of it. By the time they reach adolescence, you will no longer be as smart (or sought after) as you think you should be. Celebrate their curiosity and feed it. They love hearing the detail of everything you know. You’re their hero and if anyone knows how to make sense of things, it’s you.

•   Meet them where they are.

Some kids will love new things and will want to try everything and speak to everyone. Others will take longer to warm up. Unless it is a child who races towards the unknown like it’s the only thing to do, introduce new things and people gradually. There’s so much to learn and little people do a brilliant job of taking it all in when they’re given the space to do it at their own pace.

•  Play

Play is such an important part of learning about the world. So much of their play is actually a rehearsal for real life. If your child is scared of something, introduce it during play. That way, they can be in charge of whatever it is they are worried about, whether it’s playing with the (unplugged) vacuum cleaner, being the monster, or having a ‘monster’ as a special pet. Give them some ideas, but let them take it from there. Through play they can practice their responses, different scenarios, and get comfortable with scary things from a safe distance.

•  Be careful not to overreact.

It’s important to validate what your child is feeling, but it’s also important not to overreact to the fear. If you scoop your child up every time they become scared, you might be inadvertently reinforcing the fear. Rather than over-comforting, get down on their level and talk to them about it after naming what you see – ‘That balloon scared you when it popped didn’t it.’

•  Don’t avoid.

It’s completely understandable that a loving parent would want to protect their child from the bad feelings that come with fear. Sometimes it feels as though the only way to do this is to support their avoidance of whatever it is that’s frightening. Here’s the rub. It makes things better in the short term, but in the long term will keep the fear well fed. The more something is avoided, the more that avoidance is confirmed as the only way to feel safe. It also takes away the opportunity for your child to learn that they are resilient, strong and resourceful enough to cope. It’s important for kids to learn that a little bit of discomfort is okay and that it’s a sign that they are about to do something really brave – and that they have what they need inside them to cope.

•  Let them explore their fear safely.

Introduce the fear gently, in a way that your child can feel as though they have control. If your child is terrified of the vacuum cleaner, explore it with them while it isn’t plugged in. If your child is terrified of dogs, introduce them to dogs in books, in a movie, through a pet shop window, behind a fence. Do this gradually and in small steps, starting with the least scariest (maybe a picture of a dog) and working up in gently to the fear that upsets them most (patting a real dog). The more you can help them to feel empowered and in control of their world, the braver they will feel. (For a more detailed step by step description of how to do this, see here.)

•  Don’t give excessive reassurance.

If your child has had a genuine fright or is a little broken-hearted, there is nothing like a cuddle and reassurance to steady the ground beneath them. When that reassurance is excessive though, it can confirm that there is something to be worried about. It can also take away their opportunity to grow their own confidence and ability to self-soothe. Finding the scaffold between an anxious thought and a brave response is something every child is capable of. Understandably, it can be wildly difficult to hold off on reassurance, particularly when all you want to do is scoop them up and protect them from the world that they are feeling the hard edges of. What is healthier, is setting them on a course that will empower them to find within themselves the strength and resources to manage their own fear or anxiety. Reassure them, then remind them that they know the answer, or lovingly direct them to find their own answers or evidence to back up their concerns. Let them know you love the way they are starting to think about these things for themselves.

•  Understand the physical signs of fear.

Fear might show itself in physical ways. Children might have shaky hands, they might suck their thumbs or their fingers and they might develop nervous little tics. When this happens, respond to the feelings behind the physical symptoms – fear, insecurity, uncertainty.

•  Something soft and familiar makes the world feel lovelier. It just does.

Toys or special things might be a familiar passenger wherever your child goes. Let this happen. Your child will let go of the toy or whatever special thing they have when they are ready. Security blankets will often be the bridge between the unknown and familiar, and will form a strong foundation upon which they will build confidence and trust in their own capacity to cope with new and unfamiliar things.

•  Be alive to what they are watching on TV or reading in books.

If you can, watch their shows with them to understand how they are making sense of what they see. Some kids will handle anything they see, and others will turn it into a brilliant but terrifying nightmare or vivid thoughts that become a little too pushy.

•  Remember they’re watching.

They’ll be watching everything you do. If they see you terrified of dogs, it will easy for them to learn this same response. Remember though, if you can influence their fears, you can influence their courage. Let them see you being brave whenever you can.

•  Validate their fears and let them put word to their fears.

Let them talk about their fears. The more they can do this, the more they will be able to make sense of the big feelings that don’t make any sense to them at all. Talking about feelings connects the literal left side of the brain to the emotional right side of the brain. When there is a strong connection between the right brain and the left brain, children will start to make sense of their experience, rather than being barrelled by big feelings that make no sense to them at all.

•  Acknowledge any brave behavior.

Because they’ll always love being your hero and it will teach them that they can be their own.

And finally …

It can always be unsettling when fears come home and throw themselves in your child’s way. Often though, fears are a sign that your child is travelling along just as he or she should be. The world can be a confusing place – even for adults. Of course, sometimes fear will lead to a healthy avoidance – snakes, spiders, crossing a busy road. Sometimes though, fear will be a burly imposter that pretends to be scarier than it is.

Fears are proof that your child is learning more about the world, sharpening their minds, expanding their sense of the world and what it means to them, and learning about their own capacity to cope. As they experience more of the world, they will come to figure out for themselves that the things that seem scary aren’t so scary after all, and that with time, understanding, and some brave behavior, they can step bravely through or around anything that might unsteady them along the way.

Fear and Anxiety – An Age by Age Guide to Common Fears, The Reasons for Each and How to Manage Them