Tag Archive for: Anxiety

Anxiety + Diabetes

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WRITTEN BY: Kristi Caporoso, MSW, LSW

State(s) of Fear

Anxiety has become one of the most commonly diagnosed mental illnesses in the United States. It seems everywhere you turn, someone is talking about it. Whether it’s their child or themselves that are afflicted, everyone and their mother seems to suffer from some level of anxiety. There has been a particular uptick in the level of anxiety reported in children and adolescents. While mental health professionals are trying to put their finger on what exactly is contributing to this – technology, political climate, homework – you don’t have to dig deep to find a reason for increased levels of anxiety in those living with Type 1 diabetes. To begin unpacking this issue, first let’s take a look at what the “A” word actually means.

What is anxiety, exactly?

A certain level of anxiety is healthy – necessary, even. It is what prevents us from engaging in dangerous behaviors, and what keeps us motivated to accomplish the things we need to do. The dictionary definition of anxiety reads as follows: “distress or uneasiness of mind caused by fear of danger or misfortune.”1 When this distress gets too high, or is disproportionate to the situation provoking it, the person tends to suffer from anxiety instead of benefitting from it.

Some of the more common forms of anxiety disorders are:

Generalized Anxiety Disorder (GAD)

A prolonged state of worry or tendency to worry about any and everything. GAD can have physical manifestations, such as GI problems and difficulty sleeping.  Someone living with GAD will have a tendency to view everything through a lens of anxiety, and be bombarded with “what-ifs?”

Panic Disorder

Panic disorder can occur after a person experiences one or multiple panic attacks, and is living in constant fear of the next one occurring. Everyone experiences panic attacks in different ways, but the most common symptoms are shortness of breath, feelings of impending doom, de-personalization (that feeling when you are floating outside your body), and heart palpitations, to name a few.

Social Anxiety Disorder

Basically what it sounds like, social anxiety disorder is when people experience extreme discomfort and anxiety around other people. This anxiety is rooted in the fear of what others think of you, or of embarrassing yourself or looking foolish.

Diabetes & Anxiety

T1D and anxiety are made to exacerbate one another. The fears and thought patterns that fuel anxiety are inherent to managing diabetes. On the flip side, struggling with anxiety can wreak havoc on your blood sugars. The more time I’ve spent working with and trying to pick apart anxiety disorders, the more I’ve realized how counterintuitive diabetes management is to anxiety levels.

What ifs

Running through the back of every anxious mind is a pestering whisper of what if? “What if I die?” “What if I embarrass myself?” “What if I fail?” These persistent questions can be crippling. However, when managing diabetes, it is often necessary to ponder what if. For example, I am about to pre-bolus for my dinner on my way home, but what if I get stuck in traffic? I am preparing for a run by adjusting my dosage and snacking, but what if it rains?

At the forefront of diabetes management is planning. Unfortunately, planning often invites what ifs, and what ifs can easily manifest into anxiety. When you are living with anxiety, it is often difficult to differentiate between rational or helpful what ifs and irrational, detrimental ones. Considering the rain or traffic while planning your insulin dosage can be productive, while repetitively pondering the possibility of going low and passing out during your exercise routine is not.

Living in the present

Similarly, planning for diabetes care can interfere with being present in the current moment. In recent years there has been growing evidence of the efficacy of mindfulness-based stress reduction (MBSR) and meditation for treatment of anxiety2. Much of our worry is rooted in what may or may not happen in the future. But it is hard to focus on the present moment and often difficult to be spontaneous when you’ve got insulin on board (IOB), sensors with downward-pointing arrows, and a fixed amount of juice in your handbag. Even the actual practice of meditation can be interrupted by alerting insulin pumps and CGMs. As mentioned above, diabetes management involves a lot of planning. And a lot of planning means a lot of future-oriented thinking.

Checking

Much like planning, with diabetes checking is essential. Checking you blood sugar, checking your IOB, checking your low supplies. But for someone with anxiety, checking can spiral into an obsessive ritual. People suffering from obsessive-compulsive disorder (OCD) have certain rituals they perform to quiet obsessive thoughts that repeatedly run through their mind. Because checking is so essential for diabetes management, it’s easy for someone susceptible to anxiety to fall into a pattern of over-checking. Picture this: you feel anxious about going low, check your sensor data and see no downward arrows. You feel a temporary wave of relief. But moments later, those thoughts recur. They get louder and louder in your head, until you have to check your sensor again – still no downward arrows. You see how this can fall into a negative thought-behavior cycle.

Where do we go from here?

Fortunately, much like type one, anxiety is manageable. But it takes work. If you feel like anxiety is interfering with you or your child’s everyday life, consider seeing a therapist. There are many therapists who have experience working with people with chronic illness. And if they don’t, BT1 has a helpful guide to teach them about type 13.

Where to start: finding a therapist

Your primary care doctor or pediatrician may have some referrals. Or, if you feel comfortable, ask around. It’s more than likely that many people in your life see a therapist and you have no idea. Or, if you have private insurance, you can try calling the “Member Services” number on the back of the insurance card and asking for referrals to local in-network behavioral health providers. There are also many ways to locate a therapist online:

If you have Medicaid (or Medical, or your state’s equivalent), your state’s Division of Mental Health and Addiction Services should have resources for local community mental health centers that accept this insurance. Your therapist or primary care doctor will also be able to suggest if you should consult a psychiatrist. A psychiatrist can prescribe medications for behavioral health concerns.

While diabetes and anxiety may make a great pair, you don’t have to constantly live at their mercy. As you learn to accept and manage your anxiety, you’ll learn how to live well with it. It won’t be easy, and there’s a lot of trial and error. Of course, having type one means you’re used to that! And always remember, you’re not alone in this.

REFERENCES

  1. HTTP://WWW.DICTIONARY.COM/BROWSE/ANXIETY?S=T
  2. HTTPS://WWW.MINDFUL.ORG/JON-KABAT-ZINN-DEFINING-MINDFULNESS/
  3. HTTPS://BEYONDTYPE1.ORG/T1D-GUIDE-MENTAL-HEALTH-CARE-PROVIDERS/

SOURCE

Don’t Get Crushed By Anxiety

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By Laura Greenstein

Have you ever felt hesitant about approaching someone you met eyes with? Or felt nervous talking to someone you’re interested in? Or felt a knot in your stomach while finding the courage to ask someone on a date? Most likely, you’ve experienced at least one—or maybe all—of these feelings, because anxiety and dating are a difficult pair to separate.

Dating enhances several of our deepest fears: rejection, being judged, getting emotionally wounded. It can be challenging to overcome these fears and put yourself out there. In fact, our dating culture has shaped itself aroundthese fears in an attempt to make the process of dating “easier.” But in many ways, this evolution has made dating more complicated and anxiety-inducing than ever. Take, for example:

Meeting People Online

Many online websites and apps have been created so people can screen potential suitors before ever having to physically meet them. For those who engage in online dating, there is a multitude of new concerns to contend with: Is this person real or are they just “catfishing” (using a fake profile)? How are they going to perceive me based on my profile? What questions can I ask to get to know them? This is all before the anxiety of actually meeting the person.

Knowing “The Rules”

It has become the norm to refrain from showing too much interest in someone you’re getting to know. This standard has produced a set of unspoken “rules” for any person engaging in modern dating culture. Some of these rules include:

  • Don’t double text (i.e. send an additional text before the person responds to your first text). This makes you seem too eager.
  • Don’t call someone. This will likely be met with distaste and confusion because phone calls are essentially obsolete.
  • Don’t respond immediately to a text message. This makes it seem like you were sitting around waiting for them to text you.
  • Don’t “like” any old posts or photos on their social media. Otherwise, they will know you were “Facebook stalking” them, or intently monitoring or looking through their Facebook updates or history.
  • Don’t let them see you typing for too long on systems that show the other person when you are typing a message (e.g. iMessage, Facebook Messenger, etc.). Then they will know you were putting a lot of thought into saying the perfect thing.

If someone breaks these rules, they are typically perceived as desperate and unattractive. So if we like someone, we have to bury it away. It’s almost a competition of who can be less interested. How can our pride be hurt if our attitude is: “Oh I wasn’t really that into you anyway”?

Dealing With “Trendy” Rejections

The way people reject those they are casually dating is constantly changing based on what’s “in.” For a while, the trend was “ghosting,” or abruptly ignoring the person on every channel of communication. This causes the person rejected to anxiously wonder when the other person will respond and what they did so wrong. Similarly, there is also the “slow fade,” which is the same thing, except more drawn-out.

As if those trends weren’t bad enough, there’s a new one coined “breadcrumbing,” which is not being interested in someone, but continuing to lead them on. People who do this are trying to keep a person interested while they seek out other options.

How Can We Make This Easier?

With all these challenges (and more), it’s important to maintain your mental health when trying to connect with someone. And it’s important to remember that dating isn’t hopeless—even if you experience a mental health condition that makes it even harder. Here are a few things you can do to reduce your anxiety while dating:

❤️ Accept Yourself First

As cliché as it sounds, it is essential to love yourself and be happy with who you are before you add another person to the mix. A lot of dating anxiety happens because of insecurities within ourselves. Learning to be content and fulfilled while single before looking for a relationship is extremely helpful towards dating in a healthy way. When your happiness isn’t dependent on your search, you won’t put as much pressure on the situation or feel as anxious about every person you meet.

“Your relationship with yourself sets the tone for every other relationship you have.” – Robert Holden 

❤️ Be You Always

Once you have accepted yourself, you will feel comfortable being open and honest about who you are. You will respect yourself and won’t waste your time playing the usual games to pique someone’s interest. If someone doesn’t like you or the fact that you are open with your feelings, then they’re not the type of person you should be with anyways.

❤️ Dismiss Exaggerated Thoughts

Thoughts that rev up anxious thoughts need to be either ignored or thought through in a logical way. For example: “I’ll be alone forever” is not a rational thought. Yes, you may have to wait to find someone, but most likely, you will not be alone for the entirety of your life. Being able to recognize that a thought is exaggerated can be helpful in minimizing your anxiety.

❤️ Know It’s Okay to Feel Anxious

It’s okay to feel nervous, awkward and uncomfortable when first meeting someone. And it’s also okay to tell them that when you meet them—chances are they feel the same way. After all, it’s human nature to feel nervous at the prospect of finding a partner.

 

Laura Greenstein is a communications coordinator at NAMI.

 

https://www.nami.org/Blogs/NAMI-Blog/April-2017/Don-t-Get-Crushed-by-Anxiety

Overcoming Stigma

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I was sitting alone in the hallway of the Carter Center conference area in Atlanta during the 2012 Rosalynn Carter Symposium on Mental Health Policy. I had just finished being a panelist and talking about how employment and education helped me overcome the stigma associated with my depression. The conference was still in session, so I had the hallway to myself. I sat quietly, reflecting on the fact that I had been invited to speak here as both a clinician working in community mental health and a person living with depression.

Two scenes flashed through my mind highlighting two very different points in my life: getting offered a job as a therapist at the mental health center where I completed my internship for my Master’s in social work, and sitting in a psych ward on the eve of my 18thbirthday, wondering if I would graduate from high school.

Persevering Through Depression

It took many years of perseverance for me to become that professional sitting on a panel at a national conference. Though I managed to graduate from high school, I dropped out of college at 19 as my depression worsened. I was unemployed, and my only income was Social Security disability. Years of failed depression treatments included medication and talk therapy.

I spent most of my time alone doing what I refer to as “stewing in my own depressive juices.” This lasted for 10 years. During that time, I was challenged by the symptoms of mental illness— insomnia, loss of appetite, lack of concentration, suicidal thoughts. After a decade of being unemployed and living on Social Security, I decided that for my own survival, I had to return to school and complete my social work degree. Of course, my depression was against this:

“You can’t go back to school; you will fail.”

“You won’t be able to concentrate enough to complete your assignments.”

“You’re too stupid to get a college degree.”

Somehow, I decided to talk back to these negative thoughts. My response was simple: “I’m just going to do the best I can.”

And I did. I got myself back to school and finished my degree in social work. Around that time, I also tried a different treatment for my depression, and it worked. Things got easier.

Today, I feel incredibly lucky to say that I am doing exactly what I want to be doing. But really, luck had little to do with it. Besides my symptoms of depression, I faced an additional barrier to school, employment and inclusion in general: unhelpful attitudes from well intentionedhealth professionals—in other words, stigma.

Learning To Reject Stigma

One mental health professional once told me, “Maybe you’re not getting better because you’re not trying hard enough.” Another warned me, “You might not be ready to go back to school full time. Shouldn’t you just take one class and see how that goes?” A psychiatrist decided, without asking for my opinion, that I should be sent to live in a group home for people with mental illness. (That did not happen, and that treatment relationship ended that day.)

These scenarios were fueled by the stigma associated with mental illness—stigma that ultimately serves to limit and exclude rather than encourage and include. Had I listened to those professionals, I might never have returned to school or entered the workforce.

So how did I overcome the stigma that I faced? I rejected it. Rejecting—or overcoming—stigma, whether it be self-stigma, public stigma or structural stigma, is one of the keys for those of us living with mental illness. This is not an easy task, to be sure, but it is becoming more possible and a bit easier as more and more of us of speak out about our mental health conditions.

 

After working as a therapist and witnessing the negative effects of stigma on clients and their family members, I decided to develop a stigma-reduction training curriculum called “Overcoming Stigma.” I spent several months reading every scientific article I could find about stigma research. Most of it simply documented that stigma exists (in hospitals, in psychiatry, in substanceusetreatment centers, in pharmacies, universities, employment, housing, etc.) and that levels of stigma have not changed over the last decade.

According to many studies, effectively reducing stigma pointed to one intervention: contact with someone successfully managing a mental illness. One shining example of this is NAMI’s In Our Own Voice (IOOV) program. People with mental health conditions share their powerful personal stories in this free 60- or 90-minute presentation. I decided to integrate elements of IOOV into the beginning of my trainings by briefly disclosing my own depression and giving a few examples of my experiences with stigma. The rest of the training includes a description of the seven most common types of stigma experienced by people with mental illness and substance-use disorders, research about the effects of these stigmas, ways to reduce stigma, and the clinical and agency assessment tools I developed.

I have presented Overcoming Stigma trainings in many different health care settings, and the curriculum continues to evolve, always guided by the latest stigma research. Recent research shows that stigma training needs to be ongoing instead of a one-time thing and, it likely needs to address many stigmas all at once.

My trainings get everyone involved in the discussion; I like to ask for anecdotes from attendees. Here are some real-life examples of stigma shared by health care professionals who have attended my trainings over the past several years:

• A cardiac surgeon said he would not do surgery on a person with schizophrenia because he didn’t think the person would be able to do the required follow-up care.

• A therapist shared that as a Ph.D. student, he was told he would lose his scholarship if he left for “depression” treatment but could keep it if he left for “medical” treatment.

• A mother puts off making an appointment for her daughter to see a therapist despite her daughter experiencing severe symptoms of anxiety because she doesn’t want her daughter to be labeled as “crazy.”

• A physician attendee said it was well known in her neighborhood that her son had been hospitalized with bipolar disorder and no one acknowledged this fact (much less offered any type of support).

• A mental health clinician working in an emergency room said doctors and nurses often referred to patients in the ER with mental illness as “her patients,” rather than “our patients.”

If I do my job well, attendees leave with the understanding that we all have a role to play in reducing these harmful kinds of stigma. Personally, I still experience stigma, but I am no longer limited by it. I sometimes even chuckle when I hear someone say something particularly stigmatizing because I immediately think, “Well, that’s going to be part of my next training.” That’s not to say it isn’t still discouraging to see or hear things that continue to perpetuate stigma, but for me, there is a feeling of freedom and power in being able to turn a potential lost opportunity into one that is gained.

 

Gretchen Grappone, LICSW is a trainer and consultant with Atlas Research in Washington, D.C. Her work includes projects with VA medical centers, community mental health centers and other health care settings around the country. She lives in New York City.

https://www.nami.org/Blogs/NAMI-Blog/October-2018/Overcoming-Stigma

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